So I had this great idea to writeup all these practical tips for patients, not just medical professionals, but the devil’s always in the details. (The details being that I forgot to actually write them.) Better late than never.
Radiology. This is most “imaging” you get: x-rays, CT (aka CAT) scans, MRI scans, ultrasounds. All that jazz. Most radiologists don’t see patients, unless they’re doing some sort of procedure (swallowing contrast or barium, putting contrast or barium up your butt, etc.); there are interventional radiologists, who see patients, but that’s more specialized.
- There are many different imaging studies, and they’re good for different things, so don’t get too concerned if you “only” get an ultrasound to look at your gallbladder.
- I think the main concern most people have about radiology is the radiation they get from a test. While high doses of radiation can be concerning for the risks of new cancers (breast, thyroid, and blood cancers come to mind), your average CT scan or x-ray is a relatively low dose of radiation (and ultrasound and MRIs don’t use radiation, they use sound and magnets, respectively). The fact is (sit down, take a deep breath), you’re getting radiation every day. Seriously! About 360 millirem per year. Do the math, and that’s about 1 mrem per day. A chest x-ray is about 2-4 days’ worth more of radiation (here’s a full list). So that’s 364 mrem per year instead of 360. While there’s no “safe” radiation dosage, as all radiation breaks up DNA and creates free radicals, everything in medicine is a risk-benefit ratio. Everything has a risk, everything has a benefit. The equivalent of getting an abdominal x-ray is like traveling 2500 miles by car (pdf) if you compare risk activities. And if you’re getting an x-ray or scan, we’re concerned you probably have something far more painful or life-threatening going on inside your body, something that’s much more likely to hurt you than the radiation will.
- I should also clear up some confusion about the effects of radiation. There’s two types of effects: linear and threshold. Linear is the cancer–the more radiation you get, the more likely you are to develop cancer. Threshold means that below a certain dose of radiation, you don’t have any side effects, and above it, you start to have effects. These threshold effects are the skin damage, GI tract damage, hair falling out, etc.
I hope that clears things up about radiology, or at least some of the fears and concerns. If you really want a primer on radiation, try this.
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There’s a number of types of seizures, but here’s a short list of the most common with common descriptions (every person is unique!), in case you’re concerned in a child, friend, or loved one. Seizures are divided into partial and generalized. Partial means they affect only part of the brain, whereas generalized affect the entire brain. There are usually medications that can treat these seizures.
- Simple Partial: It’s simple because you don’t lose consciousness. They can be motor (have muscle movements of a limb, for example), sensory (see weird things, have weird smells), autonomic (heart rate or breathing rate changes) or psychic (feeling deja vu).
- Complex Partial, aka Partial Complex, aka Temporal Lobe Epilepsy: They’re complex, because the person loses consciousness. People will blank out, maybe smack their lips, fumble with their hands, pick at their clothing, or blink their eyes sometimes. These can “secondarily generalize,” which means they can start with this seizure type, and then have a full shaking seizure. Complex partial seizures often have auras–the person can tell they’re about to have a seizure by seeing something in their vision, having a muscle tightness, a feeling of stomach fullness, weird smell, or almost anything else.
- Absence Seizures, aka Petit Mal: These start in kids. This is the kid in class that, out of nowhere, will just stare blankly into space, like they’re daydreaming, and then snap out of it in less than a minute. Many times they’re diagnosed with attention problems, when they’re actually having seizures. They lose consciousness, but immediately go back to whatever they’re doing, and don’t even necessarily realize they’ve had a seizure. (They’ll just pick up their conversation where they stopped, for instance.)
- Generalized Tonic-Clonic Seizures, aka Grand Mal: Your classic Hollywood seizure. Starts with the tonic portion (increased tone), where the person arches their back, straightens their arms out, and is very rigid. Then the clonic part starts–more medical speak for the rhythmic jerking of the muscles.
