Your ER Doc » General Health

Everything Bad For You is Now Good

Your ER Doc — Sat, 01 May 2010 19:29:19 +0000

News Alert!

Everything Bad For You is Now Good

Great news! All of my former guilty pleasures have turned out to be health foods. Instead of fearing that my addiction to dark chocolate, coffee and red wine is leading me to premature death, I am in fact increasing my life span, and reducing my chance of many horrible diseases. Yes!

Take coffee. I cannot function in the morning until I’ve had a large cup, sometimes two. I’ve always felt bad about this, knowing that I am dependent on the tasty black liquid, and its stimulant effects. My family understands that each morning during the pre-coffee phase, I will be unable to communicate effectively, beyond some basic grunting noises. I shuffle around, scratching and muttering while the beans are grinding and the water is percolating. I have felt badly about this, and I admit I am weak and powerless against the mighty bean. But recent evidence demonstrates that coffee drinkers have lower rates of dementia, parkinsons disease, diabetes, colon cancer, liver disease, and even dental decay! This is the best news ever! It completely justifies my total lack of willpower. I don’t even need to consider quitting coffee. In fact, after reading these studies, I might just increase my daily coffee intake by a cup or two!

As if this wasn’t good enough, another serious weakness has proven instead to be a strength. Dark chocolate, that silky smooth gift from above, is also good for you!

It’s true! Dark chocolate is loaded with anti-oxidants, plant phenols, and epicatechin which improve health and lower blood pressure. Yay! Studies also might have mentioned that moderation is the key to dark chocolate, but I was cramming fistfuls of Lindt truffles in my mouth by the time I read that part, and the article got smeared.

Okay, so by now all of us are thinking this news is too good to be true. Coffee and dark chocolate!? Impossible. But it gets better. As if to prove that God is in fact truly benevolent, my 3rd favorite thing is also healthy. Red wine. Oh yes, red wine is loaded with anti-oxidants, and one glass a day can have a positive effect on cholesterol, blood pressure, prevention of cancer, and heart disease.

So now that everything that used to be bad is good, I can’t help wondering–What’s next? Will researchers discover that Cheetoes make you smarter? Will sitting on the couch watching SportsCenter stop baldness? I’m not sure, but I’m not taking any chances. Sometimes you just can’t afford to wait for the research to happen.

Video Re-enactment of a Recent ER Visit

Your ER Doc — Tue, 01 Dec 2009 05:15:44 +0000

Large Clamp Please

Your ER Doc — Mon, 30 Nov 2009 00:40:32 +0000

Let’s face it, everything is funnier in the middle of the night. After about 5 cups of coffee, and no sleep you just get the giggles. On my last night shift, a favorite nursing supervisor was in charge, and I decided to have a little fun. I called her and asked if she knew where to find the Jass clamp.
“The what clamp?” she asked.
“The Jass clamp. J, A, S, S.” I said.
“Well what’s it for?”
“It’s for draining Lar abscesses.” I said. “The full name is Lar Jass clamp.”
“Okay, I’ll see if I can track it down.” she said.
Over the next hour, she searched every corner of the hospital, asking everyone if they had seen the Lar Jass clamp. She finally called me back and reported that she couldn’t find it anywhere.
“Can you slowly repeat what you are looking for?” I asked.
Slowly, she said, “The. Lar. Jass. Clamp.”

I couldn’t help laughing at that point, and understanding finally found her.
“Oh you’re going to get a large ass beatdown.” she said.

