"Things I learn" & "Medicine Sucks" discussion thread

In any case, "possibly pregnant" is not an emergency. If she's really so poor she can't pay, there's probably a charity clinic she could go to, instead of wasting the ER's time.

 

According to the Superstars over at Vagina_Pagina, the test sticks from the Dollar Store are some of the most reliable ones on the market.

No, seriously!

 

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I love you people in the ER so much for all you do for your patients. I made sure to bring in some muffins for the folks in the ER where my mom works; sounded like they were a hit.

If a patient can afford the time to go to the university's psychologist to see if S.O.B. and fatigue is caused by stress or something, then said patient doesn't need the ambulance to go to the ER!
Though at least the ER docs figured out what was wrong... Labyrinthitis, of all things I haven't heard of.

Also, if you can't figure out what's wrong with the girl who has had heart problems for years and no one has figured out what was wrong so far, don't decide that the diagnosis is "panic attacks.'
If her cardiologist can't figure out the heart problem and the girl is one of the most laid back people in the world, it seems extremely unlikely that panic attacks are the problem.
[edit] I know that they were just trying to get her out of there with some sort of diagnosis rather than just going "I don't know" because I'm fairly sure that makes the ER docs feel worse about their job...

 

Good for you. I have a box of chocolates and a card I'm playing to send to the A&E in my area, they've treated both myself & my husband recently & they were wonderful about it, couldn't have asked for better treatment.

 

Hello. I'm another of these people who aren't doctors, attracted like cyber-flies to the internet-pervading odour of the famous ER thread. Good to see you have created a separate thread where people like me can post without interfering with the "proper" one.

I have an interest in most things with a scientific/technical aspect, and since my mum is a doctor, I have learnt the odd thing from her. (Favourite reading material around ages 5-8 was the Heart section of "Anatomy" by Gardner/Gray/O'Rahilly, and Wolff's "Diseases of the Eye"...) I therefore have a level of knowledge which could be described as "enough to be dangerous but not enough to be useful", and indeed have given serious consideration to the idea of using razor blade, soldering iron, superglue and purified street cocaine to perform a DIY vasectomy. I'm not posting to report the results of actually having done it, though; rather I am posting because the question quoted below is one that has been asked of me...

Situation: I had been feeling like crap for some days with something resembling flu but not flu. Fever (or so it felt, I do not have a thermometer to check), delirium, lethargy, dyspnoea on exertion to the point of near syncope after climbing one flight of stairs, and enough clear, fluid mucus in my respiratory system to run a mucus-powered car for a week. Parents emailed me to ask how I was getting on, and I replied with a summary of the last couple of days which included a mention of difficulty sleeping because whichever lung was on the lower side would start bubbling after a few minutes of lying that way and it was an annoying sound and sensation. That has happened on quite a few previous occasions when I've had a horrible snot disease, so I'd always thought of it as a normal symptom caused by excessive mucus and nothing more than an annoyance.

Three hours after sending that email, someone comes banging on my door. It's my dad. He has come to take me to A&E. I protest that I am not an emergency. He says that mum is freaking out thinking I might have pneumonia. I say no I don't, I always get bubbling lungs when I lie down if I've got this much mucus going on. He says mum won't be satisfied with that and she wants me to go to hospital. Eventually I agree to go purely to calm her down.

Now, the time is approaching midnight... on New Year's Eve. So it's a pretty safe bet that A&E is going to be full of people suffering what I believe is known as "trauma secondary to EtOH intoxication" who do actually need to be seen urgently. Hardly an auspicious time for this sort of caper... So I take pains to explain the circumstances of my visit, point out that I'm there for my mum's benefit rather than my own, state that I do not consider myself to be an emergency and that furthermore I feel like a knob being there at all. I repeat this explanation to everyone I get to see, from admissions through triage and having my temperature taken (normal, much to my surprise) followed by various other tests all the way up to a chest X-ray.

After the X-ray I get to sit in some room which has been temporarily repurposed as a holding area for patients who aren't actually leaking, and wait there for some time until another doctor arrives - it is the first time I have seen this particular doctor. She says that they basically don't know what's wrong with me. My white cell count is slightly elevated so there has been something, but every other test came back normal. It's not pneumonia, whatever it is. It's not flu either, but what it is, they can't say. She then says they want to keep me in overnight for observation and for them to have more time to ponder over what it might be.

