And the winner is...

My Quora Answer to:
What is the most obvious case of a patient 'faking it' that you have ever seen?

One of my favorite stories.

I worked 20+ years in ER's across Wisconsin, from Lake Geneva & Walworth in the the southern part of the state, all the way up to Superior (they'd fly me to Duluth), to Racine, Kenosha, and Milwaukee in the east, to LaCrosse in the west. Unfortunately for this woman, a week before she tried to fool me in Oshkosh, and started the same routine a week later in Hartford.

Her cover story was severe dental pain. She didn't recognize me, so she didn't know I could see right through it. Dental pain is a tough one because crappy looking dentition doesn't necessarily mean there is any pain. Conversely, the most benign looking teeth can be a source of severe pain.

She did have crappy dentition. “I broke a tooth last week and my dentist can't see me until next week.” As an aside, most will see emergent cases like fractures and tooth avulsions. “I can't wait til then and I need pain meds now.” That was my first red flag because she said the same thing exactly a week before.

She begins to cry. “The only thing that works is oxycontin.” 2nd flag.

“Ok, let's try Toradol first.” “I'm allergic to it. #3. “Really? What happens?” “I pass out.” #3 1/2, since syncope can result from allergic reactions but we normally see other reactions first like rashes, difficulty breathing and swallowing, and panic. So she only gets 1/2 a point for that one.

In Hartford I get inspired. “We have a new long-acting anesthetic. The problem is that it takes awhile to work. So I'll numb it up first with lidocaine. You should get immediate and then about 24 hours of relief. Come back then and I'll leave a note to the physicians replacing me to do the same thing. In the meantime, I'll have a hospital employee help get you into a dentist sooner.”

She didn't think things would go like that, so she agreed, I did the injections, and we waited. And waited. “That didn't help. Can I please have something stronger?” Red flag #4. “No. But I will send you home with enough Tylenol to get you through.” She left in anger.

An hour later we get a call from the West Bend ER. “Did so-and-so check in there?” Apparently, she would make circuits of smaller ER's around the state. The major hospitals in Milwaukee refused to see her so she spread her wings and flew.

I always said that sometimes I should give in and prescribe their narcotic of choice, like an Oscar for great acting. But no. I always held the higher ground.

https://qr.ae/TWhY2t

Running and Supplements

Answer to What is the best drug to take to make me faster at running? by Michael Mangold
If you mean over-the-counter medications, then No-Doz is good as stated previously. Caffeine causes the release of free fatty acids (FFA) from fat cells, and is an energy source for the body. Of course it is minimally effective in runners with low body fat in the first place. You could drink coffee 30 minutes beforehand to get the same effect, but then you'd have to pee during the run.

Again, as stated previously, Vitamin B12 helps increase red blood cells. Erythropoietin, a naturally occurring chemical does the same. Using it intravenously is prohibited in professional sports (think Lance Armstrong) and is cost-prohibitive to amateurs. Ironically, donating whole blood increases erythropoietin because your body thinks you have a major hemorrhage and releases large amounts of the chemical in response.

Runners ingest baking soda before a run because it helps neutralize lactic acid, the end-organs of anaerobic (without oxygen) metabolism. You'd have to take it mixed in water though, so we're back to the pee issue again.

Although they don't increase speed, you should take antioxidants chronically. These include but are not limited to Vitamin C and E. An excellent antioxidant, EGCG (Epigallocatechin Gallate), is found in green tea. The tea also contains caffeine, but not as much as coffee and No-Doz. However, you can buy green tea capsules then take as many as you need to reach the same level of caffeine a half hour before a run.

http://bit.ly/2JT9Umm

Coronary Artery Disease and Orgasms

Can a man with a weak heart die from an organism?

Michael Mangold, Retired Physician (1990-present)

Answered Sun

Orgasm?

If you mean orgasm then the answer is “yes.” The best celebrity anecdote is from Richard Pryor whose own father “came and went” at the same time while having sex with one of his own prostitutes (he was a pimp).

These days, we older men with heart disease need to be extra careful because taking nitroglycerin, having Coronary Artery Disease, and using Viagra to flog a dying horse, all add up to what our special needs government calls a “Black Box Warning.” In other words, proceed with caution. But in all honesty, no one ever in the midst of passion has stepped back to say, “hey, let's think about this first.”

Sildenafil, the generic name/form of Viagra, works by relaxing the smoothe muscles that line the arterial (oxygen-carrying) side of our blood system. In penises, that's a good thing. But in horny old men, that means a lot of the blood moves from the core (heart, lungs, etc.) to the periphery, leaving less blood to oxygenate these vital organs. So, at the moment of ecstasy there is a battle, and the poor ol' geezer often loses.

Taps are now on order.

https://www.quora.com/Can-a-man-with-a-weak-heart-die-from-an-organism/answer/Michael-Mangold-4?ch=99&share=975918a2&srid=TCJzj