I’ll take mine plain…

He was a funny little man. The black leather chaps and jacket almost hung off his body even though I’m sure they were a size small. On his way to the Sturgis Motorcycle rally he had veered off the road while admiring the view and slid on the gravel at the side of the road. His left thumb took all the force and rapidly popped out of joint. While he wasn’t in that much pain, there was no way he could drive his motorcycle twenty miles to the nearest hospital.

As soon as he climbed out of the ambulance,  you couldn’t help but laugh. He had a smile from ear to ear and despite his bike touring vacation being potentially ruined by a ride ending injury, he was all about enjoying himself in the moment, no worries about the past or future.  But if appearances were everything, he might not be someone you’d want to admit you were friends with… or at least not take home to mother.

What would otherwise be called a sunshine smile revealed yellowed nubs of teeth barely long enough to chew a piece of bread.  When he laughed, a raspy smokey breath of air filled the space in front of him…you could almost see the years of cigarette smoke that had built  up in  his lungs.

His friends were equally as happy and easy going. I really can’t explain why this little man was so fascinating to me. I guess because in my role as an ER doc, I get to see all sides of people. Normally I wouldn’t have given this man and his friends the time of day. I mean, based on appearances alone, he was kind of gross.  And if you judged a man by the stickers on his black motorcycle skull cap, well, he was downright disgusting.  When he went to xray for his thumb, I took photos of the bumper stickers on his helmet.

“I was born with nothing, and still have plenty of it left”

“I’m looking for the perfect woman, a nymphomaniac who owns a liquor store”

“Could you drive any better if that phone was up your a**”

“I’ll be sober tomorrow, but you’ll still be ugly”

And perhaps the most disgusting of al and yet somehow amusing…

“9 out of 10 women are battered, but I’m still eatin’ mine plain”

After he returned from x-ray, he asked if he could go outside and have a cigarette while he waited for the results. So he and his buddies headed out to the ambulance bay and smoked and laughed and laughed and smoked.  I guess what was really intersting was that despite all the messages he carried around on his helmet and the tough persona he emulated in the motorcycle outfit and mannerisms, the whole group of them was just downright nice.

They were polite and thankful and optimistic about the rest of their trip to Sturgis. I placed a splint on his left hand, and he hopped on the back of his buddy’s motorcycle and they rode off into the mountains together, both of them wearing helmets even though not required by law.

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Every Patient has a Story

Hmm…been reading through my archives, sharing stories with different folks. I’ve always wanted to cull down the archives and self publish a book. But what would I call it?  How about “Every Patient has a Story…”  What do you think? It would need a subtitle for sure.

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Life is Short and Cyclocross Rocks

I left teh Rocky Mountains 3 days early this summer in order to come home for a memorial service for a good friend of mine who died suddenly & unexpectedly at the age of 39.  Myself and the rest of his friends were crushed…I feel cheated that I will never get to go climbing with him again, or drinking or running or just sitting around a campfire. I’m mad.  But spending the weekend with my dear, old friends was wonderful.  I couldn’t have gone through all of it by myself.

While tragic, it made me realize how much time I spend idle and unfocused. I’ve been far more optimistic thinking to myself, What would Mikey do right now?  He wasn’t one to waste time with anything…always planning his next adventure.

Tonight I had a choice to race another crit or to do cyclocross practice.  Since I always finish last in the crits, and every single moment is painful, I thought, why flagellate myself? Cross is fun, fast, requires skill and technique and practice.

I was one of 5 women there and about 15 men. For the most part we held our own and for 2 of the women, it was their first cross experience ever. I think they are bike shopping now.

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Sprint Triathlon Training Sites

As some of you know, I have done a handful (or more) of triathlons in the past. I recently decided to help a friend out with her Sprint Triathlon Training website and blog.   In addition to thoughtful articles, she has a free Training Book and12 Week Sprint Triathlon Training Guide that you can download.  All the information is solid by my review.   Check it out and let me know what you think.

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Rocky Mountain Summers are Back

This is my 5th summer working in the Rocky Mountains at a small rural ER.  Since last year, the ER has been totally renovated.  It now has the appearance of a modern, urban ER with trauma bays, sliding glass doors providing privacy in each room, a psych observation room with the ability to lock down all supply doors, an orthopedic room and more. Its beautiful, but I miss having a true “Emergency Room” which provided  a stark contrast to my urban inner city and referral hospital environments.

I worked the first four days upon arriving here, so it wasn’t until yesterday that I had a chance to go out for a ride.  I was all ready to hit the road when I looked at the fork on my bike, and it was a bit crooked. I pushed down and uh oh…Fork screwed. Headset broken. Head tube cracked. Damn.  On the way out, i had run into a metal “warning” bar while going through a drive through and heard an awful noise on the roof.   The mountain bike rolled backward over it’s front wheel holder and was simply thrown free of the impact with no frame damage to the bike that I can tell.  Teh road bike was not so lucky as the forks were securely locked into the fork mount carrier.

Damn.

I called my bike shop back home and  had them super-stat a new bike build that should be here by the weekend.   An expensive mistake all in the name of a quick breakfast. Guess I know where I”ll be spending this month’s paycheck.

