They Told Her It Was Just A Wine Headache (w/Dr. Kathy Travnicek) | Incident Report 242
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- Опубліковано 15 тра 2019
- When Dr. Kathy Travnicek, a 30-something pain doctor, had a sudden severe headache, she quickly learned what happens when a physician becomes a patient in our ridiculously dysfunctional healthcare system.
Links, audio podcast, and more at zdoggmd.com/podcasting/kathy-headache
Classic! Last year I tore my esophagus basically from just below the xiphoid to the diaphragm. I had gagged on a bit of steak, tried to swallow some wine. No help. I spewed red wine. I tried warm water. A glass of water going down met stomach contents coming up - pop goes the esophagus.
I get medical transport to the ER. I told the ER doc, "I blew up my esophagus." The ER doc looks at my wine stained shirt, poked my abdomen (much pain) asked what else I had to drink that day (4 beers). His instant diagnosis was "pancreatitis." When I asked; why it was medial pain?, why I was bringing up fresh blood?, and that the onset was with a food obstruction?, his answer was "You got me there."
I immediately transferred to the next nearest ER. On the way out I told him he could get work in a butcher's shop where his skills would match the job.
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.
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.
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.
Thank you for your service!
I had the same issue in the ER with a bowel obstruction. Almost died this Feb. Same scenario, high pain tolerance, athlete. Send home with a dx of an ovarian cyst came back to ER 8 hrs later in severe pain. Told the ER doc this was not an ovarian cyst and I wasn't going home till they checked me properly. Never even did an abdiminal assessment. Surgeon finally checked me and ran me to OR. I thought I was going to perf in the ER. Scary as F***
My friend who is a plastic surgeon had a volvulus and had the exact same scenario. They tried to discharge her and told her she must have had an ovarian cyst the ruptured in her late 30s without previous history of cysts. She protested and they finally relented and did a CT. Rushed into surgery and was 30 minutes from colostomy bag and perhaps death.
This is one of my fears! Because of the way healthcare workers dismiss my progressing declining health
@@christiscool4u I understand. I get treated with such suspicion de to some of my medication and the fact that I look pretty healthy compared to the reality. I have good aging genes. Unfortunately ER physicians see a whole mix of people and develop biases. I got sent home and basically got called a wimp. Luckily radiology does a 2nd pass on x-rays because the ER doctor missed my pneumothorax. He called me before I got home and told me to come back. The worst part was the doctor lied and told me he happened to look at my x-rays again and saw the collapsed lung that time. Didn't call him on the fact he was lying and he called right before shift change but at least I felt justified knowing that after 4 days of not being able to breathe I wasn't a wimp there was something seriously wrong. Chest tubes aren't fun.
A friend, who is a nurse, had headaches that got progressively worse. Docs couldn't find anything and labeled her a seeker. These were her co-workers! She remained insistent that there was something wrong. Good thing because she wound up having brain surgery to repair a congenital defect.
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.
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!
It’s true. When you are geriatric, they do not prioritize you. You are not considered worthy of their efforts and they make you wait, if they do anything at all. So frustrating.
The switch to EPIC and the computer charting becoming ruler over my profession as a nurse, I decided to leave nursing altogether. EVERYTHING was about the computer. It ruled everyone and everything. I couldn't have been more done. Don't believe I ever grieved this loss. I look back with great memories of a time when nurses and doctors would actually have a few minutes to talk and enjoy each other's presence. But what I miss most, was having a a few minutes of time to encourage and comfort my patients.
@Cat Bee I see the computer being the epicenter of my shift rather than the patient. I really try to make time to actually sit and talk to my patients during my shift, but it's hard. I understand why we have so many computerized steps, but it does cut into patient time.
I agree wholeheartedly!!! I hated EPIC!!!!!!! Still do and I am retired......thank God.....early retirement due to a surgery gone wrong>>>sepsis>> coma>> vent dependent for months and worse. It left me permanently disabled.
I left nursing as well.
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.
Interestingly i just finished nursing school and on my final exam, “worst headache of my life” was the answer to s&s’s of a bleed.
I have severe migraines and each new "headache" is the new "worst headache of my life" so no matter what happens to me in regards to a headache I'll never be listened to and will probably end up dead.
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!
Speaking as a nurse, we are the best deniers. Thank goodness all ended well
I’m kind of thankful that doctors are having this happen, it’s validating
Kinda like, "welcome to the club."
They're human...they even die...🤷♂️
L
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?!
