Monthly Archives: June 2012

Three Cases (and Three Causes) of Rhabdomyolysis

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Rhabdomyolysis is one of those diseases, like acute alcohol withdrawal, that I have seen much more commonly in my jails than I ever did when I worked in the emergency department.

Rhabdomyolysis occurs when skeletal muscle cells die and rupture, releasing the protein myoglobin into the blood stream.  The kidneys attempt to clear the myoglobin,  however, if the concentration of myoglobin is too high, it will literally solidify inside the renal tubules, causing kidney failure.  This is considered bad! Continue reading →

Is This Inmate Gaming Me?

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Lanea runs the pharmacy at the Ada Co. Jail in Boise. Should I have her order in some oxybutynin?

I have seen several patients recently with an unusual complaint.

A typical presentation would be this:  a male in his early 30s and without medical history  complains of frequent urination: “I have to get up 10-12 times a night to pee.”  He reports no other symptoms, like dysuria or discharge or pain.  This reportedly has been going on for years, though he has never before sought medical attention for it.  He says it got worse once he arrived at his current jail around three months ago. Continue reading →

What is the Most Cost-Effective Treatment for Genital Warts? The Answer May Surprise You!

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Genital Warts. I’ll let you imagine where they might be located.

Aldo Torrente recently wrote, “Currently I have several patients with genital warts.  In my facility there are three alternatives: podophyline, verruca freeze, and trichloroacetic acid.
In all cases, the provider ONLY can apply the topical treatment.  What is the protocol to treat genital warts? What is the most effective method?”

Condylomata acuminata (genital warts) is,of course, a sexually transmitted disease caused by Human Papillomavirus (HPV). Continue reading →

Quiz Time! Name That Rash!

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A patient presents to your clinic with this rash on her arm.  She reports that it began three days ago and has steadily gotten worse.  Now, the rash is weeping and crusting a little bit.  It hurts and itches.

She has been in jail for around 6 weeks.  Her only other visits to the medical clinic in that time were for “Athlete’s Foot,” for which she was treated with anti-fungal cream, and depression for which she was prescribed citalopram.  She is on no other medications.

What is it? Continue reading →

Tips on How to Say “No!”

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One of the many things that make correctional medicine different from “outside” medicine is that we in correctional medicine have to say “No” a lot.  Doctors on the outside do not say “No” very often because they must keep their customers (I mean patients) happy or the patients will find themselves a new doctor.

Correctional medicine is very different.  Our patients are not our customers.  And we have to say “No” a lot in order to maintain the safety and security of our facility, in order to be fair, and so not to enable our patients’ addictions and maladaptive behavior. Continue reading →