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Monday, January 31, 2011

Dealing with High Blood Pressure

High blood pressure, or Hypertension, is dangerous because it can guide to heart attacks, heart failure, strokes, or kidney disease.


High blood pressure, or Hypertension, is dangerous because it can guide to heart attacks, heart failure, strokes, or kidney disease. The aim of hypertension healing is to lower high blood pressure and protect important organs, like the heart, brain, and kidneys from damage. Treatment for hypertension has been linked with reductions in heart attack (20%-25%), stroke (reduced an average of 35%-40%), and heart failure (more than 50%), according to research.

High blood pressure is classified as:
·         Stage 1 Hypertension:140-159/90-99 mmHg
·         Stage 2 Hypertension: 160 or greater/ 100 or greater mmHg
·         Normal blood pressure: less than 120/80 mmHg

·         Pre-hypertension: 120-139/80-89 mmHg
·         Hypertension: greater than 140/90 mmHg
All patients with blood pressure readings larger than 120/80 should be encouraged to make daily life modifications, such as quitting smoking, eating a healthier diet, and getting more exercise. Treatment with medication is suggested to lower blood pressure to less than 140/90 mmHg. For patients who chronic kidney disease or have diabetes the recommended blood pressure is less than 130/80 mmHg.
Treating high blood pressure involves lifestyle changes and probably drug therapy.

Sunday, January 30, 2011

World's top blood pressure drug gets failing mark



World NEW YORK: The world's most popular blood pressure medicine is much less effective than comparable drugs and gives patients a false sense of security, researchers said Monday.

In a review of earlier studies, they found the drug, a diuretic, or "water pill," called hydrochlorothiazide, lowered blood pressure by only about half as much as common alternatives such as beta blockers and ACE inhibitors.

High blood pressure affects about a third of US adults, according to the National Heart, Lung, and Blood Institute (NHLBI), and ups the risk of heart attack and stroke when left unchecked.

"By giving hydrochlorothiazide we give patients and physicians a false sense of security," said study researcher Dr. Franz Messerli, who heads the hypertension program at St. Luke's-Roosevelt Hospital in New York.

"Hydrochlorothiazide should no longer be used alone," he urged, adding that he has been prescribing it to patients himself for the past 25 years.

The drug belongs to an older group of water pills called thiazides, which are sold as generics for a few dollars per month. It is also sold as Aquazide H and HydroDIURIL, among other brand names.

The NHLBI currently recommends thiazides as first-line treatment to rein in high blood pressure, after a large government-funded study failed to find additional benefits from newer, more expensive medicines.

The problem is that hydrochlorothiazide, which wasn't tested in that study, remains the go-to water pill, said Messerli.

According to his report, published in the Journal of the American College of Cardiology, American doctors wrote 134 million prescriptions for the drug in 2008 alone, landing it far ahead of the beta-blocker atenolol, the second-most commonly used blood pressure medicine.

"You cannot just recommend a thiazide as the NHLBI does, knowing that for physicians that translates into hydrochlorothiazide," Messerli told Reuters Health.

Neither the NHLBI nor the American Heart Association could be reached for comments.

For the new study, Messerli and colleagues reviewed 19 studies that compared hydrochlorothiazide to other drugs in randomized trials.

Measured over 24 hours, the low doses of hydrochlorothiazide commonly used reduced systolic or "top" blood pressure by 6.5 points. A top reading of more than 140 is considered high blood pressure.

In contrast, angiotensin-converting enzyme, or ACE, inhibitors cut the top number by 12.9 points, beta blockers by 11.2 points, and calcium-channel blockers by 11 points.

While higher doses of hydrochlorothiazide were more effective, Messerli said they were rarely used because of an increase in side effects such as blood sugar and insulin problems.

He added that office-based blood pressure measurements could be deceiving, because hydrochlorothiazide appears to be particularly weak during the night.

"We know that nighttime blood pressure and early-morning blood pressure are very important risk factors for strokes and heart attacks," Messerli said, although he added that how hydrochlorothiazide affects those risks has never been studied.

