My Headache May Have Prevented A Stranger's Bone Marrow Transplant
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- เผยแพร่เมื่อ 30 มิ.ย. 2024
- How my headache may have prevented a woman from receiving a bone marrow transplant...I analyze 7+ hours I spent in the Stanford emergency department as a patient, touching on issues of the uncertainty of diagnostic tests, anxiety, unintended consequences, and of course, cost.
(Conflict of Interest Statement: I'm on the faculty at Stanford School of Medicine - but neither the school nor hospital had any input on the content of this video.)
![ภาพนี้ก็ฮาเหมือนกันนะเนี้ย #1 SS8 [ พากย์นรก MEME.EXE ] | easy boy](http://i.ytimg.com/vi/Ytc50m91QK8/mqdefault.jpg)
Thank you for sharing your story. As a neurosurgeon, I knew where this was headed and thought “I bet he will have a infundibulum.” I can’t imagine how stressed lay people would be in this position. After the birth of my daughter I had some atypical complications...the curse of the health care provider as a patient. Medicine isn’t always “textbook” and there is much grey.
A few important notes [SPOILERS AHEAD]:
...[scroll down]...
1. Please don’t be worried about my health. I feel great! The prevalence of intracranial aneurysms is ~3% (yes, 1 in 33 middle-aged adults is walking around with a cerebral aneurysm!) The overwhelming majority of these aneurysms never rupture or require treatment. And it’s not even clear if I have one.
2. Don’t let my experience with registering as a bone marrow donor dissuade you from registering yourself! Yes, the donor network was ridiculous with my specific situation. But I would 100% register and attempt to donate again. You can sign up to register to be a donor here with Be The Match: bethematch.org/support-the-cause/donate-bone-marrow/join-the-marrow-registry/
3. It has been pointed out to me that a negative non-contrast head CT within 6 hours of headache onset is often considered sufficient to rule out a SAH, thus eliminating the need for LP or CTA. However, that practice is not universal, and depends upon the pre-CT probability of a SAH. I’m obviously not unbiased in this assessment, but in my opinion, the combination of new onset of unusually severe, thunderclap headaches that were triggered by exertion placed my pre-CT probability of SAH at higher than typical for patients receiving a “r/o SAH” evaluation.
EDIT: I hope I made this clear in the video, but if not, I believe my care was great (aside from the cost, of which my insurance covered >90%). Everyone from the ER triage nurse to the MRI tech was great. For the most part, the tests and interventions that were unnecessary are nevertheless typically done, and most of which I probably would have ordered myself had I been the treating doctor. Even something like the "traumatic" lumbar puncture was just bad luck, and unlikely to be related to the physician's skill or technique. What made the experience less-than-ideal for me had nothing to do with the people, but rather the fact that diagnostic uncertainty is still present even at one of the best hospitals in the world, and that every test or intervention that we do risks unintended downstream consequences - the specifics of which cannot always be predicted.
Hi Dr. Strong, I'm glad your health is fine. I am a 4th year med student and have watched your lectures for a few years now. During this emergency, your care was about as good as it could be, yet even you were dissatisfied. I'll be guilty of ordering numerous unnecessary tests as an intern this summer I'm sure, how can I combat this as the junior person on my teams? In my clerkship years attendings never asked what the running cost of our workup would be, nor did any resident ever hesitate to order a panel if it might "rule something out" (particularly on specialty consult services like ID or rheumatology). In fact, at the university hospital (as opposed to the county hospital we rotate at) many more affluent patients took offense to any perceived hesitation to order a study or procedure as it signaled incomplete care or a loose end. How aggressively (if at all) should I pursue cost stewardship for patients
Dr your lectures are asome!!! you rock!!!!!!!
@@folumb Thanks for the comment! I wouldn't say that I was dissatisfied with my care. I actually think it was really good (just expensive!). There's a difference between being satisfied, and feeling like the care was perfect. I was satisfied. And as I replied to another viewer, I would have done very little differently had I been the doctor; and my care would have cost the patient almost as much. (Having now been through this, and having seen how much is charged for some of these things, I would approach the work-up more differently than I would have beforehand.)
