Uncategorized
A patient’s very scary ski vacation
Published
7 years agoon
Posted By
Outlaw PartnersBy Dr. Jeff Daniels EBS Medical Columnist
In between the torn ACLs and fractured shoulders suffered on the slopes, occasionally an unusual and previously unseen medical oddity presents itself to the clinic. When that happens, we muster all of our resources and try to get to the bottom of it.
One such case presented in February, when a young man visiting Big Sky looked in the mirror and noticed that one of his eyelids was drooping, and the pupil of that eye was a lot smaller than his other pupil. To say that this scared him would be putting it mildly!
He came into the office and I had all of the medical students and residents working with me examine him and give their opinion. None of us could find any other neurological abnormality aside from the droopy eyelid (ptosis) and the constricted pupil (meiosis).
His history didn’t give us any clues either: He was from the East Coast, but had never had a problem at this elevation. He was here skiing, but hadn’t experienced head trauma. He was traveling with friends, and he may have had more to drink than usual, but that commonly occurs on a ski vacation. His vision was 20/20 on the affected side, and his only other complaint was a mild headache on the same side of his head as the ptosis and meiosis.
All of the emergency medicine residents wanted him to immediately get a CT scan of the brain, as well as a CT angiogram, looking for aneurysms and bleeding near the nerves that go to the eye. We were able to arrange for these tests immediately at the Big Sky Medical Center, and the CT angiogram suggested that the blood vessels in a certain part of the brain were inflamed.
It so happened that a frequent guest lecturer for the students and residents, who happened to be a neurosurgeon, was coming to talk to us about interesting cases that evening. Our patient was only too happy to come in and get an opinion, so we all crowded into an examination room as a very careful and thorough neurological examination was done.
Finding no other abnormalities, our neurosurgeon ruled out many terrible problems, but couldn’t pinpoint a diagnosis. He didn’t think that the CT angiogram findings were that significant, but agreed that giving a steroid to treat vasculitis would be appropriate.
Our patient left for home the next day, and within a week was able to see the head of neurology at Johns Hopkins Hospital in Baltimore, Maryland. The patient emailed me that he was told he had a condition called “reversible cerebral vasoconstriction syndrome” or RCVS, with an emphasis on “reversible.” He was told to avoid alcohol for three months, take two Aleve twice a day, and not to come back to altitude for a while—and his symptoms have slowly been resolving.
Reading more about RCVS, it sounds a lot worse than what our patient experienced. “Thunderclap” headaches and seizures could be part of the syndrome, along with a variety of neurological findings. Thunderclap headaches are described as being felt on both sides of the head, reaching a very severe degree within one minute of onset. This is supposed to be a symptom in 95 percent of cases of RCVS, but fortunately not in our case!
The good news is that the syndrome usually resolves in about three weeks, as it appears to be happening for our patient. I texted the diagnosis to our neurosurgeon, who responded “interesting!”
Dr. Jeff Daniels was the recipient of the 2016 Big Sky Chamber of Commerce Chet Huntley Lifetime Achievement Award and has been practicing medicine in Big Sky since 1994, when he and his family moved here from New York City. A unique program he implements has attracted more than 700 medical students and young doctors to train with the Medical Clinic of Big Sky.
The Outlaw Partners is a creative marketing, media and events company based in Big Sky, Montana.
Upcoming Events
april, 2024
Event Type :
All
All
Arts
Education
Music
Other
Sports
Event Details
Children turning 5 on or before 9/10/2024:
more
Event Details
Children turning 5 on or before
9/10/2024: Kindergarten
enrollment for the 2024-2025 school year can be completed by following the
registration process now.
Children
born on or after September 11, 2019: 4K enrollment is now open for
families that have a 4-year-old they would like to enroll in our program for
the 2023-2024 school year. Please complete the 4K Interest Form to
express your interest. Completing this form does not guarantee enrollment into
the 4K program. Enrollment is capped at twenty 4-year-olds currently
residing within Big Sky School District boundary full time and will be
determined by birth date in calendar order of those born on or after September
11, 2018. Interest form closes on May 30th.
Enrollment now is critical for fall preparations. Thank you!
Time
February 26 (Monday) - April 21 (Sunday)
Event Details
Saturday, March 23rd 6:00-8:00pm We will combine the heart-opening powers of cacao with the transcendental powers of breathwork and sound. Together, these practices will give us the opportunity for a deep
more
Event Details
Saturday, March 23rd 6:00-8:00pm
Time
March 23 (Saturday) 6:00 pm - April 23 (Tuesday) 8:00 pm
Location
Santosha Wellness Center
169 Snowy Mountain Circle
Event Details
We all are familiar with using a limited palette, but do you use one? Do you know how to use a
more
Event Details
We all are familiar with using a limited palette, but do you use one? Do you know how to use a limited palette to create different color combinations? Are you tired of carrying around 15-20 different tubes when you paint plein air? Have you ever wanted to create a certain “mood” in a painting but failed? Do you create a lot of mud? Do you struggle to achieve color harmony? All these problems are addressed in John’s workbook in clear and concise language!
Based on the bestselling “Limited Palatte, Unlimited Color” workbook written by John Pototschnik, the workshop is run by Maggie Shane and Annie McCoy, accomplished landscape (acrylic) and plein air (oil) artists,exhibitors at the Big Sky Artists’ Studio & Gallery and members of the Big Sky Artists Collective.
Each student will receive a copy of “Limited Palette, Unlimited Color” to keep and take home to continue your limited palette journey. We will show you how to use the color wheel and mix your own clean mixtures to successfully create a mood for your paintings.
Each day, we will create a different limited palette color chart and paint a version of a simple landscape using John’s directives. You will then be able to go home and paint more schemes using the book for guidance.
Workshop is open to painters (oil or acrylic) of any level although students must have some basic knowledge of the medium he or she uses. Students will be provided the book ($92 value), color wheel, value scale and canvas papers to complete the daily exercises.
Sundays, April 14, 21 and 28, 2024
Noon until 6PM.
$170.
Time
14 (Sunday) 12:00 pm - 28 (Sunday) 6:00 pm
Event Details
Come join us at Cowboy Coffee as we celebrate a fun night of drinks, games, and meeting others within the community. This event is from 6-8 and all are welcome
Event Details
Come join us at Cowboy Coffee as we celebrate a fun night of drinks, games, and meeting others within the community. This event is from 6-8 and all are welcome to come, if you don’t know who to bring come alone this is a great mixer event! This is an event hosted by Big Sky OUT as we work to provide queer safe spaces throughout the community.
Time
(Sunday) 6:00 pm - 8:00 pm
Location
Cowboy Coffee
25 Town Center Ave. Big Sky, MT 59716