They Told Her It Was Just A Wine Headache (w/Dr. Kathy Travnicek) | Incident Report 242

They Told Her It Was Just A Wine Headache (w/Dr. Kathy Travnicek) | Incident Report 242


– What up, fam? It’s your boy, ZDogg
MD, welcome to the show. This is going live to supporters because I love my supporter tribe. Thank you for subscribing. You get this stuff first
completely uncensored. We’ll decide whether to censor it for the main audience when we put it out. The way we do it now is
we go live to supporters. We get your comments. We interact with you and then, we go to a
podcast in a couple days. So, that’s out to the world and then to the main page for everybody to watch via web posts, YouTube, all that. But, getting it here first means you get your questions answered. Today, we have a crazy story. This is insane. So you guys all remember
Dr. Kathy Travnicek from three previous
episodes that she’s been on. She is a physical med and rehab doc right here in Las Vegas, specializes in pain. So we’ve done shows on Dilaudid. We’ve done shows on running ultramarathons and crazy endurance sports. And we’ve done shows on, you know should physicians
be packing guns, all kinds of crazy topics. Kathy T. is our go to person. But something crazy happened in the last few months. I got a text from Kathy T. and she’s like, I’m in the hospital and you’ll never believe what happened. So, she’s here today to
talk about what happened because it is a cautionary
tale for all of us. Kathy T., welcome to the show! – Well, hello. – How are you? You look good, girl! – I, well, I’m fully recovered 100% good and I’m exercising again. – The thing is like you almost died and yet, here you are. You just got back from Egypt. You’re going to Toronto to speak. You’re on the circuit
talking about pain management and things like this. But the thing is, you almost died. And when I got that text from you, I remember just going, oh my gosh, what? And just start at the
beginning of what happened? And walk us through it
because it is insane. – It really is insane. And I would’ve never thought
that it would happen. So, I’m at Hubert Keller’s birthday party. Okay–
– Oh wow. a surprise birthday party. – Big chef guy? – Yeah. And I’m hanging out talking. I’d been there for about eight hours. Actually, before I went, that morning, I ran 18 miles. – You know, just a morning run, 18 miles.
– Morning, easy run. So, you guys who don’t know, Kathy’s like a serious endurance athlete. So she is crazy. You’ve climbed Everest a couple times? – In my dreams, but yes. – Oh, nice. – Yeah (laughing).
– Nice, nice. – So go on. So you’re at Keller’s party. – Yeah and before I’d went there, at one o’ clock, I’d had some lunch. So I go to the party around two and around 9:00 PM I’m talking and hanging out. I had not had that much to drink that day. I’d had maybe a glass or two of wine and I had some food. I got a severe, like sudden severe headache and it started in the back of my head and it radiated to the front. It felt like electric lightning. I remember going, ow, ow. I was talking to someone and they said, you know are you okay? And I’m like, yeah, I’m fine. Because in my mind, I
thought this will go away. And it just kept shooting and I said, I’ll be right back. I went and I sat down with my friends who were with me there and I said, hey guys, I got a really bad headache. They said, are you okay? Are you okay? In my mind, I’m always, okay, yeah, I’m fine. I’m fine, I’m fine. Then, I felt sick. So I went to one of the back bathrooms. I went in the bathroom, locked the door and had nausea and
vomiting in the bathroom for about 20 minutes. And as I’m throwing up and laying on the floor feeling sick, I’m kind of like what is this? I’m probably dehydrated, maybe I have a virus. Because I had thrown up my lunch, which I’d eaten at one o’ clock, it’s now 9:00 PM. So in my mind, I had some virus, so I’m thinking, I have to get home, how am I gonna get home, I can’t drive like this. – Are you still having the headache? The crazy– – Severe headache. – Have you ever had anything like this? – Never had a headache ever
in my life, period, never. Never had a headache. And so I get up about, it was about 20, 30 minutes later, I get up and I walk out. And I feel, I’m convincing
myself that I’m okay, I’m gonna drive home and I’m
just gonna sleep this off. – Wow. And this is at Keller’s party? – This is at Keller’s party. – And let me just recap– – And I didn’t want to tell anybody because of where I was at. – Oh my gosh. – I pretended I was totally fine because I was embarrassed, I didn’t want to cause a scene. – Oh my gosh. You know this running
18 miles in the morning, that’s not unusual for you. – No, I run 18 to 20 miles every Sunday. – That’s crazy. – Thank you. – And also awesome. – Yeah. – So, at this point, you’re embarrassed. You’re like, I’m just gonna get home, walk it off, sleep it off, all that. – Yep, yep, so I drive home. I didn’t have any other symptoms. The drunk feeling went away. I didn’t really feel drunk but the severe headache was there. I’d made sure not to drive interstate so I drove the side roads home and I pulled over every
mile or two to throw up. – Oh my God. And I would wait and then
I drove to the house, parked and went upstairs,
got in bed and laid down and thought, okay, good, I’m safe. I’m at home. I’ll be fine. I’ll sleep a few hours, I’ll go to work in the morning. This will be fine. And as the night went on, I got some sleep, but the nausea and vomiting resolved and the headache got worse.
– Wow. And, you know as a pain
management specialist, I’m going through how bad is the headache, how bad could this really be? What is this on the pain scale? Because you know when I’m
explaining to patients who, you know they come in, they circle their whole body, they write 20 plus–
– Right. and I’m like, hey, let’s talk about
what a 10 out of 10 is. You’re getting mauled by a bear. You’ve been hit by a car and it’s dragging you down the road. You know all these ideas of what 10 out of 10 pain is. When I thought about those, no, it’s not really a 10. It’s, I don’t know, it’s moderate pain. It’s pretty bad, but I can get up. I walked around and drove home and I was thinking about the ultras. There were a few ultras that were very, very painful and I’m like well it’s definitely not that. So I was trying to put it in context of my experiences of how bad the pain was. So I rationalized it wasn’t that bad, it was gonna be okay. – We’re really good at
rationalizing as doctors, right. – Yeah. – And we’re good at going
into work when we’re sick. – Yeah.
– We’re good at sucking it up. We’re good at all of those things and nurses are even better at it. – Yeah, 100%. So I realized I needed to go to the ER in the morning when I stood up out of bed and everything went white and I had a severe headache and I fell back in bed. So I said okay, that was bad. Now I can’t function so now I’m gonna go to the ER. This is ER status now. But the pain in my mind I thought you know, I can handle this. I kept telling myself
I’m tougher than this, I can handle this. It’s not that bad. – And you have a trained mind because you’re running ultras and
doing these extreme things that require mind over body. – Yes, yes, you’re working through a lot of pain or it’s a
lot of mental tasking. So I had called my neighbor, who had incidentally
had an ischemic stroke six months earlier and I’d help him with his dog and stuff
so he took my dog, Yogi, and he drove me to the hospital. I remember, you know it’s Vegas in June so it’s very sunny and I remember it being very bright and
I had my sunglasses on. But it’s Vegas in June and everybody has photophobia, right? So I didn’t really
recognize it as a symptom until I got into the hospital because then it was like kind of a hard to see things. So the first hospital I went to– – No names, please.
– No names, no names. Perfect, there was nobody
in the waiting room. I got right in, triaged right away. And I at this point,
sorry I forgot to mention, when I was at my house
I was taking my vitals, I was doing a physical exam on myself. I was like maybe I blew a C23 disc and I’m like doing neck tenderness. I’m seriously doing diagnostic
triaging at my house. – Well of course you are.
– Yeah. – Yeah, of course you are.
(laughing) Because I mean I would do the same thing. I’ve done that. – Yeah, my meningeal
signs, the whole thing. And I had nuchal rigidity at this point. I couldn’t move my head because
I got a severe headache. – Wow! – So I’m sitting in the chair and I’m looking up at the PA like this because I can’t look up, my eyes are going up. So I explain to her the story. I said yes, I have a severe headache. I don’t have a history of headache, this is completely new. I tell her the story
but what she heard was I was at a party, I had a glass of wine, and now I have a headache. That’s all she heard. So she looks at me and says, after I tell her the whole story– – And she’s seeing a young woman. – Yes, young woman,
blonde, Vegas, whatever. But I can’t move my head
and she still says to me oh, sounds like a wine headache. We’ll give you the migraine cocktail and we’ll send you home. And the fire that just boiled, I was fucking pissed. I was so pissed because first of all I’m a pain management physician. I wouldn’t be in the ER for a
fucking wine headache, okay. And I’ve had wine in my day, I’ve never gotten a headache from it. Two, I run ultras, and I said this to her. I said I’m a pain management physician. I have to assess pain everyday. Two, I run ultras. I’m running 50 mile races all the time. And number three, I wouldn’t be in the fucking ER with a wine headache. Get me the doctor now. Like that’s all I said. And I couldn’t look at her like at that point I’d looked down so I don’t know what her reaction was. All I know is she was
gone and I was in the back and I was talking to the
ER doctor right away. – Wow, holy shit! – So had I not advocated for myself or had I not kept
rationalizing I was okay, which I had been doing
the 12 hours before, I would have probably got
the cocktail and sent home and then who knows what
would have happened. – And you know, I can tell you right now what that PA was thinking is here’s a fucking great example of how doctors are the worst fucking patients. – Yep.
– Like she thinks she knows everything,
she’s talking down to me even though she can’t
make eye contact with me. This and this and this,
that’s what she’s thinking. – Yeah, but I told her,
I can not move my head to look up at you. And she said, do you
have any neck tenderness. And I remember saying
no, I’ve done the exam. I did all my physical exam stuff at home. I can’t move my head,
I have nuchal rigidity. It hurts, the headache’s severe, my neurological exam is normal. I’m showing her my reflex and yeah. – And you’re afebrile, right? – Completely. I had checked my temperature at home. I was monitoring my pulse at home. But still for some reason
in my mind I had a virus. I had an early meningitis or something because in my mind I was looking at everything that had happened and trying to figure out from what happened that day what this could be but
bleed never crossed my mind. – Common things happen commonly so you’re thinking it’s
a viral meningitis, some kind of viral, another
viral syndrome with headache. You’ve never had anything like this and you’ve been through a lot of stuff. – Yeah.
– Oh, my God. And you know, did they do any
labs or anything off the bat? – Yeah, so I was right
when they took me back there was a nurse who was on her computer facing away from me and she says what do you want for pain? This is actually the
first thing that happened. And I said well, just
IV Tylenol will be fine. I don’t really want anything else. She said we don’t have IV Tylenol but we have Toradol and morphine so which one do you want? And I said don’t give me the morphine, I don’t want that. I’ll just take the Toradol. Because again, I’m not
thinking I have a bleed. I’m completely, it’s viral. I’ll get some antibiotics
or I’ll get some treatment and I’ll be out of here. – Wow. – So she almost gives
it to me and then says you know what, let me check
with the doctor first. And so she went to the
