From the monthly archives:

February 2009

Number 1 – Don’t smoke

It’s unbelievable how many patients I see regularly for lung infections, and emphysema flare-ups who are still smoking heavily. My standard line is “Doctors and medicine cannot compete with cigarettes. Cigarettes always win.”
I know patients would believe me if I told them not to drop a bowling ball on their foot, if they want to be able walk normally. Yet people are always surprised when I tell them that they cannot expect normal health when they smoke.
Now I know quitting is hard, and nicotine is really addictive, but life is short, and we don’t need to make it shorter.
And we don’t want to spend it getting lectured to by a know-it-all ER doctor like myself.


I have new respect for veterinarians. Our dog recently started acting kind of funny, and we weren’t sure what was wrong with him. He seemed to be moving very stiffly and slowly. The vet dived into it like a detective and determined that he herniated a disc in his back. When I have patients who strain their back, they come in and say “Hey doc, I hurt my back!” Dogs can’t tell you anything. Now granted, some patients are evasive, or confused, and we have to play detective as well, but we have the advantage vet_service_dogof being able to order about 8 thousand tests. We call this the shotgun approach. For example, one of the most common complaints among elderly nursing home patients is weakness, or “not acting right.” This usually results in a battery of expensive tests, searching for an explanation. Pet owners won’t put up with that kind of expense, and so vets have to be “sharp shooters.” Kudos vets.


bike-in-trash-canIf you have been cycling a lot, and notice that your penis has been going completely numb, here is my medical recommendation:  Throw your bicycle into a dumpster.



Number 2 – Don’t fall

Okay, this may not be an exciting category, but falls are a huge problem, especially for the elderly. Falls are the most likely cause of injury for those over age 65. Hang glider accidents are a close second. Kidding! If you know anyone who is unsteady on their feet, they should have a home safety evaluation right away to look for all the possible places they could fall down. Stairs, throw rugs are notorious.
Now if you think just because you’re not a senior, and pretty healthy, that you are immune to the plague of falls sweeping our nation, think again! We see healthy people all day long that have fallen off decks, down stairs, jumping out of trucks, climbing fences, off ladders, etc. I had a firefighter fall off a ladder from 15 feet up because he had the feet set on a smooth, slippery concrete, and no-one was holding on for him. Dumb! If he was saving a life at the time, I could forgive it, but he was just cleaning out rain gutters.



One thing that I learned as a resident in emergency medicine is that when a patient has cardiac arrest after a car crash, motorcycle crash or some other major trauma, those people are not going to do well.

In fact, it is rare for them to survive.

Of course, there are exceptions. One such patient was the victim of a high speed motorcycle crash into a large tree. When paramedics got to him, he was essentially dead. No pulse, no breathing. They got him intubated, started CPR, and headed toward the ER. Surprisingly, on arrival, he had regained a strong pulse and blood pressure. It was speculated that when he crashed, he was knocked unconscious, and because of how his body was positioned, he could not breath, perhaps because his face was against the ground, or something was pushing on his airway. Instead of developing cardiac arrest because of severe bleeding, head injury, etc, he had suffered a respiratory arrest, which was correctable. He ended up recovering, and proving there is always an exception to the rule.