Alert to Artists: Painting is Hazardous to Your Health

A retired man came in for severe, persistent lower back pain. He had finished painting his basement and his wife asked him to paint the second floor.
Unfortunately, he fell off the ladder. He had slipped and fallen on his back. He got acupuncture treatment for one month including x-rays which showed L2 compression fracture. He has more pain when sitting down (which compresses the vertebrae compared to when he stands)

Thus, the patient had severe pain any time he was sitting down. Other specialists tried to give him steroid shots which were not successful.

After the failed shots, Doc referred the patient to a spine surgeon. The patient underwent vertebroplasty which is an procedure for stabilizing compression fractures in the spine. Bone cement is injected and the cement hardens, stabilizing and supporting the spine.

This kind of surgery will usually relieve the pain compared to all of these conservative treatments.

It was initially said to see that the couple could not fulfill their lifelong dream of traveling around the world together.  Fortunately, when I saw them the second time around when they came back to the office, the patient was almost pain free. And their trip around the world was just delayed by just a year.

I might think about being an orthopedic surgeon because the surgery literally changed the retiree's life around.

Babysitting

Middle aged woman came in today complaining of hand pain for sixteen years. The pain was on and off and began after the birth of her first child.

Every time she uses her hands, she gets numbness in her 2nd, 3rd, and 4th fingers of her hand. She denies any strength problems. In her daily life, she lifts alot. She baby sits 6 months to 15 month old babies.

Upon physical examination, she had clear tinnel signs. (The Dr. uses the hammer and taps the patients flexor side of the wrist.) The patient's wrist would clearly withdraw every time she was tapped. (Doc demonstrated this when she tapped me and nothing happened)

Patient did not have any signs of thenar atrophy in her hands.  Which is good because that means the medial nerve was not significantly damaged. She did not have positive phalen sign.

The patient was told to rest the wrists and keep the wrists at 15 degree mild dorsi flexion while she is sleeping as well as avoiding overuse of the wrists.

Unfortunately, if her job is to babysit fairly heavy children who must be lifted because they cannot walk, patient may eventually suffer more.....

The Tilt Test

A longtime patient of Doc, a middle-aged Asian woman, came in for a checkup.She was completely fine. She did however have certain episodes from a decade ago.

She would have prodromal symptoms like sweating in the palms and feet and hazy, blurry vision. Then all of a sudden she would pass out! Whether she was sitting or standing, it would not matter, she would pass out if she incurred these particular symptoms. Non-specific beta blocker had to be prescribed for the patient. Since she was prescribed the medication she did not have another episode for almost20 years and had been Doc’s patient since.

The patient went to nationally known emergency rooms three separate times. Each time, the ER did a CT scan, blood work, and the all of the results came back negative for any abnormalities.

 Doc happened to be on call for one of those ER visits.  They stated it was not a seizure and there was no indication of cancer or other serious diseases. However, when Doc answered the phone, she had a strong inclination that it might be neurocardiogenic syncope.

To confirm this, the patient was immediately scheduled for a tilt test. This is a controversial test. Patient would be given isoproterenol in an effort to induce symptoms of passing out to confirm the diagnosis. (The tilt is gradually increased upwards, which would then induce higher blood pressure, but because of the isoproterenol, the patient’s blood pressure would decrease thereby creating fainting episodes). Isoproterenol is supposed to increase the blood pressure and heart rate but her body was reacting in a completely opposite manner.

In all their years, the cardiologists doing the tests had never seen someone react so quickly to isoproterenol.  Her beta fibers were reacting oppositely.

Cardiogenic syncope is thought to have 3 separate causes:  1) the brain; 2) the patinet's own psychology or mental state; and 3) the heart.

For the patient, it was obviosuly her heart that was the issue.