Moving on. I'll just be using this blog to itemize my own thoughts. I am committed to attending medical school but the grind that I am going to go through will be difficult.
I have just finished my Sociology and Psychology requirements(have one more online course that I will take over the fall.)
I'll take 9 credits of GMU BCPM(Biology, Chemistry, Physics, and Mathematics courses) each in the Fall and Spring to boost my GPA.
I am beginning to volunteer at Jill's house and at ACHN free clinic in chantilly(though I still need to hear back from them--the free clinic that is.)
On top of this, I'll still be working at my mom's office.
And I'll be retaking the MCAT. But I know I can do it.
Monday, June 27, 2016
Thursday, April 7, 2016
Nine Lives
Patient, F, Mid 50s, Asian.
This was a previous patient with ventricular shunt, with h/o saggital vein thrombosis and aneurysm rupture as indicated in previous cases.
Patient develops acute severe onset of headache, fever, and neck pain.
She goes to the ER.
ER believes she has like cold symptoms.(It is unfortunate that the ER needs to see patients too quickly that sometimes things are missed.) Thus, they beleived her temperature was not high enough to be considered serious. Er sends patient home. Patient becomes more ill. Good son takes mother back to ER as her condition worsens.
ER conducts a CSF(cerebral spinal fluid analysis or Spinal Tap-side note great movie.) Doctors note that her symptoms are highly suggestive of acute meningitis. Meningism lining of the cover of the brain became irritated.
Patient is put on immediate IV and two ABs to cover gram positive and negative bacterial infections. My mother stated you cannot take a chance with a suspicion of meningitis. The fatality rates can reach upwards of 50%.
Wonderfully, patient recovered fully and fever broke within a few days. CSF never grew culture. Which is odd(basically it is to confirm the bacterial infection, but patient still survived.)
If you read through my cases, this is the same patient who has survived three times through
1) aneurysm rupture
2) Saggital vein thrombosis
3) bacterial meningitis.
You could say given these ridiculous chances, she might have six more lives like a cat.
This was a previous patient with ventricular shunt, with h/o saggital vein thrombosis and aneurysm rupture as indicated in previous cases.
Patient develops acute severe onset of headache, fever, and neck pain.
She goes to the ER.
ER believes she has like cold symptoms.(It is unfortunate that the ER needs to see patients too quickly that sometimes things are missed.) Thus, they beleived her temperature was not high enough to be considered serious. Er sends patient home. Patient becomes more ill. Good son takes mother back to ER as her condition worsens.
ER conducts a CSF(cerebral spinal fluid analysis or Spinal Tap-side note great movie.) Doctors note that her symptoms are highly suggestive of acute meningitis. Meningism lining of the cover of the brain became irritated.
Patient is put on immediate IV and two ABs to cover gram positive and negative bacterial infections. My mother stated you cannot take a chance with a suspicion of meningitis. The fatality rates can reach upwards of 50%.
Wonderfully, patient recovered fully and fever broke within a few days. CSF never grew culture. Which is odd(basically it is to confirm the bacterial infection, but patient still survived.)
If you read through my cases, this is the same patient who has survived three times through
1) aneurysm rupture
2) Saggital vein thrombosis
3) bacterial meningitis.
You could say given these ridiculous chances, she might have six more lives like a cat.
Monday, March 28, 2016
Liver
In a physician's toolbox, blood tests are obviously one of their primary weapons.
In this particular patient, his or her stats were the following(please remember I always get permission from the patients.)
Patient believed he ate something bad. Patient presented acute onset of fatigue, nausea, but had no vomiting, diarrhea, abdominal pain, and fever. physical appearance was unremarkable except a look of acute fatigue. BT results showed:
bilirubin, total - 2.0
alkaline phosphatase, S(stands for serum) - 125
AST (SGOT) - 181
ALT (SGPT) - 197
Reference ranges as follows in the BT:
0.0-1.2
39-117
0-40
0-44
Now remember my mother has always emphasized the relative percentage from the baseline. Any person can see that this person's numbers are abnormal.
These blood test names correlate with liver function. These numbers indicate acute liver injury or parenchymal(meaning inside the tissue rather than an obstruction. Thus bilirubin and alkaline phosphatase numbers would be higher if there was an obstruction.) In the liver, these two items will be most likely elevated in the obstruction setting.