The new findings don't concern other thiazides such as chlorthalidone or indapamide.

Apart from drug treatment, lifestyle modifications also help rein in blood pressure. Doctors often recommend eating a healthy diet with a low sodium content as well as exercising more and not smoking.

Saturday, January 29, 2011

Almonds curb diabetes, heart disease: study



Almonds curb diabetes, heart disease: study NEW JERSEY: A new study conducted at the University of Medicine and Dentistry of New Jersey has suggested that eating almonds could help prevent diabetes and heart disease.

Scientists discovered that including the nuts into our diets could help treat type 2 diabetes. As well as combating the condition, linked to obesity and physical inactivity, it could tackle cardiovascular disease, they said.

Diabetics have a shortage of insulin or a decreased ability to use the hormone that allows glucose to enter cells and be converted to energy.

When diabetes is not controlled, glucose and fats remain in the blood and over time, damage vital organs.

The latest study showed that a diet rich in almonds may help improve insulin sensitivity and decrease LDL-cholesterol levels in those with pre-diabetes, a condition in which people have blood glucose levels higher than normal but not high enough to be classified as diabetes.

USMLE STEP 3 MCQ 3



Question:
An 8 year old boy has testicular pain of gradual onset over the last three days. The pain is localized to the upper pole with a positive cremasteric reflex. A hard, tender nodule of less than 5mm in size is palpable in this region. On inspection there is a small bluish discoloration and localised tenderness in the upper pole of the testes. Doppler ultrasonography reveals a small nodule adjacent to the upper pole of the testis and normal vascularity. The most appropriate next step would be


a) prompt surgical exploration
b) needle aspiration
c) ceftriaxone and doxycycline
d) nonsteroidal anti-inflammatory agents
e) radionuclide scintigraphy

Correct Answer: D


Explanation:

Urgent operation is unnecessary in those in whom a tender nodule is found (pathognomonic of a torted appendage) and in those presenting after more than 24h of pain with scrotal erythema and oedema. The likely diagnosis in this case is a torted appendage and in cases of torsion of the testis there is no prospect of salvage at this stage. Torsion of the appendix testis is the most common cause of testicular pain in boys between 2 and 11 yr but is rare in adolescents. The appendix testis is a stalklike structure that is a vestigial embryonic remnant of the mullerian (paramesonephric) ductal system that is attached to the upper pole of the testis. When it undergoes torsion, progressive inflammation and swelling of the testis and epididymis occurs, resulting in testicular pain and scrotal erythema. The onset of pain is usually gradual. Palpation of the testis usually reveals a 3-5 mm tender indurated mass on the upper pole . In some cases, the appendage that has undergone torsion may be visible through the scrotal skin, termed the blue dot sign. In some boys, distinguishing torsion of the appendix from testicular torsion is difficult. In such cases, a testicular flow scan or color Doppler ultrasonography may be helpful. The natural history of torsion of the appendix testis is for the inflammation to resolve in 3-10 days. Nonoperative treatment is recommended, including bed rest and analgesia with nonsteroidal anti-inflammatory medication for 5 days. If the diagnosis is uncertain, scrotal exploration is recommended

Listen to Heart sounds with your i-phone by using iStethoscope Expert application




There's been tremendous hype about the new blood pressure cuff for iPhone. What if you could also use your iPhone to listen for abdominal gurgles, wheezes, or even the heartbeat of your unborn child?

The iStethoscope Expert app makes this possible, and best of all, it's free! You can use your device's microphone to listen for heart, lung, and bowel sounds. The app has a built-in noise canceler that will help amplify the sound of interest. If your device does not have a microphone, or if you'd simply like to enhance the sound, you may purchase the CardioTech electronic stethoscope peripheral by Zetris for $24.99.

