American Thinker Blog: A doctor responds to Obama's NYT op-ed

American Thinker Blog: A doctor responds to Obama's NYT op-ed

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Just say no

Today I had to tell a patient that I wouldn't give her a prescription for more pain pills. While this patient, a 52 year-old woman with atypical chest pain (i.e. NOT a myocardial infarction or angina) was in the hospital I put her on Morphine to manage her chest pain. This was appropriate given the severity of her pain and the fact that the initial workup did include acute coronary syndrome (i.e. a real deal heart attack). However, when arranging her discharge she asked for more pain meds and on research I found that she had already been prescribed a month supply 1.5 weeks ago . . . so likely this was drug-seeking behavior and I could not in good conscience double cover this lady . . . despite the fact that she told me I was "the best doctor she had ever had" . . . which may have been more attributable to her learned skill of successful drug-seeking behavior than to my skills as a physician. There's a dose of Richmond, VA reality for ya.

Butterflies

Some photos taken at a Butterfly exhibition at Lewis Ginter Botanical Gardens in Richmond, VA:

Night float

Working the night shifts at the Cardiac / Coronary ICU. Day starts at 7:45 PM and usually ends 9-10 AM this next morning. The part that feels weird is coming back to work the same day you left . . . I am though starting to get used to coming home and getting some sleep during the day. Which is tough to me because I think I have a sensitive Suprachiasmatic Nucleus. Whaa??

We think that the day / night circadian rhythm in humans is regulated by sunlight hitting the retina and triggering signals to flow down neurons to the suprachiasmatic nucleus (SCN), a small area of the brain located in the hypothalamus. The SCN in turn causes the pineal gland (another brain structure) to dole out certain amounts of the hormone melatonin. Melatonin levels in your body peak at night and get low during the day, and are involved in creating your proper sleep / wake physiologic balance.



So the bits of sunlight coming past the shades in my bedroom during the day is kind of messing with me a little. But I'm adjusting. Wonder how much the flip side -- sitting in a dark room all day as a Radiologist -- will affect me . . . think I should probably make sure to eat lunch outdoors every day to trigger the SCN / pineal gland (and take care of sunlight-derived vitamin D production too!)

Buddycare

The latest crisis in the health care world: our cat "The Buddy" has been vomiting for several weeks straight. He's still eating, drinking, pooping normally, he just vomits out partially digested feeds 1-2 times per day. The vet initially thought it was a stomach bug and gave him an antibiotic shot (Flagyl, I think). This didn't help. I was wondering if he might even have pain-induced vomiting from a kidney stone. Sweewawa took him back to the vet today. Turns out cats don't usually get kidney stones (get bladder stones instead). Got an xray of The Buddy (a process which I hear hey enjoyed immensely) which is quite cool to see! I've included it below.



Some things to point out that are fun to see --> you can clearly see the spine along the top of the image going to join with his hip / rear legs on the right, and you can see the tail leaving the spine. You can see the thin kitty ribs along the left side of the image and the dark area with the thin white lines is his lungs with vessels. To the right of the lungs in the image is a bright (white) area that is his kitty liver (not kitty litter). The loopy loops in the middle are his intestines, and you can see air (dark color) and stool (mottled whiter color). Apparently (I wouldn't have picked this up from my own Radiology training) this pattern of air / stool in the intestines is consistent with some serious hairball buildup. So he's on some oral treatments (special food & some tuna-flavored laxative) that will help him with this. So $275 later we have a correct diagnosis and an appropriate treatment . . . I hope. One thing, I was glad that the diagnosis arrived at was hairballs -- something completely out of the realm of what I learned in medical school and beyond. So I have an excuse for not arriving at the diagnosis before the vet :)

US Health Care is top notch

An interesting report was prepared by a senior fellow at the Hoover Institution and a professor of radiology and chief of neuroradiology at Stanford University Medical School by the name of Scott W. Atlas:

http://www.hoover.org/publications/digest/49525427.html

Not a doctor

Beware the High Cost of Unintended Consequences

Beware the High Cost of Unintended Consequences

still going strong

Still going strong in the Cardiac ICU. 30 hour shift (with no sleep) from Fri --> Sat. Then starting night shifts on today --> Thu. It's pretty intense. Have also already encountered many interesting ethical issues. Whether or not to continue life support in a patient who is brain dead . . . how much care to provide for patients who are illegal immigrants . . . how to handle patients whose own reckless lifestyle keeps landing them back in the Emergency Department or ICU . . . the list goes on and we see these cases every day.

One great piece of advice passed along to me by a really excellent resident: always assume a test you're ordering will be negative (or an intervention you are ordering won't help) and know what you'd do next. In other words, always be thinking one step further down the chain. It's an essential skill in chess and is equally important in inpatient wards. You don't take that pawn with your rook just because the move is there . . . you do it because affects your opponent's next move, which sets you up for the next move, which affects your opponent's next move . . . which sets you up further. The person with chest pain who looks like he's having a heart attack but the cardiac enzymes you ordered are negative and the EKG is non-ischemic . . . always gotta have a "what's next" in mind . . .