June 24th, 2008 by Dr. Val Jones in News
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I was reading about disease statistics today and came across some interesting information. See if you can guess the condition based on these factoids:
Time of injury:
Summer season (highest incidence in July)
Most common on the weekends (usually Saturday)
Most common at night
Average age at injury: 31.7 years old
Gender: 82% male
Number of new cases per year in the US: 10,000
So, have you guessed the condition?
Fireworks injuries perhaps? Binge drinking? Syphillis? Sasquatch attacks? Nope, guess again…
The answer is…
Spinal cord injury.
Spinal cord injuries are most often caused by motor vehicle accidents (44%), followed by violence (24%), falls (22%), sports (most are diving) 8%, and other issues 2%. The most common level of injury is in the neck, resulting in paralysis of all four limbs.
Why should we be worried about Saturday nights in July? Because that’s when people are at the highest risk for spinal cord injuries. School’s out, drinking and partying commence, and young men (more commonly than women) may drive while intoxicated and crash their cars. Please be careful this summer everyone, no one thinks they’ll be in an accident, until it’s too late.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 15th, 2008 by Dr. Val Jones in True Stories
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I spent my senior year of college abroad in Scotland. Between the fall and spring semesters I went on a ski trip to Austria, and in usual Val fashion did something klutzy out of enthusiasm. I was racing down a slalom course in a snow storm and was so excited to have finished without missing a wicket that I looked up at some bystanders to give them a thumb’s up and I tripped on a clump of snow and fell down. Unfortunately my binding didn’t release and I ripped some ligaments off my knee. I heard them pop too. It was quite gross.
Anyway, I was shipped back to Canada for a complex ACL repair procedure by the Olympic Ski Team’s surgeon (I was NOT Olympic material in case any of you had the slightest doubt – I was just in the right hospital at the right time). What followed my fine surgery was a not so fine follow up – in fact I didn’t get any physical therapy whatsoever, and had no idea about how to make my knee functional again. All I knew is that it hurt like heck and I didn’t want to move it. And I pretty much didn’t. Not for a month or so.
Now the healthcare professionals in the audience just winced at that. Not moving a limb for a month is highly inadvisable. My knee became contracted so that I couldn’t straighten it at all. I could barely bear weight on it and I relied almost solely on crutches. I didn’t know how long knees were supposed to take to heal so I figured everyone went through this crutch phase for months.
I returned to Scotland for my spring semester, and I can tell you that traveling alone with one functional leg, a pair of crutches, winter gear and two suitcases is no piece of cake. But the most memorable part of this whole debacle was when I received my new dorm room assignment: the room was on the 5th floor – no elevators. I pleaded with the dorm warden (a humorless, underweight Scottish man with extraordinarily greasy hair and snaggle teeth) to have pity on me and reassign me to a room on the first floor or maybe the second. He handed me the 5th floor room keys unflinchingly.
So it took me about an hour to drag myself and all my stuff up to the 5th floor. I was really in a lot of pain, and totally exhausted from the multi-stop flight overseas – hadn’t slept in about 36 hours. Of course the room was the last one at the end of the hall and no other students had checked in yet – the whole place was deserted because I’d come back early to see if I could get a more conveniently located room (thinking ahead).
When I got to my room I was nearly overwhelmed by the smell of vomit. Apparently the winter session kids had been using my dorm room for drunken partying and had puked on the mattress. I was so tired all I wanted to do was go to sleep but the options were the cement floor or the pukey mattress so I called down to the front desk. The warden picked up – I really couldn’t understand much of what he said in his thick brogue. I explained to him that I’d made it to my room but that the mattress was covered in vomit and I wondered if (now) I might be eligible for a different room. He said he’d come up to check on the mattress.
It took him about 40 minutes to show up. He made no eye contact with me as I limped after him into the room to show him the vomit. He looked at the mattress, smiled wryly, dragged it to the edge of the bed frame and flipped it over. Then he walked out of the room and went back down the stairs to retake his post at the front desk at the entrance to the building.
Now that’s cold.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 10th, 2008 by Dr. Val Jones in True Stories
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I’ve been presenting cases of important diagnoses made simply by physical exam. A ganglion cyst, a foot ulcer, and a dissecting abdominal aortic aneurysm were all correctly identified with a basic physical exam. However, there are times when a physical exam may not be enough – and reliance on it alone can be quite misleading.
A middle aged man was referred to our sports rehabilitation clinic after undergoing an unsuccessful orthopedic surgical procedure. He had been lifting heavy weights at his gym for some time, and was complaining of weakness in his right arm. He eventually got an appointment with an orthopedic surgeon, who noted that his right biceps muscle was severely reduced in its bulk. Assuming he had ruptured his biceps tendon, he was scheduled for repair the next week.
The surgeon was baffled after opening the arm and exploring the anatomy – the biceps tendons were both perfectly in tact, though the muscle was indeed quite atrophic.
