#Neuro and Spine Clinic

[neurospecialist]

5 Tips for Back pain relief

Low back pain is a very common complaint in adults and old aged people. Due to predominance of jobs requiring prolonged sitting, unhealthy dietary habits, improper posture, poor bone healthy, lack of physical activities and smoking, the incidence of low backache has increased significantly. It is one of the major causes for absence from work.

Low back ache generally improves with rest and medication over a period of days to week. But if it doesn't improve for weeks, it is a matter of concern and it requires evaluation by experts.

Dr Boorgula Meher Thej, is a Consultant Neurosurgeon, Specialist in Brain and Spine, he was trained at the prestigious All India Institute of Medical sciences, New Delhi. He has a fellowship in Minimally Invasive Spine surgery. He has an experience of 4 years as a Consultant Neurosurgeon. He is presently working as an Assistant Professor Neurosurgery at MNR Medical College and Hospital, Sangareddy District, Telangana. #Neurosurgery.with.Boorgula #BestNeuroDoctorSangareddy #BestSpinespecialistinSangareddy

What are Warning signs for back pain?

Low back pain is generally mild and resolves in few days to weeks but there are few warning signs which point towards a serious problem.

Persistent pain: Back pain which doesn't improve after treatment even after several weeks of treatment points towards some serious causes.

Shooting pain: Back pain which shoots to other parts of the body like legs, soles, forwards points towards nerve compression.

Associated with inability to control urine or pass urine.

Associated with weakness- inability to move your foot or legs.

Associated with tingling sensation or numbness in your limbs

Fever, weight loss, pain which doesn't improve with rest point towards grave issues.

History of cancer

History of TB

History of trauma

If you have one or more of these warning signs, a a Neurosurgery consultation is required.

What structures of the spine are involved in causing pain?

The pain in the back may be caused by

Muscular pain: This is the most common cause of back pain, caused by improper sleeping, improper weight lifting, improper posture, high velocity sports. This requires medication and few days of rest.

Discogenic pain: when there is an extrusion of the disc it causes pain. Low grade disc herniations require rest followed by physiotherapy.

Neurogenic pain: This happens when there is nerve impingement due to disc extrusion or narrowing of foramen, there is sharp shooting pain which radiates to one or both legs.

What activities are good for spine?

Less intense aerobic exercises like walking, Jogging help in reducing the body weight.

Strength training improves the bone health and improves spine health. But care must be taken to ensure appropriate posture while lifting as wrong posture can lead to injuries.

Swimming is considered ideal exercise for spine.

Incase of old-age or in degenerative diseases of spine, back strengthening exercises are sufficient, these include

Ankle toe movements

Stretching at all joints

Cat - Cow exercises

Pelvic bridges

Single leg bridges

Spine extension exercises

Glutes Isometrics

Superman position

Side plank

How to prevent Back Pain

Regular exercise : Regular aerobic exercise is associated with less incidence of Low back pain. Sedentary lifestyle, with prolonged sitting is linked to higher incidence of low back pain.

Posture: A good posture maintenance, while sitting, and during all activities ensures healthy spine.

Healthy diet: A good diet rich in vitamins, minerals, esp. calcium, Vit-D is essential for bone healthy and spine health.

Avoiding smoking: Smoking is linked to worsening of spine health and accelerated degeneration of the spine.

Body weight: Higher body weight, with higher BMI is a very serious risk factor for degeneration of spine

[vencerhospital]

Nerve Block

Neural blockades are also known as nerve blocks. These are a type of Nerve Block therapy. This can help prevent or alleviate a wide range of pain. For your comfort, we at Vencer Hospital give each patient sedative medication prior to the Nerve Block treatment. Before allowing someone to enter the operating room, it is customary to make sure the block is functional.

[sureshblogs]

Swastik Ayurveda: Transforming Healthcare in Hydernagar with Comprehensive Ayurvedic Solutions

Introduction:

Nestled in the heart of Hydernagar, Swastik Ayurveda stands as a beacon of traditional wellness amidst the urban landscape. Offering a wide array of Ayurvedic treatments, therapies, and consultations, Swastik Ayurveda caters to diverse healthcare needs, ranging from neurological issues to joint disorders. In this article, we explore the extensive range of services provided by Swastik Ayurveda, establishing it as a premier destination for holistic healing in Hydernagar.