Regarding cost stewardship, I'm very glad that you are already thinking about this as a student. This doesn't get nearly as much attention as it should in school and residency. Unfortunately, your desire to pursue cost effective workups for your patients will be limited by your attendings. Some attendings favor a less-is-more approach (from both a cost, as well as risk perspective), and some attendings also give interns and residents plenty of autonomy to make such decisions themselves, but other attendings are the opposite. However, as a student or intern, I wouldn't make this a priority since you may end up upsetting patients who will give that feedback to your attending, and ultimately that comes back to you. There are some points where it might be more benign to suggest cutting back unnecessary testing - for example, low hanging fruit are "routine" daily CBCs and chemistry panels on patients who have been stable for a while. But you will be largely at the mercy of your attendings.
Hi
I am glad that you are doing well. But as you mentioned yourself what you went through is a recurring scenario that happens to millions of people going to the ER in this country on a daily basis.
Unless we have algorithms that as far as they are followed by the ER providers , they won’t be responsible for subsequent events
, many of these “incidentalimoas”
Would cause massive over run of our health care systems, unless the medical societies, and the major health care systems like Stanford, Harvard that their staff/Academics set the rules down for “quality care”
Intervene ,
the cost of health care would keep raising with no added quality or improved outcomes.
Strong Medicine Hi Dr Strong thank you for sharing your personal story and great insight into the healthcare delivery in secondary care. I’ve recommended your video and channel to several colleagues of mine. Of interest, did you ever find out the cause of your headache and if not how do you deal with the uncertainty? I understand these questions are personal so please don’t feel obligated to answer unless you’re comfortable 🙂
Eric. You are a genuine person. A real doctor who cares patients with his heart. I salute you and thank you for what you do. God bless you.
Wow, very interesting and informative! I really enjoy hearing how you process info and integrate it as a doc and as a patient!
This video was AWESOME! This needs to reach out to more people!
Another amazing presentation. Thank you for sharing, like always, learned a lot.
I’m glad you’re feeling well. Im feeling throughly demoralized after the video though😂
It’s like no matter how much knowledge we seem or think we have, we still aren’t very effectual. And that’s at Stanford, one of the best institutions. Also depressing to see the prices and think about how our decisions to help a patient today may just ruin them later via financial burdens.
Super nice presentation of a personal case of headache . Glad to hear you are healthy and all your comments much appreciated . Thank you .
Great story. Definitly makes you look at things from a different angle.
Great video, Eric. Thanks a lot for sharing it
Great story. Thanks.
Yes, it's a big difference when you self (or someone from your family) become a patient. I used to work as a doctor in the Netherlands when my son got DM type 1. And it still strikes me how many blunders you can get even with this medical classic case.
Great video! ”Too much medicine” is definitely a thing. And oh my the cost of lab tests, imaging and just health care in general in USA is insane...
Thanks for sharing your experience. It really helps me.
Thank you for sharing your experience so effectively sir . These situations happen in my country too. I am relieved to know that you are perfect in health at the end😄
In my residency in general surgery , in our ward there was a lady - wife of one of our fellow residents - who was hospitalized to be diagnosed and treated her malaise and fatigue and decreased appetite . Surprisingly many professors of medicine in and out of hospital were called and invited to see what is the problem with this lady. Many different and costly tests and imaging were done .I was amazed that she is in bed for two weeks with NO diagnosis !. No one could ?? ! . At last one of the junior residents , for the first time went in to examine the patient . And he did it .The patient had meningitis of TB origin . How the senior resident came to this diagnosis ? He answered , "by just history taking and physical examination ".
Thanks for sharing this!
Ur talks are always awesome sir...
I love your videos Dr. Strong!
