Dr. Cranquis' Mumbled Gripes
(Disclaimer: Questions related to medical topics will be answered to the best of Dr. Cranquis' (and Google's) knowledge, but the internet-delivered wisdom on this blog CAN NOT AND SHOULD NOT SUBSTITUTE for your Real-Life Doctor's personal attention + examination, and your own common sense too! If you think you're having a medical emergency, hang up and go email 911. The author of this blog takes no responsibility for any medical, relationship, scholastic, financial, or other decisions you may make based on information found in this blog.)
And since people seem to be a bit confused about this: any "real-sounding" patients names are just horrible puns, and not HIPAA violations.
Got a great question from Not That Kind of Chronic (whose sense of humor in blog naming I quite enjoy)
Your recent post mentioned not to wear nail polish to a rheumatologist. I always have a manicure. Can you tell me what my nails might show?
The first time you see one, yes. It’s not absolutely necessary to remove your polish, but the condition of your nails can tell your rheumatologist about the state of your health, and many doctors will examine both your fingernails and toenails… It’s particularly important if you are seeking a diagnosis from a rheumatologist, gastroenterologist, or other specialist for a systemic disease!
Here’s why:
- Nail Pitting — can be indicative of psoriasis (important for patients with Psoriatic Arthritis), Reactive Arthritis, and other connective tissue diseases
- Spoon Nails (Koilonychia)— can be indicative of Systemic Lupus, Raynaud’s, and anemia
- Yellow Nail Syndrome — occurs in Rheumatoid Arthritis patients or often the result of infection or medications, both of which are relevant to Autoimmune Arthritis patients.
- Splinter Hemorrhages— small blood clots under the nail can indicate Systemic Lupus, Rheumatoid Arthritis, Antiphospholipid Syndrome, Psoriasis, Vasculitis, and Scleroderma (all rheumatology-related).
- Nail Clubbing— can occur with Irritable Bowel Disease (e.g., Crohn’s, Ulcerative Colitis), liver disease, and pulmonary diseases.
- Both Discoid and Systemic Lupus can cause nail changes such as cracking, curling, and even complete loss of nails.
- Rheumatoid Vasculitis or Nail Fold Vasculitis— can cause pitting, sores, redness, and infarcts of the nail-bed (not a pretty picture).
- Nail health can also reveal possible vitamin deficiencies and malnutrition, both important when treating rheumatological diseases.
A terrific summary of nail-related findings of chronic disease, by the ever-excellent “dealing with chronic diseases” blogger Chronic Curve!
Overheard, a patient talking (rather loudly) with a general surgeon in an exam room near my urgent care.
I shudder to think what the cure might be…
- 20-something female patient with "stomach pain": I need to be tested for the HPY virus because my boyfriend gave it to me.
- Cranquis: Do you mean HPV, which causes genital warts?
- Patient: No, I'm pretty sure it's called HPY. My boyfriend was diagnosed with it a few weeks ago, and I got it this morning.
- Cranquis *confused*: I... hmm. Ok, what symptoms was your boyfriend having?
- Patient: His stomach hurt. And now this morning I woke up with diarrhea and vomiting, and my stomach hurt afterwards, and that's when I ~knew~ he gave me HPY.
- Cranquis: Wait wait wait. By any chance, was your boyfriend diagnosed with H. Pylori bacteria in his stomach, which causes ulcers?
- Patient: Yeah, ~THAT'S~ it!
- Cranquis: *speechless -- which misunderstanding do I tackle first?*
- Cranquis: ...and the GI doc said that although the Vitamin C tablet had only been stuck in the patient's esophagus for a couple hours, it had already created an ulcer.
- Nurse *serious tone*: Oh wow! I'm never taking a Vitamin C again!
- Cranquis *dripping sarcasm*: Absolutely. And I never drink water, because I've heard you can drown in that stuff.
Harvard Magazine article
…But other placebo treatments (sham acupuncture, pills, or other fake interventions) are nowhere near ready for clinical application—and Kaptchuk is not recommending that they should be. Such treatments all require deception on the part of doctors, an aspect of placebo medicine that raises serious ethical questions for practitioners.
This was disturbing for Kaptchuk, too; deception played no role in his own success as a healer. But years of considering the question led him to his next clinical experiment: What if he simply told people they were taking placebos? The question ultimately inspired a pilot study, published by the peer-reviewed science and medicine journal PLOS ONE in 2010, that yielded his most famous findings to date. His team again compared two groups of IBS sufferers. One group received no treatment. The other patients were told they’d be taking fake, inert drugs (delivered in bottles labeled “placebo pills”) and told also that placebos often have healing effects.
The study’s results shocked the investigators themselves: even patients who knew they were taking placebos described real improvement, reporting twice as much symptom relief as the no-treatment group. That’s a difference so significant, says Kaptchuk, it’s comparable to the improvement seen in trials for the best real IBS drugs…
The entire article (though rather long) is terrific, and you should go read it — but I highlighted the portion that really struck me. The human brain is AMAZING.
