Tuesday, October 27, 2009
Bubu's Plum Wine
Today we bottled our own plum wine. The recipe is a secret, but the basics of it involves fermenting plums & plum-cots over about a 6 month period. We tried a little before bottling the rest and it is very tasty indeed.
Tuesday, October 20, 2009
Inpatient Digestive Health
Yesterday started a new rotation: Inpatient GI / Digestive Health. Will likely be a very challenging month. Pancreatitis, Liver cancers, Crohn's disease, Peptic ulcers, Diverticulitis . . . you name it, we see it. I think it'll be tough, but manageable, and a good learning experience. Days start between 6 - 7 AM and sometimes go until 10 - 11 PM. But some days are a little lighter.
Will write more later . . .
Sunday, October 11, 2009
Thursday, October 8, 2009
Methamphetamine
A powerful video on the effects of methamphetamine use. It cuts off at the end, but I think this is the best one on the net.
A brief summary of a recent patient encounter I had with a polysubstance abuser.
Ms. A is a 27 year old white female I recently had as a patient. She had a long history of drug abuse, including Heroin, Cocaine, Club drugs, and Amphetamines. She presented to the hospital with diffuse body aches, restlessness, high heart rate, an increased WBC count (usually a marker of infection), no fever, and a history of several weeks of nausea with occasional vomiting. In the hospital she was hysterical, crying loudly and sometimes writhing in pain and rocking back and forth. The initial differential diagnosis was broad, but high on the list for me was opiate withdrawal or possible (viral) infection. She was tested for influenza, blood and urine cultures were sent to rule out an infection of her body fluids, and a urine drug screen was sent. She was negative for all things tested for except her urine came back as positive for Amphetamines.
This young patient was on daily Methadone (a long acting opiate) via a Methadone clinic for prior Heroin addiction, reportedly in remission. Certainly a requisite for participating in such a clinic is that you are otherwise drug-free. During my initial interview with her she completely denied any past or current drug use. It took the urine drug screen, some detective work, and further interviewing with her to tease out the extensive drug history. And in all likelihood she came to the hospital with the knowledge that she could likely get a "fix", or opiate pain medications (at taxpayer expense) by putting on just the right act. Or another way of looking at it is that she was truly in "pain", but this pain was somatization of the psychological and physical stress she was putting her body through with administration and withdrawal (when money or supply ran out) of street drugs, often laced with dangerous impurities.
I did my best to rule out any fixable medical conditions, got the Substance Abuse specialists at the hospital to come see her, kept her comfortable while she was at the hospital, and then sent her on her way. Before she left I gave my best shot at an inspirational / motivational speech about the dangers of drugs and how she had much good life ahead of her. I'm not hopeful it sank in, as this patient looked to be pretty deep in the hole.
A brief summary of a recent patient encounter I had with a polysubstance abuser.
Ms. A is a 27 year old white female I recently had as a patient. She had a long history of drug abuse, including Heroin, Cocaine, Club drugs, and Amphetamines. She presented to the hospital with diffuse body aches, restlessness, high heart rate, an increased WBC count (usually a marker of infection), no fever, and a history of several weeks of nausea with occasional vomiting. In the hospital she was hysterical, crying loudly and sometimes writhing in pain and rocking back and forth. The initial differential diagnosis was broad, but high on the list for me was opiate withdrawal or possible (viral) infection. She was tested for influenza, blood and urine cultures were sent to rule out an infection of her body fluids, and a urine drug screen was sent. She was negative for all things tested for except her urine came back as positive for Amphetamines.
This young patient was on daily Methadone (a long acting opiate) via a Methadone clinic for prior Heroin addiction, reportedly in remission. Certainly a requisite for participating in such a clinic is that you are otherwise drug-free. During my initial interview with her she completely denied any past or current drug use. It took the urine drug screen, some detective work, and further interviewing with her to tease out the extensive drug history. And in all likelihood she came to the hospital with the knowledge that she could likely get a "fix", or opiate pain medications (at taxpayer expense) by putting on just the right act. Or another way of looking at it is that she was truly in "pain", but this pain was somatization of the psychological and physical stress she was putting her body through with administration and withdrawal (when money or supply ran out) of street drugs, often laced with dangerous impurities.
I did my best to rule out any fixable medical conditions, got the Substance Abuse specialists at the hospital to come see her, kept her comfortable while she was at the hospital, and then sent her on her way. Before she left I gave my best shot at an inspirational / motivational speech about the dangers of drugs and how she had much good life ahead of her. I'm not hopeful it sank in, as this patient looked to be pretty deep in the hole.
Monday, October 5, 2009
Sir Hugh Lloyd-Jones
"The Greeks were not tolerant of the well-meaning idiot." --Sir Hugh Lloyd-Jones, great Classics scholar who passed away today. I met this knighted gentleman once when I was a boy in the UK, when my father was a visiting Classics professor at Oxford University. Love this quote. Full obituary here.
Sunday, October 4, 2009
Breaking the news
The past couple of weeks have been pretty challenging. For some reason a dark cloud has been hovering over my area of the hospital and I have gotten several patients in a row with new diagnoses of lung cancer. This is all the more odd since we have a dedicated Hematology / Oncology service, still these patients have been coming to me of late on the regular Medicine wards.
