As I walked in tonight, I talked to the charge nurse, as usual, to see what the flow of the unit had been like until I got there. She told me that we were full, which hasn’t been uncommon as of late. With our unit, a good number of homeless guys present to the ER in cold weather with issues that they hope will get them admitted. Honestly, many claim they have the desire to harm themselves as a means of admission. We typically admit them if we have space, which is sad sometimes as their need is not something they should be in the hospital for. I will say, I do not have an issue with this, but it is a sad state of affairs that we have a high number of homelessness. Anyhow, back to the fun.

My night started with a call for a patient with a cold who “wanted something more for it.” This ought to be good I thought. He was already getting a pretty good non-narcotic cough medicine (Dextromethorphan and guaifenesin), which is really pretty good for symptom treatment for anyone. It is over the counter and should be taken as directed on the bottle. If you do this, it should help the cough as well as clear congestion. We encouraged more fluids of course and advised him to rest as much as possible. He insisted on some Sudafed. Ok, not a fan of this, however, there are some advantages to Sudafed. The first is that it does a lovely job of drying out mucous membranes and clearing snot out of the nose and sinuses. It works great unless you have a history of abusing amphetamines. So, this was out for him. Also, a sad statement when so many folks are limited due to addiction. We offered him a nasal steroid. With a cold, you just treat symptoms. There is no cure of course, and really nothing has been empirically proven to shorten a cold. Of course, in the middle of one that is not what you want to hear.

I also had a call for insomnia. These are fun since you really look at what the patient is already taking for interactions. These often become a matter of patient preference. The patient knew what they wanted, and I had no objections. Honestly, she can’t get too crazy with what we give since we banned the Ambien walrus from our unit. Thankfully, she slept through the night, so that was successful.

Next was a call to look at hemorrhoids at 2 am. The patient was concerned with the amount of bright red blood he saw when he wiped. Well, he should have been. He has the worst case of multiple hemorrhoids I have ever seen. I won’t get into details; however, I will talk a second about how to keep those things in check. First off, my old favorite, plenty of fluids and plenty of fiber. If you have that working for you, it helps regulate the colon and keeps things flowing. You really should avoid laxatives or things like Imodium, like I spoke about in an earlier post. These speed up or slow the gut unnaturally and yeah, the yo-yo effect. Fiber works both ways. It bulks up stool in diarrhea, and it can help move it in constipation. In either situation, if you are straining or going to frequently, you run the chance of irritating your anus. If you strain, some of the small blood vessels around the anus can bulge. It’s like a varicose vein on your butt. If you still end up with them, look above and make those adjustments. Also, try doing a sitz bath in warm water. This means sitting in a bucket or tub with warm water to help ease the swelling. You can also use creams such as 2.5% cortisone cream or Phenylephrine (Preparation H). These can help, but hydrocortisone should be used sparingly as cortisone can thin the skin. Bottom line (ha, bottom), take care of things downstairs. If you don’t, things can go south quick (I slay me sometimes).

Thankfully, it was calm for a bit, and then there was a fall. Even though he was not injured, I had to look at him to make sure he was fine. He was, and he was cranky, but they all can be.

Well, the roads were treacherous this morning. Now to spend the day with the hounds and my warm coffin. The bats can fend for themselves today.