Promote your business or product on 700level.com. For
more information about advertising with us CLICK HERE!

Jules, I've always wondered this, WTF does a "Punctured Lung" feel like, and how the F does it get fixed? I mean, do you start weezing and stuff? And does it heal itself with rest or do you have to "go in there"?

Well, GGB, it's a fairly insightful question you ask.

How do they "feel"? They are often described as sharp pain worse with deep breaths or pain radiating to the shoulder. Sometimes, they are described as vague chest pain and confused for cardiac symptoms. They are not exclusively caused by blunt or penetrating trauma (like Romo). They can also be caused in asthmatics, severe coughing, etc (the latter while uncommon is mostly seen with weed users).

There are no specific "rules" for management or treatment of a pneumothorax, aka, punctured lung.

First, if the patient is not short of breath and is not having troubles oxygenating, you don't treat.

It depends on age/medical condition of the patient as well. For young patients, the overall stress created by having a partially expanded single lung is not the same as a 70 year old with heart disease or emphysema from smoking. In those cases, I haven't hesitated to put in chest tubes immediately if I thought there was any risk.

Often, xrays are repeated within a finite interval (usually 4-6 hours). IF the amount of air that has leaked into the space around the lung is increased, then, that is often an indication to consider chest tube placement.

If the patient is a trauma patient who is in serious or critical condition, then often times chest tubes are placed if you can't hear normal breath sounds or if the patient is crashing and you don't have time to run a full set of diagnostic tests on them. Though, considering how things are done today, this is becoming uncommon with CT scanners in every hospital and every ED.

Ultimately, air will be reabsorbed and the lung will fully expand so long as the lung injury is small enough.

Second, if the injury is large enough, then often the air around the lung is significant and you have to put in a chest tube into the space within the thoracic cavity in the space around the lung and continue suctioning air until the lung heals and re-expands. For most cases, they are often removed in under a week. They can stay longer if the patient has a large leak through a large conduit between the lung and space around it (called a bronchopleural fistula) or has scarring (fibrosis) of their lung; these require more effort to re-expand the lung.

Third, some people say if the amount of air exceeds 20% of the size of half the thorax (right or left), then they advocate putting in tubes.

For a guy who is young, this is often not an issue. Romo is far more likely to be having pain from his rib fracture than trouble breathing or pain from his pneumothorax.

Jules, if I put in the same about of overall time running, but break it up over periods of time, does that burn the same amount of calories as if I ran all at once?

I'm thinking about breaking my 30 minute run in the morning to three 10 minute runs spaced out during the day and don't know if that'll keep me at the same place I want to be or if I need to add more somehow.

Out of curiousity, lyte, why breaking it down? Seems like more time involved by having several runs versus one.

Before the kid came, I could get up early and run in the morning. Now, getting him packed up and ready to leave in the morning leaves me with little time to get myself ready and into work. When I get home we feed him, play a bit and then put him down and I don't want to run before bed, so that leaves during work. I can fit in time around lunch but if I go 30 minutes during lunch I'll be kinda sweaty and need to shower so if I just swap shoes out and jog for 10 minutes, I'm not as bad off. I can also take a couple breaks during the day, swap out the shoes and get some running in then.

Seems to me if you lack intensity and don't even sweat that it won't compare to a single session run. Maybe run faster for your ten minute runs to compensate since you don't have to last as long? I don't have any science backing that up though, just my own experience from training for races in the past.

I'm guessing it won't be as much, but someone mentioned that it's better for you to spread out eating so maybe spreading out workouts is good, and I figured I'd ask Jules if he knew.

The problem is intensity, Lyte. If you run for 10 minutes, go harder or try intervals (30 seconds with 60 second recovery or 1 minute and 2 minute recovery).

It does sort of take time to get your "engine warmed up". The second "loss" is that intensity over time boosts your base metabolic rate for a long time.

You will lose comparable calories running 3 10 minute runs, but your boost to your basic metabolic rate is compromised. If you are doing this for weight management, then you will lose out. The way you can compensate for it is running harder or intervals. The risk with that is that are more prone to injury.

I'd suggest that you make an arrangement with your significant other to allow each other the time for training. 30 minutes from the day (4 or 5 times per week) is generally doable. My colleague is going through this now.

I wanted to clarify, boosting your basic metabolic rate is the biggest value to calorie burning and overall fitness. So, the longer run has a bigger boost.

With weight training, you have to approach muscle fatigue to really gain benefits. Larger muscles consume more energy at rest than less lean muscle or more fat. So, with weights, you have to at least approach muscle fatigue, but since you can isolate better you might be able to get away with shorter work outs.

Yeah before the house I was lifting but I don't anymore. Running for me is easy, it's just finding the time.

Doc, is there a thyroid condition that would be undetected by a conventional thyroid test? I'm convinced my friend has an issue with hers (as her metabolism is quite low, but she works out regularly, only takes in about 1500 cal/day and has somehow GAINED weight), but tests have come back negative, and I'm not convinced the tests are accurate.

Conventional thyroid testing is usually initiated as a screening test.

The screen is for thyroid stimulating hormone (TSH). Depending on the clinical symptoms, it can give indication as to whether the thyroid is over or under active.