Usually your videos are so polished and PERFECT (I love them) but I like how in this one more of your personality shows. Its a little more real, a little less polished.
Thanks very much Eric. Your video discussing your father's medical experiences is one my favorites and one I've shared with trainees the most. This story is equally useful, especially for trainees struggling to identify the border between what we consider necessary testing and what isn't. It also demonstrates how even when we do everything basically correctly and even when there is a good outcome, there are still lots of significant harms and costs inherent in modern medicine.
Also, I was shocked by the list price numbers you gave. Is there any chance you could compare and contrast the list price numbers with the actual hospital cost and/or the medicare and medicaid reimbursement costs? As a VA doc, I usually only have to think about the taxpayer cost, i.e. the facility's actual cost for a given intervention. The lab testing and imaging costs in particular were orders of magnitude higher than the numbers I've been given by local admin.
i thoroughly enjoyed this whole narrative of your ED experience, I really hope we all become better physicians with patient experience, totally gets you to put things in their true perspective, now things like ED wait time, diagnostic ambiguity, the whole thing as the patient makes arrangements and gathers up courage and financial concerns to just take the trip, along with many other things,
if we all can do anything to make this experience as pleasant and easy as possible, that'd be a win, may god help us with this. Thanks, and again amazing story
Just curious, were you disqualified from a BM donation based on a query diagnosis of aneurysm or a recent ED visit?
@@ttrdf They were vague about it, which was understandable since the representative I spoke to wasn't medically trained.
I am so glad u r healthy. Alhamdulillah.
This past February. Ambulance to the ER for Aiden and very intense abdominal pain. I have a high pain tolerance, I’ve never felt the need to call an ambulance, until that morning. I waited in the emergency room for 4 hires before being seen; abdominal CT and a diagnoses of mild “colitis”. I’ve never had colitis and haven’t had any stomach problems since that day. I get sent home after being seen in a hallway. 5 hours later the stomach pain happens again, same instant intensity, except this time I got a Thunderclap headache the same moment. Another ambulance, because all I could think was that I had an aneurism rupture. Waited nearly 5 hours in the most pain I’ve ever felt, then got a bed. Was under observation for 6 hours, only 1 nurse made a small note about my headache, even though I kept saying I don’t care about the stomach pain, I’m here because I’ve never had a headache like that. Headache only stopped (after 6 hours) because of morphine I go home in the morning. I have a 2 day prescription for narcotics and told to manage my pain at home until the antibiotics can start working on the colitis.
Next day, another thunderclap headache, take pain pills and it stops after 3 hours. two days after that, I have a third Thunderclap headache that doesn’t stop and pain never goes below 7. I can’t keep much down, I can’t sleep.
4 days later, I go back to the ER because the headache won’t stop. It’s called a migraine (even though I have had migraines, and this isn’t it) and the MRI and CT are clear. A neurological resident sees me, is concerned about the 3 thunderclap headaches I’ve had and that my reflexes are hyper sensitive. Gets a LP, I’m admitted and two hours later I’m in neurology icu.
6 MRIs, cranial doppler, 3 Lumbar punctures, a CT, and an angiogram. I’m in the hospital 9 days and diagnosed with RCVS, a brain bleed that they can’t locate the origin of, and my cerebral spinal fluid pressure is twice as high as it should be.
I’m just now nearing the end of the 3 month RCVS window. Last MRA in March showed less narrowing, and I have another in a week to check again.
The worst part for me was the waiting in the ER to be seen, in the most continuous pain I’ve ever been in. I wanted to be admitted, I knew something was wrong.
I'm so sorry to hear about your experience! I hope your recovery has gone better than the route to diagnosis. RCVS can be really rough, especially when many doctors who aren't neurologists haven't even heard of it. I've actually been considering adding to my underappreciated diseases playlist.
@@StrongMed even the neurologists I spoke with were newer to it. So, i don't have a lot of information on long term outcomes or symptoms after recover other than "some headaches". it was very interesting, and I never want to do it again.