back and he said no, I’m ruling out a head bleed. So she came back and said I can’t give you any blood thinning medications because we are ruling out bleed. And that’s at that point I’m like oh, it ain’t that but that’s okay. So (laughing)–
– It’s funny. How many patients have come into the Emergency Department like first of all I don’t want the morphine, fucking give me IV Tylenol? Who says that?
– Yeah, I do. – Nobody, except for Kathy T. because you know why? Because Kathy T. has years
of experience managing pain. Now this is what really
fucking chaps my hide is that there’s so many patients who are effectively dependent on opioids who think that IV Tylenol is a joke and this and this and this and that’s not how you manage pain and they are so fucking wrong. – Yeah.
– But that’s all right. That’s another subject. – I actually learned that. So I learned how powerful Tylenol was as a pain management tool in my internship at University of Nevada Reno. We would have elderly patients come in with hip fractures and they
couldn’t tolerate the opiates and we would give them Tylenol scheduled and they would do fine. – They do fine.
– They do fine. You don’t need an opiate for that. And I learned that in internship and I’ve carried that with me throughout my entire career. – See we trained at different times. You know what I learned at internship? That we’re under treating pain and that narcotics don’t lead to addiction in people who have any pain of any sort. Fucking bullshit.
– Yeah, it’s crazy. It’s crazy. – So back to you in the emergency room having the worst headache, the
first headache, of your life. The first headache–
– The very first. – of your life. Forget about worst. Nuchal rigidity, your neck is stiff, you’ve sent the PA out, the doctor’s here. And sometimes a doctor’s
worse than anybody else. – He was fantastic. – That’s awesome. – The ER doctor was fantastic. He took me seriously and he said, the first thing he said was I don’t think you have meningitis. I’ve seen a lot of
meningitis cases even early. You just, something else is going on. So he had a feeling it was something else, he just didn’t know what. So had the labs, had the CT head, and the whole time I’m there I’m just observing the ER, watching patients, trying to just distract myself. And I refused any pain
medication while I was there. I was just I don’t need
it, I can tolerate this. Because the headache
would pulsate and then it would crescendo and spike and then it would decrescendo.
– Wow. – So I was just paying attention to the headache and my heart rate and the physiological mechanisms
that were happening. And then they called my name and they brought me back
and they give me a gown. They said you need to put this on. They started to put the EKG lubes on, we need to hook you up,
we need to monitor you. And I said, oh shit.
– Oh wow. – Then I got scared.
– Yeah, yeah, yeah. – Then I got scared and I went blank. When I went blank I couldn’t
think of what it could be. You’re panicked, you’re
scared, you’re vulnerable. You turn into 100% patient, there’s no doctor there. Like I’m not being a doctor now. Now I’m just a vulnerable patient. And I got in bed and the
doctor came in with a nurse and they both grabbed
my had and I’m thinking I have cancer. I didn’t, you know when they come in and do that– – That’s where your mind
jumped to, to cancer? – That’s where my mind jumped
because I’m just scared. So there’s no rational
thought, you’re just scared. So he said you know I can’t believe I’m saying this to you but you have a subarachnoid hemorrhage
and it’s not that small and we need to transfer you to the Level 1 trauma center here in town. You’re probably gonna need
a neurosurgical procedure. – Wow.
– And I just started bawling. – Oh, my God.
– And that’s when I lost it. And that’s when I texted you because I knew where I was going. I’m like you need to come
see me in the hospital. – Yeah, yeah, yeah, yeah. – And then my parents and other
people that I’m close with. Made sure my dog was okay. And then texted the guy who dropped me off who had a stroke. I had told him oh, I’ll
just get some antibiotics or I’ll get some fluids or something. I’ll be fine. You’ll come pick me up in an hour. And I texted him, I’m like,
I actually had a stroke. – Holy crap! – So then it got real I had a stroke. And I’m in my 30s and I had a stroke. – That is unbelievable. When I got the text from
you my jaw had dropped. And immediately I talked to my wife who actually does a lot
of neuroradiology at night and I think we ended up
looking at your films. But we’re cutting ahead. The hospital you were transferring to was the right answer so everything
was being done correctly. – Correct.
– And oh my gosh, man. And you’re kind of alone in Vegas, right. Or do you have– – Yeah, I’m alone and my
parents are in Mississippi and then my boyfriend is in LA. I have friends all over the country and I do have friends here but in terms of direct family nobody’s here. So I was just telling people to come travel in and then everybody that I knew who was a neurosurgeon I would call. And I couldn’t text very well because the screen of the light was causing, I was having that photosensitivity. – Even that much light? – Yeah. And then when I was crying uncontrollably I couldn’t call people. I had to wait for that to go away before I could make a phone call. – I love how you, that
was a condition that I suffered from for a minute where I was crying uncontrollably. I needed to wait for that to resolve. – Yeah, that resolved and
then I made a phone call. (laughing) – Oh, man. I’m just glad you’re alive
to laugh about it now and to talk about it
and to spread the word. So at this point you probably got… So tell me, keep going with the story because this is something
everybody needs to hear. Because first of all,
young people get strokes. Second of all, we deny
women’s symptoms all the time. It’s a wine headache,
come on, fucking come on. Number next, okay, how
do we manage this now and how did it happen? Everybody’s got the questions. We’re all on the edge of our seats. Tell us the story. – Okay. So I get transferred to UMC
right away in an ambulance and that ride wouldn’t have been so bad had it not been for all of the bumps. Every time I hit a bump I was like ow. And then it would go down. And the guys, they were
trying to tell stories to distract me and they–
– The EMS guys. – Yeah, and anytime we
would hit it and say oh, they’d be like, we have
morphine, we have morphine. And I said, I don’t want the morphine. Because it would spike to a 10, it would be severe but
then it would come down. It would go down to more
of a moderate level. So I could tolerate a few
seconds of a 10 out of 10 and so I didn’t want the mediation. So we get to UMC, I get into the ER, which that ER is packed
like balls to the wall. – Yeah, that ER is cra!
– It’s crazy. – We’ve shot videos in that ER. – It’s crazy, it’s crazy. – That’s where we shot Readmission. – So two of my friends in town
came to the ER to be with me and they were scared. Like they were full on scared (laughing). – In the Emergency Department. – In the Emergency Department at UMC. It was great, that was a funniest part. (laughing) I’m trying to calm them down. In my own ER room. – Right.
(laughing) I’ve been in that position. Yeah, wow.
– It was so funny. And the nurse was fantastic,
the ER doctor was fantastic. The initial process there
was great, they were great. The funny thing is so the ER doctor, they go through the medical history and ask you about your medications. The nurse comes through
and does the same thing, asks you your medications. And then is when I had realized I was gonna be admitted and so the pharmacists comes in and
he asks my home medications. I’ve got two home medications
and I had like four or five. Then there was somebody else who asked me, maybe he was a resident. So four people and they
were never even ordered. Not that that’s huge but think about it, you have four people coming in doing a job and I’ve got the ER doctor putting it in, and then I’ve got the nurse checking it, and then I’m being
transferred to the neuro ICU, the resident’s supposed to check that, and the pharmacist is
supposed to check it, and they were all missed. I mean for patients who are complicated I thought, how often does this happen? – Every single fucking day. – It’s crazy. – It’s crazy because we don’t
have a system, we have chaos. We don’t have a process,
we have a bunch of parallel processes all
competing with each other. We don’t do it right
in the hospital at all. And I’ll tell you this
as a hospital specialist, it is a fucking shit show most of the time in every, every organization. – And I was shocked because I thought these are not high level meds. I got two meds, it’s not a big deal. So but while I was in
the ER I got the CTA. Now when I got the CTA it had been about 16 to 18 hours after the initial headache. This is me after I’d gone back and kind of wrote all this down. Later on after I recovered
I wrote the history down. So I’m realizing that now
it was about 16 to 18 hours. And as I’m transferring from one bed to the other bed in the CTA room I got this severe sacral pain. And it wasn’t low back pain it was sacral and it outlined my sacrum. And it was so bad it took my breath away. It was worse than the headache. And I thought okay, yeah,
the headache’s not a 10, that’s a 10. And I remember sitting there and I gasped and the CT Tech said, are you okay. Yeah, yeah, yeah, I’m fine. You know me. Yeah, yeah, I’m fine, just
some sacral pain, it’s fine. And I remember thinking,
oh shit, what is that? I don’t know what that is. And it was not from bedrest because I had only been laying
in a bed for a few hours. It couldn’t have been bedrest and it wasn’t my low back either. So get the CTA–
– It’s a CTA angiogram so they’re outlining the
vessels in your brain. – Yes, yes. And boy is it weird getting that contrast. – Tell me about that because
a lot of people say this but no one tells the patient, except for the great techs. – Yes, nobody told me except the tech. So I get in there and he says, it’s gonna be hot, it’s
gonna be uncomfortable, it’s gonna spread throughout your body and it’s gonna feel like
you have to urinate. And I thought oh yeah, that’s
not a big deal, whatever. It’s really uncomfortable and it started in my arm when he put in the contrast, and it went up and it spread
into my head and my face to where my mouth felt hot. And I opened my mouth
because I was like ahh– – You’re gonna breathe fire. – To get the heat out
because it felt so hot. And then it went down my body, it felt like I had to urinate, and then it was over. But I thought, I don’t
want to do that again. That’s not fun. – How interesting, you never hear that. – So I was trying to ask people, you know when you start asking people very detailed questions that
are physics really questions like why do I feel hot? Oh, it’s the ion movements. (laughing) – Nobody has a fucking clue, right. – Yeah, yeah, yeah. And at that point I was
like good enough for me. I was so tired and just kind
of burnt out, it’s fine. (laughing) That was pretty funny. – Yeah, that’s pretty good. – So I get up into the neuro ICU and this is when I realized I
miss the days of paper charts. – Tell me why, this is interesting. – So I’m in the ICU
and I hadn’t had fluids and I knew I’d had that contrast and I knew I was getting another femoral angio through a femoral approach. – Tell the people who don’t know why contrast and not
getting fluids is a thing, is a bad problem. – Kidney failure. – Yeah, one of the
complications of IV contrast. – Yeah, and it’s not uncommon. So I’m thinking okay, I’m dehydrated. I haven’t had anything to drink. I just had a contrast
scan and they told me they were gonna order fluids. They didn’t order fluids or they did and then I got transferred
before I got them. So now I’m in the ICU and
the nurse is fantastic. The nurses in the neuro ICU are fantastic. – Oh hell yeah. – So I’m telling her I
really need IV fluids. You can starve me for
10 days, I don’t care. I need IV fluids. And I can see the doctors rounding with their little computer thing. – WOWs, workstation on wheels. – Yeah, anyways. – I miss the day when
