Saw a really kind patient today that is a Harley rider, complete with the leather vest and boots and all. He’s a big guy, obese, and has obstructive sleep apnea
(he stops breathing when he sleeps because there’s lots of fat around his airway). The usual treatment for sleep apnea is a CPAP machine (continue positive
airway pressure. You wear this mask at night that’s hooked up to a machine that blows air into you so your airway stays open).
He hated the mask–felt claustrophobic with it on–so now he just goes out and rides his Harley down the highway, and tilts his head up a bit so his
nostrils hit the air stream. Similar effect, and works well for him, he reports.
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Dr Charles is on a roll
.
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on No Higher Calling
In a little more good-spirited fun,
someone has knitted a digestive system
. The liver’s a little small, and the common bile duct is emptying into the stomach, instead of the pancreas/duodenum, but hey. Not bad.
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I’ve always thought that one way to tell if you’re truly fluent in another language is if you can make a joke in the language–humor requires not
just meaning and proper grammar, but a level of comfort with the language and a good sense of comic timing. It’s totally true for the medical languages, too.
Case in point: at the beginning of this month’s rotation, I attended a weekly neuroradiology conference where the attendings kept making these
only-funny-to-neurologist jokes about patient’s MRI scans, and I didn’t get a single one. They all went right over my head, but everyone else in the room
was just cracking up.
Yesterday in clinic, I found myself making an only-funny-to-neurologist joke while evaluating a teenager with chronic daily headaches. As I sat down to present to the
attending, I said, “Looks like a pretty classic case of giant cell arteritis,” and I got a good laugh from her.
Giant cell arteritis is a headache disease, but only presents in people over the age of 55. Ha! Err… ha. Sigh. Soooo lame.
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on Mastering Medicalese
I’m pretty convinced a big plus of going into the surgical or emergency medicine fields is the stories that you get out of it. Blatantly stolen from an
attending:
“You wouldn’t believe the kind of lies people make up when they present to the ER with something stuck up their butt. My favorite? A man comes to the ER
with a zucchini up there, and proceeds to tell me, ‘Yeah, I was gardening naked tonight at home when I fell backwards and it got stuck up there.'”
Another hint from the attending–“If you ever get a votive candle stuck, don’t just pull on the wick. It’ll come right out, because your body
has warmed up the candle wax, and you just won’t get anywhere.”
I’m tellin’ ya. It’s all about the stories.
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What’s better than The Beatles’ song about a budding medical student who serially kills people with a metal mallet?
When it’s put to animation
.
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I just laughed out loud in the library
reading this piece from the NEJM
:
Words never seem more needless to a busy resident than those elicited from a somatizing patient during a complete review of systems. All the compulsiveness nurtured
in medical school evaporates before the onslaught of bewildering trivial complaints that have presumably found, finally, a sympathetic ear. How to shut off the
torrent of words?
The conventional strategy is to ask questions that have simple yes-or-no answers, but this rarely hinders the determined somatizer from expanding a yes response
into an intricate account of the details of his or her belly pain or dizziness. Long ago, a creative fellow resident invented the only effective method I know of
for dealing with a patient with an all-positive review of systems, though I hesitate to recommend it. We called it the “Corning couplets” in his honor.
Typical couplets might be “Have you ever had constipation or syphilis?” and “Do you have headaches or lice?”
[via
kevinmd
]
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except student loans and coffee.
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on Nothing Is Certain In Med School…
I’m reviewing cardiovascular and respiratory physiology for the Boards right now, and a little self-experimentation goes a long way. I have a little burst
capillary in my cornea right now, and I’m pretty sure it’s from doing a
Valsalva maneuver
to refresh my blood pressure and heart rate physiology. And whenever I start reading about
tidal volumes and functional residual capacities and dead space
, I have this uncontrolled need to breathe really deeply.
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Heard today in class, which seems like it’ll be a really interesting month of classes. (Oh, the ESR is the “erythrocyte sedimentation rate,” a lab
test that’s known for being very non-specific.)
Q: What’s the best reason to get an ESR?
A: To tell if the lab’s open or not.
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on ESR Joke