Thanks for sharing that story! Interesting that the prices on Stanford master charge sheet are like 10x those on my hospital's. sure illustrates variation in costs (Im in Rochester NY, btw)
I felt as if im being told a great story. D Strong is such a good talker.
Same here. I could pause during his other lectures, but not this video. LOL
I'm an intern in a govt run university hospital in India, nd though investigations like CT angio are not very readily available, they are all offered free of cost.
1898$ for a saline bolus! Here it's readily offered free of cost to anyone requiring it.
US healthcare is costly!!
Yea..But we have two different systems of healthcare here. The privatized Apollo and Max vs the free government hospital.. Accordingly, the number of hectic hours of work by doctors, time of waiting for patients, availability of latest drugs, security for doctors etc etc varies depending on whether we are in the private or the government side..Although costwise, it's quite right that the US citizens are paying one hell of a price..I can't imagine the scenario if Indian hospitals charge patients like that.. We'll be having a mass genocide..I guess this affordability is one of the reasons why medical tourism is booming in our country..
And btw, I'm doing my internship at Chennai.
As a US Citizen, I agree wholeheartedly.
@@ajeetalbert91 I agree with you. It is true that Indian private hospital provide services but also sometimes unnecessary drug prescription and diagnostic procedures are ordered which is in fact a way to Loot people in India .
Thanks for sharing. I found this video as I am still undergoing investigation for my 'thunderclap' headache. I had very similar tests, first a CT, followed by an LP and recently and MRA. I am now on a waiting list to see a neurologist for suspected RCVS/ Vasospasms.
I'm sorry to hear about your situation, which obviously I can relate to. We also considered RCVS for me, but the headaches still have never recurred after the ER visit, so it's mostly a moot point. I wish you luck with the rest of the work-up and outcome!
@@StrongMed Thank you, me too.
I used to work in hospital as an RN and I am pretty certain all those tests would not have been done if you weren't a doctor to be quite honest. They thought they were being thorough by putting you through all those tests because if they had missed something, it would have been very embarrassing for them. A regular person's visit to the ER for a headache would have gotten a basic lab panel and a CT. If those are normal, the pt is sent home with NSAID and to follow up with PCP. Thank you for your videos. I have learned so much from you.
Thanks for the comment! I don't discount that possibility you suggest. But since this video came out, a number of physicians have talked to me about it, including whether or not the LP and CTA were indicated. There seems to be a 50/50 split on the question, but every person who works at Stanford was in favor of the additional testing (irrespective of who I was). Maybe the Stanford culture errs on the side of more testing... Also, as I mentioned elsewhere in the comments, the relevant UpToDate article also recommends following a negative non-contrast CT with an LP. While UpToDate should not be the definitive answer to all clinical questions, many physicians use it as such, so often what UTD claims functionally becomes the standard of care.
I think we can comment forever on all the different possible scenarios that could have happened.
What is inescapable however is that with your specific presenting symptoms SAH was a top differential diagnosis and you needed to be in the ER that night. It is very easy to comment with the benefit of hindsight of normal tests.
The cost is umbelievable.
Thanks for sharing. I would put cervicogenic headache in the Ddx.
During operation: Doctor to Nurse: "Scalpel please,. I saw another 10 000 Dollars that have to be removed."😀
I know a lot of people who went through similar journeys for different symptoms, some of them even needing surgery, and all this for a cost of 30 dollars. However, was in Sweden, of course.
I had one experience several years ago that I think warrants to be shared here. This was from back when I had medical insurance.
One day, I went to urgent care for abdominal pain. Nothing remarkable. Even on ultrasound with a full bladder, absolutely nothing.
Then a week later, I started getting this painless rectal bleeding without constipation and the only way to avoid the bleeding was to take magnesium oxide at the risk of having a diarrhea accident. To this day, I still don't know what caused the bleeding. I know what hemorrhoidal bleeding is like and that definitely wasn't it. And I'm pretty certain it wasn't my period either. After a week, the GI bleed(or what I assumed to be a GI bleed) resolved spontaneously. But then, a few days later, I was in pain again.
