Torofy Blog

Depression and Heart Disease

SHOCKING Patient Story | It Started With Foot Pain…

– Hey, guys, welcome to another episode of the Wednesday Checkup. Today, I wanna tell you
about a really interesting patient encounter I had just the other day and then we’re gonna follow up that story with one of my favorite
segments, Mail Time. You ready? (whooping) (mellow music) My nurse rooms the patient,
takes all the vitals, brings all the information, including the chief complaint to me. Tells me that the patient
has normal vital signs, normal blood pressure, pulse, high 90s. That he’s a mid 60-year-old male. That the breathing rate is normal. And that the patient’s chief complaint is that there’s this redness
surrounding the right foot, that the patient is worried about, that the antibiotics haven’t really, that they haven’t really seen an improvement in the
redness of the right foot, despite using antibiotics
in the last 48 hours. Prior to walking into the
room with the patient, I did look at the electronic health record and found out they have an extensive list of medical conditions and are take a lot of
medications for them. Hypothyroid, osteoporosis, diabetes type 2, high
cholesterol, atrial fibrillation, so I know that this patient
does have medications onboard and other conditions at play. It’s important for me as a doctor to check that before going into a room so that I can see how
maybe those illnesses and those medications can be factoring in to the current problem. After hearing the story about the foot, I asked the patient if there
were any other complaints. And I generally have a list of what we call a review of systems, where I ask a few general questions just to see how the
patient’s doing overall. Constitutional symptoms
like fever, fatigue, unexplained weight loss, then we have the cardiovascular ones, palpitations, chest pain, then with the respiratory
ones, shortness of breath. You sort of get the idea. The patient did mention that he felt a little bit more short
of breath than usual. He attributed that to the pain and discomfort from his right leg. That he thought maybe he
wasn’t sleeping as well and there were all these
sorts of explanations he had in his mind for
why that was happening. So I listened to the patient’s lungs, crystal clear, no problem. When I listened to the patient’s heart, I hear something that I
didn’t expect to hear. The patient was having an
irregularly irregular rhythm, meaning that it was an irregular rate, that is was above 100, and it was an irregular rhythm, meaning that it didn’t have
a consistent beat to it. Ba-boom, boom, ba-boo-boo-boom, boom. That is essentially the
beat that we would hear if a patient has atrial fibrillation. Now I know this patient
has a history of that so it makes it a little
bit more easy for me to expect to hear that. But a patient who has atrial
fibrillation actively, at a fast rate is dangerous. Reason being is the heart
doesn’t like to be beating very rapidly for a long period of time. At rest, your heart rate should be somewhere between 60 and 100. However, my patient was beating
somewhere in the low 100s when I listened and I checked their pulse. I asked the patient, “Have you felt any palpitations
in the last few days?” Meaning that they feel
like their heart’s racing or beating outside of their chest. That’s a very common way to explain it. And the patient says to me, “You know doctor, the last few days, “I did feel a little bit “and I wasn’t sure if it’s my AFib,” the atrial fibrillation, “kicking in. “But it went away, so I
assumed nothing of it. “Is that okay?” Let me do something, let me get an EKG just to see how your heart is doing, how fast is it beating, confirm that this is fact AFib, and we’ll move on from there. And we sort of put the
foot issue to the side because A, he’s actually
being treated for it, and B, the more concerning
issue for the time being would be the heart. Upon getting the EKG, we found out that my physical exam was correct and the patient was having AFib. And he was having AFib with RVR. I know that’s a mouthful. AFib is that atrial fibrillation where the top of the heart beats irregularly at an irregular rate. But then his ventricles, as a result of having those excess beats, was also beating very quickly. That’s the lower portion of the heart that actually pumps out blood
to the rest of the body. His heart was working very hard in order to maintain this rhythm. But this isn’t normal. My patient’s at rest, his heart shouldn’t be beating that quickly. Upon further review of that EKG, I found that he was having segments of what’s known as ST depressions. And what ST depressions,
specifically on an EKG signify is that the heart isn’t
getting enough blood and it’s suffering. It’s actually being choked out. We call this a type 2 MI which
ones a type 2 heart attack. When the heart is beating so fast that it’s not getting enough blood because it’s being overworked and there’s actual damage to
