Hunting Fentanyl

August, 2016

I saw a patient tonight that was about 40 years old. He came in for other reasons, but in the interview, he said he was on a Fentanyl patch for chronic back pain. My patient commented that he went out in the woods this morning to put up his deer stand.

Fentanyl is a synthetic form of morphine. It is a mind altering substance, meaning that it clouds judgement, alters reaction time and just plain messes with the mind. Yeah, just like alcohol.

I can see it now. Come November my patient will come in from a hunting accident;

“I fell out of my deer stand and broke my neck.” or,

“I thought he looked like a deer so I shot him. I didn’t realize that it was my Brother-in-law.”

or some other ridiculous story.

So, these Doctors (this is not an unusual occurrence) are sending him out to work as a welder and hunt while this trans-dermal patch makes sure he has sufficient narcotic in his body to relieve his pain 24/7

I’m often embarrassed by my colleagues.

Your grumpy Uncle/Brother Dave.

Weary

The Cost of Doing Business

January, 2015

I was very lucky when I started medical school. At that time, Baylor offered it’s Texas-resident medical students the same tuition as the Texas state schools. Baylor was a private Medical school and charged much more for out of state and much, much more for out of country tuition (I think I remember it was $10,000 per semester for foreign students). I paid $500 per semester for the first 2 years. Then the state legislature upped the ante to $2000 per semester. A 4 fold increase hit hard but was nothing compared to today’s rates.

But tuition doesn’t pay the bills. There are billions of dollars from private and government sources that make up the difference in what it costs to put a student through 4 years of medical school. The figures below reflect the dollars at that time.

1979-1983 Medical School $3 million
1983-1987 Residency $6 million
2015 Diagnosing an aphous ulcer (fever blister) in the ED at     12:15 am,  Priceless!

 

Musings from your Grumpy Uncle/Brother Dave.

Weary

That Snake Ain’t Dead

Recently, my buddy and his wife were out driving around in North Central Texas and they came upon a snake in the road.  Traffic was practically nonexistent so he stopped to investigate.  He has been a hunter/fisherman as long as he has been walking.  But he grew up in the heartland in an area that had few snakes, and he had never seen a rattlesnake.   The area where he’s from might have one copperhead or water moccasin.  But I doubt it.  So, snake lore escapes him.  When he got out of the truck, he said the snake just laid there.  It didn’t coil, rattle or try to slither off.  The snake had rattlers on its tail and a diamond pattern in medium dark brown down its back.  So being who he is, he wanted to skin it and tan the skin.  And, he wanted to dress it, cook and eat it to try the delicacy of rattle snake.  But what fool would want to get bit by a rattle snake; he had no guns, shovels or hoes.

These 2 Midwesterners often spend their time fishing so they did have an assortment of fishing rods and reels in the truck.  My buddy is a Marine and one of their mottos is improvise, adapt and overcome. So, he sacrificed a fishing rod to achieve his goal.  The tip top of the rod broke, but he had his snake.  I’m sure that somewhere in the area, there is some native Texan wondering just what the hell that fella is doing swatting that poor snake with a fishing pole?  Rattle snakes are not uncommon in the area and most locals wouldn’t bother to stop and look, much less try to attack a rattle snake.  After the fishing pole attack, they were excited and they had to have a “photo op”.

If you would, study these pictures and tell me what is wrong.  It didn’t take me a second to understand. Hint look at the snake.

My buddy tossed the snake in the bed of his truck and off they went to Walmart for tanning supplies.  When they came out, he wanted another look at his prize and when he did they heard that very distinctive sound, that sound that will bring the hair on your neck to an upright position and cause you to jump back no matter who or where you are.  The “dead” snake had come back to life and was coiled, ready to strike and buzzing it’s rattles.  It was rather pissed off at the fishing-pole-wielding-crazy maniac that interrupted it’s lunch.  But, the snake still lost.  After another thrashing and some knife work, he found a partially decomposed mouse in the intestines.  Gross.  His wife said he was gagging the entire time he dressed the snake out.  So if you are walking through the parking lot at a Walmart and you hear a rattle snake rattle, don’t bother looking for a snake, look around for my buddy.

Now, on to what one should observe from the pictures, and at what would have been nice to have noticed at the scene.

