Okay, not quite a hundred years, but at least a few. Had a lady come in with a draining wound on her leg. She had a lump on her shin for years, but it didn’t get ugly until she bumped it. Then it grew and started festering. She popped it and drained it at home, but it got redder and angrier. She came in with a little draining crater of pus and fun. “I can see the bone!” We got her started on antibiotics, and on a whim, I ordered an x-ray. It showed a round foreign body right where the crater was. As I was confirming the location with ultrasound, she asked if I could tell if it was a boy or a girl.
“It’s a boy.”
“Oh yay, I wanted another boy.
(pause)
“It’s got all it’s body parts?”
“Ten finger, ten toes. Looks like a healthy little chunker.”
I put on my magnifying loupes, and went to work. The pick-ups scraped up against something hard. It was slippery, so it was hard to pluck out.
“He doesn’t want to come out. We may have to go to C-section.”
“Oh maaaaan. I wanted a natural birth.”
I finally got enough purchase to yank it out. We all stared at it for a while trying to figure out what the hell it was. It looked like small egg-shaped stone, with the coloring of a Chicken McNugget. The nurse suggested that it might be a teratoma. A teratoma is a medical oddity that I’ve never been able to figure out. By some congenital freak of nature, little bits of hair, teeth, skin, bone, or whatever form tumors in random places in the body. This little baby didn’t have teeth, but it may have had a hair. The lady was pretty cool about it, and let me take a pic. I don’t know, looks a petrified booger. We sent it to pathology, so hopefully we’ll get an answer. I’ll certainly blog about it when I get the results.
I submitted a design for the Boulder Center for Sports Medicine Contest (BCSM). The prize is a $500 gift certificate to BCSM for their services. I’d love to win a bike fit. 
We also have some cool stickers coming soon. Pics in the next post.
Last thing, keep your eyes peeled for the Alchemist ad in the next edition of Mountain Flyer. Due out in July.
Speaking of Walt . . . He stripped a 32 tooth cog from an old steel cassette and welded it to a 16 tooth cog for the bike-mower to make it easier to turn the cranks. The 32 tooth cog was kinda flimsy without the cassette, so he welded a 28 tooth cog to it to give it extra support. That Walt. Heesa-kinda-crazy. I’ll get a pic of it in a future post. He’s going to give the fork a little extra rake too. Walt also installed a starnut, and he let me steal a couple old 29er tires out of his trash. I swear. I may not be allowed in his shop anymore because I seem to always leave with my pockets full of his stuff. The bike-mower should be fully operational soon. Pics of that to come too.
A gigantic, curious spectacle with clowns, freaks, and flaming hoops to jump through. The clowns and the freaks, I think we already know about. It’s the damn hoops that make me want to pull my hair out. What hoops you ask? The gasoline soaked circles of hell and damnation that we call “Trailblazer”. WTF? Yeah, WTF. Trailblazer is some idiotic administrator’s idea of documentation standards for emergency doctors. We have to jump through these impossibly stupid hoops if we ever want to see a dime from Medicare, even if it means riding a ridiculously tiny bicycle through that ring of fire. Here’s just a couple examples:
2. Differential Diagnosis. Another ill-conceived exercise in mental masturbation. Medicare requires that we document at least four different things that the stated problem could be. I’m not saying that thinking about some of the other possibilities is a bad idea. But to mandate that we do this on every and all patients, regardless of the complaint is ludicrous. Had a fella that couldn’t get a piece of steak to go all the way down his esophagus. Diagnosis: impacted esophageal foreign body. Differential Diagnosis: Rib eye, New York Strip, Filet, Chicken. Had a fella that jammed a vibrator in his poo-hole and couldn’t get it out. Diagnosis: rectal foreign body. Differential diagnosis: Ribbed, Scented, Flavored, Magnum.
