Internal Medicine 1 month in… our patient is a “carrot” & marijuana dude

8 01 2013

We do a lot of scut monkey work: collecting blood work, delivering them to the labs, dropping off consult papers on different floors in the hospital. I’m on the Medicine floors this first month and so far we’ve seen simple cases to very devastating situations where patients have to be intubated. Devastating in the sense that the person is just lying there with a tube in their mouth with poor oral hygiene, foley in their genitals passed thru ureter to their bladder, and most of the time they appear comatosed.


One of the patients we work with is a “carrot”. Eyes are yellow-orange, a term we call jaundiced. Skin is yellowish all over her body, legs are swollen, even the hair looks orange. The urine is a dark brown color as seen through a foley bag. I don’t know what happened in this patient’s life, and how the patient could binge-drink even on a chronic daily basis to get to this point. The patient is only 50-something yrs old! Alcohol must have led to dependence without it, the patient could not function without jitteriness. This is a vicious cycle: depression + alcohol = even worse depression. Now with the liver cirrhosis the patient’s depression is even more.  Not to mention, the patient probably shot their own pancreas too with alcoholism.

What is binge-drinking? What is at-risk drinking?
MALE has more than 4 drinks in one sitting or 14 weekly.
FEMALE more than 3 drinks in a day or 7 weekly.

What constitutes as one drink?
12 oz beer
5 oz wine
1.5 oz hard liquor

12 fl oz of
regular beer
= 8-9 fl oz of
malt liquor
(shown in a 12-oz glass)
= 5 fl oz of
table wine
= 3-4 oz of
fortified wine
(such as sherry or port; 3.5 oz shown)
= 2-3 oz of
cordial, liqueur, or aperitif
(2.5 oz shown)
= 1.5 oz of
(a single jigger or shot)
= 1.5 fl oz shot of
80-proof spirits
(“hard liquor“)
12 fl oz of regular beer - about 5% alcohol 8 - 9 fl oz of malt liquor in a 12 oz glass - about 7% alcohol 5 fl oz of table wine - about 12% alcohol 3-4 oz of fortified wine - about 17% alcohol 2-3 oz of cordial, liquer, or aperitif - about 24% alcohol 1.5 oz of brandy (a single jigger) - about 40% alcohol 1.5 fl oz shot of 80-proof spirits ('hard liquor' - whiskey, gin, rum, , vodka, tequila, etc.) - about 40% alcohol
about 5% alcohol about 7% alcohol about 12% alcohol about 17% alcohol about 24% alcohol about 40% alcohol about 40% alcohol

In this new year, I hope that people drink to merry and celebrate happiness but understand the effects of how powerful alcohol can do and to drink with moderation.



I had a wonderful opportunity of meeting a 22 year old young man who came in with vomiting and stomach pain. We had great conversation about medical marijuana and why it helps people who are already sick and who has cancer, those needing helping to increase their appetite. We talked about how cigarettes have more than 4,000 chemicals and >60 cancer agents and that marijuana is so much stronger and worse. The young dude did not realize that smoking marijuana messed him up so bad even though it was only twice a week (in what amount, I didn’t ask).  Smoking or marijuana smoking could lead to esophageal lining changes and ruin the tube that brings food to the stomach or esophageal cancer.  This was bad since the patient already had Helicobacter Pylori in his stomach that could lead to stomach ulcers to begin with on top of the smoking and spicy food habits. The other thing was the patient like brushing his tongue. If one consistently put lesions/cuts/openings in the mouth and put over 4,000 chemicals + 60 cancer agents into the mouth this could might as well lead to buccal carcinoma or mouth cancer.

Smoking could put a hole into your lungs without you knowing it and cause a spontaneous pneumothorax.

What is pneumothorax?

