Recent content by topwise

This is a case I'm struggling with. Any thoughts would be greatly appreciated: Patient is a 60ish right-handed homeless male with a history of heavy labor on his hands. He also has a distant history of cervical fractures. He was hospitalized for septic meningitis about a month ago...

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How about INR prior to joint injections? What guidelines do you use?

I had a patient who responded to Ambien, and I agree it was a marked but not "incredible" response. It was enough for a dependent patient to improve enough to go home, but he was hardly reciting Shakespeare or anything. It doesn't work often, but it's worth trying in certain patients.

I don't know how many attendings are truly malicious, but I do think there are attendings who do yell and lose their temper a lot. And they do not act that way around colleagues or their bosses, only to underlings who have no recourse and just have to take it.

Yeah, I can't even imagine trying to confront an attending. Maybe a temperamental resident, but definitely not an attending. (FYI: This is not a surgical attending, although I can see why you might assume that.)

My cousin is a med student and asked me for advice with this: He has an attending who yells at him all the time for no good reason... just very temperamental. I told him to ignore it, but this is a specialty he's interested in and he's freaking out a lot. Any other advice I can pass on?

The answer is that they don't "match up" in any way that is intuitive without knowing the brachial plexus. Some peripheral nerves, such as the ulnar nerve (C8-T1) or the musculocutaneous nerve (C5-C6), have most of their innervation from two nerve roots, but the other peripheral nerves have...

I can't imagine anything would be that urgent, considering it's been going on for over a year.

Yeah, I think he definitely had adhesive capsulitis. And yes, he was shunted. I was just confused by the findings being bilateral. Also, I thought it was odd that the median CMAP was low but the ulnar CMAP was normal. I was thinking about a possible TOS but that should have low ulnar SNAP...

No c-spine MRI. Some b/b symptoms but this is confounded by the hydrocephalus.

Patient is a 50 year old man with a long term history of DM, as well as a history of hydrocephalus for the past year. He's had recent worsening b/l hand weakness and shoulder pain as well as decreased ROM, despite injections and PT. He also gets intermittent swelling in his hands, but denies...

What about NSAIDs? If it is seen on X-ray but just barely, is it still too late?

For those of you who do inpatient rehab, I'm just wondering what you do in the treatment or ppx of heterotopic ossification? I've been looking at some recent reviews that seem to support prophylaxis with NSAIDs and etidronate, but that once the HO is forming, there isn't as much you can do.

Rounds in something like medicine in an academic center are only one style of rounding. I dislike that style as well. When I was an intern at a county hospital, often each of the interns would round individually with the attending on our patients, and there was none of that scary pimping. As...