Third World Love in Ethiopia

Today I had an amazing day in Ethiopia. We woke up around 5 AM to drive to the mountains, Wunania, which are about 40 minutes away from Gondar, Ethiopia. It reminded me of why I love the third world. First off, we were in a VW-like bus.

There were no seatbelt. The road was unpaved half of the way there. The paved part, was actually a little bit more scary. People walk on the streets since there is no sidewalk. Donkeys, at times, dart into the middle-of-the-road making us brake suddenly and fall out of our seats.

People carrying their flour, teff, on their heads, beautiful children and their mothers walking hand-in-hand, and different smells both good and bad were everywhere. We hiked for about 3 miles up to the mountaintop. Then the guide stopped, and told us to sit. For 30 minutes we sat silently on top of the mountain just looking at the beautiful scenery. For 30 minutes, no talking, just us and the birds, and down below the monkeys. The monkeys were just playing, it look like a game of tag. It was a good time for me to think about this entire trip, and possibly how it will change me.

After our hiking experience, we went back to the clinic. It was a beautiful clinic today where we screened about 40 people. The kids, their mothers, fathers were all there to get checked by me and the nurse I came with, Leanna. We found several different pathologies, but most of all we had fun playing with them, laughing, giggling, and tickling their small protruding bellies.

At 3 PM, I went over the hospital to lead rounds on the surgical ward. The head of surgery asked me to talk about trauma. In particular to talk about the treatment of a pneumothorax, femur fractures, and wound infections. There were about 20 medical students with notebooks open with pen on the paper, just excited to have a different perspective. They presented three cases, and then I got to ask them all questions. We talked about pathophysiology and the treatment in the US versus the treatment in Ethiopia. Much of it was the same. Some of it, however, was much different. Since they do not have wall suctioning, treatment of pneumothorax is a bit different. Since they do not have portable chest x-rays, the treatment of tension pneumothorax comes more on clinical acumen. Since they have way more trauma than we could ever possibly think about in Chicago (that’s a strange thought), they were all little experts on trauma care. For an hour and a half we discussed all of this, and they seemed enthusiastic. It truly was one of the highlights of my trip.

We got got back at the hotel, and I was exhausted. I mean, when the last time I hiked 5 miles in about 6000 feet altitude, and then worked all day. It was well worth it. But it did make me think about the Third World again. Although it’s dismal to see such poverty, naked babies, severe homelessness, seven people living in one hunt, there was some so much beauty in how much happiness and optimism they all had. The kids were still kids. The mothers and fathers trying to do the best they could with the resources they had. Today was the Ethiopia I was hoping for, however had never been to. As Leanna and I had some food on the balcony restaurant of our hotel, overlooking the plaza, I sipped my beer, exhausted, both feeling like if we had to go home tomorrow, it would’ve been all worth it.

Ethiopia – A Truly Humbling Experience -

Hello all-

I’ve been asked to blog about my experience here in Ethiopia. It’s truly been amazing. I’ll start with discussing my first day at the hospital.

We have been sent to Gondar where the second largest medical school in Ethiopia is located. This is a beautiful city, of 250,000 people. The medical school is very large, and the medical system lot different than the United States. First I started in the ICU.
We rounded on the three patients in there. I was a bit nervous, however I realized that I was there to observe, and if they had any questions on how we do it in the United States, I could possibly tell them. I was in for a big surprise.

Here’s the thing, the science of medicine is very similar all over the world (just open the textebooks of medicine, surgery, and emergency medicine), the medicine practiced in each region of the world is totally different. For example the first patient I saw, had meningitis. Actually, it was a bit more complicated than that. He was 25 years old, and had cerebral meningitis. How many cases of cerebral meningitis have you seen? Personally, in the United States, I’ve see none. I have, however, seen about four cases in Haiti. That being said they see it all the time. Interestingly, the patient had a GCS of three. They do not have any functional ventilators on the medicine floor. They do have, ventilators, for the surgical patients in the Operating Rooms. For this reason they could not intubate the patient. When they saw the patient initially, he had a GCS of 6… When we saw the patient about 36 hours later, he was having focal seizures. As we were rounding on the patient has left arm was shaking. The attending, the residence, and the medical students watched it, but they did not do anything. As we discussed the case, it was evident that the patient was in critical condition, and I was afraid that he would not make it. He had agonal breathing, around 3 times a minute. His heart rate was about 120. And he was seizing. He was laid flat, with an NG tube. They did not intubated the patient for the reasons of not having a functional ventilator. We discussed the case at length. He had been given dilantin 1 g load. He was also getting it twice a day. Unfortunately, they cannot check levels. They added another drug because of the seizure. Patient had a high fever about 103°F. His pulse ox was 88 Percent. They asked me what I thought was going on, and they also asking what we have would have done in the United States.