Ayurvedic Treatment in Hydernagar:

For residents seeking authentic Ayurvedic treatment in Hydernagar, Swastik Ayurveda serves as a trusted partner in health and wellness. With a focus on personalized care and holistic healing, the clinic offers tailored treatment plans for various ailments, ensuring optimal outcomes for every patient.

Ayurvedic Hospital, Clinic, and Therapy Center:

As a leading Ayurvedic hospital and clinic in Hydernagar, Swastik Ayurveda provides a comprehensive range of services under one roof. From diagnostic assessments to therapeutic interventions, the clinic's state-of-the-art facilities and skilled healthcare professionals ensure a seamless healthcare experience for every visitor.

Expertise in Neurological and Spinal Disorders:

Neurological and spinal problems can significantly impact one's quality of life. At Swastik Ayurveda, specialized neuro clinics and spine clinics offer advanced Ayurvedic solutions for such conditions. The clinic's team of experts employs a combination of herbal treatments, therapies, and lifestyle modifications to address neuro and spine-related issues effectively.

The Best Ayurvedic Doctors:

Swastik Ayurveda prides itself on housing some of the best Ayurvedic doctors in Hydernagar. With their unparalleled expertise and compassionate care, these doctors guide patients towards optimal health and well-being. Their commitment to excellence ensures that every patient receives the highest standard of care and attention.

Herbal Treatments and Natural Remedies:

Central to Ayurvedic practice is the use of natural herbs and remedies to restore balance and harmony within the body. Swastik Ayurveda offers a range of herbal treatments tailored to address specific health concerns, including neurological disorders, spinal problems, and joint ailments. These herbal formulations are carefully prepared and administered to ensure maximum efficacy and safety.

Promoting Wellness Through Ayurveda:

Beyond treating ailments, Swastik Ayurveda is dedicated to promoting overall wellness through Ayurveda. The clinic hosts educational programs, workshops, and wellness retreats to empower individuals with the knowledge and tools to lead a balanced and healthy lifestyle. By integrating ancient wisdom with modern practices, Swastik Ayurveda strives to foster a community committed to holistic well-being.

Conclusion:

In a world where modern healthcare often overlooks the holistic aspect of healing, Swastik Ayurveda stands as a beacon of hope for residents of Hydernagar. With its comprehensive range of Ayurvedic treatments, therapies, and expert consultations, Swastik Ayurveda continues to redefine healthcare by prioritizing the well-being of its patients. Whether you're seeking relief from neurological issues, spinal problems, or joint disorders, Swastik Ayurveda is committed to guiding you on your journey to optimal health and vitality.

[abirddogmoment]

A lot about Mav's decline and a little about how it makes me look at Rory.

I didn't talk about it very much here, but Mav was really subtle in his signs of pain when he was declining from his spine injury. Some of the things that tipped me off were changes to his gait, lower tailset, slower movement, reluctance/slowness getting on or off furniture, and needing extra cuddling. These things could easily be brushed off as him being tired or him being disinterested, and it really made me doubt what I was seeing.

I was sure Mav had something really wrong with him, but it was so hard to convince the vet of that. She said things like "are you sure you didn't just train him not to jump on the furniture?" and "sometimes dogs slow down as they age", meaning well but ultimately making things a lot harder for me. This, coupled with Mav's happiness at the vet and overall stoic personality, gaslit me into thinking I was imagining things. I googled things like "munchausen by proxy symptoms" because I needed to know if I was the real problem.

When Mav went for his OFA hips and elbow rads, I had them take spine rads as well, hoping it would answer my question and help find out what was wrong with him. When his rads came back normal, I cried. It was partly in relief that it wasn't something structural, but also partly desperation that I couldn't prove something was wrong.

I pushed my vet to refer Mav for a neuro consult. It took four months to get her to agree and then for the neuro clinic to schedule Mav in. In that time, I started tracking his decline with a special quality of life chart I made specifically for him. It showed a degeneration of his QOL, but I still thought maybe I was dramatizing things and imagining it.

When Mav went for his neuro consult, they took him back for tests for ten minutes, then came back and solemnly told me they were certain his problem was neurological. They then asked me if they could take him back and let their vet students do the (non-invasive) tests on him for practice because he was such a happy dog. Of course I said yes.

They told me he wasn't a good candidate for surgery. I could do an MRI, but it would be expensive and wouldn't add much besides a formal diagnosis. They recommended palliative care.

I sobbed while driving home. Part of it was relief that I finally knew I wasn't imagining things. Most of it was heartbreak.