US(ultrasound) confirmed no obstruction. Remember, I said relative, 2.0 to 1.2 and 125 to 117 is not that high.
Doctor started patient on an antibiotic for presumed bacterial gastroenteritis. After 1 tablet, the patient significantly improved. He or she felt much better.
Conclusion? It could have been some acute food poisoning that affected his liver. The reason this is interesting is that most food poisonings do not affect the liver(particularly the liver enzymes.) Sometimes that is the problem with medicine, you might never know the problem but as long as the patient gets better, the end result is fine. Doctors need to be humble that they sometimes .cannot figure out everything - you just need to accept the result. Just be happy that the patient feels better.(It still bothers my mother as to what it was but she just golfs it off.)
Wednesday, February 24, 2016
Lucky Storm
Recently, the east coast had the storm of the century. By the way, if you ever live on a driveway, you should absolutely purchase a gas powered snow blower. It is one of the greatest inventions of all time and made my family's time in the snow a lot easier.
But one of my mother's patients had some complications during the storm.
Middle aged white male with a history of hypertension, hyper cholesterol, and was non compliant with medications. During the storm, the patient was shoveling the snow as most people were doing. After he had shoveled the snow, he experienced a sudden onset of severe upper back pain and had difficulty breathing.
He called 911 and they took him to the nearest ER. However, because of the storm the nearest ER was at capacity and they had to take him to the next nearest hospital. At the new hospital, the pt stated he was have severe back spasms but after examination, the doctors determined that he had an aortic aneuysm near the aortic arch and he needed to undergo urgent repair of his aorta. He underwent cardio thoracic surgery and his aorta was eventually repaired.
The luck came into the picture as if he had simply waited at the nearest ER, that facility was not equipped to handle a complicated procedure that the patient required. Thankfully, there were no complications and the patient fully recovered.
But one of my mother's patients had some complications during the storm.
Middle aged white male with a history of hypertension, hyper cholesterol, and was non compliant with medications. During the storm, the patient was shoveling the snow as most people were doing. After he had shoveled the snow, he experienced a sudden onset of severe upper back pain and had difficulty breathing.
He called 911 and they took him to the nearest ER. However, because of the storm the nearest ER was at capacity and they had to take him to the next nearest hospital. At the new hospital, the pt stated he was have severe back spasms but after examination, the doctors determined that he had an aortic aneuysm near the aortic arch and he needed to undergo urgent repair of his aorta. He underwent cardio thoracic surgery and his aorta was eventually repaired.
The luck came into the picture as if he had simply waited at the nearest ER, that facility was not equipped to handle a complicated procedure that the patient required. Thankfully, there were no complications and the patient fully recovered.
Tuesday, February 23, 2016
Missed time/hiatus
Been busy lately but I have many exciting cases that I will be posting. I also had to get some permission from a couple patient cases that I had forgotten but there are some really cool cases as well as some personal ones. Stay tuned!
Thursday, February 18, 2016
Father's Eyes
My father has been experiencing quite a complicated case.
He has had underlying issues of diabetes and hyperthyroidism. Both conditions were intermittently under control.
Subsequently about 6 months prior, patient's eyes started tearing especially in windy conditions and increasingly in colder weather. Patient was also experiencing double vision in the periphery. Looking down and looking side.
At evening, difficulty driving as a result of double vision.
Patient went to the first ophthalmologist. Pt stated it was a very short office visit(first time visit) and stated it was rushed and ended in 15 minutes. Patient was told it was simply blephariitis and docotr said to sue baby shampoo(so the eyes won't tear) and wipe.
Patient then went to a second ophthalmologist. This physician was concerned about the underlying conditions of diabetes and hyperthyroidism. This doctor checked his eye pressure and there was borderline glaucoma, This physician was also concerned of my father's outward appearance of bluging eyes which can be indicative of Grave's disease(see earlier posts).
