Home / Author Archives: WhiteCoat

Author Archives: WhiteCoat

Battling diarrhea with … yeast

Recently-published meta-analysis shows that the yeast Saccharomyces boulardii has “clear beneficial effects” on children with acute diarrhea. Pooling of 22 studies showed that duration and amount of diarrhea was significantly reduced in children who took the supplement. Interesting back story to the discovery of Saccharomyces boulardii: The yeast is found on the skin of lychee fruits. French scientist Henri Boulard discovered Saccharomyces boulardii in the 1920s after noticing that natives of Southeast Asia were chewing on the skin of lychee fruits in an attempt to control the symptoms or cholera. You can purchase Saccharomyces boulardii from Amazon without a prescription. Saccharomyces boulardii is related to another yeast – Saccharomyces cerevisiae – which is found on the skin of grapes and plums and is used in brewing beer and baking. Antibodies to Saccharomyces cerevisiae are often seen in patients who have inflammatory bowel disease such as Crohn’s disease and ulcerative colitis, suggesting that Saccharomyces cerevisiae may play a role in bowel inflammation. Then I begin wondering whether the link between beer and “beer belly” may be related to more than just the alcohol and the extra calories in the beer.

Read More »

Healthcare Update — 09-12-2014

Need certification or recertification in BLS, ACLS or PALS? Don’t wait for the next course to be offered at your hospital. You can get same-day certification with an entirely ONLINE course NOW at Pacific Medical Training. If you sign up for training through this link, you’ll get a 15% discount on the cost of the course at checkout and you’ll be able to download your certificate of completion as soon as you pass the online test. ———————— 40 year old father/husband went to emergency department two days after feeling nauseous when he ate breakfast. Reportedly had cardiac symptoms, including chest pain. Was in the emergency department 4-5 hours, during which time no cardiac enzymes were ever ordered, and then released. Two days later, clutches his chest and dies from heart attack. Jury awards family $4 million. Good news: Chinese researchers discover new way to kill cancer cells by injecting the metal gallium into the arteries supplying the tumors. Bad news: In rabbit studies, the metal somehow finds its way into the heart and lungs and forms deposits there. $62 million medical malpractice award to patient who goes to Winthrop University Hospital for endoscopic removal of an ectopic pregnancy, developed complications from an unnoticed bowel perforation, then developed sepsis that eventually required amputation of both legs. In addition, the high doses of antibiotics she was receiving caused her to lose her hearing. When a front page story about the patient ran in the newspapers during trial, the hospital’s attorneys requested a mistrial, stating that the plaintiff “should be thankful the doctors were able to save her life.” Not really a good argument to use. In the end, the plaintiff and her attorney were happy that “justice was served” and someone in the comment section to the article suggests that everyone “remember this case the next time you find yourself asking why a Tylenol in the ER costs you 30 bucks.” Ohio jury awards patient and husband $1.2 million when patient had persistent pain after undergoing partial hysterectomy and physician didn’t order CT scan to diagnose perforated bowel until the patient was “critically ill.” By the time the complication had been diagnosed, she had developed respiratory distress syndrome and now requires a walker to help her walk. Remember how the government is making elderly patients pay for more care when they’re admitted as “observation” versus fully admitted? Then they came up with the “two midnight” rule, where providers had to predict whether a patient would need to stay in the hospital for two midnights – and then sign an attestation to that effect. The government won’t give “prior authorizations” for admissions, so providers are left to guess whether the government will retrospectively consider an admission appropriate, and anything deemed as “unnecessary” care is considered fraudulent when the government is billed for it. End result? Community Hospital Systems pays $98 million to settle false claims allegations. “The United States alleged that from 2005 through 2010, CHS engaged in a deliberate corporate-driven scheme to increase inpatient admissions of Medicare, Medicaid and the Department of Defense’s (DOD) TRICARE program beneficiaries over the age of 65 who originally presented to the emergency departments at 119 CHS hospitals. The government further alleged that the inpatient admission of these beneficiaries was not medically necessary, and that the care needed by, and provided to, these beneficiaries should have been provided in a less costly outpatient or observation setting.” Several emergency physicians and emergency nurses were “whistleblowers” in the case. When a hospital wants to admit you as an “observation” status, keep criminal investigations and settlements like this in mind. One ...

