My 17-Year Quest For The Correct Medical Diagnosis
How many times can you begin again? That's what I asked myself as I entered the Hospital for Special Surgery, just three weeks after my first lumbar spine epidural steroid injection and SI joint procedure. I was late. I spent two hours stuck in traffic during my drive from New Jersey to New York. So I was frazzled and my thoughts were scattered when I arrived. Yet, that question, can I start over again after another procedure rattled around in my head. My entire adulthood has been a long and winding road, at least medically. At 17, a sparse menstrual cycle, joint pain and spontaneous fever left doctors scratching their heads about what was wrong with me. I got progressively worse during my time at Boston College and it's been downhill ever since. Sure, I was tested for every common ailment. Since I'm African-American doctors focused on conditions associated with my race like sickle cell anemia, sarcoidosis, lupus and even multiple sclerosis but none of them proved to be the source of my deteriorating condition. So, doctors treated what went wrong with me on an individual basis. When I hemorrhaged and almost died, I was given something to help my blood clot and a D&C procedure was done. When I began coughing up blood, doctors pumped my stomach, removed the polyps from my esophagus. When my pancreas became inflamed, I got pain meds, drugs to reduce swelling and a digestive enzyme to help me process food. I did what I was told. I swallowed pills, took what I call a hospital t...
Atypical chest pain is of diverse origin. Typically, we initially consider cardiac etiology. When pain appears non-cardiac, there is a tendency to underestimate the illness, especially if the patient has neuropsychiatric illness. Our resident with dementia and anxiety disorder had chest pain; the diagnosis was unexpected.
We present a rare case of hemichorea associated with a hemorrhagic stroke in the contralateral striatum.
Chronic pain is common among older adults, as is the use of medications to treat these symptoms. Aging physiology, in combination with a higher likelihood of medication use and declining renal function, makes older adults more susceptible to adverse drug effects. As such, monitoring for side effects and changes in renal function is important to avoid drug toxicity, especially during acute illness when medication errors and acute changes in renal function are more likely to occur among older adults.
Many patients are discharged to post-acute care facilities (PACFs) following surgery. These patients have either had major surgery and require close monitoring and intensive rehabilitation, or have significant medical co-morbidities. Currently they are transported, sometimes at considerable cost, to the surgeon ’s office for post-surgery visits (PSVs). These trips can be painful and uncomfortable. A staff member from the PACF may need to accompany the patient. During PSVs surgeons observe the patient's incision(s), and assess potential complications following surgery, pain, and functional recovery.
The geriatric population is at high risk of severe low blood glucose (LBG) events due to diminished homeostatic mechanisms, especially on hypoglycemic medications. Moderate to severe LBG events in these patients can contribute to behavior changes such as agitation, change in level of consciousness, disruption of sleep, instability and increased risk of myocardial infarction, stroke and falls. Rapid recognition and appropriate treatment and prevention of LBG and recurrences can reduce risk for hospitalization in the geriatric population.
Chronic pain is among the most common reasons for seeking medical attention. In the United States, 1 in 5 adults had chronic pain in 2016 and it is estimated to cost over $500 billion annually in direct medical costs and disability. It is a prevalent problem among residents in the nursing home. Non-pharmacologic therapies are the most preferred treatment for chronic pain as pharmacological therapies, such as opioids, have proven to be less effective and associated with numerous side effects among older adults.
CONCLUSIONS: In the present systematic review and meta-analyses, varenicline was shown to reduce alcohol craving but not improve drinking-related outcomes in subjects with AUDs. PMID: 32097546 [PubMed - in process]
Conclusions Interprofessional SUD educational interventions improved health professions students’ knowledge, skills, and attitudes toward SUDs and interprofessional collaboration. Future SUD curriculum design should emphasize assessment and measure changes in students’ behaviors and patient or health care outcomes. Interprofessional SUD education can be instrumental in preparing the future workforce to manage this pressing and complex public health threat.
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