Naked Side Effects of Ambien

Your ER Doc — Thu, 12 Nov 2009 00:49:34 +0000

I believe this could be a new protocol for cardiac stress testing.
Recently on the late shift, the nurses on the telemetry unit were alerted to an elderly female patient who was having tachycardia. Her heart rate had been steady at around 80, but for no clear reason it accelerated to about 150 beats per minute. The charge nurse walked quickly over to investigate.
The patient noted that she had been having some insomnia, so she decided to read her romance novel. Suddenly, she had a very realistic hallucination.
“What did you see dear?” asked the nurse.
“Well, it was a very good looking man, who just walked into my room and asked where the grocery store was. And, he was . . . completely naked.” She admitted.
The nurse reassured the patient that it was nothing, and tucked her back into bed, and then chuckled her way back to the nurses station. A few minutes later while doing some charting, she was surprised to see another patient standing in front of the counter. It was a 40 year old man admitted for gallstones. He had been given a dose of Ambien for sleep about an hour before.
“Excuse me, can you show me where the grocery store is?” asked the man.
“I certainly can,” said the nurse, who then gently walked the sleepwalking (and completely naked) patient back to his room.

Worst construction accidents I have seen

Your ER Doc — Sun, 08 Nov 2009 05:53:41 +0000

I was attempting to build a deck today, pretending to be a handy guy, and as per my usual custom thinking about the worst construction accidents I have seen.

These are not just morbid ruminations of my darker side, but useful ways to avoid being hurt. Standing on a ladder while using a circular saw to cut off a piece of trim really gets the imagination going, because of the sheer number of different ways to lacerate, contuse, dismember, and abrade your body. For instance, I must remember to keep the ladder secure so I don’t tip over, breaking my wrist and impaling my face on a piece of rebar.

I can’t cut off a piece of lumber, and let it fall on my foot and then break my neck when I stumble in pain. Perhaps most importantly, I want to make sure I don’t position my body over a fence so that if I do fall off the ladder, I don’t straddle the fence and crush my testicles. Even when I’m finished using the circular saw, I must remember not to set it down while it’s running, so that it doesn’t run over my foot and amputate my toes. In fact, I’ve gotten so paranoid about all of these scenarios that sometimes I find myself just staring at my power tools, too afraid to pick them up.

Perhaps this is why the deck is unfinished after 6 months.

Opiate overuse and Michael Jackson: Time for the pendulum to swing back?

Your ER Doc — Mon, 13 Jul 2009 01:08:13 +0000

I was recently asked by a police officer why doctors prescribe so much opiate medication knowing full well that we are in the midst of an addiction crisis. Many people are hooked on opiates; pills, patches and injections, and the problem is getting worse. Anyone who works in the ER is aware of “drug seeking” patients who may not have a real medical problem, but repeatedly come into the ER seeking narcotics for various types of pain. The police officer sincerely wanted to know why doctors are so willing to prescribe high doses of opiates when the costs of addiction are so high, and this question has recently been brought into the spotlight with the death of Michael Jackson.

It’s a difficult question to answer, but I feel there are several sources of pressure put upon physicians to provide these medications. First, when dealing with a patient who is in pain, or appears to be, it can be impossible to sort out when a patient needs opiates for legitimate reasons, and when it is merely feeding a long term addiction. We are trained to provide comfort and relief from suffering to our patients, and we generally will err on the side of treating pain, rather than withholding addictive medications.

Additionally, physicians and hospitals are now obsessed with patient satisfaction. We are monitored constantly, at the level of the hospital, the ER and individual physician. When satisfaction goes up, physicians are rewarded, and when it goes down their very jobs may be at stake. If a doctor takes a “hard line” with opiate seeking patients, satisfaction numbers will predictably plummet. Not giving some patients the opiates that they want and expect will often times result in arguments, profanity, and calls and letters to administration.

Finally, pain is now considered by the medical establishment as the “new vital sign.” When patients present to the ER, they are asked to rate their pain 1 through 10, and then this number is followed all the way through discharge or admission. The implications with regard to opiate addicted patients can be profound. If a person states they have a 10/10 pain on arrival and it has not decreased whatsoever at discharge, the physician appears to be at best complacent, at worst sadistic.

For the above reasons, I believe the medical establishment is helping to fuel the opiate crisis in the US, and it is time to re-evaluate our expectations and our processes.

Michael Jackson die of a Heart Attack, or Cardiac Arrest?