Read More »

Assault With A Semi-Deadly Weapon

Ramen Noodle Bowl

A man comes to the registration window clutching both sides of his head. “Help me … please. My head … it’s killing me.” He is brought straight back to a room and the doctor is called right in to see him. Between moans, the doctor gets the history. “I was fine before the fight. Then my baby’s momma came to my house with her boyfriend. She was nice at first, then she started arguing with me. Then he got all tough and tried to get all in my face. Then out of the blue, she grabs a bowl off the counter and hits me over the head with it.” “Wow. Did you pass out?” “No. But I was damn close.” “Did the bowl break?” “No, it wasn’t open.” “What do you mean it wasn’t open? What kind of bowl was it?” “One of those Ramen Noodle bowls.” “Wait. You mean one of those little plastic bowls with the peel off paper on the top?” “Yeah. But that sh*t HURTS!” “Did you get hit with anything else?” “No. She just slammed me in the head with the Ramen Noodle bowl then they took off running. I think I may have a concussion.” “Pardon me a minute.” The doc walks out into the nurse’s station shaking his head. He regains his composure and walks back into the room. “Well, after examining you, there are no signs of bleeding inside your brain and no concussion. We’ll give you some Tylenol … number three … here and then give you a prescription for a couple of days of Dolobid (pronounced “Da-LAW-bid”). You can follow up with your family physician if you’re not feeling better.” With that, the patient was given three Tylenol tablets, given a prescription for Dolobid, and discharged in stable condition. A couple of hours later, the patient calls the emergency department. “Man, that wasn’t no Dilaudid. That was crap. Can’t y’all just call me in some Oxycontins to last me through the night?” “No. We can’t call Oxycontin into a pharmacy. Try some ice and the Dolobid. You should feel better tomorrow.” So the nurse who took care of the patient overheard the conversation and made a suggestion. “I know something you can call in that would probably help more than pain medications.” “What’s that?” “Testosterone patches?” “Harrr harrr. That’s scheduled, too, you know.” “A football helmet?” “Nonprescription. Not carried in drug stores. Don’t you have patients to see?” “Some plastic bags to store the Ramen Noodles in?” “Stop. I’m getting a concussion.” ———————– This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on Dr.WhiteCoat.com, please e-mail me.

Read More »

How To Get Rid of Fruit Flies

Fruit Fly Vinegar Trap

They’re back. And now I’m an expert at exterminating them. A couple of years ago, I wrote a post about how we had a fruit fly problem and how we got rid of the problem. The fruit flies always seem to appear in late summer and hang around until late fall. And they love to dive bomb at people’s faces. Before learning about the solution, I would grab them out of the air. But fruit flies are pretty adept at dodging giant hands. So I started clapping them to death. That worked most of the time, but they would win by sheer numbers. It was like some freaky insect zombie movie. Kill one and it attracts even more. I’d even keep a couple of cans of Raid about the house and spray them, but that got Mrs. WhiteCoat upset. A couple of years ago, a neighbor suggesting putting out a glass of apple cider vinegar. Apparently, fruit flies are drawn to the aroma since it smells like fermenting fruit … which happens to be a fruit fly delicacy. They dive bomb the glass then can’t get out and drown. He also suggested putting a few drops of soap in the vinegar to break the surface tension so that the fruit flies couldn’t float on the top of the water like these water strider insects. So we set up a vinegar trap. Put a half inch of vinegar into a glass, add a couple drops of soap, and put it near the garbage can or the sink. Putting the glass in the microwave for 15 seconds will get more aroma out of the vinegar and attract more flies. Your home will be noticeably less fruit fly laden in no time. We’ve seen some of the fruit flies coming out of the garbage disposal, so one of the things we did to help prevent the fruit flies from coming around was to first throw some baking soda down the drain then run hot water and the disposal, then throw a bowl of ice cubes down the drain and run the disposal again. If this post has helped you out or if you have any other suggestions, please leave a comment in the comment section to let me know.

Read More »

What’s The Diagnosis 22

Child Skin Lesion

A six year old child is brought to the emergency department by an aunt and a Child Protective Services worker. He was sent home from school by the teacher who said that the child appeared to have marks from being hit over the shoulder by a whip. The school principal called Child Protective Services. The child says he wasn’t hit by a whip but can’t say what, if anything, did happen. The lesion is dry, rough, and non-tender. It does not appear to be a bruise. No drainage. No fever. No URI symptoms. No other lesions anywhere else on the body. The child is up to date on immunizations. What’s the diagnosis and what’s the treatment? Answer posted below in a few days. . . . . . . . . .    Answer: Lighter Burn to the Neck The mark wasn’t caused by a whip, but rather was caused by a worse form of abuse. A lighter burn is caused by keeping the flame of the lighter lit until the metal head of the lighter gets hot, then using the hot metal head to burn the skin. See the picture for a comparison – probably not the same lighter, but the characteristic “U” -shaped outline of the lighter burn becomes more apparent. While the burn may initially appear too narrow to match the outline of the lighter head, by holding down on the patient’s shoulder and stretching the skin, a near-perfect match to the head of the lighter was obtained. The patient and his sibling were removed from the household until further investigations could be completed.

