There must be something in the water because the number of patients having seizures in the last two weeks is out of control. Almost daily, it seems that the nurses are called on the radio to go to the scene where an offender is seizing. This causes the nurses to grab the crash kit and hop in the golf cart "ambulance" and take off speeding. Several of these folks have been taken to the ER in a real ambulance....Then they come back to me later in the day with no records, a patient education hand out for "neck pain," and a prescription for some narcotics we can't fill. Neat. I think last week they loaded up a "seizing" patient with some drugs because she was so groggy and hypotensive when she came back that I transferred her to the infirmary at another prison. (God bless that infirmary doctor, who lives in a Winnebago, for accepting the transfer.) I had to call him today to transfer another seizer who I can't get under control. He then traded me back the first lady who hadn't seized at all while she was there. I'm not surprised because her description of her seizures was vague and didn't quite compute ("I called the guard and said, 'hey i'm having a seizure!'...[insert fully body shaking])
Did I miss all of the lectures and didactics in residency about primary care management of epilepsy? I've been trying to read up and consult more experienced prison docs but don't feel that confident in the fine tuning of anti-epileptic drugs regimens. I did order my first EEG recently on another possible epileptic who is "seizing in her sleep" and wakes with "sore tongue and gums." We'll see what the EEG reveals...most of the imaging studies I have ordered have reported normal findings, save for a few arthritic joints and two cases of osteoporosis in relatively young women. I guess that's a good thing.
Things to look forward to: Mexican pot luck with the nurses tomorrow and my first trip back to Seattle this weekend!
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