Your ER Doc — Sun, 05 Jul 2009 16:46:09 +0000

I’ve been in the UK for the last 2 weeks, and over here many of the papers say he died of heart attack. However, in the United States, when you say “heart attack” that is the same as a myocardial infarction. This means that the coronary arteries get clogged up, and are unable to deliver oxygen and blood to the heart muscle. Cardiac arrest is when the heart stops beating, whatever the actual cause. In some people, cardiac arrest occurs from a heart attack, but it can also be due to medications, arrythmia, blood clots, trouble breathing, etc. When an autopsy is done, the pathologist will check for many different causes of cardiac arrest, including the possibility of drug and alcohol intoxication.

Diagnosis? You’re drunk.

Your ER Doc — Wed, 17 Jun 2009 02:29:57 +0000

A middle aged man recently drove to the ER looking to get some medical attention for a rash that he had for over a year. It was a bit unusual to come to the ER for a chronic rash, but I’ve seen stranger things for sure. The timing was stranger still, since it was about 2am. But let’s give him the benefit of the doubt, and assume he was just trying to come in when the ER wasn’t too crowded.

It wasn’t though–pretty much packed and full of cops who were there for a car crash and an assault. This turned out to be bad news for the man with the rash since he was completely drunk. He knew it was bad mojo when he pulled into the parking lot and saw all the squad cars. If his plan was to be inconspicuous, that didn’t work too well, because he drove in the wrong way on a one-way driveway. As calmly as possible, he tried to perform a casual 3-point U-turn. Unfortunately, he ended up on the curb, and nearly hit the ambulance entrance doors. This did not go unnoticed by our boys in blue, and the man was quickly arrested for DUI, his car was impounded, and he was given a notice to appear before the court. At that point, he should have just been glad he wasn’t going to spend the night at county jail, but he was pretty mad. He stomped over to register in the ER and demanded a blood alcohol level, since he “wasn’t even drunk!”

1 hour later and a measured blood alcohol level of 0.25, the man was ready for discharge.

“Well what’s my diagnosis?!” he demanded.

“Looks like you’re drunk, sir.”

Chelation therapy

Your ER Doc — Mon, 01 Jun 2009 19:10:45 +0000

Last week a physician colleague of mine mentioned that chelation therapy is a completely valid and useful treatment for coronary disease. He noted that there are countries where patients can’t even get bypass surgery unless they have been through chelation first.
Chelation therapy is when a substance, usually EDTA, is given in order to “sponge up” minerals and heavy metals that can cause inflammation, and perhaps contribute to coronary disease.
My recollection was that chelation therapy had never shown a benefit in clinical trials for coronary disease. My colleague said that there was plenty of good research out there that was beneficial, but that the drug companies, and cardiovascular disease establishment were squashing the data in order to maintain the status quo.
That’s quite an accusation. That would mean that thousands of doctors and scientists were engaged in a gigantic conspiracy to keep a valuable, and relatively inexpensive treatment from patients in order to make money through prescription medication, bypass surgery, angioplasty, etc. When you consider that coronary heart disease in the number one killer of men and women, and that many people suffer significant disability from it, this would be a conspiracy far more destructive than any genocide on record. It would make Pol Pot seem like a harmless old curmudgeon.
I decided to do a little research myself and eventually found myself on one of my favorite sites, Quackwatch.com, written by Saul Green, PhD. He has an excellent review of the chelation for vascular disease issue.
There have been some good studies done on chelation therapy, with no benefit shown. There also are a couple of large trials ongoing. There are no studies that show any significant benefit that I could find.
Now maybe Dr. Green has a garage full of Ferraris with bumperstickers that say “I love angioplasty” given to him by the American College of Cardiology, I’m not sure.
Or just perhaps there are some alternative practitioners making some claims (and a lot of money) that are based on marginal science. Hmm, that sounds familiar.

CDC Update

Your ER Doc — Mon, 04 May 2009 15:54:08 +0000

Avoid this type of activity