- Febrile Seizures: These are like the above GTC seizures, but only in kids 6 months to 5 years old, and associated with a fever. Two-thirds of kids with one febrile seizure won’t have another, so neurologists usually don’t treat unless the child has more than one. (Once you have more than one, you have a pretty good chance you’ll have more.)
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(This is the first in what will be a series of practical tips I’ve learned on my clerkships that are applicable to everyone, not just medical professionals.)
There are many types of seizures, not just the classical shaking ones you see on television. If someone should have one of these seizures, however, or another one where they fall down or lose consciousness, there’s some basic first aid guidelines, and also some myths that need to be dispelled. Use your common sense, keep the person safe, and reailze that in most cases, the seizure will end on its own. If it lasts more than 5 minutes, then you should call 911. From epilepsy.com, one of the best medical websites I’ve found for a specific disorder
- Stay calm. You’re probably more scared than the person having the seizure; they’re unconscious (for shaking seizures, know as generalized tonic-clonic seizures, as well as many others).
- Prevent injury. Make sure the person isn’t going to hit a piece of furniture with their body, knock over a glass and get cut, or grab a cord and pull an object onto themselves, etc.
- Pay attention to the length of the seizure.
- Make the person as comfortable as possible.
- Keep onlookers away.
- Do not hold the person down. You don’t need to restrain them.
- Do not put anything in the person’s mouth. There’s a big misconception that you should stick a spoon or something into a person’s mouth. They’re not going to swallow their tongue, but they may bite it.
- Do not give the person water, pills, or food until fully alert.
- If the seizure continues for longer than five minutes, call 911
- Be sensitive and supportive, and ask others to do the same.
- The person may become incontinent (soil themselves with urine or stool). This is normal.
- The person may bite their tongue or cheek, so they may have a little bloody saliva coming out of their mouths. This can look very scary, but is probably normal.
After the seizure, the person should be placed on her left side, in the recovery position. There’s a small risk of post-seizure vomiting, before the person is fully alert. The left side is better than the right because the left side has a sharper angle of the lungs, so there’s probably a slightly smaller risk of vomit going into the lungs. Therefore, the person’s head should be turned so that any vomit will drain out of the mouth without being inhaled. After the seizure, the person enters the postictal state, which is just medical lingo for post-seizure. People can be very sleepy or confused at this time, so stay with the person until she recovers (5 to 20 minutes).
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Rachel Gets Fruity is a sexually clever ad to encourage men to perform regular testicular self-examinations to help prevent testicular cancer.
Unfortunately, The US Preventative Screening Task Force doesn’t think testicular screening will be all that helpful; Rachel’s ad would have been better served encouraging screening for colorectal cancer, but we all know that putting something up your butt automatically turns you gay. I guess if that happened, Rachel’s ad wouldn’t be as effective anymore.
Dear Google and Karen Wickre,
I loved your story “We Get Letters (2)” about new parents finding information to help prevent a blood transfusion of their newborn, but it’s inaccurate that the blood transfusion would be “extremely dangerous,” as the parents report. Blood transfusions are generally *extremely safe*, and the “danger” is a myth medical professionals have to dispel all the time. It’d be great if you noted this in your entries.
From Nelson’s Pediatrics:
“a current estimate for risk of transfusion-associated HIV is 1/1 million donor exposures, with estimates ranging from 1/800,000 to 1/2 million donor exposures. Similarly, the risk of viral hepatitis C is 1/1 million donor exposures. Transfusion-associated cytomegalovirus can be nearly eliminated by transfusing leukocyte-reduced cellular blood products or by selecting blood from donors seronegative for antibody to cytomegalovirus.”
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Okay, I’m probably sacrificing my overall attractiveness with this one, too, but it’s all in the name of patient care and relieving suffering, which I hope are valiant and attractive enough to outweigh the too-much-information-eww-gross-disgusting part.
I used to make fun of my college friend Sam for doing this, because it really is pretty gross, and he did it in the public bathroom, but I’m sorry, Sam. You were right.
