Daily Med Facts

11/29/2019

Is the tryptophan in turkey really why you’re so sleepy today? Short answer: no!

Long answer: this myth finds its roots in the fact that tryptophan, an amino acid contained in turkey, is a precursor for serotonin and melatonin. However, all meats contain tryptophan, not just turkey. So your post-meal drowsiness is just a regular ole food coma, and nothing more.

Even longer answer: a large bolus tryptophan does not result in a massive increase in the production of serotonin and melatonin. The transporter across the blood-brain barrier for tryptophan also transports phenylalanine, which is also found in meat. Phenylalanine outcompetes tryptophan at the transporter, preventing a significant influx of tryptophan into the brain!

11/24/2019

This weekend’s case of a young male with high blood pressure, headaches, and interesting physical exam findings is an illustration of Coarctation of the Aorta. This congenital condition is characterized by a narrowed point in the thoracic aorta, which results in high blood pressure in the head and upper extremities with decreased BP and pulses in the lower extremities. More severe cases are diagnosed during infancy, whereas some cases go undiscovered until adulthood. Characteristic findings on the chest X-ray are the “3 Sign” (yellow, blue, and green arrows), which illustrates the irregular contour of the aorta, and “rib notching” (red arrows), which is due to dilation of intercostal arteries as they try to bypass the coarctation. Image from and extra info at https://www.mayoclinic.org/diseases-conditions/coarctation-of-the-aorta/symptoms-causes/syc-20352529

11/22/2019

Here’s a case for the weekend! A 25-year old male comes to your clinic because he was told his blood pressure was high at his company’s health fair. He denies any symptoms other than occasional headaches, and having a low exercise tolerance ever since he was a child.

On physical exam, his BP is 160/110. Pulses are strong in his upper extremities, but weak in his pale feet. Attached is his chest X-ray. Can anyone diagnose this young fellow? Stay tuned for the answer!

11/15/2019

Here’s a quick piece of advice for pre-meds and medical students that will make your life much, much easier!

Be sure to keep a running list of clubs, community service projects, leadership positions, presentations, work/shadowing experiences, etc. that you participate in. Applications for medical school and residency require descriptions, dates, and contact info for every experience you list. It’s far easier to keep a running list rather than trying to rack your brain for everything you’ve done over the last couple years.

Residency applications let you list up to 15 experiences. Unless things have changed since my day, med school apps take up to 15 as well. As always, free to reach out with any questions regarding the process!

11/15/2019

This CT scan of the chest shows lipoid pneumonia, which can occur as a direct result of va**ng.

Many v**e “juices” are dissolved in oil-based substances. Inhaled oil deposits within the lungs, as seen in this CT. Cases can be so severe as to require intubation or ECMO (a life support machine that oxygenates blood when lungs can no longer do it themselves). Unfortunately, lipoid pneumonia is only one of several known mechanisms of va**ng-related injury. **ng

Citation and additional info at https://www.acepnow.com/article/what-you-need-to-know-about-va**ng-associated-pulmonary-injury/?elq_mid=39941&elq_cid=20112239&utm_campaign=25242&utm_source=eloquaEmail&utm_medium=email&utm_content=Email-Research-IssueAlert-ACEPeNOW_10-20-19_10-16-19.html

11/13/2019

Ebstein’s anomaly is a congenital heart defect where the tricuspid valve (the valve between the right atrium and right ventricle) is farther down into the ventricle than it should be. This can cause problems with the right side of the heart effectively pumping blood to the lungs like it should. The blood is able to go back into the enlarged atrium instead of into the lungs. This anomaly can be linked to using certain prescription drugs while pregnant, like lithium or benzodiazepines. Also, the similarly named Jeffrey EPstein didn’t kill himself.

11/13/2019

Zombies in real life?? That’s what I thought when I first learned about this disease.

Have you ever heard of African Sleeping Sickness? This parasitic disease, aka African Trypanosomiasis, only occurs in West and East Africa. The parasite is spread by the bite of the tsetse fly, and initially results in a large sore with accompanying fever and joint aches. Over the next couple weeks, the parasite invades the central nervous system, resulting in confusion, personality changes, daytime sleepiness and nighttime insomnia. Without treatment, the disease progresses to mental deterioration, coma, and death. The good news are that Trypanosomiasis is survivable with treatment, and has very rarely ever been brought back to U.S. soil! More info and citation at https://www.cdc.gov/parasites/sleepingsickness/disease.html

11/11/2019

Squeamish alert! A lateral canthotomy is an urgent procedure performed in the emergency room to treat orbital compartment syndrome. OCS occurs when blood pools in the small space behind the eye as a result of blunt facial trauma. This rapid increase in pressure compresses the optic nerve and blood supply, leading to irreversible vision loss if not addressed quickly. The treatment is a lateral canthotomy, in which an incision is made along the lateral corner of the eye and the ligament(s) holding the eye are snipped. These incisions release the pressure from behind the eye, and are later repaired by ophthalmology.

11/11/2019

This figure from a 10-year study by the CDC shows the probabilities of a patient who has never before taken opioids getting addicted after their first prescription. As one could imagine, that probability increases drastically in proportion to the size of the initial prescription. After just a 5-day prescription, 10% patients were still continuing to use opioids one year later! Therefore, it is incumbent upon doctors and pharmacists to exhibit good stewardship of these medications, and for patients to use them minimally and responsibly. Citation and description of the study at https://cherishresearch.org/2017/04/frightening-chart-opioids/

11/09/2019

Yesterday’s case was a honeymooner whose blood pressure tanked after taking nitroglycerin for chest pain. Nitroglycerin relieves chest pain by dilating the blood vessels, resulting in lowered blood pressure and less work for the heart. Turns out, one major contraindication for taking nitro is when a patient is also taking vi**ra! Nitro and vi**ra both have the same vasodilative effect, so taking both at the same time leads to a rapid drop in blood pressure!

11/08/2019

Here’s a case! A 55 year-old diabetic male gets married and goes on a honeymoon with his new wife. On the second night of their trip, he develops mild chest pain, so he takes two sublingual nitros. Within a few moments, he becomes unresponsive. When EMS arrives, his blood pressure is 60/30.

Does anyone have any thoughts of what happened to this poor guy?

11/07/2019