At this point I figure enough is enough. What they do know by now is enough to convince my mum that I do not have one foot and most of the leg in the grave, and for myself I never thought I did anyway, so as far as I'm concerned the desired result has been achieved. I've been stuck in here for several hours feeling like a knob for wasting their time and resources on one of the busiest nights of the year. Now they want me to waste a bed as well... I never have spent the night in a hospital ward, and never been in one for more than a couple of hours, but that is enough to know that the only way I would spend the night in one is if I was either physically incapable of not spending the night in one, or so ill that I neither knew nor cared where I was. I'd rather spend the night in a prison cell, and I do know what that's like... behind the safety of a locked door, with no other people, your own toilet and the freedom to use it, and better food

So I said no, not happening, I'm going home. At which point she asked the same question I've quoted above To which I replied by once again explaining that I was only there because my mum was worried, that their reassurance that I was not in fact about to die would be enough to stop her worrying, and that from my own point of view it had been a waste of everyone's time and I was just as annoyed about it as she was and embarrassed to boot.

So... not everyone who comes into A&E/ER being a knob necessarily wants to be a knob, it may just be that the alternative was being a bigger knob to their mum

(Whatever it was didn't get any worse, and passed off by itself in a couple of weeks.)

I do not know what "trying to 302 herself" means but I would love it if it happened to mean "trying to obtain some kind of temporary transfer", and so would anyone else reading who is familiar with HTTP status response codes

 

Or How to almost kill your patient.

Woman not known for going to bother doctors starts get very sore neck muscles. So sore that her neck retracts, jaw goes into spasm, walking and sitting are agony, and eating is impossible. When she finally come to see you, at your busy GP practice and has waited patiently for 3 hours, glance up, take her chin and twist the neck from side to side, grunt, and then tell her it's just a pulled neck muscle and she's to take some panadol, have a hot shower, rest, and "stop thinking about yourself. It's nothing."

When this doesn't work, and a week later she is back in the surgery, now with very sore throat, not having eaten for 3 days, neck muscles almost completely and permenantly tight, and a new symptom of waking every morning at 1am, sweating so hard her clothes are drenched but shivering uncontrolably and so hard and violently it feels like her tendons are about to rip, once again grunt, poke and prod her neck, take a cursory look in her throat, and then tell her its still probably a pulled musle. Apply heat gel, have hot showers, and rest.

5 days later, when the woman has had an attack at work, frightening her staff and lasting for 40 minutes before she could finally swallow down some panadiene forte, and her partner has dragged her into the clinic and demmanded she see another doctor.

Who takes one look at her throat and recoils in shock, diagnosing massive strep/staph infection that has left only a tiny hole for breathing and swallowing. Listen to the patient and go pale at the video of the early morning convulsions. And then start writing a test sheet for every blood test known to mankind to find out what's really wrong. Start the patient on massive amounts of Amoxy until the results come back, to try and control the throat infections.

When the results come back, and frighten the daylights out of you, call the patient and order them to get down to the clinic. When they do, tell them that they have had a massive glandular fever attack, with they resulting liver and kidney issues. When the patient asks if the first doctor could have prevented some of it by diagnosing it earlier, admit it might have helped, but not made a lot of difference.

Result: Patient recovered and has all liver and kidney function returned, but it was a very close call.

 

So, in other words, lie.

 

It's rather poor form to throw colleagues under the bus, especially if you don't entirely know the story behind their management decisions.

 

Yeah, yeah, yeah, I know it's old.

My sister is actually one who totally missed that she was pregnant until 7 months with her first kid. Her cycles were (and still are) always pretty light and she skips months randomly anyway. Never had morning sickness, never was tender or anything, bra size never changed. Really didn't gain much weight, but when she gained I think 8 pounds, it was over Thanksgiving/Christmas so she just figured that's what it was from, and that's why her jeans didn't button.

It was middle of January, she had a routine dr visit and she goes "Why haven't you been in for prenatal care?"

Yup. My nephew was born March 19th.

My sister is all of 5'1" and 110 pounds. Kid was 8 pounds, 15 ounces. I have NO idea where he was hiding for 7 months because she sure didn't look pregnant and on March 18th, she maybe looked 5-6 months pregnant.

 

I know this is an old post, responding to an even older one. BUT....as an amputee, myself, getting the death stare over a misstep (pardon the pun) like that IS unusual.

Let me paint a picture for you of life as someone with a highly visible disability--this will be longish, but it may help many like me in dealing with both medical professionals and civilians who frequent this forum (and friends they pass this on to).

Typical adult reaction to a visibly disabled person is to look away and studiously avoid looking at the person...which makes him all the more aware of his status as "a cripple" rather than "a person".

