- Hey, guys, welcome to another episode of the Wednesday Checkup. Today, I wanna tell you
about a really interesting patient encounter I had just the other day and then we're gonna follow up that story with one of my favorite
segments, Mail Time. You ready? (whooping) (mellow music) My nurse rooms the patient,
takes all the vitals, brings all the information, including the chief complaint to me. Tells me that the patient
has normal vital signs, normal blood pressure, pulse, high 90s. That he's a mid 60-year-old male. That the breathing rate is normal. And that the patient's chief complaint is that there's this redness
surrounding the right foot, that the patient is worried about, that the antibiotics haven't really, that they haven't really seen an improvement in the
redness of the right foot, despite using antibiotics
in the last 48 hours. Prior to walking into the
room with the patient, I did look at the electronic health record and found out they have an extensive list of medical conditions and are take a lot of
medications for them. Hypothyroid, osteoporosis, diabetes type 2, high
cholesterol, atrial fibrillation, so I know that this patient
does have medications onboard and other conditions at play. It's important for me as a doctor to check that before going into a room so that I can see how
maybe those illnesses and those medications can be factoring in to the current problem. After hearing the story about the foot, I asked the patient if there
were any other complaints. And I generally have a list of what we call a review of systems, where I ask a few general questions just to see how the
patient's doing overall. Constitutional symptoms
like fever, fatigue, unexplained weight loss, then we have the cardiovascular ones, palpitations, chest pain, then with the respiratory
ones, shortness of breath. You sort of get the idea. The patient did mention that he felt a little bit more short
of breath than usual. He attributed that to the pain and discomfort from his right leg. That he thought maybe he
wasn't sleeping as well and there were all these
sorts of explanations he had in his mind for
why that was happening. So I listened to the patient's lungs, crystal clear, no problem. When I listened to the patient's heart, I hear something that I
didn't expect to hear. The patient was having an
irregularly irregular rhythm, meaning that it was an irregular rate, that is was above 100, and it was an irregular rhythm, meaning that it didn't have
a consistent beat to it. Ba-boom, boom, ba-boo-boo-boom, boom. That is essentially the
beat that we would hear if a patient has atrial fibrillation. Now I know this patient
has a history of that so it makes it a little
bit more easy for me to expect to hear that. But a patient who has atrial
fibrillation actively, at a fast rate is dangerous. Reason being is the heart
doesn't like to be beating very rapidly for a long period of time. At rest, your heart rate should be somewhere between 60 and 100. However, my patient was beating
somewhere in the low 100s when I listened and I checked their pulse. I asked the patient, "Have you felt any palpitations
in the last few days?" Meaning that they feel
like their heart's racing or beating outside of their chest. That's a very common way to explain it. And the patient says to me, "You know doctor, the last few days, "I did feel a little bit "and I wasn't sure if it's my AFib," the atrial fibrillation, "kicking in. "But it went away, so I
assumed nothing of it. "Is that okay?" Let me do something, let me get an EKG just to see how your heart is doing, how fast is it beating, confirm that this is fact AFib, and we'll move on from there. And we sort of put the
foot issue to the side because A, he's actually
being treated for it, and B, the more concerning
issue for the time being would be the heart. Upon getting the EKG, we found out that my physical exam was correct and the patient was having AFib. And he was having AFib with RVR. I know that's a mouthful. AFib is that atrial fibrillation where the top of the heart beats irregularly at an irregular rate. But then his ventricles, as a result of having those excess beats, was also beating very quickly. That's the lower portion of the heart that actually pumps out blood
to the rest of the body. His heart was working very hard in order to maintain this rhythm. But this isn't normal. My patient's at rest, his heart shouldn't be beating that quickly. Upon further review of that EKG, I found that he was having segments of what's known as ST depressions. And what ST depressions,
specifically on an EKG signify is that the heart isn't
getting enough blood and it's suffering. It's actually being choked out. We call this a type 2 MI which
ones a type 2 heart attack. When the heart is beating so fast that it's not getting enough blood because it's being overworked and there's actual damage to
the muscle tissue of the heart. So I told him that we have to call 911 and we have to get him