Had a nice lady come in yesterday with a nosebleed. This is usually no big deal. A little Silver Nitrate or nasal packing. But this thing was really flowing. I couldn’t see the source, so I just plugged it up with Merocel packing. She kept on bleeding, so I shoved a rhino rocket in there. The Rhino has a balloon that you inflate in the nostril, and it generally hurts like hell. I jammed it in as far as she would let me, and I filled up the balloon, but she kept on bleeding. It was just going down her throat. Eventually, she started having a hard time breathing. I looked in the back of her throat and saw a trail of clot. Using some long ring forceps, I had her say the standard “Aaaah”. Felt like the game “Operation”. She tolerated me sticking a giant metal instrument to the back of her throat remarkably well. It was a delicate procedure. The clot was slippery and slithered around like an angry leech. I finally got the clamps on it and started to pull. But it didn’t want to come. I stretched the tail of it to her teeth, but then it started to tear. So I shoved my hand in there and grabbed it toward the base with my fingers. With a little love, the clot finally dislodged and went “POP”, and I yanked out a clot the size of a small gerbil. The smell was nauseating but tempered by her husband’s sense of humor. He smirked that he was going to mount it on the wall like a trout.
Saw a fella the other day for passing out at home. He was visiting from out of town, and he just “done fell out” in his son’s kitchen. Had some nausea, but otherwise, he had no complaints. Did a bunch of testing in the ER, and ended up admitting him to the hospital just cus. Got a call from the admitting doc today to tell me that he ended up having a big ol’ saddle pulmonary embolus. The kind that causes otherwise healthy folks to drop dead in their tracks. Whew, that was a close one. Makes me want to sell more t-shirts.
Forgot to give props to Ken for his short track win last Wednesday. He had ridden super West Mag right before. For those who don’t know, Super West Mag starts in Boulder, goes up Magnolia to West mag. Single track at West Mag, then back to Boulder. Around 5 hours of riding and probably around 7000 feet of climbing. He came home, switched bikes, and then threw down on the rest of the men’s C’s at short track. He’s on left side of the mass start (right side of pic) in the old STC jersey (#135). Soon that will be an 
I groaned when I saw the chief complaint on the board “runny nose”. You have got to f**king kidding me, right? Reluctantly, I shuffled over to room #1 and etched a smile onto my face. “Hi, I’m Jeff, I’m the doc here. I hear that the little guy has a runny nose.” And then I looked at the kid. His face was puffed out on the right, and he had stanky, purulent snot oozing out of his nose. Technically, it was still a runny nose, but something wasn’t right.
Okay. I hate to toot my own horn, but I gotta brag a little on this one. Had a fella come in with a dislocated hip. He’d had a hip replacement and was doing some stretching when POP, out came his hip. He was remarkably calm, especially considering his hip was clearly not where it should have been. Usually when a dislocated hip comes in, you have to get an IV real quick, give em a crap load of pain meds, and then prepare the consent paperwork to turn off their lights, so that you can put it back in. That process usually involves a lot of resources and time. After you’ve got them counting sheep, the process of relocation looks a little something like this: doc squatting up on the stretcher, bear-hugging the offending leg, pulling until his veins are popping. It’s not a scene unlike a tug-o-war contest or trying to squeeze out the mother load. Well, I got it in my head that I could reduce this guy’s hip without sedating him. I am really quite good with shoulder dislocations, and I do them all while the patient is awake. Some of my partners don’t believe me, but I really do, and the patients love it. I’ve reduced plenty of hips by the method described above, but never without sedation. The guy was skeptical, but I was able to finally convince him to let me try. We carefully turned him over on his belly, and then I slowly let his leg hang off the side, much like how I do the shoulders. 
After a little gentle traction and wiggling on my part, the hip clunked back into place. The patient gave a huge sigh of relief and offered me his first born. I don’t know why I thought Jedi mind tricks would reduce that hip, but it just felt right. It’s kinda the Mr. Miyagi approach. I bet none of my partners have ever tried to do that.
On the first shift of five in a row. Can you imagine having to work five days in a row? Like OMG! No one works that many days in a row! Yeah, I know, stop the belly-aching, some people work every day of their lives.
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