Mike Radzienda writes…

A man presented with urinary retention and a UTI. He also complained  of mid -thoracic spine pain that was sub-acute. His PMD treated him with antibiotics but his symptoms persisted. He had worsening urinary symptoms and developed lower extremity weakness. On presentation to the hospital, he was admitted to the neurology service and was found to have spastic paralysis of his lower extremities. Exam at that time showed marked upper motor neuron sign in his legs. A brain MRI was read as normal. An MRI of the spine revealed no evidence of spinal cord disease but the thoracic images were not interpretable due to motion artifact. The neurologist commented in his note that the MRI of the spine was normal. The following day the MRI was redone and reported out as, “a retro-pulsed disc is compressing the spinal cord at T-8 and there is enhancement in the anterior portion of the cord adjacent to the area of cord flattening.”

Subsequently, the team never (more…)

Mike Radzienda writes…

In my fourteen years of medical practice, I had written a Do Not Resuscitate (DNR) order based on medical futility once. The patient was terminally ill, comatose, and without next of kin. The DNR order was by concurring physicians. It was not contested, and the patient ultimately died peacefully.

Last week, I wrote my second DNR order based on medical futility. This time was not so simple. (more…)

Robert Chang writes…

Ground level work
Taking a break from my prior themes, I just returned from Honduras where I act as clinic director, triage, medical student instructor, pre-operative clinic, coordinator for medical consulting with physicians back home for obscure cases and whatever else needed to be done to keep our one week of general medicine/ENT clinic and surgeries going smoothly.  The week away was refreshing, whether it was the little kids, the cyst-that-was-actually-a-botfly that we removed from someone’s head, or mentoring students (one of whom was featured in the local paper). (more…)