Email a Friend
Print Article
Rears and Ears
Although I run the ENT board for WebMD, my practice is primary care. During my clinic day, I see everything that walks, crawls, or is carried through the door. I see about 120-140 patients a week. I estimate that 40-50 of them have problems related to their ears. Last week was a unique week, since I had a disproportionate number of problems related to rears, lots of lacerations, and other injuries. So, it was a week of Rears and Ears.
If you have young children, especially children in preschool or day-care, you know that these winter months are ear infection months. Since most middle ear infections in children are related to colds, the cold and flu season is really ear infection season.
The week started out with a little boy who tried to cut his own hair with a pair of very sharp, sewing scissors. As he trimmed the sides, he also cut off a nice piece of ear. Fortunately, it was able to be successfully repaired.
We only had two patients who inserted foreign bodies in their ears and noses. The pencil eraser in the ear was easily retrieved, but another one (a bead in the nose) was a real clinical challenge. The three year old became so upset and agitated over our repeated attempts to get this bead out of her nose, she lunged out at her mother who was gently blowing in her mouth (a technique that may help dislodge the nasal foreign body) and bit the mother's lower lip. We ended up sending the little girl to the ER where she could be sedated; but I had to put a dozen sutures in Mom's lip.
About half of the children coming in with potential middle ear infections did not have a problem. Yes, they may have felt something in their ears, but it wasn't an infection. There can be many causes of ear pain that have nothing to do with the ear. For instance, a bad tooth (particularly the molars) can cause pain to be referred to the ears. Tonsil infections, lymph node enlargement, sinus infections, salivary gland disorders, etc, all can cause the ears to hurt. Sometimes, babies are just observed pulling on their ears and parents think that have an ear infection.
In the midst of all of these ear-related problems, there was one issue further south. Most of the rear-end issues in pediatrics involve diaper rashes. Unlike the old days when diaper rashes were either yeast or primary irritants, now we are seeing more and more cases of MRSA - an antibiotic resistant Staph infection. So far, I have found a half-dozen of these in the last month.
In the last seven years, I have devoted my practice to pediatrics which encompasses children from age five minutes to age 21. I can have a four-pound preemie in one room; and a 250 pound adolescent linebacker in another room. It was the big linebacker that had the butt issue.
Hemorrhoids are really common problems, but not typically in children. This young man came in wearing a very painful, blue, golf-ball-sized, thrombosed hemorrhoid. The proctologist (colon-rectal surgeon) refused to see him because he was a "child". He was 5 weeks short of his 18th birthday, if you can believe it. The general surgeons did not want to see him, either. So, here was a young man in acute distress with a huge hemorrhoid. He needed some immediate help. I put away my otoscope and prepared to do the relatively-minor rectal surgery myself.
We got him prepared (medically and emotionally) and put him on the procedure table with his butt prominently "in the air". No sooner that we had him exposed to the elements, than other staff started barging in the procedure room. You would think that a closed door would somehow trigger someone to at least knock, but no....
The first intrusion was another doc in the office who wanted to show me his new digital camera. The thought he would take a few pictures of me sewing up a laceration. When he walked in with the camera, the teenager was stunned. Naturally, he did not snap any photos for our bulletin board. Since supplies are also kept in this area, at least two medical assistants barged in looking for various things. One of them actually thought I was talking to someone -- a butt-head, apparently. I was able to finish the surgical procedure with just these three interruptions. Incidentally, the grateful patient is doing well and is back on the football field; running a bit faster than last week.
Another life saved...so to speak.
Related Topics:
Technorati Tags: primary care, ear infections, cold, flu, hemorrhoids
If you have young children, especially children in preschool or day-care, you know that these winter months are ear infection months. Since most middle ear infections in children are related to colds, the cold and flu season is really ear infection season.
The week started out with a little boy who tried to cut his own hair with a pair of very sharp, sewing scissors. As he trimmed the sides, he also cut off a nice piece of ear. Fortunately, it was able to be successfully repaired.
We only had two patients who inserted foreign bodies in their ears and noses. The pencil eraser in the ear was easily retrieved, but another one (a bead in the nose) was a real clinical challenge. The three year old became so upset and agitated over our repeated attempts to get this bead out of her nose, she lunged out at her mother who was gently blowing in her mouth (a technique that may help dislodge the nasal foreign body) and bit the mother's lower lip. We ended up sending the little girl to the ER where she could be sedated; but I had to put a dozen sutures in Mom's lip.
About half of the children coming in with potential middle ear infections did not have a problem. Yes, they may have felt something in their ears, but it wasn't an infection. There can be many causes of ear pain that have nothing to do with the ear. For instance, a bad tooth (particularly the molars) can cause pain to be referred to the ears. Tonsil infections, lymph node enlargement, sinus infections, salivary gland disorders, etc, all can cause the ears to hurt. Sometimes, babies are just observed pulling on their ears and parents think that have an ear infection.
In the midst of all of these ear-related problems, there was one issue further south. Most of the rear-end issues in pediatrics involve diaper rashes. Unlike the old days when diaper rashes were either yeast or primary irritants, now we are seeing more and more cases of MRSA - an antibiotic resistant Staph infection. So far, I have found a half-dozen of these in the last month.
In the last seven years, I have devoted my practice to pediatrics which encompasses children from age five minutes to age 21. I can have a four-pound preemie in one room; and a 250 pound adolescent linebacker in another room. It was the big linebacker that had the butt issue.
Hemorrhoids are really common problems, but not typically in children. This young man came in wearing a very painful, blue, golf-ball-sized, thrombosed hemorrhoid. The proctologist (colon-rectal surgeon) refused to see him because he was a "child". He was 5 weeks short of his 18th birthday, if you can believe it. The general surgeons did not want to see him, either. So, here was a young man in acute distress with a huge hemorrhoid. He needed some immediate help. I put away my otoscope and prepared to do the relatively-minor rectal surgery myself.
We got him prepared (medically and emotionally) and put him on the procedure table with his butt prominently "in the air". No sooner that we had him exposed to the elements, than other staff started barging in the procedure room. You would think that a closed door would somehow trigger someone to at least knock, but no....
The first intrusion was another doc in the office who wanted to show me his new digital camera. The thought he would take a few pictures of me sewing up a laceration. When he walked in with the camera, the teenager was stunned. Naturally, he did not snap any photos for our bulletin board. Since supplies are also kept in this area, at least two medical assistants barged in looking for various things. One of them actually thought I was talking to someone -- a butt-head, apparently. I was able to finish the surgical procedure with just these three interruptions. Incidentally, the grateful patient is doing well and is back on the football field; running a bit faster than last week.
Another life saved...so to speak.
Related Topics:
Technorati Tags: primary care, ear infections, cold, flu, hemorrhoids
3 Comments:
If that was me I would not have been happy. Yesterday I was at the doctor and twice a nurse knocked on the door while the doctor was with me to ask her a question. That irriated me. They couldn't wait the 5 mins. my doctor would have been with me!
my 4 year old gets ear infections and she goes to a very small school i breast fed i don't smoke how can i further help her from getting ear infections
Your collegue's disregard for your patient's dignity is apalling. I hope you reprimanded him.
His thoughtlessness could end up costing him, or the practice, business. After the second time of being left exposed with the examining room door standing open I fired my doctor and found another who showed appropriate respect for my privacy and dignity.
Post a Comment