Slightly tangential, but in Brave New World they trained future embryos to be rocket-plane engineers altering oxygen levels based on their vertical orientation.
> The first of a batch of two hundred and fifty embyronic rocket-place engineers was just passing the eleven hundred metre mark on Rack 3. A special mechanism kept their containers in constant rotation. "To improve their sense of balance," Mr. Foster explained. "Doing repairs on the outside of a rocket in mid-air is a ticklish job. We slacken off the circulation when they're right way up, so that they're half starved, and double the flow of surrogate when they're upside down. They learn to associate topsy-turvydom with well-being; in fact, they're only truly happy when they're standing on their heads."
Reading this article makes one appreciate just how much expertise doctors have. As soon as the doctor was presented with a few symptoms, he was able to begin running through a checklist of problems related to this specific issue and arrived relatively quickly at the solution.
Many doctors are able to routinely do this for dozens of ailments under intense pressure, making them even more impressive.
And unfortunately some doctors cannot make a proper diagnostic even after visiting them several times, and having a rather uncommon, but not rare, condition. First hand experience.
How can I rapidly ascertain (within the first minutes of meeting for the first time) if I'm talking to such a doctor, vs someone who's going to complacently sit around and pontificate about what's possible without actually actioning anything?
The pattern matching could easily be automated. It's basically a game of 21 questions. Doctors sometimes fail here by getting too fixated on prior probabilities ("this condition is very uncommon so you don't have it").
The expertise, and IME this is rare, is in turning vague descriptions into matchable patterns, prompting for more detail when needed, and explaining things at the appropriate level (which for some patients might be quite high, others quite low).
If you enjoyed this article, you might also enjoy The Man Who Mistook His Wife for a Hat and Other Clinical Tales by Oliver Sacks. It’s a book of essays about brain function and disorders, but each begins with an individual who exhibits particularly unusual symptoms. They don’t have tidy resolutions like this article, but the book is well-written and engaging—-as are the rest of Dr. Sack’s writings.
Just started reading this. It's really sucked me in, but it also fills me with a sort of biological dread. Something goes wrong with your brain-meat and suddenly you find yourself teleported 40 years into the future every time you look in the mirror, or become an unstuck, powerless spirit inside your own body.
> Or her blood pressure could be so low that blood reached the brain only when she was upside down. Blood pressure that low could have been triggered by an allergic reaction, anaphylactic shock, or severe dehydration.
So, if this is a generic thing about low blood-pressure, including—potentially—low blood-pressure from shock... then could inverting someone who's going into shock in the field (where an ambulance is not yet arrived), be neuroprotective—ensuring they keep some oxygenated blood near their blood-brain barrier to feed their brain, long enough to stave off brain damage until EMTs can arrive and get a saline+steroid IV into them? Would it work for all types of shock? Toxic shock, for example?
I know that in the case of the article, the cause turned out to be a malfunction of the pacemaker itself, but is the doctor's original line of thinking still valid?
Interesting point, as this is actually the topic of some debate.
The position you're referring to is known as the Trendelenburg Position. The benefits were thought to lie not so much with increasing perfusion to the brain, but bringing more blood back to the heart (known as preload), thereby increasing cardiac output and increasing blood flow to vital organs. If you're interested in this, there's some neat physiology called the Frank-Starling law [0].
However, it turns out that in practice, cardiac output doesn't actually improve. In fact, this position also increases the risk of fluid build up in the lungs (pulmonary oedema) and can worsen cerebral perfusion [1]. Therefore, it's falling out of favour in the context of shock. A compromise might be to elevate solely the legs, but its efficacy is also being questioned.
This illustrates a recurring theme in modern medicine; the human body & disease is so complex and poorly modelled, that it's often not possible to translate intuition or first principles of physiology into treatment. Instead, one relies on real world studies like those reviewed in [1] - AKA 'evidence-based medicine'.
This is why they have, no joke, inflatable pants [0] more commonly known as "Military Anti Shock Trousers(MAST)".
I am not a dr (IANAD?) but the idea is that you inflate the pants around a patient's legs which helps both push and keep blood out of the lower limbs and closer to the hear and brain. In principle, you could do the same by tying a tourniquet around each leg but the MASTs probably cause less tissue damage and are more adjustable.
