January 26, 2020
SHOCKING Patient Story | It Started With Foot Pain…

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. Please help me. I’m 30 years old and I’m dying. My doctor found out through a biopsy done of my nerve that I have both wallerian and axonal degeneration. None of my specialists can figure out why my nerves are deteriorating. I need fresh knowledgeable eyes. Please help me 🙏🏻

  2. Lol I use closed captioning but at the beginning when it normally says “pee-whoop!” It said “(whooping)”. I am confusion

  3. Dr Mike: I can find your underlying medical condition. Btw, tea and honey for colds.

    Also Mike: Doesn’t understand how honey is made.

    Dr Mike, the bees have a mini kitchen in their hives, with cute little pots and utensils and everything.

  4. Awesome video as always. Could you talk about white coat syndrome one day, if you haven’t already? I hate that I’m always too nervous around medical personnel to properly emphasize how much help I need. Thanks!

  5. This story is similar to my grandpa's story. He went to the doctor for a normal checkup and my grandma made him tell the Doc that he's been short of breath when doing small types of exercise (gardening, etc.). Looked at his lungs/hearts and decided to get an EKG, and it was abnormal. Turns out his heart was 90% blocked and had to get by pass surgery! (He's all good now!). Tell your doctor everything!

  6. Hi, Dr Mike, I truly enjoy watching all of your programs here in YouTube. Thanks for sharing. Warm regards from Malaysia.😊

  7. When I was 23 I went to my GP for flu-like symptoms. I really thought I was feeling horrible from a bacterial or viral infection of some sort. I was vomiting, weak, fatigued. After being referred to three diff floors to have multiple tests done I ended up in surgery that same day to remove my appendix!

  8. Wait!!

    What happened to the guys foot?!?! (Seriously, I'm glad he's ok, but now I wanna know about the foot!) 🤣

  9. Have you ever made a mistake and it cost someone their life? I would love to hear that story if you have one and how you dealt with their passing and how it made you a better doctor.

  10. Hey I have hoshimotos and my thyroid is inflamed, so it's pressing against my esophagus. I've been choking on things, but I'm not aspirating on them. Should I make an appointment with my doctor or wait until my next one in February?

  11. I think this video is very important for other doctors to see and understand. A year ago I went in for symptoms like appendicitis and I went to the clinic which they ended up telling me it was just a cyst and it should go away. Similar pain in the right side quite often for a year every once in awhile. Fast forward to last week and I couldn’t even sit straight my right side hurt so bad. Appendicitis? No. They diagnosed me with “gas” and sent me home and after a week I’m still in pain. I’m sure there is something more going on but they always only focus on a given area and could be missing something entirely different.

  12. I have been told for years that my palpitations are anxiety related. I agree they could be.. however my mother has A PHIB and my older sister has tachycardia now. I've been checking my pulse every day and on days where I have a cold or just don't feel good my pulse is 120 at rest. At the h9ghest it's been 130. I tell myself hey you're fine and I am calm before it happens. It really.. can't be anxiety when all the sudden my face flushes and it feels like I'm sitting far too close to a campfire and my hearts starts to pound like crazy.. it throws me into a physical panic attack where I can't move my hands they lock up and my body goes numb.

  13. Has a patients family member ever had a problem with an autopsy being done on the patient?

    Has anyone without health insurance had someone with health insurance fill out their hospital for?
    The episode of Friends where Monica fills out Rachel’s hospital form.

    Carols second act has an episode about a patient called a Zebra. Is Zebra a real medical term for a patient?

    Person: My foot hurts
    Movie My Big Fat Greek Wedding: use windex
    Person: I’m not going to be cleaning windows
    Movie: it’s not for cleaning windows it’s for your foot

    What are some Weird things patients have used for cures?

  14. I felt my heart beating out of my chest for over 2 months when i was going to school and met an emotionally abusive girl i sadly fell for.

  15. Living in the uk if i went in to my GP with a red foot, he'd look at it and say "yep your foots red, try not to walk on it too much" and send me home. I know… because that LITERALLY happened to me 2 months ago.

  16. welcome to another episode…"OF!".. the wednesday checkup……
    Could i "BE!" wearing any more clothes!
    okay there chandler hahahah

  17. yooooooo am a first year med student and we literally just learnt ECGs last week and all the heart stuff and its so cool hearing it from an actual clinical perspective!!!

