Archive for October, 2016
I recently went mountain biking in Moab, Utah. Unfortunately, I fell just as our ride was starting. It was soon apparent to me that I had broken some ribs on the left side of my chest. I painfully rode back to the trailhead and found a ride back into town, rather than trying to ride the rest of the 26 miles we had planned for that morning.
Since there is really no treatment for broken ribs, I knew there was no reason for me to seek medical care. I just set myself up on the couch of our rented condo and tried not to move around too much until I could head back home.
A week later, I was back at work, feeling better and was taking only ibuprofen for pain. “This has not been that bad,” I thought to myself. Little did I suspect that a surprise setback lay ahead.
I woke up on Saturday morning, eight days after my fall. As I got out of bed, I was surprised that I had more pain in my chest than I had been experiencing the previous few days.
While I was in the shower, the pain got a lot worse and any movement was now causing severe pain. Getting dressed was really tough but I pressed on, feeling sure it would soon pass.
As I started down the stairs into the living room, I was seized with a muscle spasm along my left spine that left me completely incapacitated. I hollered, stiffened and became unable to breath or move until the muscle spasm relaxed and the broken ends of my ribs were not being driven against each other.
The spectacle I presented on the stairs caused everyone in the house to come running. My wife, son and daughter-in-law rushed to my side, trying at the same time to understand what was wrong and wondering how they could help.
Several things went through my head as this was going on. I know enough about this sort of thing to understand, basically, what was going on. The pain from my broken rib was causing my back muscles to go into spasm. That was causing severe pain which was making the muscle spasms worse. Whenever I moved, I was caught in this terrible cycle and the only thing that helped was to not move, at all. Understanding this, I was not worried that I might have some terrible, life-threatening condition. I recognized that this understanding helped me a lot, compared to people without my training and experience who might be freaking out, wondering if they were dying or something.
I next thought that I always have to ask my patients to rate their pain on a scale from 0 to 10. In doing so, I sometimes wonder what pain I would rate at a level of 10, the most pain anyone could experience. “Now I know,” I thought.
After I was through with my clinical and analytic thoughts, my attention turned to how to get off the stairs. If I moved my trunk at all, like to take a step, the pain would come back and I couldn’t move. There was nothing I could do about it. With help from my wife and son, I forced myself down the stairs and collapsed on the couch, trying not to scream the whole time.
There I stayed the rest of the day, unable to move without triggering the same terrible pain. When it came time to try to take a nap, I needed help from my wife and son who moved me as if I were a piece of fragile furniture, trying to keep my spine from moving.
At bedtime, they helped me in the same way back up to my bed. The next day I still had pain and had to be careful but was some better. By the following day, I still had the rib pain but all of the spasms were gone. Today, I am almost pain free. I am back to riding my bike with no problems.
Now, I told you that story to tell you this one:
The next week at work, I introduced myself to my next patient. She was a lady about my age who told me a sad story about being attacked three days earlier by her mother, who suffered from Alzheimer’s Disease. She had been knocked to the ground and injured her chest. She told me she was pretty sure she had broken a rib and, knowing there was nothing to do for it, had just been taking ibuprofen and putting up with the pain.
What brought her in was that she had woken that morning with severe muscle spasms on the same side as her broken rib. The pain was so severe she was incapacitated by it and was worried about a complication of her chest injury.
As I listened to her, I had a hard time not smiling, which I knew would not be perceived well. As soon as she had a chance to tell me of her concerns, I briefly told her of my experience the weekend before. I explained what I thought had happened to both of us. I reassured her that what she was going through was completely understandable and she had nothing to fear. I also assured her that we would get her feeling better in a short time.
After some intravenous morphine and valium, she was feeling much better. She went home relieved to know she was going to be fine, happy to be out of pain and appreciative of a doctor who was able to empathize so distinctly with her suffering.
There is some irony in recognizing that she went to the emergency department and got some help while I just stayed at home and suffered.
My friend, Lisa, sent me a recipe for Hard Boiled Egg Chocolate Chip Cookies. “What the…?” I asked. A quick Google search showed that something that sounded bizarre to me was, actually, all over the place. I tried some different recipes and this is the one I liked the best. They are very moist but are not nearly as good the next day so make small batches or eat them up!
