Tuesday, September 27, 2011

Terms Everywhere

It's all about vocabulary.

Anything protected from outsiders must have a code that only the insiders know. That vocabulary of terms is the "fair maiden", protected in the towers by the knights in white smocks with black rubber tubes of grail around their necks and in their ears. To know "the imagewords" is to be a member of the secret society of potions and spells that few are permitted to use or allowed entry.


And when the attacks at the gates by nurse practitioners, physician assistants, chiropractors, pharmacists and the many "non-knights" becomes too brutal, the knights convene and invent new words, new exams, new "steps", new rules, new regs, newances...and they smile broadly.


Mu ha ha!!

That'll keep them to the other side of the mote.

The fair maiden is protected again.


Monday, September 26, 2011

Cluster Headache

Pretty darn bad, apparently.

A cluster headache is one-sided head pain that may involve tearing of the eyes and a stuffy nose. Attacks occur regularly for 1 week to 1 year, separated by long pain-free periods that last at least 1 month.

They are "episodic" (most common) with 2 or 3 headaches a day for 1-2 months, brief HA free period and repeating pattern after that. The other type is "chronic" is about the same but without a period of sustained relief. Both are more common in men, and often feel like " an ice pick in the eye."

Of course it's always a good idea to see if the patient actually does have a pick in the eye before treating.

Ice pick headache

Saturday, September 24, 2011

Sorta Just Snuck Up On Me

The patient struggled to the table. "This has been progressing for a few months and is getting worse. It just sort of snuck up on me, a little more each day, week.

I've had tingling over my body in different place. I'm numb here, here, here and here (pointing). I can't seem to keep my balance on uneven surfaces and have been falling a bunch. My legs and arms feel so weak and my vision is getting worse, almost daily. I've been seeing double and it's very blurry."

"How old? I'm 48 doc. I'm very active; at least I was. I drive a tuck for work and love to hike and bike with my wife and kids."


"Lets get a MRI and see you back. I have an idea what this is all about, but I want to be sure."


"I'll want to run a few more tests but I'm sorry, it is what I thought. You have M.S., Multiple Sclerosis. I'm afraid you may not be driving anymore and while we have some treatments that will help control the episodes you have been having, this may get worse over time."


And that's how it is. One day young, active, hiking and biking...the next, struggling to get up from a chair or climb stairs.  And the presentation, signs and symptoms are as varied as the stories with many different nerve maladies affects:

Multiple sclerosis is an autoimmune disease that affects the brain and spinal cord (central nervous system). Symptoms vary, because the location and severity of each attack can be different. It usually happens in "episodes", period of time with symptoms and many patients can be kept in remission with various therapies, medications etc. Episodes can last for days, weeks, months....or forever.

For me, after my neurology rotation, it will always be the "just sorta snuck on me" disease.

Wednesday, September 21, 2011

Get rid of my headache doc, and I'll give you my daughter!

Migraine headaches suck! That would be an understatement to those really having them. Migraines create great dysfunction in life, work, relationships, mood, self esteem, eating habits, traveling habits and almost every other area of life.

So when a patient finds a cure, usually through a provider that's willing to walk the combinations of medications (both rescue and suppression), other therapies and time... patients are ecstatic. Now they don't normally give away daughters and other parts of their family, but they do make grand gestures.

"How are you headaches going Mr. Jones? We've had quite the challenge with these, haven't we?"

"Doc, they are GONE!! I love you!! That combination of [select from the buffet - Amerge, Axert, Frova, Imitrex, Maxalt, Sumavel, Treximet, Zomig, Botox, Migranal, Ergomar, Caffergot, Amitriptyline, Atenolol, Diltiazem, Doxepin, Verapamil...just to name a few] did the trick!"

"That's great Mr. Jones.I'm thrilled for you and that we could finally get you some relief. By the way, I love you watch. It's very nice. Ok, so I'll see you back in about 3 months to see how your doing."

"Sounds good doc. Here take the watch. It's just an old thing anyway. Enjoy it!" And with that, he handed the doc the watch, and walked out.


Thankful just doesn't cover the gesture.

Monday, September 12, 2011

Furiously Filling Fat Full Fast

I am so full of knowledge at this point, I'm afraid to learn anything new for fear that it will force something out that I might need later for exams, practice or human conversation. I don't think there is any room possible for any more. I'm almost completely full.


And just in time too. Nearly done with this phase of study and the next exam coming soon. It's anticipation and future relieve rolled into a tight package of anxiety. The ultimate performance anxiety.

I've met some interesting folks these past weeks of intensive study; all on the same mission. We all have our strategies for success and they couldn't be more different from each other. But the ultimate goal is the same. Fill up just enough to not push anything out the other side of our brains and promptly regurgitate what we know or think we know at the appropriate time, in the appropriate exam moment so we can onward to the next "Step".

I pray for no leakage of any vital information, including my name.