Favorite Quotes
"For every complex problem, there is a solution that is simple, neat, and wrong." - HL Mencken
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"I hear and I forget. I see and I remember. I do and I understand." - Confucius
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"The good physician treats the disease; the great physician treats the patient who has the disease" - Sir William Osler
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" The best test of a person's character is how he or she treats those with less power." - Bob Sutton
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"Those are my principles, and if you don't like them - well, I have others." - Groucho Marx
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"The difference between genius and stupidity is that genius has its limits." - Albert Einstein
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"It is hard enough to remember my opinions, without also remembering my reasons for them" - Friedrich Nietzsche
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"Anyone can make the simple complicated. Creativity is making the complicated simple." - Charles Mingus
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"Not everything that can be counted counts, and not everything that counts can be counted." - Albert Einstein
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"A foolish consistency is the hobgoblin of little minds, adored by little statesman and philosophers and divines. With consistency a great soul has simply nothing to do." - Ralph Waldo Emerson
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"This ain't no party, this ain't no disco, this ain't no fooling around." - Talking Heads, Life During Wartime
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"What is hateful to you, do not do to your neighbour. This is the whole Torah; all the rest is commentary. Go and learn it." - Hillel, Talmud, Shabbath 31a
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"You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing." - Thomas Sowell
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"An idealist is one who, on noticing that a rose smells better than a cabbage, concludes that it will also make better soup." - HL Mencken
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"If you only have a hammer, you tend to see every problem as a nail." - Abraham Maslow
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"A great teacher is one who realizes that he himself is also a student and whose goal is not to dictate the answers, but to stimulate his students creativity enough so that they go out and find the answers themselves." - Herbie Hancock
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"There are no facts, only interpretations." - Nietzsche
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"An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you do know and what you don't." - Anatole France
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"In character, in manner, in style, in all things, the supreme excellence is simplicity." - Henry Wadsworth Longfellow ====
Nov - 15
Dec - 19
Jan - 21
Feb - 8
Mar -
17 days at the VA – Day 10
24 Nov2009
We were on call on day 10. I saw one new patient – a 38-year-old man with abdominal pain. His pain started in the middle of the night – it was sharp, mid-epigastric without radiation. He had several episodes of vomiting.
At the bedside I took a food history. He had eaten a tuna salad sandwich for lunch on Sunday – he made the tuna salad fresh and the mayonnaise came from the refrigerator. He ate "a lot of junk" food later that day.
He denies any previous such pain history. He has no major medical problems.
I saw him in the afternoon; the pain had receded from 8/10 to 3/10. He denied any diarrhea.
His exam revealed some mid-epigastric tenderness, but no guarding or rebound.
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This morning he felt back to normal and was hungry. His labs were all normal. CT of the abdomen showed one gallstone; RUQ ultrasound showed multiple stones.
Does he need a cholecystectomy?
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- What caused the pancreatitis?
- 15 days at the VA – day 10
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- In: Medical Rants
3 Responses to 17 days at the VA – Day 10
Un-named
November 24th, 2009 at 6:33 pm
To me, not yet.
Jared
November 25th, 2009 at 8:30 am
Without knowing the thickness of the walls of the gallbladder, I would say that I cannot make a surgical determination.
However, just because the mayo was in the fridge, does not mean that it had not previously spent considerable time out of the fridge… or other ingredients/meals.
My feeling is without marked inflammation in the gallbladder it is of gastric or pancreatic origin.
Robyn
November 25th, 2009 at 7:28 pm
Jared – Commercially prepared mayo is pretty good to go even when opened and left out of the refrigerator for hours. OTOH – I'm not sure why anyone would leave mayo out for hours – or use warm mayo in a salad of any kind (unless the mayo came from an unopened jar and the salad was to be refrigerated). So I would pretty much rule out GI problems as a result of food poisoning.
Not being a doctor (just a decent cook who has never poisoned anyone) – don't have a clue about any other Dx. I would ask the patient if he experienced constipation – not only diarrhea (some GI problems can present with either or both symptoms). I would also ask him how much junk food he had – what kinds – and how much beer he drank to wash it down (smile)? Also how often he ate this way. Also whether he ever had pain on a scale of 8/10 before – and what it was (many guys are kind of wusses when it comes to pain).
BTW – don't know beans about gallstones (never had any – knock wood) - but here is an explanation for non-doctors:
http://womenshealth.about.com/cs/gallbladder/a/gallstonessymtr.htm
Robyn