Author Archives: Simi K. Rao

HealthWise: On Call #3 A Young Woman Who Took Too Much Fever Medicine.

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Based on true events:

A young woman in the late teens called 911 after she swallowed a whole bottle (100 pills) of a common fever and pain medicine called Tylenol (generic Acetaminophen). She was depressed and despondent because her family didn’t understand her. She also took another bottle (more than 3/4 full, unknown quantity) of Tylenol PM (acetaminophen + diphenhydramine) a common OTC (over the counter) drug sold as a non-habit forming pain reliever and nighttime sleepaid. She said she wanted to end it all, but then got scared and called for help.

She had ingested these pills about 6 hours ago and had begun to vomit before calling. She admitted to vomiting some pill fragments.

When I talked to her, she admitted she had made a mistake, and wanted to live not die.

Fortunately her vitals signs were normal, she was alert and completely with it but her blood work showed an elevated acetaminophen level and signs of liver injury. Her EKG (electrocardiogram) was normal.

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HealthWise: On Call #2 A Young Man Who Went Blue in the Face

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The following is based on true events:

RM is only 21. “Don’t be surprised doc. He’s tiny!” His nurse informed me before I stepped into the room. So he was. Tiny (barely over 5 ft, under a hundred lbs) and young. His innocent face belied the colorful life he’d led so far. RM had been admitted because he had popped a couple of fentanyl tablets he’d bought on the street (the same drug that was found in Prince’s and Tom Petty’s system). When I inquired why, he said he’d been taking the drug for the past 6 months or so; 2 to 3 a day “to get high that’s all” he informed me as if talking about the weather. “No, I don’t want to kill myself but I get depressed sometimes;” was his response when I asked if he’d had any intention to cause harm to himself. I tried to maintain a straight professional face but I was flabbergasted. I was shocked he was still alive. The lethal dose of fentanyl is very small– a quarter of a milligram, and this young man had consumed several times that. He was one hell of a lucky boy.

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Shaking the Family Tree: Alcoholic

ADAPT: sentinel against substance abuse

I have encountered alcoholism both in my personal and professional life. The damage done is incalculable and recovery is long and arduous. Who better to tell about it than someone who has made the journey herself?

Here I present a series of guest posts by Dallas Hembra titled Shaking the Family Tree on Alcoholism from a layman’s point of view.

Shaking the Family Tree is a book by Dallas Hembra; a double genre memoir/poetry offering that looks at the genetic predisposition for alcoholism from a layman’s point of view.

The victims include the alcoholic, adult children of alcoholics, and family members and loved ones who suffer the shared consequences.

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HealthWise: On Call #1 A Young Woman with Fatigue and Shortness of Breath

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On Call is a series where I present some interesting cases I saw in the course of my practice.

Case #1: A Young Woman with Fatigue and Shortness of breath

Mrs. S, is a very pleasant 35 yo young woman. She is married with two young children and is a school teacher by profession. She was referred to the hospital by her doctor for evaluation of new onset shortness of breath and concern of a serious heart condition.

When I interviewed her she told me the shortness of breath has been now ongoing for about a month and steadily getting worse. In the beginning she noticed she was unusually exhausted when she reached home from school and didn’t find the energy to prepare dinner and play with her kids (something she really loved to do). She also notes headaches, irritability of mood, difficulty concentrating which has been affecting her work as well as dizziness. She is also very concerned that she is losing hair. She denies that she is under much stress and says her family has just returned from a two week holiday. Unfortunately, she couldn’t enjoy herself very much because of how exhausted she felt.

Her symptoms have progressed to the extent that now she is out of breath when she walks up a short flight of stairs; she also notes a feeling of tightness across her chest. She also feels her heart racing and puffiness in her arms and legs. She is worried she has a serious heart condition especially since her father died of a heart attack in his 60s.

When I examined her I was struck by the pallor of her skin. I also noticed her tongue was swollen and her nails were thin and brittle and there was definite swelling around her ankles.

Her heart rate was regular but fast– 90-100 beats/minute, she had a normal blood pressure and oxygen level.

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HealthWise: Dementia- An Overview

The Self Portraits of William Utermohlen

The White Room

I lie on the bed

in the white room

They sit around me

These strangers with familiar voices

I think we are waiting for something

or someone.

These strangers, they look at me

They mutter words I don’t understand

A man in a white coat walks in

He stands next to my bed.

He speaks not to me,

but to these strangers

They are talking about me, I know.

About what, I don’t understand.

Irritated, I kick off the covers.

Mother! They chide me and pull them back.

About the poem: This is a poem about dementia, the hallmark of the disease being loss of memory. I write about a scene I came across during my rounds in the hospital—an elderly woman in the advanced stages of dementia is lying on the bed surrounded by her caring relatives. It’s difficult to know what’s going on in the poor woman’s mind because she has lost the ability to speak, even comprehend. Yet it’s apparent she’s unaware of her ailment. She doesn’t even know where she is or who she is with.

Dementia is a syndrome that results in gradual and progressive decline of previously acquired mental abilities that results in a loss of social and occupational functioning and ultimately to loss of independence. It is imperative to distinguish this from normal aging- normal aging never results in loss of independence.

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Weekend Getaway: The Grand Canyon

The Grand Canyon. Who hasn’t heard of it? Everyone has. But you need to go there for yourself to realize it’s awesomeness! Grand doesn’t come close to describing it. I’ve been there a few times–still I catch my breath each time I lay eyes on it. Over two billion years of earth layers were cut by the mighty Colorado river and it’s tributaries.

