Laundromat Diagnosis

[Richard B the EMT]

While in the coin operated laundry center, I was approached by a woman I know, from that laundromat. She wanted my opinion, as an EMT, on something.

She is just 40 years old. She just lost a bit over 100 pounds by dieting, and admits she is a bit of a nervous person, with a slight case of GIRD, but is otherwise in reasonably good health.

She complains of a small patch of skin moving at the notch of her collarbone. Her doctor(s) say it is nothing to worry about. She is awaiting new medical coverage, and won't be able to see another doctor for at least a month. On my observation, I actually had to have it pointed out to me, as the affected area is so small. It is the size of a pinky fingernail, and does pulsate in time with her pulse.

I restate that she just lost weight, and did not have either Gastric Re-Sectioning (Stomach Stapling) or "Lap-Banding".

She states that, although there is no unusual sensations in the area of the pulsations, the fact that she is having them, is "driving her nuts". She is on prescription Zantac for the GIRD, but noted the pulsations prior to starting the meds. She denies taking any other meds. X-Rays are negative for anything.

Her doctor says that it is a common and harmless condition.

While emphasizing that this was outside my expertise (I'm an EMT-B, working BLS), and that my opinion could not be held to specifics, I mentioned a guess, labled as such to her at the time, that the pulsations could have been skin formerly supported by body fat, now a bit loose because of the weight loss. The observed pulsations could be caused by normal blood vessels moving with her pulse, causing the overlying skin to do the pulsations. I suggested having the new doctor, under the new coverage, send her for a Doppler or Sonogram of the affected area of the neck and upper torso. All here know I have been in EMS from 1973. In that time, while I have seen JVD (Jugular Vein Distention) and the Tracheal Shift associated with a collapsed lung, I never recall having seen the skin at the collarbone notch pulsating as hers is, Again, her doctor says that it is a common and harmless condition. 1) What is it?2) Is it potentially harmful?3) Has anyone seen anything similar to what I describe?

4) What other medical advice could I have given? (No suggestions of running away when someone asks medical advice of me when off duty will be entertained)

[WestSideBorderPatrol]

Hmm, well aside from turning and running away, it sounds like you gave good advice.

From what you described, I don't think that we have to worry about a AAA or anything, as it is too high up. I don't know if a sonogram would be of much help since the sternum is right there and there isn't much soft tissue. My BLS guess would be that it is either a vessel or something that she can now feel b/c of the weight loss, or she is just feeling her heart beat.