We all learn so much from consult notes: I had a patient fail her tilt table test and the cardiologist put her on low dose Paxil and I called and asked "is it so she feels better about her POTS?" and he said that no, it helps. I haven't seen any literature about it, but I've kept it in my tool kit.
Thanks for the update and hope you're enjoying your vacation. I keep thinking about the scene from Jaws where they shared scars....
Hi Jan- agree with you… when I do have time to read the finer points of the specialist consultations there is often good stuff to learn/be reminded of. And POTS is becoming more common as you know so I’ll have to do a deep dive on this if only for my own reeducation. Without going into a big Paxil search now, here’s quick validation at least, and thanks!
Glad you didn’t concuss. When I had my TKR several years back, I was advised to rub Vit E oil into the healing incision (post stitches removal) 2-3x/day. It worked- scar is barely visible.
Thanks for adding this one PJJ, and I have definitely heard of using Vitamin E, too. Haven’t tried it personally or recommended it professionally. Here’s what the Cochrane data crunchers conclude:
“ Results: Only six studies met the inclusion criteria. Of these six included studies, three reported a significant improvement in the cosmetic appearance of scars when using vitamin E: one study used topical vitamin E in white children as monotherapy, and two studies used vitamin E in an adult population as combination therapy. The other three selected studies showed no significant improvement in scar appearance when using topical vitamin E as monotherapy. Two of the six included studies reported adverse events of vitamin E application: contact dermatitis and increased incidence of itching and rash.”
Thanks for sharing, reminded me of the time I nicked a quarter inch wound, just above my left eyebrow. Didn't think anything of it until the blood was gushing over my left eye. Thought I sliced open my forehead. Cleaning up and was surprised to see a tiny nick. Sort of reminded me of wrestlers "juicing" or "blading" during matches.
That scab is an important part of the immune and body response. It's amazing process to prevent the infection turning into a nasty disease. I would like to mention that a, long ago, a Australian surgeon mentioning to me that he used honey as wound dressing (warning to readers, do not try this at home. Strictly anecdotal!) Sharing this short video with your readers.
Yea that’s a real bleeding prone spot! Some of the boxing matches back on the day were (?still are) decided by blood getting into boxers eyes. Can’t watch blood sports anymore. And the honey anecdote is historically true. Can’t recommend that now bc impurities and a lot of honey is mixed with high fructose corn syrup… but we’ve used that Medihoney stuff and some wound care specialists do as well!
I hope the restaurant person did arrange to have that shelf removed. I'd have probably cussed up a storm at the stupidity of whoever installed the shelf in its perilous location.
I also hope you're healing well and that the scar will be invisible or hardly noticeable.
Appreciate that Mim! As the person kind of stared blankly at me I couldn’t tell if they were caught off guard or nonchalant, so I added that I’m not the kind of person who sues, but the next person might be. Hate to drop that but I got the feeling I wasn’t the first, nor would be the last.
Have to stop absentmindedly scratching my head at times. That sets me back.
Seriously, generating a scar-ry story to educate your readers, especially while on vacation, is going above and beyond. Thank you, but for gossakes, enjoy your vacation!
Unusual technique. Friend sustained a 10 cm scalp lac in backcountry wilderness (7 pack miles to asphalt). Once pressure controlled bleeding, I used adjacent patient's hairs to tie interrupted "sutures" - apposed wound very well; appeared well healed 10 days later! Obviously requires medium hair length.
This is totally valid, and props for doing it in such circumstances! How did you tie the hair strands, simple knots? Here is a quick article and video on “how” for anyone else interested, though in the video it is being done in an ER and not backcountry. Very cool!
Yes, because he had fairly long , thick hair, tied 1 or a few hairs over needle-nose pliers in square knots. Biggest draw-back was trying to tease the knotted hair apart after healing!
Sorry to hear this, but glad it seems under control, and lucky you to have an obstetrician/gynaecologist to patch up the wound! My spouse is a GP but doesn't love surgery, though she did steristrip our kid's wound and superglued it too! Handy to know about the steroid - I think my wife already knows, but I'll share it with her anyway! Cochrane isn't always helpful - see the review on masks! Anyway, I'm pleased to report I've been tolerating Metformin fine feel pretty much back to normal D10! Take care!
That’s great you have a physician partner, too! This trip has been a good reminder that I need to restock on steristrips and find some dermabond somehow. Agreed re: Cochrane. And thanks for sharing the D10 update! So happy to hear that!
Cheers Ryan! I hope you're actually enjoying writing these replies, because if you're not you really should go focus on enjoying your holiday! Take care and have a good one!
Thanks for the tips - that will be handy for my pts . Vis a vis scars. - as Bessel van der Kolk put it , “ The Body Keeps the Score” .
Hi Michael and well stated, ironically I sustained this injury on Dutch soil so the Bessel van der Kolk title is apropos!
We all learn so much from consult notes: I had a patient fail her tilt table test and the cardiologist put her on low dose Paxil and I called and asked "is it so she feels better about her POTS?" and he said that no, it helps. I haven't seen any literature about it, but I've kept it in my tool kit.
Thanks for the update and hope you're enjoying your vacation. I keep thinking about the scene from Jaws where they shared scars....
Hi Jan- agree with you… when I do have time to read the finer points of the specialist consultations there is often good stuff to learn/be reminded of. And POTS is becoming more common as you know so I’ll have to do a deep dive on this if only for my own reeducation. Without going into a big Paxil search now, here’s quick validation at least, and thanks!
https://www.potsuk.org/managingpots/medication-2/#:~:text=Sertraline%2C%20escitalopram%2C%20citalopram%2C%20paroxetine,be%20useful%20in%20treating%20PoTS.