I've been an RN for 29 years. I have had so many bad experiences as a patient. Ended up in the hospital for 17 days after doctors blew me off for 6 weeks and my colon almost perforated. During my blood transfusion they basically said that I was way sicker than I looked.😩😩😩😡
Lori C the one time I knew I was potentially very sick was when I was pregnant with my second child, nausea - vomiting - diarrhea - and my husband said to me on his way to work... “you should probably call the clinic today, because if you were my patient, I’d probably have you in the kennel on IV fluids”
Ok, so my husband is a large animal veterinarian. I did call the clinic. My husband was able to join me. In fact, when the MD couldn’t find a liter bag of IV fluid, the two doctors in the room agreed to use a liter from off my husband’s truck. Ever have a COLD IV? A very unique sensation.
@@tanya5322 LOL!
My adult daughter got really sick one weekend night, bad enough I took her to the ER. They assessed her, attributed it to early onset viral infection. BySunday, she had deteriorated so that I ended up taking her to a different ER. They wasted no time. The doctor diagnosed toxic megacolon secondary to C-diff. He instructed me to get a head start, as he was arranging her transport by ambulance to a larger hospital. She went straight to ICU. The Gastroenterologist summoned me at midnight; told me he had a surgeon on standby and that her condition was “very grave.” I almost lost my smart, vivacious, funny (a natural blonde, she knew more ‘blonde’ jokes than anyone else I knew) oldest daughter that night.
Long story short, she survived without surgery, and is doing well now, 12 years later. She got out of direct patient care - she was a CNA then - and is her healthy, vivacious self! I remember those feelings of helplessness and defeat when she was so ill. As an RN, I forgot everything I ever knew; I was just a mom who could have lost her daughter. Thankful for the healthcare professionals who helped her turn the page!
I had ALL the same symptoms & yep it was a stroke - when I was 32! And on top of that I have spina Bifida & hydrocephalus (I have a VP shunt), and I've had 63 surgeries.
Excellent post... I appreciate it more than y'all know. I'm 37, but a few years ago I had the exact same thing happened to me. I lived in Alaska at the time and the ER doc and nurses were fantastic. A few hours later I was on a medical flight to Seattle - I had to have a surgery but I was able to come home 2 weeks later.
Shout-out to my hemiplegic migraines and migraines with aura that mimic all these symptoms and worse leaving me perpetually unsure if it's just a migraine or if I'm having a stroke this time.
@pygmywombat; I hear ya! I've been in this situation dozens of times in the last 40 years. Scary, ain't it?
It's terrifying to have chronic intractable migraines with aura. I've developed new symptoms over the 35 years that I've had migraines. My left side gets weak, I slur my speech, I stutter, I struggle for the words I'm trying to say. Since I had 2 doses of 140mg Aimovig, my migraine onset is very rapid and much more intense (including vomiting). I'm looking forward to the day it'll be out of my system.
Having aura increases our risk of stroke later in life. I'm on 360mg Verapamil as a preventive for the migraines and was told it's important to remain on it due to the aura. I track my symptoms and triggers (humidity, dewpoint, barometric pressure). Should I display a neurological sign that's not related to my triggers or that's much worse than normal, I know I have to be seen by a doctor.
Someone very important to me passed away due to complications of hemiplegic migraines. Bless you. I hope that something is found soon that can help migraine sufferers!
Kathy T- I’m so glad you did this. As a nurse, I’m so annoyed that nurses didn’t take telephone orders for what you needed! Amongst other things!
Many institutions forbid nurses from taking verbal orders except in emergencies and believe providers should enter orders immediately if needed. Not saying that's right but if that's the policy...
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.
I hope you sued that doctor. Malpractice to overlook an obvious sign of DVT! Unfortunately, we all learn that we must advocate for ourselves, for we alone know what is normal or grossly out of whack with our bodies. Young parents learn this very early on with their children too, b/c docs tend to make light of a parent's concern that something is not right with their child.
I know docs hate it, but we have to be a squeaky wheel.
@@catbee1452 we have to be the squeaky wheel because 9 times out of 10 it’s the only way doctors will actually LISTEN to us. It shouldn’t have to be that way.
@@brendafowler3522 Yes, I know this is true. And I'm a 41year healthcare veteran too!
Thank you for sharing Dr. Travnicek's story! I had an ischemic stroke at 47 and Dr. Travnicek's story brought back a lot of memories of my time in the ER and ICU! The lesson is sometimes the best advocate for the patient is the patient!
Just had a doctor as a patient and he was super nice but I got the sense he felt the same way. Didn't want to ask for pain meds and didn't want to ask a bunch of questions but I could tell he was frustrated with some of the processes and computer issues (my COW was being glitchy). He did start giving his roommate medical advice though lol
Bahaha at giving his roommate medical advice! That's funny. I had a cardiologist with spinal stenosis once when I was still a CNA. We had mutual admiration but he didn't like everyone. I was in nursing school, and I knew how to gently let his bed down, or lift the head up in a way that caused as little discomfort as possible. So rewarding when we make those connections and we're able to do good for others in need.
