From the category archives:

Questions for the ER Doc

Did you know that Stroke is the 3rd leading cause of death and disability in the United States and the main cause of serious disability? Do you know the warning signs and what to do? Consider these 5 signs that individually or together may be symptoms of a stroke.

First – Difficulty walking: stumbling, dizziness or loss of coordination.

Second – Unclear speaking and understanding: confusion, slurred words or not finding the right words to explain what is happening.

Third – Paralysis or numbness on one side of your body or face. Your mouth may droop when you try to smile.

Fourth – Vision problems: sudden blurred, blackened, or double vision in one or both eyes.

Fifth – Sudden and severe Headache that may include vomiting, dizziness or confusion

If you or someone you know is having these signs, call 911 and seek medical help immediately. Treatment is available, but time is crucial.


edta_3dLast 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,, 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.


health-careQ: I recently lost my health insurance benefits and now have to buy my own coverage. I can barely afford even the cheapest policy out there.

Any ideas?

A: Okay, first of all, this website is “Your ER Doc” not “Your Insurance Agent,” and certainly not “Your Congressman” but I’ll take a stab at it. You have to have insurance in case something catastrophic happens, so I favor a relatively inexpensive PPO plan with a very high deductible. This will deal with large bills that could result from hospitalizations, surgeries, etc. Under ordinary circumstances however, most healthy people will not get close to their deductible. This means that you now have to avoid getting sick or hurt as much as possible to save costs. It is absolutely imperative that you take full responsibility for your health. First read my top 10 list, “How to Stay out of the ER,” and also follow the following rules below.
Here’s how many cigarettes you can smoke per day: 0.
Here’s how many alcoholic beverages you can have per day: 1.
Here’s your new diet plan (which by the way I completely stole): Eat food, not too much, mostly plants.
Here’s your list of high impact sports you can participate in: Chess.
Here’s how much faster than the speed limit you may drive: 0.
Here’s how much exercise you need: 30 minutes aerobic every other day.

I’m sorry this is restrictive my friend, but at least it’s cheap.



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.


Welcome to another installment of the Top 10 Ways to Avoid the ER

Number 4 – Drugs

Drugs like methamphetamines, heroine, and cocaine are the scourge of every emergency department I have worked in. Meth is the biggest problem now. If these drugs did not exist, I have no doubt that health care costs would be much lower, people would be much happier, and my job would be way easier.
Here are the problems you can anticipate if you are using these drugs:
Heart attacks
Infections in the skin, heart and blood
Psychotic behavior (sometimes shrieking profanities at your ER doctor)
Rotting teeth
Heart failure
Liver damage
Kidney disease
Brain damage
It’s always amazing when I see patients who have been using meth for days, and they come into the ER complaining of “Not feeling good.” Shocker! I usually ask why they expect to feel good after using these destructive chemicals for days on end. Then I explain that we are going to get to know each other very well, because they are going to come back repeatedly into the ER until their body is a complete toxic waste dump–unless of course, they quit. Sometimes this works.