Read More »

Healthcare Update — 07-28-2014

Patients with “insurance” wonder why they can’t find access to medical care? Here’s a good example of why: Wisconsin pays a pittance to those who care for its Medicaid patients. As in 71% lower for office visits than private insurance payment rates, 76% to 78% lower for hospital care than private insurance rates, and 91% lower for emergency care than private insurance rates. According to the article: One result of Medicaid’s low payment rates for physicians is a shortage of primary care clinics in low-income neighborhoods in Milwaukee. That contributes to many people seeking care in high-cost hospital emergency departments. Wheaton Franciscan-St. Joseph estimates that roughly half of the patients in its emergency department — the busiest in the state — could be treated elsewhere. Letter to the editor about the article from an emergency physician notes that the abysmal payment rates make it difficult to recruit and maintain emergency physicians in Wisconsin. Oregon hospital notes “record breaking” increases in emergency department visits after Obamacare implemented. Average daily patient volumes in the 60s increased to the mid-70s with some spikes up to 100 patients per day. Wait times also increasing. BMJ investigation shows that drug manufacturer Boehringer Ingelheim reportedly hid data from regulators regarding safety of Pradaxa [dabigatran]. Some Life Pro Tips from Reddit contributors on how to speak to people who have hearing impairment. Not scientific, but I’ve found that I tend to speak slower and enunciate each word when a patient initially says that he or she cannot hear me. After going back and forth once or twice, I’m usually able to speak in a normal or near-normal voice. Any ENT experts care to chime in? Slowly, of course. And for all you young whippersnappers out there, here are two related sitcom videos related to auditory issues from Monty Python and Taxi. More on the $190 million Johns Hopkins settlement after gynecologist found to have taken secret pictures of up to 8000 patients. Hopkins joined an insurance collective with other universities such as Yale, Cornell, Columbia, and the University of Rochester. Now money will be coming out of the pockets of several institutions that had nothing to do with the Hopkins incidents. Recently-published CDC study based on 2012 data shows that children covered by Medicaid use the emergency departments at a rate nearly double that of patients with private insurance. Pregnant California woman in labor is unable to cross street to get into hospital for 30 minutes because President Obama’s motorcade was passing through at the time. Pakistani town organizes protest of 100 people calling for a doctor to be arrested when patient under doctor’s care dies of stroke. Protestors laid patient’s body in road in front of the clinic and initially refuse to leave. Philadelphia psychiatrist pulls out gun and shoots armed patient who had just shot his case worker. Police admit that the doctor’s actions stopped the patient from going on a rampage and killing others, but police are also “investigating” why the doctor had a gun at work since “bringing guns to work is against the rules at the hospital.” Those “no gun” zones work so well. Obviously the patient in the incident was playing close attention to the rules. And Chicago is a shining example of how properly implemented gun-free zones save lives. You know all those fitness wristbands and fitness apps for your phone? They’re a gold mine for advertisers and identity thieves. Almost 75% of the apps studied sent data to third parties; nearly half shared personal information with advertisers — all without the user’s knowledge. Another analysis found that the top ...

Read More »

