The patient, a man in his 70s, had abdominal pain serious enough to send him to a VA Pittsburgh Healthcare hospital. Doctors there found the culprit: a gallstone had inflamed his pancreas.
Dr. Daniel Hall, a surgeon who met with the patient, explained that pancreatitis can be fairly mild, as in this case, or severe enough to cause death. Recovery usually requires five to seven days, some of them in a hospital, during which the stone passes or a doctor uses a flexible scope to remove the blockage.
But "because it can be life-threatening, after patients recover, we usually take out the gall bladder to prevent its happening again," Dr. Hall said.
A cholecystectomy, as that operation is known, isn't high-risk surgery. When done with a laparoscope to avoid large incisions, it's usually an outpatient procedure.
More ...
https://www.nytimes.com/2019/12/13/health/frail-elderly-surgery.html?
Saturday, December 14, 2019
A Runner Suddenly Developed Asthma. It Was Stranger Than It Seemed. - The New York Times
It was chest pain that brought the 34-year-old woman to the emergency room at Montefiore Medical Center in the Bronx. She'd been coughing for days, but that morning the pain was so bad she was worried that it had turned into pneumonia. She tried to tough it out, but when it was no better by the end of the day, she decided to go to the E.R.
It took a few hours, but finally the physician assistant caring for her in the E.R. brought some good news. She didn't have pneumonia; she didn't have a clot in her lungs. This was just muscle strain from coughing. The year before, she was told she had asthma.
She was given inhalers to stop the coughing and wheezing, but they didn't seem to do much. So she didn't use them.
The P.A. encouraged the woman to use her inhalers; they really would prevent the episodes of coughing and wheezing that had sent her to the E.R. so often that year. The woman nodded; she'd heard this speech before. The P.A. asked whether she'd like ibuprofen for the pain. Absolutely not, the patient said. After years of taking it for muscle pain after working out or racing, she had developed some kind of allergy to it. What about ketorolac? the P.A. offered. It's the same type of painkiller but a completely different compound.
Pain relief sounded appealing. But within seconds of getting the intravenous medication, the woman felt an intense pressure in her chest. Her windpipe narrowed as if she had something stuck in her throat. She tried to shout, "I can't breathe!" The only sound that came out was an unintelligible whisper.
More ...
https://www.nytimes.com/2019/12/12/magazine/aspirin-exacerbated-respiratory-disease-aerd.html?
It took a few hours, but finally the physician assistant caring for her in the E.R. brought some good news. She didn't have pneumonia; she didn't have a clot in her lungs. This was just muscle strain from coughing. The year before, she was told she had asthma.
She was given inhalers to stop the coughing and wheezing, but they didn't seem to do much. So she didn't use them.
The P.A. encouraged the woman to use her inhalers; they really would prevent the episodes of coughing and wheezing that had sent her to the E.R. so often that year. The woman nodded; she'd heard this speech before. The P.A. asked whether she'd like ibuprofen for the pain. Absolutely not, the patient said. After years of taking it for muscle pain after working out or racing, she had developed some kind of allergy to it. What about ketorolac? the P.A. offered. It's the same type of painkiller but a completely different compound.
Pain relief sounded appealing. But within seconds of getting the intravenous medication, the woman felt an intense pressure in her chest. Her windpipe narrowed as if she had something stuck in her throat. She tried to shout, "I can't breathe!" The only sound that came out was an unintelligible whisper.
More ...
https://www.nytimes.com/2019/12/12/magazine/aspirin-exacerbated-respiratory-disease-aerd.html?
Friday, December 13, 2019
Snapshots of My Patients - The New York Times
A little over a year ago, our electronic medical record started to include photographs of patients along with their medical information.
These thumbnail images, which appear at the top left-hand corner of the computer screen next to a name, age and birthdate, are intended as a safety measure, to help ensure that clinicians are placing orders and entering documentation for the correct patient when multiple patient records might be open simultaneously.
As I was scanning through my day's clinic schedule recently, I was struck by the different ways my patients approached taking the picture. All of them had been given a diagnosis of cancer, and many were dealing with a range of health issues. I found myself wondering whether these snapshots might give me further insight into how they viewed their medical conditions.
The standard photo is taken from a camera located at the registration desk, by the cancer center's main entrance. The photos are always taken at an upward angle, usually capturing my patients slightly off-center, with the lobby's drop ceiling and a couple of LED canister lights as an unflattering backdrop. Most don't smile — no fun fighting traffic into downtown Cleveland, searching for a parking spot, walking to our building and then having a doctor's appointment, often many times per week.
No fun having cancer.
More ...
https://www.nytimes.com/2019/12/12/well/live/doctors-patients-electronic-medical-records-cancer-hospital.html
These thumbnail images, which appear at the top left-hand corner of the computer screen next to a name, age and birthdate, are intended as a safety measure, to help ensure that clinicians are placing orders and entering documentation for the correct patient when multiple patient records might be open simultaneously.
As I was scanning through my day's clinic schedule recently, I was struck by the different ways my patients approached taking the picture. All of them had been given a diagnosis of cancer, and many were dealing with a range of health issues. I found myself wondering whether these snapshots might give me further insight into how they viewed their medical conditions.
The standard photo is taken from a camera located at the registration desk, by the cancer center's main entrance. The photos are always taken at an upward angle, usually capturing my patients slightly off-center, with the lobby's drop ceiling and a couple of LED canister lights as an unflattering backdrop. Most don't smile — no fun fighting traffic into downtown Cleveland, searching for a parking spot, walking to our building and then having a doctor's appointment, often many times per week.
No fun having cancer.
More ...
https://www.nytimes.com/2019/12/12/well/live/doctors-patients-electronic-medical-records-cancer-hospital.html
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