we could call ’em COWs. – Why can’t you call ’em COWs? – Apparently a patient overheard residents talking about their COW and they thought that they were talking about the patient because the patient was obese. (laughing) And so in the infinite
wisdom of management they’re like uh, from
henceforth shalt it be written that we shall call them
WOWs, workstation on wheels, instead of computers on
wheels, which is what they are. – Oh, my God, that’s awesome. – So the residents got the COWs. – The COWs, okay. So I see the COW, the WOW, and I remember saying to her, can you just pop over there and tell them that I haven’t had fluids. I’m gonna have a another contrast. All they need to do is order some fluids, that’s all I need. I don’t want to complain
about anything else, I just want some fluids. And she went there and told them and then she went there and told them this is over a few hours I didn’t get the fluid order. And I remember thinking
remember back in the day when you could just call the nurse when you were rounding on another floor and say hey, you know what, I forgot to write that fluid order. Or they’ll call you, hey,
this patient needs fluids. Sure, go ahead do this, set this up. I’ll come by and I’ll
sign it in a little bit. So I’d write it down that
I gave that verbal order. They’d write it in the
chart, verbal order, and the fluids would have got hung. And I sat there and waited
because it needed to be put in the fucking computer. – You know what, fuck the computer. – Yeah, exactly. – And the thing is we’ve
trained our staff so much to be dependent on the
computer that when it fails it’s downtime orders
and everyone panics man. But I’ll tell you, when
I worked at Stanford and we had EPIC then I would cross the bay because we would rotate
to Washington Hospital and Fremont Community Hospital. There was nothing, it was
paper charts to start with and just read only version of EPIC. Oh, my God it was great. And you know what, we
were 100% more collegial. We had a doctor’s lounge. The nurses and us were all friends. We would talk to each other.
– Yes. – It was fucking great.
– Yes. And people now are relying
too much on the computer and I realized that
during my stay in the ICU because I had, there was an ICU attending. I only saw him once and he
didn’t really do anything. It was really neurology
would come in and then I had neurosurgery and then because UMC has this continuity of care, the Internal Medicine
doctor that I was gonna be transferred to on the floor eventually would come and see me. So I would have four doctors and I had a few different residents
who rarely identified themselves or what service they were on. And they weren’t talking to each other. So there was no team work. And one would come in and
tell me this is the plan and then someone else
would come in the room and tell me a different plan. And at one point I thought, thank God I’m alert and oriented because
I’m a make my own plan. So I talked to the neurosurgeon and then I talked to a bunch of
my neurosurgery friends and they all had a same plan, they were all on the same page, and I said, this is what we’re gonna do. Neurosurgery says we’re gonna
do this, this, and this, and we’re gonna do this, this, and this. So if the ICU resident came in and said, oh we’re gonna discharge you today, out. Go talk to neurosurgery. Like I can’t do that. Then neurology would come and say well we think we’re gonna
discharge you tomorrow, maybe the day after. We’ll do CTA as an outpatient. And I just said look, I can’t, there’s so many different opinions here. Please talk to neurosurgery, please. We’re just gonna do what neurosurgery says because they are taking
this very seriously because you can miss an
aneurysm on the first angio. Yeah, go ahead. – No, I want to ask you this because what did the angio show because
I think people are asking what was it? Was it an aneurysm? What was it? – So my CTA was negative and when the resident came in the room his response was, your CTA is negative and that’s kind of weird. That’s how that was relayed to me. (laughing) – So you had a bleed on
your standard CT non-con. Is that what they saw? – Yeah, so they saw a
subarachnoid hemorrhage on the CT. The CTA was negative. – So they didn’t see anything
bleeding from a vessel. No aneurysm, right. – Then they said we need to do an angio femoral approach the next day. So I was scheduled with
interventional radiology. I went in Monday morning at 9 AM, I got that on Tuesday morning 9 AM. – Got it.
– And it was negative. And at that time, so
my baseline heart rate, this is another thing, my
baseline heart rate is in the 40s and my blood pressure baseline
is 90 over 60 consistently. – Right, because you’re an
athlete, an endurance athlete. – So my initial, when I
was first hospitalized, my blood pressure was like 120s over 80s and my heart rate was like 60, 70, so it’s a little bit higher. – High for you, yeah.
– Yeah, high for me. So when I went to have my first angio, they were able to give
me a little bit of Versed to relax me for the angio. I remember being relaxed and they have to walk you through it. And then you have to either the tech or the radiologist says
to hold your breath, so you hold your breath. They shoot the contrast
and they take the pictures. And you can feel the
contrast in each blood vessel of your brain.
– Wow. – It’s fascinating, it’s fascinating. – And you’re also kind of
doped out a little on Versed. – Yeah, so the first angio
I was a little relaxed but I was awake and
aware and I could feel it but I was okay with it. The second angio all my vitals
had gone back to normal. So my baseline heart
rate was like 43 I think when I went down there and 90 over 60 and nobody wanted to give me any sedation. – Because they were treating the numbers– – They were treating the numbers. So they don’t, in the
hospital everyone’s so used to treating sick patients,
they don’t know how to treat healthy patients. And so–
– Definitely true. – And they really didn’t
want to give me any sedation and I said I’m about to have this angio with no sedation, let’s do this. Like I don’t have a choice, let’s do it. And it wasn’t painful. You don’t really need an
opiate for this procedure. If I were to tell
physicians, even patients, you don’t need fentanyl,
you don’t need an opiate, you need the Versed. I had significant anxiety
because I could kind of feel that coil and I
was like oh, oh, oh, oh. – Wow, wow. – Yeah, yeah, and then
everything’s more intense. The contrast is more
intense when they’re like hold your breath, (mouth noise), whoa. – Man.
– Yeah, it was way more intense, but you could, whatever. You know I got through it. – Yeah, but you’re you. – Yeah, I mean a regular patient would need Versed for that procedure. Yeah, 100%. It was negative.
– Wow. – So the response I got
from the neurologist is that we don’t know why you bled, we don’t know what this is. What did he say? The chance of this happening to you is like getting hit by lightning. The chance of it ever happening again is probably getting hit by lightning twice so live your life, go do your thing. But I still didn’t have what it was, what a diagnosis was. I’m like well how can you say that if you don’t know what the is? – And you had a subarachnoid
bleed without a source. – Yeah, without an aneurysm. When you look at stroke, 87% are ischemic and the other 13% are
subarachnoid hemorrhage. And then when you just take
the subarachnoid hemorrhage, maybe 85% is an aneurysm bleed, whether trauma, ruptured aneurysm. And then the other 10% is non-aneurysm subarachnoid
hemorrhage and that’s what I had. So the working diagnosis is perimesencephalic subarachnoid hemorrhage. Say that five times fast. – Perimesencephalic
subarachnoid hemorrhage. That’s what my wife called it when she saw your stuff. She was like oh yes, we see this. And I was like huh
because as a hospitalist I’m like como? – Yeah, I never heard of it. It was a first time I’d ever heard of it. So the neurosurgeon
was the one who came in and said you had a perimesencephalic subarachnoid hemorrhage. We don’t know why people have this. It could be an arterial venous bleed. It’s thought to be more
to have a venous source but we don’t know. But patients do very well. There’s no long-term risk. You can go back to living
your life, doing your thing. So there’s no limitations. – So it was like an anomaly that happened. – Yes. – And you’re not doing lines of coke and smoking crack and doing meth. – Now by the way, I was
not tested for that. So let’s talk about that. – Let’s talk about that. Oh, Kathy T. is a local doctor in town. We’ll give her a pass, treat her as a VIP. Funny, you got all the negative effects of being a physician patient. – Unfortunately, yes. – Being a woman, being
blonde, living in Vegas. – Yeah, I mean it varied by provider in terms of the judgment or the treatment that I got so probably that first PA I was just some little white, blonde girl in Vegas who was drunk and
just needed a cocktail. A migraine cocktail, not a real cocktail. – One of the few times white
people get treated worse. (laughing) – Yeah, yeah for sure. White bias.
– Right, right. – And then the other times I think I was treated differently
because I was a physician. But physicians have
substance use disorders and physicians, I mean
cocaine and methamphetamines in Nevada are coming
back as the number one abused substances, even more than heroine. And so when someone comes in
with any type of head bleed, you should be testing for substances that cause any of those things. And cocaine is known to cause
subarachnoid hemorrhage. – Yeah, of course. But the first thing I thought. – And I wouldn’t have been offended. – I know, when I read
your story I was like, did I not know Kathy was a coke abuser. – I don’t like to tell people. – I know, neither do I. I just snort it and then pretend I didn’t. But no I mean you have
to treat your patients as if you would treat any other patient. And that’s the problem
with the VIP syndrome, that’s the problem with physicians. And again, you were a
victim of all these biases. What if that were the case,
they would have missed that. – Yeah. The other thing that was interesting is for the pain management throughout the hospitalization stay was interesting. So people push opiates more than I was, I was surprised to be honest. So they would ask what my pain score was and I would say look, let’s
say it’s a moderate pain, I’ll give it a five, six at baseline and then it would crescendo to a 10 and then it would come back down. But it would be there a few seconds and come down and I kept
telling myself you know what, I can tolerate this. But at night it got pretty bad and they kept telling me we don’t have any pain medication for this. You have to take an opiate. An opiate’s the only thing that works. – Wow.
– That’s it. And I hadn’t looked up, I had photophobia at the
time but I did this later. But I hadn’t looked up the guidelines for pain management of
subarachnoid hemorrhage. And I couldn’t initially because I couldn’t read the computer screen. My mom had come at this time, she’d brought my computer in but I couldn’t look at the screen. So I remember one night it was particularly bad and
I had trouble sleeping and I thought let me just
try a little fentanyl, just give me a little bit. And one reason they use fentanyl is it has a lower hypotensive effect and that’s why they give the fentanyl. So I got a dose of it and I remember sitting there sometime later just feeling sedated and tired but
the pain was still there. It didn’t do anything. And I just thought,
this stuff doesn’t work. And when you have opiates in a situation where you need to monitor
for neurological compromise it’s not really the
best medication to use. So I told the nurse once
I was the next morning, I said take it off my med list. I don’t want it on my med list, I’m not gonna take it, it didn’t work. It sedated me and it could alter my neurological exam and I don’t want another $100,000 work up for a stroke I didn’t have. – Wow, holy shit man. It’s so rare in these interviews where I’m just sitting here
like this the whole time. Like just getting schooled. (Kathy T. laughing) This is amazing. You know we did a show
with a dude out of Yale who was talking about
subcutaneous opioid protocol. – Yes, is saw that, that was cool. – And it’s interesting because we do in the hospital create a lot of problems. Because what if they had given you like just repeated opioids,
