From the monthly archives:

January 2009

When you work in the medical field, you tend to explain everything you can in medical terms. As they say, when you’re a hammer, everything looks like a nail. Such is the case with Rod Blagojevich, a strong contender for knucklehead of the year.

I have been pondering why a man in such a prominent and visible position, such as Governor of Illinois, would act like he has. He has been accused by authorities of attempting to sell a vacant senate seat, and the DA says there are audio tapes that prove this. The governor has denied any wrongdoing. The President-elect has said Blagojevich should step down, but instead he has appointed a replacement to the Senate, all while Illinois considers impeachment. This does not sound like normal behavior.

What we need here is a diagnosis, so let’s consider Narcissistic personality disorder.

To meet criteria for this diagnosis, a person has to have 5 of the following criteria:

1) has a grandiose sense of self-importance

2) is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

3) believes that he or she is “special” and unique

4) requires excessive admiration

5) has a sense of entitlement

6) is interpersonally exploitative

7) lacks empathy

8 ) is often envious of others or believes others are envious of him or her

9) shows arrogant, haughty behaviors or attitudes

Hmm. Sounds like we have a winner. The good news for Blagojevich is that now he has a diagnosis to blame everything on. He’s a victim too! Well, at least it’s better than the Twinkie defense.

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John Travolta’s 16 year old son died recently, and provided us all with a tragic reminder of how serious seizure disorders can be. Risk of death in those who suffer from generalized “grand mal” seizures is higher than the general population for a couple different reasons.

First, risk of trauma during a seizure is substantial. Head injuries are particularly common. I usually tell patients who have had seizures to avoid potentially dangerous activities, but just standing up can be dangerous if a seizure strikes suddenly.

Drowning is a well known risk of seizures, and can happen even in a bathtub with very little water in it. Showers are usually safer than baths, but falling in a shower is not exactly benign either.

Seizures that continue for a long time can cause permanent damage, so if seizure patients are left alone and have an attack, this can be disastrous as well.

Overall, many seizure patients are well controlled with medications and can have a normal life expectancy, but as this case emphasizes, there are significant risks.

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Q:

How do you feel about the use of cough syrups?

 

Mark – Portland, OR

 

A:

 

I’ll admit I’m not a big fan of cough suppressants. I frequently am asked for a prescription for medication to “just stop me from coughing.” But it’s important to remember that there is a reason for the cough. The body is trying to get rid of debris in the lungs, and infectious material. It isn’t necessarily a good idea to simply stop the cough from happening.

Cough suppressants like codeine act on brain to decrease the cough reflex. Better than simply stopping the brain from wanting to cough are treatments that allow the lungs to clear infection, and to heal. This includes steam therapy, expectorants to clear mucous, and staying hydrated. Cough drops can help an irritated throat feel better and decrease cough. Sleeping with the head elevated can also be useful. Some patients benefit from inhaled medications to relax the airways and allow improved airflow. Antibiotics are sometimes indicated, as well as steroids such as prednisone.

Most of the time, to determine the best solution to a cough, a visit to the doctor is needed to take a history and listen to your lungs. For patients that have a dry, hacking cough that is keeping them awake, cough suppressants may be an option, but it shouldn’t be an automatic.

 

 

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Q:

Dear ER Doc,

I have been hearing about the low carb diet lately and am thinking about trying it out.  Is this just another fad diet or is there some science behind it?  I need to lose about 50 pounds.

 

Lisa, Fresno CA

 

A:

Lisa, there certainly are a lot of fad diets out there that don’t have any scientific basis, but low carbohydrate diets are not among them.  Recently, a study was published in the New England Journal of Medicine which compared 3 diets against each other–a traditional low fat diet, a Mediterranean diet, and a low carbohydrate diet.  The low carbohydrate diet was based on the “Atkins diet” which has been in use for many years.  In this study, the low carbohydrate diet compared very favorably to the other diets, both in total weight loss and improvement in cholesterol profiles, despite the fact that calories were not restricted in this group.  There were some limitations to the study, and further research will be required (as usual), but overall, this is helpful information.  If you are interested in pursuing this option, I urge you to speak to your physician and get more information regarding both diet, and exercise.  I applaud your desire to make healthy changes, which include weight loss, and I’m sure it will lessen your chance of visiting me in the ER!

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