That night, I snacked on tomatoes only to vomit them back up. I told my mom "I think I'm having appendicitis". She of course didn't believe me at first and she got me Pepto Bismal from the store for both the pain and the nausea. Nausea relief was immediate. Pain relief took much longer. I couldn't sleep for a while.
When I did finally sleep and woke up, I was still in pain. It was at the borderline of my pain threshold. I texted my dad and he told me to wake up my mom, which I did. I told her that I was still in pain and she got up and drove me to the ER. I get a first set of vitals within minutes and apparently their blood pressure machine was malfunctioning, as it showed hypotension but I had no symptoms of low blood pressure.
Anyway, I get into a room and one of the first things the nurse asks for is a urine test. I couldn't urinate though, not even a drop, so I was put on an IV of normal saline.
After a few hours, I could finally give the urine sample. Turned out normal except for ketones, which I kind of expected as I hadn't eaten anything since the nausea hit. The nurses come back to take vitals and ask me how bad the pain is. I told them it's at a 6. I had an abdominal exam done and 5 hours after the urine test, I was sent for an abdominal CT. I was NPO at this point.
I was given an injection of contrast and in a few hours, I heard doctors talking about appendicitis. Turns out my CT did turn out positive for early stage appendicitis.
After a couple of hours, the doctors told me that I would admitted and have surgery in the morning. Despite being NPO, a nurse gave me oral Tylenol along with my daily Phenobarbital and just a small amount of water. As I expected, the Tylenol didn't do anything, so I was later given a morphine injection.
Despite how late it was, I couldn't sleep. So I just relaxed. In the morning, I was sent to surgery. I remember after the surgery, hearing that the surgeons were worried because took so long to wake from the anesthesia. I did find out I had ovarian cysts and that the appendix wasn't that inflamed. The surgeon did nothing about the cysts as they were simple clear fluid cysts. I was first given saltine crackers(my nausea was still there for a little bit), then graham crackers, then I ordered pancakes as soon my nausea was gone. As you could probably tell, I was very hungry.
I was discharged with a prescription of ibuprofen and another prescription of Oxycodone and was told walk and sit 3 times a day. After 2 weeks, I could swim. After a little more than a month, I could do abdominal exercises again.
And histology came back as follows:
Transmural inflammation at the tip with sporadic, mucosal inflammation elsewhere
So I did have appendicitis, just not severe enough to explain my pain full. And I later found out that ovarian cysts are an appendicitis mimic.
Interesting to see things from your point of view, I wonder is there anything you would have done differently if you were the ER doc? A lot of these complications seem inevitable from our approach to medical problems.
Like I say in the video, I think I got excellent care, and the ED docs who treated me were great. One thing I would not have done was to call neurosurgery after the negative CT angiogram (even though it turned out to not be negative after all, it's unlikely the junior neurosurgery resident would have picked up something that radiology initially missed). I also would not have ordered LFTs or the liter of saline. However, despite my criticism of it, I probably would have reflexively ordered the IV magnesium and the CSF culture/gram stain as they did; hopefully now I will think twice about such decisions with my own patients! (EDIT: In the end, despite my criticism of the cost and a little excessive testing, I think I would have ended up costing the patient nearly the same amount of money if I had been the ED doc)
You are totally correct that leaving a patient with anxiety (and other complications) from diagnostic uncertainty after a series of tests which failed to identify a specific "answer" does feel inevitable.
I am just glad you are ok. You are my idol!
Although your point was to describe the situation as a patient, but the costs were actually the most significant thing I noticed...
I was trying to convert them into our currency and with every single one I experienced a new shock!
That's the American healthcare system! The most expensive in the world by a huge margin, and around the 37th in terms of overall quality.
Any tips on how to get into a Stanford residency?