you’re getting the buzz without any–
– Without any pain relief. – And the next thing you know you’re out on the pills and the next thing you know you’re doing heroine. – Yep, and nobody did, that’s the other thing, nobody did any type of
opiate risk assessment or addiction assessment. So nobody asked me if I
had a history of addiction to any substance or if I had abused any substance in the past. No one had asked if I had a
family history of addiction. Now sure, you walk in and they’ll say, what’s your family history? Uh, my mom, you think immediately like my mom has diabetes and
high blood pressure, whatever it is, and then you move on. But I’ve learned in my practice you have to specifically
ask about addiction because patient’s don’t identify that as a medical disorder. They will not tell you. So you have to ask, have
you ever used a substance. And I don’t use legality as a judge point. – You don’t say an
illegal substance, right. – Legal, illegal, it doesn’t matter. It doesn’t matter. I mean people are addicted to food. Look at the obesity epidemic. Sugar’s legal, people are addicted to it. So legality has nothing
to do with addiction. So I would specifically ask do you have a personal history with addiction? Do you have a personal history of using substances that alter your mind that you have a problem with? Do you have a family history
of any addiction to anything? I just open the flood gates. Gambling, food, nicotine, alcohol. And they’ll tell you but if you don’t specifically ask I’ve never had a patient just tell me their father was an alcoholic in their family medical history unless I ask specifically. And that never happened in my stay. And when you look at all
the opiate risk tools for who’s at risk for addiction, nobody asked me any of
those specific questions. So they would never know. So the question to me was why you’re encouraging opiates for
what I later found out, later on when I Googled, I
literally did a Google search and then did a PubMed search on what the guidelines were for pain management in subarachnoid hemorrhage. There are none because nothing works. – Wow.
– Yeah. Opiates don’t work, they don’t work. Yeah. And I would read some of these websites, opiates are the only pain reliever. Give fentanyl, give fentanyl, but there would be no citation for where they got that data from. It was just like you should do this but I couldn’t find the
literature supporting it. – Right.
– Because there is none. – You know Kathy it’s crazy because when this all happened I think a couple of weeks had gone by, you’d been discharged,
you were doing okay, the crisis was over, the acute crisis– – I think I had had my MRI. I had to have a repeat
MRI to make sure that when the blood was gone
there wasn’t a tumor. – Right, so how did that go? – Fine, normal.
– Good. And I remember you reached
out and you were like there’s a lot of shit
that went fucking crazy that your audience needs to know about. And I said yeah, it sounds like it. And then you sent a typed thing because you were like
I need to type this up before I forget. – It took me a few days and
I had to think and go back. – I still have it and
it is 90% more detailed and more angry because I think you were truly traumatized by
this experience at the time. – At the time I was. Now I’m still just mad
about the wine headache. That really pisses me off
still, that’s the main thing. Because it affected my entire stay because I was worried
I was gonna be judged, because I had been judged
in my first encounter. So every time someone came in the room I made sure that wasn’t, I really tried to make it a point not to be judged. So I knew about asshole
doctors as patients. I wasn’t gonna be an asshole. I tried to be nice. I also knew that people, I just really tried to make it easy because I was afraid of being judged because I had been judged. And it could have cost me. It could have cost other patients. So when you look at young patients who present with stroke, and classically for my type of stroke it’s severe, worst headache of your life, nausea, vomiting. You can get meningeal signs and you can get photophobia but mostly it’s severe headache, nausea, vomiting. – And that’s all it is and that could be mixed up with a lot of things. – Exactly. So when I went and looked
at some of the numbers in terms of stroke, the
rates for ischemic stroke are increasing in patients aged 30 to 40 because of obesity and
diabetes and hypertension. But in my non-aneurysm type stroke where we don’t know the risk factors. There aren’t really any risk factors, it’s just a random event. Those types of strokes are not increasing. – I see.
– And so when a young patient comes in you still have stroke is still in your differential diagnosis. You still have to think about it, it’s got to be on that list because ischemic stroke is going up in the population and you will see young patients with stroke. And there was an article I was reading in the New York Times where they quoted a study that showed that
one in seven patients that are younger that present with stroke are misdiagnosed. – I think I saw that
article and we actually did a show on a UCLA study
about young people with stroke and then we made a video,
Can’t Feel My Face, a parody of The Weeknd’s, trying to recognize the FAST acronym. And now it’s even BE FAST. Balance, I forget what the E is now. They always add acronyms. Well someone will have
to school me on this. But the bottom line is it’s
a real thing in young people. I don’t know if I ever
told you this story, this is nothing like what you went through and yet a parallel
track where it was minor but could have been the end of my life. And it was simply I’m
sitting there with Josh.O, we’re running turntables, it was like three or four years ago. And I’m typing on the computer, and this again what’s it like when a physician becomes a patient. And there’s a shame component because what you said about how you were judged for the wine headache,
let’s not minimize that. It tainted the entire stay for you because you know there’s a
component of shame or judgment. We all as humans feel that. And think about our poor patients who come in and maybe they’re
addicted to crack cocaine– – Yeah, they get judged all the time. – They get judged all the time. – Yeah, it’s not a disease. They’re crazy, get ’em out. – That’s right and in the beginning, you don’t think that
taints their stay, right. – 100%. – We’re biased on every
level for everything against physicians because
of the VIP syndrome, there’s racial bias,
there’s socioeconomic bias, there’s substance abuse and legal bias, how do we treat our jail patients, all these other things, because we’re not perfect, we’re humans. We can’t blame people for this but we have to institute
institutional structures that help us do better. That’s why I think certain protocols, certain processes,
certain repeatable steps would have prevented
some of the missed things that might have happened. – Yeah, absolutely. I mean I teach this even to patients when they come into me with a compliant. I have a it’s called a
differential diagnosis. We practice medicine
based on probabilities. So you have a list of probabilities, you have a list of possibilities and what our job is to do is to figure out what the diagnosis is but we
have to work through this. So I tell patients it may
be this, it may be this. This is what we’re gonna do
to try and figure this out. So I try to educate my patients on that because I have had some patients say I went to this doctor
and they misdiagnosed me so I just left. Wait a minute, wait a
minute, wait a minute. Maybe they did but did
they have a list of things that it could be that
they were working through? Sometimes we don’t get
it right the first time, I get it. – Yeah, that’s why we’re– – A differential diagnosis is there. It’s not this is what you have, bye. – So Andy Reid says balance and the BE stands for balance and
eyes, vision changes. Which makes perfect sense. – Yeah and I had, does photophobia account for vision changes? – Yeah, I would think
so, I would think so. Now the other thing I would say, so we were talking about protocols. I’ll say to the defense of UMC Hospital, they’re probably the best hospital in town and I’ve seen the same– – Oh yeah. I still had good care by most of them. – But the thing is what happened to you happens at the best
academic medical centers around the country and
it’s this discohesion, competing processes– – They’re on the computer,
they think other people are reading their note and
they don’t have to communicate. That’s a problem. – We call that electronic silos. – Oh, it’s terrible. – And we put it in our rap song, EHR State of Mind, for that very reason that they are horrible. It used to be we talked to each other. So that’s the other thing. And then working as a team that’s cohesive instead of these separate elements always trying to turf and bump and well we’re gonna discharge,
no we’re gonna discharge. What you did was you took an advocacy role and said listen no, we’re gonna do what the quarterback says. And in this case with this
disease it’s the neurosurgeon. – It’s neurosurgery.
– It’s neurosurgery. It’s not the intern, it’s not this. That’s brilliant so that’s a lesson for people for self-advocacy
in the hospital. We will you and I will do a show in the future about how
to advocate for yourself when you’re in the hospital. I think it’s a great topic. And that’ll be out for the muggles. Now getting back to what happened to me because this is all about me, Kathy. – Of course. – Yes, you’re a superhero athlete, yes, you’re an amazing pain doc and a tremendous teacher and I’m humbled in your presence, honestly. It’s amazing to sit here and listen to you but hear about me.
– Let’s do it. – I’m sitting here, I’m
typing on the computer and I suddenly have a visual defect. So I can not see the words on the page. And I’m looking at it, now at this point I’m 39 or 40. – And your first thought’s probably, how much coffee did I have today. That’s what I would have thought. – Exactly, I’m like rubbing my eyes. And I’m sitting with Josh and we’re both working on trying to get turntable of the ground and it’s 110 degrees outside. It’s maybe my first or
second Vegas summer. Maybe my first Vegas summer. I’m coming from the Bay Area and I’m like man this is weird. And then finally I’m like, Josh, is my computer screwed up. I slide it over and
he’s like no, it’s fine. He reads it to me and I’m like, I can’t read a single word on this. It’s all rubbish. And then things started getting weirder. So all of my peripheral vision started to get kind of hazy and I started seeing the words kind of moving and getting this feeling of disengagement like something’s not right. Like the tunnel is closing and I’ve never felt this in my life. I’m like holy shit. No headache, no nothing. So at this point I turn to Josh and I go, Josh.O, I don’t want to frighten you, I’m a 40-year-old man. And at this point I didn’t realize that I had this clotting predisposition that I had done 23 &
Me and found out I have Factor 5 leiden and heterozygous and prothrombin 20210A heterozygous. So if I had known that I would have gone to the ER right away. – When you’re done with this story I want to ask you a
question about 23 & Me. – Oh, totally, totally, totally. It’s a good conversation. So at this point I’m just a youngish guy who has no family history of anything, I’m a physician, and I’m going through the differential in my head. My head is foggy. – Right, so you don’t
get the full differential because you’re not 100%. I did the same thing. – I’m not 100%. Isn’t it weird and you’re
sitting there going okay, I hope I’m not missing anything because even at my best I’m
pretty developmentally delayed. (Kathy T. laughing) And now I’m really at a disadvantage and I’m with a guy who’s
23 who knows nothing about medicine. So in strange town with no support except for the family’s off somewhere. So I start going okay, Josh, I need you to Google