Notable features of this app include:
- Guides to heart, lung, and bowel sounds, including phonocardiograms, audio demonstrations and text explanations.
- Sound interpreters that help determine the underlying pathology of an abnormal sound.
- Stethoscope sound library including over 60 sounds.
- Hear fetal heart sounds at 20 weeks.
- Record, send, and save sounds for review.



Since the USMLE Step 1 exam now includes audio in some of the questions, this will be very useful for medical students studying auscultation, as well as for physicians, other healthcare personnel, and even for patient education or use at home. I'm excited to see the evolvement of these medical equipment attachments!

iStethoscope Expert is compatible with iPhone, iPad, and iPod touch.

Download this Application free from Itunes Store Here

1. Oxford English and Oxford Medical dictionary plus viewer for symbian supported phones (most nokia phones)


 For Download click here




Installation instructions:
The file you are downloading is a self extracting file....run it in your pc...it will give you 3 files , copy them to your cell phone...install the three files as following:-

1. Install 'msdict_Signed.sis' first.
2. Than install "msdict_oxford_english_dictionary.sis"
3. Now install 'msdictoxfordmedical_signed.sisx'

Regiter it with this key: 32454-16767
...

Plan your acticities by using iStudiez application for iphone



If you're a medical student, you may want to think about using iStudiez Pro as you study for your exams. This is a great tool that can help you leverage mobile technology as you're going through medical school. iStudiez can help you organize your schedule, keep up with homework and assignments, and stay on top of your grades. If you're on a tight budget, then you can get iStudiez Lite for free.

Once you start using the app you will immediately want nothing else to be the tool to arrange all your schedule and homework once and for good. Read below and find out why iStudiez Pro would be the most efficient app on your device!

ORGANIZING YOUR SCHEDULE
:
Unique built-in planner lets you input and easy manage all types of schedules including classic, alternating (A & B weeks), rotating and block schedule. Not only you can enter most common course details, but also add instructors with all related information such as office hours, affiliation, phone number and email address. As well you are welcome to add holiday periods and even cancel separate classes in case of outstanding events. In addition, you are supplied with an expanded set of icons designed especially for iStudiez Pro to mark your class types and extracurricular activities. Color labels are available for your convenience to mark each particular course.

FOLLOWING UP WITH YOUR HOMEWORK:
Special section is dedicated to keep track of your homework and assignments. Whatever is the way you are used to manage your tasks, you will find it all in iStudiez Pro. Either you want to organize your assignments by date, by course or by priority, or sort them into pending and completed, you have all options at your hand. Sometimes you might have group work, so it is envisaged that you can add a partner to any of your assignments (either choose from contacts or create a new contact right inside the app).

SUMMARIZING IT UP FOR YOU:
Once your schedule is added, the summary of current classes and tasks is automatically reflected in Today view. You'll see list of events and assignments including all details such as event type, location, time left, class instructor, number of tasks pending and what's next on schedule. Courses reflected in Today view are easily modifiable in each and every detail. Today icon always sticks you to the current date!

TRACKING YOUR GRADE/GPA
:
This option is based on assignments (support of weighted/non-weighted assignments), and GPA calculator is available both for current and past semesters. Support of most world used grading scales (letter grades, percents, points).

KEEPING YOU ALERT:
You will always be up to date with pending tasks and upcoming classes and events with iStudiez Pro. The app boasts Push Notifications feature which allows you set general alarm time for your classes and separate alarms for each of your assignments and homework. Setting the alarms is quick and smartly integrated within the interface of the app, so prepare to be the most resulting fellow ever with no special memorizing efforts!

GUARDING YOUR DATA
:
No way you will ever lose your data if something's wrong with your device. iStudiez Pro takes care of you and offers the option to back up your data by sending it to your e-mail address with tapping just one button!


Download from itune now

Born Without a Face ( Treacher Collins sydrome :Worst case of medical history )




Treacher Collins syndrome (also known as "Treacher Collins–Franceschetti syndrome) is a rare genetic disorder characterized by craniofacial deformities.Treacher Collins syndrome is found in 1 in 10,000 births. The typical physical features include downward slanting eyes, micrognathia (a small lower jaw), conductive hearing loss, underdeveloped zygoma, drooping part of the lateral lower eyelids, and malformed or absent ears.

