Curbside Consult Thread

[TexTechCoug]

I opened this thinking I'd be treated to another interesting story, but saw that this happened to your mom. I hope she's okay and that she gets well.

My mom should be fine. I'll have to think of some interesting cases to post, my challenge is that as an anesthesiologist many of things I consider interesting have very specific anesthesia related elements that may not apply/or be too intriguing to everybody else.

[hostile]

My mom was anticoagulated on Coumadin and had a fall while hiking. Today she had a fasciotomy for anterior compartment syndrome in one of her legs.

Bummer.

Most of the time, for single compartment fasciotomy, I'm able to get the skin closed a few days down the road without requiring a skin graft. The defect in the fascia will be permanent and may result in a bulge on the affected leg, causing it to appear larger than the other side. This is rarely painful if the fascia has been adequately released. There is a slight chance of her experiencing weakness in the anterior compartment muscles due the loss of force by having the fascia released.

[TexTechCoug]

Most of the time, for single compartment fasciotomy, I'm able to get the skin closed a few days down the road without requiring a skin graft. The defect in the fascia will be permanent and may result in a bulge on the affected leg, causing it to appear larger than the other side. This is rarely painful if the fascia has been adequately released. There is a slight chance of her experiencing weakness in the anterior compartment muscles due the loss of force by having the fascia released.

Closed up yesterday. Drain out today and headed home. Seems to have gone well.

Next up is another ablation (#3) to try and take care of that pesky atrial fibrillation, which is really the source of all her health issues, including the compartment syndrome.

[OceanBlue]

Question, where my left shoulder meets my neck is hurting. Its always tight but it hurts tonight where I have taken two Naperson and I dont take stuff normally. I was lifting a fair amount last week so thats most likely the cause.
Any thoughts on how to get this part of the body to heal ?
Massage ? Thanks in advance.

[wuapinmon]

I thought the physicians might think this case was pretty cool, though it doesn't have a happy ending.

http://shellsonmybeach.blogspot.com/2010/07/right-where-i-belong.html

[ERCougar]

Physician burnout study:

http://www.reuters.com/article/2012/08/20/us-doctors-burnout-idUSBRE87J0RJ20120820

I knew we'd be one of the highest, but family medicine surprised me.
Lowest rates: dermatology and preventive medicine (whatever that means).

[mtnbiker]

I thought the physicians might think this case was pretty cool, though it doesn't have a happy ending.

http://shellsonmybeach.blogspot.com/...-i-belong.html

That's really crazy to have all the organs and major blood vessels reversed. I understand an ex-brother in law had a baby with that condition about a year or so ago. The docs really scrambled and did some major surgeries to correct the condition. I haven't heard anything for a while, but I think the baby's doing ok.

[San Juan Sun]

I thought the physicians might think this case was pretty cool, though it doesn't have a happy ending.

http://shellsonmybeach.blogspot.com/...-i-belong.html

I've seen similar cases.

Once as the ICU intern, where a patient had several days of normal chest x-rays, and then a CT scan with the organs reversed (the x-ray techs were flipping the x-rays around to the "right" side thinking they were processed incorrectly).

Once where a patient had an appendicitis on the left side, the exact opposite mirror image of where the appendix should be. The mirror image laparoscopic appendectomy was successful.

[smokymountainrain]

I've seen similar cases.

Doesn't Randy Foye have Situs Inversus? I'm pretty sure he does.

[smokymountainrain]

That's really crazy to have all the organs and major blood vessels reversed. I understand an ex-brother in law had a baby with that condition about a year or so ago. The docs really scrambled and did some major surgeries to correct the condition. I haven't heard anything for a while, but I think the baby's doing ok.

Crazy that one could be an elite athlete with that condition.

[TexTechCoug]

Had one true total situs inversus. He had Kartgeners, which may have been part of the explanation.

[San Juan Sun]

Every time I see someone on a new motorcycle, I smile and think to myself "There's a future patient."

[chrisrenrut]

Every time I see someone on a new motorcycle, I smile and think to myself "There's a future patient."

Every time I see a med student, I think to myself "There is a future malpractice suit".

[San Juan Sun]

Every time I see a med student, I think to myself "There is a future malpractice suit".

Not every student. A few will flunk out.

As terrible as it may be, having a suit filed against you is far better than joining the traumatic brain injury biker gang in our ICU.

[doctorcoug]

I never expected this, but the thing that keeps me up at night since becoming a real doctor (^_-) is trying to decide how to manage patients that have recommendations from specialists that I disagree with. I feel an absolute obligation to do what is right for the patient, but I totally worry about pissing off the specialist. So I end up doing this huge song and dance that takes me twice as long and I still worry. The patient walks out believing their specialist is amazing, so that is good. But the specialists probably don't appreciate it.

I didn't realize how controlling I am of my patients. Also, I am now recognizing the huge benefits, education-wise, of working at a teaching hospital. I miss residency.

So, my PCP colleagues, how do you deal with disagreements in management? More importantly, how do you keep a good relationship when you disagree? This is tough.

via a galaxy s3 far far away