for me in a doctor way. So I need you to Google visual field disturbance, no headache. And he does that and he comes up with some images and I can now see only out of the corner of my vision. My macular vision is bad. So I look out of the corner and it shows exactly what I’m starting to see which is a fortification spectra. Which is a scintillating sort of thing like this with distortion all around it. And it’s in both eyes. I close my eyes, I see it in both eyes. When I close my eyes I still see it. And at this point I’m like
this sounds lik a migraine aura but I have no headache and
I’ve never had migraines. And I go okay, listen
Josh, this is the thing. I am going to self-diagnosis
myself right now with the nuance that migraine
aura without headache. – So did you go to the ER
and get a migraine cocktail? (laughing) – The aura’s set, a little of that lala. No, I told them I said if
I stop being able to speak, if I look weak, if I’m not able to stand, if there’s anything else wrong with me, you are responsible for calling 9-1-1. And he goes, you could
see this kid, he’s 23. His eyes get really big and he’s like this doctor is telling
me that there’s a chance that he’s gonna have to call 9-1-1. So now suddenly all eyes are on me. And I’m like, just give me a few minutes. I’m gonna sit here, give me a water, and I’m watching it
happen and I’m like oh, this is like I remember from the textbook. And then it evolves out
and I start to get better and then a little mild
headache right frontal temporal and the whole thing lasted
about an hour and it was done. – Wow. – And I tell you if I were a muggle, I would have gone to the ER and it would have been the right answer. Right now in retrospect it was. I’ve had them since then
maybe two or three times and it has to do probably with, I talked to a neurology buddy at UCSF, high heat, low humidity environments for the first time often can trigger that in some patients migraines
with visual symptoms. So for me that’s probably what it was. – So is that why you’re moving? – That’s why I’m moving, yeah. You know what though, Kathy T.? – What? – We’re gonna still have
you on the show though all the time. – Okay, thanks. – Because I’m still gonna
be back in Vegas quite a bit and we’re keeping the studio. – Yeah, the studio is amazing. – And so don’t you fret, Kathy T. Vegas is still near and dear to my heart. But yeah, so the bottom line is we need to be better patients but see the thing is if you hadn’t advocated as a physician things
could have gotten ugly. And you might have gotten a test that wasn’t necessary that then led to iatrogenic complications that
then led to real problems. So it’s scary. – It really is, it really is scary. And after I was, the
last thing that happened. There were two more things that happened in terms of medications. So when I was on the step down unit, that sacral pain got worse. – Yeah, tell me about
that sacral pain, yeah. We never followed up on that. – So the headache started getting better and the sacral pain got
worse and it would come very randomly. And at one point I got up in the morning and I wasn’t allowed to exercise for about a month or two so I was doing like leg swings, range of motion exercises and I’m standing there and I go to walk around the unit and thank God I was right by my bed. It came on and it was so severe I had to get in bed. I almost fell down because
the pain was so bad. And I thought okay, I got
to ask about this again. So I called a neurosurgery friend because I’m like I’m not asking the, I can’t, neurology, I had asked neurology. They, I don’t know what that is. I don’t know what it is. The Internal Medicine asked neurology. It’s just punt, punt, punt, they just would punt it to somebody else and then it would get punted again. So my neurosurgery friend said oh, I know exactly what that is. He said probably what happened is the blood products have descended to the lower sacral sac and that’s why it’s pulsating and it’s just
causing pain down there. So that will resolve. – Holy fucking shit. – So I was pissed, why
didn’t I think of that. – Well because you’re not a neurosurgeon. (laughing) – That but it makes so much sense. And it pulsated like my
headache had pulsated. – Because blood vessels that are beating are squeezing the blood products. – Yes, yes.
– Holy crap. – It was just very
bizarre that it outlined, like it perfectly outlined my sacrum. It was the bizarrest thing ever. – Is that the way the
cecal sac is just shaped? I don’t even know, I don’t
know the amount any more. – So it comes around the spinal cord and then it ends around S1,
S2, in that lower sacral area. And so I think, just
because I had a little bit down that was pulling
there, and that’s why it just affected the sacral
root in the sacral area. – And some of that pain
may even be referred. I mean you never know whether
it’s kind of deep pain. – And nothing really helped. So at that point I thought
I need something for this because this is bad. But again I didn’t want and opiate. By this time my photophobia had gone away so now I’m on doing my PubMed searches on pain management for meningeal pain and I look up Gabapentin. I’m like Gabapentin
would be great for this. And the Internal Medicine doctor didn’t want to write me any medications until he cleared it with neurology because he didn’t feel comfortable. Totally respectable, I get it. So I said okay, I’m gonna bill a Level 4 pain management consult. I’m gonna do my own pain management. (laughing) So I go through, I go look up Gabapentin and it actually was recently approved for safety in bleeds. In any type of head bleeds
you can use Gabapentin safely. That came out in like 2014, 2015. So I’m like okay, check, safe. Next, now what dose
should I start myself at? So I thought I’ll just
start at what I would start it in a patient my age. So I told the nurse,
I said call the doctor and have him write 300 mg of Gabapentin in the morning and then two 300s at night. Let me start with one. I’ll take two if I need it. Let’s just see. And she says okay. So she calls the Internal Medicine doctor who refuses to do it, calls the neurologist. So I don’t hear back for maybe a day. Because I was in the
hospital for eight days so it was like two days later that the Internal Medicine doctor comes in and he says I’m sorry, I
didn’t want to write anything. I had to clear it with neurology. Neurology said it was okay. I said oh yeah, I know it’s okay. I can send you the data that they did that this is safe to use in bleeding. And he said, I’ll just
write whatever you want. Then they ended up
writing it so I took it. It ended up helping, I could sleep. So I took the Gabapentin at night, which really helped me sleep which did help just overall. – You did your own pain consult. – I did my own consult. – See this is the thing, the instinct on the part of the team is to be defensive about that. Oh, fuck. – No, they weren’t defensive at all, which was nice. – That’s good. – But I’m sure they would have. – If it were me I would
have been defensive. – Yeah, you would have been like shut up. – Yeah, like oh great. Actually that’s not true because when you have a specialist. So Kathy T. is a pain specialist. So it’s one thing if you’re a psychiatrist and you’re like I want Dilaudid for my– – I need Xanax.
– Right, right. (Kathy T. laughing)
And then you’re like well hmm, physician treat thyself with thy drugs and become thy addict. Sorry, suffer from they addiction. – Yeah, thank you.
– Thank you. So you had a question
for me about 23 & Me. – Okay. So my 23 & Me when I did it came back, it was like stellar. So what I wanted to do is send it to my insurance company for a discount. (laughing) I’m gonna take exception with this and I’ll tell you why. Because mine was fucked up and if my insurance company, if there are pre-existing conditions, even though I’ve had no clots, nothing, they’re gonna look at the fact that I have a 75% lifetime probability of having a DVT based on
studies that are squirrely and then they’re gonna
say you’re uninsurable. So it’s a double-edged sword. – So whenever you have
some type of health, well I looked up perimesencephalic stroke and future outcomes. And on the stroke AHA website they did a study on this because patients were being denied health
insurance and life insurance. – Based on a previous stroke. – Yes, based on a previous stroke. So it is published in the stroke journal that patients with
perimesencephalic stroke do well, have little to
no risk of re-bleeding, and have no change in
their life expectancy. So we should not be judged or penalized by physicians, life, and health insurances. – I fucking love it. – Thank God they published that. – That’s so good.
– It’s amazing. – Because you know it’s come up. – Yeah, and unfortunately in medicine now we have to think this way and we have to publish shit like that. – Yeah, yeah. God bless us sometimes. – I know. Sometimes we do okay stuff. – And I hate us sometimes. Sometime we do okay and
sometimes we are so fallible and I want to be replaced by a computer. – Some days I’m like computers. (laughing) – By the way, I want to thank Kathy T. for a specific gift that she gave me. She always comes bearing gifts and today’s gift is this. I was hoping for a battle of wits with you but you appear to be unarmed. And this was specifically aimed at you, every single anti-vaxxer
that I’m looking at. (Kathy T. laughing) So thank you. By the way, we did the whole show on how anti-vax memes are just the dumbest– – The memes.
– The memes, oh, that’s right. – I call ’em memes. – Yeah, Kathy T. on our first show she’s like isn’t it memes? Like you did not know
the pronunciation of meme because why would you. – And even when you corrected me, I was like it’s a meme. – It’s a meme. You know what I think it’s
la meme choix in French, it’s the same thing. (foreign language) the more things change, the
more they stay the same. – Exactly. – And memes have stayed
the same for too long with anti-vaxxers. They are dumb.
– Yeah. – Kathy T., any parting words? Should we take some comments? Hit me with the parting words. – Parting words are
there are a lot of people who your life could end at any moment. You don’t know how much
time you have here. – This is getting dark. – Actually no, I mean I think that you really have to
analyze what you’re doing and if you’re happy. If you have a bucket list, if there are things you want to do and you haven’t done them, if you’re unhappy with
something you’re doing and you need to make a change, do it now because you really don’t know how much time you have left. So make the most of the time you do have. – Damn. I mean living in the moment, me? Hell nah. I’m always living three
seconds behind girl. (laughing) – I’m in yesterday. – I’m still living in this moment. Hey guys, what’s going on. Anyways man, I got to say. The comments are mostly like uh, so there’s no much to read here. I just got to say this, I am so glad that you’re
alive, that you are well. – Thanks, me too, thank you. – I’m so glad that you could come out of this and teach us about everything that’s wrong and right. And also I think you’re gonna save a life because someone’s gonna have the symptom and is gonna go in and be like I remember Kathy T. talking about this and I’m not gonna miss it. Dude, so grateful to you. – Oh, thank you. – So grateful. So looking forward to
hanging out in the future and having you back on the show. – Ahh, thank you. – And I still think that guest host that like ZDogg and Kathy T, kind of like Regis and Kathy Lee– – We should, I thought about that like I’ll have a glass of wine. – Of course you will. And then they’ll accuse you
of having a wine headache. – Yeah, and then I’ll be a drunkard. (laughing) – It always struck me that
Regis was the alcoholic. Hey, what’s going on? I don’t know, hey, give me another. What’s this, water? No, it’s vodka. Ah, Kathy T., thanks again. ZPac, I want to thank
you for being with us. Supporters thank you so much. Sign up as a supporter if you haven’t. If your seeing this on the replay, please share it with
people you care about. Spread the word. And we out, peace! Do we need a thumbnail Tom Hyniver. – Do it! – Okay, we look over here, Kathy T. And we kind of make a face like the thumbnail face. Like duck face, both of us duck face. – Wait, am I looking here? – No, at that little
camera up there, yeah. – Okay. – Right in the lens and you
make a little duck face. (ZDogg laughing)