As someone with a chronic illness that causes daily pain, I manage it well and stay an athlete in my ways. Everytime I find myself in the hospital opioids are pushed on me, but I am young, and destined to be in pain for the rest of my life. I state that I feel it's irresponsible for me to take opiates and they don't effect my pain at the beginning of every stay. They still push. It's surreal to me
Same here. Chronic pain, opioids don't help (in fact they make me feel awful) yet I've had them repeatedly offered/suggested by several doctors, even after having stated during discussion of history that they do not resolve my pain, I prefer (strongly) not to take them, and they make me feel nauseous and dizzy.
I had this experience several times 'till my current doc. That's when I knew I had found the right doctor (finally!)
Exactly my Dads scenario when he had a subarachnoid hemorrhage at age 40. Had my Mom not been an excellent patient advocate, he too would have gone home. She refused to take him. 14 days later, he was out of the ICU and the first patient in the Tower building at Inova Fairfax Hospital in Falls Church, VA. When you said, intense HA and N/V, it was my first thought. Glad to hear you are doing well. It is the perfect description of when you are a patient (who is a medical professional) vulnerable.
Had a difficulty breathing in the resuscitation room the other night. Charting nurse comes running out asking if the patient has been registered. The registration staff said she was working on it and the nurse replied with "This patients going to code if we dont get her registered."
Regarding pain medications, all we have in the prehospital setting are opioids. We need Ketamine, Acetaminophen, or Toradol prehospital.
Great story. Fantastic video.
Where are you working? Purdue EMS?
@@edwardgrabinsky6369 Western US Fire Based EMS.
My father in law had a stroke, he’d been sick to his stomach in the morning, so was most likely dehydrated. He was flown to a hospital 100 miles away by chopper. We drove down, got there, he was still in the ER, and had no fluids, no meds, anything. I was astonished.
Great video! As a Physician Assistant if feel sad we are judged in unfavorable situations but we must know our limitation to be safe.
I am an RN , been one for more years than I want to admit . I don’t want to see an NP or PA when I am sick enough to go to Dr. or Hospital. I have already ruled out simple stuff because I don’t go unless I think l am dying . Too many very inexperienced people in those positions. Sorry to offend anyone .... And yep I am old enough to remember paper charts and actually talking to each other.
How do we advocate for ourselves when we aren’t medical professionals?
That's your bias. I've received superior care from NPs, PAs and MDs, DOs
Having been cared for by NPs and working with PAs, I agree with your "bias".
A bias may be favorable or unfavorable.
I completely understand this, but there are many who use the ER as if it were their GP, so PAs have a place there too.
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.
Uploaded whilst commuting, great way to spend my waiting time!
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.
You guys are great. The medical world can be real frustrating as a patient. I appreciate you all being cognizant of all of that and I'm glad Dr. T is ok!
The medical world is evolving and becoming super frustrating equally the same for us doctors as it is for patients. Everything being electronic, quals people overrriding our patient management, noone speaking up for overworked doctors and nurses. Makes my head throb😡 Glad Dr. T had a good outcome in spite of it all.
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!
Wow, this was amazing. So much information. Thank you. Glad she is well now. Fantastic podcast - first one I've heard/seen - hooked!
Same. Enjoyed it so much!
There are so many times in this story where a typical patient would not be heard & treated, I couldn’t even finish listening. It’s too sad.
Most of us aren’t perky, blonde ultra-fit physicians with neurosurgeon pals on speed dial...and likely wouldn’t have even made it to the 2nd hospital.
Being an actual patient-Best training you can have, Doctor. I hope your patients can benefit from it.
After all that experience, could you both let up on the patient shaming jokes, mostly about most patients being drug seekers or exaggerating pain?
Anne, I'm not sure what the 'perky, blond ultra-fit physicians' has to do with anything. Not sure if you are in the healthcare profession but, nothing they said was patient shaming...it's all truth. The point that's being made here is that we ALL need to be our own advocates when it comes to healthcare, even the professionals within their own profession. I am an RN but almost died of sepsis. I was confident that my situation was emergent and refused to back down. I was way more sick than I appeared. Had I not insisted on the blood work and a chest xray (I wasn't coughing but knew something was going on in my lungs) and another 60 minutes, I would have been dead. I coded 3 times. It's terrifying that healthcare professionals are stretched beyond their capabilities that a patient (ANY patient) would fall through the cracks in the worst way possible.
1) I was a nurse for over 20 years and am very familiar with the changes that have taken place in healthcare.
2) My reference to “perky, blond ultra-fit physician” is in relation to how differently one is treated if you are NOT those things.
3) This is supposed to be about self-advocacy and how incredibly mismanaged this all was for her.