It was funny how the Attending doctor said this word to the patient and was oblivious to the fact that he didn’t know what it meant. This is where a tiny hole in the lungs caused the air to go outside the lung pushing back down, causing the lung to collapse on itself. This makes the patient have chest pain and breathing distress. But the patient was lucky his tiny hole closed up on its own. Not everyone close holes by themselves.


7 06 2012

article link here

Truck driver of 28 years, now 69 years old with unilateral (on one side of face) dermatoheliosis. Skin is damaged by UVA/UVB rays from sunlight exposure causing wrinkles.

Over the break…

16 04 2012

the coolest thing I did was kill a centipede!

I remembered Dr. Kalliecharan told us once that these are poisonous and the larger ones could cause anaphylactic shock. He mentioned the first time it bit you gives allergic reaction and the second time is a worse response and that one could die.  The centipede looks like a long cockroach of some sort, but it’s not!

I played with babies for a long time and visited family. I still vividly remember my aunt’s cute little pie smiling when I was gently washing his smelly hair (as if he really enjoyed it!). What a cute 1.5 months old! And there was Solera, she’s a handful but the cutest thing I remember her doing was thinking bed time was play time. She wiggled around in bed with her diapered butt up, and squirmed around tossing and turning the blanket to find a comfy position. Then my aunt came in and she put her shorty little leg over my aunt’s neck and just laughed. What a cute 1 year old! Then there’s Emily, she puts her arm out but no one picks her up so she’ll just draw her arms back to her body. What a cute 6 months old!

My grandpa and I, we turned off the main electrical switch and caused a house blackout for some good hour. It was pretty embarrassing since we crashed our uncle and aunty’s place already. But I did value that time very much as grandpa didn’t let us light his holy candles that he displayed on his dresser hehe. This valuable time, little Syler (who’s turning 3) clinged on me because of the dark and wouldn’t get off so we got a chance to bond trust. My other uncle and aunty’s family were there and everyone just sat together in the living room or huddled around the kitchen table.  I’d say sometimes lights out is really a priceless experience. It also breaks your heart when you hear a 2 yr old learn the word “shoes” and says it for the first time correctly as he frantically searches for his pair of shoes so that he could go outside to play.

All of this is truly endearing.

I missed some of my bigger cousins. We met but didn’t appropriately hang out longer. I’ll visit again in the future and hopefully not be obligated to studying. 🙂

Autism and vaccination

12 04 2012

A healthy discussion amongst doctors? Seems like Dr. Harvey Karp is nailing it right on about evidence-based medicine.


Dr. Jay Gordon’s response to their discussion.


And the person who originally started the whole Autism and Vaccination link Andrew Wakefield is no longer a doctor, stripped of his medical license, and in worst called fraud studies.


Eat what you want, but in moderation

20 03 2012

I suppose even if you are sharing, it’s still a lot of calories for one person alone.  Average calories needed is around 2,000/day for an adult. Obviously you need more based on activity level and metabolic rate.

Chili’s Onion String and Crispy Jalapeno Stack

One appetizer: 2,130 calories; 213g fat, 31g saturated; 1,320mg sodium.



I brought this to school once. It had more than 800 mg of sodium. Our daily limit is about 2 grams with functioning kidneys in adults. This is a lot of salt for a little kid!

Aspartame Fight!

20 01 2012

I’m so glad this Doctor wrote the same thing about what I found in Aspartame. Here was my previous post on Aspartame.

Addiction and others

1 01 2012

I got it!

All along I thought a person’s obsession is much related to OCD behavior… and it appears that way. But the truth has to do with increase dopamine and ADDICTION. Dopamine also plays a key role in the limbic reward system and is increased in addiction. Dopamine is also involved in Anxiety and Agitation issues. Hence, a person who’s going through some kind of withdrawal due to some drug addiction will appear agitated at other people. Not only that, they’re always antsy and preoccupied with an idea, thoughts, or feelings for several days could even be longer than a week.

In other words, it’s similar to OCD, since OCD itself is a type of anxiety disorder.