DUDE YOU ARE LITERALLY EVERYWHERE HAHAHA
music.saves. us. 😉
Unfortunately, I don't have any tips other than the generic ones: get great letters, get honors in the specialty you're going into, and do well on Step 1. If I tried to be more specific than that, I'm gonna get the PDs after me!
Only 6 minutes in and loving your narration. $9k for just walking in? Wow. Lol at the magnesium
I was in the emergency room (I held out as long as I could because I know how it is) last month, spent hours there, in part just waiting around to be seen. And don't get me started about my hospital stay after my awake craniotomy for a brain biopsy-- they had no bed for me. I love and admire doctors and nurses but man, what a twisted and mangled system.
Very nice vedio ........
👍👍👍
Those pesky details we provide because we want to be honest & do the right thing. Mine excluded me from being eligible to become an Air Force pilot. Didn't matter that I was a commercial pilot already with years of instructing. A skull fracture age 7 and the killer the hospital record guesstimate of more than 30 min of loss of consciousness. No airline career for me. Never should have told my first AME!! Thanks Doc!
I enjoyed it
I’m glad I live in a country with universal healthcare... those prices are extortionate...
Considering the CT was done within 6 hours of the onset of headache could question if any further workup to specifically rule out a SAH is even necessary!
This is a great illustration of imo one of the bigger advantages of LP over CTA - NOT finding irrelevant tiny non-dangerous things like these
This is definitely a great point. It's outside my usual scope of practice, but my impression from talking to people and reading through some literature (after the fact) is that there's not consensus on what clinicians actually do, but the bulk of the evidence suggests you are generally correct. (Interestingly, the relevant UpToDate article - not that UpToDate should be the final word on any topic - states that in the setting of possible SAH, "A head computed tomography (CT) without contrast should be performed and, if negative, an LP should follow in most cases." - which contrasts with multiple studies concluding the opposite.
Another view might account for the pretest (i.e. pre-CT) probability of SAH. For example, if the pretest probability is typical (or less than typical) for a severe acute headache patient in the ED, a negative non-con CT (if within 6 hours) is prob sufficient, but if the pretest prob is significantly higher than typical, maybe an LP is warranted? I don't think I would be qualified enough or unbiased enough to say with any degree of confidence where my pre-CT probability of SAH fell. But I had just read the aforementioned UpToDate article before heading to the ED, so when offered the option, I went with the LP.
Like I said, this is outside my scope of practice and expertise, so I don't know what the right answer is here as to whether or not I should have been just discharged after the negative non-con scan. I'm totally opening to hearing more opinions as to whether or not the ED made a mistake in continuing the work-up.
@@StrongMed My understanding of the literature is that the sensitivity of a non contrast CT within 6 hours is basically 100% or very very close to it assuming it is read by an experienced radiologist - ie. not the prelim report you would have had in the middle of the night. To me it seems like may have been overkill to continue a SAH focused workup, but there are of course other dangerous causes of headache (although this did sound like a textbook SAH!)
@@stephencashman I wonder how much difference it would have made if I had presented during the day, when our neurorads attendings are reading the ER films alongside the residents in real time. Maybe the ED would have felt the initial CT was sufficient, and discharged me immediately after. I just don't know how much the ER docs consider who is reading the scan when making clinical decisions.
Strong Medicine I’d say definitely of significant relevance for dangerous to miss things like this!! I am an ED doc
i LOL'ed when u said u went to UptoDate to read up. 😂
Hi Doc Strong, thanks for this and all your other great videos - they've been very useful to me personally. Does your experience as a patient make you favour a socially funded universal healthcare provision or a system that protects US citizens from being bankrupted by ill health?
I didn't need to become a patient to favor universal healthcare. I literally don't know a single doctor personally who opposes universal healthcare (though that doesn't mean everyone supports "Medicare 4 All", which is just one of many systems that would provide that.)
Im from Canada and this astounds me. $9000 to check in at the ER?!?!
we can do all the tests for 100$ in vietnam :(.