I hope your head heals quickly. I want to see your "in-house" artist's rendition of the event!
Thanks, Gemma! I’ll spare the artist in residence this assignment, but I think she would do a pretty funny one actually 😆
Glad you didn’t concuss. When I had my TKR several years back, I was advised to rub Vit E oil into the healing incision (post stitches removal) 2-3x/day. It worked- scar is barely visible.
Thanks for adding this one PJJ, and I have definitely heard of using Vitamin E, too. Haven’t tried it personally or recommended it professionally. Here’s what the Cochrane data crunchers conclude:
“ Results: Only six studies met the inclusion criteria. Of these six included studies, three reported a significant improvement in the cosmetic appearance of scars when using vitamin E: one study used topical vitamin E in white children as monotherapy, and two studies used vitamin E in an adult population as combination therapy. The other three selected studies showed no significant improvement in scar appearance when using topical vitamin E as monotherapy. Two of the six included studies reported adverse events of vitamin E application: contact dermatitis and increased incidence of itching and rash.”
https://pubmed.ncbi.nlm.nih.gov/26977069/#:~:text=Conclusions%3A%20We%20conclude%20that%20there,to%20justify%20its%20widespread%20use.
You're perpetually interesting and useful. Thanks!
Thank you Cheryl, this makes me happy!
I recall a movie (Heathers?) in which the greatest insult was that another person was “boring!” Will keep trying not to be.
Thank you, Doctor Ryan! I hope your head wound is healing properly! Hugs!
Thanks Sharon! Steristrips are looking pretty raggedy but all good 👍
I hope you heal quickly and you will make that cap look good!!
Thanks Cathy! I wear one with this 6 point star actually designed by George Washington:
https://www.muzemerch.com/museum-of-the-american-revolution-liberty-star-cap
Thanks for sharing, reminded me of the time I nicked a quarter inch wound, just above my left eyebrow. Didn't think anything of it until the blood was gushing over my left eye. Thought I sliced open my forehead. Cleaning up and was surprised to see a tiny nick. Sort of reminded me of wrestlers "juicing" or "blading" during matches.
That scab is an important part of the immune and body response. It's amazing process to prevent the infection turning into a nasty disease. I would like to mention that a, long ago, a Australian surgeon mentioning to me that he used honey as wound dressing (warning to readers, do not try this at home. Strictly anecdotal!) Sharing this short video with your readers.
https://www.youtube.com/watch?v=1VBLmyDjC0w
Yea that’s a real bleeding prone spot! Some of the boxing matches back on the day were (?still are) decided by blood getting into boxers eyes. Can’t watch blood sports anymore. And the honey anecdote is historically true. Can’t recommend that now bc impurities and a lot of honey is mixed with high fructose corn syrup… but we’ve used that Medihoney stuff and some wound care specialists do as well!
I hope the restaurant person did arrange to have that shelf removed. I'd have probably cussed up a storm at the stupidity of whoever installed the shelf in its perilous location.
I also hope you're healing well and that the scar will be invisible or hardly noticeable.
Appreciate that Mim! As the person kind of stared blankly at me I couldn’t tell if they were caught off guard or nonchalant, so I added that I’m not the kind of person who sues, but the next person might be. Hate to drop that but I got the feeling I wasn’t the first, nor would be the last.
Have to stop absentmindedly scratching my head at times. That sets me back.
It’s getting more and more difficult these days not to scratch one’s head.
👌😆
Seriously, generating a scar-ry story to educate your readers, especially while on vacation, is going above and beyond. Thank you, but for gossakes, enjoy your vacation!
Will do, and this one was banged out on a long train ride so all good. Back to it, excellent reminder 😉
Unusual technique. Friend sustained a 10 cm scalp lac in backcountry wilderness (7 pack miles to asphalt). Once pressure controlled bleeding, I used adjacent patient's hairs to tie interrupted "sutures" - apposed wound very well; appeared well healed 10 days later! Obviously requires medium hair length.
This is totally valid, and props for doing it in such circumstances! How did you tie the hair strands, simple knots? Here is a quick article and video on “how” for anyone else interested, though in the video it is being done in an ER and not backcountry. Very cool!
https://www.avivaplasticsurgery.com/hair-apposition-technique-how-to-fix-a-scalp-cut
Yes, because he had fairly long , thick hair, tied 1 or a few hairs over needle-nose pliers in square knots. Biggest draw-back was trying to tease the knotted hair apart after healing!
Sorry to hear this, but glad it seems under control, and lucky you to have an obstetrician/gynaecologist to patch up the wound! My spouse is a GP but doesn't love surgery, though she did steristrip our kid's wound and superglued it too! Handy to know about the steroid - I think my wife already knows, but I'll share it with her anyway! Cochrane isn't always helpful - see the review on masks! Anyway, I'm pleased to report I've been tolerating Metformin fine feel pretty much back to normal D10! Take care!
That’s great you have a physician partner, too! This trip has been a good reminder that I need to restock on steristrips and find some dermabond somehow. Agreed re: Cochrane. And thanks for sharing the D10 update! So happy to hear that!
Cheers Ryan! I hope you're actually enjoying writing these replies, because if you're not you really should go focus on enjoying your holiday! Take care and have a good one!