Emergency Minute - Hilarious Medical Things

Ever hear of High Altitude Flatus Expulsion, AKA HAFE or farting due to altitude and pressure changes? Have you ever heard that urinating on someone is the treatment for some marine bites and poisons? What are some of the strange or even humorous things that can happen to us?  Join me for a light-hearted discussion as we dive into some of these diagnoses and treatments. 

Transcript

Welcome back everyone, how are y’all feeling? Thanks for joining us this week for another episode of Emergency Minute. This week is Episode 10 – Hilarious Medical Things. Before we get started, I wanted to thank each one of you for listening, commenting, sharing, and reviewing. It really makes a difference in helping me launch this show and I couldn’t do it without effort from each of you. And if you haven’t left me a review on Apple or Spotify, or even my professional Facebook page yet, I need you to do me a favor and stand up, walk over to a mirror in your house or even in your car if you’re listening, you can look in the rearview mirror. Now say slowly, I’m a bad friend, I’m a bad person. Then come back and resume listening. If you haven’t checked out Episode 9, Medical Necessities when Traveling, you might want to give it a listen or you may get traveler’s diarrhea. Those who don’t follow me on social media yet, I do make some medical humor videos and some other useful educational content so be sure to check them out on TikTok, Instagram, Facebook, and YouTube at Drjparente.  

Let’s start this podcast with a bang, literally. High Altitude Flatus Expulsion, aka HAFE. HAFE is when you are at a higher altitude and you have flatus, or pass gas, aka fart, with increased frequency to due to the pressure changes. Yes, this is a real thing. This was discovered by physicians who were mountain climbing in 1980 and noticed the odor as they were climbing, then noticed they were farting a ton, as well. Once they figured out this was related to increased altitude, they had quite the laugh as they could almost fart on command. This is reminiscent of the 2nd greatest movie of all time: Christmas Vacation. Where Aunt Bethany says “Did I break wind?” to which Uncle Lewis replies “Jesus, did the room clear out?” Meanwhile, back to our climbers…

They thought about different names to call this, as they needed to give it a term as nothing in medicine can exist without a name. One of the names they considered was Rocky Mountain Barking Spiders! Absolutely hilarious, and apparently a cousin to Rocky Mountain Spotted Fever. Instead, they figured to be taken seriously, they’d need a more professional sounding name. So they piggy-backed off the other altitude diagnoses, HAPE and HACE, which stand for high altitude pulmonary edema and high altitude cerebral edema, which are bad things that can happen to climbers at altitude with fluid on the lungs, or in severe cases in the brain. Hence, HAFE. 

Now, if you’ve ever been on an airplane, then you have experienced HAFE, as well. Airplanes are pressurized, so it’s not nearly as severe as if you were truly at that altitude. Another term often used is “bubble guts” which means something else but is a moniker that can be used for any number of gastrointestinal sounds and sensations. 

A terrific quote from the physicians who discovered this, Dr.’s Arnold and Auerbach “I don’t know why people are ashamed of it. It’s a natural process, and at altitude it’s enhanced.” Then he added “you shouldn’t put your hind end into a campfire, because back flashes are a real phenomenon. I’ve never heard of anybody exploding because of that, but people have been singed where they don’t want to be.”

What’s next? How about neuropraxia? What is neuropraxia? A neurologic condition where a part of your body stops working. For the sake of this podcast, which is titled hilarious things that can happen to your body, I will focus on temporary causes of neuropraxia that some may find humorous. Obviously, there are more dangerous and permanent forms of this, too, and there is nothing humorous about that. So in order to avoid offending everyone, I just wanted to state that in advance in the soft society we are currently living in. Moving on. 

 So if there is an injury or undo pressure applied to the peroneal nerve, aka the nerve that runs just lateral and outside of your knee, your foot will drop, meaning, you cannot flex your foot up. I had a patient once who was sitting Indian style with her legs crossed for an extended period of time and must have had enough pressure on the common peroneal nerve that it caused her to have foot drop. Apparently, Google tells me we cannot say Indian style anymore, despite the fact that it was named for the characteristic sitting style of Native Americans? So we are now calling this criss-cross applesauce. Sigh. 

 For these patients, we typically have them take anti-inflammatories or sometimes even steroids, ice and stretch the area, and refer them to neurology. Most times this is self-limited which means it just goes away after a few days on its own. In cases where it does not, patients will need additional testing such as an EMG (electromyelography) which is a painful test that tests each of the nerve’s ability, so to speak, in the affected extremity. 

 Another example of this would be wrist drop which is from radial nerve palsy. I once had a patient that was on a long drive and had his arm out the window for a lengthy time period. He must have put just the right pressure on that nerve causing an injury that lead to the wrist drop. Not to be confused with lead poisoning which can also cause this. So don’t eat lead paint, kids. That’s just good life advice. 

 How about Scombroid poisoning? This is a massive histamine reaction due to improperly stored or handled fish. Histamine is heat stabile, which means even if you properly cook that piece of fish, you could still get the poisoning.  Typically you see this with Tuna and Mackerel but can also see it with Anchovies and Sardines. How does this present? Well this is an extremely intense histamine reaction. Where else do we see histamine reactions? Allergic reactions; however, the important distinction is that Scombroid poisoning is just that, a poisoning, it is not an allergic reaction. 

 So this massive rush of histamine causes rashes all over like urticaria or hives, flushing, nausea and vomiting, sweating, diarrhea, dizziness, and headaches, and can impact your lungs with spasm and wheezing, can even lead to respiratory distress and shock. This will usually occur within 10-90 minutes after the ingestion and is usually out of your system within several hours but can last as long as 1-2 days. 