At least the more mild version of raising their legs is definitely recommended for people in shock. Probably something as aggressive as completely flipping them upside down will depend on why they're in shock in the first place.
> Passive leg raise, also known as shock position, is a treatment for shock...
I can't be the only one that called it as soon as I read the word "pacemaker". Nice to see that the hospital still went through the troubleshooting flow chart though.
Do you have a background in cardiology? It may be more likely that the pacemaker would jump out to you as the cause because you're not familiar with the other possible causes.
I bet they used a micro usb cable. Sometimes those things can be so janky my phone won't charge unless you kinda fold them and rest the phone on it a certain way.
While reading this I thought it sounded familiar, and realized this is exactly what happens in the Grey's anatomy episode "Love Turns You Upside Down". Interesting that it was based on a real life situation, it seems like a lot of episodes are.
Going to the hospital must've been interesting. I wonder if she, in her mid-60s, was seated upside down in the car, or if the man carried her upside down through public transport.
I really miss the Discover Magazine medical diagnosis podcasts about stuff like this. I don't work in medicine at all but I loved the mystery/problem solving aspect - reminded me of being on call for platform services, without the human life aspect of course.
I sometimes remember then end of that episode when they drive to the coast, out of the blue for no reason. I mustn't have been very old when I saw it.
That one and the volcano one, and the hilbilly mother under the bed one.
I think there are definitely people who have a circadian rhythm that would compel them to move west due to feeling more “in-tune” with the west and continually chasing that feeling.
Non-American here, I can't be the only one to find the use of "coughing spell" (especially "spell") on a medical setting... Weird. Maybe it's my understanding of the English language and how I perceive that word.
See "(Entry 4 of 5)", the second noun definition of spell [1]. "an indeterminate period of time" or "a stretch of a specified type of weather" as in, "we've had a long dry spell; I hope it rains soon".
It does not sound particularly strange or unscientific to me.
They really make it hard to resist ad blockers. I cannot concentrate on the text with everything blinking and new ads loaded in constantly. Such a death spiral to try to compensate for low ad revenue by making sure to get extreme amounts of ad views from the few suckers that are exposed to them.
[+] [-] rickyplouis|5 years ago|reply
> The first of a batch of two hundred and fifty embyronic rocket-place engineers was just passing the eleven hundred metre mark on Rack 3. A special mechanism kept their containers in constant rotation. "To improve their sense of balance," Mr. Foster explained. "Doing repairs on the outside of a rocket in mid-air is a ticklish job. We slacken off the circulation when they're right way up, so that they're half starved, and double the flow of surrogate when they're upside down. They learn to associate topsy-turvydom with well-being; in fact, they're only truly happy when they're standing on their heads."
[+] [-] murican22|5 years ago|reply
Many doctors are able to routinely do this for dozens of ailments under intense pressure, making them even more impressive.
[+] [-] jerome-jh|5 years ago|reply
Well that's life.
[+] [-] exikyut|5 years ago|reply
[+] [-] wolco|5 years ago|reply
[+] [-] nitrogen|5 years ago|reply
The expertise, and IME this is rare, is in turning vague descriptions into matchable patterns, prompting for more detail when needed, and explaining things at the appropriate level (which for some patients might be quite high, others quite low).
[+] [-] jerryr|5 years ago|reply
[+] [-] archagon|5 years ago|reply
[+] [-] phyzome|5 years ago|reply
[+] [-] forgotmypw17|5 years ago|reply
[+] [-] saeranv|5 years ago|reply
[+] [-] fibbery|5 years ago|reply
[+] [-] derefr|5 years ago|reply
So, if this is a generic thing about low blood-pressure, including—potentially—low blood-pressure from shock... then could inverting someone who's going into shock in the field (where an ambulance is not yet arrived), be neuroprotective—ensuring they keep some oxygenated blood near their blood-brain barrier to feed their brain, long enough to stave off brain damage until EMTs can arrive and get a saline+steroid IV into them? Would it work for all types of shock? Toxic shock, for example?