The signs of this disorder vary greatly, ranging from almost unnoticeable to severe. Most affected patients have underdeveloped facial bones, which result in a sunken appearance in the middle of the face, a prominent nose, and a very small jaw and chin (micrognathia). Some people with this condition are also born with a cleft palate. Malocclusion of teeth also is present. In severe cases, the micrognathia may displace the tongue of an affected neonate (new-born) sufficiently to cause obstruction of the oropharynx and potentially life-threatening respiratory problems, but it has been known that the epiglottis can be surgically removed to help in airway obstruction. The neonate will asphyxiate unless a proper airway is established. The condition is bilateral (occurring on both sides of the face) and the involvement is symmetrical. Congenital heart disease is an unusual feature.

People with Treacher Collins syndrome often have eyes that slant downward, sparse eyelashes, and a notch in the lower eyelids called a coloboma. The coloboma is at the junction of lateral 1/3 and middle 1/3 of lower lid which is associated with other congenital abnormalities apart from Treacher Collins syndrome. People with Treacher Collins syndrome may also need a feeding tube because some cases are so severe that they cannot swallow. This condition is also characterized by absent, small, or unusually formed ears (pinnae), called microtia. Defects in the middle ear (which contains three small bones that transmit sound) cause hearing loss in about half of cases. People with Treacher Collins syndrome usually have normal intelligence.

USMLE STEP 3 MCQ 2





Question:

A health aid worker sustains an accidental needlestick injury contaminated by blood from a Hepatitis B positive person. He has been appropriately vaccinated against Hepatitis B. He is given a Hepatitis B vaccine booster. What other agent is most likely to help reduce the severity of clinical infection with hepatitis B?

a) hepatitis B immune globulin (HBIG
b) hepatitis B virus DNA
c) hepatitis B e antigen
d) hepatitis A
e) a course of acyclovir

Correct Answer: A or D
Explanation:

Hepatitis B immune globulin (HBIG) is prepared from the plasma of persons with high-titer anti-HBs and contains anti-HBs at titers in the range of 1:100,000 or higher. HBIG appears to attenuate clinical illness, rather than prevent infection. It is recommended in conjunction with the vaccine for postexposure prophylaxis. Hepatitis B vaccine (already given in this patient) has been recommended as preexposure prophylaxis, primarily for population subgroups considered to be at high risk of exposure to HBV (eg, health and laboratory workers exposed to blood, hemodialysis staff and patients, residents and staff of custodial institutions, promiscuous persons, IV drug users, patients requiring repeated administration of blood products or clotting factors, and household and sexual contacts of chronic HBsAg carriers).


USMLE STEP 3 MCQ 1




Question:
A 10-year-old girl develops rhinorrhoea and nasal pruritus after visiting a friend who has a kitten The most appropriate treatment would include



a) Antigen avoidance
b) immunotherapy against the known offending antigen
c) Antihistamine-decongestant preparation
d) Topical adrenergic agonist
e) oral adrenergic agonist




Correct Answer: A

Explanation:

Antigen avoidence is most successful when a single antigen can be identified as the causative agent. Since the 10-year-old girl developed symptoms only after being exposed to her friend's kitten, it is likely that avoiding cats will alleviate her symptoms. Antigen avoidence is not feasible for all patients, however. For example, while a patient may be able to avoid animal dander indoors, the avoidance of multiple outdoor antigens is likely to prove difficult, if not impossible. Nonetheless, sensible enviornmental precautions will help to limit excerbation of symptoms.

Do Cellular Phones Lead To Bone Weakening?



Wearing a cell phone on your belt may lead to decreased bone density in an area of the pelvis that is commonly used for bone grafts, according to a study in the September issue of The Journal of Craniofacial Surgery, under the editorship of Mutaz B. Habal, MD, FRCSC. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.