Typical adult reaction when they have a child with them...for instance in a grocery store parking lot: Look away quickly, grab kid by hand or arm, and drag them, hissing loudly enough to be heard from 6 cars behind you and across the lane (where you have moved to put more distance between precious baby and the gimp that might cause your precious baby's legs to fall off just like his did if allowed too close) "Don't STARE! It's RUDE!"

Sorry, kids are curious, they're going to stare...and if they're doing so, at least they are looking at you like a PERSON, not "a cripple". I'd rather you let your darling walk up and ask their questions...it's honest curiosity, if I don't want to talk about it, it's a kid, I can respond "it's a really bad story, and I don't like to talk about it", and a kid will take that at face value...or I can answer his question with a friendly smile, being relieved to find that rare adult who is not only conscious of the fact I may be bent and dented, but I'm still "people", nothing to be apprehensive about.

At this point, with all my health issues related to my service time, and the accident, I'm pretty much custom made to entertain children...literally custom made. Glass eye, often not worn, and an eye patch worn instead, "peg leg" (actually a nice alloy piece of engineering artwork), and some nifty, highly visible scars. I go out of my way to make kids giggle and be comfortable...it means they have a better chance of growing up understanding that a few missing bits and pieces, some extra aftermarket hardware, and such doesn't remove you from being a normal human being in all other respects. And more likely to understand their legs won't magically fall off, and they won't mysteriously go blind because they sat next to someone like me on the bus. It alo means I get to make those parents realize the extent of how demeaning their avoidance behavior is, regardless of the psychological underpinnings.

You get someone like me, a former soldier...I am/was used to doing things most people will never make the choice to TRY, routinely, being unusually physically capable, etcetra. To someone like me, losing a limb, depth perception, and "half my vision" is devastating at first...we are, in a way "supermen" while in fighting condition...as I said routinely doing what most people can't/won't do. Take that away from us via injury, it's BAD...because not only are we now "broken people", but we are too familiar with being unusually capable, and suddenly we can't even match a 14 year old couch potato video game addicted who has been out of the sun so long he glows in the dark, until we re-learn how to walk, run, balance, and on and on. It hurts us, makes us doubt our worth even more than someone without that background (and it's devastating to THEM, as is...so you may be able to begin to imagine what I'm trying to convey)...it contributes to depression that already exists...usually dangerous depression, on and off.

But you treat me like I'm just Joe Average with a bit of modifications no more significant than my tattoos, or a few scars maybe more spectacular than usual, but not uncommon to be seen (visible scarring in general, I mean), I'm going to instantly forgive any "misstep" you may make, verbally...if not laugh at it, tell you to drop the discomfort you're feeling in your self-conscious "did I just offend the cripple?" perception, and probably crack a couple jokes along the same vein, myself, to set you back at ease.

Medical personnel who work PT, prosthetic specialists, and such treat us differently than the general public...but in a way, they don't count, because it's their job to do so, AND they deal with us day in and day out, to the point our issues are simply "mechanical issues to be worked around" in their eyes, the injuries become somewhat invisible to them. The general public, though? Man, you find those people "blind to the damages"...it's like finding the Koor al Nuhr diamond in a box of Cracker Jacks.

Don't be uncomfortable, don't avoid eye contact. If you're curious (morbidly or not), but hesitant, ask if it's OK if you ask me about my injuries. If I'm uncomfortable, I'll say so, if not, I'll answer HAPPILY. Same goes for about 99% of the other amputees/visibly disabled I know, between the VA, and our local hospital's PT offices. If you have the stones, presume I'll be happy to discuss it, and just ask your questions...again, if I'm uncomfortable, it's much more polite for you to ask, and me to say "I'd rather not talk about it", then carry on a conversation about something else...because you're treating me like a human, not a curiosity or a freak show...than it is for you to move as far from me as you can, thinking you're not being obvious about it, and very obviously and studiously avoiding even looking at me, which is both demeaning and dehumanizing.

Put yourselves in my shoe...if you lost a leg, how would you prefer your kids' friends, and their parents, and their school's administration, and their teachers treat you? Cripple, somehow less-than-human, or a perfectly normal human being with aftermarket modifications? How about complete strangers? Which would you prefer to face from them?

 

Disagree...quite compassionate.
I know you're in medicine while I'm not (except as a common patient...apparently I never outgrew the macho, stupid 19 year old me...even shy a lower leg and eye, I still insist on doing things like trying to snowboard, ice cave exploring, and rock/ice climbing...believe it or not, a slightly modified fixed horseman's spur bolted to self-tapped holes in your "foot" makes for one HELL of a good way to get a toehold on an ice or rock face), but have you dealt with late stage cancer patients that can talk to you, and describe their pain, nausea, depression, fear, and anger, yet?