 What makes this diagnosis so difficult is that the fish will taste and smell the same. Also, it looks almost exactly like an allergic reaction. So, people will often think they have a seafood allergy. The treatment is antihistamines such as Benadryl and Pepcid. If it gets severe enough, you may need steroids and if it becomes life-threatening, which is rare, epinephrine aka adrenaline may be needed. But the majority of these cases are self-limited, which means they just go away. 

 Now contrast this with a different type of poisoning that is even more interesting and one of my favorite syndromes: Ciguatera toxicity. I’ve only diagnosed this once in my career, and I’m pretty sure the nurses thought I was some type of diagnostic genius after that case.  CFP or Ciguatera Fish Poisoning comes from a naturally occurring toxin sometimes found in reef fish, usually in tropical climates. 

It can have a myriad of presentations from GI to cardiac to neuro. The most famous symptom is the reversal of hot vs. cold sensations. Correct, you pick up something hot and it feels cold, and vice versa, you pick up something cold and it feels hot. It can also cause numbness and what’s called paresthesia. 

Most of these cases are self-limited and go away on their own within a few days. Much to my surprise, this is a reportable disease, which I learned today haha. In fact, most physicians don’t even know this is a reportable disease, according to one study. Usually this is found in tropical or subtropical places. In some areas where this is common, especially amongst the locals, they don’t even seek out treatment because they know exactly what this is, so most of the estimates about frequency and prevalence are likely inaccurate. 

However, from the data we do have, this is not that common in places like the Caribbean, Florida, Hawaii, etc., but is much more common in places like the Marshall Islands and French Polynesia. 

Let’s stick with seafood and marine life. Another hilarious thing that can happen in medicine, although probably not that hilarious to the person it happens to, are heat labile toxins. So, what does this mean? Well, there are certain stings that can occur in saltwater that will hurt…a lot, due to a toxin. Many of these are heat labile, which means the heat will deactivate the toxin and eliminate the pain. 

So if you see someone on the beach with their foot in a bucket, assume it’s full of hot water to eliminate the pain. That’s correct, if you have one of these toxins, and submerge your affected body part (most commonly your foot/ankle) in hot water, it will cause the pain to go from 10/10 to nearly 0/10. 

What are some examples? Sea urchins, lionfish, scorpion fish, stone fish and stingrays all have heat labile toxins and they do recommend treatment with HWI or hot water immersion for about 30 minutes in 45-degree Celsius water, which is about 113 degrees Fahrenheit. Keep in mind your average hot tub is around 100 and the max recommended temperature is 104. So this water is really hot. 

This has been proven in the studies to be superior to applying ice or ice packs to the area immediately after the injury, so it does work. Also, don’t forget your tetanus shot and your antibiotics as puncture wounds can get nasty, and foot infections can get nasty, too. Put the 2 together and it can be a recipe for disaster. 

Side note, and perhaps I should do another medical myth’s podcast. Upcoming selfish plug alert… If you haven’t already, check out Episode 8 Medical Myths that just won’t die. Sea water will wash the wound and make it nice and clean. The salt will kill any of the bacteria and “wash out the wound.” Errrr. Wrong. Incorrect. Saltwater can have some nasty organisms, as well. Most common organism for my medical students and residents out there? That’s correct, Vibrio, treated by Doxycycline. 

Speaking of medical students and residents, has anyone heard that peeing on a jellyfish sting is the appropriate treatment? I’m sure you’ve seen that hilarious Friend’s episode where Monica gets stung by jellyfish and tries to pee on herself, can’t, asks Joey to step up, he gets stage fright, and ultimately it is Chandler that pees on her to “treat her.” To which Monica responds that he will always be the guy that peed on her. I digress. The reality is that peeing on someone has never been proven to be of any benefit. Now, is that because it would be awfully difficult to get individuals to sign up for that study!? Can you imagine? 

Ok, looking for some broke ass medical students. Ok, just lineup over there. We are going to give you each $50. After that, you’re going to put your leg in bucket full of jellyfish. After the inevitable stinging that takes place, you’re going to take your leg out and hospital administrators have graciously volunteered to urinate on you to see if it subjectively helps your pain. Ok, any questions? Haha. Could you imagine in this day in age when people get offended by every little thing the outrage with this study!? I digress. 

There are far better options to treat jellyfish stings than urinating on someone. The first thing to do is to remove the tentacles and you need to do this carefully. If you grab the tentacles, you will get stung, as well. Even if you have gloves on, grabbing them is still not a good idea as you will incidentally squeeze more of the nematocysts toxins into the wound even with just gentle pressure. So the best thing to do is to grab a credit card and scrape along the wound cutting off the tentacles at the skin without pumping more toxin into the wound. 

Then, pour some vinegar on the wounds to help neutralize the toxins somewhat. Finally, use the HWI (hot water immersion) discussed previously to help with the heat labile toxins from the injury. The vast majority of these will not require antibiotics. You may need some topical hydrocortisone cream or antihistamines for itching and inflammation. There are some more lethal forms of jellyfish stings that require an anti-venom but those are pretty rare and usually regionally specific. 

Well, that’s all I’ve got this week, so thank you for joining me for this week’s episode of Emergency Minute. If you like what you’ve been listening to please consider sharing this show with someone you know. And if I have offended you at all, please consider leaving me a nasty review. You can follow me on any social media platform at Drjparente. And as always, peace, love and happiness to everyone out there. Cheers guys!