We discussed intubating the patient for airway protection. This certainly would’ve been done. Because the patient did not have a secure airway, I was sure that the patient had an aspiration pneumonia. They agreed and ordered an x-ray, and there was an infiltrate/pneumonia in the right upper lobe. We discuss places for aspiration pneumonia can occur, and went through the pathophysiology and treatment. The patient was started on ceftriaxone and Flagyl. It was an unfortunate care, and I’m concerned he’ll die overnight. That being said, what can you do when you don’t have a ventilator? Although they were giving the best care to the patient that they could, without essential equipment, complications will occur. And in this case, it probably would have saved this young patient’s life. Now he’s battling hypoxemia due to a preventable aspiration pneumonia and cerebral meningitis…

Patient number two, was a sixy-year-old female with a history of rheumatic fever. She had congestive heart failure due to rheumatic heart disease. Again, in the US, we get these patients to the cardiothoracic surgeon for a valve replacement… They almost never develop heart failure due to this. Her ejection fraction was about 25% per cardiac echo. She was talking complaining of burning epigastrium. The monitor, which I assume was V1, showed ST elevation. We talked about the patient at length, however no other treatment was administered. No EKG was done. The patient was already on full dose treatment with Lasix, ace inhibitor, and other medications. They did not have nitroglycerine. The sad part is, she could not live for long without a valve replacement. There is no one in Gondar that can do this, and she nor her family did not have the money to get the surgery in Addis. She was doomed because medications could not fix her problem…

Unfortunately, 5 hours later, I was called to her bedside because of ventricular fibrillation. They had never used the defibrillator they had, so I helped them with this. Unfortunately, the defibrillator could only give the shock of 50 jules. This is certainly not enough to get her out of her rhythm. Also, they did not intubate the patient, as they do not have any ventilator. CPR was started and they awaited my arrival for defibrillation. The machine was old, but had simple instructions with pictures. I put in the maximum jules, but the metal pieces on… It was an old school defibrillator, had to put the gel on, stand over the patient, put the metal pieces on the correct area of the chest, and shock the patient.

It did take about 20 seconds to charge, which was frustrating. But then, it charged and we defibrillator the patient with 50 jewels. I did this about four times, but there was no way she would be converted with such little electricity. It is unfortunate, this patient needed a valve replacement. She was maxed out on medications, and could not be saved. I’m suspecting that her valve continued to fail with worsening heart failure, then had an Acute myocardial infarction (heart attack) and then had an arrhythmia. She passed away. The resuscitation was an interesting one. The mourning of the patient’s family was very similar to Haiti’s mourning. Lot’s of crying, yelling, and women passing out. I asked the team if any of the family was going to come in to see the body, and they told me no. They don’t allow family into the room after the patient dies because they fear hysteria and possibly violence. It’s very different than how we do it.

I also rounded in the ER… Amazing pathology… Significant Tuberculosis, AIDS with PCP, diabetic ketoacidosis with a severe hand infection and abscess, and 38 year old with a massive stroke with hemiparesis, multiple cases of malaria, and hypertensive emergency. Much of this stuff, we do not see in the US. I was at awe with what I saw. There was a theme, although our medical education and system is the greatest in the world, I could not diagnose and treat most of the diseases I saw today. Now that’s humbling.

Cyberchondria

It’s been interesting to see what trends in healthcare and what does not. Safety issues? Heat? Cold? Cyberchondria? I’ve gotten recent mail questioning if it even exists. Well, let me tell you this: I think it does. Here’s a great segment put on by my local NPN (with me as a guest and answering some of the questions): Eight Forty-eight. Take a listen (it’s only 20 minutes long), some really great questions and comments. Great discussion.

http://bit.ly/KqIud3

Enjoy!