But hey..afterall your magnesium was corrected..
Ironically, IV magnesium works poorly. Some oral magnesium tablets would have been more effective.
And he came out super well hydrated
@@stephencashman The many times people are like oh you have a headache? Drink some water! 😂
How can it be $9400 to just attend ER?
Welcome to America.
oh my God
This is a prime example of what is wrong with modern medicine….patients are being robbed by the medical practice involved ordering procedures and materials that are not medically indicated and unnecessary. The insurance companies pass on the cost of the padded hospital bill back to the unknowing public in elevated insurance rates. I for one am completely fed up with BS like this.
In the video, I discuss the fact that despite the extreme expense, very little was "not medically indicated" (e.g. checking my magnesium and repleting it when it was a little below the normal range).
was discharge AMA?
Lol. No, the ED was sufficiently understanding.
Don't you think, your hradaches could be related to low magnesium? That's why your headache disappeared after correcting that. It is said to be linked to a kind of migraine.
I appreciate the suggestion, but they were not migraine headaches that I was experiencing. Also, a one-time low serum magnesium is a poor reflection of total body magnesium stores; if I was truly magnesium deficient (which is possible), there is no way a single dose of IV mag would fix it.
At 24 I had a grapefruit sized mediastinal germ cell tumor misdiagnosed as pneumonia by two different doctors in two chest images before a radiologist figured out what it was. The doctor apologized later, and I ended up shadowing him when I was planning on going to medical school. I ended up in public health rather than becoming a medical doctor, but it was a big turning point in my life. That was 10 years ago last August 2018.
I'm very glad that it sounds like you are doing well now. That's a bold decision to shadow the doc who misdiagnosed you - I don't think I would even have had the guts to ask them! You must have had a good preexisting relationship.
@@StrongMed Thank you, yes I'm doing well. He was just the first of 3 or 4 doctors to make the same diagnosis mistake, and I don't hold grudges so I don't hold it against him. My dad actually taught him math in high school, and he's my parent's GP now. It's hard to strike a balance between cases like yours and mine, it's one thing I don't mind missing out on. When my code messes up it's not generally that big of a deal since I can go back and fix it pretty easily (I do molecular epidemiology of hepatitis viruses as a bioinformatician).
Imagine in Algeria i can do all this for free 😂😂😂
What a coincidence, I thought today about registering as a BM donor. Will do it now.
Offtopic Mg: www.ncbi.nlm.nih.gov/books/NBK507271/
It does indeed help a friend of mine (she's suffering from migraines; we've been taught this also in pathophysio, quote: "[...] as a potential treatment, you should try it since it's cheap.").
Maybe the headache was cause you needed magnesium?
It's a good thought, but magnesium depletion doesn't cause headaches. And my level was just a tiny bit below the normal range.
Get well soon sir ...57457 $ ....it’s costly sir ..
Thanks! This happened 8 months ago, and I've felt totally fine since. And yes $57k for a headache eval (that doesn't even find a diagnosis) is quite costly!
sir I am a medical student from India .....and your vedios had helped me a lot ....I m thankful to u sir ..
A comment about your conclusion: You are one of the only few good doctors already. I agree with one of the other comments that the prices are extortion. Unnecessary examinations........And these things make medical care unattainable for people in the united states. Poor doctors, too many guidelines, and incompetence. In my opinion, medical school is for people who can keep their mouths shut and follow bad rules. Too few doctors have enough real education/knowledge to understand how the physiology and biochemistry, molecular biology works. For example, one only needs calc 1 and physics without calculus to get into medical school. In my opinion, there is not possible way to understand what is going in in human bodies without the tools for the language of medicine. I love the way you think and express yourself. I am not as smart or organized as you and many other scientists, so it helps me to get partially spoon fed in the end. Thank you.
$38.43 or $3,843?
I'm not sure which specific charge this is referring to, but since everything about the American healthcare system is vastly more expensive than anywhere else in the world, it's probably the latter!