It's quite tough to break the news. I won't ever forget Mr. P, a 55 year old white male with no previous medical history, a totally healthy guy who came to me with swelling of the face and neck. He had been experiencing for the last month or so increased swelling of his face and neck, particularly when leaning over e.g. when he would tie his shoes. He had also noticed some new intermittent shortness of breath. He came to the hospital to check it out and we did imaging which showed a significant "soft tissue" mass in his right lung. This mass had been likely growing for quite some time and was now almost totally occluding the Superior Vena Cava (SVC), one of the major veins that returns blood to the heart. He actually had significant "collateralization", which means that small accessory veins around the SVC had picked up the slack from the occluded big vein over time. This "SVC Syndrome" clearly accounted for his neck/face swelling and shortness of breath symptoms.
I recognized the possibility of cancer right away and had the tough job of breaking the news to this patient and his wife, who is a health care worker herself. This patient as I mentioned was totally healthy before. Had smoked cigarettes for 30 years but had totally quit 5 years ago. I explained to them sensitively and clearly what I thought was going on and what further testing we needed to do -- in this case we proceeded with a bronchoscopic biopsy of the lung mass. I got to know the patient and his wife quite well over the next several days, and was with them as they learned that the mass was in fact Adenocarcinoma of the Lung, spoke to specialists in Hematology / Oncology and Radiation Oncology, and set them up for all their future care needs. The prognosis is not good, but it was very fulfilling to be able to be there with these very pleasant people, answering their questions and helping to ease their very difficult transition into dealing with a new diagnosis of cancer. The wife gave me a big hug on the patient's discharge day, and I have been continuing to follow the patient's progress via the electronic charting. I hope his available chemotherapy and radiation therapy options, while not likely curative treatments, will at least allow this patient to lengthen his amount of quality life left and allow him to die with dignity and on his own terms. Oncology is a tough field, I'm glad that I didn't go into it, as I think that I do have a pretty high degree of sensitivity (though I can be kind of cold sometimes) and the weight of sharing in people's new cancer diagnoses over years and years would be pretty tough. I was glad though to have had the opportunity to participate in this gentleman's care and to have made a positive difference in his life.
It's quite tough to break the news. I won't ever forget Mr. P, a 55 year old white male with no previous medical history, a totally healthy guy who came to me with swelling of the face and neck. He had been experiencing for the last month or so increased swelling of his face and neck, particularly when leaning over e.g. when he would tie his shoes. He had also noticed some new intermittent shortness of breath. He came to the hospital to check it out and we did imaging which showed a significant "soft tissue" mass in his right lung. This mass had been likely growing for quite some time and was now almost totally occluding the Superior Vena Cava (SVC), one of the major veins that returns blood to the heart. He actually had significant "collateralization", which means that small accessory veins around the SVC had picked up the slack from the occluded big vein over time. This "SVC Syndrome" clearly accounted for his neck/face swelling and shortness of breath symptoms.
I recognized the possibility of cancer right away and had the tough job of breaking the news to this patient and his wife, who is a health care worker herself. This patient as I mentioned was totally healthy before. Had smoked cigarettes for 30 years but had totally quit 5 years ago. I explained to them sensitively and clearly what I thought was going on and what further testing we needed to do -- in this case we proceeded with a bronchoscopic biopsy of the lung mass. I got to know the patient and his wife quite well over the next several days, and was with them as they learned that the mass was in fact Adenocarcinoma of the Lung, spoke to specialists in Hematology / Oncology and Radiation Oncology, and set them up for all their future care needs. The prognosis is not good, but it was very fulfilling to be able to be there with these very pleasant people, answering their questions and helping to ease their very difficult transition into dealing with a new diagnosis of cancer. The wife gave me a big hug on the patient's discharge day, and I have been continuing to follow the patient's progress via the electronic charting. I hope his available chemotherapy and radiation therapy options, while not likely curative treatments, will at least allow this patient to lengthen his amount of quality life left and allow him to die with dignity and on his own terms. Oncology is a tough field, I'm glad that I didn't go into it, as I think that I do have a pretty high degree of sensitivity (though I can be kind of cold sometimes) and the weight of sharing in people's new cancer diagnoses over years and years would be pretty tough. I was glad though to have had the opportunity to participate in this gentleman's care and to have made a positive difference in his life.
Thursday, October 1, 2009
Clemency
Mr. C is a 57 year old african american male prisoner with a history of hepatitis C liver cirrhosis who presented to the emergency department with complaints of abdominal pain, diffuse bony pains, nausea, and loss of appetite. After pan-scanning Mr. C it became evident that he had widely metastatic cancer. Given the history of Hepatitis C and the prominent masses in his liver as well as a lab test called AFP which had rapidly doubled, it was thought that he had a type of Liver cancer called Hepatocellular Cancer. A biopsy of his Virchow's Node (left supraclavicular lymph node) confirmed my suspicions. The imaging showed likely metastases to his rib cage, spine, hip, adrenal glands, and spleen. This was late stage cancer, associated with an extremely poor prognosis. Mr. C probably had less than 2 months to live, and I had the tough job of telling him his diagnosis and likely prognosis. The attending physician and I decided to try to put a silver lining on this bleak grey cloud by petitioning to the judge to award Mr. C clemency, so that he could leave prison and spend his remaining days on earth with his family, including his young grandchildren who he had not yet gotten to see much of at all. I made numerous calls, and faxed over official paperwork to the judge's office stating that death for him was "imminent". There wasn't too much that we could do for Mr. C medically, but I did feel good to have helped him and his family in this small way.
Subscribe to:
Posts (Atom)
