Showing posts with label Medicine. Show all posts
Showing posts with label Medicine. Show all posts
Sunday, January 30, 2011
Sunday, May 2, 2010
Hunter Holmes McGuire
The Hunter Holmes McGuire VA Medical Center, where I proudly served our nation's veterans of war as an intern in Internal medicine for 5 1/2 months during 2009-2010.
Friday, February 5, 2010
Crohn's cat
Theenie decided to spend the evening studying the difference between Ulcerative Colitis and Crohn's disease. I expect a full report in the morning.
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 . . .
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.
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.
Saturday, September 12, 2009
Hammer paged
Being hammer paged is the phenomenon during intern year where your pager goes off every 1 minute. While on the phone & putting in orders into the computer for one patient you are getting paged about the next, and then pages can stack up pretty quick. Having an organized system for dealing with being hammer paged is key.
Monday, August 10, 2009
Just say no
Today I had to tell a patient that I wouldn't give her a prescription for more pain pills. While this patient, a 52 year-old woman with atypical chest pain (i.e. NOT a myocardial infarction or angina) was in the hospital I put her on Morphine to manage her chest pain. This was appropriate given the severity of her pain and the fact that the initial workup did include acute coronary syndrome (i.e. a real deal heart attack). However, when arranging her discharge she asked for more pain meds and on research I found that she had already been prescribed a month supply 1.5 weeks ago . . . so likely this was drug-seeking behavior and I could not in good conscience double cover this lady . . . despite the fact that she told me I was "the best doctor she had ever had" . . . which may have been more attributable to her learned skill of successful drug-seeking behavior than to my skills as a physician. There's a dose of Richmond, VA reality for ya.
Tuesday, August 4, 2009
Night float
Working the night shifts at the Cardiac / Coronary ICU. Day starts at 7:45 PM and usually ends 9-10 AM this next morning. The part that feels weird is coming back to work the same day you left . . . I am though starting to get used to coming home and getting some sleep during the day. Which is tough to me because I think I have a sensitive Suprachiasmatic Nucleus. Whaa??
We think that the day / night circadian rhythm in humans is regulated by sunlight hitting the retina and triggering signals to flow down neurons to the suprachiasmatic nucleus (SCN), a small area of the brain located in the hypothalamus. The SCN in turn causes the pineal gland (another brain structure) to dole out certain amounts of the hormone melatonin. Melatonin levels in your body peak at night and get low during the day, and are involved in creating your proper sleep / wake physiologic balance.
So the bits of sunlight coming past the shades in my bedroom during the day is kind of messing with me a little. But I'm adjusting. Wonder how much the flip side -- sitting in a dark room all day as a Radiologist -- will affect me . . . think I should probably make sure to eat lunch outdoors every day to trigger the SCN / pineal gland (and take care of sunlight-derived vitamin D production too!)
We think that the day / night circadian rhythm in humans is regulated by sunlight hitting the retina and triggering signals to flow down neurons to the suprachiasmatic nucleus (SCN), a small area of the brain located in the hypothalamus. The SCN in turn causes the pineal gland (another brain structure) to dole out certain amounts of the hormone melatonin. Melatonin levels in your body peak at night and get low during the day, and are involved in creating your proper sleep / wake physiologic balance.
So the bits of sunlight coming past the shades in my bedroom during the day is kind of messing with me a little. But I'm adjusting. Wonder how much the flip side -- sitting in a dark room all day as a Radiologist -- will affect me . . . think I should probably make sure to eat lunch outdoors every day to trigger the SCN / pineal gland (and take care of sunlight-derived vitamin D production too!)
Buddycare
The latest crisis in the health care world: our cat "The Buddy" has been vomiting for several weeks straight. He's still eating, drinking, pooping normally, he just vomits out partially digested feeds 1-2 times per day. The vet initially thought it was a stomach bug and gave him an antibiotic shot (Flagyl, I think). This didn't help. I was wondering if he might even have pain-induced vomiting from a kidney stone. Sweewawa took him back to the vet today. Turns out cats don't usually get kidney stones (get bladder stones instead). Got an xray of The Buddy (a process which I hear hey enjoyed immensely) which is quite cool to see! I've included it below.
