Y'all Just Want Your Hugs!

As I read Kate's digest of a study about the value of hugging among female spider monkeys over at The Anterior Commissure, I couldn't help but remember an incident that occurred a little while back on the wards. I was part of a team taking care of an older arthritic woman who had severe vertigo. She grew up in Alabama and frequently would share with us various stories about Southern tradition.

Anyway, soon after she was admitted, the team went about identifying the cause of her dizziness. One common cause of vertigo is the presence of a little stone in the semicircular canals of the ears. A stone, called an canalith (latin for 'canal stone') can impede fluid movement and interfere with your sense of balance. To see if a stone is the cause, physicians can do what is called the Dix-Hallpike maneuver. This maneuver tests for canalithiasis of the posterior semicircular canal, which is the most common cause of vertigo. The general idea of the Dix-Hallpike is shown in the picture below:If a canalith is present, the patient will get dizzy and his eyes will mover rapidly from side to side. This rhythmic regular oscillation of the eyes has a special medical name: nystagmus. Apart from invoking the emergency evacuation procedure cards on airlines, this image shows how our friendly frail old patient might have trouble completing the maneuver on her own. A good amount of core muscle strength is needed to extend and flex the trunk while the care provider gently twists the head. This is the part of the story that Kate's post reminded me of:

In order to properly conduct this test with the patient, the medical resident sat on the bed to support the patient's body while the attending physician turned her head appropriately. In the process of doing this, the charming, aged, once-southern belle announced, "Now Ah know why y'all er doin' this test. Y'all just want your hugs! If ya'd just sed so in the first place, Ah'd be happy t'oblige y'all."

I suppose that's one way for medical students to get their endorphins on the wards!

Parts of this story have been fictionalized to protect the privacy of persons involved. The elements pertinent for the 'teaching moment' remain. The image is from UpToDate.