Liver

A patient came in with known history of liver cancer. He came in with itchy skin and it was clear the patient of suffering from jaundice. He had yellow eyes and yellowish dark skin. Even though he has a dark tanned complex it was still obvious that he had yellow skin. Yellow eye (sclera)

He was also having a fever, loss of appetite, and indigestion plus abdominal bloating and mild chills. Doc thought that he might have growing existing hepatoma blocking the bile duct causing obstructive jaundice associated with fever consistent with acute bile duct infection(acute colongititis) Or bile duct stone. He was sent to ER and admitted to regular medical care. They confirmed acute colongitis from growing hepatoma. He underwent immediate ERCP(define) endoscopic Sphrinctroctomy.

The surgery relieved the obstruction but he suffered arterial injury complications. He had to take 4 units of transfusion.

I just found it really interesting how the symptoms were so pronounced in his skin color and general condition.  One look and it was clear the patient was seriously ill.

Boops! I did it again...

50 year old lady came in with a history of RA, rheumatoid arthritis. She also had many joint deformities. Her symptoms were nasal congestion, yellow phlegm, hoarseness, shortness of breath, and severe coughing. Her condition was not improving before she came to Doc. An x-ray order showed a hazy density in her lungs. She was then referred to her pulmonologist (or pulmonary disease specialist, one who specializes in treatment of pulmonary conditions or diseases).

The pulmonologist determined that she had boop. (Yes, this is an actual term. It is an acronym for Bronchiolitis obliterans with organizing pneumonia.) Basically the tiny sacs or alveoli and small bronchi become very inflamed and infected causing severe pain, coughing, and other symptoms.

She underwent a very high dose of steroids.

However, from the huge influx of steroids the patient developed Cushing syndrome.

Cushing syndrome is developed in two ways, either intrinsically or extrinsically. This was an extrinsic case as she was consuming prednisone.

Cushing Syndrome Symptoms: moon-face, weight gain, increased blood pressure, hump neck, increase in blood suger, edema, and reddish, unusual stretch marks.

Her steroids were gradually tapered off over time and she was eventually cured.

I see people...

A young woman came in complaining of a severe headache in the front part of her head.

According to the patient, the headaches would usually happen before the start of her periods. This time however the headache started after her period. The patient was experiencing nausea and vomiting. She was very sensitive to loud sounds and light. It was a recurring headache every menstrual cycle. But there were no other neurological symptoms. Patient denied any family history of migraine headaches.

Doc concluded that menstruation related to migraine headaches was the likely cause. This diagnosis makes sense because of hormonal changes during a period.

Treatment options were simply anti-migraine medicine (sumatriptan). The medicine does not prevent headaches, only relieves the symptoms before it starts.

Doc noted that some some patients experience a visual "aura". Some people see some light changes in their vision. So it is almost like a clue that a migraine headache was the likely cause.  In extreme cases, some people can get a stroke from their migraine headaches.

Allergy

In the office, we decided to bring in allergy prick testing. It is very simple. All you have to do is grab the prick device dip it in the wells and apply it to the patient's skin. Then after 30 minutes compare it to the positive control (histamine) and compare.

The common treatments for allergies are usually OTC medications like allegra or claritin. However, for some patients these medications are not enough. So they turn to treatment options such as SCIT(subcutaneous immunotherapy). This involves the patient coming into the office and receiving shots of the specified allergens according to their allergy test. They then receive shots of increasing concentration until they can reach "maintenance" or to the point where they only need to take a shot once a month to maintain their allergy relief.

I personally did SCIT at one point. However, continually going into the office and continually paying a copay adds up very quickly. In Europe, there is a very similar treatment called SLIT(sublingual immunotherapy). You simply apply the treatment under your tongue and increase the concentrations over time. It is not as accepted in the states but it very well could be.