Thanksgiving Dinner with a Side of ER

Happy Thanksgiving, everyone!

I was reading the Web this morning, and this story reminded me of a Thanksgiving a couple years ago.

The news story is about how Thanksgiving dinner can cause flareups of gout. Gout -- if you don't know -- is an inflammatory joint disease caused by the deposition of little crystals of uric acid. Uric acid is a compound found in many types of food and drink. It is actually a product of purine metabolism (purine is a component of DNA). Foods that have the most purines are meats -- particularly sweat meats. Here is a list of danger foods. Eating lots of these foods can cause a flareup of gout. The symptoms include painful inflammation in peripheral joints -- most often the big toe. A bummer for all concerned. Just a suggestion: if you have gout, don't overdue it and make sure to take your medication this morning. (Gout is a problem on Thanksgiving partly because it is associated with the metabolic syndrome. Drugs to treat gout either deal with the underlying inflammation or increase uric acid excretion from the kidneys.)

Anyway, the news story reminded me of several years ago when my Dad was working the night shift on Thanksgiving in the ER. When you have an ER doc for a Dad, holidays are often a little weird. We had dinner early that day, so that he could sleep and go to work. Because I was a medical student, I agreed to go with him for at least to first several hours to help out and spend time with him on Thanksgiving.

You would be quite frankly shocked the number of people who come into the ER after Thanksgiving dinner. These are the usual suspects of overconsumption -- what I have come to call the unholy triad of holiday meals. These include:

• Chest pain -- This may or may not be a heart attack. That night we did see a woman who had a heart attack after dinner, but she also was a smoker and had a genetic hyperlipidemia. It could also be indigestion. Tough to tell until you get an EKG.
• Gallstones -- The mnemonic for gallstone risk is "fat, forty and female." Those are the individuals who are at the greatest risk for gallstones, and that evening we did see a relatively overweight 40ish woman show up with pain in her right epigastric region (on your right, right below your rib cage above your belly button), likely gallstones. Gall stones originate in your gall bladder -- a structure which you don't really need. The gall bladder holds bile. Bile comes from your liver and is used to digest fat foods. Gallstones are composed of cholesterol. If you have them already, then a fatty meal like Thanksgiving will crank up your bile production. The bile will try and push them through your bile duct to your intestines. Large stone, small whole, lots of pain...you get the picture.
• Gout -- Talked about above. Didn't actually see someone that night, though I have friends who work in the ER who say it is on the rise.

All of these are very reasonable, good reasons to come into the ER on Thanksgiving, but I would caution you that if you have the above listed conditions to eat with moderation. The ER is not a pleasant place to spend Thanksgiving, and being in a lot of pain doesn't help either.

Here is where it gets weird. I am going to caution the lot of you that this story is exceptionally gross. If you have a weak stomach or haven't eaten yet, be warned.

Gross story: Later in the evening when I was thinking about going, I hear that the ambulance is bringing in a kid with trauma. I am thinking to myself: '"who gets shot on Thanksgiving?" This is not a major trauma center, so whatever it is can't be that serious. They bring in this 20 year old kid with his right ear hanging on by a thread, drunk as a skunk. We are talking .300 alcohol level in the ER -- which means that it was probably a bunch higher when he was partying.

The story goes that this jackass and his friends were partying on Thanskgiving evening. They had decided to get drunk and do donuts in some parking lot somewhere. But the fun really began when this kid decided to hang out on the side of the car while they were doing the donuts. Apparently the guy fell and got dragged -- hence the less than attached ear. Gross.

This guy was really loud, by the way. I understand completely and was sympathetic about his pain, but that is a good way to alienate the staff if you are there on Thanksgiving.

So they have to call the surgeon -- small ER, not someone on call at night -- to get him to come in and look at this chaps ear. Enter the none-too-happy surgeon who takes a look at this guys ear and claims that he can reattach it, but probably needs to use leaches. (Leaches are infuse a substance that will keep if from clotting up.) I don't know this for certain, but the surgeon may have examined the kid a little longer than he needed to -- the pain being an additional cautionary tale that he should not do that again. You could see the cartilage. Yuck.

The moral of the story is: everyone parties on Thanksgiving. There are many good reasons to come to the ER on Thanksgiving, horrible chest pain among them. But don't let the reason be that you and your drunk friends did donuts in a parking lot and injured yourselves. That is just stupid.