My last trip there a few years ago was my most memorable one. It was part of a school trip– with my daughter and some of her classmates. We stayed in the Grand Canyon village at the South rim for two days and even hiked down the South Kaibab trail— only part of the way (it’s extremely steep and strenous). We also saw a mule train, the once almost extinct California Condor which the largest flying bird in North America with a wingspan reaching 10 ft—brought back by a dedicated captive breeding program.

As I have mentioned before I am inspired by my travels and the places I visit. I try to bring them into my writings whenever I can. You will find some of my experiences of the Grand Canyon in my books– Inconvenient Relations and its sequel- Now and Forever. You can check them out here.

HealthWise: Food and Immunity

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Current COVID crisis has generated a lot of interest in immunity, especially natural and innate immunity. One way to improve it is by eating right.

Below is a very opportune guest post by Palak Nagpal, who is a nutritionist based out of Delhi, India.

IMMUNITY

Immunity isn’t built overnight nor does eating a superfood alone help you to build it.

I know there is a lot of information out there so I’ll keep this short and crisp. Keep checking off the things you are including in your nutrition plan every day and make space for those which you aren’t. Here’s a list of important foods particularly important for boosting our immunity:

Load up on Vitamin C

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Sources: Amla/gooseberry, lemon, orange, kiwi, guava, black pepper, bell pepper

2. Vitamin E is the most well-known antioxidant which fights infection and keeps our immune system strong. Nuts & seeds are rich in Vitamin E.

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HealthWise: COVID 19 and How it has Changed the World

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This is a guest post by Sonali Dhir on the current times and how it has changed us and our lives:–

I have lived and worked in New Jersey my whole life. Covid-19 changed our way of life drastically here since mid -March of this year. Pre-Covid-19, if we did not feel like cooking, we could head less than a few miles from home and find a fast food joint or restaurant open to grab a bite to eat. Our waiter or waitress would ask us what we wanted and we would simply order what we liked on the menu. It was not just the food but the experience that led us out of our homes. It was normal, it was a break from the usual routine of work, school, running errands and then returning home. However, post the eruption of Covid-19, the new normal is cooking at home, going out for essentials, working from home if possible and homeschooling children. There were closures of beloved small businesses we used to frequent when it was actually safe outside or to go somewhere when we felt the need to go. Now everything must be meticulous planned prior to going anywhere. Want a haircut or nails done? Make an appointment. Want to go shopping? Wait in line six feet apart until there is enough room for you to enter.

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HealthWise: COVID 19 Overview

Coronavirus Disease 2019 Rotator Graphic for af.mil.

Disclaimer: This is a general overview of COVID 19. A lot of the information is evolving therefore kindly refer to the CDC or your country’s public health agency.

I am a practising physician, an Internist and hospitalist working in the USA and this is my small attempt to raise awareness about this virus.

What is COVID 19 or SARs COV 2?

COVID 19 or SARs COV 2 is the virus (severe acute respiratory syndrome coronavirus 2) which is responsible for the pandemic across the world. It originated from Wuhan, China. We first learned about it when a cluster of cases with severe pneumonia was reported around New Year’s Eve 2019.

Some facts: As of today:–

World over 12.9 million cases and over 571 thousand deaths.

Equally important! Over 7 million recoveries!

US: over 3.3 million cases; 137,000 deaths and over 980,000 recoveries. Curve going up again.

India: over 878,000 cases. Over 23000 deaths 553,000 recovered- cases still rising

UK: 290, 000 cases. Over 44800 deaths.

China 85,522 cases. Reported Deaths: below 5K

Italy: 243,000 cases Deaths: 34,954 and 1.9 million recovered. Less than 300 cases are being reported everyday now. Lockdown worked!

Spain: 254,000 cases. Deaths 28,403. 150K recoveries.

South Korea: 13,479 cases. 289 deaths. 12,204 recoveries. Over 90% recovery rate!

Japan: 21,500 cases.. Below 700 deaths.

Hongkong: 1522 cases. 8 deaths. 1217 recovered!

One death is too many. Yet it is important to know that most people who get the infection recover.

Overall death rate is probably less than 1% (as many cases are asymptomatic and undiagnosed). It’s also important to keep in mind that this rate is considerably higher in the at risk population.

The mortality (death) rate in India is much lower than other countries – (why?- unaccounted deaths (doubt), underlying resistance/immunity which ‘protects’ against severe illness?)

Besides the above the cost of the infection has been much higher- people have lost their livelihoods, their jobs and businesses have been shut down- some permanently. It has also had a huge mental health cost– such as isolation, lack of contact with your loved ones and dying alone from the disease.

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The Fickle Mind

the mind is a strange thing it can be brilliant and irrational Often generating senseless chatter Don't take to heart Ignore it.

The mind is at the center of the body. It controls/ influences every organ. Yet, a lot of its workings remain a mystery. How it does or doesn’t control or manipulate our thoughts and emotions. How things long ‘forgotten’ manifest in our subconscious in our dreams and influence our health and behaviour. How we carry our trauma with us like a back breaking burden.

There are many ways to heal- nature, meditation, mindfulness, counseling, etc. But first we have to recognize and be aware that sometimes we are our greatest enemies.