Post #2 – Final Post from Haiti

What We’re Doing in Haiti – Again-

In retrospect, this is what was said by a member of our team regarding what we’re doing:

We are on a fact-finding mission and while we are there, let’s try to help, wherever we can, but first do not destroy what has already been built. Remember, this is a long term journey for this ER, hospital, city, and country.

A few months ago, the Israeli Ministry of Health built a new Critical Care Unit (CCU). As you know, the Israelis know a lot about trauma and resuscitation. It’s unfortunate they have had to become the leaders in this filed, but they are now educating and building units that will help other people.

The Israeli Ministry of Health agreed to build this CCU, however, they did not wish to supervise and overlook how it is used, so they asked a partner of theirs, Jewish Healthcare International (JHI) to do the education and operations portion of the CCU. To bridge the Israeli Ministry of Health and JHI, they sent Shirley, an Israeli to the newly built unit to ensure it is used properly and that there is an infrastructure for its continued use after she leaves. JHI sent 4 of us, in order to gather facts and come back and report to them what we think it needs to survive. Shirley was extremely helpful in explaining what she had already done and we began understanding what was needed for future success. Shirley is a Pediatric Intensive Care Nurse in Tel Aviv. She was sent to Cap Haitian for 8 months and used her managerial skills to organize the CCU, building an inventory, staffing the newly built CCU, and writing the order protocols which includes who gets in the CCU (must be sick, but cannot be too sick). Most importantly, she got buy-in from the hospital administration. She is the last resource the Israelis will be giving to the hospital for this CCU and now JHI will take over. As I said, we are here on a fact-finding mission, and our team will help determine what resources JHI can give the hospital.

The Critical Care Unit

The CCU is like no other part of the Justinian University Hospital. It looks like a long skinny rectangle, as if someone attached 2 trailer homes linked together by the ends. When you walk in the only door, you feel this rush of cold air and cleanliness. It is the only place, other than the operating rooms, with central air conditioning. There is a waiting room with 2 rooms next to it where a patient can be triaged, then a second door leads you to a long hallway lined with clean beds. To the left is a room that looks like our trauma/resuscitation bay at Northwestern Memorial Hospital. There’s a monitor, cart for emergent procedures, medication cart, suction, in-wall oxygen, and enough room for multiple people to work on the patient. Down the hall was another room, filled with 6 beds, separated by curtains and a nursing desk. The CCU is staffed by 1 MD for 12 hours shifts. There are 5 MDs that rotate covering the CCU 24 hours a day. Although there are many doctors, only a handful has bought into this early resuscitation and the whole art of emergency medicine. These physicians understand trauma and critical care. They move fast and have advanced knowledge in emergency medicine.

This CCU is beautiful. It is the opposite of what the ER is like, which is located about a 30 second walk from the CCU. Let me describe the ER:

First off, it’s in the middle of the hospital campus. You see registration first and pay the required admission fee (less than 3$), then patient line up and are seen by interns (Haitian doctors who are just out of medical school). Patients are seen on a first come, first serve basis. There is no triage. The attendings are internal medicine doctors without any emergency medicine training. In a word, the ER is: chaotic. It is also dirty, extremely smelly, not sanitary (no easily accessible running water and no easily accessible gloves), and because there are no supplies and RN assignments, it’s disorganized and inefficient. Let’s say this, I’m an ER doctor and I did not like going there.

Okay, that’s the background of what the ER is… The CCU vs. the ER was like heaven vs. Hell of hospitals.

Our goal… To make sure that the CCU is used correctly and is well-run. Also, while we were there, not to take over control of the ER (because we’ll be gone in a week and we all know that it’ll go right back to where it was prior to our arrival). So we needed to educate, and with the MDs in the ER and CCU, to help them see and understand how different operational changes can really make an effective change. The ER nurse who was leading my group, Leanna, with the help of the leading resident, helped develop a triage protocol, waiting space, and mentality of sending patients who did not need the ER to their required areas quickly. It was amazing what the place turned into: an efficient, almost wait-free ER. We did notice, that when we left, it quickly slipped back to what it had been prior to us being there… And that’s the fear we all have.