Wernicke-Korsakoff Syndrome and alcohol

For those who will be drinking lots this holiday, it’s safe to understand what it can do to your body. Example, let’s say one is already obese, the effect of drinking will not only cause macrovesicular fatty change in the liver which could be reversible if it’s not long-term. But long-term damages are irreversible. Just being fat itself is causing fatty change in the liver already. Chronic alcoholism not only affects the liver, it affects the brain as well. Alcohol damages the mammillary body and affects a person’s memory. Impaired memory is actually permanent (per UWORLD review).  This is why people fill in the gaps by “confabulating” or making up stories they want to believe. Wernicke’s area in the brain is related to language motor speech and lies close to the opthalmic nerve. Too much drink can cause opthalmoplegia (eye problems), ataxia (imbalance), and nystagmus (more eye problems). Imagine putting this  together with frequent flying in the sky, which increases intracranial pressure which presses down on brain structures and nerves in the brain.

Alcohol leads to poor absorption in the gut causing vitamin deficiencies. Chronic alcohol leads to thiamine deficiency, this affects the brain and also could cause wet beri-beri (a type of high output heart failure). This translates to heart problems!

So while it is fun to have a few drinks with friends, it’s less healthy to be promoting it, especially for those who have health problems to begin with.


So much for a New Year’s health rambling. Hopefully no one sees this until much later so that I’m not taking away the fun.

Free cell status: game 265 of 1 million.

Motivation to study

19 10 2011

I’m home!

My father used to close his door when he went to bed. However, due to his health condition he’s been sleeping with the door open. Once in the morning if I happened to pass by, I would peek in just to hear him snoring. That’s so I know he’s still alive. I’ve been away for two years. I looked at his meds and realize that some have expired and the plastic vials are just sitting there. Expired PhosLo?? Hmm …

Before that I was sort of lazy and didn’t study hard enough. Sub-par studying doesn’t do me any good!

The home is in such a mess. It’s almost uninhabitable, but as soon as my mom saw me, she started getting excited and cleaned & vacuumed. This is definitely not in any condition for a healthy person to live in. Sometimes I wonder how people can let go of everything and be so unenthusiastic about their home. Seriously though, this place is a hot mess! It looks like a shelter more than a home. In fact, it is worse looking than a shelter.

On the bright side, it is peaceful here. I promise I’ll make it … time to study.

Gestational Diabetes

6 10 2011

Filtered load = GFR x Px

During pregnancy, there is increased in proteins, increased in Glomerular Filtrate Rate (GFR) in the kidneys and hence increased in Filtration load. This overloads the proximal tubule of the kidneys and so we see glucose in the urine. The question is how much glucose is right and how much is too much for a pregnant woman?

Human chorionic somatomammotropin (hCS) or hPL (human placental lactogen) could this be the culprit?

hPL is secreted by the syncytial trophoblasts from early pregnancy into maternal circulation. This increase in hPL provides glucose to the baby at the expense of the mother. hPL increases as mother’s glucose levels decrease.  hPL stimulates mom’s IGF-1 and could cause insulin resistance and carbohydrates intolerance. While the mom mobilizes free fatty acids, glucose, amino acids, and fatty acids are moved into the fetus to provide nutrition.  hPL could be the cause for insulin resistance in the second half of pregnancy. Playing a key role in increasing insulin production from islet cells,  causing amino acids to decrease while increasing triglycerides, free fatty acids, and cholesterol could further cause insulin resistance. (info from Kaplan review).

I read somewhere that postpartum this could go away for some. Maybe if they work on their diet and get back into healthy BMI range? There’s this concern that the mother would have future diabetes and the baby would be large.  If that is the case, should we monitor the size of the baby?

Birthday cake randoms:

80% of expiratory volume is used to blow out birthday candles in the 1st second. The rest is distinguished by water coming from spit …

Tan Le’s mind control

3 10 2011

Getting there.  Finally something that reads brain signals to input to devices to control them.