I know that in the case of the article, the cause turned out to be a malfunction of the pacemaker itself, but is the doctor's original line of thinking still valid?
[+] [-] dahele|5 years ago|reply
The position you're referring to is known as the Trendelenburg Position. The benefits were thought to lie not so much with increasing perfusion to the brain, but bringing more blood back to the heart (known as preload), thereby increasing cardiac output and increasing blood flow to vital organs. If you're interested in this, there's some neat physiology called the Frank-Starling law [0].
However, it turns out that in practice, cardiac output doesn't actually improve. In fact, this position also increases the risk of fluid build up in the lungs (pulmonary oedema) and can worsen cerebral perfusion [1]. Therefore, it's falling out of favour in the context of shock. A compromise might be to elevate solely the legs, but its efficacy is also being questioned.
This illustrates a recurring theme in modern medicine; the human body & disease is so complex and poorly modelled, that it's often not possible to translate intuition or first principles of physiology into treatment. Instead, one relies on real world studies like those reviewed in [1] - AKA 'evidence-based medicine'.
[0] https://en.wikipedia.org/wiki/Frank%E2%80%93Starling_law
[1] https://www.cambridge.org/core/services/aop-cambridge-core/c...
[+] [-] alexpotato|5 years ago|reply
I am not a dr (IANAD?) but the idea is that you inflate the pants around a patient's legs which helps both push and keep blood out of the lower limbs and closer to the hear and brain. In principle, you could do the same by tying a tourniquet around each leg but the MASTs probably cause less tissue damage and are more adjustable.
[0] - https://en.wikipedia.org/wiki/Military_anti-shock_trousers
[+] [-] czinck|5 years ago|reply
> Passive leg raise, also known as shock position, is a treatment for shock...
https://en.wikipedia.org/wiki/Passive_leg_raise
[+] [-] mikestew|5 years ago|reply
"If the face is red, raise the head. If the face is pale, raise the tail."
[+] [-] unknown|5 years ago|reply
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[+] [-] throwaway0a5e|5 years ago|reply
[+] [-] JshWright|5 years ago|reply
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[+] [-] dijit27|5 years ago|reply
[+] [-] bobloblaw45|5 years ago|reply
[+] [-] kube-system|5 years ago|reply
[+] [-] MetaDark|5 years ago|reply
[+] [-] jolmg|5 years ago|reply
[+] [-] fred_is_fred|5 years ago|reply
[+] [-] FpUser|5 years ago|reply
[+] [-] RickJWagner|5 years ago|reply
Upside down
Boy, you turn me
Inside out
And round and round
[+] [-] extro|5 years ago|reply
What should we do with people like this?
[+] [-] brazzy|5 years ago|reply
[+] [-] stronglikedan|5 years ago|reply
[+] [-] NikolaeVarius|5 years ago|reply
At most, this should have prompted is "Well thats different"
[+] [-] black_puppydog|5 years ago|reply
[+] [-] thibran|5 years ago|reply
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[+] [-] centimeter|5 years ago|reply
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[+] [-] rodw|5 years ago|reply
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[+] [-] ashleyn|5 years ago|reply
[+] [-] totetsu|5 years ago|reply
[+] [-] dijit|5 years ago|reply
I think there are definitely people who have a circadian rhythm that would compel them to move west due to feeling more “in-tune” with the west and continually chasing that feeling.
[+] [-] IgorPartola|5 years ago|reply
[+] [-] pedrocx486|5 years ago|reply
[+] [-] pmahoney|5 years ago|reply
It does not sound particularly strange or unscientific to me.
[1] https://www.merriam-webster.com/dictionary/spell
[+] [-] mekkkkkk|5 years ago|reply
They really make it hard to resist ad blockers. I cannot concentrate on the text with everything blinking and new ads loaded in constantly. Such a death spiral to try to compensate for low ad revenue by making sure to get extreme amounts of ad views from the few suckers that are exposed to them.
[+] [-] citiguy|5 years ago|reply
[+] [-] fizixer|5 years ago|reply
Should we call such articles Harry-Potter journalism?
There's also related style of articles, very popular in NYTimes, that could safely be called Ulysses journalism.