It does sound horrible, but with things like: getting immediate attention by merely informing the “Wine Headache PA” that “I am a Pain Management Physician”, her telling her treating physicians what her neurologist friends were texting to her, what she Googled (in a “doctor way”), and her ICU nurse accepting her own dosage orders for GABA...that’s not the self-advocacy that most of us would have available, including nurses. My point is that all the places she was let down by systems, assholes, incompetence-the negative effect & outcome would be multiplied many times over for the typical patient.
4) There were several joking references that were patient-shaming from both doctors about how most patients exaggerate and want more pain meds than they need. I am well aware that there are many who abuse the healthcare system to get drugs, but enough with the denigrating jokes assuming everyone in pain is a drug seeker or exaggerating their symptoms. It’s hard enough to be heard without these assumptions. Save this “humor” for the Doctor’s or Nurse’s Lounge.
5) I am a fan of ZdoggMD, but this one didn’t give the self-advocacy message that was intended, IMHO.
Or you could just be happy that she didn't die and is now telling us a story about the messed up medical system
Rachel T. Umm, yeah, of course that’s great that she didn’t die. I don’t know what that has to do with my comments.
I guess you don’t understand my point:
What is described in this video speaks to the deficits in the healthcare system.
My comment refers to most patients having even less chance of being heard than this young, pretty physician.
She was able to advocate for herself in ways that most people cannot.
@@annegrant8741 I knew exactly what you meant with your comments, and agree completely. I went to the ER maybe a dozen times in the 40+ years I've had intractable migraines, until i just gave up from being consistently refused treatment of any type (including just for dehydration) & being monumentally sick of being shamed, yelled at, cussed out, & generally abused for 'drug seeking' (including, again, the time I begged for only fluids). I'd be in literal blinding agony & vomiting uncontrollably, they could check records to see I wasn't a "frequent flyer" (which they wouldn't even bother with b/c they "knew" why I was there). I can't even imagine what an ER is like these days, & have no interest in finding out. I truly think I'd rather die at home than get the vicious abuse they dish out at ERs in lieu of treatment.
Had weeks of nausea and diarrhea, dropped 20lbs in a month, anxiety, severe dehydration. Can't walk on my own, rapid heart rate and low BP. ER doc ran a CBC, looked at me and told me I was just fine, that it was just anxiety. I told him absolutely not, something is wrong, he fought me and told me nothing was wrong, I told him no. Get your supervisor.
2 hours later diagnosed with c diff and a raging UTI. Hospitalist takes over my case and places me in hospital for the next 2 weeks. Next day vitamin levels so low they mirrored starving children in a 3rd world country. The CBC that the ER doc initially ran? Results all over the map. Very few normal results.
I don't know why docs don't believe women. But I'm tired of it. I've almost lost my life TWICE due to docs brushing me off. And I'm only 29.
Alicia Barbon I can relate, went to the ER 3 times before they would test me for c-diff..because my bp was so low and I had started bleeding. I feel like many Dr's where I moved to, do not listen or care.
I can relate so much to this! I’ve had CDiff twice- the second time the ER refused to even test me and it wasn’t till my primary ran an outpatient test that it was discovered I was positive and needed antibiotics. The length of time CDiff was running rampant in my body makes me think it’s caused the intestinal dysmortility I now have.
Yes the ER docs/nurses are THE WORST. I have been misdiagnosed more than once because I was blown off. It's mind blowing how bad it is these days. Don't EVER go to ER. I refuse to go because of the incompetent nurses and docs. I take no pleasure in saying this but when they are playing with my life, I think I have the right to take up for myself. I implore you to quit working if you really have that much disdain for your patients.
ZDogg is my rock star because I think he cares and is a part of the solution.
This old Neuro Nurse suspected an aneurysm when stated "worse headache" and had N/V
Suspect bleed... why contrast? Confused
@@vptammy Because a CT angiogram (CTA) entails contrast to be injected for the aneurysm to be visible. Non-contrast CTs can detect bleeding, but not the culprit aneurysm.
"Worst headache" made me think of hemorrhage. Glad they found hers with little delay.
This is the scenario that many migraineurs live with repeatedly...I get headaches so bad I literally bang my head on the wall, & can vomit so violently & uncontrollably I nearly suffocate. I've figured for years that I'd die of an aneurism or stroke b/c there's no way for me to differentiate.
@@kellyhoward6941 I had a boyfriend who had Hemiplegic Migraines. Same deal. It was very difficult and he actually coded once in the ED, and ended up in ICU. He ended up passing away because the altered mental status and pain mixture caused him to forget that he had already taken his narcotics, and his anxiety medication (Librium), took them again, and accidentally overdosed. Very sad outcome. I feel for migraine sufferers and hope that over time medical science is able to figure something out for you all! Hugs
Love your work zdoggmd
As physicians please remember to not be judgmental ...about others that may be even more frightened than you were and need a little medicine to maintain during such a frightening event . I agree that the medical community way over prescribed pain meds in the past. I now see times when patients actually suffer when the occasional dose of opiate or anti anxiety med would ease some suffering. Not talking about a crap ton. But it still has a place in medicine. We tend to go from one extreme to another in this country . Happy middle ground is good.