Some things to point out that are fun to see --> you can clearly see the spine along the top of the image going to join with his hip / rear legs on the right, and you can see the tail leaving the spine. You can see the thin kitty ribs along the left side of the image and the dark area with the thin white lines is his lungs with vessels. To the right of the lungs in the image is a bright (white) area that is his kitty liver (not kitty litter). The loopy loops in the middle are his intestines, and you can see air (dark color) and stool (mottled whiter color). Apparently (I wouldn't have picked this up from my own Radiology training) this pattern of air / stool in the intestines is consistent with some serious hairball buildup. So he's on some oral treatments (special food & some tuna-flavored laxative) that will help him with this. So $275 later we have a correct diagnosis and an appropriate treatment . . . I hope. One thing, I was glad that the diagnosis arrived at was hairballs -- something completely out of the realm of what I learned in medical school and beyond. So I have an excuse for not arriving at the diagnosis before the vet :)
Some things to point out that are fun to see --> you can clearly see the spine along the top of the image going to join with his hip / rear legs on the right, and you can see the tail leaving the spine. You can see the thin kitty ribs along the left side of the image and the dark area with the thin white lines is his lungs with vessels. To the right of the lungs in the image is a bright (white) area that is his kitty liver (not kitty litter). The loopy loops in the middle are his intestines, and you can see air (dark color) and stool (mottled whiter color). Apparently (I wouldn't have picked this up from my own Radiology training) this pattern of air / stool in the intestines is consistent with some serious hairball buildup. So he's on some oral treatments (special food & some tuna-flavored laxative) that will help him with this. So $275 later we have a correct diagnosis and an appropriate treatment . . . I hope. One thing, I was glad that the diagnosis arrived at was hairballs -- something completely out of the realm of what I learned in medical school and beyond. So I have an excuse for not arriving at the diagnosis before the vet :)
US Health Care is top notch
An interesting report was prepared by a senior fellow at the Hoover Institution and a professor of radiology and chief of neuroradiology at Stanford University Medical School by the name of Scott W. Atlas:
http://www.hoover.org/publications/digest/49525427.html
http://www.hoover.org/publications/digest/49525427.html
Monday, August 3, 2009
Sunday, August 2, 2009
still going strong
Still going strong in the Cardiac ICU. 30 hour shift (with no sleep) from Fri --> Sat. Then starting night shifts on today --> Thu. It's pretty intense. Have also already encountered many interesting ethical issues. Whether or not to continue life support in a patient who is brain dead . . . how much care to provide for patients who are illegal immigrants . . . how to handle patients whose own reckless lifestyle keeps landing them back in the Emergency Department or ICU . . . the list goes on and we see these cases every day.
One great piece of advice passed along to me by a really excellent resident: always assume a test you're ordering will be negative (or an intervention you are ordering won't help) and know what you'd do next. In other words, always be thinking one step further down the chain. It's an essential skill in chess and is equally important in inpatient wards. You don't take that pawn with your rook just because the move is there . . . you do it because affects your opponent's next move, which sets you up for the next move, which affects your opponent's next move . . . which sets you up further. The person with chest pain who looks like he's having a heart attack but the cardiac enzymes you ordered are negative and the EKG is non-ischemic . . . always gotta have a "what's next" in mind . . .
One great piece of advice passed along to me by a really excellent resident: always assume a test you're ordering will be negative (or an intervention you are ordering won't help) and know what you'd do next. In other words, always be thinking one step further down the chain. It's an essential skill in chess and is equally important in inpatient wards. You don't take that pawn with your rook just because the move is there . . . you do it because affects your opponent's next move, which sets you up for the next move, which affects your opponent's next move . . . which sets you up further. The person with chest pain who looks like he's having a heart attack but the cardiac enzymes you ordered are negative and the EKG is non-ischemic . . . always gotta have a "what's next" in mind . . .
Wednesday, July 29, 2009
Death certificate
Today had to pronounce a patient dead. Quite an experience. This was a 47 year old african american male with a past medical history significant for hypertension and cardiovascular disease who had suffered a cardiac arrest. His heart had stopped for unknown reasons, he was resuscitated by EMS personnel, and brought to the hospital where he was started on Arctic protocol. This is a relatively new medical advance whereby we cool the blood of patients with recent cardiac arrest, bringing down their overall body temperature, with the intention of trying to save brain. In some patients it works, in this patient it did not. He likely had just suffered to much of an anoxic (no oxygen) brain injury from his arrest. So after rewarming him from the Arctic protocol, he was found by Neurologists to be brain dead. Still he remained on a ventilator, and we were keeping him "alive" with machines and fluids. Once we confirmed his brain death then the tough decision had to be made to take him off the ventilator. We discussed the medical course and the plan at length with his family. It was quite tough for them. This man was still relatively young, I think it was quite hard for them to let go, even with the knowledge that he was essentially already dead.