@@StrongMed at 20:00 you state that because of good insurance, this "incident" ended up costing thirty eight forty three........it probably is the latter, but I was curious about the actual cost, after insurance.
@@JohnstonPettigrew Ah...yes, it was definitely $3,843!
@@StrongMed thanks.
why didn't you receive any painkillers ?
They were offerred, but I initially declined - I didn't want it to confuse the clinical picture. By the time a hemorrhage was ruled out, the pain was already much better on its own.
also it would have cost you $1200 for some Tylenol.....
Thanks for sharing your story of headache . As you spend time and money , I found no common sense diagnosis in your headache . No mention of a tension headache , no mention of migraine , no PE regarding ENT and your vision , and no mention of a localized bulge or mass on the sculp .
Ughhh what an utterly ridiculous reason to rule out a potential donor. Hope the leukemia patient got their transplant!
I know, right? A lot of time had elapsed between getting rejected and when I made the video - otherwise my frustration would have made for a totally different video.
Your health care system is insane. I work in Australia - A PRIVATE MRI - that is, entirely private physicians, you pay out of pocket, just like in the states, for a for-profit organisation - would cost you about 500~800 Australian dollars. We use the same machines. The same methodology. The quality of our radiologists are comparable.
You are literally paying 10~15 times more for the SAME SCAN using the SAME equipment, performed by techs and reported by radiologists who are, in many cases, NO BETTER, than ours. And again, in the Australian system, that is the charge for a PRIVATE scan for a FOR-PROFIT company. And like your radiologists, ours eat well and drive fancy cars too. And the private hospitals do make a fair amount of money.
I can't believe US citizens are willing to just pay 10~15 times more than the rest of us, for literally no reason. And again, I'm not talking about Australia's PUBLIC health system - we have a dual public and private system here. You can pay out of pocket to go privately if you want, and our costs are MUCH, MUCH, MUCH lower than yours while giving pretty much the same level of care. That's something the US government doesn't want you to know.
>That's something the US government doesn't want you to know.
No, Americans all know it. We are stuck with it because our increasingly broken political system prevents the development of meaningful solutions for any significant problem.
That kind of patient that goes to the ER and 6-7 hours later decides that he /she is bored is sometimes the reason why ER doctors get angry .. Why aren’t Migraines in the differential diagnosis ? Why is a hemorrhage the most likely diagnosis ? Did you experience Headaches later ? Do you still have them ? Or did your insurance paid so much money and you and your family got into so much stress for a simple headache that all of us are allow to have once in our life without any clinical significance ?
When I said that *one* of the reasons I was going to leave without seeing neurosurgery was because "I was tired of being there", I didn't mean that I was "bored" - I meant I was physically exhausted. (I should have said "I was tired *from* being there"). But the primary reason was that I knew a neurosurgery consult meant a few more hours there and it seemed unlikely they would say anything that would have justified the wait. And the NS consult when the CTA was negative felt kinda of like a CYA decision that was unnecessary to begin with.
A migraine was on the differential, but lower down for a number of reasons. First, it would be unusual for a first migraine to happen at my age. Migraines are not thunderclap in nature. There were no associated symptoms typical of migraines. And most notably, the first 3 of my 4 headaches were much much shorter (2 - 10 minutes) than migraines (4-72 hours). While having a series of headaches in quick succession is also very unusual to be from a subarachnoid hemorrhage, there is a well described phenomenon of a "sentinel headache" in SAH in which a massive hemorrhage is preceded by a self-limited, unusually severe headache by days-weeks.
As I mentioned in the video, my headaches never recurred.
If a ED doc wrote-off every exertional, thunderclap, worst headache of one's life, as a "simple headache", they are committing malpractice. Some sources list SAH as the most common etiology of a thunderclap headache (though still a minority of such patients, as one study estimated it at 8%).
agree 1 million percent. SAH should always be ruled out with your presenting symptoms.