DocTalk

Re: DocTalk at your service

After two weeks on the road, it's nice to settle back into my almost normal life. Amazing what little coverage there is for North American sport in Europe. For all that is written about NBA basketball being a worldwide sport, I read nothing of the playoffs in England and France. The Stanley Cup was nonexistent in Belgium and Germany and baseball wasn't even a glimmer. Lots of stuff on soccer and cricket and even a little rugby thrown in.

So it's back to the real world and time to catch up.

http://www.mddirect.org

 

Re: DocTalk at your service

Doc, I found this one today, and I have to ask...
Ok, Sammy got beaned, it was bad, but he's ok, seemingly no long-term effects.
Now, we see results about NFL players...obviously, this is a result of hits not as hard as a beaning, but ones that happen over and over, especially on the offensive and defensive lines.
What, short of inventing devices like HANS that is just a helmet that can prevent repetitive brain sloshing, can be done?

 

Re: DocTalk at your service

Recognizing subtle symptoms of concussion and then removing an athlete from competition would be a start. That would take a culture change for sport. Historically, the individual would suffer for the good of the team, risking further injury. A sea change would suggest that teammates watch over an injured teammate and not allow him to return until there is no danger of worsening an injury.

In concussion, guidelines exist for return to play based on the severity of the head injury. Three of the most commonly used are those by Cantu, the Colorado Medical Society and the American Academy of Neurology, though there is no consensus as to which is best. Should people be interested, I can provide copies of the guidelines that we use at my hospital. IM me with your mailing address.

 

Re: DocTalk at your service

Doc, I was hospitalized this week after blacking out and it was discovered I had a potassium count of 2.5. They told me if I had not been in such good physical condition I could have suffered a stroke. I was stupid and didn't hydrate well enough during a peak period of exercise and paid for it. When I left the hospital two days later, my potassium count was 4.4.

Can you explain potassium counts and perhaps elaborate not only on the importance of keeping it up, but how to?

Thanks so much.

 

Re: DocTalk at your service

Potassium is an electrolyte or chemical in the body that is needed to provide energy for cells, including muscle, to function properly. The levels are maintained the kidney, since it can detect too little or too much and adapt. However, loss in other areas can override that control mechanism.

The two most common causes are the use of diuretics (water pills for blood pressure control) or profuse diarrhea where potassium is lost and total body stores of the chemical is depleted. Occasionally, athletes who sweat excessively can become dehydrated and lose significant potassium. Low levels of potassium in the body can cause generalized weakness and muscle aches. And since the heart is also a muscle, it can cause some electrical conductivity problems.

Elevated potassium levels are almost more concerning and can cause sudden changes in heart electrical activity and death. High potassium occurs in people with kidney failure and the inability to remove potassium from the blood stream, significant muscle injury called rhabdomyalisis, where the potassium in the muscle cells are spilled into the blood stream in high concentration or excess intake (including salt substitutes which replace the sodium with potassium). It is also a potential complication of a diabetic ketoacidosis, where a diabetic patient's sugar spiral out of control. High potassiums are a true medical emergencies.

The body lives in a pretty narrow range of normal but it is also pretty good at keeping itself within that range. It also tolerates some slide outside that range, but depending on the issue, those compensation mechanisms can be extensive or minimal.

 

Re: DocTalk at your service

The USA Today coverage of concussion and minor head injury on Tuesday is well worth the read.
http://www.usatoday.com/sports/football/nfl/2007-06-18-concussions-cover_N.htm?csp=34
http://www.usatoday.com/sports/football/nfl/2007-06-19-concussions-summit_N.htm?csp=34
http://www.usatoday.com/sports/baseball/2007-06-18-focus-concussions_N.htm?csp=34

 

Re: DocTalk at your service

Resident graduation is tomorrow and the crop of newly minted MDs will be showing up in the hospital any day. It's bittersweet when the senior residents leave. I know that they are ready to begin their careers in the real world, but I've grown attached to many of them, especially the surgery residents, who have shared many of their nights on call the past five years with me in the ER. I will miss their wit and wisdom.

Please read more at the website. Thanks

www.mddirect.org

 

Re: DocTalk at your service

Sorry about the delay.

Alli is the over the counter iteration of Orlistat, a weight loss product that works by decreasing absorption of fat molecules that have been eaten. About 25% of the fat is passed on to the colon undigested.

The good news is that the pill works and studies show that weight loss can be achieved and people can keep it off. There a couple of downsides. The fat that is not absorbed will make stool oily and smell bad (as if feces could smell worse). They also become more frequent and loose and sometimes hard to control. A less important side effect is that fat soluble vitamins (A,D,E,K...and sometimes Y? I joke) may need to be taken as a supplement, if fat absorption really is limited.

As with any diet aid, Alli is just that, an aid. It should be used in addition to a sensible diet and regular exercise program for maximal resultys. It shold not be seen as a license to pig out on fatty foods.

 

Re: DocTalk at your service

Slowly but surely, I'm returning to the real world after spending the first half of the month on the road. The medical topics keep happening in the sports world, but my take on them had to wait while I finished a couple articles for emedicine and webMD. Sprains and strains this installment with knee injury information to be published soon.

http://www.emedicinehealth.com/sprains_and_strains/article_em.htm
http://www.webmd.com/a-to-z-guides/sprains-and-strains

 

Re: DocTalk at your service

Summer is officially here, now that I've seen my first case of heat cramps in the ER. With prep sports camps in full swing and football training camps soon upon us, it's time to review heat related illnesses on the website. Thanks for reading.

www.MDdirect.org

 

Re: DocTalk at your service

Dr. Ben:

Was reading one of the stories on your site and came across a condition that never made sense to me:

Common sense suggests an enlarged heart, one with more muscle than it needs, would pump more strongly than necessary. I spend at least 45 minutes per day engaging in what I'd term "rigorous" cardio activity. Surely my heart is larger than my sedentary friends.