Like many physicians, she was very hard on herself…she refers to the limbic-hippocampal tracts…those are axons [not the soms cell bodies…that you can grow by knowing how to activate the limbic system when you study…I teach my doctors…all of my students [some are neurologists and EPs…yet they are never taught how to use this mechanism. I have a safe, ultra-low dose form of HRT that helps. I prove it to every class I treat to a sample shot that helps them for one week! That one vial of 6 mg can treat the whole class of 80mphysicians…it is just 6 mg divided by 80…[so I use a lot of diligent and a 31 G needle. Your body needs somatomedin C! All emergency physicians I have ever tested…thousands are deficient! [based on a low IGF-1 level; mean serum values are 92…normal is 240-245 depending on which lab you use; Labcore and other similar companies can perform the test; it is a simple venous blood draw. It proves to me that most EPs have pituitary dysfunction…that is why you are tired grumpy and easily catch a cold! It affects your skeletal/cardiac/muscle mass [both decline by early midlife]. I was tested over and over for 4byears and it was a 45 degree line heading lower and lower…so low Inbegan on a 6 mg vial every 2.5 weeks. Now one vial lasts me about one month…my level is not physiologic but I,notice enough benefit that I prefer to keep the dose as low as possible. This hormone increases the synthesis of critical pathways that promote the synthesis of critical bodily proteins…this includes myelin in the Bain and spinal cord! I created a protocol in the 1990s that treats a host of conditions: it is a true rapid cure for central spinal cord syndrome [both pure edema-related and/or those that include an MRI proven spinal cord hemorrhage [the first patient was a 75-y-o-chronic smoker with poorly controlled diabetes [type II] who needed and took insulin. Yet he had a Cadillac fall on his, suffered traumatic asphyxia and was in a trauma ICU bed with a tracheotomy x 6wks. Then “in early ambulatory recovery” walking on Boca beach he coughed so hard he ruptured his anterior spinal artery at C6. Within one h he had severe weakness with burning in his UEs [most symptomatic in his hands]. His legs were functionally a 1/5 then a 0/5 for motor power by the the 2nd hour. He was taken to the local hospital and had his bleed Dxed by MRI [boca Hospital. 4 days post his bleed I was notified and he agreed to try my protocol. He was fully ambulatory w/o need for any assistive walking device on the 8th day. Next it gets interesting! His son, a minister stopped his injections [they are just 0.15 mL] so he decided it was God not the medicine. His dad was back in his immediate “post-bleed state” with both hands burning like “fire” and the same pattern of arms weaker than legs but no useful motor function of either. The burning is due to iron [from senescent RBCs] still present on days 8-9-10-11…and likely present for weeks. By restarting his identical dose it took two days for his “second miraculous recovery.” He completed my 8nweek protocol but…WAS ABLE TO RESUME ALL DUTIES AS A MECHANIC BY WEEK TWO….he moved back to Brazil where he built a house with his own hands. He died at age 85 from a surgery while he was put under general anesthesia. He had an iatrogenic death! I have used my protocol to treat and cure radial, ulnar and median N neurapraxia injuries as well as a physician with common perineal N neurapraxia. I was able to eliminate agitated depression in one male physician age 52 in about 3 weeks. [He wrote to me; called me and told me this prevented his divorce!
What is my point. I don’t “just teach EM board prep”.
MOST OF MY PRIVATE PRACTICE PATIENTS ARE PHYSICIANS! …and… ALL OF THEM ATTENDED BOTH OF MY EM BOARD PREP PROGRAMS AS WELL AS MY MINIPREP [A 3 HR PREP OF CASE SIMULATIONS …SINGLES PLUS AT LEAT ONE MULTIPLE PT ENCOUNTER IN CHICAGO ONE OR MORE DAYS BEFORE YOUR LIVE EXAM! My candidates are much more prepared than any ABEM/AOBEM/BCEM examiners!!!
“Dear Doctor C” I could actually hear your voice while I was taking my oral examination. I started an alpha-dose dobutamine drip using the rule you taught us and the ABEM board wrote to me a “letter of excellence”. Because Imsaid I wanted 17 ml per hour of that mix [150 mg in 250 mL D5w…and I said I want 17 microdrops per minute [the same as 17 mL/hr] and I told the examiner to check my math and be certain it was exactly 10 micrograms per kg per min [alpha dose]…She was impressed! How often do people get such feedback?” I responded you are the second physician…the other was a participant of the 8-Day Review who scored 100% correct answers! One other had a 94% but he didn’t get a special letter…But a 94% on that exam is an A+!
