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Postby 2 cents » Wed Oct 21, 2009 4:58 pm

rasb wrote:Not very difficult to diagnose, with or without an MD. What a joke !


Listen, I am not saying a flu shot is causing this woman's condition. I am not certain her condition is genuine. But you are manifesting ignorance with your above comment.
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Postby Marlow » Wed Oct 21, 2009 5:04 pm

2 cents wrote:But you are manifesting ignorance with your above comment.

Is that a lot like being a delusional lunatic that insists he sees things that aren't actually there?
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Postby Pego » Wed Oct 21, 2009 5:05 pm

2 cents wrote:
DrJay wrote:You know who she looks like.....Joe Cocker on stage!


Do you actually practice medicine? Or do you simply play a doctor on message boards? Do you really think you can diagnose this woman from your laptop?


I have studied and practiced the craft of neurology including movement disorder in excess of 40 years. I think, I can offer a pretty decent guess.
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Postby 2 cents » Wed Oct 21, 2009 5:07 pm

Well, guess away, Pego, guess away....I guess this is multiple choice...
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Postby Pego » Wed Oct 21, 2009 5:11 pm

2 cents wrote:Well, guess away, Pego, guess away....I guess this is multiple choice...


Precisely. Three options in differential diagnosis. Organic dystonia is not among them.
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Postby DrJay » Wed Oct 21, 2009 5:14 pm

2 cents wrote:
DrJay wrote:You know who she looks like.....Joe Cocker on stage!


Do you actually practice medicine? Or do you simply play a doctor on message boards? Do you really think you can diagnose this woman from your laptop?


I'm a general internist, in real life. I am not a neurologist--pego is, read his brief comments--but I've seen enough neurologic illness in my 18 years since completing my residency to view that video with a whopping big dose of skepticism. I don't think it is possible to have those movements as an involuntary part of a neurologic illness (as opposed to a psychiatric illness, such as a conversion disorder:

http://en.wikipedia.org/wiki/Conversion_disorder)

yet have very close to normal motor function simply by changing to a trot or backwards walking. Like I said, her movements look volitional to me. If she came to me as a patient, I would send her to a good neurologist. I suspect he/she would say this is not any form of dystonia, or any other neurologic disease.
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Postby 2 cents » Wed Oct 21, 2009 5:17 pm

If you suspect she may have a psychiatric disorder, or a psychogenic disorder, would that be a good reason to mock her?
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Postby DrJay » Wed Oct 21, 2009 5:24 pm

I've seen patients who claimed one entire side of their body was numb, from crown of the head to tips of the toes, right up to their midline, with absolutely no other neurologic symptoms whatsoever....not possible, there is no neurologic lesion that can do that. A friend who worked for the Public Health Service in the hills of eastern Kentucky had a few patients come in, proclaiming in a preacherly sort of dramatic voice, "Doctah! Doctah! Ahm BLAHND! Ah kint SEE! Jesus strook me BLAHND!" and they could see, they had no illness making them blind. We can't always find a precise explanation for some symptoms, but we can often say "X" is definitely NOT due to "Y" and I'm pretty sure this lady's movements are not due to a neurologic movement disorder. Again, I'll defer to a neurologist.
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Postby DrJay » Wed Oct 21, 2009 5:35 pm

2 cents wrote:If you suspect she may have a psychiatric disorder, or a psychogenic disorder, would that be a good reason to mock her?


Point well taken. It may not be fair, but in the world of publicity-seeking balloon boy fathers and ambulance-chasing lawyers, it's hard for me not to look at this in a negative way. She didn't come in to my office seeking help, she came via youtube and Channel 16, with a claim that the flu shot "did this" to her. One would hope Channel 16 would have a physician-consultant they would check with before airing such a story. But no. This is precisely the sort of mindset that leads to multi-billion dollar settlements between Dow Corning and women who claim their silicone breast implants caused their rheumatoid arthritis, or lupus, or fibromyalgia, even though such a connection has been proven in valid scientific studies NOT to exist. Why do we ignore rational science in this country, in favor of sound bites, snake oil, and hysteria?
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Postby rasb » Wed Oct 21, 2009 5:39 pm

2 cents wrote:
rasb wrote:Not very difficult to diagnose, with or without an MD. What a joke !


Listen, I am not saying a flu shot is causing this woman's condition. I am not certain her condition is genuine. But you are manifesting ignorance with your above comment.


Really ? How incredibly clever of you, to notice my ignorance... We are blessed by your genius, and I, for one, can't wait to get your 3 cents worth.
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Postby bad hammy » Wed Oct 21, 2009 5:47 pm

DrJay wrote:It may not be fair, but in the world of . . . ambulance-chasing lawyers, it's hard for me not to look at this in a negative way.