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.
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.
I’m just watching this now, so I haven’t seen the full video yet, but I do want to say thank you. We honestly do make the worst patients.
It took me years to get diagnosed with cluster headaches after another episode of thunderclap headache which was suspected to be an aneurysm.
Neurology isn’t my speciality! I panicked and luckily now have an amazing team of headache specialist neurology specialists who are passionate, driven and really empathetic with their patients.
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.
As an eye doctor, I see so many patients coming into the clinic with symptoms of migraine without aura! Scary when it happens to you!
wow, i enjoyed this way more than i expected! :D
Told myself I wouldn’t watch but a few minutes cuz I’m not on WiFi but couldn’t stop listening!! Great convo
I'm a retired nurse. When she started describing symptoms, the first thing that came to mind was some kind of intracranial bleed, like an aneurysm. They have a tendency to go unnoticed until they get ready to do a serious number on their victims. It was just too acute of an onset of symptoms, with no history of anything. I am old school, and lived through the introduction of computers. "They" think it helps to cover legal and mass communication better, but it actually doesn't. It seems to slow things down in more ways than you mentioned, especially in an emergency. I've had Dr's, as patients, and they do tend to intimidate, but some of that has to do with the nurse's confidence level. Experience has taught me that they are people first! And they get scared, like anybody else. Their minds go a thousand miles a minute, and because they know so much, it gets even hairier for them. Compassion works, and instead of having a battle of wits/rank with them, if you respect their knowledge and listen, it goes a lot better. Not listening bugs most people. I found that they'll discuss with you instead of trying to pull rank on you. I also think they didn't suspect addiction because you said you told them you were an endurance athlete. Anyone who runs 50 mile marathons is serious! That wouldn't suggest addiction to me. Most serious athletes are highly concerned with not contaminating their bodies. They know it messes with performance.
I listened to this whole thing and it did not feel like an hour - good on ya! 👍
If she hadn’t been a doc she would’ve been sent home.
Absolutely great episode! The guest was just adorable & as funny as ma man Zdogg. Another so freakin relatable topic which gives me more patience, understanding & reassurance that It's not just me thinking this way about modern western medicine. I'm an overseas GP trainee who works in Australia & got sick of the hospital system here after spending 3.5 years in it, mainly to tick some boxes. Big Thanks to you guys & keep it up!
What a story, thanks for sharing
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!
What a great episode! Sometimes, doctors are absolutely the worse patients in the sense that nurses have to advocate for them, to them. My favorite was when a beloved ER doc had a cardiac event, diagnosed it themselves via an ekg and symptoms, but wanted to complete their shift prior to treatment 😂. We said, absolutely not and literally had to force them to leave and get treated.
Glad all went well for you! And thanks for the great content zdogg!
Great informative episide.
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
I would say nurses are the worst and I’m a flight medic / nurse .. they will try to run there own emergency as if medics don’t know how to do anything and 99 percent of the time the nurse isn’t even an emergency care nurse
What a story! Not finished yet, but it's so bizarre hearing about sedation for the CT angio etc, because in the UK we don't get any sedation etc for those procedures; it's fascinating seeing the differences in such standard procedures between the two countries!
I don't think she was sedated for the CTA (that would be bizarre here too... barring anxiety issues). Sounded like the Versed was later during fluoroscopy/femoral cath in the interventional radiology suite, which is a standard practice in that department.
Sweet Doc so glad you got yourself into the ED, but loved it when you said, "I'm effing pissed." I loved using IV Tylenol...it works. Signed, Newly Retired RN
Re: the sacral pain: we call it the settling effect
Figured that this was this issue by process of elimination. Blood I’d heavier than csf, it settles.
In my earlier days as an RN, we had "standing orders" that we could implement following procedures
Good to learn that doctors are as bad as us ordinary patients when it comes to judging when to go to the E.R.
So many possible questions / comments I could make.
The three day migraine that wouldn’t go away (despite OTC meds) where the pain was probably only about a consistent 5/10, but I told the doctor I would rather go through labor again. At least you know labor will come to an end.
But I would like to address the problem of healthcare providers not taking people seriously. While I have never really experienced that myself, my daughter, as a young mother, has. She looks younger than she is, and was 23 when her first was born. Medical staff not familiar with her background seem to assume that she has been consulting “dr Google” prior to presenting with her child. More than once has she had to explain that she has a degree in chemistry, but did not complete the minor in biology. She has been a certified lifeguard since the age of 15, and that she was helping her veterinarian father in farm calls since she was in grade school. (She initially entered college as pre-vet)
More than once has she had to push for diagnostic work to be done, only to have a surprised doctor come back and have to admit that she was right to be concerned.
