100 years of foreign body

27 06 2010

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.


“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.

Elephant Journal Review

25 06 2010

Check out the Alchemist product review in Elephant Journal


Read it, “Like it”, comment on it (but please be nice).

Big props to Jussi, who purchased a “T.V Sucks, Ride your Bike” t-shirt.  I had to adjust the shipping settings in the checkout because Jussi resides in FINLAND! He heard about us through the Waltworks blog. Thanks, Jussi, for bearing with us as we figured out how to set-up shipping.  Jussi also inquired about More Cowbell.  That is slated to come out in late summer, in time for CX season.  Thanks also to Walt for the “referral”.

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.

Tomorrow is another night shift, so if the patients give me a break, you can expect another post.  Hopefully, something interesting will come in.

The Circus is Coming to Town!

21 06 2010

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:

1. “Review of Systems”.  Clearly the brainchild of some non-practicing internist who in their former life only had the ability to evaluate one patient every few hours, and whose H&P (history and physical) resembled the unedited version of War and Peace.  Why do I need to ask about burning with urination when someone has an open leg fracture? Because the bastards tell me I have to in order to get paid for my services.  The “Complete” Review of System has degenerated  into the same incomprehensible mumbling of garbage that we all go through before we get to the meat of the dictation.

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.

Barnum and Bailey may be dead, but the circus is alive and well.  If you join, you’ll have to share a bunk with the horse riding monkey.

Vivienne reprimanded me for not actually writing about priapism in the last post.  Yes, I left it in the title.  No, I didn’t have the energy to write about it last night.  Alas, this wasn’t actually my patient, but one of the other doc’s.  Fella came in with an erection that just wouldn’t quit.   Most guys reading this might be saying,”Where can I can I get some of that?”.  But there is good wood, and then there is not so good wood.  It can be painful if you leave the light on for too long. His Jimmy had been standing tall for hours, and he was in a world of hurt.  The doc injected phenylephrine into the side of his donger, and he wilted like a cut flower.  Probably the first time the guy was so relieved he couldn’t keep it up for a woman, and the first time the woman was so proud she could turn off a guy so effectively.

Claire is going to be working a table for Bike to Work day on June 24th.  She’ll be at Community Cycles off the Goose Creek path.   Look for the Alchemist banner,  grab a bagel, and talk real loud about how cool our shirts are.

Nosebleeds, Priests, and Priapism

20 06 2010

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.

What a guy.

I’m feeling a little guilty.  Bob, who is a volunteer at Avista, and one of the nicest guys you will ever meet, was helping out in the ER the other day.  He has a sunny disposition, and is always being exceeding nice to patients and staff.  He usually gives me a some kind of pep talk, even when I don’t need one.

“Hellllooo, Dr. Wu”

“Hey Bob.  What’s cookin?”

“Oh. it’s just another beautiful day. You are looking good!”

“Thanks, Bob.”

“You know what, Dr. Wu?  Every time I see you, you look better every time.”



“Are you trying to sleep with me?”

Poor guy was mortified.  Speechless. You have to understand.  Bob is a 70 year old, white-haired former priest.  He was so embarrassed, he couldn’t talk to me for the rest of the shift. Now I’m feeling bad about embarrassing him like that.  Perhaps he will let me Hail Mary or confess or something that Catholics do when they feel guilty about naughtiness.

Got an email from Karli at Full Cycle.  We are going to do another run of some of the custom designs we did for them over a year ago.  Karli was our first customer when we were still Spare Tire Cycling.  Pretty cool.

Working on the art for the plantable tag.  Pic to follow.

It’s 650am, and I’ve been up all night.  More on Priapism in the next post.

Near fatal emboli and short track

15 06 2010

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 Alchemist jersey.  Ken won a tiny $3 fish taco from the taco truck.   I’m used to the Philly food trucks.  For $3, I’m used to seeing a massive pile food.  How did I do? Well, I lolligagged most of the race then dropped my chain twice and finished somewhere in the middle.  But I was wearing the best (read, only) t-shirt.

Nasal foreign bodies

13 06 2010

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.

The parents said that his little bro just learned how to pick his nose and may have stuck his finger up the kid’s nose two days ago.  I tried to look up in there, but all I saw was a nostril swollen shut.  I figured there just had to be something up there that I couldn’t see.  So I had mom blow hard into the kid’s mouth while I held the opposite nostril shut.  This works pretty much every time to get out the little crap that kids  jam up their noses.  But the nostril was so plugged up, air wasn’t even getting through.

Something wasn’t right, but I wasn’t sure what, so I sent him to ENT.  The ENT had a similar experience, and was just about to send the kid home with antibiotics when he felt a hard “tink” when he went to suction.  After some wrestling, he ended up pulling out a button battery from the kid’s nose.  That was a close one.  Button batteries are notorious killers of kids who swallow them because they erode through the intestinal wall. This battery had eroded a fair part of the kids nasal passage, and if we had missed it, it would have eroded into his sinuses and BRAIN!