I scrutinized Mav's final decline because I couldn't let him suffer. I had hard lines ("when he can't run" and "when the painkillers stop working") and he reached those, but he was still so happy. He still had so much joy in his life. I made the call anyway.

The day came. He trotted into the vet's office like he was meeting his best friend at a restaurant. The vet carried him back to get a port and he wagged his tail the whole time. He scarfed down an entire fistful of cookies.

It was still, without a single doubt, the right choice for Maverick. I have thought about it from every angle, torn apart every single decision, and there's nothing I would do differently if I could go back and do it all again.

Now Rory came to me with a weird gait. She came to me with occasional dorsal shivers (the skin thing horses do) and extremely occasionally bunny hops while running. Not enough for me to think there's something seriously wrong with her, but enough for me to send videos to her breeder. I tried to believe it was just a symptom of puppy uglies or that she just needed more time to grow gracefully.

I debated it for two months, but I finally took Rory for an assessment at a sports physio vet here in town. When I filled out the intake form, I made it clear that I could be concerned over nothing, that this could be a waste of $85 and an hour of our time.

She scheduled us in, did her hands on assessment, and found a knot in Rory's thigh. She gave us some stretches and we have a few more rechecks, but Rory should be totally fine and her gait should improved within the week. All the symptoms point towards a longterm overcompensation to reduce weight on her one leg.

I felt so stupid going into the sports vet today. I almost cancelled my appointment twice because I was sure I was imagining things. Even when she was examining Rory, I was preparing my apology for wasting her time.

Rory is going to feel better. She's going to get to grow up without the effects caused from an overcompensation from shifting her weight in a weird way. She probably would've been fine even without the appointment, but she's going to be even better now.

It's a whole lot of text to say something cliché like trust your instincts or don't overthink it, but it is what it is.

[absneuro]

Best Neuro Hospital in Hyderabad

ABS Neuro hospital the best neuro hospital in hyderabad started as a clinic in 2018 and converted to a hospital in 2021. It is first of its kind in South Hyderabad. This Hospital has served around hundred thousand patients including inpatients, OP patients and the thousand major neuro and spine surgeries the best neuro hospital in hyderabad.

[flyonthewallmedstudent]

Bartonella henselae

Case Report:

23M veterinary student from home with a cat, presents with a one year history of neck swelling, 1 month of fevers and lethargy. Also he lives in Karachi.

The fevers are a/w chills and rigours that response to paracetamol and have no particular pattern to them.

He doesnt have any arthralgias or arthritis or rash.

They find pretty sizable lymph nodes on exam in the cervical chain and inguinal regions.

He starts developing hypotension and they start him on some vasopressors and meropenem.

The fevers don't respond, and someone decides to start azithromycin, which it does respond to.

He's also worked up for IE given the chronicity of events.

Eventually on biopsy of the lymph node, the lab finds bartonella hensalae.

Microbiology + transmission:

aka cat scratch fever, so this is why history is so important to infectious diseases physicians.

it's actually disease of cats that can spread to their humans via bites and scratches. Or the cat licks a wound etc.

and unfortunately also via arthropod vectors and mossies

after entry into a host, it's main target cells are CD34s, immune cells, and then alters the host immune system

it's interesting special power is that it can predispose hosts to other pathogens in this manner

it's a gram negative rod (pink rods)

Historical trivia

the fun bits

genus of Bartonella is named for a Peruvian scientist (Alberto Barton, also had interest in brucellosis and leishmaniasis --> other tropical diseases taht cause fevers of unclear origin), he isolated the bacteria from patients during an outbreak among railway works in South america. This was 1905.

reminds me of love in the time of cholera, when people still wrote physical letters.

species of bartonella henselae is actually named for Diane Henselae, a researcher from Oklahoma, who collected samples during an outbreak there in the mid 1980s.

rare for someone who discovered a species named for them to be both alive and a woman, and I can't find much about her online.

there are other bartonella species that cause historically significant diseases like trench foot (bartonella quintana, transmitted by lice) and carrion's disease (bartonella bacilliformis, with a high mortality rate). another post for another day.