I get it, hypochondriacs and Munchausen’s exists, but that should not necessarily be a provider’s first thought.
Your comments display your naivety. A degree if Chemistry, working as a lifeguard, and helping out a veterinarian doesn't make you close to being a clinician.
😂😂😂
Huli and your comment displays your arrogance.
I did not say that she is, or thinks she is, smarter than a clinician with years of advanced training. I said that she has more education and experience than some clinicians •assume• based on her youthful appearance. If she somehow thought she was “smarter than”... then she would not bother with consulting the MDs.
She gave birth via cesarean just one week before her senior year of college. When the L&D nurses called in the OB on call for a consult due to decel’s in baby’s heart rate during contractions - (she had planned for her Family Practice Dr to deliver) - the OB gave two options: 1) a section delivery now or 2) she could try to continue labor and see what might happen, but it was his opinion that she would end up in his OR in about 2-3 hours anyway.
My daughter has seen less than pleasant outcomes when farmers chose options 2 for sows and cows, she surprised everyone in the room when she said to the OB “I guess we’re having a cesarean”. One of the nurses even double checked, reminding her that her written birth plan had said wanted to avoid a surgical delivery. She reminded the nurse that, bottom line, she wanted a live baby.
Her family practice Dr was in the OR, saw the position the baby and umbilical cord was in, and assured her that she made the right decision.
While still in the hospital, my daughter noticed signs of possible jaundice and asked the nurse if she should be concerned, and if she should offer a supplemental bottle of some sort because her milk hadn’t come in yet. The nurse brushed it off as normal and refused to bring a bottle.
Except...
The day my daughter was discharged, the baby had to be kept in the nursery another night wrapped up in a Bili-blanket. Baby was discharged a day later and sent home with a rental Bili-blanket.
About 5-6 months later, while visiting us for a long weekend, the baby was showing signs of respiratory illness. Between her experience having heard the sounds of pneumonia in 1400 pound cattle and 7 pound piglets, combined with her husband’s experience working as a CNA in a hospice facility, they were concerned about the sounds their baby was making, and felt a trip to urgent care here was warranted vs waiting another day and half to try and see their aforementioned Family Doctor.
The local Urgent Care Doc didn’t know my daughter, made assumptions based on her youthful appearance - (Probably guessed she was a teen mother) - then assured them that it was “just a cold”, nothing to worry about.
Except, it wasn’t.
Less than 48 hours later, the baby was not getting better, and was taken to see their family doctor. Where baby’s O2 sat struggled to maintain an 80. If the O2 level did not improve with immediate nebulizer treatment, the Dr was going to admit baby to the nearest PICU, 2 hours away. Fortunately, baby’s numbers improved enough that the Dr trusted my daughter and son in law to be able to manage nebs at home. (Bonus, my son in law’s sister in law lives in that college town and is an RN)
Hospitalization was avoided, but RSV had done its damage to baby’s lungs, causing pediatric asthma. Could this have been avoided if that Urgent Care Doc done a nasal swab? I honestly don’t know, but by the time that kid was 2 he already knew the drill for chest X-rays to rule out pneumonia, and now sees a pediatric pulmonologist twice a year. And an endocrinologist because the asthma meds can stunt a child’s growth.
Two more children have arrived in that family, and you can bet my daughter still advocates for their care, because at nearly 30 years old, she still looks younger than her baby sister who is only 20.
By and large, doctors are wonderful, intelligent, well trained people. But they are still human beings, susceptible to making mistakes and/or erroneous assumptions.
She respects the education and training doctors have, but she also expects to be treated as an adult, and not a 12 year old.
I will most certainly go through my bucket list when I finally finish medical school as well 😂
I had no idea Kathy had To go through this. I’m glad she rebounded.
When I had my tonsils and adenoids out and septum fixed, I was sent home with a duragesic patch in 2003(around the time they came out). Plus pain killers in pill form and other meds. I started to overdose and went to the ER. At the time I didn't know what was happening to me, but I ripped the patch off because of instinct. I did know it was the strongest drug so I suspected it. I started to feel better by the time I was in the ER. Things checked out ok other than low potassium. The doc claimed the patch couldn't hurt me and slapped a new on one me and sent me away. In the coming months the news started coming out that some of those 3 day patches were allowing too much fentanyl through and people were dying. I had multiple medical professionals say that fentanyl patch *could not hurt me*. My trust in doctors has gone from almost complete to very skeptical as I have had many experiences over the years like this but this was the most dangerous.
"During investigations into patient overdoses, the FDA found leaking patches to be yet another cause for concern. Johnson & Johnson’s suppliers issued several recalls of millions of patches when it became clear that the patches were defective. Once the patch developed a leak, all control over dosage was lost, and patients were placed at an extreme risk for Fentanyl overdose and its severe effects, including death. Since then, Johnson & Johnson has lost several wrongful death lawsuits and is currently facing many more because of this defect in the patch."