Especially if your a doctor, right Jay?

(where is that smiley thingy?)
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Postby 2 cents » Wed Oct 21, 2009 5:52 pm

rasb wrote:Really ? How incredibly clever of you, to notice my ignorance..


Yes, I would concur that you can call me Captain Obvious for ascertaining your ignorance...
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Postby DrJay » Wed Oct 21, 2009 5:53 pm

2 cents wrote:If you suspect she may have a psychiatric disorder, or a psychogenic disorder, would that be a good reason to mock her?


Let's assume she has a conversion disorder, because if this is simply an attempt to build a lawsuit, a la the finger-in-the-chili at Wendy's, then she should just be jailed.

In my experience, when you try to work with these folks (speaking as if this is a conversion disorder), in a rational and compassionate manner (yes, believe it or not, I have some compassion for people), they, and particulary their spouse and other family members, treat you as if you are the Devil incarnate, as if you are a complete idiot, as if you never went to medical school. They get nasty, tell you to your face that what you are saying is wrong and "unacceptable". "You need to do more tests," they say. "You're jumping to conclusions," they proclaim. Then, "We want to see a specialist." "Well, Mrs. Smith, you already saw a very good neurologist, the best in town, and he agreed that this is not a neurologic disorder such as dystonia. He also felt you have a conversion disorder, like we discussed." "Well, he doesn't know what he's talking about." They make threats. Then, fortunately, they move on to another physician and repeat the same.

Sound familiar, pego???
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Postby DrJay » Wed Oct 21, 2009 5:55 pm

bad hammy wrote:
DrJay wrote:It may not be fair, but in the world of . . . ambulance-chasing lawyers, it's hard for me not to look at this in a negative way.

Especially if your a doctor, right Jay?

(where is that smiley thingy?)


Oh yeah....and people who come in complaing of bad hammys are the WORST!! :D :)
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Postby 2 cents » Wed Oct 21, 2009 5:58 pm

DrJay wrote:
2 cents wrote:If you suspect she may have a psychiatric disorder, or a psychogenic disorder, would that be a good reason to mock her?


Let's assume she has a conversion disorder, because if this is simply an attempt to build a lawsuit, a la the finger-in-the-chili at Wendy's, then she should just be jailed.

In my experience, when you try to work with these folks (speaking as if this is a conversion disorder), in a rational and compassionate manner (yes, believe it or not, I have some compassion for people), they treat you as if you are the Devil incarnate, as if you are a complete idiot. They get nasty, tell you to your face that what you are saying is wrong and "unacceptable". "You're jumping to conclusions," they proclaim. "Well, he doesn't know what he's talking about." They make threats.


It sounds like you're describing what happens on this board when most of these jokers start discussing politics...
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Postby Daisy » Wed Oct 21, 2009 6:00 pm

DrJay wrote:Oh yeah....and people who come in complaing of bad hammys are the WORST!! :D :)

Worse than those complaining of whiplash?
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Postby DrJay » Wed Oct 21, 2009 6:10 pm

To be fair, the medical profession is not all squeaky-clean. We have our share of charlatans and publicity-seekers as well.
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Postby Pego » Wed Oct 21, 2009 6:13 pm

DrJay wrote:Sound familiar, pego???


One of the things I don't mind having left behind.

BTW, conversion, somatization, dissociation I always liked. I am fascinated by all aspects of hysterical disorders. It's those other things you mention that make you sick.
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Postby no one » Wed Oct 21, 2009 6:14 pm

Factitious disorder
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Postby rasb » Wed Oct 21, 2009 6:15 pm

2 cents wrote:
rasb wrote:Really ? How incredibly clever of you, to notice my ignorance..


Yes, I would concur that you can call me Captain Obvious for ascertaining your ignorance...


So, mister couple of pennies worth, lie back on my couch, and try your best to explain when you first remember the "you can call me Captain", complex developing in your psyche....:)
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Postby gh » Thu Oct 22, 2009 1:16 pm

guru wrote:
Marlow wrote:I thought I read that 250,000,000 (!!!) vaccines were ordered for the USA and the first batches are rolling out now!!!!!



You did. There will be more than enough for anyone who wants one.


from my paper this morning:

<<Public health authorities have been lecturing people for months to get the swine flu vaccine, but to those who actually listened: Good luck finding it.