Do you think an animal suffers these to any lesser degree than a human, just because they can't tell you about it verbally, and won't cry unless it's more painful than normal by orders of magnitude?

I wouldn't wish chemo/radiation therapy for late stage severe cancers, where the remission rate is below 15% on my worst enemy...and that suffering is NOT worth the extra month or year or two you might survive...while dealing with all of that, the whole extended period you bought yourself.

It is kinder to put them down, when you know they're suffering, even if you know you could make them "more comfortable" by use of meds...because "more comfortable" is not "pain free". That animal is still suffering horribly, just can't let you know clearly.

It's another situation when there's a realistic chance the animal can be cured...you go to the wall for them, then. But when it's a "slim to none" hope, or a sure thing it's going to kill them, just a matter of "how long can they hold on", then you are TORTURING that animal out of pure selfishness...a selfish desire to postpone your own emotional suffering at having lost a precious part of your life, at the cost of increasing and extending ITS suffering.

 

No, they don't suffer the pain and nausea that you know of. They won't express distress over pain that's consistent and ongoing, only when it's fresh and sharp...such as when pressing on an injured area or inflamed organ, or anytime they move a broken limb, which creates a whole new pain. nausea doesn't mean vomiting, as you know as a human doctor...sometimes it simply means "feel sick to your stomach, absolutely miserable, and convinced that if you even TRY to eat, you're going to projectile vomit right across the county line"...another feeling an animal can't express to you EXCEPT through evidencing a lessened appetite.

 

Thank you for taking the time to write all this. When I see a disabled person in the supermarket or whatever, I always look away because "it's not polite to stare" has been drummed into me since I was a little kid. Now I'm going to try to break myself of that habit. I never realized that the "pointedly not staring" thing is just as insulting if not more so than blatant staring.

Thanks again!

 

This, exactly this.

Our beagle Meaghan was diagnosed with terminal liver cancer back in October. Chemo/radiation doesn't work on this kind of cancer, and operating to remove it might end with her bleeding out on the table. We've chosen to keep giving her the Denemarin (a liver drug) and just see what happens. If she starts showing pain, we'll treat that. Nausea, vomiting, etc. we'll treat. But there will come a time when her quality of life is utter crap, and we'll have to let her go.

It's so difficult to do, but it's the kindest thing we can do for them. So far, she's doing really well. The vet even said, "This is a very sick dog on paper. But that's not what I'm seeing when I look at her.".

Each day is another reward.

 

Exactly. When I was able to ride, I always figured I'd rather someone who could use them in half-decent health get any usable organs than spend whatever remains of my life bedridden and helpless. I agree with AB on this one, at least.

 

NP...basically, most of us don't care to be reminded or treated as "broken" or "less than human"...we're already all too aware. You don't stare at PTSD cases, Fibromyalgia cases, or other "invisible disabilities" just as, if not more crippling, even if you know the person suffers them...why should a visible disability be treated any differently? Just like it doesn't work to tell a clinically depressed person "cheer up, it's not that bad, stop being a drama queen", it doesn't help to reinforce the perception of "separation" that I, if not all amputees, deal with internally.
Apparently this is at least a common, if not prevalent, attitude among those with injury-incurred visible disabilities. Illness incurred (like diabetes type 2) may be an entirely different story, I couldn't tell you, as I deal with very few people in that kind of position (and those I have dealt with seem to be rather hostile by nature, in the circumstances in which I have dealt with them).

Just treat me, and most like me, as "plain folks", you'll make our day, because you're a rare gem.

 

That's what I try to do. But like I said, I realize now I should avoid obviously not looking at disabled people. Everyone is just a person, and we all want to be treated the same way: like a human being.

 

A brief tale of personal stupidity that almost ended up going in the main thread before I saw this one.

I decided to try pushing my drinking skills to the limit last week. As it turns out, if you drink enough to kill a lesser man, you will wish you were a lesser man. I'm pretty sure the only reason I didn't call in to EMS myself is because I was too drunk to make the call. So if you even get so drunk as to wish you would die, whatever you do, don't let your not quite as wasted friends try to pump you full of caffeine to try to sober you up sooner. Not only, as you kept claiming, will this not work at all, but you will now be somewhat more lucid; all the better to appreciate just how horribly wasted you are. When you wake up, you will swear that everything, including, your liver, which lacks sensory neurons, is exacting revenge on you. If you are still just regular miserable drunk at this point, that's good -- it means enough time to cram down a good half dozen ibuprofen just before you conk out again, making your ensuing hangover only blindingly painful, but at the price of giving your liver another thing to gripe about. Expect fully to be almost completely out of it until the following morning.

