Been a while since I’ve done one of these.
A recent personal health related saga motivated me to put this one together. 👇
A 🧵
1/
A recent personal health related saga motivated me to put this one together. 👇
A 🧵
1/
First off, I am now fully recovered.
Thankful to the fantastic clinical teams @WRBethesda for the excellent and timely care provided. 🙏
2/
Thankful to the fantastic clinical teams @WRBethesda for the excellent and timely care provided. 🙏
2/
3 months ago, I began having post-prandial epigastric abdominal pain lasting 30-90 mins would resolve spontaneously…until one night, it just didn’t.
Pain 10/10. Could not sit still, constant with intermittently colicky. Went to the nearest ED.
3/
Pain 10/10. Could not sit still, constant with intermittently colicky. Went to the nearest ED.
3/
Closest ED at the time which was @InovaHealth Fairfax.
As I was being checked in, I was basically on the floor, writhing in pain.
Not expecting anyone to jump through any hoops, but the lack of empathy or compassion from nearly everyone was immediate and palpable. 😐
4/
As I was being checked in, I was basically on the floor, writhing in pain.
Not expecting anyone to jump through any hoops, but the lack of empathy or compassion from nearly everyone was immediate and palpable. 😐
4/
Receptionist was stone faced and robotic…not an ounce of urgency displayed.
Almost as if she did not believe my pain was real.
After about 30 mins on the floor of the lobby in ED – a kind soul finally brought a wheelchair to bring me into the triage area.
5/
Almost as if she did not believe my pain was real.
After about 30 mins on the floor of the lobby in ED – a kind soul finally brought a wheelchair to bring me into the triage area.
5/
Once placed in a room in a hospital bed, I asked for something for my pain.
Another wave of skepticism exhibited by a total lack of empathy, no urgency.
I let them know at that time. “Look, I am an #CritCare doc.
This is the LAST place I want to be.
Please help."
6/
Another wave of skepticism exhibited by a total lack of empathy, no urgency.
I let them know at that time. “Look, I am an #CritCare doc.
This is the LAST place I want to be.
Please help."
6/
✅ UNMET NEED #1 – Need a reliable way to detect REAL pain.
It was clear that I was automatically labeled as a drug seeker.
I don’t blame anyone for this, but we need to be able to differentiate real from “fake” pain.
Anyone in #MedTech or #MedTwitter looking at this?
7/
It was clear that I was automatically labeled as a drug seeker.
I don’t blame anyone for this, but we need to be able to differentiate real from “fake” pain.
Anyone in #MedTech or #MedTwitter looking at this?
7/
After about an hour, I received 4 mg of Morphine.
My pain went from a 10 to a 9.
I asked for something more – eyes rolling now.
👉Another hour passed. 8 mg of morphine this time.
👉Another reluctant 8 mg given 90 mins later.
Finally, I was no longer writhing.
8/
My pain went from a 10 to a 9.
I asked for something more – eyes rolling now.
👉Another hour passed. 8 mg of morphine this time.
👉Another reluctant 8 mg given 90 mins later.
Finally, I was no longer writhing.
8/
UNMET NEED #2 – in the face of our current opioid crisis, there is a clear and immediate need for a non-opioid, non-addictive, alternative for pain (besides just NSAIDs or acetaminophen).
I know many are working on this.
👉Thoughts on how close we are?
9/
I know many are working on this.
👉Thoughts on how close we are?
9/
Labs sent. RUQ US done.
Pain now bearable.
I was NPO, felt parched, and a bit lightheaded.
I asked for some IVF which seemed to irritate the nurse.
No indication for IVFs I was told.
Reluctantly - LR started.
Damn pendulum - some IVFs are OK!
10/
Pain now bearable.
I was NPO, felt parched, and a bit lightheaded.
I asked for some IVF which seemed to irritate the nurse.
No indication for IVFs I was told.
Reluctantly - LR started.
Damn pendulum - some IVFs are OK!
10/
At this point, I am convinced I have an obstructed bile duct.
To my amazement, RUQ US was NEGATIVE.
✅CBD 4 mm.
✅No stones.
✅No GB wall thickening.
✅No fluid.
✅Pan labs all normal.
Of course - this only reinforced the impression that I was a drug seeker.
11/
To my amazement, RUQ US was NEGATIVE.
✅CBD 4 mm.
✅No stones.
✅No GB wall thickening.
✅No fluid.
✅Pan labs all normal.
Of course - this only reinforced the impression that I was a drug seeker.
11/
ED doc to his credit, even ordered a CT scan and acknowledged that it was odd that I had severe pain.
Not sure how genuine, but the first pseudo-acknowledgment that my pain was real.
CT was basically negative.
Him - “maybe you passed a small stone” 🤷
12/
Not sure how genuine, but the first pseudo-acknowledgment that my pain was real.
CT was basically negative.
Him - “maybe you passed a small stone” 🤷
12/
Fast forward 3 months.
Recovering from a mild case of #COVID.
Decide to self-medicate (a lot) with ibuprofen and acetaminophen throughout the night.
Pain is bad…but going to the ED (my mind) would be worse.
✅Chills
✅Sweats
✅Fever
✅No sleep
I power through.
13/
Recovering from a mild case of #COVID.
Decide to self-medicate (a lot) with ibuprofen and acetaminophen throughout the night.
Pain is bad…but going to the ED (my mind) would be worse.
✅Chills
✅Sweats
✅Fever
✅No sleep
I power through.
13/
Two days later, my wife tells me “your eyeballs are yellow”...
Went to go get labs.
👉Biliary obstructive pattern with increased transaminases and lipase! 😮
Still having residual pains.
Went to Walter Reed this time.
14/
Went to go get labs.
👉Biliary obstructive pattern with increased transaminases and lipase! 😮
Still having residual pains.
Went to Walter Reed this time.
14/
Admitted to hospital.
Ultrasound shows thickened gallbladder, possible PERFORATION! Read “could be cancer” 😱
CT scan done shows terrible looking gallbladder with tons of inflammation.
Neither US or CT show stones.
MRCP 👉gallstone in the CBD and stones in the GB.
15/
Ultrasound shows thickened gallbladder, possible PERFORATION! Read “could be cancer” 😱
CT scan done shows terrible looking gallbladder with tons of inflammation.
Neither US or CT show stones.
MRCP 👉gallstone in the CBD and stones in the GB.
15/
ERCP - CBD stone extraction.
Lap chole – confirms that my “liver, duodenum and omentum basically contained an exploding gall bladder” (not my words)!
Partial chole followed by stent placement.
Now fully recovered.
I feel very fortunate. 🙏🙏🙏
16/
Lap chole – confirms that my “liver, duodenum and omentum basically contained an exploding gall bladder” (not my words)!
Partial chole followed by stent placement.
Now fully recovered.
I feel very fortunate. 🙏🙏🙏
16/
A couple of lessons for #MedTwitter
✅Don’t be a hero (or do what I did).
✅US and CT scan can MISS gallstones!
How common this is?? #GITwitter #Surgery
/End
✅Don’t be a hero (or do what I did).
✅US and CT scan can MISS gallstones!
How common this is?? #GITwitter #Surgery
/End
Ok. One more. Pictures from my Lap Chole. 
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