The U.S. Centers for Disease Control and Prevention for months has said that the vaccine would be widely available - with about 50 million doses - by mid-October. But as the end of the month approaches, fewer than 13 million doses have been delivered to states.....>>



Read more: http://www.sfgate.com/cgi-bin/article.c ... z0UhXnDBUg
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Postby BisonHurdler » Thu Oct 22, 2009 1:18 pm

It was supposed to be easily available to all medical students here at the beginning of this month. We're 2/3 of the way through October and we're still receiving emails from Health Services stating "still no word on those H1N1 vaccines yet, sorry guys . . . "
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Postby Daisy » Thu Oct 22, 2009 1:35 pm

BisonHurdler wrote:It was supposed to be easily available to all medical students here at the beginning of this month. We're 2/3 of the way through October and we're still receiving emails from Health Services stating "still no word on those H1N1 vaccines yet, sorry guys . . . "

It's in our local schools now. They start vaccinating next week.
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Postby 2 cents » Thu Oct 22, 2009 1:41 pm

I recently heard somebody say that flu vaccines are like beanie babies...some people will line up for hours in parking lots to get them...and some people despise them...
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Postby Zat0pek » Thu Oct 22, 2009 2:02 pm

DrJay wrote: Also his hired-gun, can't-earn-a-living-practicing-real-medicine expert witnesses.


Not true. Being an expert witness (in anything, not just medicine) pays handsomely (whether a plaintiffs or defense witness) and there are a large number of engineers, physicians, accountants, etc. who would love to be experts but don't have the CV or experience for it.

But, yes, there is a certain term that we all use for those experts (in any discipline) who will sell you whatever opinion you want; it's nomally applied to the less sophisticated practioners of the world's oldest profession.
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Postby DrJay » Thu Oct 22, 2009 3:39 pm

Zat0pek wrote:
DrJay wrote: Also his hired-gun, can't-earn-a-living-practicing-real-medicine expert witnesses.

and there are a large number of engineers, physicians, accountants, etc. who would love to be experts but don't have the CV or experience for it.


The expert witness for the plaintiff was a yo-yo in the one malpractice case I've been involved in, as an expert witness for the defense. Some of the things he said were laughable.
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Postby Marlow » Thu Oct 22, 2009 3:46 pm

Daisy wrote:
BisonHurdler wrote:It was supposed to be easily available to all medical students here at the beginning of this month. We're 2/3 of the way through October and we're still receiving emails from Health Services stating "still no word on those H1N1 vaccines yet, sorry guys . . . "

It's in our local schools now. They start vaccinating next week.

It's available in private (i.e., rich people) clinics here now, but the rest of us schlubs have to wait 2 more weeks apparently.
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Postby guru » Thu Oct 22, 2009 5:14 pm

gh wrote:
guru wrote:
Marlow wrote:I thought I read that 250,000,000 (!!!) vaccines were ordered for the USA and the first batches are rolling out now!!!!!



You did. There will be more than enough for anyone who wants one.


from my paper this morning:

<<Public health authorities have been lecturing people for months to get the swine flu vaccine, but to those who actually listened: Good luck finding it.

The U.S. Centers for Disease Control and Prevention for months has said that the vaccine would be widely available - with about 50 million doses - by mid-October. But as the end of the month approaches, fewer than 13 million doses have been delivered to states.....>>



Read more: http://www.sfgate.com/cgi-bin/article.c ... z0UhXnDBUg



We're swimming in the stuff here. Anyone who wants one can get one through the health department, or one of the various clinics(schools, churches, fire houses, etc) set up through the suburbs. They're actually going to the individual schools to make it easier for those who want one to get one.


http://tinyurl.com/ykua5yl


Needless to say, I passed.
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Postby bambam » Thu Oct 22, 2009 5:50 pm

DrJay wrote:
2 cents wrote:If you suspect she may have a psychiatric disorder, or a psychogenic disorder, would that be a good reason to mock her?


Let's assume she has a conversion disorder, because if this is simply an attempt to build a lawsuit, a la the finger-in-the-chili at Wendy's, then she should just be jailed.

In my experience, when you try to work with these folks (speaking as if this is a conversion disorder), in a rational and compassionate manner (yes, believe it or not, I have some compassion for people), they, and particulary their spouse and other family members, treat you as if you are the Devil incarnate, as if you are a complete idiot, as if you never went to medical school. They get nasty, tell you to your face that what you are saying is wrong and "unacceptable". "You need to do more tests," they say. "You're jumping to conclusions," they proclaim. Then, "We want to see a specialist." "Well, Mrs. Smith, you already saw a very good neurologist, the best in town, and he agreed that this is not a neurologic disorder such as dystonia. He also felt you have a conversion disorder, like we discussed." "Well, he doesn't know what he's talking about." They make threats. Then, fortunately, they move on to another physician and repeat the same.

Sound familiar, pego???


