Does Lightning Strike Twice?

My uncle in Sweden got hit by lightning twice. He is a stubborn farmer, who twice was a little too late getting his tractor and plow off the field in a flash thunderstorm.

Today I saw Gordon Grass, the man who had surgery for his subclavian steal that I had diagnosed recently. One of his symptoms had been dizziness and multiple falls. Gordon’s blood pressure is now equal in both arms and his brain doesn’t have to share its blood supply with his left arm anymore. But he is still dizzy and lately he has had this strange, irregular clicking in his right ear. It is definitely not his pulse. I had seen him for this a week ago and as his right eardrum looked dull and his Weber and Rinne tuning fork tests were equivocal, I prescribed a nasal steroid spray and told him that would probably clear up his symptoms.

Today he was back.

“I’ve been reading online about acoustic neuromas, and I have all the symptoms”, he said.

“Don’t you know you can only have one rare condition and you’ve already had yours”, I sad with feigned seriousness. He smiled faintly. I repeated his tuning fork tests and did a whispered voice discrimination test. His eardrum still didn’t look quite normal.

At that moment, there was a ruckus in the hallway. I excused myself and left Gordon’s room. Autumn and the receptionist were wheeling a man I’d never seen before, about my own age, down the hall in a wheelchair. He was moaning and writhing in obvious pain.

I instantly remembered Winfield Smith, a patient I had almost twenty years ago. He arrived the same way, writhing in the waiting room wheelchair, and he had an arterial embolism in his leg. We shipped him to Cityside via ambulance and he was soon on the operating table under the care of the same vascular surgeon, then new to our area, who had just taken care of Gordon Grass across the hall.

“It’s my leg, it’s a clot, just like seven years ago”, the stranger in the hall groaned.

“What happened?” I asked as we wheeled him into an empty exam room. His right shoe and sock were already off.

“I was walking to the store and this pain just grabbed me in the thigh”, he said.

“The sheriff dropped him off”, Autumn said. “He flagged the cruiser down.“

I knelt down in front of him, just like I had done when Mr. Smith rolled in the same way twenty years ago, and checked the skin temperature of his right foot. He winced at my light touch. His foot was a little dusky in color and his skin was slightly cool. I couldn’t feel any pulses.

“Let me just get my Doppler”, I said and got my little hand held device from my office.

Same result with the Doppler – no distal pulses.

“Let’s call the ambulance. I’ll alert the hospital” I began. A few minutes later the crew wheeled him down the hall to their rig and I returned to Gordon and his ticking ear.

I told Gordon that it wasn’t likely that he had an acoustic neuroma, partly because of his exam findings and also (I guessed) because the MRA’s he had before his vascular surgery probably would have picked up a tumor. I said I wanted to make a referral to Dr. Ritz, the wise old ENT specialist who bailed me out with my bacterial parotitis case a while back.

“This ticking is driving me crazy”, Gordon said.

“We sometimes prescribe low dose Valium for ear noises, because of how intolerable they can be”, I explained.

“I’ll have some then”, he quipped.

1 Response to “Does Lightning Strike Twice?”

  1. 1 meyati February 10, 2015 at 5:30 pm

    Non-medically-it can strike 3 times. A cowboy in Wilcox, AZ, had his horse killed while he was riding it. The other cowboys weren’t hurt. Another time his horse fell over, the horseshoes were knocked off and the hat brim fell down, around his neck. He rode double, and they led the horse back. The vet said the horse was OK, but they waited a few months before anybody rode it again. The next time the cowboy was knocked off his horse, and the saddle was split in half. After that if a storm, showed up, the cowboy tried to find a protected place, and he unsaddled his horse-tied it up , and the cowboy curled up with the saddle over him. He and his horse were never struck again.

    I doubt that I’ll have medical lightning strike me, I have the problem of several minor things coming together- and doctors thinking that lightning struck me. That’s no fun either. It’s sort of like when a friend, Ray W, was riding next to a sombrero shaped hill one morning-that was all by itself and there was some lightning.. He woke up to find himself hanging onto the saddle horn, and his horse was staggering. He was weak and confused. When it got dark, the horse remembered hay and grain-and staggered off to home. His wife got him in the truck- unsaddled the poor horse and fed it. She drove Ray to the hospital, where they said nothing was wrong. A few days later, he went out to the hill. There he found his burnt stetson, and almost a trench from the horse staggering around that hill for hour after hour. The new horseshoes were ground down. They waited a week- and changed the shoes. They also put on hoof dressings to treat the hooves.
    Vitamin B6 and B12 deficiency- not anemic at all–doctors- stoke, mini-strokes, brain cancer, Parkinson’s, etc., Lots of MRIs at different facilities- A neurologist finally did a B test-she explained that I wasn’t anemic-but it was the only thing left. Lab work in- go to Walmart and buy some B6 and B12- I became healthy-regained my balance, light quit hurting my eyes, I began remembering things-my classmates stopped taking notes for me when I fell asleep (I stood in class and leaned against the wall-these football players would stand with me and catch me if I fell asleep and kept me from falling).
    Anyway, I was on a horse that was doing its best to do its job and take care of me. I appreciate the fine doctors at the University of New Mexico Student Health Center. We staggered, but they carried me to safety.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.


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