So with about a dozen family members around, we prepared to withdraw the ventilator support. We kept only IV fluids and medications to prevent him from having seizures or pain. Then we removed the breathing tube, and this young patient slipped away quietly into the day. Without the ventilator his brain did not tell the muscles of his diaphragm to keep breathing. He took no more breaths, so slowly his heart ran out of oxygen and it too stopped beating. I watched this process on the telemonitor, while trying simultaneously to be there in a caring way for the family. They cried, in fact they sobbed quite loudly. The emotion in the room was palpable. But in this scene I still had to do my job. I confirmed that he had in fact passed away, by feeling for pulses, examining his pupils for any response, and listening for any breathing.
He had passed away, and after consoling the family some more, I went to fill out the required paperwork, including the death certificate. Felt kind of weird, to have experienced as a 3rd year medical student the joy of helping to deliver babies. Now I had completed the other bookend, and had officially declared the end of life. Being a doctor really does mean being a part of the whole life process from beginning to end.
Monday, July 27, 2009
CICU
First day of Cardiac ICU. Wow. It's as intense as I thought it would be. Within hours of arriving I was helping with a "Code". That means cardiac arrest, the real deal with chest compressions, shocks, the whole nine yards. The rest of the day was House-style rapid-paced differential diagnosing on multiple patients at once. One thing about manning the CICU . . . you can never claim that it's boring. Hours today: awoke at 4:30 AM, shower/breakfast/headed to hospital, back by 9:30 PM. Not much time for much else besides eat and sleep now . . . back to work same time tomorrow morning.
Saturday, July 25, 2009
Just beat it
I was really struck with a patient who I encountered while manning the Pulmonary clinics this week. This 65 year old gentleman had been hit by four separate cancers and had beat them all. Throat, Lung, Prostate, Colon. Definitive treatment completed, still going strong. He tells me, "If another one pops up, you cut it out and I'll beat it again." What gutsy determination! This guy credits the fact that he's still alive to his attitude and willpower. I think it's quite possible he's stumbled on the power of the mind . . .
Tuesday, July 21, 2009
Patent-able idea?
Today, on the spur of the moment, came up with a draft of an idea for a medical device / method for helping to cure patients with Bronchopulmonary Fistula (BPF). I've gotten some good feedback on the idea already and may move forward with testing / patenting / etc. It actually felt pretty neat to turn my creative side on today, even if this doesn't result in an actual patent or my name on a device . . . Cheers, Dr. Kowawa
Monday, July 20, 2009
So Much to Say
OK, so a lot has been happening. So chronologically and briefly . . .
"Pull" went well. Spent two days wearing the Inpatient Digestive health hat. I happened to have seen a boatload of patients with liver problems. Most frequent patient was a 60ish male with a history of alcohol abuse or hepatitis infection who presented with liver cirrhosis and the complications that accompany it -- for example ascites, or fluid in the belly. The liver produces proteins, and proteins such as albumin help keep the fluid part of blood (plasma) inside of the blood vessels. Low protein --> fluid seeps out of the vessels into the belly. One guy I saw had gained 19 lbs of fluid to his belly in 1 month. So we tap it . . . and drain it off. And replace the proteins via IV . . . and do lots of other stuff. The experience was incredibly fast paced, pager going off constantly, balancing several things at once, but it was a great learning experience. This kind of busy-ness is the quintessential intern experience . . .
On Friday got up at 5:15 AM, got ready, went to the hosptal, and didn't get home until 10:15 PM. On returning sweewawa and I had a late dinner, and then I got an email from my Mom. Turns out Dad had a freak fall -- ruptured both quadriceps tendons while doing his normal walk on the trail near the local high school. No trauma, just a sudden snap and then both legs were flexed as he fell to the ground. Without the balancing force of the quadriceps the muscles of flexion worked unopposed. To make matters worse as my poor dad struggled to get up a bunch of hornets stung him repeatedly. It must have been awful!! So he was taken by ambulance to the hospital where I was born, and by the next day (Saturday), after XRays and MRIs a orthopedic surgeon had gone in and re-attached the tendons to the patella using sutures and metal hooks. Quite an ordeal.