77 Replies to “They Told Her It Was Just A Wine Headache (w/Dr. Kathy Travnicek) | Incident Report 242”

  1. While I'm not a medical professional, I learned a long time ago that I have to advocate for myself.

    At the age of 20 I started to take birth control and after only about 3 weeks started to have severe pain in my left leg. I'm talking to the point where a prescription strength ibuprofen (800mg) didn't even touch the pain. I knew something wasn't right and I called my primary care doc and explained everything. Her EXACT words to me were "Well, it could be a blood clot, but stop taking the birth control and we'll see if that helps."

    Why did she brush me off? Because I was only 20…in her opinion I was too young for something like that to happen. My mom ended up taking me to the emergency clinic where they immediately sent me for an ultrasound…lo and behold there was a DVT in my left knee. The following 8 months were some of the worst in my life because I ended up with so much pain that some days I could barely walk. I was used to walking between 6 and 10 miles a day, and some days it was all I could do to get out of bed.

    I was also tested during that time for Factor V Leiden, which at the time wasn't all that well known. After that experience, I will NEVER let a doctor ignore my symptoms again. It doesn't matter how old or young you are…dangerous medical conditions can happen at any age.

  2. I'm a retired RN who was knocked under a loaded trailer & crushed & drug along the asphalt for 15-20 feet. I knew I had crushed my left chest because I heard & felt it. I immediately knew I had a flail chest & waited for the impending respiratory distress. I wouldn't let anyone help me to me feet, a gr8 decision! I also had open compound fractures of my left hand. I stayed in "nurse mode" even talking directly to dispatch. Long story short, the night before scheduled surgery, a multiple car wreck came thru the ER & ICU beds were needed. As I'd been stable, they elected to move me to a floor temporarily. The floor nurse came up to get me & I showed her that ONE of my IVs had blown. She started to tell me she couldn't move me refusing to believe me when I pointed out that I had two IVs while in the unit. This delayed transfer until close to change of shift. This resulted in 6 people trying to get me into the floor bed in a hurry. Even with pain meds on board, I was trying to direct safe care for myself. As I was being asked about my height (gotta get the numbers on transfer sheet!) , one of the aids elevated my left arm with one hand due to the 2 others using the draw sheet. Let me mention, I'm 5'2" & 110 pounds. I immediately felt the rib segments puncture my lung. I told staff to get stat portable chest X-ray & prepare to get trauma surgeon notified. They literally stood there for what seemed an eternity watching me struggle to breathe. When they realized what they had done, they did everything they could to cover their asses. They actually tried to imply that I was complaining because my pain control IV had infiltrated & THAT was my issue! Rushed back to ICU, I gave verbal OK for intubation & chest tubes. Surgery was done that day, hand repaired & ribs 2 thru 7 were plated. The hospital (a level 2 trauma hospital) really dismissed my continued desire to address the transfer issue which should have been looked at to prevent future incidents. I discussed a malpractice suit to be sure the hospital would address this issue & even with X-rays defining when the lung puncture had occurred, my attorney told me chances of prevailing was low & would cost me a ton of money up front. I'm NOT a litiginous person, I just wanted the hospital to deal with their procedures to prevent further incidents. I'm grateful to have recovered to the extent I have & always recommend people have family present when hospitalized. This is not always possible however & hospitals CAN do much better than they do. If Dr. Kathy thinks that her care was impacted by the staffs perception of her, just wait. When you're older & retired, you're treated much worse! Glad she had a good outcome, Drs becoming patients opens many eyes to the shortcomings of our medical systems!

  3. yea, it sucks when health care providers don't listen to their patients. as a nurse I can tell you the same thing is happening with parents of vaccine injured.

  4. This show was cool, up to point where you pooped on anti vaxxers. Zdog, you're too young, uninformed as a doctor. you have a long way to go.

  5. Lost my 36 y/o cousin to his 2nd stroke (1st @ 18) a couple years ago. Family has been on a young stroke awareness rampage ever since, after what they experienced (I’m in Aus). Started a foundation, the whole nine. I know if I get into med i’ll never forget this. Glad it’s getting airtime and attention. Glad Kathy T’s ok too.

  6. Can you and Cathy T please do a show on fibromyalgia, for medical professionals and muggals. Is fybromyalgia a real disease?

  7. Same thing happened to my sister, she had a history of brain tumors. Started having symptoms, headaches, vomiting, vision changes. Went to the ER and primary care multiple times and sent her home each time, she collapsed at work and she heard the paramedics complaining that they had to rush someone to the hospital that only has a "migraine". She had a tumor bigger then a golf ball and almost died. Her ICU doctor said he stayed up all night waiting for the call she had passed, he was so amazed that she survived and her type of tumor redeveloped. He wants to write a medical paper on her.

  8. I am glad she’s doing better!! Please please speak of rare diseases like mast cell activation syndrome…..and Ehlers Danlos!, not many know about these….and it is a good thing for medical people to be on the other side!! Iv Tylenol’s super expensive but amazing works amazing

  9. You aren't kidding about how reliant people are on the computers. "We're on downtime procedures," is waaaaayyyy to often followed by "What are my downtime procedures?" (I don't know. That's a clinical thing) or "So should I just go tell my patients we can't treat them because YOU can't do your job?" (because sarcasim is really going to help.) The way people react when one out of many systems is offline makes me deathly afraid of winding up in the hospital during a power outage when they're ALL offline.