However, the patient continued to doctor hop as he wasn't receiving any effective treatment options. Pt then went to see a series of specialists including some of the leading ophthalmologist at JHU. The third ophthalmologist was able to explain his double vision. He had an orbital ultrasound test done that showed that there was hypertrophy his inferior and medial rectus muscles (there are six muscles in the eye that help you move around.) The double vision was the result of his eyes being misaligned from hypertrophy from those particular surrounding eye muscles.
The ophthalmologist concludes that the eye tearing is most liekly from inflammation which was blocking the tear ducts.(we have tear ducts that allow some tears to drain so we don't look like we're crying all the time.)
The best way to treat inflammation is through oral steroids. However problem with steroids is that it increase sugar level(which is a complication from diabetes) which can contribute to the glaucoma.
The ophthalmologist together with the endocrinologist that it would be take methylprenisode 16 mg bid.
PT was on new methyl-steroid significantly reduced tearing and with new prescription with new prism eyeglasses, pt has adjusted vision while it is early to tell he seems to be doing much better.
He will be having followups with ophthalmologist and glaucoma specialist and endocrinologist.
He was very frustrated that he had to see so many doctors. Some in the beginning where he felt that the physicians didn't really care about him. And I saw that it is so critical to make sure that the patient knows that the doctor cares about your problems. Obviously he had a very unique case with complicated underlying issues. But the doctor needs to make sure that the patient feels cared for and isn't just one appointment in a day of thirty.
He has had underlying issues of diabetes and hyperthyroidism. Both conditions were intermittently under control.
Subsequently about 6 months prior, patient's eyes started tearing especially in windy conditions and increasingly in colder weather. Patient was also experiencing double vision in the periphery. Looking down and looking side.
At evening, difficulty driving as a result of double vision.
Patient went to the first ophthalmologist. Pt stated it was a very short office visit(first time visit) and stated it was rushed and ended in 15 minutes. Patient was told it was simply blephariitis and docotr said to sue baby shampoo(so the eyes won't tear) and wipe.
Patient then went to a second ophthalmologist. This physician was concerned about the underlying conditions of diabetes and hyperthyroidism. This doctor checked his eye pressure and there was borderline glaucoma, This physician was also concerned of my father's outward appearance of bluging eyes which can be indicative of Grave's disease(see earlier posts).
However, the patient continued to doctor hop as he wasn't receiving any effective treatment options. Pt then went to see a series of specialists including some of the leading ophthalmologist at JHU. The third ophthalmologist was able to explain his double vision. He had an orbital ultrasound test done that showed that there was hypertrophy his inferior and medial rectus muscles (there are six muscles in the eye that help you move around.) The double vision was the result of his eyes being misaligned from hypertrophy from those particular surrounding eye muscles.
The ophthalmologist concludes that the eye tearing is most liekly from inflammation which was blocking the tear ducts.(we have tear ducts that allow some tears to drain so we don't look like we're crying all the time.)
The best way to treat inflammation is through oral steroids. However problem with steroids is that it increase sugar level(which is a complication from diabetes) which can contribute to the glaucoma.
The ophthalmologist together with the endocrinologist that it would be take methylprenisode 16 mg bid.
PT was on new methyl-steroid significantly reduced tearing and with new prescription with new prism eyeglasses, pt has adjusted vision while it is early to tell he seems to be doing much better.
He will be having followups with ophthalmologist and glaucoma specialist and endocrinologist.
He was very frustrated that he had to see so many doctors. Some in the beginning where he felt that the physicians didn't really care about him. And I saw that it is so critical to make sure that the patient knows that the doctor cares about your problems. Obviously he had a very unique case with complicated underlying issues. But the doctor needs to make sure that the patient feels cared for and isn't just one appointment in a day of thirty.
Monday, February 1, 2016
Bad food
This case was a typical one but one that healthy middle aged woman.
After eating a hotdog and a pizza at a well known wholesale food court within one and a half hours, she developed severe abdominal cramps and profuse watery diarrhea. She also had nausea and vomiting for the rest of the day.
She was taken to the ER and was given a massive amount IV fluids and antiemetics(anti vomiting medication) and within two days she fully recovered.
What was the problem?
It was most likely staphylococcus aureus, which is an exotoxin related illness. Given that the patient's symptoms had a very acute onset within 3-6 hours after her meal and her very fast recovery.
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