With long-term exposure, electromagnetic fields from cell phones could weaken the bone, potentially affecting the outcomes of surgical procedures using bone grafts, according to the new study by Dr. Tolga Atay and colleagues of Suleyman Demirel University, Isparta, Turkey.

Bone Density Slightly Reduced on Side Where Cell Phone Is Worn

The researchers measured bone density at the upper rims of the pelvis (iliac wings) in 150 men who were cell phone users and carried their phones on their belts. The measurements were performed using a technique called dual x-ray absorptiometry the same test used to measure bone density in patients with osteoporosis and other bone diseases.

Bone density was compared on the side where the men wore their phones (the right side in 122 men and the left side in 28) versus the opposite side. The men carried their phones for an average of 15 hours per day, and had used cell phones for an average of 6 years.

The results showed a slight reduction in iliac wing bone density on the side where the men carried their phones. The difference was not statistically significant, and did not approach the reductions seen in osteoporosis. However, the researchers point out that the men were relatively young average 32 years and that further bone weakening may occur with longer follow-up.

The results raise the possibility that bone density could be adversely affected by electromagnetic fields emitted by cell phones. Studies are evaluating the use of electromagnetic fields as a treatment to increase bone density in osteoporosis. However, those studies have used very low frequencies of 15 to 52 MHz. In contrast, the men in the new study carried cell phones with frequencies of 900 to 1,800 MHz.

The ilac wings are a widely used source of bone for bone grafting, so any reduction in bone density may be of special importance to reconstructive surgery. At least in procedures where bone density is important for good outcomes, surgeons may want to consider the possible effects of exposure to electromagnetic fields from cell phones.

The researchers emphasize that their findings are preliminary. Coming generations of mobile technology may lead to the development of new cell phones with lower exposure to electromagnetic fields. Meanwhile, Dr. Atay and colleagues conclude, "It would be better to keep mobile phones as far as possible from our body during our daily lives."

Memories take hold better during sleep: study





 PARIS: The best way to not forget a newly learned poem, card trick or algebra equation may be to take a quick nap, scientists surprised by their own findings reported.

In experiments, researchers in Germany showed that the brain is better during sleep than during wakefulness at resisting attempts to scramble or corrupt a recent memory.

Their study, published in Nature Neuroscience, provides new insights into the hugely complex process by which we store and retrieve deliberately acquired information -- learning, in short.

Earlier research showed that fresh memories, stored temporarily in a region of the brain called the hippocampus, do not gel immediately.

It was also known that reactivation of those memories soon after learning plays a crucial role in their transfer to more permanent storage in the brain's "hard drive," the neocortex.

During wakefulness, however, this period of reactivation renders the memories more fragile.

Learning a second poem at this juncture, for example, will likely make it harder to commit the first one to deep memory.

Bjorn Rasch of the University of Lubeck in Germany and three colleagues assumed that the same thing happens when we sleep, and designed an experiment to find out if they were right.

Twenty-four volunteers were asked to memorise 15 pairs of cards showing pictures of animals and everyday objects. While performing the exercise, they were exposed to a slightly unpleasant odour.

Forty minutes later, half the subjects who had stayed awake were asked to learn a second, slightly different pattern of cards.

Just before starting, they were again made to smell the same odour, designed to trigger their memory of the first exercise.

The 12 other subjects, meanwhile, did the second exercise after a brief snooze, during which they were exposed to the odour while in a state called slow-wave sleep.

Both groups were then tested on the original task.

Much to the surprise of the researchers, the sleep group performed significantly better, retaining on average 85 percent of the patterns, compared to 60 percent for those who had remained awake.

"Reactivation of memories had completely different effects on the state of wakefulness and sleep," said lead author Susanne Diekelmann, also from the University of Lubeck.

"Based on brain imaging data, we suggest the reason for this unexpected result is that already during the first few minutes of sleep, the transfer from hippocampus to neocortex has been initiated," she said in an email exchange.

