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Pre-R | Mobile Urgent Care
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This is a free event. Dr. Slishman will be interviewing local pediatric neurologist Dr. Debra Balke.
Dr. Balke is one of the founders of the Central Coast Autism Spectrum Center and is both professionally and personally connected to the autism community. They will be exploring autism spectrum disorders, including some of the controversial issues facing this increasingly common diagnosis. Bring your questions!
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Slishman Rescue Harness built for big people, but way more fun with #CurlyMax!
Sold only by our friends at Rescue Essentials https://www.rescue-essentials.com/slishman-rescue-harness-…/
Is your Ergo rated to 400lbs? :)
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Summer is here, and with summer comes beautiful hikes and sometimes the dreaded poison oak!

We've received several calls from patients with poison oak related rash. Most want to tear their skin off. One even got pulled over by a police officer hoping to meet up with us for help. (Hopefully that doesn't violate HIPPA.)

People suffering allergic reactions in general are everything from mellow to miserable to moribund. But their treatment paths are fairly similar. Depending on urgency, we consider topicals, then orals, then IM or IV meds.

Rash and anaphylaxis lie on opposite ends of the allergy spectrum. My heart weeps for everyone who gets an ER bill for a simple local rash. Topical OTC hydrocortisone or Benadryl +/- oral Benadryl +/- prednisone (prescription) are cutting edge care, and quite easy to deliver even with telemedicine. When the allergy is more severe, a shot of Decadron or Depo Medrol can help immensely as well, so a house call will often suffice.

Find more info on allergic reaction red flags vs. happy words in our Anxiometer page: https://pre-r.com/anxiometer/
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If you don't have a primary care physician and you'd like to pursue an X-ray, CT, MRI, ultrasound or a digital mammography just give us a call. We can talk about the risks and benefits of various studies, and walk you through the process.

Selma Carlson Diagnostic Center is the local imaging center we use most, because they're super helpful and quick. Studies are interpreted by excellent radiologists and reports generated very quickly. You'll leave with a CD as well on request.

Once you have your results we're happy to talk with you about next steps and whether or not to seek specialist services. 

You can read a bit more about our services at https://pre-r.com/services/
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Sea Urchin Sting (Wana)

This week we have been covering for our friends in Kauai at PoipuMobileMD.com
Every practice setting has its specialty. For Poipu Mobile MD it appears to be "Wana" stings. Patients often arrive after surfing, or walking on shallow rocks. They generally describe a sudden stabbing pain, which ramps up far beyond what you may feel by stepping on a nail. Puncture by the spines causes one level of agony. But it's the venom from the spines and "pedicellaria" in between that crank the pain up to 11.
Patients call regularly with this problem. The most recent victim to call said it was the worst pain he'd ever experienced, and far worse than when he broke both bones in his lower leg. He said it was like a wave that took over his whole body, then he couldn't think straight and nearly passed out. (Naturally, all the mothers in the room rolled their eyes.)
The quick fix in this case was a bupivacaine digital block. That bought time for conversation and a little digging.
Read more at our Anxiometer page to know the red flags vs. happy words on this topic https://pre-r.com/anxiometer/
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Diarrhea
Another fun topic, but pretty relevant on the Central Coast these past few weeks.
Three experiences over the years have taught me more on this than any textbook. The first was back in high school when giardia found the community, and I lost about 15 pounds in 2 weeks. It was a "slow burn" as I was able to keep playing soccer, and even take a painfully long school bus trip to Long Island. I still remember every pothole. From the experience I discovered the miracle of metronidazole (Flagyl), and I can recall my renewed sense of hope after just 24 hours.
Lesson two was aboard a cruise ship heading from Valparaiso to Rio with 300+ afflicted passengers. I'd really never witnessed such an outbreak before. Happily, I dodged the bullet myself, and everyone lived to tell the tale.
Lesson three came last week when I finally got to experience a saline infusion. The Central Coast gastric typhoon first hit Vanessa, then me the following day. I was amazed by how fast dehydration set in, and how hard it was to pry my head off the floor. But what a difference that saline made.
Before leaving the safety and comfort of your own bowl to find an ER, know the buzzwords. Read more at our Anxiometer page to know the red flags vs. happy words on this topic https://pre-r.com/anxiometer/
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Whether or not the idea is revolutionary, I'm convinced that medicine is due for an internet based game changer. There is so much general discontent amongst caregivers and patients alike that it seems inevitable.

https://www.wsj.com/articles/high-tech-help-for-the-freelance-physician-1490393841
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Since mental health coverage seems headed the direction of women's health... and actual women in the Trumpcare room... I thought suicidality might be the right next Anxiometer post.
As for chest pain and belly pain, Pre-R shouldn't be tops on your list of resources to call if you're feeling suicidal. However, similarly, it's worth knowing your local resources and what to expect should you take your suicidal thoughts, or your distressed loved ones, to an emergency department.
Frankly, I've been avoiding this Anxiometer post because it's a sensitive topic. We all bring our own baggage, beliefs and histories. Perspectives on suicide itself are all over the map. My aunt with end stage MS killed herself in the early 90s. I can count three doctors who I've worked with who have also taken their lives. While shootings get plenty of press in the US, unfortunately, our suicide rates exceed homicide.
Check our Anxiometer post about Suicide to know what do to if you suspect a family or friend is feeling suicidal. https://pre-r.com/anxiometer/
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