So What Did We Do?

After 2 days of us observing and talking with the residents, attending physicians, nurses, and others, we got a good sense of what was going on. I witnessed many, many different kinds of cases. I worked along side the resident (there were two who essentially ran the entire ER and CCU). In the CCU, I participated in a trauma case where a pickup truck with 5 people in the back of the pickup rolled over. All came to us. I witnessed how they triaged 2 to the CCU and three to the ER. It was a beautiful scene, as Haiti does not have a triage system or a trauma center mentality. Since it was during the day, there were four physicians in the CCU.

The first patient, a 30-year-old female was placed in trauma bay #2. She was lifeless and she had no pulse. The resident looked up and said to me, “She has no pulse!” I asked him what he wanted to do, and he looked at me and said, “she’s dead.” Now, for us in the US, this is our protocol, as a traumatic arrest is pronounced dead. We are done, it’s pretty easy, but in Haiti it’s a bit harder culturally. It made me relieved that he was so decisive. He went over to the next patient where she suffered major facial trauma, forehead hematoma, nasal fractures, and at least 6 upper and 4 lower teeth fractures. A c-collar was place appropriately, a primary assessment was done and then a secondary assessment. There were multiple physicians, buy it was not chaotic. The nurses simultaneously placed two large bore IVs and the patient was placed on the cardiac monitor. I thought to myself – there is NO way this would have happened in the ER. This CCU is a success, as it saves lives, and it must be continued.

This patient did very well. She was transferred a day later to the surgery ward, which is a room with over twenty patients in gurneys without curtains, lying side-by-side where family members do 75% of the nursing care. Where if the orders say wound changes three times-a-day, IV fluids, and Ancef every 8 hours, then the family member goes to the pharmacy, purchases wound care materials, IV fluids, and Ancef for the nurses to use for that day.

Later on that day, the senior resident came to me and asked me if I’ve ever seen a dislocated jaw. I smiled and said I had. I asked him, is it a young girl who could not close her mouth after yawning? With wild eyes, he said, “Yes! How did you know?!” Funny, the things you see as a resident in Emergency Medicine. I told him to put her in the CCU where we could mildly sedate her and reduce it. He was very excited. We gave her 5mg Valium IM, and 15 minutes later I taped up his thumbs (you sometimes get an accidental snap of the jaw, causing the patient to clench down on your thumbs) and he mostly reduced her jaw by himself. It was a fun, very gratifying procedure. The patient was extremely happy.

We had other patients, and although there weren’t many actual findings, we discussed the workups and treatments of syncope (passing out), head injury, calcium channel blocker overdose, and vague abdominal pain (without the use of CT scan).

Health care is different here. It would be difficult for me to be here, but on one hand, I could see myself loving it. Here’s an example:

With the resident, I saw the next patient. It was quite bizarre… The patient was a 70-year-old female who had purple colored lesions all over, including on the bottom of her foot, palate, arms, and had a rock hard non-tender abdomen. She was emaciated, and only a bit uncomfortable. I had no idea what it was. The resident wasn’t sure either. The other internal medicine physician came over, and took a look. He looked it over for 15 seconds and turned to us and said, “She has Kaposi Sarcoma and probably AIDS.” Ah… I’ve seen pictures of this, and I’ve read about this, but I’ve never seen it. It was impressive. The internal medicine doctor talked with the patient for about 10 minutes and then the patient started leaving with the help of her family. I asked the resident what was going on, so he talked with the doctor and discovered that the family had a feeling that this is what it was, but just needed a confirmation. They told us that she was old, and it was her time, that she had lived a good life. We offered admission to see the internal medicine doctors, but the patient would like to go home, where her family was.

How beautiful is that? That mentality rarely exists here in the states. I’m unsure why. Why are we brainwashed to think dying at the hospital is the best place to dye? Let me tell you… It’s not, and it’s one of the worse places to die. I have a few stories like the one above in all my visits to Haiti. The Haitians seem to understand the bigger picture.

So, in Conclusion

We taught, we observed, we made some diagnoses, gave some treatments, and we are going back to JHI where we will advise them on what they can do with their funders’ money to ensure the continued use of this CCU which the Israelis built. How often should a group be sent to the hospital? Who should come? What should they do? What education should be taught while there? In the next few weeks I’ll be writing up my report. The week I had was very insightful. The physicians and patients in Haiti are amazing people. Their stories pre- and post- earthquake make me remember why I initially came. Their resilience is why I continue to come back.

