Category Archives: Ask The Doc

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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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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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.