After only 40 minutes of shuteye, significant chunks of memory were already "downloaded" and stored where they "could no longer be disrupted by new information that is encoded in the hippocampus," she explained.

Diekelmann said the positive impact of short periods of sleep on memory consolidation could have implications for memory-intensive activities such as language training.

The findings, she said, also point to a strategy for helping victims of post-traumatic stress syndrome, a debilitating condition caused by extreme experiences.

The reactivation techniques "might prove useful in re-processing and un-learning unwanted memories," she said. "And reactivation of newly learned memories during ensuing sleep could then help consolidate the desired therapeutic effects for the long-term."

Diekelmann cautioned that computers are an imperfect metaphor for the way memories are stored in the brain.

"Human memory is absolutely dynamic. Memories are not statically 'archived' in the neocortex but are subject to constant changes by various influences," she said.

Likewise, the act of remembering does not simply entail "reading" the stored data, she added. "Recall is a reconstructive process in which memories can be changed and distorted."

Diabetes on rise in Asian Americans


Diabetes on rise in Asian Americans NEW YORK: Despite being thinner, Asian Americans are more likely than whites to have type diabetes 2 -- and the problem is growing, a new study finds.

Using data from an ongoing government health survey, researchers found that Asian Americans had consistently higher rates of type 2 diabetes than white Americans from 1997 to 2008.

What's more, diabetes rates rose over time for both racial groups -- reaching 8 percent among Asian adults and 6 percent among whites.

That was despite the fact that Asian Americans were less likely to be overweight, one of the prime risk factors for type 2 diabetes.

The findings, reported in the journal Diabetes Care, are in line with past studies showing that Asian background itself is a risk factor for diabetes.

But while researchers know that Asians are at increased diabetes risk, most people are probably unaware of that, said Hsin-Chieh "Jessica" Yeh, an assistant professor at Johns Hopkins University in Baltimore and the senior researcher on the new study.

Genes are partly to blame, Yeh said. But it's the combination of genetic vulnerability and lifestyle that's key, she pointed out.

"Asians may be even more susceptible to unhealthy food and related weight gain," Yeh said.

Specifically, studies have shown that even though Asian adults tend to weigh less than white and black adults, they often have a higher percentage of fat surrounding their abdominal organs. This so-called "visceral" fat is particularly linked to the risk of type 2 diabetes.

Then there is exercise, which is thought to help lower diabetes risk regardless of body weight. Based on health surveys, Asian immigrants to the U.S. are less physically active than native-born non-Asians, Yeh and her colleagues note.

So for Asian Americans -- as for all Americans -- healthy diet choices, calorie consciousness and regular exercise are key to curbing diabetes risk, Yeh said.

The findings are based on 230,500 U.S. adults who took part in a nationally representative government health survey between 1997 and 2008. Just over 11,000 were Asian American, with the majority being foreign-born.

Over the 12 years of the study, the number of Asian Americans reporting a diabetes diagnosis rose from just over 4 percent to 8 percent. Among white adults, the prevalence rose from just under 4 percent to 6 percent.

That was despite the fact that compared with their white counterparts, Asian Americans had a consistently lower body mass index, or BMI -- a measure of weight in relation to height -- and lower rates of obesity. In 2006-2008, 25 percent of whites were obese, versus 17 percent of Asians.

When Yeh's team accounted for factors like age, BMI, income and reported exercise levels, Asian background itself was linked to a 30 percent to 50 percent higher likelihood of having diabetes.

"The main implication of our study is that type 2 diabetes is a growing public health problem for Asian Americans that requires urgent attention," Yeh's team writes.

It's possible that their statistics aren't precisely correct, the researchers acknowledge. For one thing, they had to assume that participants answered the survey questions correctly. They couldn't account for how people of mixed race identified themselves. And they didn't have information on any other diabetes risk factors, such as what participants usually ate, and whether anyone else in their family had diabetes.

