Does this T wave pattern mean anything?
Written by Michael Doyle DO and Timothy Palmieri MD. Edited by Bracey, Meyers, Grauer, and SmithA 50-something-year-old female with a history of an unknown
personality disorder and alcohol use disorder arrived via EMS following cardiac arrest with return
of spontaneous circulation. The described rhythm was an irregular, wide complex
rhythm. By EMS report, open pill bottles were found nearby at the scene, including quetiapine, fluoxetine, hydroxyzine, and gabapentin. She was successfully revived
after several rounds of ACLS including defibrillation and amiodarone.On arrival to the ED the patient was intubated with normal vi...
Source: Dr. Smith's ECG Blog - October 23, 2023 Category: Cardiology Authors: Bracey Source Type: blogs
The complex world of identifying nociplastic pains
Towards the end of 2017, IASP put forward a new mechanistic classification: nociplastic pain. The definition is: “Pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain.
Note: Patients can have a combination of nociceptive and nociplastic pain”.
This was great news! Prior to this, the term “central sensitisation” was used and abused to describe processes involved in ongoing pain that wasn’t inflammatory or neuro...
Source: HealthSkills Weblog - May 15, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Chronic pain Clinical reasoning Coping strategies Interdisciplinary teams Pain conditions Professional topics Research Science in practice biopsychosocial nociplastic Source Type: blogs
We Shouldn ’t Tolerate Sloppy Allergy Lists
By HANS DUVEFELT
The medication and allergy lists seem like they would be the most important parts of a health record to keep current and accurate. But we all see errors too often.
I think it shouldn’t be possible to enter an allergy without describing the reaction. Because without that information the list becomes completely useless.
The other day I saw a patient who needed an urgent CT angiogram. The allergy list said “All Contrast Materials”, which isn’t even “structured data entry”, and thus not recognized by the computer if my EMR (Me again, Greenway!) would have been clever enough to check for al...
Source: The Health Care Blog - October 4, 2021 Category: Consumer Health News Authors: Christina Liu Tags: Medical Practice Primary Care Hans Duvefelt Source Type: blogs
Not all pain is the same
When I started working in the field of persistent pain, many of the approaches used were based on the idea that every pain was the same. Oh yes, of course we had neuropathic pain and inflammatory pain, but our treatments tended to approach each person as if they were pretty similar. We later refined that approach and started to look at people in groups. In the service I worked in, we used the Westhaven-Yale Multidimensional Pain Inventory which generates three main psychologically-based profiles – and for a long time this was a very useful way of establishing who needed the three-week residential programme, and who w...
Source: HealthSkills Weblog - May 23, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Chronic pain Clinical reasoning Pain conditions Professional topics Research Science in practice Source Type: blogs
The Pain Is In Your Brain: Your Knees Know Next to Nothing
By HANS DUVEFELT
A “frozen shoulder” can be manipulated to move freely again under general anesthesia. The medications we use to put patients to sleep for such procedures work on the brain and don’t concentrate in the shoulder joints at all.
An ingrown toenail can be removed or an arthritic knee can be replaced by injecting a local anesthetic – at the base of the toe or into the spine – interrupting the connection between the body and the brain.
An arthritic knuckle can stop hurting and move more freely after a steroid injection that dramatically reduces inflammation, giving lasting relief long after any...
Source: The Health Care Blog - April 14, 2021 Category: Consumer Health News Authors: Christina Liu Tags: Medical Practice Patients Physicians Primary Care Hans Duvefelt Pain Management Source Type: blogs
Treating neuropathy: Which medication is best?
Imagine experiencing burning, tingling, and numbness in your legs day in and day out, getting worse over time — and your doctors can’t find a reason for it.
That’s the situation for millions of people who suffer from idiopathic sensory polyneuropathy. The term “idiopathic” means that no cause can be identified; “sensory” refers to the type of nerve, in this case those carrying nerve signals such as pain or temperature; “poly” means “many” and “neuropathy” means nerve disease. So, this is a condition of unknown cause that damages multiple nerves; the most affected nerves tend to be those th...
Source: Harvard Health Blog - December 1, 2020 Category: Consumer Health News Authors: Robert H. Shmerling, MD Tags: Drugs and Supplements Health Neurological conditions Pain Management Source Type: blogs
If cannabis becomes a problem: How to manage withdrawal
This study is a meta-analysis — a study which includes many studies that are deemed similar enough to lump together, in order to increase the numerical power of the study and, ideally, the strength of the conclusions. The authors included studies that go all the way back to the mid-1990s — a time when cannabis was illegal in the US, different in potency, and when there was no choice or control over strains or cannabinoid compositions, as there is now. One of the studies in the meta-analysis included “cannabis dependent inpatients” in a German psychiatric hospital in which 118 patients were being detoxified from can...
Source: Harvard Health Blog - May 26, 2020 Category: Consumer Health News Authors: Peter Grinspoon, MD Tags: Addiction Marijuana Mental Health Source Type: blogs
Cannabis questions … so many questions!
Recently I wrote a summary of my readings around cannabis for pain. It’s a hot topic in New Zealand because we’re holding a referendum on cannabis law reform next year, and as expected, all the lobby groups are out in force! My interest is sparked because so many of the people I work with as patients also use cannabis – and the evidence from RCTs is pretty poor. And YET as a recent study colleagues and I carried out with people who have spinal cord injury and neuropathic pain, cannabis is something that holds appeal, and interestingly, seems to provide some useful effects.
