From: sbharris@ix.netcom.com (Steven B. Harris )
Subject: Re: What's wrong with my sister ?
Date: 09 Sep 1995
Newsgroups: sci.med,sci.med.immunology,no.medisin

In <42pmks$amf@vkhdsu01.hda.hydro.com> hdaarel@hda.hydro.com (Arild
Ellingsen) writes:

>My sister has had a health problem for nearly 3 years, is still
>suffering, and doctors/hospitals here in Norway can't find the
>reason. Here is a summary her doctors have given to me:
>
>34 year old female, BW loss 10 kg to 45 kg the last weeks before
>hemithyreoidectomi (claimed difficulty in swallowing) because of
>a follicular adenoma (BMI 16). Preop.hypokalemia (K=2-3 mmol/l).
>Later also low Zinc, low Erythr.folic acid and low Ferritin. Thorough
>examination of endocrine status, kidney function, g-i absorption neg.
>No indication of Bartter syndrome or use of laxatives. No proof of
>anorexia. Later generalised prurigo nodularis. Fatigue, coldness,
>increased demand of sleep. In periods moderately increased liver
>enzymes, neg. Hepatitis serology.
>
>Substituted with Potassium, Zinc and Folic acid without change in
>symptoms.
>
>Is this a known clinical syndrome ?
>
>--
>Thanks for any help. Arild
>
>Email: Arild.Ellingsen@hda.hydro.com
>X.400: G=arild;S=ellingsen;O=hda;P=hydro;A=telemax;C=no


   Whatever it is, her doctors are letting her starve to death.  I
suggest you get her nutrition by nasogastric tube (if necessary) until
you figure out what is wrong. ***Do not let patients starve while
doctors scratch their heads***   This is the first rule of medicine
(and more than occasionally forgotten by surgeons).  If she refuses the
NG tube, your diagnosis has been made: anorexia.  The "proof" of
anorexia is in the behavior-- there aren't any medical tests for it.
Although all the signs of malnutrition which you've noted (low K, low
ferritin, low body weight, "problems" swallowing, etc, etc) are all
suggestive.

                                          Steve Harris, M.D.

From: sbharris@ix.netcom.com (Steven B. Harris )
Subject: Re: What's wrong with my sister ?
Date: 09 Sep 1995
Newsgroups: sci.med,sci.med.immunology,no.medisin

In <42rfm6$1bm@fu-berlin.de> Dietrich Delekat
<delekat@fub46.zedat.fu-berlin.de> writes:

>Dear Steve,
>
>IMHO a good doctor - scratching his head or not - would be a little bit
>more cautious with such quick diagnoses without knowing the patient at
>all and having very little information about him.
>Making a diagnosis of anorexia on the grounds of refusing a nasogastric
>tube is ... well, let's respect net policy rules here.
>By the way - they are mostly NOT fools down there in Norway.
>
>Gruss
>Dietrich



  As I said in my private post, it's not matter of a patient who simply
refuses an NG tube.  It's a malnurished patient who refuses nutrition
by any means you offer or try.  When this happens you have anorexia
nervosa by definition.  It's not nuclear physics.  Whether this happens
in this case remains to be seen, but you certainly cannot explain away
a 22 lb weight loss and malnutrition in a young woman over three years
by invoking a thyroid adenoma.  Nor, on this time frame, is it going to
be a malignancy.

   By the way, letting patients starve is not a matter of intelligence
or not, but rather a matter of sensitivity.  I've seen some very smart
doctors do it.  The skeleton in the hospital closet is often the
patient, a fact which has been known for years, and hasn't changed a
great deal.  Even, I have no doubt, in Norway.

                                                Steve Harris, M.D.

From: sbharris@ix.netcom.com (Steven B. Harris )
Subject: Re: What's wrong with my sister ?
Date: 10 Sep 1995
Newsgroups: sci.med,sci.med.immunology,no.medisin

In <1995Sep9.164116.9719@jarvis.cs.toronto.edu> craig@cs.toronto.edu
(Craig MacDonald) writes:

>sbharris@ix.netcom.com (Steven B. Harris ) writes:
>>[post omited]  By the way, letting patients starve is not a matter of
>>intelligence or not, but rather a matter of sensitivity.  I've seen
>>some very smart doctors do it.
>
>While you watched and the patient starved what did you do?

   Answer: never nothing!  It's so far happened always before I got
called in as a professional.  In one case the wife of a 47 year old
friend of mine called me *the day* he died of peritonitis and pneumonia
in another state-- 3 weeks after fairly simple abdominal surgery, and
35 lbs lighter than a month before (no, they never made any concerted
attempt to feed him, either as inpatient or outpatient).  I'm urging
her to sue-- yes-- another doctor.  No comments, please, about how we
always cover our own butts.

   They did try to do it to my own father once (after a ICU admission
for multiple trauma) while I watched, but I made such a fuss that they
relented.  Helps to have a doc in the family.  He, for whatever
reasons, survived.

> Did you
>feel bound by "professional ethics" to remain silent or did you make
>your dissent known?  Doctors who tell these horror stories are usually
>guilty of the sin of omission, telling these stories to make their
>egos still larger while cleverly hiding their feelings of guilt.
>
>If the shoe doesn't fit you, don't worry, I know it fits many readers
>of this thread.


   No doubt!  Thanks, but this shoe in particular doesn't fit me, since
I've had a big interest in the subject even before medical school.  I'm
not saying I resent doctors who've sinned and now seen the light.  That
happens to all of us for *something* (and that's why they call it the
"practice" of medicine)  But my medical sins, such as they are, have
not been in this area <g>.

   And yes (in case you're wondering), I'm a licensed M.D. (in two
states now-- groan), board-certified in medicine and geriatrics, and
have so far never been sued or subjected to disciplinary action of any
kind.  Not that I think this is some kind of guarantee-- I just thought
you'd like to know.

                                        Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Post-hysterectomy Sex Abstracts (Re: Doctor-bashing)
Date: 19 Mar 1999 11:13:56 GMT

In <clw-1803991734060001@i48-14-39.pdx.du.teleport.com>
clw@teleport.com writes:

>And who is to protect the patient from the nurse.  I have seen patients in
>extremis because of errors in medication administration, patients who
>were in agony for hours because the nurse had not answered the patients
>call button, Messed up ventilator settings because a nurse thought she
>knew more than the respiratory therapy tech, a patient with a perforated
>trachea and carotid artery because the nurse did not know how to fixate a
>tracheostomy tube. One of the most dangerous things in the medical world
>is the person who has only basic training who then thinks they are
>experts and do not follow instructions.



     You left out the one gets my goat most often as a gerontologist.
Patient is reported ill with fever, and with horrible vitals.   This
gets them sent to the to the hospital, where they are found to have a
sodiums of 175, like some Cuban boat person lost at sea.  Nursing
history is that the patient had stopped eating and drinking a couple of
days ago, but the doctor had not been called because the patient didn't
look sick and didn't have a fever (imagine that, a 90 year old woman
uroseptic with no fever).

     Where do you suppose they teach some of these nurses that people
who quit eating and drinking are eventually going to crash, and that
something should be done about this sooner rather than later?  Perhaps
there's some course on human photosynthesis for nurses destined to work
nightshift on the Medicaid wing in St. Elsewhere Unskilled Nursing
Facility?