Despite these shortcomings of the study, Yeh recommends that along with making healthy lifestyle choices, middle-aged and older Asian Americans should be sure to have routine check-ups with their doctor. Blood sugar tests can detect the abnormally high levels that signal "pre-diabetes."

In some Asian cultures, Yeh noted, routine doctor visits are not the norm, and that could be one factor in Asian Americans' higher diabetes rate.

Funny Doctor's Stories

1. A man comes into the ER and yells, "My wife‘s going to have her baby in the cab!" I grabbed my stuff, rushed out to the cab, lifted the lady‘s dress, and began to take off her underwear. Suddenly I noticed that there were several cabs -- and I was in the wrong one.
>>>>>Submitted by Dr. Mark MacDonald

2. At the beginning of my shift I placed a stethoscope on an elderly and slightly deaf female patient‘s anterior chest wall. "Big breaths," I instructed. "Yes, they used to be," replied the patient.
>>>>>Submitted by Dr. Richard Byrnes

3. One day I had to be the bearer of bad news when I told a wife that her husband had died of a massive myocardial infarct. Not more than five minutes later, I heard her reporting to the rest of the family that he had died of a "massive internal fart."
>>>>>Submitted by Dr. Susan Steinberg

4. During a patient‘s two week follow-up appointment with his cardiologist, he informed me, his doctor, that he was having trouble with one of his medications. "Which one? " I asked. "The patch. The nurse told me to put on a new patch every six hours and now I‘m running out of places to put it!" I had him quickly undress and discovered what I hoped I wouldn‘t see. Yes, the man had over fifty patches on his body! Now, the instructions include removal of the old patch before applying a new one.
>>>>>Submitted by Dr. Rebecca St. Clair

5. While acquainting myself with a new elderly patient, I asked, "How long have you been bedridden?" After a look of complete confusion she answered..."Why, not for about twenty years -- when my husband was alive."
>>>>>Submitted by Dr. Steven Swanson

6. I was caring for a woman and asked, "So how‘s your breakfast this morning?" "It‘s very good, except for the Kentucky Jelly. I can‘t seem to get used to the taste," the patient replied. I then asked to see the jelly and the woman produced a foil packet labeled "KY Jelly."
>>>>>Submitted by Dr. Leonard Kransdorf

7. A nurse was on duty in the Emergency Room, when a young woman with purple hair styled into a punk rocker mohawk, sporting a variety of tattoos, and wearing strange clothing, entered. It was quickly determined that the patient had acute appendicitis, so she was scheduled for immediate surgery. When she was completely disrobed on the operating table, the staff noticed that her pubic hair had been dyed green, and above it there was a tattoo that read, "Keep off the grass." Once the surgery was completed, the surgeon wrote a short note on the patient‘s dressing, which said, "Sorry, had to mow the lawn."
>>>>>Submitted by RN no name

8. As a new, young MD doing his residency in OB, I was quite embarrassed when performing female pelvic exams. To cover my embarrassment I had unconsciously formed a habit of whistling softly. The middle-aged lady upon whom I was performing this exam suddenly burst out laughing and further embarrassing me. I looked up from my work and sheepishly said, "I‘m sorry. Was I tickling you?"She replied, "No doctor, but the song you were whistling was, I wish I was an Oscar Meyer Wiener!”
>>>>>Dr. wouldn‘t submit his name

A Family Doctor in the Land of the Amish

An Amish man came in with a chief complaint of having his “right ear blocked for two years.” He had a big piece of cotton stuck in the ear after trying “sweet oil” and other natural remedies. I checked the ear and it was indeed packed with cotton and wax. After my nurse did extensive lavage, I rechecked the canal and found it clear. As I handed him the bill he said, “Doctor, can I have my cotton ball back?” I handed it to him and asked, “What do you want it for?” He responded, “Well, everything is so loud now.” Guess I'll be seeing him back in a couple of years.
Another time I came in after hours on a weekend to sew up a seven-year-old Amish child. He had cut himself in the forehead playing with sharp and dangerous farm implements. The father brought him along with three other children. I soon figured out that the “yes, we are patients in your practice” over the phone actually meant “we go to the other doc up the road, but he won't come in on weekends.” With a sigh, I had the father fill out the patient information sheet while I set up the suture tray.