If the TSH is very high and the patient is exhibiting symptoms of low thyroid function, it is often an issue with the gland itself under producing thyroid hormones. TSH production is dependent on circulating thyroid hormone levels and other bio-markers which serve as feedback (too little or too much thyroid).

If the TSH is very low and the patient is exhibiting symptoms of low thyroid hormone, then it is a secondary problem with the secretion of TSH. This is very uncommon.

If TSH is high and the patient has symtpoms of an over-active thyroid, then the problem is over production of TSH and is secondary (not with the gland itself) stimulation. It is also uncommon.

If the TSH is low and the symptoms suggest an overactive thyroid, then the problem is over production and a primary problem with the thyroid gland itself.

Having said all of this, TSH is still a screening but not a definitive exam for this. It is also important to note that certain types of thyroid conditions (lymphocytic or "subacute" or chronic thyroiditis) can often have normal screening exams despite symptoms of low thyroid hormone circulating levels.

The next step is to simply ask if she is having irregular periods but is usually regular (very personal question but medically relevant because thyroid hormone indirectly impacts this).

The next level of testing is to get a complete thyroid panel which includes free and bound thyroid levels (two hormones called T3 and T4). This is to get an accurate amount of hormonal levels. The "bound" thyroid is adjusted for but needs to be counted (even though it is has no metabolic impact) because the proteins that bind the thyroid hormone can increase in response to certain stresses.

Finally, you have to wonder if she is aware of her calorie count. Late night eating (or sleep-eating....yes, it exists) or just some psychological block may cause her to miscount calories. She may have temporary weight gain depending on the time of her menstrual cycle.

PS, calorie counts are based on nutritional needs and cannot be "one size fits all". Seth probably needs 2500-3000 for his size and more if he works out regularly. So, if she is 5'1" and is working out 30 minutes/3 times per week, then 1500 may be just about right for her.

It may be that she is simply overworked, over stressed and over eating (but unaware).

One other thing to keep in mind regarding this is to consider having her parathyroid hormone checked if her thyroid is normal and she is accurate about her calorie counts.

Thanks, Doc. I can tell you she eats somewhat regularly, maybe a snack from time to time but not downing a king size Twix, and she's very meticulous about counting how much she's eaten during the day. She's seeing a nutritionalist (no, not in THAT way) and she's following the plan as close as possible (but even if she goes over, it's below 2000).

I keep harping about the thyroid only because her sister has an issue with it, and hasn't gotten it checked (though she exhibits all the symptoms I've read, like weight gain and depression), and it's something that's been in her family.

Thanks for the info, Doc. Appreciate it much and it kind of confirms to me that it needs to be tested further.

Ur welcome. One other thing that might be worth mentioning is that "weight gain" could be from developing more lean muscle. It is common after the initial weight loss that people will stabilize or gain a pound or two during the lean muscle development phase.

Hopefully, it isn't something major and can be chalked up to burning the candle at both ends.

I've got one for you, Jules. Last night, I had pain on the right side of my chest. I figured I tweaked something lifting and I was uncomfortable, but no biggie.

This morning, I woke up and the pain was on the left side (no pain on the right). At some point in the last hour, the pain moved back to the right side (didn't really notice exactly when, but it's now all on the right side...none on the left). It feels like muscle pain to me, but my medical opinion is muscles don't move around your body.

I think I'm dying. Can you confirm?

"She's seeing a nutritionalist (no, not in THAT way)"



She's a friend, why would you care if it WAS in "THAT" way?

FD's got a chest-burster.

GGB - minor point of clarification, nothing more

Bass, a friend of my wife has a similar problem, but he's also unsure of the cause.

Bump for Jules...the wait time in the 700 Level Health Care System is absurd. Welcome to Obama's America.

Not sure, FD. What sort of work were you doing that you tweaked it? Where is the pain? Axilla? Shoulder? If shoulder, then where? Sharp or dull pain? Are you physically exerting yourself at the time of onset?

Migrating pain is odd and more difficult to pin down on a muscle related injury.

If you are 40 or older, you might need to make sure the ticker is not at risk. One other common problem that can cause vague symptoms is reflux.

However, if you had a sharp pain that is reproducible with certain motions or a mechanism of injury that would explain the pain itself....then I'd agree it is likely muscle pain.

You can monitor this over a few days and see if it is getting worse. If you don't have a known bleeding risk, then baby aspirin might not hurt either.

I don't think it is cardiac related. Despite the migration, it is still likely muscle related.

Oh, and one last odd thing......if you are constipated, you can experience strange pains. I saw more than a few patients with vague chest and shoulder pain cured by a good shit.

love the 'level triage.

Jules, what are your thoughts on the chiropractic field as a whole?

A couple of weekends ago I let someone cum in my mouth. A couple days later I got strep throat. Coincidence?

Is that an official question for Jules?

Yes

So should I assume that's why I had to remove Peyton Hillis from my fantasy line up at the last moment last Sunday?

Wild nite on the town for Mr. Hillis - Strep?

Super.

Glad I don't own Romo in any leagues....

1 2 3 4 5 6 7 8 9 10 11 12 13 14  15 16 17 18 19 20 21 22