The DTs

The other day, I saw my first true case of delerium tremens. I have seen lots of people withdrawing from alcohol, even alcohol withdrawal siezures, but this was the first true case of delerium tremems of my career.

He was native american (who do not genetically metabolize alchol well, but I think that’s irrelavent) who had been locked out of his house by his roommate all day & night. He told me he drinks daily, but I didn’t trust the amount he told me. In medical school, we were taught to always multiply the amount the patient says by two. (Keep that in mind when your doc asks you how much you smoke or drink. 😉 ) He had gone at least 24 hours without a drink, but possibly more. He looked like a wreck with soiled undies & covered with layers of dirt and mud.

While he was in the department, he had “the shakes” continuously. I tried some ativan to calm him down, but it didn’t make a bit of difference. I tried more ativan to no avail. His hallucinations, originally entertaining for the staff, became bizarre & strange and he stopped interacting with us all together, responding only to the voices and images his mind had created. They were all around his bed, you could almost see them clearly by the way he interacted with them. It was very unsettling. Despite fluids, he remained tachycardic, and I finally made the decision to intubate him and squash the building neurotransmitter overload going on in his brain with my favorite sedative, propofol, aka “milk of amnesia”.

Texas boy dies of rabies

This boy died of rabies about a month after being bitten by a bat that flew into his open window at night. He wasn’t sure if he’d been bitten by it.

Just so that you know, waking up with a bat in your room is an indication for getting the rabies vaccination series, 2 shots on day one (a vaccine and an immunoglobulin), then additional booster shots on days 1,3,7,14 & 28 from the bite.

I always tell the kids that we give a rabies series to that they could become vets if they wanted because they’ve already had the shots! Once you get the series, there is a different booster shot schedule if you get bitten again, but you never have to go through the entire series again.

Dog Radio

Yes, it’s true, there is now an internet radio station for dogs! It was started by a Thai dog groomer who plays the tunes for the dogs in his shop to put them in a better mood. I don’t understand Thai, and I am not a dog, but the music does put me in a good mood. Check it out:

http://dogradiothailand.com/

Wicked Ride

Tonight I did a mountain bike ride with the “Girlies” from the local mountain biking club. While no longer titled the “girlie ride”, it is almost always led by women. Tonight’s was led by an incredibly strong tiny woman who does 24 hour solo mountain bike races, and to say she is fast and strong is an understatement! This is the ride that is basically her back yard. I did it last fall with her and one other guy, and I was totally wasted. The kind of wasted where you can’t even turn your front tire without falling over because you’ve got no reserves with which to pull out of any type of mistake. I couldn’t walk for a few days afterwards!

So I was nervous about tonight’s ride. I remembered the pain of the ride, most of which was in the dark, and recalled none of the fun. But I wanted to get out with the group and this promised to be a good group of folks tonight.

Well, I wasn’t the fastest, but for the first time (?ever) I wasn’t the slowest either! Now I’ve been on rides where there were clear beginners that I was faster than…but this was a ride with a bunch of technically experienced folks. Now maybe some of them were out of their regular shape, but when I was the 3rd of 6 people to the top of the last climb up from the river, man was I stoked!

I felt strong through the entire ride, and this time, i had a blast. Near the end the ride dips and dives over and through the creek about 8 times as the trail meanders towards the river…what a blast. I topped it off with a 10 minute trail run as part of my triathlon training.

I’m ready to ride with the girlies again anytime!

Geometry

Geometry

Today I hopped on my trusty old mountain bike, after having put a few hundred miles on my new road bike. My trusty old mountain bike, that always fit me just like a glove felt…awkward. I felt top heavy, it felt squirrelly, uncertain and unsteady. Or maybe it was just me.

I’m shocked at how acustomed I’ve become to the fit and “geometry” of my new road bike that was fitted for me. I never thought I’d feel like a road bike was more comfortable than my gold ol’ bridgestone.