Clinical features

incubation period: up to 10 days

initial: rash at site of injection or intro of pathogen, from there it travels to local lymph nodes causing lymphadenopathy about 1-3 weeks later

From CDC guidelines who took image from NEJM

Bsymptoms - low grade fevers/malaise/fatigue

epidemio: occurs most often (for a rare disease) in kids < 15

Complications

infection affecting the eye (neuro-retinitis = visual changes, irritation and photophobia), liver, spleen, brain/spine (transverse myelitis, encephalitis etc), bones and heart valves (IE)

Increased risk groups for complications

HIV/AIDs, immunocompromised hosts (i.e. transplants), mortality is an issue in this group, as disseminated disease a possibility

small risk of IE in groups with RFs for develop this (prosthetic valves, damaged valves, unrepaired congential heart disease etc)

Investigations

challenging, no gold standard test as the sens and spec is variable for each individual one, so it's a combination really, of history exam and a variety of confirmatory tests

PCR (variable spec/sens), serology (indirect and often negative in early stages, can also be positive for years post treatment and doesn't differentiate from other bartonella species), cultures are definitive but it can take 21 days for anything to grow (it's fastidious)

histopath of lymph nodes helpful - stains: silver stain or Warthin Starry stain (silver nitrate) which is kind of a reverse starry starry night used for spirochetes like helicobacter.

in IE, it can be culture negative, which can confuse diagnosis

From Wiki

Management

mild disease is self resolving

first line: few days azithromycin or doxycycline can reduce symptoms and is indicated for enlarged lymph nodes to reduce size or unresolving LAD >1 month

in case of eye infection or IE expect longer duration of hterapy, like doxy and rif for 4-6 weeks

will also respond to bactrim, cipro, rif and gent

Prevention from the CDC:

avoid strays, wash hands after petting cats, keep strays from your cat, avoid owning new kittens who are < 1 yr if you are immunocompromised

avoid getting scratched..which is kinda hilarious but can see why

Sources

stat pearls

case report above

wikipaedia

Rare diseases

CDC guidelines

[she-karev]

Signs and Secrets

Age Rating: 12+

Fandom: Grey’s Anatomy

AN: Hey guys so I had to rearrange my posts which means deleting the first draft of this and reposting it. I'm still on the fence on whether I should change my fancast to Victoria Pedretti. Your opinion matters and the poll will be up for the next five days so if you haven't voted hurry and click!

Summary: Amber works at the clinic when a roller coaster crashed while her intern friends gossip and speculate over who she’s dating.

Words: 3781

After about 3 hours with Darcy we were able to confirm she had a badly bruised spine but not torn. We explained this to Darcy and her parents in the patient room where we moved her and fitted her with a spinal halo. Her dad is deaf and her mom is hearing and are by her side anxious over her diagnosis.

“The good news is that her spine is intact.” Andrew explains as Jerry interprets for them, “The MRI showed no visible injury and the exam went great. Her spinal cord is badly bruised though due to the stampede and she’ll need physical therapy to regain full function.”

“For how long?” The dad asks and Jerry interprets.

“We would need our chief of neuro Dr. Shepherd to confirm but all in all it looks like she’ll regain strength over the next few days and in a couple of weeks she should be back on her feet and ride that rollercoaster in no time.”

Darcy signs no, “At this point I’ll settle for a night in watching Netflix.”

“How long does she have to wear this thing on her head?” Her mom asks.

“Her spine is still healing from the bruises so we’re gonna keep her for observation over the next 7 days and if her spine continues to improve we should get it off at day 5.” I explain to them. The dad looks at us gratefully and signs as Jerry interprets.

“Thank you both so much. I can’t tell you how afraid I was thinking she wouldn’t be able to tell you what’s wrong and you wouldn’t understand but she got lucky to have two people who know sign like you.”

“Well actually it was all Dr. Karev.” Andrew explains causing me to feel flustered, “She noticed your daughter trying to communicate and thanks to her we were able to treat Darcy and let her know what was happening.”

“Thank you, Dr. Karev.” The mom says, “I can’t tell you how refreshing it is to have a doctor who learned my baby’s language.”

“Of course, I’m glad I could help.” I turn to Dr. DeLuca for further instructions.

“Right well I’m gonna check to see if Dr. Shepherd is available to look at Darcy’s films, Dr. Karev will be here to monitor.” DeLuca explains and the dad signs.

“Um he’s asking if they can go pick up their son from school so he can be here as well.” I interpret.

“Yeah sure we’ll take good care of Darcy you can go and the nurse will take you up when you come back.” The parents sign bye and love you to Darcy and leave the room. DeLuca clears his throat and turns to me, “Dr. Karev, I trust you can take care of Darcy.”

“Absolutely Dr. DeLuca you can count on me.” He nods and leaves the room. I readjust the halo when Dahlia walks in catching me off guard.

“Hey.” She walks in with a tablet, “The chief wanted me to check on the deaf teenager to make sure she’s being taken care of.”