  18. Hey Doc Mike, I have an unusual story for you.
    Starting off – I have a heart murmur, and have been going to a cardiologist since I was in middle school.
    I also have been playing the Nintendo DS since it first came out. Not sure where I'm going here?
    That's where the "unusual" bit comes in… ANYWAY
    I go in for my yearly and they check my bp, it was good. Then they had me remove my shirt and bra so they could do the Electrocardiogram. It had been a usual thing, and at that time had always had good results.
    This time around I had my DS on and was playing a game on it. I had brought it in before, but had always turned it off so the battery wouldn't drain out. This time it had a full charge so I thought what the heck I'll keep playing it.
    They did the EKG and sent it to the doctor to review. He came in and explained that they'd gotten unusual results so they were going to do it again. They did it again, same thing. "Unusual Results"
    So I said "you think maybe it's my gameboy?" The doctor said "oh no It's not that" and waved me off.
    The doctor left me alone, the nurse takes the sticky connectors off
    (the things they stick on your skin that the wires get clipped onto) and I get redressed.
    He comes back in and asks to see my gameboy ds. I'm confused but curious so I say yes and he leaves with it
    He didn't explain but I guessed he was gonna test another patient who was also having an EKG done and see if the results would be different. I guess they were cuz he came back in smiling. He gave me back my gameboy and I asked about my earlier comment about the strange results from before being caused by my gameboy.
    He showed me two printouts from the EKG one from one of my earlier visits and the one from this time.
    I couldn't read them but he explained that the lines were supposed to look something similar to the way they did before but they didn't, and he showed me the paper from the other person and it looked strange too.
    You can try to research this yourself if you want, but best way I can explain all this is that the waves from my gameboy somehow interfered with the Electrocardiogram machine making the results come out wrong!
    Sorry for the rant but I'd like to hear what you think about this, so i gave you all the context I could remember.
    Wackiest cardiologist visits I've ever had. Suffice to say I don't bring my gameboy ds in there anymore.

  19. Came in with nausea and a high temperature to my small town family doc at five years old, just over 20 years ago. I also had bad joint pain but as a child it's difficult to verbalise this to adults, especially since it was 2am and me crouching bent over and limping could have been seen as hey she's sick and exhausted – but my mom luckily called in since she was a first time mom at the time and didn't like my temperature.

    Working off this he began to suspect meningitis, not sure of the details how and my mother can't exactly remember since it was a panicky time. Back then the main meningitis sign was advertised as the rash, which I hadn't developed yet, so my mother hadn't even thought of this. He gave me a large shot before even being too certain deciding it was better to try to stop it in it's tracks as it took an hour to drive to the E.R and by then it could have spread and been a lot worse. Doctors maintained through my 2 week stay that that shot saved my life, or at the very least my limbs. So thankful for Dr. Feore!!!

  20. Ever since I start smoking (I'm trying to stop) there's a pain in my foot. No redness. My parents don't
    have medical aid and the state hospital doesn't help at all
    My dad lost his job so there ain't no money to see a doctor

  21. I actually found out Dr. Mike is a D.O after hearing him mention in one of his other videos that he performs osteopathic manipulation. I was surprised as most people with medical ambitions go for an M.D, which is considered slightly better (within both the medical and ordinary society of people?) and more advantageous in terms of income (in the context of healthcare profession salaries) as they tend to practice in urban areas with a large population of people, whereas most D.Os are presumed to practice in mainly rural areas. Upon my limited research in the past, D.Os have a more holistic perspective on treating the body; rather than focusing on specifically one area, they consider the complexity and the relations of that area to the rest of the body, something I think that all doctors have a responsibility to do. Unfortunately, often times, when your doctor is an M.D, they'll just focus on that one specific area and provide prescriptions and shots and call it a day. Upon my own experience with such narrow minded ways of treatment and their impact on my family, I respect Dr. Mike even more for being a more dynamic, insightful, and welcoming doctor who genuinely cares and works for improving the ordinary person's health, something I feel that is lacking in most doctors and the healthcare system in general nowadays.

  22. Legit though Dr.Mike. I live in Sweden, I get healthcare for basically free. BUT if I could buy a medical service from someone like you I would pay good money for it.

  23. When I was 11 I had a heart rate of 125 and the doctors were just saying things like hey your heart is beating quickly and they shrugged it off. Is anything going to affect me in the long term? Can anyone answers with any ideas of what it could be.

  24. The argument that there's a person sitting there is very important. I actually got a referral for an ADHD diagnosis after coming in for a rash.

  25. my resting pulse is ALWAYS 55-58 bpm because im tall and sporty and it freaks the nurse out everytime until they ask how much sport i do. lol

  26. 7:46 "Many" is a relative term.
    8:42 Would people notice?
    9:03 Oh, Rikki! 🙂
    In case you're wondering, that would be RIkki Poynter who was the first person from whom I heard about the need to caption your YouTube videos.

  27. Patient: my foot hurts. Doctor: let's do an EKG. Patient: what is it doc? Doc: we need to call 911! They could have died! Saved patient's life: Aw, shucks it was nothing.

  28. I wish more doctors will think like this because about 7 years ago I went to 2 different Dr and both said I only have the Flu and I just got worse then I went to a 3rd one and he actually did some tests and found out I have swine flu

  29. I've never seen anyone so excited about opening mail from random people. It's extremely cute, and I'll gonna go have a heart attack in the corner. Don't worry.

  30. 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.

  31. 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.

  32. 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

  33. 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.)

  34. 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 😊

  35. 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 🐝

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