From the monthly archives:

October 2008

My child has been diagnosed with severe allergic reactions to a number of foods including peanuts. We were told that we must keep something called an “Epi-Pen” on hand at all times in case she has a sudden reaction. What does this device do exactly and will it “cure” the reaction or just buy us some time to get her to medical attention like an emergency room?
Epi-pens are commonly prescribed to patients with a history of serious allergic reactions known as anaphylaxis.  With anaphylaxis, patients may have trouble breathing, swelling, rash, dizziness, and it can get rapidly worse, and in some cases be fatal.  These reactions usually occur after a patient is exposed to something they are allergic to, such as a bee sting, certain foods such as peanuts, or latex.  ER doctors often prescribe the “Epi-pen” after seeing patients with anaphylaxis, because it is a very effective way to reduce these symptoms and allow patients time to get in to see a doctor or come to the emergency room.
The Epi-pen is given by the patient to themsevles, as a shot, and it releases a medicine called epinephrine.  This decreases the allergic reaction, but beware, epinephrine does not “cure” it.  The allergic reaction can come back after the epinephrine wears off.  Therefore, it is important to seek medical care immediately with any serious allergic reaction, even if you have used an Epi-pen.
Allergy doctors prescribe quite a few Epi-pens, because they have been shown to reduce the chance of death from anaphylaxis, and it’s important to have these readily available, especially when immediate medical attention may be difficult to obtain.  Anyone with a history of serious allergic reactions should see their primary physician as well, and consider follow up with an allergy specialist.


Recently I had a patient present with an allergic reaction on his arm.  ”I think something bit me.”

He did have a red dot in the middle of the red swollen area.  He then proceeded to tell me how he thought he had been bit by an assassin bug.  Now these bugs are the source of some controversy in Northern California.  I have spoken to an entomologist who says we don’t have real assassin bugs in our area.

The patient was not convinced.  He went home, searched his house and found a black bug with a small head.  He put it in a jar, and brought it in to the ER (still alive) for me to look at.  I had to admit that it looked quite a bit like the photographs I found on Google.  A colleague of mine took one look at the bug, took it out of the jar, and put it in his hand.  He then proceeded to “smack it around” trying to get it to bite him.  The bug did nothing, however.  

It simply took the abuse, and then stood there.  ”It’s a beetle,” my colleague declared.

The charge nurse was not convinced.  ”If it’s an assassin bug, maybe he won’t just bite you,” she said.  ”Maybe he waits until you least suspect it, and then sneaks up from behind, with a knife.”



Dear ER Doc,

Why dose my nose run when I eat spicy foods?

Steve’s Mom, Southern California




I will admit that I have never seen a patient come to the ER for this problem, but it’s a good question nevertheless.  And if I had a runny nose when eating spicy foods, this would limit my diet significantly, so we should get to the bottom of it right now.  Fortunately, this condition has a medical name to make doctors sound smart, and it is called “gustatory rhinitis.”  What happens is that spicy foods contain capsaicin, an irritating chemical found in peppers.  This substance also is the primary irritant in pepper spray.  It acts directly on nerves and causes an inflammatory response, which releases fluid from nearby blood vessels.  The blood vessels in the nose are very close to the surface, and so fluid leaks right out of them.  Your best bet is avoiding spicy foods, although some researchers have used topical atropine to reduce the effect.

My advice?  Tone down the spice!  Or bring tissue to Mexican restaurants with you.



As you may have heard, today is “Blog Action Day” organized by which is an annual nonprofit event that aims to unite the world’s bloggers, podcasters and videocasters, to post about the same issue on the same day. The aim is to raise awareness and trigger a global discussion and this year’s topic is poverty. I am pleased to be one of over 11,000 blogs participating.

The theme made me recall one of the most troubling cases I have seen. It happened when I was a medical student in Los Angeles.  A homeless man walked into the ER complaining about flies constantly buzzing about his head.  He was brought back into an examination room, and the nurse handed me the chart with a look of shock on her face.  I glanced at his medical history and noted that he was diagnosed with cancer of his sinuses a few months before, but he had not come back for any follow up.

He was about 50 years old, his hair and clothing were completely unkempt.  He had apparently been living underneath an overpass for a long time.  As I approached him, I noted that the right side of his forehead and cheek were hugely swollen, and there were open wounds in these areas.  I leaned in for a closer look and shined my penlight into the wounds.

What I saw nearly made me fall over backwards.  Dozens of wriggling maggots were writhing throughout the depths of these wounds.  I noticed that they were trying to escape the light, diving deeper into the poor man’s face.

He was right about the flies, of course, there were several in the room flying around.  He asked me for some pain medication, and I was more than happy to order all he needed.


Q: With the financial crisis, have you seen more people with suicide attempts in the ER?

Stephanie – Henderson, NV


Congratulations to you, Stephanie, for the most morbid question of the week. The answer is no, thank goodness, I have not seen more people with suicide attempts due to the economic crisis. I have seen quite a few people with anxiety who are struggling with financial problems, losing their job, family stress, etc. I would certainly strongly encourage anyone who is battling depression, or considering suicide for any reason to please get help. If you don’t know where to go, or who to talk to, contact the National Suicide Prevention Lifeline (1-800-273-TALK), or go to your local Emergency Department.