  10. Thank you ! Fuck the computer !! I realize they are a wonderful asset in certain areas., but really ?? The patient is suffering because our system in this day and age is totally screwed up and priorities are just ass backwards !! It saddens me that patients are missing out , losing hope in healthcare in general, and probably not receiving the best treatment because they are more of a # instead of a human being who needs more hands on face to face attention and CARE. How has this happened ? it wasnt always this way !! I can assure you of this !! I practiced an RN for 25 years beginning in 1984. The patient came first we paid attention to them. we listened to them. they mattered. We touched and hugged and loved and genuinely cared !! the fucking computer and miles of paperwork came second. I understand the importance of documentation. but hey pay attention to the human soul who is sick and needs to know you care. they are at your mercy healthcare people !! communicate. Show compassion. Do the do!! Hands on / get it done !! Fuck that computer !! It will wait until later !! and the freakin hospital will get paid !! and maybe we will begin to see more patients thrive instead of just surviving the traumatic hospital

  11. Wow, this was amazing. So much information. Thank you. Glad she is well now. Fantastic podcast – first one I've heard/seen – hooked!

  12. Silly question, but given the ultimate diagnosis and outcome, wouldn't (in this case) the discharge as a wine headache have been just as good? A few weeks later and back to normal?

  13. my poor grandmother was in the hospital for a week (maybe more I can't remember) after a bad fall. The only medication that she desperately needed to function was her anti-depressants. what did she not get? her damn anti-depressants. so not only do you have an older woman who fell and needs to do PT and get her strength back. you have an older woman that doesn't want to eat and if she does eat you have to feed her because she's so tired she can't pick up her arm to feed herself. I've also had a family member die after getting an optional surgery because he had a blood clot. He complained about the pain but the nurses and doctors just gave him some morphine and told him to be quiet.

  14. 20 years ago this year, my 54 yo husband had a “subarachnoid hemorrhage of unknown etiology “ much more acute presentation. Initial CT: Blood in all 4 fissures. ICP within 12 hours, ended up with VP Shunt. 3 ateriograms were negative for aneurysm. What impressed me the most is that in 20 years, there is no more knowledge about this condition.
    What Dr T was told is the same that we were told 20 years ago.

  15. Always say that doctors need to spend a month being a patient and it will totally change how they practice. Also show how medically naive patients are screwed. I have MD and am so grateful that my schooling came in handy. Wasted tons of money going to school to not be able to work but at least I can direct my own care and do decent medical research. With a rare disease that has been key and I diagnosed myself before my doctors. Wish I could correct all the inaccuracies in my chart. So many inaccuracies.

  16. I'm no longer a nurse,. I worked in a small town and we still had not switched to Electronic charting etc. my daughter had a baby about that time. There were 8 nurses in her delivery room running around like they were crazy and the main focus was charting..I even heard one nurse tell another nurse, I wouldn't write that..it could be used against you. The dr. Came in finally yet was still gloving up and no one caught the baby. Thankfully my granddaughter did not fall off the table and was fine. I was just so angry about the care, and it made me think of where healthcare is now. The facility I worked at was finally switching over but I had already had enough of other issues. I stay home with my 4 yr old son now, Have more time for my physical and mental health. I am much happier. I still applaud all the nurses out there, most work really hard and care about their work.

  17. From an EMS perspective former/current nurses are my favorite patients because they tolerate pain pretty well, understand the EMS transfer of care process, give you a good report (basically) of what's happening to them, and let you do your job. Doctors and public safety professionals are the worst because the doctors downplay it and the Firefighter/Cops/Paramedics or whatever will tell you how they ran the same call better 20 years ago. Great episode, very educational

  18. The Entitled Doctor "whines" because she didn't "special treatment, BooHoo," while abusing the rest of the Cattle/patients in the Hospital.

  19. I'm on gabapentin for anxiety. I wish it helped with pain. I still get headaches at least once a week.

  20. This episode makes me so mad. As a physician who's taken my mother to the ER three times this week, I can promise you this is a problem in California too. The condescension of medicine, even to its own, is truly mind blowing. People are dying because of laziness. Only in the hospital and war can you murder someone with no repercussions.

  21. Th literature indicates that women, in general, aren’t taken seriously in medical settings. Now, just subtract from there with respect to minority experiences while seeking medical care. This might be eye-opening for the two of you, but for the general public, this docs experience is not out of the ordinary. Unfortunately.

  22. Great video! As a Physician Assistant if feel sad we are judged in unfavorable situations but we must know our limitation to be safe.

  23. I’ve seen this, maybe not to this scale before. I took my daughter in at 8 years old to the emergency room. She was found in the bathroom barely conscious. She could barely talk, and her vision was barely there but only red. ER was an hour drive away after I had help carrying her to the car. They came in, diagnosed her without a test, for strep throat. The only test they did perform was blood sugar which they said was fairly low, so they gave her some juice and sent me out with a prescription for an antibiotic. Later in life after she was an adult and struggled…and after I had attempted to get her PCP to do an A1C test at 17 years – that did not occur, she was diagnosed w type 1 diabetes and is currently on insulin. I am not a physician but had been around diabetics enough and kept trying to get someone to look into this. This is frustrating as I think this impacted her on a multitude of levels….and it was frustrating as a parent to watch her go through this nearly her entire life. It was also frustrating to not have anyone take me or her symptoms seriously. Thank you for letting me share.

  24. My last ER visit was an eye opener for me!!! I went in with nerve damage pain from my neck down my left arm (I have MS with lesions in my C spine along with my brain). I told them I was an 8 on the pain scale and for the next 20 mins all they wanted to talk about was giving me a flu shot. I do not take Flu Shots and was in so much pain, but I had to argue with them about it!!!! I did also refuse OxyContin, don't do those either… I finally left with the steroids I knew I needed , which I got relief by the next day. I am not a Doctor, but have known for many years the protocol for MS flare ups is steroid treatment.

  25. This was great! I am glad that all is okay with dr Kathy. Being a nurse and a patient with a number of issues, I truly understand the bias that goes with being female and in the medical profession. We are frequently brushed off. Case in point, last fall/winter was not feeling “right”. I pushed until had testing. Diagnosis in the end was esophageal CA T1b. I ended up,saving my own life. If I had listed to the doctors, come back in 6-12 months, would have been a completely different story. Being your own advocate is important especially when female and in the medical profession.
    Kudos to you Dr. Kathy.

  26. In the last month I’ve had 2 surgeries-1 to deal with emergency complications. Pain management is a joke. I was given nothing after. I have shaken for 3 weeks due to all the darn trauma. And my Doctor informed me that she’s no longer prescribing any opioids including what I occasionally get for migraines. Migraine due to my legal blindness. The system is broken. And it is breaking people.

  27. I’m sorry this happened to you and I’m not happy it happened but I am, let me explain: first I am medically trained but not a nurse or Dr… I can’t tell you how many times I’ve seen other patients and myself getting ignored, orders not being put in, getting treated like “oh it’s nothing serious” I am glad you’re ok, maybe forward your experience to the rest of the medical field to maybe help things change or go back to a coordinated effort

  28. Why don't doctors just stop being assholes? It's like someone told them that they were rock stars and they believed it.

  29. Good show guys!! The entire story is sadly on point. It reinforces the need to listen to your patients without bias, do your research, and don’t be afraid to ask. When we knew little our minds were open to possibilities, once we get highly educated the possibilities of seeing the zebra narrow. Use a few minutes to listen to the entire story and then communicated with the team. Continuity of care will save lives.

  30. Hold up………………this bitch expects me to believe she has NEVER had a headache -.-…………….come on now

  31. Sudden onset severe headache is a sign of bleed! How does an MD not know that? She keeps on talking herself and others out of a bleed! Why would she wait all night with a sudden onset worse headache of her life?!

  32. Most of the staff here doesn’t take anyone seriously in any practice here. I’ve been in moderate/severe back pain since I was 16 only getting worse 26 now. I’m worst horror story from my last ER experience. I was taken by ambulance for a severe asthma attack, couldn’t breathe almost at all when they got here. I was taken to the local ER here (which is a bandaid hospital as we call it) I was shaking really bad and freezing. I kept telling the nurse that I’m freezing cold and I mean it felt like I was in the snow naked cold. She told me she can’t give me any blankets and I’m cold because of my fever (I didn’t have a fever at any point not in the ambulance or there) I’ve got so many lead wires coming off me, bp super low when I came in from the ambulance, on oxygen because my levels were low and of course also received albuterol also. I had already told them I was also probably dehydrated because I had bath room issues from laxatives, I kept telling them I needed to use the bathroom and they kept ignoring me and I ended up getting sick on myself. I alerted the nurse that I’m now covered in feces, freezing, can barely breathe, low bp, super high heart rate. They said they were getting stuff to clean me up and be right back. I laid there crying because I was so embarrassed and sick with my husband next to me for 45 mins. Someone passed by my room and I yelled to them and they said they’d get someone. Waited another 30 mins. Finally I freaked out and started screaming at the top of my lungs for the fking doctor now. My husband had been running up and down the halls looking for help for me through all this too. The as much as I hate to say it bitch of the nurse I had came in and scolded me I demanded to be transferred to a hospital across town and that I demand the doctor in here now. The doctor comes in quickly he heard me yelling, of course I’m angry and scared and totally freaking out. I told him what happened and he looked like he was going to cry and was so upset for me. He apologized for the way I had been treated he would transfer me to any hospital I wanted to go to immediately. He said I should have never been treated the way I was, he’s new there and they have a lot of changes to make there, that no patient shouldn’t be treated the way I was at all. I was picked up by the ambulance for transfer the emt guys were awesome had a great conversation the whole 45 min ride to the new hospital. By this point at the new hospital I’m in the ER again of course and now my bp is high, my heart rate is high, oxygen still a little low but stabling out. I’m admitted. Of course they give me morphine around the clock for pain, Ativan via Iv for my anxiety (which I’m prescribed at the time daily also), they gave me both at the same time then of course I’m flying high out of it gave me a shot for blood thinner in my belly. Ironically my pcp was my inpatient doctor who also released me from the hospital after a week. We really need to take a hard look at our staffs in hospitals and the way patients are treated and not listened to almost at all. My pcp has also told me they won’t send me to a pain management doctor because of my age even though medications isn’t the only thing they could help with my pain. I was also told by a “ student” pa tell me I should just invest in a wheelchair and call it a day instead of trying to help me.