So during all this time I was doing my homework. It's exceedingly rare for someone to have bilateral rupture of the quadriceps tendons. Typically one of those rare individuals will have a underlying condition -- kidney failure, diabetes, prolonged steroid use, recent fluoroquinolone (an antibiotic) use, lupus . . . my dad had none of these things. But my Mom told me incidentally that he had recently been started on a Statin, the leading drug used to lower cholesterol. And I had an inkling in my mind that I had learned in med school or out in practice that there was this VERY rare side effect of tendon problems in Statin users . . . and looked it up. It's not an official adverse event listed on the drug info, but there have been case reports of people with tendonitis and tendon rupture on the drug. So I'm intrigued and have been learning all I can about this. I may write this up for publication.
My parents were just getting ready to leave for a trip to Europe, followed by a year of working in England. Now all the plans have to be postponed / modified as my Dad goes through rehab. It's all pretty hard on him -- he definitely isn't enjoying being pretty much totally confined to the bed for most of the day. Who would like that? I really hope the recovery is complete and as fast as can be -- and I'm trying to be supportive emotionally and from a physician standpoint . . .
So since that I've headed back to Pulmonary Consults at the Veterans hospital. Stayed late this evening. Got to do a lot of interesting stuff. Did my first ever emergent flexible bronchoscopy. Briefly, had a patient who had gunk (yes, that's a medical term) in his airways and couldn't breathe. The arterial blood gas numbers and portable chest radiographs were starting to look screwy. I used a long scope to traverse the tunnels of the bronchi (lung airways), then suctioned it out. Problem solved, very rewarding to practice that kind of medicine.
"Pull" went well. Spent two days wearing the Inpatient Digestive health hat. I happened to have seen a boatload of patients with liver problems. Most frequent patient was a 60ish male with a history of alcohol abuse or hepatitis infection who presented with liver cirrhosis and the complications that accompany it -- for example ascites, or fluid in the belly. The liver produces proteins, and proteins such as albumin help keep the fluid part of blood (plasma) inside of the blood vessels. Low protein --> fluid seeps out of the vessels into the belly. One guy I saw had gained 19 lbs of fluid to his belly in 1 month. So we tap it . . . and drain it off. And replace the proteins via IV . . . and do lots of other stuff. The experience was incredibly fast paced, pager going off constantly, balancing several things at once, but it was a great learning experience. This kind of busy-ness is the quintessential intern experience . . .
On Friday got up at 5:15 AM, got ready, went to the hosptal, and didn't get home until 10:15 PM. On returning sweewawa and I had a late dinner, and then I got an email from my Mom. Turns out Dad had a freak fall -- ruptured both quadriceps tendons while doing his normal walk on the trail near the local high school. No trauma, just a sudden snap and then both legs were flexed as he fell to the ground. Without the balancing force of the quadriceps the muscles of flexion worked unopposed. To make matters worse as my poor dad struggled to get up a bunch of hornets stung him repeatedly. It must have been awful!! So he was taken by ambulance to the hospital where I was born, and by the next day (Saturday), after XRays and MRIs a orthopedic surgeon had gone in and re-attached the tendons to the patella using sutures and metal hooks. Quite an ordeal.
So during all this time I was doing my homework. It's exceedingly rare for someone to have bilateral rupture of the quadriceps tendons. Typically one of those rare individuals will have a underlying condition -- kidney failure, diabetes, prolonged steroid use, recent fluoroquinolone (an antibiotic) use, lupus . . . my dad had none of these things. But my Mom told me incidentally that he had recently been started on a Statin, the leading drug used to lower cholesterol. And I had an inkling in my mind that I had learned in med school or out in practice that there was this VERY rare side effect of tendon problems in Statin users . . . and looked it up. It's not an official adverse event listed on the drug info, but there have been case reports of people with tendonitis and tendon rupture on the drug. So I'm intrigued and have been learning all I can about this. I may write this up for publication.
My parents were just getting ready to leave for a trip to Europe, followed by a year of working in England. Now all the plans have to be postponed / modified as my Dad goes through rehab. It's all pretty hard on him -- he definitely isn't enjoying being pretty much totally confined to the bed for most of the day. Who would like that? I really hope the recovery is complete and as fast as can be -- and I'm trying to be supportive emotionally and from a physician standpoint . . .
So since that I've headed back to Pulmonary Consults at the Veterans hospital. Stayed late this evening. Got to do a lot of interesting stuff. Did my first ever emergent flexible bronchoscopy. Briefly, had a patient who had gunk (yes, that's a medical term) in his airways and couldn't breathe. The arterial blood gas numbers and portable chest radiographs were starting to look screwy. I used a long scope to traverse the tunnels of the bronchi (lung airways), then suctioned it out. Problem solved, very rewarding to practice that kind of medicine.
Wednesday, July 15, 2009
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