“She’s good we’re good I know sign language so I was able to keep her from being restrained like a prisoner.” I explain as I look at the screws, “Now I am making sure the halo is put in place and Dr. DeLuca is out getting Dr. Shepherd for a consult.”

“Okay great, that’s great.”

Darcy asks me, “Who is she?”

“Oh right sorry.” I stand back and sign, “Darcy this is Dr. Qadri she’s here to check on you and make sure your okay.”

Darcy raises her eyebrow, “She’s here to make sure I don’t sue them for tying me down you mean?”

“Yeah.” I nod, “We are so sorry for that and I promise it felt necessary due to fear of causing paralysis and when I realized what was happening, I stopped them immediately.”

“I guess that’s what I get for going out and getting hurt.” Darcy says bitterly, “You know when your on a rollercoaster deaf it feels so much more scary. Although I guess it’s even more scary when you can’t hear a rollercoaster falling off the tracks. I bet it must have looked cool.”

I chuckle as Dahlia looks at her vitals and puts them on her tablet, “Well I wouldn’t know the closest to a roller coaster accident I got was Final Destination 3. And you know I was thinking about checking out the carnival this weekend but now I’m just gonna spend the night in.”

“Well, if you want a ride with your doctor boyfriend I suggest the Great Wheel.” I pause and look at her shocked by her speculation that DeLuca is my boyfriend, “It’s totally safe and it’s slow and intimate so you two can make out while overlooking the whole city.”

I chuckle nervously and Dahlia looks at me confused and I clear my throat. I turn to Darcy and sign without speaking so I don’t give anything away to Qadri, “What makes you think Dr. DeLuca is my boyfriend?”

Darcy narrows her eyes like it was so clear, “Oh please it is so obvious especially to me. Even when I was afraid, I wouldn’t walk I could notice the eyes you made at each other. It was like you were mentally undressing each other.”

I shake my head flustered and continue signing, “I don’t know where you get that idea, he and I are coworkers that’s all.”

Darcy grins amused, “I observe people closely because I have to and I learned to read body language as a result. The body language you two were showing was ‘I want to take your clothes off and take you right here and now’ I guess this is a secret and your afraid your friend will interpret me.”

I look to Qadri to see if she understands but she’s looking at her tablet and looks up at me confused, “What is it?”

I exhale in relief, “Nothing are you done with your notes?”

“Yeah, I should keep going God knows the chief is gonna get after me for slowing things down. See you later.”

Qadri leaves and I go back to conversing with Darcy, “You know you’re a lot smarter than my friends here and they have medical degree’s. They couldn’t figure out in two weeks what you figured out in two hours bravo.” I wave my hands to applaud her and she smiles proudly.

“Just so you know.” Darcy signs, “He is really cute.”

I grin cooly, “He is although he could keep it down with the staring for the next super observant deaf kid we treat.” Darcy grins, “And he’s not my boyfriend, we’re just having fun.”

Darcy grins mischievously, “He looks fun. Which means you should put a label on it before someone else comes along and takes him for a rollercoaster ride.”

I laugh at her innuendo just as DeLuca walks in with Shepherd, “Hey I see I made it in time for comedy hour, what are we joking about?”

I look at Andrew with a grin and respond, “Nothing just some funny youtube videos where the cat juggles a melon. Dr. Shepherd I already adjusted her halo and the nurses gave her a painkiller.”

Shepherd nods, “Okay let’s see what we got here.”

------------------------------------------------------------------------------

After about 12 hours of suturing in the pit and treating burns, I lean against the brick wall of the tunnel sitting on the gurney next to Helm with Casey taking up most of the space and the others occupying the gurney next to us. Right after Dr. Grey won the Harper Avery award like we all predicted we went to the tunnel to rest and reminisce on our day. The six of us are exhausted and about ready to sleep the day away. I’m so tired I’m not even mad that most of them got to assist and I didn’t even Roy which would blow my top off if I wasn’t trying to keep my eyes open.

“This day was epic.” Casey says with tired joy.

“I’m so tired I can’t feel my teeth.” Schmitt says as he rubs his eyes.

“I almost stitched my finger to a person.” I chuckle at Helm who looks at me offended, “At least I saw an O.R. before you She-Karev what do you say to that?”

“I say.” I decide to sign so she won’t understand, “Next time I’ll hurt you just for the chance to fight over your surgery.” I grin at her confused face.

“What is that?” Helm asks.