(n.b. an excessively graphic photo used to be here, but my wife told me it was too gross for public consumption.)

Claire took some Alchemist shirts over to Elephant Journal for product review.  Hopefully they dig it and are willing to give us some props.  Supposed to have received the Alchemist team kit by now.  Hope to get it soon, and have some pics up.

I got me a bike-mower. Jealous?

11 06 2010

Sh*t yeah!  The bike-mower is aliiiiive!  It’s so cool, and so freaky, the rest of the bike and mower world will be drooling over it.   From spandex clad roadies to John Deere, trucker-cap wearing yardmen,  the admiration really doesn’t end.  Walt (Waltworks) Wehner built this baby up in an hour. The man has skeels.  His neighbor saw it as we were testing it out, and she couldn’t keep her eyes off of it.   We finally had to pry her off of it like a pre-teen girl at a Justin Bieber concert.  I mean, it is gorgeous.  With a bigger track cog, a star nut, and some Waltworks decals, it will be even more crunk and voluptuous.  The ingredients:

1. Orange fixie track bike that’s nearly gotten me killed a dozen times cus it ain’t got no brakes.

2. Scott push mower that’s lasted a remarkable 6 years since we moved to Boulder. I used to curse at it, now I love on it.

3. Waltgenuity

More photos a video to come.

An elegant hip relocation

8 06 2010

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.

Pic of the upcoming plantable, seeded tag coming soon.  I know, it’s so exciting, isn’t it?

A killer idea came to me today while I was riding home from work. I’m going to mount a camera on top of my helmet for the Breck Epic. The Epic video from last year is super cool, but shot mainly by guys from the side of the trail.  It would be great to have an Alchemist video blog from a rider’s perspective.  I might try to do a couple races before that too.  Maybe short track.  Stay tuned for more on that.

Helium and Heart Attacks

7 06 2010

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.

Had an interesting case this morning.  Fella brought in for altered mental status.  He was found unconscious in a parking lot.  Paramedics gave him a little narcan to wake him up, and he started complaining of chest pain.  He ended up having a big time MI (heart attack). Turns out that the guy had a full tank of helium in the back of his car, and he had been huffing it.  I remember whippets, but I don’t remember huffing helium except to make my voice sound like Mickey Mouse.  But this guy was serious about it.  I suppose he was so intent on getting high from helium that he asphyxiated from it (because it displaces oxygen), and that induced his heart attack.  He should probably stick to more legitimate ways of getting high.  As manifested by the above pic, helium doesn’t lead to anything good.

Looking forward to the Mountain Flyer ad coming out later this month.  Look out for it.  Claire will be pounding the pavement soon to market the Alchemist Threads.  The plantable, seeded tags are looking good.  They will be adorning the shirts in the future.  We’ll be doing some trade with Bloomin’. Shirts for tags.  The design is in the works.  Will post later.

As promised here is the mock-up of the much anticipated Walt Works t-shirt.  Will try to get as close to team colors as possible.   Will be available 0n AlchemistThreadworks.com this summer.

Got a little hitch in the plans for the rest of the other planned designs for the summer.  It looks like the printer platens to do the full frontal designs are too expensive for our printer to purchase at this time.  They don’t forsee enough usage to justify the expense, so some of the designs like Alchemist Wings  and Boss Hogg are on the back-burner or will need some modifications .  When Alchemist goes supersonic, and we are printing many thousands of shirts, then perhaps, they can drop down and buy the necessary platens.  but until then, we’re back to more traditional printing placements.


3 06 2010

Been spending a nice few days in Houston with the fam.  Needed the break after the Memorial weekend ER sufferfest.  Anything to restore my faith in humanity.  With Busse climbing Denali, I’ll have more shifts in June.  I don’t know how guys like Ron and Drew and Dan do it.  I’m such a sissy about having to work more than a few shifts in a row.  Any more than that and I start whining incessantly about how my candy ass is getting roughed up. Better toughen up my calluses.

 The Wu’s and the Kreidl boys took a trip to NASA today. It’s way different than when i was a kid. Totally blinged out.  It’s got the most ridiculous play structure you’ve ever seen, and lots of cool games.

Right now I’m up late blogging and watching Terminator 2, and I cant help thinking there is inspiration for a t-shirt in that movie.  “Hasta La Vista, Baby”, of course. “I’m a hairless android from the future.  I’m made of a liquid metal alloy yet to be invented yet. And I’m here to sex you up!”

I just saw the “I’ve fallen, and I can’t get up!” commercial.  Certainly there’s a t-shirt in that.

Claire helped me fill another order today.  It will be interesting to see what happens when the Mountain Flyer ad goes live.  Is there a market for an edgy organic t-shirt company with a little rock and roll and a little urban hip hop?  I guess we’ll see. 

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