To all of my future clients What is interesting IS MOST OF YOU FUNCTION W/CHRONIC UNCHANGING DOGMA/ALGOS. Yet the old algorithms are still so correct that anyone can pass with the Qs/As I wrote in 1989. Yeas Inadded 100s Of pages of updates but TDP [TORSADES] is still TDP and the basic “ rule of engagement“ have not changed!
TDP is either genetic [2 types] or it’s acquired via starvation or a drug…and T list of drugs [categories] hasn’t changed. If you see EtOH abuse plus AMS and a thread rapid pulse…it’s VT w/a pulse…and the monitor shows a “twisting of the axis”. Because the patient is an alcoholic you try IV magnesium first…next it’s a temporary transvenous pacer to increase the heart rate -that lowers the QTc] and the pt goes back into a sinus rhythm or they die from pulses VT…that is treated w/200J [not 100] as a of “asynchronous cardiversion [i.e. defibrillation]!
You start cardiac compressions too…usually the magnesium kicks in and by then you have all elytes…the K is low so you also replete that. You check all risky meds that induce TDP…and you call the PCP…the pt get icu admission, M/I workup…but shocks elevate the troponin/CPK!!! Remember “a long hypo”. HypoMg/hypoK lead to,prolonged QTc cases [YOU WILL NEED A LONG HYPODERMIC OF ELECTROLYTE TO HELP THE PT] NOTE: this is a PEER exam question from PEER V and even PEER I/I/I. Please candidates remember that if you are a member of ACEP you can purchase a copy of the pier exam as it is updated every year but one copy with his 500+ questions is not enough it’s not even close because I have over 500 pediatric questions just for pediatrics and over 500 images just for trauma plus the trauma questions which is another 500 screens. I have more data but it all comes from the core content and nothing more because the court content is based on 2500 pages which is based on 100,000 pages of references. I could write over 20,000 questions from Tintinalli in addition eight just that one addition and still not cover everything! So I have squashed it down to a few hundred pages of text into volume which is a classic manual that doesn’t need to change I need slight updates periodically and I made one that is a couple hundred pages long but you don’t really need all of that I also have a chapter called the superlatives which is in my pros of wisdom text addition seven which is coming out hopefully this year 2020 as an electron a textbook that you downloaded to your computer so you can have word searches if you put it on Microsoft Word document. I wrote it in density which means it’s in a condensed format so use density style words when you do your searches!! Remember also that most of my work almost every screen has a reference page to one addition of Tintinalli or even two or three sometimes because I pick and choose who wrote the best chapter or the best paragraph for the best sentence on a particular concept, topic, data set, or statistics etc. I learned that if you know the statistical presentation of any disease you can answer a lot of questions the math really does matter and I have a mathematical and artistic mind and not everyone is gifted with such a mind so you have to work at it it is a lifetime of study and I will always help you you just have to call me I am always a phone call away. If I tell you the truth people call me 247 365 days a year and most of the time I take everyone of those cars instantly and do not make them wait. Some people do tend to abuse my availability so there are a few people I have to limit my answers to text messages because they want to use all of my time. They even call me from the ER to help them manage cases and I do give them advice but then I tell them to call the poison control center if it’s a talks keys when I tell them to immediately call the cardiologist if it’s a heart attack that they are not sure about I know this all sounds bizarre and hard to believe but it happens to me almost daily. Here’s a classic from Dr. W Quote Dwight I have a patient actually twins who is swallowed “Ferrous fumarate tabs” and both were vomiting blood… he what do I do DWIGHT….? [panicked]. Answer start IV bonuses give Benadryl iv and start deferoxamine NOW…! That is stage III iron posonining. Diarrhea and esp vomiting blood means the iron level will be unreliable and there is free iron which causes hypotension, acidosis and death rapidly. This doctor called me on a repeated basis he is a board-certified pediatric cardiologist who switched to emergency medicine and he knows nothing about toxicology yet I spent two weeks teaching him toxicology and a private tutor him after the course in toxicology and iron overdose is a major toxins that I teach every single doctor more than once and we do an iron poison in case every time I taught him the oral board tutorial and I let him be an instructor to give him even more education… That just means he sat at a table and gave an exam with the answers right in front of him all typed up…by me. What is wrong is it’s time for him to retire because he just refuses to study or there is something wrong with him because I have tested him and he is a nice person who is super intelligent and that he’s the smartest cardiologist I ever met but for some reason he freezes he jokes when it comes to pediatric toxins if I said it was a blue baby he would be happy if you could hear a murmur other than that he cannot function in the world of pediatrics. The truth is I see this all over the United States because I have worked all over the United States including on cruise ships including in the Caribbean including virtually the west coast the west middle of the United States the south and the north eastern United States and it’s all the same everywhere I go there are doctors who are misinformed or ill-informed and do not study and then there are great doctors also but there are very few that are “in-between”