the muscle tissue of the heart. So I told him that we have to call 911 and we have to get him
sent over to the hospital in order to contain this rate, slow the rate down, and then figure out what our
long-term plan is gonna be. Now this was very stressful because the patient
started getting emotional, they started getting worried and upset because they thought they
were coming in for their foot, but here we are, diagnosing
them with a heart attack. My patient ended up going
to the emergency room. They gave him IV medications. They made sure that the rate subsided, that the enzymes that were
leaking from the damaged heart started going down and
the heart was improving. And once that started happening, they had a cardiovascular
doctor see the patient and decide what the plan
wanna gonna be moving forward. And part of that was to increase the dosage of one medication and decrease the dosage of another. And then have them follow up in one week with that same cardiologist. The point of this being is that as a doctor, you
never know what do expect, especially at a family medicine office. I had a patient on my
schedule for an infected foot, and here I am, diagnosing
him with a heart attack that they were walking around with. They actually walked a
few blocks to my office. A mistake I see a lot
of young doctors make is to get pigeonholed into a diagnosis. They see a red, swollen
foot on their screen. They only look at that body part and they say, “Okay, well
here’s a diagnosis for this,” and they forget that
there’s a whole person sitting in front of them. It’s important to take that whole person to consideration when treating a patient. Yes, the complaint is
about an infected foot, but the real concern was
with my patient’s heart and the only way I could find that out is through a thorough
history and physical exam. Had I not done those things, just looked at the foot, said,
“Okay, the foot’s improving, “you know, keep taking your antibiotics, “let’s have you follow up.” I would have been doing a
huge disservice to my patient. We have to treat the
human sitting in front us and not the ailment, or not the complaint that
they’re bringing to us. The more you can do that
as a doctor, as a person, as a police officer, it
really doesn’t even matter, the better you’re gonna fair and the better the person sitting in front of you is gonna fair. Let’s have some fun and open some packages via Mail Time, courtesy of my mail bag. West Orange, New Jersey,
that’s not too far. (bag crinkling) Oh, these are gonna be cuff links because I can tell from the cuff link box. Ooh. These are dope. These are little stethoscopes. Ooh, look at this little checkerboard tie. If it matches, you gotta wear it. Whew. Easy work. Thank you for your wonderful gift. I think I look pretty fly and I can’t wait to wear these cuff links. Fort Walton Beach, Florida. (gasping) Snickers! (gasps) Did you get Bear his favorite toy? No joke, this is Bear’s favorite toy. Little squirrels that you put in here and then he has to get them out. Bear, I have a gift for you. Oh, they make noise. This is legit, Bear’s favorite toy. He’s gonna lose his mind. Oh, it’s a mug. Aw, me and Roxy sitting side by side. How did you do this? Husky Dad, me and Roxy hanging out. Thank you, family. Okay, this one’s from Texas. Whoop! Whoa. Swarovski pens, with my name on them. But the only thing is, I’m not a DO and MD, I’m just a DO. Problematic? This is from Hungary and I’ve been to Hungary many of times. Not many of times, I’ve been there twice. I imagine this is gonna be a drawing ’cause it’s with some
really heavy cardboard. Here, let’s see. “Dear Mike, I couldn’t
decide, so I did both. “Hope you like it, best regards.” What? This is by far the best drawing I’ve ever seen of me in my life. This is pencil, folks. Is this ridiculous or what? – Wow.
– Dude, these are amazing. I’m gonna have these framed. I don’t know where I’m gonna put them because it’s kind of awkward hanging pictures of
yourself in your own house, but these are amazing. Like, this looks like me. Beau Smith or Bea Smith, please, send me your Instagram. I wanna put this on my story and share this with the world. Your art is amazing. I mean, like you can’t
draw better then that. This is from Ohio. Okay. Okay, here we go, we got socks. Get outta here! Socks with Roxy and Bear’s face on them. Come on now, chum on. I’m gonna wear these to work and people are gonna judge me and I don’t even care at all. Thank you, Kenyatta,
very much appreciated. Stay being an awesome nurse. “I’ve sent you a T-shirt I
make at our small family farm. “I guessed you wear a large or extra large “so whichever one doesn’t fit, “feel free to do whatever
you want with it.” Okay, this is a very interesting shirt. Support your local beekeeper,
I’m down with that, but why is the bee throwing up? (retches) Fun fact, all my videos are now captioned in English and Spanish, so click here to check this one out and have good laugh. As always, stay happy and healthy. (cheery music)