Post #1 – Haiti –

So, I’m on day #4 in Haiti. It’s been a phenomenal week so far. We are in Cap Haitien, Haiti, a city in the north of Haiti on the water. We are working at the Justinian University, which is the 2nd largest hospital in Haiti. Interestingly, when I came to Haiti for the first time, I worked at the University Hospital in Port-au-Prince (the largest hospital in Haiti). Justinian University has a nursing school, residency (one year for primary care), and over 250 hospital beds (including surgery, medicine, OB/GYN, pediatrics, urology, and orthopedics). Like many hospitals, the ER is not a big part of the hospital…yet.

First let me describe the hospital. It has no cardiac monitoring, very little oxygen, few lab tests, and 3-5 hours of no power a day. It costs about $3 to see a doctor, but if you need sutures or IV saline or any medications or x-rays, the doctors will write an order, and you or a family member will go to the pharmacy or radiology area, and purchase what was ordered. Obviously, in a 3rd world country, this is prohibitive, as I had a patient who was involved in a motorcycle accident who had severe proximal humerus tenderness and pain, would not get his x-rays because he had no money. The ER is crowded, and there is no real triage. In fact, patients are normally seen in a “first come, first serve” basis. The only exception of this is when people are extremely ill, where those in front have no objections to the sicker patients cutting in front of them.

How Did I Get to Cap Haitien with this group?

The Israelis, who are experts in trauma and disaster care, have invested in a critical care unit. In fact, 2 months ago, they built an 8-bed unit, which has almost everything we have in the US (cardiac monitors, suction, available IVs, medications, etc). The trouble is, the Hatians have no concept of what Emergency Medicine is. The Israeli Ministry of Health sent a woman, Shirley, to start to develop the use of this newly built, beautiful critical care unit. Shirly, who has been here for 8 months, however is leaving in 1 week. The Israelis built this new critical care unit, but clearly stated that they would not develop the use of it. This is where Jewish Healthcare International (the group I am with) got involved. Jewish Healthcare International (JHI) has a close relationship with the Israeli Health Ministry. JHI agreed to take on education and continued use of this new critical care unit. They sent down 4 of us for a fact finding mission, as well as teaching and working in the ER. This is my role…

What I’ve Been Doing

1st Day of Work:

Got up at 6am, grabbed coffee and walked a mile to the Justinian Hospital. I gave the 1st lecture on Acute Myocardial Infarction (heart attacks). The night before, I had to make major revisions because the hospital does not have any cardiac biomarkers (lab work like Troponin). Interesting to give a lecture on heart attacks without the main way we diagnose it. The other different thing was that we had a translator to translate our lectures from English to French. The physicians spoke and understood English, but at our lectures we had many nurses and nursing students. There were a total of 40 students at the lectures, all extremely attentive and smiling, many taking notes. It was great to see. We had a lot of interaction, which is not the case for most Haitian students. I asked a lot of questions, many of which I was curious about… They don’t have PCI or thrombolytics. In theory, they have aspirin, Beta-blockers, statin, Ace Inhibitors, and Plavix (I have not seen anyone on these medications while I have worked). There is no dietician to discuss low-fat diet, which is almost impossible here, as most food is fried, large amounts of rice, and a desert of fruits and vegetables. In theory, these patients are written for the above medications but the absolute truth is, they don’t take them or the patients stop taking these medications due to cost.

Working in the ER – Same Problem, Different Country

One thing that made me chuckle is that the Haitians run into the same problem that we have in the US (and the same thing I research). They are “over crowded” due to keeping admitted patients in the ER (ie, boarding these patients). The senior resident, who is 1 of 2 MDs that run the ER asked me: What do you all do about this in the US? Ha, I thought and they told him to develop relationships with the medicine teams, develop protocols, engage the hospital administration, etc… He said, “yeah, right.”

We worked until 6pm. I was pretty exhausted, but extremely amazed at the students’ gratefulness. I did 2 hours of didactic lectures, 1 hour of small group, saw 5 patients with the resident while doing some bedside teaching. Pretty awesome day.