What he didn’t realize was that the man had not ruptured his tendon, but had severely impinged his musculocutaneous nerve where it travels through the coracobrachialis muscle. The heavy weight lifting had caused his coracobrachialis muscle to hypertrophy to a point where the nerve supplying the biceps muscle was actually crushed by the size of the muscle.
The man slowly regained nerve function and was fine so long as he didn’t lift heavy weights again. The only long term side effect that he suffered was a surgical scar on the inner side of his right arm.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 4th, 2008 by Dr. Val Jones in Humor
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Today I attended a lecture given by an orthopedic surgeon. He was in his early 40’s, tall, and athletic in appearance. He spoke about spinal injuries the way a young boy would talk about crashing his toys together – vertebrae were “smashed, crunched, or wrecked” in various ways. He showed the audience various CT scans and x-rays of the neck, and proudly described the hardware he used to fuse spinal segments. Here are some choice quotes from his lecture:
“I think I’m losing my voice. I don’t talk that much at home because I have all girls. Um… so the cement from a kyphoplasty can get into the veins and travel to the lungs, but it’s not like a big clump gets in them or anything. It’s more like little tiny microscopic pieces of cement. You know, they kind of cause bronchio… bronchiec… broncho… broncholectasis or something. I don’t remember. But if your vertebral body is smushed, what are you going to do? It’s just really awesome to stick that balloon in there and blow up the area. With kyphoplasty you get less… whatever that word is… spill of cement
…So with the thoracic spine I come at it from the back because otherwise the heart gets in the way. Also, I use a posterior approach because then I don’t need another surgeon in there with me, and it’s hard to find them on Saturday mornings.
…If you see lateral translation of the spine then you know you’ve torn everything up. I mean, that thing is going to be a disaster zone so you may as well just go in there with all you’ve got. Hey, if you need surgery, you need surgery. But if a high c-spine injury isn’t unstable then don’t immobilize it or it’ll freeze up like an elbow. You won’t be able to do much more than move your eyes.
…And here’s a case of a guy with Tuberculosis in his spine. We opened that sucker up and it just poured out all over the place. It was awesome. He’s totally fine now.”
I was trying so hard not to giggle throughout this “academic lecture.” It was actually kind of refreshing to get the straight scoop on spinal surgery from an orthopedist who obviously loves what he does. But at the same time, I felt strangely nervous…This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 24th, 2008 by Dr. Val Jones in True Stories
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I was participating in morning rounds with a team of internal medicine residents. That day was the beginning of a rotation change, and a new “house attending” (the doctor in charge of the inpatients who had no primary care physician) was getting to know his patients. The residents who had been caring for the patients took turns explaining (near the bedsides) what had gone on since their admissions to the hospital, and described their treatment plans.
One intern presented a case of a patient with “fever of unknown origin” (FUO). This particular diagnosis will make any internal medicine specialist delirious with curiosity and excitement, since it means that all the previous attempts at discerning the cause of the patients fever have failed. Generally, a fever only receives this exciting honor when it has gone on for at least 3 weeks without apparent cause.
The intern explained (in excruciating detail I might add) every single potential cause of the fever and how he had ruled them out with tests and deductive reasoning. The attending was hanging on every word, and nodding in approval of some real zebras (rare and highly unlikely causes for the fever) that the intern had thought to consider and disprove.
I must admit that my mind wandered a bit during this long exercise, and instead I looked at the patient, smiled, and examined his thick frame with my eyes. Of course, an attending has a keen sense for wandering minds, and so to “teach me a lesson” he abruptly stopped the intern’s presentation and looked me dead in the eye. You could have heard a pin drop.
“So, Dr. Jones” he snarled. “You seem to have this all sorted out, don’t you. Apparently you have determined the diagnosis?”
“Well, yes, I think I may have.” I replied calmly.
The attending’s face turned a slightly brighter pink. “Well, then, don’t withhold your brilliance from us any longer. You’re a rehab resident, are you not?” He made a dismissive move with his right hand and rolled his eyes.
“Yes, I am.” (Snickers from the internal medicine residents.) I shot a glance at them that shut them up.
I continued, “Well, Dr. ‘Attending,’ as the intern was reviewing the potential causes of FUO, I took a look at the patient. It seems that there is a pus stain on the bottom of his right sock. I didn’t hear the intern describe the patient’s foot exam.”
The intern’s face went white as a sheet.
The attending turned to the intern with an expression of betrayal. “Did you examine this patient’s feet?”
“Well I uh… well, no.” Stammered the intern. “I guess I forgot to remove his socks.”
The attending marched over to the bedside and quickly removed the patient’s right sock, a small snow storm of dried skin flakes fell gently to the hospital floor. A festering foot ulcer proudly displayed itself to the team.
The attending gingerly nodded at me. He turned to the intern and announced that he would be given an extra night of call this month so that he’d have time to examine his patients’ bodies from head to TOE.
The patient was treated with antibiotics and sent home.
The intern later went on to become a radiologist.
I am working on improving patient empowerment on a national basis through Revolution Health.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