I’ll just lay it out there now: suck warm salt water up your nose.
If you feel a sore throat or cold coming on, get a mug of warm salt water, and suck it up each nostril. I have absolutely no evidence to support this, as I’m just not in the mood to search PubMed, but I’ve had good results.
And for you post-nasal drip sore-throaters like me, this will most likely cure your sore throat. It flushes the mucous off your soft palate that’s collected during the night. Gross? I guess. But if it saves one person a sore throat, I’m okay with that.
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The cure for canker sores in two paragraphs, but first, a little education: I’m talking about canker sores, also known as apthous ulcers, found inside your mouth. I’m not talking about herpes sores, which are usually found around the lips or on the genitals, or syphillis chancres, or chancroid, yet another similar-sounding STD. Canker sores probably have an unknown viral or bacterial cause from what I’ve read, and are not STDs, for the damn record.
If you get canker sores recurrently like I do (mine are generally from stress), you’ve probably tried every possible cure. I’ve tried vitamins, amino acids, yogurt bacterial cultures that you have to keep in the refridgerator, mouthwashes, toothpastes, numbing agents, and anti-viral drugs, with absolutely zero success. When I was in high school, I had 17 in my mouth at one time. I’m not kidding. (Thankfully I’ve learned to de-stress since then.)
But I’ve finally found a cure (for me at least), thanks to the doctor at the student health service: triamcinolone paste (it’s a corticosteroid). The stuff works wonders. Spread the gospel, please. Dry off the canker sore, put the paste on the canker sore just before bed, fall asleep, repeat for a couple days, and it’ll hurt less and heal much faster. Your doctor can easily prescribe it, and it’s a generic, so it’s cheap.
Please appreciate this advice, I’m probably sacrificing my kissing-attractiveness by posting this one.
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I’ve come to realize in the past couple of days that there’s a huge danger associated with smoking that I’d never heard about before: smoking makes you a really poor surgical candidate.
Surgery is a really stressful event on the body: it basically challenges every organ in your body, from your brain to your heart to your lungs to your kidneys and everywhere else. But surgery is especially hard on your heart, and requires good lungs to provide oxygen to the body. Smoking hits both of these pretty hard. It destroys the lungs with emphysema and chronic bronchitis, and it leads to heart disease and damages your arteries as well.
So if you’re a smoker, and you find out later that you need surgery, some surgeons may consider you a “poor surgical candidate,” meaning you’re a high risk patient that may not respond to the surgery’s stresses well, and may have many more complications and a higher risk of death from the surgery. This is for all types of surgeries: everything from routine hernia repairs to cancer removals to gastric bypasses for obesity. Not only does smoking cause many types of cancer, but it makes you less likely that a surgeon will want to operate on you in the first place. And that’s a place that no one wants to be in their future.
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Most common surgeries in the US: dilation and curettage, hysterectomy, tonsillectomy, hernia repair, oopherectomy, cholecystectomy. Surprising then that most surgeons are male.
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Binge drinking 5 drinks in an hour gets you much more drunk than if you were to have the 5 drinks over the course of a night-but why?
It turns out that the enzymes that allow you to digest alcohol get fully saturated when you drink. So once you have your first drink, any more that you have sits around in your body, making you that much drunker, raising your blood alcohol level that much higher, making your hangover that much nastier, and making potential mates that much hotter. All because your body can’t process the alcohol any faster. It’s like pouring more water into a funnel than the funnel can drain out the bottom: the excess water starts to fill up the funnel. This, my chemistry kiddies, is zero-order kinetics.
It also happens with aspirin and phenytoin (Dilantin), an anti-seizure drug.
Graham Walker. Taking the fun out of drinking since 2005.
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5-10% of alcohol is removed from the body through the breath. This fact, of course, lead a classmate to ask if you can sober-up by hyperventilating. “Theoretically, yes,” said the lecturer.