- While working through a case study.
- T: ...So the DRE was positive for blood, so what would be the next investigation you would like to do?
- H: Release the black mamba.
- P: Did you just refer to a colonoscopy as the black mamba?
- T: That is seriously disturbing.
- P: And it has a wicked bite.
- H: Well we take bites of tissue for biopsy purposes on colonoscopy so it is close.
- P: No. No, they are not even remotely close to being the same.
- T: Oh man, I cannot get that image out of my head! Ah!
Is it sad that I look at this and think: cirrhosis, ascites, MI, HTN? Argh damn you medicine for taking the fun out of photos like these!
Talk about a BEER belly xD
Awww yeah, I’d tap that.
No, seriously. That guy needs an abdominal pericentesis.
- Cranquis: ...and foods that can make your acid reflux worse include citrus, spices, tomatoes, peppermint, tea, coffee, and chocolate.
- 12-year old patient: Oh no, chocolate! But it's Halloween!
- Cranquis: Yep.
- Patient: So you mean I can't...?
- Cranquis: Nope.
- Patient: Awwww, this sucks.
- Cranquis: Trust me, I don't like being the Grinch who stole Halloween.
- Cranquis: ... so I spoke with the GI doc, and he'd like to see you tomorrow to check into your stomach problems.
- Patient: Ok, cool.
- Patient's friend: What GI doctor is she going to see?
- Cranquis: Dr. X.
- Friend: Oh man, you got Doctor X! He's great. My GI doc is Doctor Y, and he's just poopy.
- Cranquis: Well, technically, all GI docs... never mind.
- Patient and Friend: Huh?
- Cranquis: Never mind.
- Cranquis: So, Benny, when did your stomach start hurting this time?
- 6-year-old Benny (who I've seen many times for chronic stomach pains and constipation): After I ate the beef jerky and drank my milk today.
- Cranquis: Uh-oh! Beef jerky and milk! That's not very good for your tummy, buddy.
- Benny: Yeah.
- Cranquis: Ok, come up on the table so I can examine you.
- Benny: I don't want to.
- Mother: C'MON BENNY, GET UP ON THE TABLE AND I'LL TAKE YOU TO MCDONALD'S AFTERWARDS!
- Cranquis: Uhh...
Uh-oh. You wake up at 4am with stomach cramps, nausea, and feeling flushed. A few minutes later, you’re kneeling before the Porcelain Altar, retching up your guts. Then just as you’re hoping the worst is over, you feel your bowels clench, and you start The Dance of the Toilet Bowl and Trash Can as everything in your intestinal tract makes for the nearest exit, like some kind of demon-possessed Pushmi-pullyu.
Now, real quick: when you sign in at the Urgent Care, what do you call your symptoms?
Did you say “Stomach Flu”? Well, sorry to inform you, Mr. Ralph Thunderpants, but you’re wrong. It’s not the flu at all.
- Cranquis: So has your stomach hurt at all lately, Melena?
- 8-year-old patient Melena (with recent "blood in stool"): Only one time.
- Cranquis: When was that?
- Melena: When I had death hunger! I was ~STARVING!~
- Cranquis: How can I help you today, sir?
- 40-something male patient *sitting on exam table, swinging feet anxiously the whole time*: WELL I'VE BEEN CANNING MY OWN VEGETABLES LATELY AND I KNOW THAT YOU CAN GET BOTULISM IF THE JAR DOESN'T SEAL PROPERLY, AND I WENT TO EAT A JAR OF TOMATOES YESTERDAY AND THE JAR HADN'T SEALED, SO I JUST DIPPED MY PINKY FINGER IN TO TASTE IT, AND IT TASTED OK BUT I DIDN'T EAT IT, BUT LATER I STARTED HAVING GAS AND FEELING CRAMPY, THEN TODAY I FEEL FINE, BUT I NEED YOU TO CHECK ME FOR BOTULISM.
- Cranquis *hasn't written down a single word while listening to this speech*: So... you feel fine now.
- Patient: YES.
- Cranquis: Congratulations, you don't have botulism. Will you be needing a note for missing work today?
- Patient: ...YES.
Dear Constipated Lady:
Yes, being unable to poop is a lousy situation. But I think I would have a bit more sympathy for your situation if the following facts weren’t true about your case:
- Your GI doctor keeps telling you to stop eating dairy, but you persist because “cheese is so yummy.”
- Your GI doctor has told you to self-administer Fleet enemas a couple times per week, but you refuse (because “I don’t like the idea of sticking it inside me.”)
- Your abdominal xray reveals a strange oval-shaped foreign body over the pelvic region — and on further questioning, you admit that your husband inserted a perfume bottle into your vagina during your sexy-times last night. A perfume bottle. Which you left in place for your visit to the doctor’s office. A entire perfume bottle. Not just the bottle cap, but the entire bottle.
Let’s do a little size comparison, shall we?
.