The study we conducted (see i...
Source: HealthSkills Weblog - October 28, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Coping strategies Pain Pain conditions Research cannabis medicinal cannabis qualitative Source Type: blogs
Off-label use of gabapentin and pregabalin for anxiety
An excerpt from Understanding Medicines for Anxiety. In addition to medicines with FDA indications for anxiety, such as benzodiazepines and some antidepressants, a number of drugs are frequently prescribed off-label. Among these are gabapentin and the related compound pregabalin, collectively known as gabapentino ids. Their popularity is remarkable: gabapentin has been the tenth most commonly prescribed medicine […]Find jobs at Careers by KevinMD.com. Search thousands of physician, PA, NP, and CRNA jobs now. Learn more. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - July 31, 2019 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/wallace-b-mendelson" rel="tag" > Wallace B. Mendelson, MD < /a > < /span > Tags: Meds Psychiatry Source Type: blogs
Millions Take Gabapentin for Pain. But There ’s Scant Evidence It Works. - The New York Times
One of the most widely prescribed prescription drugs, gabapentin, is being taken by millions of patients despite little or no evidence that it can relieve their pain.In 2006, I wrote about gabapentin after discovering accidentally that it could counter hot flashes.The drug was initially approved 25 years ago to treat seizure disorders, but it is now commonly prescribed off-label to treat all kinds of pain, acute and chronic, in addition to hot flashes, chronic cough and a host of other medical problems.The F.D.A. approves a drug for specific uses and doses if the company demonstrates it is safe and effective for its intend...
Source: Psychology of Pain - May 22, 2019 Category: Anesthesiology Source Type: blogs
The Folly of Self Referral
By HANS DUVEFELT, MD
A lot of Americans think they should be able to make an appointment with a specialist on their own, and view the referral from a primary care provider as an unnecessary roadblock.
This “system” often doesn’t work, because of the way medical specialties are divided up.
If belly pain is due to gallbladder problems you need a general surgeon. If it’s due to pancreas cancer, you need an oncologic surgeon. If the cause is Crohn’s disease, any gastroenterologist will do, but with Sphincter of Oddi problems, you’ll need a gastroenterologist who does ERCPs, and not all of them do. Now, of ...
Source: The Health Care Blog - May 17, 2019 Category: Consumer Health News Authors: Christina Liu Tags: Medical Practice Physicians Hans Duvefelt primary care Source Type: blogs
Goodbye to Compounded Analgesic Creams
This study is one of the largest and best-designed study I ' m aware of of these creams, and the findings are pretty clear: such creams benefit patients via placebo mechanisms, aka they don ' t work.Note that there is a separate body of research on some other topicals which should not be confused with this study. Eg, the 5% lidocaine patch for post-herpetic neuralgia, topical capsaicin for a variety of neuropathies, and at least some topical NSAIDs for osteoarthritis, and topical opioids. I ' m not broadly endorsing those either - it ' s complicated - however they weren ' t tested here and the take home point is we should ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 11, 2019 Category: Palliative Care Source Type: blogs
Timer heals all things
When Nat was five he started his life at the May School in Arlington. The May is a behavioral school, dedicated to positive reinforcement such as earning tokens towards desirables, taking small incremental steps towards goals, and scrupulous attention to “behaviors.” The May people jumped right in to getting Nat’s attention, which is one of the first lessons taught in behavioral schools. I was very heartened to see Nat learning how to pay attention to people.
Nat’s first May teacher was joyful and kind. She focused her bright eyes on Nat and got him to listen to her sometimes. At the May Nat learned...
Source: Susan's Blog - December 24, 2018 Category: Child Development Authors: Susan Senator Tags: Uncategorized Source Type: blogs
Alcohol use disorder: When is drinking a problem?
Over the past few months, a conversation about alcohol use has been center stage in the national news. Stories about underage drinking, blacking out, and harmful behavior associated with alcohol use are quite common in many families around the world. The rise of the opioid epidemic in the US has rightly caught our attention, but overshadowed a much more common problem. In the United States, from 2006 to 2010 alcohol-associated deaths accounted for 88,000 deaths annually, or almost 10% of all US deaths.
While many people are becoming aware that medication assisted therapy can help treat opioid use disorder, very few know th...
Source: Harvard Health Blog - December 20, 2018 Category: Consumer Health News Authors: Marcelo Campos, MD Tags: Health Source Type: blogs
Live the Wheat Belly lifestyle, get off prescription medications
Take a look at the list of medications people have been able to stop by following the Wheat Belly lifestyle.
These represent medications prescribed by doctors to, in effect, “treat” the consequences of consuming wheat and grains. They prescribe drugs to treat inflammation, swelling, skin rashes, gastrointestinal irritation, high blood sugars, airway allergy, joint pain, high blood pressure, leg edema and other abnormal effects caused by wheat and grains.
The list includes anti-inflammatory and pain medication, acid reflux drugs, injectable and oral drugs for diabetes, numerous anti-hypertensive agents, asthma i...
Source: Wheat Belly Blog - October 27, 2018 Category: Cardiology Authors: Dr. Davis Tags: News & Updates autoimmune blood sugar bowel flora cholesterol Gliadin gluten-free grain-free grains Inflammation undoctored Weight Loss wheat belly Source Type: blogs