Johnson & Johnson are evil.
I’m listening to this in the ER. I’m a nurse for years. Chest pain, palpitations, headache, left side neck pain, elevated wave. Troponin’s negative. BP still 170/110. I take daily, 80 mg of Inderal and 160 of Valsartan. Took them earlier as in 8 hours ago. No other Sx. Discharged and F/u with PCP and Cardio. Not to mention that the nurse tech came in after 2 hours and switch my adult BP cuff to an extra large cuff. My arms are 14 inch. A extra large cuff WILL read a lower BP. I told the ER Dr about it and she poopooed it. Thank you guys for this video. It got me through the 6 hour ER nothing. At least my troponins were negative, and other blood work was negative (CBC, BMP, Mg)
The 170/110 was after I asked to be checked with an adult cuff before I left.
Hearing her initial symptoms subarachnoid hemorrhage was the first on my differential diagnosis. I saw this many times during training. A lot of times in athletes.
yep - exercise will kill you!!! - a personal belief of me and Garfield the cat. - Thanks for the great video!!!
Me too. I'm an NP, not sure what that PA saw, but I thought subarachnoid hemorrhage right away.
Ocular migraine without headache! What a crazy experience. I am a Pathologist who makes his living with his eyes. I've always had 20/20 or better vision. Just a few months ago I had my first (and only so far) ocular migraine with the classic lightning bolt scintillation. I was so lucky that I could call my Ophthalmologist friend and he literally talked me though it over the phone. That was absolutely terrifying.
Had my first ocular migraine come on kind of like this when I first started wearing glasses. No headache at first, just the visual disturbance. Extremely frightening.
evcotter08 I used to get them from the birth control pills I was in decades ago. The OB/Gyn had me stop taking them, but sent me for a neuro consult, just to be cautious.
What a story! Reminds me of being blown off by doctors for tendinitis in my elbow. All they heard was I had been roller skating the night before, but ignored that I had not fallen. I was in enough pain I wound up in the ER, they referred me to a ortho guy who wouldn't give me the time of day, told me it was a hemotoma without telling me what that was, they gave me a sling in a box (in a box!) and sent me home. I had to figure it all out myself. Luckily I had made an appointment with the ortho my Dad sees who specializes in knees and elbows, because I felt I could trust him more. So three days later, with an arm that now won't move at the elbow, go in and he actually spends time with me and gives me a formal diagnosis of tendinitis and now I need PT to get my elbow mobile again because the sling froze it. What a nightmare! Thankfully I have full ROM back in that joint, but I'm still pissed the first guy blew me off.
They tried to give me Tylenol with codine for the pain, too (at the ER), despite me telling them we have a family history of reactions bad enough to codine that people land in the ER. I refused it, just upped my ibuprofen dose. Worked well until my teeth went numb. LOL
Would absolutely love a video on patient self advocacy. I think so many people could benefit from it. There are so many subtle nuances to navigating your own health, and it's such a process. I feel like I am more self-advocating since my tendinitis incident, and now that I went to school and became licensed as a massage therapist. We had to take basic A&P, in-depth myology and kinesiology, and basic neurology. Gave me new language and understanding when I speak to my PCP, and an ability to be part of my own health care instead of just a spectator, if that makes sense. Everyone deserves to be able to play an active role in their health, instead of a passive one.
I am a 2 time stroke survivor, I was also 39 with my first stroke. My second was also a a hemorrhage.
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.
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.
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.
Wow I'm just a medic, and in the first few minutes of her description of symptoms she described I thought bleed.......glad she recovered.
Wow, thank you for sharing your story, Dr. Travnicek. good parts and scary parts. Looking forward to the upcoming episode on advocating for self and family. Z Dogg, as your sharing your headache symptoms, sympathy symptoms kicked in, haha. I had to look away from the computer and take a deep breath. I get migraines that easily. :/
I am so glad she is OK. As a nurse I have had some very similar experiences (different health issues). Medical professionals don't follow guidelines, narcotics are indeed pushed (I almost died of a respiratory arrest after a small dose of morphine). Makes you wonder how many women and healthcare professionals die, because they are not getting appropriate treatment. I am just so glad I have nurse friends who come to my aid when things like this happen, a nurse friend saved my life when I had my respiratory arrest.
Oh hell yes. Those migraines are weird. I've had only a couple auras. I have painful migraines without aura. My first aura tripped me out so hard. Had just finished a "physically demanding task" ahem and jumped in the shower. I started getting this squiggly lightning bolt in the periphery of my right eye. It started coming more into the front of my vision and growing. It started turning rainbow in color. I started feeling very strange but no pain. Eventually about 15 minutes in I lost all the peripheral vision in that eye. I should have gone to a doc as it was the first time, but I was out of it and for some reason my scare factor just turned off. I just sat there and watched TV very calmly and it came back in about an hour.
