Cruel summer

This has been a hot summer, and as a result, we've seen sickle cell patients running into all kinds of trouble. Sickle cell is an annoying disease in that everything can set off a crisis. If it's too hot or too cold, too much exercise or not enough, dehydrated or drinking the wrong liquids... there are so many triggers and they're all common sorts of things.

Because sickle cell patients have been running into so much trouble, the nurses and physicians are complaining about them and their unbelievable consumption of opioids. I've seen some patients take in enough dilaudid to put down a horse. People accuse them all the time of drug seeking and inappropriate use.

The thing about having sickle cell disease though is that it is rife with chronic ischemic pain. That hurts. It also lowers life expectancy by decades with median age at time of death in the 40's. That sucks.

I hate giving out huge doses of opioids as much as the next guy, but pain is pain, and if I had sickle cell, then I'd want a little more dilaudid too.

Human lie detector

The show 'Lie to Me' is based on the idea of microexpressions, and if you can accurately see and interpret these findings, then you can be a human lie detector.

I seem to have a knack for this, as I am usually pretty good at spotting the liars, the folks who are outright dishonest about their history of medications usually. But they usually make it pretty easy when they tell me they need 6 xanax a day and oxycontin is the only medication that relieves their chronic back pain.

Knowing when someone lies to you is a remarkably depressing experience. It is one thing to be ignorant of what someone is doing, but to see the lies, that hurts. Still, one thing that people really have a hard time with is the manipulative patient who is actually in pain. I know that he's mean and demanding and wants dilaudid 4mg IV q2 hr, but he is s/p fasciotomy for necrotizing fasciitis. I think he deserves some pain medication, even if he is a jerk.