Seeing as though this’ll be Valentine’s Day #2 without a significant other, I may just have to try it.
Speaking of V-Day, there’s a really nice piece at the end of this week’s This American Life about Johnny Cash, his wife, and the song Ring of Fire. Told by Sarah Jewell, one of my favorite contributors. It starts at about 47 minutes in, and it’s so sweet and romantic that it even made me feel a little less jaded and bitter about the whole thing.
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Aldehyde dehydrogenase is the enzyme in your liver that helps you get rid of alcohol (actually, it’s the second step in the process, but I digress). Some people of Asian decent have less of this enzyme, so when they drink alcohol, they can turn red; in most texts, this is a mutation that decreases alcohol metabolism.
Turns out that everyone else is the mutation. If you look at animals’ versions of aldehyde dehydrogenase, they’re more similar to the Asian version of the enzyme; so somewhere along the way (Germany? Russia? England?), I evolved the ability to drink more. (Disulfram, a drug that can help alcoholics stop drinking, blocks this enzyme, making you flush, and not enjoy the alcohol as much.)
So no, I can’t control the weather, shoot force beams out of my eyes, or read minds… but I can drink more alcohol. Better than nothing, I guess.
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Twelve to twenty-four hours of heroin withdrawal can make a person restless and develop goose bumps. That’s where “quitting cold turkey” comes from.
Twenty-four to seventy-two hours of heroin withdrawal typically leads to flu-like symptoms, and thrashing and flailing of the arms and legs. That’s where we get “kicking the habit.”
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Now that we’re in endocrine, we’ve been talking about prolactin and other hormones that cause milk release, or, as the professor calls it, “milk letdown.”
My classmate Peter loved the phrase, just with a different definition: Milk letdown. When you have milk, you expect it to be really good, and it’s just okay.
Another interesting fact: the name galaxy (ex: our Milky Way) comes from the root galac-, which means milk. See picture below.
Farting-I mean, flatulence-is due to poor absorption of carbohydrates.
Beans contain raffinose and stachyose, tri- and quadrupe saccharides, and cannot be digested by humans. They get passed along through your large intestine, where your normal flora (bacteria living in your colon) feast on them. (They do this anaerobically, fermenting the carbs, so that’s where the gas comes from.)
This is clearly why I went to med school.
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We’re in GI right now, and I couldn’t be happier to learn today in lecture that “dumping” is a medical term.
Yes, that’s right. Eat too much black licorice, and your heart can stop.
(Okay, okay, it’s a bit of a dramatic extreme, but it’s true. I swear.)
Black licorice contains a compound called glycyrrhizic acid, which mimics a hormone in your body (aldosterone), which causes you to lose potassium through your urine. This causes what’s called hypokalemia, which can lead to abnormal heart rhythms. (Maintaining the right level of potassium in your body is vitally important. Too much or too little can cause abnormal heart rhythms. Luckily your kidneys usually keep everything juuuuust right.)
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Bacitracin, a common antibiotic found in Neosporin and other topical antibiotic creams, is named after a girl named Margaret Tracy. It was first discovered growing in a wound of Margaret infected with Bacillus subtilis.
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The fastest growing bacteria can double every 10 minutes (it takes human cells about 24 hours).
If these bacteria were given unlimited nutrients and a stable environment, they’d be larger than the size of the Earth in 1 day.
Amazing, isn’t it?
Did you know:
Your hypothalamus (think big brain control center) tells your body what temperature to maintain. If you’re sick, your immune system will release chemicals that cause your hypothalamus to increase your thermostat. A fever. You’ve probably had one. Your blood vessels constrict. You shiver to increase muscle heat. Your muscle is broken down to make heat.
But if your hypothalamus can induce behavioral changes to make you warmer: put on more clothes, get in certain body positions. And if you introduce the equivalent chemicals into fish, they swim toward warmer water to warm themselves. And with lizards, they’ll seek sunlight.
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