I looked at the sheet and said, “Okay … Jacob, hop up on the table and let's take a look.” This kid was incredibly stoic. Not a flinch when I said, “Okay, Jacob, now you'll feel a bee sting as I numb you up.” Jacob never moved a muscle or said a word. I fixed him without a problem and told dad to call the office for a suture removal appointment in five days.

Seventeen days later, Mom brings him back in. The front desk can't find his chart anywhere. After ten minutes of searching in vain, I tell my staff to just put him in a room. I figured I would take his sutures out and find the chart later. As I am struggling to extract my now completely buried handiwork from his forehead (he's as stoic and wordless as ever), I say, “Sorry, Jacob, I know that this may hurt a little …” Mom cuts me off and with a big smile says, “Oh! It wondered me why you didn't find the record of him! This is Amos, not Jacob. My husband always gets them mixed!”

Live Long and Prosper

It was a late fall Monday, during my third year of medical school. I had just finished a horrifically boring month of Geriatric Psychiatry at the VA hospital, and now was doing a month of Adult Psychiatry at the local psychiatric hospital. It was a locked ward, and every day we had to be buzzed in to the unit, and be buzzed out at the end of the day.
There were three medical students working the ward. We each took turns taking new patients when they were admitted and working them up. It was my turn to work up a new patient that had been brought in Sunday night.
The senior resident handed me the patient’s folder. It was a thin folder, suggesting that this was her first stay at the hospital – generally a good sign. The resident quickly dashed that hope.
“Mrs. D was brought to the ER last night for severe depression. There was no suicide attempt; her family was worried because she was staying in bed and not willing to move for the past week. Since being brought to the ward last night, she hasn’t moved at all; she’s just lay in bed staring at the ceiling.” She smiled a crooked smile at me. “Good luck.”
I looked through her chart and ER notes. There was nothing particularly alarming or interesting. She had been on outpatient treatment for depression on and off for about five years. No suicide attempts. No significant medical or family history. She was divorced with two teen-aged children.
I walked to her room, the last door on the left, opened it up and looked in. The room was dark, and a large woman was lying unmoving on the bed, staring at the ceiling. Her breathing was slow and steady and she did not seem to be in any kind of distress. I knocked and entered the room.
“Hello, ma’am. I’m the medical student, Scott. How are you doing today?”
There was no response. Not even a twitch of muscle or a flicker of eyelids.
I pulled a chair next to the head of the bed and sat down. I tried again, “Are you in any discomfort? Is there anything I can do?”
There was no change. She continued lying in bed, staring at the ceiling.
I pulled out the history form, and asked the first question. “How long have you been feeling depressed?”
No answer. No movement. It was like trying to talk to a brick wall. It was time to try a different tack.
“Tell me about your children. How old are they?”
This time there was a brief twitch of the eyes, but no other movement.
“Are you and your children getting ready for Thanksgiving?”
There was another eye twitch, but nothing else. Clearly, she could hear and probably respond, but was choosing not to.
“You were brought to the ER last night,” I said, getting no response. “So you missed Star Trek, (Star Trek is an American science fiction entertainment series and media franchise) then.” This was Star Trek the Next Generation’s last season, and it was shown on Sunday nights in St. Louis.
Her eyes opened, and she turned her head my way. “Why? Did I miss anything important?” she asked. I laughed, and we spent the next hour talking about Star Trek.
Once up and out of bed, she recovered quickly and was home by the end of the week. We established a good rapport, and had many long talks. I was glad to see her get to go home, but also sad, because she was one of the few bright spots in an otherwise dreary rotation.
There was an important lesson to be learned: Where standard dialogue had failed, where even family concerns were not enough, Star Trek had triumphed.

Monday, January 10, 2011

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