Here are a few of the patients we saw:

Severe head trauma status post motor cycle accident. GCS of 7, Left sided neglet, obtunded and clearly had aspirated, and large laceration over forehead. Patient has a very small likelihood of survival, due to no CT scanner, no neurosurgeon, and poor GCS score. He died later that evening.

Motor vehicle crash with right shoulder and tib fib lacerations and pain with severe tenderness. Since patient did not have the $15 for his x-ray, he opted to not get the x-ray. The patient had severe tenderness to those areas, but he could not afford it. I did repair his laceration with 6 stitches. We gave him a script to get the x-ray, but I’m not sure he’ll get it. Made me think about our system… We get the tests we want…

Motorcycle accident (get the theme). He had a clear clavicle fracture that was easily palpated. I talked with the resident and asked him for an x-ray. He looked at me oddly and asked why? Did I not think it looked like a clavicular fracture? – Well, I did, but I saw his point. Clinically, the patient had a clavicle fracture. He had not have other concerning findings on exam. Whoops, Western medical mentality. He was right. Sling, return to orthopedic clinic in 2 weeks. The nurse sewed up the laceration, which I might say, did an excellent job.

That’s it for now. It’s been a good trip. I’ll write more later.

Haiti – Take 3 -

I will be going to Haiti from February 3rd – 12th. This will be my third visit there in 2 years. Some would call it an addiction, but I’ll tell you why I really go. But before this, I have to thank my friends, family, and colleagues who made this possible. My mom is basically moving in to help my wife with the 3 kids. The donations from friends and family will support the mission, helping pay for the team that’s coming with me, and the equipment we’re leaving down there. And of course my colleagues who covered my shifts. So thank you to all.

I first went two weeks after the Haitian earthquake that we all heard about, which occurred in January of 2010. I was sent to Port-au-Prince with a group from Northwestern University under the non-government organization, International Medical Corps. It was amazing; we were doing on the ground disaster care, as well as very needed continual emergency care. I was there for two weeks, and it changed my life.

My second visit was one year later, in January of 2011, where I volunteered with Project Medishare, a University of Miami group that has set up a hospital in Port-au-Prince. It was much less disaster care, as the country has come close to the medical care it had prior to the earthquake. Again it was an amazing time, and I worked in the ER doing mostly clinical work, but I did a fair amount of bedside teaching.

Tomorrow, I’ll be going back to Haiti. But my mission will be very different. I will be going to Cap Haitien, teaching the medical students of Haiti emergency care. I put together lectures on heart attacks, strokes, respiratory distress, and abdominal trauma. I will be working in the ER, however I will be an “extra” – as they have now fully staffed their ER with their own people. I will be doing bedside teaching, didactic teaching, and setting up their medical education. One thing that is very different in Haiti is that once you graduate from medical school, you are a practicing physician. There is no residency for primary care physicians or emergency physicians, unlike here in the US where we will do 3-5 years of residency prior to practicing on our own. This makes clinical teaching extremely important. I am excited to go.

But although I’m giving my time to Haiti, there’s one thing that has to be mentioned. I love going there. The feeling I get when I’m there is so liberating. My perspective of the emergency care I give, the research I do, my parenting skills, and even the husband that I am improves dramatically. I get a global perspective, but I also realize how similar we all are. Why people come to the ER? What the most common complaint is? – pain. These things that I learn, and re-learn every time I go back, truly do make me happy, and for the most part, a better person and physician.

It’s Getting Cold! Weather-related Tips

Yes, it’s January in Chicago. I know, it’s cold. Every year we go through the same problem. Here’s a link to an in-studio interview I did with Fox News Chicago:

http://bit.ly/wMZOPX

Stay Warm!

Paging Dr. Google: Internet research stirs up ‘cyberchondria’

These days, it’s rare that I make it through a shift in the ER without seeing at least one patient who has Googled their symptoms and already made a self-diagnosis. This trend of do-it-yourself doctoring has become so common that we often joke that the patient has been seen by Dr. Google. In general, searching your symptoms is not a bad thing to do, as it can help you become more educated about your health. However, more information can also lead to more anxiety and a self-diagnosis that isn’t necessarily true. This is what we refer to as cyberchondria.

