Too Many Pushups

Written by Tad. Posted in Kooks

A 15-year-old boy got in trouble at football practice. As punishment, his coach sentenced him to do 150 pushups over the weekend. His mother was assigned to monitor him and make sure he was compliant.

On Monday, he was unable to move his arms, which were in severe pain, and he noted that his urine was darker than normal. All of this concerned his mother, who brought him to the emergency department. This story of over-exercising, followed by excessive muscle pain and dark urine was worrisome to me. Quick blood and urine tests confirmed my suspicion. He had rhabdomyolysis.*

The excessive use of the muscles of his arms and shoulders caused enough muscle damage that a protein, myoglobin, was released from the muscles in such large amounts that it turned his urine dark. If not treated, that same protein could be toxic to the kidneys. This patient had to be admitted to the hospital to get pain medicine and IV fluids until his muscles healed and the myoglobin was cleared from his blood and urine.

Over-exercising is one of the more common causes of this condition. As far as I know, I have never seen it just from over-use of the upper extremities. Since your legs have so much more muscle mass than your arms, it is a lot more likely for this to develop after over-use of the legs. For example, we often see prisoners who do squats over and over until they develop rhabdomyolysis. They come in from jail with leg pain and dark urine and have to get admitted to the hospital.

I wonder if my patient’s coach will assign 150 pushups as behavior modification again.

 

*I posted a case previously about rhabdomyolysis. Please see Dancing with the Stars in a previous post.

Also, for more information, check out this Wikipedia article: https://en.wikipedia.org/wiki/Rhabdomyolysis

 

Chocolate Peanut Butter Globs

Written by Tad. Posted in Cookies

chocolate peanut butter globs DSC04300

This is one of those recipes that is all over the Internet. It seems weird to call them “peanut butter” when there is no peanut butter in them at all.

For some reason, I have always referred to the chunky ingredients added at the end of the cookie recipe as “floaties.” Don’t ask me where that came from. Maybe it is because I just can’t think of a better word. Anyway, this recipe has more floaties than any other recipe I have ever made. Seriously, packed with nuts and chips.

Recipe By:

All over Internet

Yield:

36

Ingredients:

6 tablespoons unsalted butter
12 ounces semisweet chocolate chips, divided
2 ounces unsweetened chocolate
2 large eggs
1 tablespoon instant espresso or coffee powder
2 teaspoons pure vanilla extract
¾ cup sugar
⅓ cup all-purpose flour, plus 1 tablespoon
1 teaspoon baking powder
¼ teaspoon kosher salt
1 cup walnut halves, not chopped
1 cup pecan halves, not chopped
⅔ cup peanut butter chips

Directions:

1. Heat oven to 325 degrees. Line baking sheets with parchment paper.

2. In a bowl set over simmering water, melt butter, 6 ounces of chocolate chips, and unsweetened chocolate, stirring occasionally, until just melted. Remove from heat and cool for 15 minutes.

3. In bowl of electric mixer fitted with paddle, beat eggs, espresso powder and vanilla until combined.

4. Add sugar. Raise speed to medium-high and beat for 2 minutes, until the batter is thick and falls back on itself in a ribbon.

5. With  mixer on low, slowly stir in  chocolate mixture.

6. Combine ⅓ cup of flour, baking powder, and salt in a small bowl. Stir into chocolate mixture with a rubber spatula.

7. In another bowl, combine walnuts, pecans, peanut butter chips, remaining 6 ounces of chocolate chips and 1 tablespoon of flour. Fold into chocolate mixture.

8. Scoop 2 tablespoon balls of dough, 1 inch apart, onto prepared baking sheets. Bake for 15 minutes exactly. Cool on baking sheets.

Mr P., Again, Again

Written by Tad. Posted in Kooks

I am so sorry. Looks like this was still not working for some people. Here it is again. I am confident it will work this time. Thanks for your patience.

One the doctors I work with forwarded this article to me. It was written by Otis Warren, an emergency physician. It paints a great picture of a specific patient but also of the bigger social problems associated with public alcoholism.

Enjoy!

http://content.healthaffairs.org/content/35/11/2138.full

 

Eye Poke Defense

Written by Tad. Posted in Kooks

I was working in the Accident Room of Charity Hospital in New Orleans. A young man came in complaining of pain in both of his eyes. He said he had been in an argument with another man in a bar. The other guy had stuck out two fingers and poked my patient in the eyes. The pain caused my patient to bend over. When he straightened back up and opened his eyes, the other guy poked him again, the same way.