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New Concussion Guidelines Stir Up Controversy

In this latest NYT article about Concussions in Youth Sports critics of the new policy state that more kids will be injured as a result of it.  Fear that a student will hide or mask symptoms in order to stay in the same-day game has sideline docs and coaches recommending against the new guideline!

My thoughts are that peer pressure should not influence medical decision making.  Plenty of times in the ED patients, parents and adult children alike try to manipulate my recommendations to mold to their current circumstances. I always remind them that my job is to make a medical evaluation and appropriate reccomendation. What they choose to do with my recommendation is entirely up to them.

I try to leave them as fully informed as possible.

If scientific research shows that it is safer to pull kids from a same day game for any evidence of a concussion, who are the sideline docs and coaches to say that this policy is unsafe?  All we can do is educate.  The arguments against this policy are one reason why I do not envy sideline docs, because my decision would be to bench every kid that got hit in the head until further evaluation cuold take place. It’s just not worth the risk.

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My Policy on User Comments

I have noticed a large increase in the number of comments left in an effort to get backlinks to affiliate website and blogs.  While many of these are somewhat healthcare related, If you leave a comment that says something like:

“Interesting thoughts, I’d like to hear more”

and then provide a link back to “My Healthy Skin Site”, I will immediately flag it as spam

Please provide relevant comments or risk having your URL flagged as spam by the askimet plugin preventing you from posting on any wordpress blog.

For those of you commenting appropriately, please continue to do so.  I believe my Sumatriptan post has nearly 50 comments so far, and I publish every one of them whether it is pro or con because I feel it’s important to have people see all sides.

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Generic Imitrex (Sumatriptan) – Is it as Effective as Brand Name Imitrex?

Some of you may know that Doc Shazam suffers from an occasional migraine, worse at a certain time of the month, and exacerbated by lack of sleep and irregular work schedules…something not uncommon to ER docs.

I have used Imitrex with great success since my 2nd year of medical school.  Typically a 50 mg tablet relieves my headache with nearly 100% effectiveness within about 45 minutes to an hour with no significant side effects.  The first few times I took it, my muscles felt a little bit “wierd”, but otherwise no real problems.

Yesterday I obtained a refill for my Imitrex and was told that it was available in generic form, with a co-pay that was $15 instead of $35.  I was pretty excited as the outrageous cost of imitrex (over $200 for 9 tablets!) is prohibitive for a lot of people, myself included.

Since then I have taken 2 of “Dr. Reddy’s” generic sumatriptan tablets with almost no relief of headache symptoms, but a plethora of side effects, including aching muscles, nausea, “light headed” feeling and general dis-ease.

My conclusion is that they don’t work as well as brand name Imitrex for me.  Does anybody know if I can return the unused pills? I hate to have my insurance charged for medicine that isn’t going to get used.

Guess I’ll have to make some phone calls tomorrow.

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Transcript of Obama’s Election Night Speech

Already, someone has transcribed this speech.  I’m not the most politically savvy person in the world, probably among the least.  But I’ve never been so enthralled as to listen to a politician speak.  Now I want to go backwards and listen to all the speeches I didn’t hear, even back into his days as a state politician and law student.  He’s always seeming to overcome, but I guess that’s what happens when you are a smart, successful, eloquent, passionate, mixed minority, charismatic leader in the right places at the right times with the right world, political and local circumstances compelling the people to make their opinions count.

Here is the transcript of Obama’s Election Night Speech

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Daylight Savings Time Causes More Heart Attacks

Yes, I thought that the study headline seemed odd as well…after all how would a man-made construct…the clock…lead to more heart attack deaths?

In a widely report on study from the New England Journal of Medicine, heart attack deaths and hospitalizations dropped 5 % the day after clocks “fell back”, ending daylight savings time.

Could the causative factor be, oh, I don’t know…an extra hour of sleep?

Americans are chronically sleep deprived, including Doc Shazam.  THe problem is that we think that this is normal…it’s a badge of honor to be able to “function” on 4,5,6 hours of sleep per night. In reality, we only learn to tolerate the chronic fatigue associated with the lack of sleep.

What we don’t see is the toll this takes on our bodies on the inside…inflammation, arthritis, allergies, asthma, immune system problems, frequent colds, etc…

The very first thing I notice when I’m sleep deprived? My knees hurt.  They ache all day and all night.  Funny that they were fine all summer while I was working in Colorado, a regular schedule albiet 7am-7pm…my body was used to the schedule and I got 8 hours of sleep per night.

But now?  I work till 1AM or 3AM, come home, wind down for several hours, get to bead at 4, 5, 6 AM, try to sleep while it’s light out, and get up aching everywhere.  It’s not right, it’s not a natural schedule.

Just like those people in the study, my schedle is an artifiicial construct of modern society and modern medicine.  Convenience care in the ER at 10pm..what?  I’m losing sleep over some punk who wants a z pack for his cold?

The increase in heart attacks is not due to daylight savings time at all…it’s due to the artifically contrived workday requiring one to be in an office for a set duration of hours and at a certain time.   I’m all for going back to a society where we go to bed when the sun goes down and get up when it rises, living in harmony with the circadian natural rhythms.

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