TL;DR: Never drink enough booze to kill you, or you'll wish you had.

 

Been re-reading Things I learn thread
this is just from page 2
(and one from page 3)
longpost is long!!

Spoiler

"I created the sound of madness!!"

And its got microchips inside!! Tha's how gov'mnt put them in you!! Don't you people know anything!!?

jaws of 'life'... oh the irony

"Backfire drip torch"?? That... sounds like some pulsed-operation, mentally ill concrete-cutting contraption,* used for moving out patiens who have been too obese inside their room for too long to be extracted through the room's natural doorway!!
*yes, they exist; the ones most friendly to human physiology use aluminium and oxygen, the ones that let go of sanity entirely burn aluminium and fluorine

McGyver would have been proud!

wonder what it did to him

Shake your bon-bon!!!

Ah, si. Good times!!

1st i was like



Than i was like



and

Spoiler

 

This is technically a corollary to my earlier message on the "Things I learn from patients" thread: but being a nerd/scientist I started getting interested in the chemistry of it, and started to ask some funny questions... given it's relationship the aforementioned thread, I figured I'd be better placing the question here instead of as a new thread entirely!

One of my colleagues (over a lunchtime beer no less) has revealed that the "legal high" the patient had snorted contained astronomical levels of melamine* - which is believed to be why the patient is now sans one kidney... we then promptly got into a heated discussion about how much he must have snorted - given that the assay revealed that perhaps 30% of the mass** of graciously donated*** sample was melamine...

By our best back-of-the-napkin calculations, we reckon that he must have snorted at least 100 grams of melamine before his kidneys will start to complain, and even more to actually kill one of them outright.

I estimated the figures on a cursory glance at toxicology data (LD50 of 3.2-something g/kg - and the "safe limit" being around 1mg/kg (in infant formula) as being roughly 50% between them - which works out 1.5g/kg - and being 78kg, that would suggest he took 117g of melamine: which at 30%w/w means he must have snorted 390g of the stuff!

"That's ridiculous! Surely not!" my friend replied, and ran through some estimates using a different method... "oh... okay, maybe you were closer, I'm estimating that he must have taken over a kilogram of it...no, wait, closer to two kilos..."

So we collectively came to the conclusion that he's obviously been snorting melamine-tainted powder for a while and it's been resulting in chronic exposure, and this sudden acute exposure to the 30%w/w stuff pushed his already damaged kidneys over their limits and killed one of them - except I'm not sure kidneys work like that (I've not done much research into the subject - we were beer-lunching not number-crunching!) - and the other stuff in the mixture could easily have been aggravating things"

I simply can't see anybody snorting a soda-can worth of powder in one sitting or even across a few days day (to say nothing of the cost!) - but on the other hand I'm not sure of the biological half life is long enough to allow for chronic exposure (I'm pretty sure it's in the "hours" region rather than the "days" region? That's not to say he didn't have a chronic exposure! I'm not familiar with the pharmacokinetics of melamine - for all I know those melamine cyanurate crystals may just be poorly soluble within the renal tract, in which case if you're precipitating out new crystals faster than the old ones can dissolve - in which case renal injury is just a matter of time!)

So how do you folks reckon he's killed one of his kidneys? I assume he's done this over a period of time rather than an acute dose wasting one of his kidneys (to say nothing of the damage to the sinus node it caused) - but what do you guys think?

Any input would be appreciated! As I'm confused as to how this kid's managed to do this to himself



Ps - patient was sent on his way last week - with only 1 kidney, and a pacemaker. Nice going for a 25 year old!

Pps - I don't advise snorting anything that comes in a ziplock bag with a big "Lush" drawn on it in green marker. What does "Lush" mean? I dunno. Who drew it there? I dunno. Why? I dunno. When? I dunno. Where? I dunno. Who is going to get any use from the word "Lush" being there...? I dunno either.

Ppps - I don't advise snorting much to be honest!

*(severe) crystalluria, confirmed to be melamine cyanurate, and the removed kidney had severe nephrolithiasis (composed mostly of melamine cyanurate that had formed in the nephrons)

**there was also quite a lot of paracetamol... and ketoconazole in it. The "active ingredient" seems to have been some derivative of MDPV cut with some sort of opiate derivative (suspected to be a mephedrone derivative) - just in case anybody was interested

**the police searched his pockets and we ended up with some of it.