He was in so much pain that his friends brought him to the emergency department. A quick evaluation showed that his only injury was corneal abrasions or scratches on the front, clear parts of his eyes. Though this is a very painful condition, it rarely results in a complication and usually heals within a day or two. As per the custom then, we medicated and patched both of his eyes and sent him out with a prescription for pain medicine. His concerned friends helped him out of the emergency department and into their car.

Though we didn’t want to laugh at the patient, we did have a good laugh when I reminded everyone that, in The Three Stooges, Mo would poke Curly in the eyes in the same manner. When Mo tried to poke him again, Curly would use the Eye Poke Defense. He would hold his flat hand up, with the fingers extended, in front of his nose so that Mo’s finger tips could not reach Curly’s eyes.* I joked that our patient should have remembered that trick and it would have helped protect his eyes.

A few hours later, I was surprised to see this same patient come back in, patches still on his eyes, complaining of abdominal pain. He was in a lot of distress and clearly had something serious the matter with him. Only then did we get the rest of the story of what had happened at the bar.

When the eyeball-scratching altercation took place, the bouncer jumped right on the situation and, literally, threw both young men out of the bar. My patient was having trouble with his vision because of his eye injury and his balance because of all the booze he had consumed. When he was thrown out of the bar, he fell, striking his lower abdomen on the top of a fire hydrant.

A guy who has been drinking in a bar usually has a full bladder and a blow to the lower abdomen in this situation can lead to a rupture of the bladder and that is just what happened to our guy. Though he was just kind of sore there during his first visit, it wasn’t until he lost some blood and the blood and urine had some time to irritate his abdominal cavity that he started to get sick. He had to go to the operating room to have his bladder repaired.

Though holding his hand up, like Curly, may have prevented some injury to his eyes, I don’t think it would have done anything to protect his bladder.

 

*Here is a picture of Mo trying to poke Curly, who is very effectively using the Eye Poke Defense.

eye poke defense

Natalie’s Easy and Delicious Chocolate Chip Cookies

Written by Tad. Posted in Cookies

Natalie's

Probably no one needs another chocolate chip cookie recipe but Natalie, one of our physician assistants, told me there were the very best. She swears the secret is dropping them, hot out of the oven, onto the counter top. I was not disappointed!

Ingredients:

1 cup butter
1 cup sugar
1 cup brown sugar
1 egg
1 tablespoon vanilla
2½ cups flour
1 tablespoon soda
½  teaspoon salt
2½ cups chocolate chips

Directions:

1. Cream butter and sugars.

2. Stir in egg and vanilla.

3. Stir in flour, soda and salt.

4. Stir in chocolate chips.

5. Scoop 2 tablespoon balls of dough onto baking sheets lined with parchment.

6. Bake at 350 degrees for 12 to 14 minutes until bottoms and edges are just browning.

7. As soon as you take them out of the oven, drop each sheet from about a foot onto counter top.

8. When set, remove to rack to finish cooling.

Raspberry Lemon Cookies

Written by Tad. Posted in Cookies

lemon raspberry DSC04317

 

Recipe By: bakeeatrepeat.ca
Yield: 20

Ingredients:

½  cup unsalted butter, softened
1 cup granulated sugar
½ teaspoon vanilla
1 large egg
½ lemon, zest and juice
¼  teaspoon salt
¼  teaspoon baking powder
⅛  teaspoon baking soda
1½ cups all-purpose flour
¾  cup frozen raspberries, coarsely chopped

Directions:

1. Heat oven to 350 degrees. Line 2 cookie sheets with parchment paper or silicone baking mats. Set aside.

2. In large bowl, or bowl of a stand mixer, cream together butter and sugar until light and fluffy.

3. Add vanilla, egg, lemon zest and juice. Mix well, scraping down the sides of the bowl as needed.

4. Add salt, baking powder, baking soda and flour. Mix until combined.

5. Add raspberries. Mix briefly to incorporate them.

6. Drop in 2 tablespoonful balls onto prepared cookie sheets. A cookie scoop works best because the dough is extremely sticky, but two spoons work too, the cookies will just be less uniform.

7. Bake 14-16 minutes or until they are just starting to brown on the edges and are no longer shiny at all. Put the second half of the cookie dough in the fridge while the first sheet is baking. It will get even softer as the raspberries thaw.

8. Allow the cookies to cool on the baking sheet for 10 minutes before moving to a wire rack to cool completely.

Copyright © 2014 Bad Tad, MD