100 thoughts on “SHOCKING Patient Story | It Started With Foot Pain…

  1. When you said doctor should not treat symptoms, doctor should treat patient that is very true. Unfortunately many many doctors treat symptoms only. Your this video all young and new doctors should see and follow this simple rule. Good work doc.

  2. When A careful doctor saved my Life

    Once I went to the ER because I had got a gastrointestinal virus And lyringitis for 4 days in a row. Very high fever, vomiting, fading and unusual chest pain. Since I was an adult, the ambulance refused to come to get me because "it was just a throat inflammation". I went there hitchhiking. I faded while I was waiting for my turn. I came in in yellow code(Italian code). When I resumed they let me wait for 4 hours since my condition was not serious. In the meanwhile nurses mocked me for the fact that "teens comes to the Er Just for a little of Sore throat " I felt really ashamed and guilty to be there, and I usually don't want to go to see doctors because I think is not a warring condition. My turn came I change 2 doctors because it is shift changing time. The second doctor notice unusual very low potassium level. He gives me potassium .
    Then he asks me a simple question. "Do you have chest pain?" Nobody have asked me therefore I haven't mentioned .
    He decides to make me a electrocardiogram to be sure the heart was not damage.
    I was in irregular rythm. I haven't really understood the medical condition but the doctor said it was unusual as my heart was beating as I was 60 ( I was 20).
    They gave me extra potassium and monitored carefully .
    The doctor was really careful and saved my life. He told me I could I have been died from heart attack if I keep vomiting and loosing potassium.

  3. Could you go in more depths about irregular heart beats. Or even explain in more depths of VSD in particular and other types of heart murmurs

  4. Do you think you could do a video on Cystic Fibrosis (CF)?
    I have it and I am a kid. (most kids dont live up to elementary school age. Im in middle school.)

  5. Thanks for being so informative. I'm a new RN & I've obviously heard of an MI with ST elevation, but I've never heard of an MI with ST depression… It totally makes sense! Always learning something new 😊

  6. Did anyone understand the bee reference…. that’s how they make honey they eat the nectar take it to the hive regurgitate the nectar and store it in wax …. so honey is basically bee barf 🐝

  7. You're a very good doc. I have a prolactinoma but also acth, cortisol and a whole host of other hormones like androstenedione, dheas, testosterone are high. As a result, i have osteoporosis, high cholesterol, missing periods, balding from the head, thick coarse hair on the face, chin, chest and belly…. extreme fatigue, migraine attacks, constipation… the list is endless. But each doc just pushes me onto the other saying this isn't related. I keep saying the body is a whole system, not individuals systems working in isolation. Of course if there is something sitting in the master gland in the brain, my body is going to be affected. You're the first doc i saw who seconds my viewpoint. Wish you were my doctor. I could have been able to address so many of my serious health issues as a result of the tumour