  33. Dr Z & Dt T, that was an awesome de-brief! The humor in the face of our mortality,humanity, and fucked up medical system, enables the healing insight!

  34. This is quite terrifying to listen to. I've just come out of a 4-day hospital trip with pneumonia (originally they thought it could be meningitis). As someone with no medical knowledge unlike Kathy Travnicek, I am entirely at the mercy of the medical professionals knowing what they are doing, since my medically uneducated opinion might make things worse. As a patient, I often don't even know who's a doctor and who's a nurse and who's a specialist. When you get different information from different people and you don't know what's going on, it makes you afraid and stressed at an already terrifying time.

  35. This was an awesome interview. I am an Associate's level RN but finishing my BSN in a few months. I'm currently doing an EBP paper on opioid education and I learned a few things in this interview, so THANK YOU!

  36. That opioid pushing is the real deal. I needed a refill of my fiorocet for migraines from my same primary office and they refilled it but with added codeine. For the following two weeks I had to dispute to reorder it without the codeine and ended up getting a refill from my obgyno instead who was already aware of my migraine history. I've since changed my primary provider.

  37. The initial experience in the ER mirrors my sons. He was having many neurological symptoms. He had been seen at urgent care and sent home after an xray and told to take Tylenol. His symptoms continued to increase and he was declining. He is a recovering addict, clean 8 years, and all they heard in the ER was addict. They kept asking about IV drug use etc. All his drug screens were negative. They told him it was anxiety. I am a nurse and it was a university hospital that I work at. The neuro people were willing to see him but the ER doc wouldn't request a consult..Finally convinced an NP I knew to see him. MRIs were done that showed something abnormal in his brain. I was then able to get a neuro oncologist that I knew to admit him. They ruled everything out. Again they focused on anxiety. He was becoming more anxious because now he was falling, losing vision and couldn't put a sentence together. We told the numerous docs he had had several tic bites but they pretty much ignored this. After much research I found a lyme disease specialist and he is being treated and is improving. Sometimes the system sucks!!!

  38. I had severe vertigo and dizziness that lasted a long time and when my friend finally took me to an ER to find out what is wrong the triage nurse looked at me and told her to take me to a psychiatrist while looking at me.

  39. AHHH!! Thanks for the shout out, Dr. Z! RN from WHHS! We still have great and amazing teamwork, but the computers are frustrating as ever.

    And seriously thank you so much for this topic. It was incredibly enlightening. When I care for physicians, nurses, and medical personale, they are some of the strongest patients I know.

    But I am also surprised. I always, upon admission to a unit, ask about substance use and or history of abuse. But I find that sometimes problem is my patients have been admitted for a while, and volunteer that information sometime during our conversations about health in general!

  40. It's sad how common this is. I had a similar experience. I was an ER nurse, whi would never go unless i thought i was dying, had headache like lava,stiff neck, fever, severe nausea/ vomiting, photosensitivity. Hx of migraines but this was 100x worse than I'd ever experienced. I thought i had meningitis and was treated like crap, told we don't give narcotics by an urgent care before going to ER. I said, i don't want your iv fentanyl, i want a cbc and a spinal tap. They did cbc/cmp only. They gave me iv benadryl and fentanyl, i was too sick to speak up for myself, sent home. Slept for a few days. Still don't know what was wrong, my head has never been the same, my good friend had west Nile around the same time. But it's very sad how we don't take people seriously sometimes.

  41. As much as I empathize with her story, you can read between the lines on this one and tell she was the most miserable patient to treat.

  42. This is a great video, but it really reminds me of the time I spent at Stanford being amazed from hearing intelligent people say fucking this and fucking that in almost every sentence they uttered. Come on people, you're better than that!

  43. Im glad you both are understanding that because of a look you get a bias…. sadly , I have to bring someone with me who will advocate for me because I cannot trust the judgement.. i am from a family of Docs and nurses. My son has autism and seizures. Im glad to hear you both talking about how we get judged by how we look. Its messed up.. i do love epic for only one reason. My docs have put and kept notes on top for the ER doc to see. Because they judge me because my insurance was stolen 9 years ago for 3 months drug seekers stole it. However my son at the worst incident of his life. Those trauma docs didn't call his neurologist. He was on meds. They refused to call them. I ended up calling them after surgery. They had to physically come to the hospital. To get the neuro team to give him hours normal meds… WHY?? ITS ON EPIC??

  44. This story reminds me of the time I went to the ER while I was breastfeeding and I had vomiting and lightheadedness, and a wedge of 1 breast was tender, hot, and red, and I could express PUS from my nipple. I was looked as like I was crazy when I presented saying, “I have mastitis and I’m worried I’m getting septic and need IV antibiotics.” They did give me IV antibiotics, but made a point of telling me I was not septic. They asked for a urine for a pregnancy test, which I had an exceedingly hard time giving since I was so dehydrated from the vomiting. It was not a mid-stream or clean catch. When reviewing my records later, I had tachycardia and a band count above 10%, therefore was septic per my training. (I never said I thought I was in septic shock). The kicker was my primary diagnosis: UTI. This from my urine with a few white cells, plenty of epithelial cells and ketones. And nothing on my chart saying mastitis. ???

  45. This video was super interesting!

    To me, it was the bit at the end that was the most interesting the talk about the "The Sacral Plexus" or nerve's..
    I didn't catch it all.

    Could someone please enlighten me on this. Did Ms.Travnicek come to a treatment for this? was their a solution to the
    pain she felt down around her "Sacral Plexus" area on her spine?

    I watched this part of the video twice, but I didn't catch her saying what exactly the solution was.

  46. At the age of 27 I had an episode of double vision and nausea. I have had really bad trips to our er so I went home and slept, then went to my doctor who said it was a really bad migraine. If they had used the fact that I couldn't stand and that my eye started wondering would have helped me. I didnt feel a 3rd degree burn for 4 days. A month later I was told it was a stroke, two months later it was a another thing. I went blind due to cataracts, got my surgery and I still had problems. 14 months after the episode I got diagnosed with a stroke in my thalamus and a year and a half later a second stroke was diagnosed in my cerebellum. Most doctors agree it was due to blood clotting problems from h1n1 and migrain meds and birth control. Also contrast is odd, never had any meds for over 14 scans over two years. The CTA sucks, it's the worse thing ever, also it can throw people with ashma into a bad attack. I cant do it again. Multiply doctors called me a liar to my face for years, my neuro dosent believe me, but he treats my migraines really well. You want pain relief, valum makes you not care, I dont like the feeling so I try not to take it.

  47. So, funny thing about contrast, I had a scan when I was in 7th grade and the contrast wasn’t really uncomfortable, I actually kind of enjoyed it lol.

  48. I work in a level 1 trauma center, blood bank. It's so obvious, even "behind the scenes", how bad communication has become with direct caregivers. Such bad delays in care. The system is broken. Looking forward to hearing more about healthcare 3.0.

  49. Now that's a suitable coffee cup for me but I prefer a lot of small cups. Self reveal, strong black coffee is my addiction.

  50. They did you dirty Doc! A wine headache? Someone who never gets headaches and is having nausea and vomiting and such a severe headache that they lock themselves in the bathroom while at work?! Yep, they definitely did you wrong and almost killed you to top it off. You look great and I hope that you feel better now.

  51. I think as providers it is easy to look at things only through the lens of our own specialty. I would guess an opiate risk assessment was not done because concern for a head bleed would take precedence. Unfortunately with the overwhelming workload one must prioritize what will harm the patient first. Head bleed vs. potential opioid addiction? 😬

  52. PA here. Last 1.5 years in urgent care and 10 years in the Army before that. Havent finished the video, just got to the part where the PA tried to kill her and had to chime in. There is no way I'd let a sudden onset, multiple emesis enducing, worst headache of life, in a rigid, photophobic patient with no prior headache history walk away without a noncon head CT. Doesn't matter how young, how fit, or how drunk. In fact, history of alcohol consumption should make you more prone to image d/t possible amnesia regarding mechanism or distraction preventing reliable exam.

  53. Listen. Understand. Even if you’re not an MD pay attention, advocate for yourself, try to avoid pain meds that leave you unable to think. The medical team are not out to get you, they’re overloaded & the computer systems really do seem to result in cross talk & missing or inaccurate information. Learn from this woman’s experience.

  54. It's unfortunate that you had a terrible experience with a PA who did not know what she didn't know. I'm a PA and I prefer to not deal with PAs or NPs when I seek healthcare. Quite frankly, if I had it to do over I would never have become a PA. Fortunately, I am now retired but wasted many, many years in a profession that I have a great disdain for.

  55. Fentanyl sucks ass. I'm a medical oncology nurse. Does nothing for our cancer patients. Good old oral oxycodone does a much better job.

  56. I loved the contrast. They did that for me when I had my first panic attack, and I didn't know what was happening, so my doctor thought I had a clot in my lungs. The nurse told me the same thing though "uncomfortable, slightly painful, don't worry about it unless it really hurts", which did not help on top of the needle phobia on top of the panic attack.

    She should have said it was like a summer vacation in your veins, it was awesome.

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