Love these discussions. As a patient I've wondered so many things about the inside of the medicine world and it's behind an iron curtain to a large degree for someone like me. At least that is how it feels.
Achase4u I used to get migraines with aura, but my peripheral vision was unaffected while my center field of vision was blurred. I worked full time as a cashier back then, make work interesting.
That’s the problem with most patients they think medicine is an exact science. It is not. As far as not asking about addiction, they don’t ask because they are afraid of offending.
I’ve had cases of SaH where I couldn’t find the aneurysm. I presumed i just couldnt find it because of postmortem obscuring is the vessels, so this ones new for me
Pain is so complex
The saddest part of this to me is that she couldn't talk to anyone about how she was feeling or ask someone for a ride home. She could have not made it home or even hurt someone else trying to get home. But it's true docs and nurses are the worst patients.
I used to be a neuro icu nurse and the only thing I found that helped with SAH pain was iv tylenol but we stopped caring it about 5 years ago
This was something. Very important stuff raht heeeya.
As a retired Neuro ICR nurse, this was fascinating, you always need to advocate for yourself and your family. "Worst HA of your life, photophobia, nuchal regidity!!!
Can you please give the links to your and Cathy T's other shows.
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.
I love you dearly, but...not everyone reacts to pain or meds the same. I took lortab for 10 years, did not abuse it. Now I cannot get it, and nights are a nightmare. I was not the problem in the opioid crisis, but I am very much a victim.
Jaci Rogers I completely understand your situation... I'm am sorry as I truly know the struggle
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?
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.
I really hope you will do a program on advocating for yourself not only in hospitals but in Doctor's offices. I did this when I moved to a new state. My new GI wanted to scope me and I wanted a unsedated,underwater, colonoscopy cause I've never been sedated for one.. My new GI. did not want to give it and we went back and forth in the patient portal with his nurse advocating in my behalf. He also had my records from my other GI Docs and there is no mention of sedation anywhere. I finally got to talk to him on the phone and he explained his point of view and I explained why what he was afraid would happen would not happen and after a bit,he explained he did indeed give unsedated colonoscopies. We thus ended up on the same page, and I'll get to "Enjoy the show" as one Doc said before a scope.😂
. Anyway,your talks with guests are by far what I enjoy the most and this one was especially good.😂
Grateful
One problem showing in the ED model is the Fast Track triage. Any provider could have come to the same initial impression as the PA. I wouldn't be so quick to throw the PA under the bus here. It's a system setup that almost failed the patient. How this plays out is that the provider mindset is essentially predetermined if they are working the Fast Track (i.e low acuity) and also not sharing in practice of the higher acuity patients, where the SAH/intracranial hemorrhage would be ruled out first and then move into suggesting low acuity treatment, if appropriate. Excluding PAs, because of the perception of mid-level licensing, from participating in assessment (and intervention) of higher acuity is a huge mistake. Another thing also to take note is that the PA did not street the patient (which MDs are totally accountable in this also), the initial provider acted appropriately and obtained a second opinion in rapid time.
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!!!
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.
Doctors that go through stuff like this become much better doctors after.
My mom..48...sudden onset headache and confusion. ER Neurologist says, "Psych issues because she's menopausal age"..Super pissed.."fired" him. Outcome: small bleed due to genetically-determined anti clotting factor. I understand the delay for the genetic component but the sudden jump to psych because she's a middle-age woman.
Jennifer M, still happens all the time.
I'm middle age woman and unfortunately this is true.
Often there's the "anxiety" or "nerves" assumption of origin. It's happened to me as well, and I'm in the medical field.
Can someone explain the reaction to contrast?
My migraines always happen that way: auras, no headache, but then the aura fades and I get a headache, sometimes. Not always. But a triptan drug always knocks out the auras and wipes my visual field clean.
Listening to this brings back so many memories for me. I was an RN in endoscopy who had a routine nissan six years ago and left 12 days later on TPN and now have a g and a j tube and Hickman port. It’s crazy that all of the things that were issues back when I was practicing are still issues today. The parallel system thing has never made any sense to me, patients are asked the same questions by so many different people, charted in a different system by each person and none of it crosses over. I missed the paper charting as well and I hated when we had to stop calling them “cows”. It’s crazy that one patient thinking that she was being called a cow caused an entire nation to have to change the name of the computer and that the story is still the same today! You would think that after so many years that story would have at least changed a little! 😂. This story is crazy! It’s funny how all of the once in a lifetime stuff happens to us medical professionals. My aorta got nicked during my j-tube procedure at a very prestigious hospital, as if having all of the complications from the nissen wasn’t enough. You can’t make this shit up!