  8. I’ve had heart problems my whole life I’m only 22 but I had a valve replacement and a heart transplant but while I was on the list I was going to the er couple times a week With a heart rate of into the 200 s I had to take 2 years off of college to deal with this but thank god I got my transplant before we had to consider other options other than my pacemaker and medication. Your welcome for that story. Please like

  9. I may be wrong and please correct me but on the nhs (uk) this might not always happen. Firstly a regular appointment is 5-10 mins max. The doctor usually doesn’t know what the issue is until the patient walks in and tells them. Nhs stipulates (at least at my gp surgery) it is one problem for one appointment. The gp will deal with that one issue. They may do some other general checks depending on history but in my experience they don’t have time to do a full body or go deeper into other medical issues. The nhs are amazing though and I am not being critical in any way. It’s just that U.S private health care is very different.

  10. Me: Sore throat home remedies
    Google: Did you mean THROAT CANCER?
    Me:No, sore throat means a flu infection
    Google:Are you sneezing?
    Me:No, not yet
    Google:Throat cancer it is

  11. I am a programmer. Sometimes, when the program doesn't work as intended and it gives you a line with the problem, the problem actually lies somewhere completely different when the problem was because of the contents of that line clashing with a mistake in the other line that wasn't shown. When a program doesn't work, I always look for even the smallest mistakes because often times, the problems come from really small things that you did wrong or remembered incorrectly. I know some people that also try to program but only look on the section where the program supposedly stopped working. One of them asked me for help recently, I looked over the code once and found the problem. It wasn't hard. They just didn't look there.

  12. I could never be a doctor or anything in that field. I would feel sick all the time because of all of the disgusting things. I don't have any problems with blood, but don't get near me if your nose is runny.

  13. just a tip: don't wear shirts with such a tight grid pattern on them. You probably saw the pattern it produces in editing. This is caused due to the very small squares forming a grid which is not inline with the pixels of the image. I know this from doing some filming on old CRT tvs and having to deal with that. with a shirt, because it is moving, you can't really do much about it 🙁

  14. I was wondering, are they your nurses, or your MA's? I'm so curious on this as I'm becoming a Clinical Medical Assistant, and had seen that most people I've always called "Nurses" are actually Medical Assistants. Also I have the absolute worse doctors I'm seeing myself, and I'm gonna ask them if they watch you, if not they should!!

  15. Welp this sounds really weirdnind I might get hated for this buuuut when dr Mike said mail time my headphones glitched out as always and instead of mail time I heard


  16. Me : *foot pain and searches it up on google *
    Google : you have 36 diffrent cancers, take this quiz and guess wich ones?

  17. I have complex regional pain syndrome. I was having extreme spasming and screaming in pain. They did blood work and turns out I was also in DKA. I was admitted and spent 3 days there.

    Last week I went to my PCP complaining of pain when urinating, cramping while going. It had been going on for over a month. I contributed the cloudy urine to the Valsarten I started taking. As said above I have pain in my back daily so I contributed the back pain to that. I took my pain meds and it helped so I thought it was just muscular. She ordered bloodwork and called me telling me to go to the ER immediately, my kidney function was down. The pain that day got so bad they had to give me morphine. I spent 3 days getting IV fluids and antibiotics. I was bloated but that's not super abnormal for me. Now I can see just how much fluid I was holding. They gave me lasix and I was up peeing literally every 20 minutes for 24 hours. They gave me TEN bags of fluid. Again crying pain from my back isn't abnormal at all. I would've never of known if my husband hadn't pushed going to the doctor so much. Oh and my sugars were in the 300-400s. I always have an explanation for symptoms.