“Yeah she speaks sign language.” Dahlia explains as she cricks her neck.

Helm scoffs, “Of course you do, is there anything you can’t do?”

“When I figure it out I’ll let you know.” I say smugly and they chuckle when Dr. Grey and Alex enter the tunnel carrying a champagne bottle and cups.

“Scram.” Grey tells us causing them to stand but I stay since I assume sister’s are allowed.

“Yeah you heard her, scram. This is our beach.” They all walk away and Alex turns to me and rains on my parade, “You too get out.”

I look at Alex taken back, “Wha-I’m your sister!”

Alex grins, “Exactly now scram.” I groan in annoyance but do what he says and catch up with the others who look at me amused.

“I guess baby sisters aren’t allowed in the adults table.” Roy makes fun causing me to punch him in the arm.

“Whatever it’s just champagne in a tunnel if I wanted a night like that I would’ve never left Manhattan.”

Casey yawns, “So how does Dahlia know you speak sign?”

“I had a young patient come in with a bruised spine she’s deaf and I was there. I took it as a language requirement in pre med. I figured I could use my hands for something other than saving lives and Roy! I know what your gonna say and if you make a quip about my hands being used for other things I will punch you.”

Roy scoffs amused, “Oh please you don’t have the balls.” I turn around fast and make a motion to punch him in the face causing him to squeal and back away as I grin at his reaction and continue walking. The others laugh at the scene.

“Remind me which one of us has balls?” I grin maliciously as we enter the locker room.

“So you sing, you know sign language and your related to Alex Karev.” Casey lists as I lay on the bench, “Why is it we know all these things about you and yet we don’t know who your sleeping with.”

I groan, “I thought you didn’t care Parker I was rooting for you to be less annoying than the rest of them.”

Casey shrugs, “That was this morning now I’m exhausted and interested is it Major Hunt?”

I chuckle at the irony. I saw the guy naked this morning and he’s not the one I’m sleeping with, “No because the guy is a freaking dinosaur and he’s my boss and I have self-respect.”

“Is it Avery?” Helm asks and I glare at her, “Oh come on don’t pretend you don’t find him hot we all do.”

“Then why don’t you get your freak on with him if you find him delicious?”

“He’s not my type.” Helm opens her locker, “Schmitt are you still convinced it’s Eddie?”

Qadri snorts and says under her breath, “Oh please you all are oblivious.”

They look at her confused over not hearing her, “What was that?” Helm asks causing Dahlia to realize she said something and stammers.

I stand up and go to my locker inputting my combo as she speaks, “U-Um you know my second cousin is deaf.” I freeze at the second set of numbers over this new information but continue to appear cool.

“Really?” Schmitt looks at her confused.

“Y-Yeah she bet me a new headscarf I could learn the language in one month.” I pale at this and take my water bottle out staying quiet, “I lost but I learned a few words especially the dirty ones those stuck out to me the most.”

I clear my throat after I take a sip of water, “That’s uh that’s interesting very interesting to learn right now.”

Dahlia grins knowingly, “Well there’s a lot of things we don’t know about each other but you know that better than anyone right She-Karev?” Her look confirms she was able to interpret mine and Darcy’s conversation and I keep a cool head.

“Are you working tonight?” I ask.

“Yep.” Dahlia confirms and I nod.

“Me too I guess I’ll see you out there.” I quickly leave the room without saying a word to anyone and wait outside the hall for Dahlia to come out and she did. I approach her and cut to the chase, “How much did you interpret?”

Dahlia smiles at my worry, “Which part? The part where she called DeLuca your boyfriend or the part where she could tell you guys were having mind sex in front of her? Because I got both of those if you want to know.”

I sigh in despair, “Great I could’ve taken Russian but no I decided to be of use for the deaf community.”

Dahlia smiles, “Well if it makes you feel better this blows my Lin Manuel Miranda theory out of the water. How did this happen? Was it a quickie in the on-call room or did you gaze at his sultry green eyes in the ER and decided to declare your love for him out in the rain with Ed Sheeran in the background.”

I roll my eyes, “Okay first you watch way too many Nancy Meyers movies second this happened a few months ago way before I even got hired and it has continued ever since and thirdly I will allow for one more question before scaring you into keeping silence so make it count.”

Dahlia thinks for a moment, “Is he good?” I chuckle at her, “Because he looks like he’d be good.”

“Okay my three orgasms a night are none of your business.”

Qadri’s eyes widen, “Three times?! You’re kidding or you miscounted that can’t be possible.”