sent over to the hospital in order to contain this rate, slow the rate down, and then figure out what our
long-term plan is gonna be. Now this was very stressful because the patient
started getting emotional, they started getting worried and upset because they thought they
were coming in for their foot, but here we are, diagnosing
them with a heart attack. My patient ended up going
to the emergency room. They gave him IV medications. They made sure that the rate subsided, that the enzymes that were
leaking from the damaged heart started going down and
the heart was improving. And once that started happening, they had a cardiovascular
doctor see the patient and decide what the plan
wanna gonna be moving forward. And part of that was to increase the dosage of one medication and decrease the dosage of another. And then have them follow up in one week with that same cardiologist. The point of this being is that as a doctor, you
never know what do expect, especially at a family medicine office. I had a patient on my
schedule for an infected foot, and here I am, diagnosing
him with a heart attack that they were walking around with. They actually walked a
few blocks to my office. A mistake I see a lot
of young doctors make is to get pigeonholed into a diagnosis. They see a red, swollen
foot on their screen. They only look at that body part and they say, "Okay, well
here's a diagnosis for this," and they forget that
there's a whole person sitting in front of them. It's important to take that whole person to consideration when treating a patient. Yes, the complaint is
about an infected foot, but the real concern was
with my patient's heart and the only way I could find that out is through a thorough
history and physical exam. Had I not done those things, just looked at the foot, said,
"Okay, the foot's improving, "you know, keep taking your antibiotics, "let's have you follow up." I would have been doing a
huge disservice to my patient. We have to treat the
human sitting in front us and not the ailment, or not the complaint that
they're bringing to us. The more you can do that
as a doctor, as a person, as a police officer, it
really doesn't even matter, the better you're gonna fair and the better the person sitting in front of you is gonna fair. Let's have some fun and open some packages via Mail Time, courtesy of my mail bag. West Orange, New Jersey,
that's not too far. (bag crinkling) Oh, these are gonna be cuff links because I can tell from the cuff link box. Ooh. These are dope. These are little stethoscopes. Ooh, look at this little checkerboard tie. If it matches, you gotta wear it. Whew. Easy work. Thank you for your wonderful gift. I think I look pretty fly and I can't wait to wear these cuff links. Fort Walton Beach, Florida. (gasping) Snickers! (gasps) Did you get Bear his favorite toy? No joke, this is Bear's favorite toy. Little squirrels that you put in here and then he has to get them out. Bear, I have a gift for you. Oh, they make noise. This is legit, Bear's favorite toy. He's gonna lose his mind. Oh, it's a mug. Aw, me and Roxy sitting side by side. How did you do this? Husky Dad, me and Roxy hanging out. Thank you, family. Okay, this one's from Texas. Whoop! Whoa. Swarovski pens, with my name on them. But the only thing is, I'm not a DO and MD, I'm just a DO. Problematic? This is from Hungary and I've been to Hungary many of times. Not many of times, I've been there twice. I imagine this is gonna be a drawing 'cause it's with some
really heavy cardboard. Here, let's see. "Dear Mike, I couldn't
decide, so I did both. "Hope you like it, best regards." What? This is by far the best drawing I've ever seen of me in my life. This is pencil, folks. Is this ridiculous or what? - Wow.
- Dude, these are amazing. I'm gonna have these framed. I don't know where I'm gonna put them because it's kind of awkward hanging pictures of
yourself in your own house, but these are amazing. Like, this looks like me. Beau Smith or Bea Smith, please, send me your Instagram. I wanna put this on my story and share this with the world. Your art is amazing. I mean, like you can't
draw better then that. This is from Ohio. Okay. Okay, here we go, we got socks. Get outta here! Socks with Roxy and Bear's face on them. Come on now, chum on. I'm gonna wear these to work and people are gonna judge me and I don't even care at all. Thank you, Kenyatta,
very much appreciated. Stay being an awesome nurse. "I've sent you a T-shirt I
make at our small family farm. "I guessed you wear a large or extra large "so whichever one doesn't fit, "feel free to do whatever
you want with it." Okay, this is a very interesting shirt. Support your local beekeeper,
I'm down with that, but why is the bee throwing up? (retches) Fun fact, all my videos are now captioned in English and Spanish, so click here to check this one out and have good laugh. As always, stay happy and healthy. (cheery music)
