Open Mic Weekend


Haven’t had an Open Mic in a couple of months.

Leave questions, opinions, and any other medically-related comments below and I will try to get to them Monday night.

Remember, no personal attacks.


  1. So after watching the most recent episode of House I got to thinkin’:

    How come every condition/malady presented on the show already has a name? It takes them 45 minutes to have an epiphany that such and such symptoms are some random obscure condition. At what point would they believe “hmmm maybe we discovered something that no one else has seen before”? Someone had to discover Lupas and not misdiagnose it as something else that was already known at the time.

    Runner-up would be when they say “it could be X disease”. “But there’s no rash”. “Rash is only common in MOST case”. So who’s the trailblazer then that sees X disease + 1 symptom and says “well it’s still X disease + 1 symptom and not a new disease”.

    • Anything doctors see that hasn’t been seen elsewhere is “idiopathic xxxx”. When it gets seen often and is distinctive enough it becomes “xxxx syndrome”.

      There’s lots of stuff they see that doesn’t specifically match the literature of existing diseases. For those cases, all they can do is treat the symptoms and hope you get better or learn to live with the condition.

      Conditions which _have_ been seen elsewhere, they can use knowledge that has been acquired by someone else’s suffering, and hopefully use that to treat the underlying condition rather than the symptom.

    • Good question and unfortunately I don’t have an answer for you.
      Generally before one can label something as a “syndrome” there have to be enough similar cases to show that it isn’t a fluke.
      What that tipping point is … beyond my knowledge. If I was that smart, I’d have a sign or clinical finding named after me. And I don’t … yet.

  2. If a patient presents with complaints of not being able to “get the right words and memory issues and has been worked up…CT, MRI, Neuro exam, blood work, and nothing is found to connect that malady what would you do?
    My first thought is that medicines might be affecting the cognizance…what do others think?

    • The medical term is “aphasia.”
      Look up the side effects of the medications on the Daily Med site ( to see if there is a possibility that they may be causing the problem.
      If everything in the workup is normal, look into the diagnosis of primary progressive aphasia.
      Aphasia plus memory issues bring Alzheimer’s to mind.

      • When my dad stroked, he was able to communicate well, with an occasional aphasic moment…Like,”where did I put those damn things? Oh…here are my *glasses*!” Things being his glasses because we knew what he wanted but the articulating came after… And he could converse.
        My Gramma is a different story. But at 97, I don’t worry too much.

  3. Lately I’ve been seeing A LOT of youngish people (mid-thirties) have massive MI’s and strokes. WTF? Anyone else seeing this, or am I just having a string of bad luck? It always sucks when they are younger than you.

  4. I have a series of questions:

    1. How do you deal with gang related security in your ED?
    2. What is your very favorite procedure?
    3. Is ‘Beautiful Girl Syndrome’ real?
    4. Why did you pick EM?
    5. If you weren’t in EM, what specialty would you be in?
    6. If you weren’t a physician, what would you do for a living?

    • 1. Generally not a problem in my EDs. We have police stationed in the ED in the inner city hospital where I work and we don’t really have a gang issue in the rural hospital where I work part time. Even during my residency when there were multiple gang shootings some nights, the hospital was generally recognized as a neutral zone. Don’t know if that still holds true today.
      2. Don’t know that I get excited when I have to do any procedure. I like reducing joints – shoulders, hips, ankles. Also like doing nerve blocks.
      3. Absolutely. Otherwise my wife would have been off the market long before I met her.
      4. My first day of my first rotation in an emergency department was marginally controlled chaos. Two patients were in a fight and were yelling at each other across the hall. Gunshot wounds, helping code someone. Sewing up a wound when I never held a clamp before. Fishing a piece of metal out of someone’s eye. I still remember that day and remember the patients.
      5. I trained in internal medicine and emergency medicine, so I’d probably go back and open a clinic. I like the mental part of medicine – when I can figure out a diagnosis or a problem that other people haven’t. Like being able to figure out why things are happening rather than just giving medication to treat symptoms. When I used to practice medicine, one of my first steps with new patients was to remove them from most of their medications and to check them in the office on a weekly basis for a few weeks. Many (not all) patients felt better off their medications.
      6. I’d just work at my other job (which will remain a secret for the time being). I also enjoy teaching, but don’t know that I could do that every day. Or maybe I’d write books. Or photography.

      • Great questions!

        I’ve always wondered how people choose their careers …what was the moment in time they knew what they wanted to do? When they were children ..did they show a predisposition in their playing that indicated they’d make a good teacher, doctor, builder, etc.

        I remember hearing that Donald Trump was building a tall tower with blocks and didn’t have enough and so he asked to borrow his younger brothers and the brother agreed ..if he gave them back. So Donald built the tower, glued the blocks and the brother never got them back.

        And since reading med blogs …I have wondered why doctors choose certain specialties. That would make an interesting read for sure.

        So, It was interesting WC to learn that bit of info.

  5. Here’s one for you all…

    Have any of you seen cases of people severely impacted by over consumption of diet drinks?

    My brother landed in emergency last fall after not feeling well for several weeks. He had been developing weakness in his limbs, feeling increasingly fatigued, and finally felt like he was having a stroke. They were going to watch him in the ER, but then he collapsed and could not use his legs or one arm. The most notable tests at admission showed atrial fibrillation and hyperkalemia, he did not after all have a stroke. The neurologist thinks he might have thrown a clot that went through his spinal cord causing nerve damage, but they never actually found a clot after numerous imaging efforts.

    Given that my brother has Type II diabetes, the docs blamed the potassium problem on diminishing kidney function. They detoxed him of excess potassium, but he continued to have problems with severe hypotension when he would sit up. He spent 2 1/2 weeks in intensive care.

    What the docs did not, and do not know is that my brother was consuming a minimum of six 12-ounce cans of diet soda sweetened with “Ace-K”, acesulfame potassium. He also was consuming large quantities of diet iced tea, also sweeted with Ace-K.

    After getting into rehab, and being on a low-potassium diet, suddenly he went into hypokalemia and they had to start supplementing him.

    So, anyone heard of such a thing?

    • Weakness, hyperkalemia, hypotension – the first thing that I thought of was adrenal insufficiency. Doesn’t fit a lot of the other things in your description, though.
      I had never heard of Ace-K until you mentioned it here. In general, with healthy kidneys, people are able to filter excess potassium out of their bloodstream. I can’t imagine that the amount of potassium in this product would be enough to cause a substantial increase in serum potassium levels.
      In the absence of kidney disease, remember that potassium homeostasis is largely controlled by the renin-angiotensin-aldosterone system. With the swings in potassium levels that you are describing, I’d begin looking toward some disease or ingestion that affects aldosterone secretion.

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