This is a very interesting way to make cookies. I’ve never seen a cookie recipe that asked you to blend the butter into the flour as if making pastry. This is a small batch but even at that, it was pretty tricky to get the food processor to mix it up. The processor was just too full. When it was done, however, the dough was fabulous and it was really fun to mix the chocolate chips in with my hands. Had to repeat it thee times to make enough for the emergency department.
2¾ cups flour
1 cup cold butter, cut into small chunks
1 teaspoon salt
½ teaspoon baking soda
¾ cup white sugar
½ cup brown sugar
1 teaspoon vanilla extract
2 hard boiled eggs, peeled and diced finely
2 cups semi-sweet chocolate chips
1. Heat oven to 350°F.
2. Mix flour, salt and soda in a food processor.
3. Add butter and process until mixture is the texture of small crumbs.
4. Add sugars, vanilla, and boiled eggs. Pulse again until mixture comes together.
5. Remove dough to a large bowl. Add chocolate chips and combine by hand, using a wooden spoon or clean hands.
6. Scoop 2-tablespoon balls of cookie dough onto parchment-lined baking sheets. Flatten slightly with your hand.
7. Bake 13-15 minutes or until the edges of the cookies are lightly browned.
8. Remove cookies from oven and let them sit on the cookie sheet for 3-5 minutes before transferring them to a cooling rack. Eat them today.
Here is Hunter enjoying one:
Here is a picture of my hens. No wonder I am always looking for egg recipes:
One night this week, one of my physician assistants came to me frustrated that the patient he had gone to see had run him off, saying he wanted another doctor. Matt had addressed two complaints the patient had: difficulty urinating and a nagging cough. When the patient went on to more complaints, including shoulder pain he had been suffering with for over a year, Matt recommended he take up these more chronic problems with his primary care physician. That is when the patient ran Matt off.
It was now my turn. I found an elderly man asleep on a gurney wearing sunglasses and a beret pulled down over his face. I introduced myself and went over his first two problems. When I asked him if he had any other concerns, he told me about his shoulder pain, for which his primary care doctor usually gave him Vicodin. He then said all he wanted was to be treated with sympathy.
I asked him if he had come for sympathy or for Vicodin. He calmly answered, “Vicodin would be fine, thank you very much.”
This all took place in the hall right in the busiest part of the emergency department and as soon as he answered my question, I was surrounded by suppressed laughs. I had not intended my question to be comical. I’m sure he didn’t intend his answer to be funny either, but, together, they made everyone laugh. This was especially funny to staff surrounded every day by people looking for opioids for their chronic aches and pains.
Semolina is made from hard durham wheat. It is cooked, dried then ground. It looks and feels kind of like corn meal. It gives these cookies an interesting texture. They are soft and very lemony.
Hunter enjoys one after a spaghetti lunch.
Adapted from Food.com
3 large lemons
½ pound unsalted butter
½ teaspoon vanilla extract
2 cups sugar
1 teaspoon salt
3 cups semolina
1 cup all-purpose flour
To dust the cookies
½ cup sugar
1. Using a grater, grate lemon peels, removing only the yellow part. Set aside. *See notes.
2. Squeeze juice from the lemons. Set aside.
3. Combine butter, vanilla, sugar and salt in an electric mixer fitted with a paddle. Beat until creamy.
4. Add egg, ½ cup lemon juice and grated rind. Beat until incorporated.
5. Reserve any extra lemon juice for another use.
6. Decrease speed to slow. Add semolina and flour, beating until just incorporated.
7. Cover with plastic wrap and chill in the refrigerator for 1 hour.
8. Heat oven to 325°F.
9. Scoop dough into 2 tablespoon balls. Roll each ball in sugar then place on greased baking sheets.** See notes.
10. Flatten each ball to about ½ inch thick. *** See notes.
11. Bake cookies on the middle rack of an oven for about 14 minutes, or until the surface starts to crack. They will not start to brown.
12. Remove from the oven and let cool before removing from baking sheet.
*This finely grated citrus peel is called zest. I have a zester, specifically made for this job. It works ever so much better than a regular grater.
**I almost always use parchment baking papers but these didn’t come off the papers well at all.
*** My preferred method to do this: Butter the bottom of a drinking glass. Dip it into sugar. Gently flatten a dough ball to desired thickness. Re-dip in sugar before flattening the next ball.