Medical Axioms from Dr Pete Schaiberger

Schaibergerisms – from Dr Pete Schaiberger, internist in Rifle, CO, and medical teacher extraordinaire!

-“It’s the thin, middle-aged women alcoholics who die of liver disease.”

– Don’t trust computers, calculate your own QTc (QT/sq root of RR).

– Wilson’s disease:  “Usually it’s a 28-year old with liver disease who’s crazy.”
– “Scottish folks have two settings:  I’m pissed, and let’s kill the bastard.”
– “She’ll see me and recognize me, and she’ll know where we’re headed…” (re: a difficult frequent flyer)
– “The inpatient stay is the perfect opportunity to work up everything.”
– “Don’t check a troponin I until 7 days post-op in high-risk surgical patients (CAD hx) – but I don’t believe that.  In my practice, I’m going to keep checking one 2 days post-op then may repeat it.”
– In an anticoagulated patient with diverticular bleeding bad enough to need a transfusion, strongly consider hemicolectomy on the first bleed.  The second one may be the last.
– “Be afraid of the mitral valve mechanical prostheses.  It’s a low flow state and can throw clots, and anticoagulation must have bridging heparin if you’re starting warfarin.”
– Acute decompensation after cardiac instrumentation, think cardiac tamponade.
– What can falsely normalize a sed rate?  Multiple myeloma will normalize the ESR.
– “I don’t know if they’d ever sew an eye shut.  That would seem weird.”
– Preop transfusion increases risk of infection and poor outcome.
– Transfused RBCs contain EDTA and depleted 2,3-DPG, so it avidly hangs on to O2 and may not release on the microvascular level, increasing risk of poor perioperative outcomes.
– Have a very high threshold for ordering an ANA in anyone – it’s a last-choice, confirmatory test when you already suspect SLE based on other criteria (anemia, rash, joint pain, etc.).
– (for a patient on LMWH) “Want to pull the trigger and order a HIT on him?”
–  Cryptococcus is the #1 cause of chronic meningitis, followed by syphilis and histoplasmosis.
–  Copper deficiency can cause parkinsonian symptoms.
–  DDx Parkinson dz:  progressive supranuclear palsy, prion disease (Creuzfeldt-Jakob), copper deficiency.
–  “How would I describe this patient if I was writing for the New England Journal?” – regarding how to do an organized, concise presentation.
–  Iron deficiency can cause thrombocythemia (500-600K)
–  Can use non-acetylated salicylates (sal for antiinflammatory purposes in patients on anticoagulation – for example, for pleurisy.
– Propranolol inhibits the conversion of T4 to T3 in treating Graves disease, as well as providing cardiac rate control.
– Ceftriaxone can cause hepatitis, especially in high doses.
– If a patient has stridor, don’t stick anything in their throat unless you’re in the ED or OR.
– Alkalosis will cause hypocalcemia by causing mobilization of negatively charged albumin, which binds up serum calcium.  This leads to Chvostek’s and Trousseau’s sign.
– The highest LDH you’ll see is in lymphoma and in B12 deficiency.
– Procalcitonin behaves as an acute phase reactant, so not very useful for infection in the post-operative setting.
– Alk phos has to be measured fasting in white women with blood type O.
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