Rheumatology Shadowing

So this past week, I shadowed a great rheumatologist, Dr. Gradzka everyday.

Rheumatology is the study of of rehumatism(autoimmune diseases), arthritis, and other disorders of the joints, muscles, and ligaments.

It was really great to see other specialities of internal medicine. Especially with the advancement of biologics, the medicines available to treat some of the diseases has advanced. But for some of the patients there is frankly nothing that can be done except with the treatment of steroids. However, one has to be very careful of relying on steroids as they can have serious complications(see the Dr.Google case.)

It was funny, Dr. Gradzka mentioned that gold injections were once the go-to treatment. It goes to show how far medicine and treatments have advanced.

A Doctor's Touch

A video that I saw a while ago after reading Verghase's book(An incredible read)

A simple concept but a powerful, touching one nonetheless.

New Saliva Test for Alzheimers

As testing becomes more and more sophisticated and easier (see Theranos for simpler blood tests), one wonders what role the analytical aspects of a doctor will play, if anything at all.  With technology getting better and better and more widespead -- even sold by CVS for example), one wonders how doctor of the future must deal with such technologies.

I believe, however, that even with such tests, the training that doctors get and should continue to get should be an integral part of not only their training but also how they will practice medicine.  Costs will be a consideration even if a test is good as well ease of use and false negatives that will give such tests credibility.

Occipital Stroke

Pt comes in complaining of vertigo and dizziness. The Pt had fallen because of the dizziness but he did not have any balance problems. He complained of low energy, very tense, and could not relax because of these symptoms. He had earlier stopped all of his medications because he believed that they were causing his his vertigo.

Upon examination, the Dr. confirmed the symptoms and checked that he had no vision problems, no vomiting, and no chills. Dr. conducted a neurology exam and it was non-specific. Doctor ordered an MRI. The results revealed that the pt had an occipital stroke.

Pt is retaking his medications under doctor's orders. He was subsequently admitted to the hospital for further evaluation and management.

Close call

Pt called the office complaining of nose bleed and post nasal dripping.

Pt insisted that he did not have any other associated problems. Dr. advised him on the phone that he should go to the ER given that he underwent recent heart surgery and stress related issues.

Pt checked into ER for nose bleed and bloody sputum(a mixture of saliva and mucus coughed up from the respiratory tract.)

Chest x-ray in ER revealed some infiltration suggestive of pulmonary tuberculosis which was confirmed by sputum stain.

The ER had to immediately isolate the Pt. Pt is now taking multiple anti-tb medications under supervision. (They need to be supervised because if the pt misses a dose, it can be detrimental to cause multi-resistant TB.)

We still have to be vigilant of infectious diseases like TB.

It certainly was a close call as we could have also been infected.

Tech Docs...

So, even docs are not being lured by the tech siren calls....guess it's true that people went into medicine for money after all...

But young docs thinking about making millions in health tech may want to keep in mind that out of 19 named employees in the hot health startup, Rock Health, only one has an MD degree...not much of an opportunity for MDs there...

Although I can understand why the lure of tech for a group of highly educated people who are likely forced into mind-numbing routines might happen.  I work in a doctors office as an office manager and I can truly say that if policy makers don't make it a priority to keep docs in the profession, they will soon find themselves on the operating table without anyone to attend to them.

Dr. Google

Young white female presented with a history of chronic eczema or atopic dermatitis. She had this condition over several years all over her body. The chronic skin condition not only affected her physical wellbeing but negatively affected her mental wellbeing as it was very visible across her face and limbs. As a result, she had not maintained a full time job for two years.

She was using a topical steroid cream, cortisone for about one and a half years, as recommended by her doctor. After some time of steroid use, the patient was disappointed with the progress of the her skin condition, And in fact, when the patient googled the fact that steroid creams were actually bad for the skin, she was even more alarmed. So, the patient decided to suddenly stop using the cream without consulting Doc.

For the next two months, the patient had difficulties controlling her temperature when it was either cold or hot, persistent dizziness, nausea, loss of appetite, and her entire skin was swelling and oozing. She did not, however, visit the doctor because her parents told her that her reactions were the result of her own mental and psychological problems, not because of any other issues.

Finally, the patient decided to go see the doctor and explained everything, including how she found out that steroid creams were not good for her and why she stopped it suddenly and the additional conditions after she stopped using the steroid creams.

 The doctor explained that when you administer exogenous (originating from outside the patient) corticosteroids, it disturbs the negative feedback loop. The body stops producing its own corticosteroids, because the it is constantly receiving it from outside sources. So, when the patient stopped using the steroids, it has severe adverse effects on the body and can push the body into an adrenal crisis. The Doctor mentioned that in some cases the death rates for adrenal crisis like the one that the patient suffered from by stopping the steroid cream is extremely high, as much as 50%.