It was a pretty decent night. I've found that I've become rather quick with admissions. The entire process is rather streamlined due to experience, which means that I already know the system, I already have familiarity with medical decisionmaking, and I can take interviews to find out what I need to ask in a targeted manner. With nearly 4 years of training under my belt, that's the expectation. That said, I leave a tiny bit of reliance on my attendings to speed the process up because it's still a tedious process overall. It saves just enough time to keep my sanity.
At any rate, there was one interesting case today - a lady in her mid-30s who suffered a stroke. It was actually confirmed to some degree on her imaging - while we didn't see an actual clot, there was one portion of her brain which had a perfusion defect, meaning there was insufficient flow to the brain in that area. Maybe it was from a stroke that was going away on its own, maybe there was some structural damage. What we do know is that she smoked a long time ago, does drink alcohol, and several hours prior to her symptoms, went to a chiropractor who manipulated her neck.
Some chiropractors have destroyed people's lives with neck manipulation before. When it's done improperly, it has been known to cause vertebral artery dissections, which can lead to strokes, among other complications. Here's a reference.
Now, this patient did not have a vertebral artery dissection, but the potential stroke was evident. Whether these two were related is not entirely clear, hence we continued to do workup to determine other possible causes (such as a source from an undetected heart arrhythmia, etc.). Something which I forgot to order as part of the workup included some immune markers which could be genetic causes of blood clotting disorders (her grandparents both died of strokes, so there may be something there). I'll order those tomorrow evening if I can find her chart again.
It's an interesting case, but also very unfortunate. At her young age, she's going to have some degree of disability requiring physical and occupational therapy, and likely be on medications to prevent strokes for the rest of her life.
We have to count our blessings when we're young and healthy, and take advantage of it by keeping ourselves healthy and living life to its fullest. Now, saying this, aren't I just the biggest hypocrite on Hive?
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