Healthcare Update — 07-18-2014

More patients gone wild. Texas woman gets trip to the hoosegow after running a red light and colliding with another vehicle, then attacking the emergency department nurse who was trying to help her. Adding pelvic exercises to a workout may help men as much as it helps women. Kegel exercises for men *may* improve incontinence and erectile dysfunction, and one company actually created a little weight lifting system that fits over the male genitalia. Gives new meaning to the phrase “pump you up.” Not to be outdone, you can also see this article on weight training with a women’s genitalia using a jade egg. Who wouldn’t want a pelvic floor like a trampoline? Then again, just reading the article makes me think about getting one of these things for Mrs. WhiteCoat. Hat tip to Instapundit for the link North Carolina patient with chronic pain experiences an increase in pain for 2-3 weeks then waits until 3PM on a Friday afternoon to seek medical care in the emergency department rather than seeing their primary care physician in the prior 14-21 days. Given two pain shots and a prescription for pain medications but wife is still upset because he “was not adequately treated for his episode of pain,” so she writes letter to the editor of the newspaper. Speaking about chronic pain … Salix gets approval for its new drug Relistor for treatment of chronic pain in non-cancer patients. Initially approved for opioid induced constipation and is an isomer of the drug naltrexone which is used to treat alcohol dependence and occasionally used to treat opioid dependence. California’s Grant Union High School in the midst of a tuberculosis outbreak. 116 of 450 students and staff have latent TB while 5 students developed active TB including one who spread the disease to some family members. New Jersey’s University Hospital cuts emergency department beds and opens “observation unit” to ease emergency department overcrowding. Kind of interesting how state hospitals work that numbers game. Will be interesting to see how much crowding increases in both the ED and the observation unit. Naval Hospital Bremerton closing its emergency department and ICU and opening an urgent care facility April 15, 2014 article in Huffington Post by Alexander Kjerulf titled “Top 5 Reasons Why ‘The Customer Is Always Right’ Is Wrong.” Companies that exhibit this attitude create unhappy employees: “You can’t treat your employees like serfs. You have to value them … If they think that you won’t support them when a customer is out of line, even the smallest problem can cause resentment.” The “customer is always right” sentiment also creates perverse incentives where “abusive people get better treatment and conditions than nice people.” When companies enforce this culture, employees feel less valued, feel as if they have no right to respect, and gradually learn to provide “fake” good service where the courtesy is “on the surface only.” One expert noted that “when you put the employees first, they put the customers first.” The article ends by noting The fact is that some customers are just plain wrong, that businesses are better of without them, and that managers siding with unreasonable customers over employees is a very bad idea, that results in worse customer service. FDA trying to regulate tweets. Maybe it should spend more time reviewing the safety profile of drugs so that it doesn’t recall medications for safety concerns after it has approved them for 30+ years … not that something like that would ever happen. Twice. Or more. Oh, and by the way. Stare at my avatar for 30 seconds 3-4 times per day. ...

Read More »

What is an Aneurysm?

Aneurysm

The kids took out a hose to wash our cars. We have several hoses, but the kids like the cheap nylon hose for most of the jobs around the house because it is light and easy to move around. They used the cheap nylon hose to fill up a bucket with some soap and water, got some sponges, and had a lot of fun cleaning the cars. Then they put a spray nozzle on the hose to rinse the cars off. That’s when my daughter came into the house dripping wet to give me some bad news. “Dad … there’s something wrong with the hose.” I went outside and the hose was in bad shape. “The hose has an aneurysm. Not going to last much longer.” “What’s an ann-you-rism?” My youngest daughter asked. Light bulb! What a perfect idea for a blog post! I went to get my camera. At this point, you’re probably asking yourself what a garden hose has to do with a discussion of aneurysms on a medical blog. The simple answer is that the basic principles remain the same whether we’re talking about an abdominal aortic aneurysm, a brain aneurysm, a hose aneurysm, or even a balloon. In medicine, an aneurysm occurs when there is a weakness in the walls of a blood vessel. As the weakness worsens, the walls of the blood vessel  around the weakness begin to balloon out. As the walls balloon out, they get weaker. The cycle continues until eventually the wall breaks. Think of a balloon. When you first start blowing up the balloon, it is usually a lot more difficult to get the first breath of air inside. After that, it gets easier and easier to blow more air into the balloon until you reach the limits of the tensile strength in the balloon walls and … POP. Aneurysms almost always occur under pressure, so they almost exclusively occur in arteries. Venous aneurysms can occur, but are rare. This makes sense. Go back to the balloon analogy. If you don’t blow to put pressure inside the balloon, it won’t get bigger. Now think of the hose analogy. My kids didn’t notice the swelling in the hose initially because they didn’t have the spray nozzle on the hose and the water ran freely out of the end – therefore no pressure built up inside the hose. Once the spray nozzle was in place, the water had nowhere to drain, causing pressure to build up inside the hose and making the aneurysm bulge. Think about the human body. Higher blood pressure puts more pressure on aneurysm walls. Therefore, it’s a good idea to keep your blood pressure down with aneurysms. Blood vessels have many layers. Because arteries are under higher pressure than veins, arteries have more layers of reinforcement. See the picture above which was originally posted on Wikipedia. Note how there are more layers in the artery and how the smooth muscle layers are thicker than in the veins? Just like layers of clothing in the winter help to keep in warmth, layers in blood vessel walls help to maintain the blood vessel’s strength. There are two basic types of aneurysms. Fusiform aneurysms are similar to what happens when you partially inflate a “twisty balloon”. Fusiform aneurysms involve the entire diameter of the blood vessel. Berry or saccular aneurysms involve a bulge in the side of a blood vessel or can also occur where a blood vessel divides (often in the brain). Our hose had a berry aneurysm. Now here’s the cool part of the hose analogy (click on the pictures to enlarge). Note the yellow nylon coating ...

Read More »