You’ve all seen in the movies where someone gets shot dead, killed.  But the scene pans to their face and they have a look of surprise or fear on their face with the eyes open.  It can’t happen.  When an animal dies, the muscles cease to work and relax into what is called the anatomic position.  The muscles can no longer contract and it takes muscle contraction to lift the upper eye lid, regardless of the position in relation to gravity.

The same applies to the muscles of the snake.  If you noticed, the snake has an “S like” contraction of the body near the head and the head is being lifted slightly.

And, when snakes eat, they become lethargic and just lay around contemplating life’s meaning while they digest the food.  It was certainly warm enough that the snake was up and about for the summer, i.e. not hibernating.  Whacking a poor snake over the head repeatedly while they are in gustatory bliss with a fishing pole will not kill it, unless its a mighty big fishing pole.

For those waiting for the outcome, he did get his skin and snake meat and no one suffered a snake bite.

And FYI, it was a diamond back rattlesnake.

News from Texas from your grumpy Uncle/Brother Dave.

Weary

Window to Your Soul

October, 2016

OK, I admit that I am a social recluse. I spell that “curmudgeon”. I’ve already caught hell for what I’m about to write here, but go ahead and vent because what you say is just a window to your soul.

Lancet Psychiatry has published a study that states that posts to social media offer a chance to diagnose your psychiatric disorder. The study reports that posts to these social media sites are more revealing and accurate than face-to-face encounters in the psychiatrists office. Humm, that is interesting.

So the argument goes that an interactive media in/outlet that was designed so that social geeks could meet up with hot chicks in the college environment, that is based on friending/unfriending on the narcissistic whim of emotion a la 3’d grade and that is the safe haven for every mass murder since it’s inception is probably not the social status badge that the country club membership of the 1960s was. I’ll let you draw your own personal conclusion, but in my humble opinion, the first thing you should do after you log on to social media (if you must log on to begin with) is to log off.

I have to be somewhat fluent in social media because about 2/3s of our suicidal ideation cases brought to the ED for medical clearance before psychiatric admission were found out through their social media account postings. Its an obvious choice, posting a notice to all your friends. Doesn’t Anthony Weiner use a social media account to post pictures of his, uh, weiner?

In the hacker community dark web, the prime targets are social media and public wifi (the heart throb of social media). OK, if you insist, so is e-mail. But honestly, in my defense, e-mail is so old schoo, it is more attractive to Russia, the NSA and FBI hackers than the psychiatric watch dogs of society now days.

Well I’m here to tell you that Becky (the author of the Lancet piece) just skimmed the surface in her study of Facebook attendees. People that use social media by definition , are crazy. Yes I know that everyone I send this to is an avid user of social media. There you go! I don’t need no stinkin studies.

Finally, if not fully, appreciated. Your grumpy Uncle/Brother Dave.

http://www.thelancet.com/pdfs/journals/lanpsy/PIIS2215-0366(16)30041-4.pdf

https://www.cnn.com/2017/09/25/politics/anthony-weiner-sentencing/index.html

Weary

Defending GM?

May, 2014

The April 14, 2014 issue of Time magazine has a brief note about GM and faulty ignition switches. CEO Mary Barra stated in a Congressional hearing, “We will hold ourselves fully accountable.” This was about faulty ignition switches that “caused” 13 deaths. With a great deal if imagination I guess I could figure a way an ignition switch could cause death, but it would take some time.

In 2010, GM sold (not made) 8,389,769 vehicles representing a 2% increase from 2009. We will assume that sales continued to rise, but at a slightly more conservative rate (although there is evidence that the rate of sales increased during this time period). Progression analysis at a rate of 10% per year yields 2013 sales at 8,643,986 vehicles.

Given 13 deaths out of 8,643,986 possible ignition switch failures, the rate of failure is 1.5 x 10 -6. That is 1 in 664,922 vehicles.

For those not remembering their high school algebra, that is a .0000015% chance to have a failure of the ignition switch that would cause death.

Those are pretty fine tolerances to hold some one accountable for, in any industry. I never thought I’d be defending GM after the bailout fiasco, but daymnnn!

Sure am glad Congress is keeping a lid on transportation safety!

From your grumpy Uncle/Brother Dave.

Weary