I whisper, “The other night it was almost four.”

Qadri chuckles at my good fortune, “That man is a medical marvel.”

I sigh in lust, “He really is. Now for the intimidation if you-”

“Amber.” Qadri interrupts me, “You don’t have to worry, I promise I won’t tell anyone about you and DeLuca if you don’t want me to. It’s none of my business and it was just fun gossip this morning that’s all. I mean I’ve seen Gossip Girl I know how brutal it can be.”

I see that she’s genuine and decide to let her off the hook, “All right I guess I can trust you to keep this a secret.”

“I know it probably doesn’t mean much but in my opinion. It’s not as embarrassing as you think.” I raised an eyebrow at her, “It was shocking but then I got over it and it seemed normal. Except for the four orgasms that is just crazy.” I chuckled with her, “Honestly, it’s a lot more ethical than if you slept with Hunt or Avery. Their frogs and we’re egg masses yeah but DeLuca he’s a tadpole so it’s just one shift up the cycle. You have nothing to be ashamed of in my opinion.”

I exhale and look at her grateful for her advice, “People are already underestimating me as Karev’s baby sister I don’t want to give them more reason by opening my bedroom door. I mean guys get away with this but we don’t.”

“You’re preaching to the choir honey.” Qadri agrees, “Okay so I guess your secret is safe with me.”

“Thank you, Dahlia.” I say with a grin.

“So…I guess that makes us friends then.” Dahlia quips with a hopeful smile and I shake my head at her giddiness.

“Well see. Good night.” I turn to walk away from her and I see DeLuca by the nurse’s station rubbing his tired eyes but he sees me giving a grin and he grins too walking by my side.

He greets me in a doctor voice, “Dr. Karev.”

“Dr. DeLuca.” I respond with equal disinterest.

We stop outside the on-call room and he holds the door for me, “After you Dr. Karev.”

“Thank you, Dr. DeLuca.” As soon as he closes the door, we go at each other like animals.

I curl my fist around his wavy hair as we kiss and he picks me up and puts me on top of the drawer chest causing me to chuckle. I continue to kiss him and take his lab coat off; he does the same with my scrub top leaving me in my black bra. I run my hands under his shirt and pull it off quickly. We continue to explore each other with our lips and hands for several moments until I speak up at the worst possible time.

“I’m not embarrassed to be seen with you.” DeLuca pauses kissing the back of my ear and pulls back looking at me confused.

“Is there a reason you’re telling me this when I have you half naked on top of furniture?”

“Listen.” I straighten up and put my hands on his broad shoulders to steady myself, “People look at me and automatically assume I don’t work my way to success. They think I use my looks or amazing skills in bed just to get by, it’s been that way since I first hit puberty. It’s amplified more here because the second I walk into a patient room the family hopes I’m the nurse.” Andrew sighs and puts his hands on my hips listening albeit annoyed I cut our powwow short, “And I get how you don’t assume that but you know things about me that they don’t. You know I worked myself to death to get out of foster care and into state school with no help at all. You know I didn’t use my brother’s name to get an interview here but they don’t know that. I mean they’re gossiping about which attending I’m screwing for surgeries including Hunt which is ironic since I saw him naked this morning with your sister.”

Andrew groans in disgust and pulls his hands away from my body, “And the endorphin high is at a crashing stop thanks for that.” Andrew sighs and looks at me in sympathy, “I get that it’s demeaning to say the least that all those interns look at you and your DNA and assume that your…”

“A brainless slut?” Andrew looks at me in pity over how I described myself.

“No, you’re not and you shouldn’t let them get to you. I mean if they knew all the things you had to go through, they would eat their words over how wrong they were about you.” I look at him touched as he continues, “I mean you helped a deaf little girl tell us what was wrong with her. Your friends probably would have tightened her restraints more and not notice what was right there but you did and…that makes you way better than them in my opinion.”

I look at him in gratitude over how he compliments my bedside manner and I finish my statement, “I’m not embarrassed by you or shamed of you it’s just…what we have is private and I don’t want them to gawk or make fun of it. They would think I’m using you to get revenge for my brother and that you’re sleeping with me to spite Alex but they don’t know us. I don’t care about their opinions but I do care about the reputation I want to establish here.” Andrew looks at me attentively, “You have a different pedigree than me so you don’t know how addict parents and violent brothers can damage your image in the world at the age of 2. I went to private school on scholarship and…the guys assumed I was an easy project girl.” Andrew’s face shifts to pity, “All the girls hated me because I fitted my skirt more than them and they thought I was stealing their boyfriends when they saw me bump into them and…I swore I would never go through that again. I know it isn’t fair to you but it’s all about me not you I promise.”