For example, I’ve had patients with relatively common symptoms such as a runny nose, sore throat, and enlarged lymph nodes Google their symptoms and end up convinced they have cancer because there is a bump on their neck. One patient even reached a self diagnosis of non-Hodgkin’s lymphoma. With cases like this, I always sit with the patient, listen to his or her concerns and walk them through how I used their medical history, exam, test results and other factors to make a diagnosis. In most cases, the bump in the throat is not a serious threat, but rather a swollen gland caused by a virus. Typically, taking the time to explain my conclusion helps put the patient at ease.

Does this scenario sound familiar? Have you experienced cyberchondria? Before jumping to conclusions about your health, take a deep breath and remember that it’s far more likely that your sore throat is the result of a virus rather than a serious illness. No matter what you may have found online, remember this one important rule: if you’re worried about a health issue, don’t hesitate to call your primary care physician and seek care when necessary. You should never be afraid to discuss your concerns and it’s perfectly fine to acknowledge that you searched online and are now worried. Just keep things in perspective, don’t panic and have an open dialogue with your physician so they can educate you, provide an official diagnosis and explain your treatment options. Educating our patients and helping them understand their condition is an important part of our job. The internet can be an excellent resource, but it is no substitute for a trained physician.

Getting Through Holiday Festivities without a Visit to the ER

The holiday season is a festive time of year with gift exchanges, decorations, celebrations, eating, and drinking. It’s also a time that emergency rooms across the country experience a spike in visits, often caused by holiday-related accidents. As an emergency medicine physician, I’ve seen firsthand injuries take families away from their festivities and into the hospital.

When preparing for celebrations this holiday season, keep these safety tips in mind:

When decorating the house or tree, take precautions to avoid falls. The Centers for Disease Control and Prevention (CDC) estimates that falls account for 5,800 visits to ERs in December and January annually. When hanging ornaments or lights up high, make sure the ladder is secure and balanced. Do not use chairs or furniture in place of a ladder. Have another person nearby to hand you decorations so you aren’t reaching or to steady the base of the ladder to help you maintain balance. When the decorations are in place, tuck away cords or other items that may easily trip someone. Holiday decorations can easily start fires if not properly used. House fires can lead to burns and smoke inhalation. Always ensure that live trees are watered; a dry tree is much more likely to burn. Check that strings of light do not have broken cords or loose bulbs, both of which can cause a fire. Be careful to not overload outlets or string too many strands of light together. Only use holiday lights and candles when someone is in the room.

Depression and anxiety are known to increase during the holidays: Know yourself and listen to yourself. Do you really need to go down to the mall when you are exhausted and sleep deprived? Don’t forget to take care of yourself while you are trying to take care of others. Remember to exercise or take have coffee with a loved one or whatever you need to do to take a break from the craziness. If you feel yourself getting anxious (unable to sleep, mind racing, heart palpitations) tell your loved one, stop what you’re doing, and take a break. Check in on your family’s well-being. Check on your elderly friends, especially those who are widows and remember that they have a lifetime of memories that they may be effected by, so ask them about the good memories. Even kids can have signs of anxiety, so ask them how they’re doing.

When partaking in holiday festivities, be cautious about how much you eat and drink. With buffet style events, food is often sitting out for long periods of time and can cause serious illness if consumed. In the ER, we often see an increased number of patients complaining of stomach pain during the holidays because they overate. While rarely life threatening, people who suffer from chronic gastrointestinal disorders can be at serious risk from over consuming. Eat and drink in moderation, listen to your body, and even go out for a brisk walk prior or after your meal. Even a small amount of exercise can make you digest your food better and have you feeling better. From car accidents to trips and falls and even alcohol poisoning, over consumption of alcohol is the cause of many holiday-related ER visits and is the number one reasons for deaths in young adults. It’s extremely important to watch how much you drink.

Let’s be honest, the ER is the last place anyone wants to be in the holidays. These simple tips can hopefully make your holidays ER-free. From all of us at Northwestern Memorial Hospital and the Department of Emergency Medicine – Happy Holidays!

The July 2011 Heat Wave

Chicago, please know it’s pretty hot outside! ABC national newsclip on the heat: