Wednesday, October 19, 2005

Mia Listo Sekreto

Of all of the thousands of little 'insignificant' syndromes, tests, and signs we are taught in the first two years of medical school, there are a multitude of syndromes you don't plan on seeing. I plan on not seeing (or diagnosing) sarcoma botryoides, frotteurism, or scientology. They are all too uncommon to be seen by me, especially if I'm looking to go into pain management. There are several more on the list, but they are a secret. (secret=forgotten)

One of those things I thought I'd never see is Broca's aphasia. It's a syndrome where there is damage to the "outgoing communication" center of the brain, usually from a stroke, which leaves the patient unable to form words. They can still understand what is being said to them, unlike the very tragic Wernicke's aphasia. Well, one of our patients came in for treatment of shoulder pain and had symptoms of a somewhat resolved Broca's aphasia from a previous stroke. WHOA! Broca's! Here! As soon as that synapse connected in my brain the rest of my brain was engaged in inhibiting my excitement from causing me to blurt out "BROCA" several times in a Tourette's type manner.

Twenty painfully long minutes later the patient left the room and I struck an aloof pose on the side of the doorway, looked at my cuticles, and breezily told the doctor, "that was a pretty textbook case of Broca's if I've ever seen one." I'm not sure whether the phrase "if I've ever seen one" is a valid one if you've only seen one and there was no "if" about it, but I tossed it in to accentuate how aloof I was in the face of such a brilliant discovery. The discovery was, of course, that medicine includes things other than hypertension, high cholesterol, allergies, and low back pain - it includes those things we missed test questions about.
The doctor looked at me as though I'd just spoken in Esperonto.

"Broca's aphasia", I clarified.

His head tilted slightly to the side.

"From the stroke, affecting her speech", I stammered.

I wasn't sure whether he didn't understand or if Broca was a stupor inducing trigger like in Manchurian Candidate. Before drool started to gather at the corner of his mouth I went ahead and explained the condition. Deflated, I continued the rest of the day, deftly caring for hypertension, high cholesterol, allergies, and low back pain.

I apparently discovered something that was on his secret list.


Blogger Anon Emous said...

Hey, I will take anyone that can cure lower back pain! Seems no one can. Been suffering with it for the past 35 years.

Last diagnosis: "Oh, you have degenerative disc disease. Sorry, but it is not operable, and there is nothing we can do. Might try swimming."

Great news!

It is hard to believe in this day and age of modern medicine, no one can cure lower back (L5S1) problems!

12:26 PM, October 20, 2005

Blogger Nelson said...

Man, your blog cracks me up. Cracks me up to the point where I think I may not be quite so abjectly terrified about what 3rd year will do to my health/psyche/relationships...

What's your RSS feed?

3:08 PM, October 23, 2005

Blogger DocAMAZING said...


Well, I'll let you know how my psyche is doing in a few weeks. I've just started my psychology rotation, and I've heard the conditions are contagious. If you've ever talked to a psychiatrist, you'll understand what I mean. You will never see a well adjusted psychiatrist.

7:52 PM, October 23, 2005

Anonymous Kopti said...

You know there was a time when I thought I would go back to school and become a psychologist. I told my then girlfriend that I was interested in doing so and she said "so whats wrong with YOU?" She naturally grew up with one for a mother. You are on to something.

6:55 PM, November 23, 2005

Anonymous Anonymous said...

WOW, I'm a first year and just took an exam on Brocca's (Area 44&45 dominant side; i said that just to prove my credentials, lol) and thought I would never ever in a million years come across someone that has it. After reading this post it does seem like there is light at the end of the tunnel, and all the details might be important at one point.

2:28 PM, May 13, 2008


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Wednesday, October 12, 2005

Idealism returns like the herp

Manipulative medicine is taking more out of DocAMAZING than first expected. My clinic’s operating hours are 9 to 5, give or take the sum of those two numbers. So, except for one odd day out, I’ve been in clinic until 6 o’clock or, like today, 7:20. Tack on an hour’s drive home, forty minute workout, dinner #2, meaningful chatter with the missus, checking the latest dirt on my favorite BDSM anime forums, and bedtime snack and there’s not much time for working on the paper that is due at the end of the rotation. Yes, a paper is due at the end of the rotation. It feels very high school-like, such as when a teacher realizes that watching Tombstone for three class periods was not entirely justifiable and bookends the last day with a paper due comparing Doc Holliday’s motives with those of The Outsiders protagonist Pony Boy.

This rotation has been piquing my idealism in medicine again, though. It may be the actual patient contact that’s doing it. I actually switched with another person for this doctor because of his gentle, more focused, osteopathic manipulative technique. My first doc was known for what he called the “good ol’ fashioned osteopathy” of whipping joints at high velocity counter to other joints in positions that can only be likened to techniques seen in the “good ol’ fashioned Spanish Inquisition”. I feel that the ‘joint cracking’ that I thought was so cool the first year may sound and look effective, but they do little to reduce the ‘gamma gain’ that caused the lesion in the first place. In other words, I think it doesn’t really help the problem. It’s kinda like that three-pack of azithromycin you got last winter for the sniffles.


On a side note, I've got good news for smokers that comes directly from one of my lunchtime study sessions: It turns out that smoking is protective against ulcerative colitis. Smokers are only a third as likely to get the dysentery and ulcerous rectum of UC than the rest of us non-smoking suckers. However, smokers are twice more likely to get the intestinal blockage and gastrointestinal fistulas of Crohn’s disease than us non-smoking smarties. But if you work it out mathematically I think smokers are still ahead of us in avoiding debilitating GI tract disorders by sixty-six something-or-others. Euros, I think. So smokers everywhere can hack a large wad of relief as their intestines remain the envy of us, the ignorant white-toothed masses, while their lungs turn the texture of Bea Arthur’s elbow skin. (covered in tar, natch)


Anonymous Anonymous said...

i followed around an osteopath in school and learned the manipulation stuff. as far as i can tell by looking at evidence-based studies and metanalysis, that stuff is equivalent to NSAIDs, more expensive, and sometimes risky. i don't do any of it in my practice, preferring physical therapists. cool photo, i've seen that one before somewhere (my own blog i think?!)

12:39 PM, October 13, 2005

Anonymous dr charles said...

dude, you're boring.

i came here 'cuz i thought you were the real doc amazing.

stick to your textbooks.

3:04 PM, October 15, 2005

Blogger Shazam! said...

Hey, I clicked on your comment to Doc Charles, because I thought you were me! (Doc Shazam and Doc Amazing look a little similar).

Anyway, as a 3rd year MD student, I chose to shadow an osteopath because I wanted to learn more about manipulation. He didn't do a single speck of it, although he was really smart.

I would still like to learn more about it because I do feel it is therapeutic, although I'm not sure hwo many different techniques there are, I'm sure some work better htan others.

Since my own L5/s1 disk explosion, I am less than excited about reccomending high velocity maneuvers.

11:13 PM, October 16, 2005

Blogger dokan sam said...

Osteopath is a therapist who manipulates the skeleton and muscles. We are committed to providing you and your family the highest levels of osteopathic care as cost effectively as possible. . I have read it carefully and wow really awesome.

2:30 PM, April 14, 2013


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Monday, October 03, 2005

The internet is TEEMING with people!

It's a momentous time in this blog's history. Now that it gets about 52 hits per week, other DocAmazings are coming out of the woodwork. I just recently received a 'cease and desist' post from another DocAmazing, asking me not to 'flood the market'. I assume this was meant to either close the blog or change the name (probably the latter). This is one of the problems with the 'internet'. The internet is full of people. Chock full. There are people pouring out of the seams. At least a million of them.

In this melange of people there is bound to be some name overlap. Go to any forum and there is a NiteShadow, but I doubt these are all the same NiteShadow. One could be a 13 year old boy posting about how cool Insane Clown Posse is, and another could be a 14 year old boy posting about how "teh r0xorZ!!11!" Insane Clown Posse is. You could get dizzy trying to work out the implications of such a split personality until you realize that the internet is just damned full of people. You can't miss em'. At least a hundred thousand of them.

However, in respect for the name DocAmazing, I will include a little disclaimer that this Doc is not the craigslist or the netherotarecords Doc. My internet sphere is much smaller and, frankly, better decorated. I think I'll stay here.

For an update on NiteShadow:
NiteShadow races Honda hatchbacks
NiteShadow has animated girls melting in his hands
NiteShadow is Death
NiteShadow hasn't sat on any good Goethe books lately
NiteShadow feels Mexican spices are below him
NiteShadow writes Melissa Joan-Hart for spiritual guidance


Anonymous DocAmazing said...


Well, it's a start. You might also mention that I've had this handle since about 1992--used it for cartoons in med school (my "Gross Anatomy" series). I am curious what your inspiration for "Doc Amazing" was--for me, it was a homage/rip-off of Doc Savage, the pulp magazine character of the 'thirties (www.blackmask.com). If it was suggested to you by a friend, you might have Googled the thing first. Ah, well.

Enjoy the manipulative medicine studies. You're probably at the best part of your education right now--though attendings my delight in pimping you, you can relax in the knowledge that ultimate blame does not fall on you. Wait ten years, and you'll develop a keen appreciation for the concept of "liability". Don't fret--you'll adapt to it; we all did. What's your next clerkship?

1:05 PM, October 04, 2005

Anonymous NiteShadow said...

I just want you to know that I am the original NiteShadow (the one who feels Mexican spices are below him). I've been NiteShadow since October 8, 1980, when I wrote a journal entry in 4th grade Reading class, using it as a pseudonymn. All the other NiteShadows out there are pretenders to the name.

In fact, my name is SO original, I have no doubt that all those other so-called NiteShadow losers copied me out of envy and spite. I'm serious. They did it on purpose.

I mean, really, who on earth would ever think to put the words "Nite" and "Shadow" together, especially with the word "Nite" misspelled. (Now, Nightshade on the other hand, is a totally common, plebian name.)

Clearly, It's obvious that anyone who calls himself "NiteShadow" must have copied it from me. There's no way it could have been an original thought -- I mean, there's only a couple thousand people on the Internet, after all.

3:30 PM, October 05, 2005

Blogger Clive Dangerously said...

Doc senior and Doc junior should engage in Mortal Kombat to see which one is truly amazing.

10:38 AM, October 08, 2005

Anonymous LamontCranberry said...

copy a handle,
reveal the limits of
your creative reach

2:51 PM, October 08, 2005

Anonymous lamontcranberry said...

oh, and by the way,
the right word is "motherlode".
you are quite welcome.

2:55 PM, October 08, 2005

Blogger Athenas-Blade said...

This comment has been removed by a blog administrator.

8:57 PM, October 08, 2005

Blogger Caryn said...

Wait. So the "original" Doc Amazing actually borrowed his nickname, and are mad at you for coming up with the title as well? Sorry. No copyright on things like that!

Oh, and thanks for the laugh. You have a very humorous way of putting things. Hard to believe you don't have a wider audience yet.

11:38 AM, October 12, 2005


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