  18. I shouldnt have watched this before I went to bed, because when I woke up and tried to sleep again I noticed how my heartbeat felt weird… Almost as if there are tiny hearts right under my actual hear that is beating a bit after my normal hear beat, then I was awake for half an hour trying to convince myself i probably felt it wrong, and tried to hear my chest again and again but the heartbeat was always different, but yet in she same spot. (the feelings of 3 small hearts under my normal one would always be at the same place.) then when I ran to school in the morning's felt that my heart boated regularly I felt relived and decided to forget about it. (of course it was beating fast and hard but that's because I just ran so…)
    I do get chest pain a lot which is annoying, but they usually only happen when I'm at school… Wow even my body hate school lol

  19. the face portraits, …." I drew you while you were sleeping…" , Dr. Mike, "Haha! Jokes on you, I'm a doctor, I don't have time for sleep!" lol

  20. Me: oh i’m getting some earwax buildup I should probably get that checked ou-
    WebMD: I diagnose you with ear roaches, spiders, lice, cancer and death
    Me: but it’s just-
    WebMD: A H E M

  21. My experience when we discovered i have rhd was when my mom and i was going to the bank as we go down from the vehicle i couldnt walk already..and i dont know why my legs just hurt

  22. Google is always accurate for me (i think)(maybe most of the time)

    But for people its not,

    But this video from a Doctor proves that Google is right

  23. get gift wrap and tape it up then tape the art on it.. then once its full take it down and rool it up and put a new one up.. im a homeschool mom and thats what i do with their paper assinments for when people come over. then i get it out when i have to show the homeschool assessment people her work.

  24. Not sure if anyone told you this but the reason the bee is vomiting on that shirt is because Honey is literally bee vomit. They ingest nectar and some enzymes or something in their stomach turn it into honey and regurgitate it into the honeycomb of their hive for storage.

  25. The bee is throwing up because a part of the honey making process involves the bee mixing it’s saliva with an ingredient (can’t remember which). So the bee will just pop it in, swish it around, then spit it out. Clearly, those keeper have a unique sense of humor. I like it. 😂

  26. We have had a case in my family, where a dog was playing with a puppy and bit it to death because the puppy was making squeaking noises and that triggered a reflex in the dog, that he had gotten from a squeaking toy. So no more squeaking dog toys please.

  27. Me: watching video of guy telling story about another guy almost dying

    Top right corner of screen: * doctor reacts to silly medical memes*😂😂

  28. This is frustrating for me. A few days ago I was having palpitations, dr did an ekg and saw nothing, once he listened to my heart he realized something maybe actually happening, I pulled up the ECG’s that my Apple Watch records, and he diagnosed me with PAC’s. Now I’m on beta blockers waiting for a month for a cardiologist since my ecg’s show 12+ pac’s a minute. But when he first walked in the room, it was “you’re EKG is normal I don’t see anything wrong” until I begged him to listen and look.

  29. Idk if this is uncontrollable weight lost or not, but I lost 11 pounds in less then 5 hours a year ago I didn’t need a doc though

  30. Dr Mike I have a medical question I keep having adamonal pain on my left side I had an endoscope they did biopsy some of the biopsy they found nothing the last biopsy they did they found polyps in colon. I been having really bad pain since November 26 2019 till now December 30 2019 I keep going to the ER or I get admitted but nothing since to help the pain it’s 10 out of 10 of pain. I’m still waiting on a GI specialist. And I read up on polyps in colon if I don’t get treated I could get pre polyps cancer in the colon please help me with the pain the ER can’t do as much no more with my pain

  31. I have a story (no one's gonna see this but I want to get it out) I have a torn ligement and the doctor and my family all said it was just a sprain but after 4 weeks and no progress I went to the doctor to get an MRI and they found out I had a torn ligement and some bruised bones it's not that bad but it's still kinda weird

  32. I sprained my ankle 5 months ago and the doctors are saying it’s my Achilles Tendon but that runs the the heel All the way up the Back of the leg so it can’t be beacuse my ankle has been hurting and I’m confused by it It won’t go away I was in a Boot for a month then I’m getting heel stuff but it’s Not my heel

  33. Patient: I accidentally slammed my finger in the door

    Doctor: you have radiation poisoning and a liver infection in your pinky toe

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