“Amber that’s terrible.” Andrew brushes my hair back over my shoulder, “I didn’t know that and I was afraid it was because you were embarrassed of me but hearing your story, I get it now. I know how hard it is to get away from your past and make a name for yourself, it’s what I did with my dad and I see that in you too.” Andrew cradles my face in his hands and I look at him with affection, “If you don’t feel comfortable telling people about us, I’ll respect that I just…I just want to know I’m not another shameful secret of yours.”

I sigh and run my hands over his torso, “You’re not if anything you’re the best secret I have ever kept.” Andrew smiles and resumes kissing me this time it’s slow and sensual and he picks me up again putting me on the single bed. I lay under him and moan as he resumes kissing my collar bone and I stroke his back as we sink into each other. I groan and pull him back so I could ask him something else.

Andrew pulls back annoyingly and looks at me, “What is it?”

“Um…are we dating?” He looks at me surprised by my question, “It’s just that we never put a label on it and we’ve only gone out in public like twice so I just want to know if this is gonna die when you realize I am too much of a mess to handle or get tired of my sexpertise.”

Andrew grins at my joke and responds, “Well one I already knew straight off the bat you were gonna be a mess from how our first date went and I handled that spectacularly if you recall. Second I will never get tired of your sexpertise the three orgasms are evidence enough. And third yeah I like to think we are dating, is that the answer you were hoping for?”

I grin, “Yeah it actually was.” Andrew grins at me, “Okay no more interruptions I promise now come here.”

DeLuca exhales, “Thank god.” He kisses me and I moan in pleasure with us content in each other’s company.

[headpainmigraine]

So, recent appointment with my neuro was... helpful.

Apparently I’ve tried everything (???) and they don’t know what to do with me now.

They’re going to talk to the multidisciplinary clinic to see if any treatment ideas come out of that, otherwise I’m looking at ‘invasive neuromodulation’, that is, an implanted device in the base of my skull/top of my spine that will modulate the pain receptors.

Apparently some people see good results?

Literally don’t care about having the surgery, I’m more worried that it’s not going to work.

Just tired.

[thechronicallyillcorner]

June 18,2022 - I started having severe tremors of my head/neck and right arm/hand.

June 20, 2022 - I saw my PCP who was concerned with sudden onset of symptoms. He would not let me leave his office until he spoke with neuro.

June 21, 2022 - I spent 9 hours in the ER. CT was clear, Blood work was relatively normal. Sent home with Rapid neurologist appointment.

June 23, 2022 - I see the rapid Neuro clinic. He sends me for more bloodwork and refers for MRI.

August 14, 2022 - The first episode of loss of consciousness. I also had weird stabbing migraines prior to episode.

August 21, 2022 - MRI of head and spine

I had my MRI results 5 days after my scan. I never heard from the neurologist. I phoned 3 weeks later to book an appointment to discuss the results. When the receptionist phoned back she told me that the doctor wanted her to relay my "normal" results and that he would no longer be seeing me.

Normal? 1.2 cm cyst in my brain is not "NORMAL". Thats not even the kicker... It has been there for 10 YEARS. None of my doctors thought it was important information.

Now this particular type of cyst, Pineal gland cyst. Has always been over looked by the medical community. They typically watch them and wait... Even if you have all of the symptoms. They won't even discuss the possibility.

Currently feeling defeated.

Does anyone have any suggestions? Im in Canada

[jessy831health]

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If you have been in a car accident and need professional medical attention, then we encourage you to come to Orthocare Clinics. We have trained Orthopedic surgeons, Spine surgeons, Neuro-Spine surgeons, Pain management Specialists to help you recover faster and get you back on the road to health!

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Job Opening For Registered Nurse-Post Surgical In-Patient Opportunities Intuitive Health Services

Job Opening For Registered Nurse-Post Surgical In-Patient Opportunities Intuitive Health Services - Job title: Registered Nurse-Post Surgical In-Patient Opportunities Job description: your professional nursing career. Neuro Spine ICU Surgical ICU The Clinical Nurse reflects the mission, vision, and values of NM... registered professional clinical nurse (RN) is accountable and responsible for the provision and coordination of clinically... Apply for the job now! https://intuitivehealthservices.com/register

[synapsespine]

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