Not pego, but will confirm this happened to me when I made my one and only diagnosis of conversion disorder. Lady who had had shoulder surgery and came in with a "paralyzed, flail arm" which she and her husband attributed to the surgery, which was impossible given the surgery she had had. However, all the studies were normal, including her EMG/NCVs (nerve studies). They did not appreciate my diagnosis at all. That was good, because I didn't appreciate them as patients at all, and they went somewhere else - actually I saw two other notes from other MDs who agreed it was either conversion disorder or factitious.
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Postby Daisy » Thu Oct 22, 2009 6:02 pm

Zat0pek wrote:
DrJay wrote: Also his hired-gun, can't-earn-a-living-practicing-real-medicine expert witnesses.


Not true. Being an expert witness (in anything, not just medicine) pays handsomely.

Are you saying they would be good doctors but they choose not to be? I don't know any expert witnesses so I have no idea.
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Postby 26mi235 » Fri Oct 23, 2009 6:30 am

Daisy wrote:
BisonHurdler wrote:It was supposed to be easily available to all medical students here at the beginning of this month. We're 2/3 of the way through October and we're still receiving emails from Health Services stating "still no word on those H1N1 vaccines yet, sorry guys . . . "

It's in our local schools now. They start vaccinating next week.


They started vaccinating in the schools this week, but we got a message yesterday saying that not all kids would get the vaccine as scheduled because they are low; apparently they only have the nasal/live variant (which is fine with me, although my first grader prefers the shot -- not my 8th grader!). Tuesday is the scheduled day; they will send a note home with every child that does not get the vaccine that has signed up.
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Postby gh » Fri Oct 23, 2009 7:08 am

guru wrote:[....
We're swimming in the stuff here....


Wow, an even easier delivery method than the nasal spray! :)
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Postby tandfman » Fri Oct 23, 2009 12:48 pm

gh wrote:from my paper this morning:

<<Public health authorities have been lecturing people for months to get the swine flu vaccine, but to those who actually listened: Good luck finding it.

The U.S. Centers for Disease Control and Prevention for months has said that the vaccine would be widely available - with about 50 million doses - by mid-October. But as the end of the month approaches, fewer than 13 million doses have been delivered to states.....>>

Read more: http://www.sfgate.com/cgi-bin/article.c ... z0UhXnDBUg

Similar story at nytimes.com:

http://www.nytimes.com/2009/10/24/health/24flu.html

A month ago, Dr. Thomas R. Frieden, the director of the Centers for Disease Control and Prevention, warned that the flu vaccination drive soon to begin would be “a little bumpy.”

That was an understatement.
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Postby gh » Tue Oct 27, 2009 1:51 pm

talked to an ER doc I know the other day; his department has seen "about a thousand" flu patient so far this fall.

He says they're 99.9% swine. Not cost-effective to test them all clinically, but ongoing random sampling isn't turning up any seasonal flu.

In the worst case they had, 7-month-pregnant woman had severe lung issues; function diminished to point that she was compromising the fetus with lack of oxygen, so they had to do a C-section to save the baby. Shortly thereafter the mother died (not because of the surgery). :-(
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Postby BisonHurdler » Tue Oct 27, 2009 2:36 pm

gh wrote:He says they're 99.9% swine.




This is consistent with the numbers we've been given from the Infectious Disease docs and the Institute for Human Virology folks who have been lecturing for our Virology course.
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Postby DrJay » Wed Oct 28, 2009 7:30 pm

Our office received 200 doses of the injectable and 200 doses of the nasal spray version of the H1N1 vaccine this week, from the State Health Department. My kids' pediatrician hasn't even gotten any, and we didn't even request any of the nasal spray formulation.

While the peds offices and the ERs and urgent care centers have been full-on busy with kids with respiratory infections, a lot of it H1N1, we have seen an average amount of viral respiratory infections for this time of year, and very few cases that seemed like classic influenza, with high fevers, terrible body aches, and terrible cough. Almost zero among the elderly.
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Postby 26mi235 » Fri Oct 30, 2009 10:00 pm

26mi235 wrote:They started vaccinating in the schools this week, but we got a message yesterday saying that not all kids would get the vaccine as scheduled because they are low; apparently they only have the nasal/live variant (which is fine with me, although my first grader prefers the shot -- not my 8th grader!). Tuesday is the scheduled day; they will send a note home with every child that does not get the vaccine that has signed up.


They got to my sons class and most of the way through but ran out before they got to him. He came down sick two days later but it has developed slowly (slight fever briefly for a couple of days, then 103 at night and 101-104.0 the next day (today) and if he goes back to 104 they said to bring him in (and now my throat is feeling iffy (an my wife departs for 6 days on Sunday).
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Postby TNT » Wed Nov 18, 2009 3:22 pm

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Postby 26mi235 » Wed Nov 18, 2009 7:45 pm

Unfortunately, for me now a vaccine is superfluous, I got immunity the hard way.
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Postby gh » Fri Nov 20, 2009 9:09 am

I gotta tell you, it wasn't easy holding my breath for 21 hours on two flights and through three airports!
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