Thinking Citizen Blog — Four Days, Four ER Trips, Four Lessons: a Case Study
Thinking Citizen Blog — Thursday is Health, Health Care, and Global Health Policy Day
Today’s Topic: Four Days, Four ER Trips, Four Lessons: a Case Study
Have you ever had a mini-health-care disaster and learned something from it worth sharing? Well, I had one last week and this post is my best attempt to make the most of it. Four takeaways: 1.) “sleep studies” are not necessarily benign. The nasal canula can irritate your nose which can have tragic consequences if say you are on a blood-thinner like Eliquis; 2.) blood loss after “nasal packing” to stop a severe nose bleed can lead to fainting which could be fatal and a specialist may be too rushed to give a precise enough distinction between “normal seepage” (not to worry) and a torrent (“come back in”), 3.) a diagnosis of “vertigo” as in Benign Paroxysmal Positional Vertigo (BPPV) can be good 60% of the time, but this is not good for 40% of presenting patients. 4.) Every home should have Afrin in their medicine cabinet just in case someone gets a severe nose bleed (I think). General conclusion: haste makes waste. Experts — please chime in. Correct, elaborate, elucidate.
FOLLOW UP QUESTION #1 — NASAL PACKING: IS MEROCEL BETTER?
1. Attending physician (the boss of the day) at Mass Eye and Ear emergency room says the type of “nasal packing” done at the Emerson Hospital in Concord, MA was a kind not done anymore at places like Mass Eye and Ear. We use “Merocel” he says.
2. But a day or so later, I speak with a separate specialist at Mass Eye and Ear who says he does not know what the other guy was talking about.
3. I do a little Googling and find out that there was a 2014 meta-analysis that showed that Nasoprene if anything is superior to Merocel.
NB: For the non-squeamish — click on the last link for a short video demonstrating the insertion of a Merocel pack.
FOLLOW UP QUESTION #2 AFRIN — SHOULD EVERY MEDICAL CABINET HAVE SOME? (and what else should be there in order?)
1. Should you apply it almost immediately after a severe nosebleed?
2. Does this depend on whether or not you have a heart condition?
3. Why didn’t any of the five doctors I met with in the last week even mention it?
FOLLOW UP QUESTION #3 BPPV AND VERTIGO — is the Dix-Hallpike Maneuver a reliable test?
1. My new understanding is that there is a very simple test of whether or not you have BPPV (Benigh Paroxysmal Positional Vertigo).
2. This test was not performed until six months after being diagnosed with it.
3. That test consists of the therapist putting your head into eight positions. If there is no “nystagmus” (rapid involuntary eye movement), then no BPPV.
NB: This was done last Thursday and the therapist concluded that I had been misdiagnosed. Was he correct?
CONCLUSION: Medicine is as much art as science.
Merocel versus Nasopore for nasal packing: a meta-analysis of randomized controlled trials — PubMed
https://www.webmd.com/first-aid/nosebleeds-causes-and-treatments
Nasal Packing for Severe Nosebleeds
https://www.youtube.com/watch?v=U-i46nghGr0
LAST FOUR YEARS OF POSTS ORGANIZED THEMATICALLY
PDF with headlines — Google Drive
ATTACHMENTS BELOW:
#1 A graphic guide to justice (9 metaphors on one page).
#2 “39 Songs, Prayers, and Poems: the Keys to the Hearts of Seven Billion People” — Adams House Senior Common Room Presentation, 11/17/20
YOUR TURN
Please share the most interesting thing you learned in the last week related to health, health care or health care policy — the ethics, economics, politics, history…. Or the coolest, most important thing you learned in your life related to health are or health care policy that the rest of us may have missed. Or just some random health-related fact that blew you away.
This is your chance to make some one’s day. Or to cement in your mind something really important you might otherwise forget. Or to think more deeply than you otherwise would about something that matters.
