Ramsay-Hunt Syndrome

Female middle aged woman with preceding flu like illness. She came in with acute onset of left ear pain. She developed some kind of tingling sensation on the right side of the face. She also complained of left ear tinnitus(ear ringing). 

Upon examination, she had left ear drum vesicular rash with some surrounding redness. 

The doctor narrowed it down to Ramsay-Hunt Syndrome caused by zoster virus. Patient was given short course of steroids and anti-viral medications and she completely recovered by follow up visit. 

Even if you're relatively young, you can still get the zoster virus!

ICD 9 to ICD 10 Transition

So I missed a couple of posts from some time off so forgive me.

This past month was very busy.

At the beginning of this month, there was the much heralded transition from the ICD 9 to ICD 10.

I'll give a brief summary again here. The CPT codes are the procedure codes that the physician checks off as he sees you. Depending on the complexity and time of the case, the physician has varying degrees of office codes in addition to any treatment codes such as vaccines, blood tests, or other procedures like EKG, etc.

Each of these CPT codes needs a corresponding ICD codes. These codes can ensure that the insurance companies can verify that these CPT codes or procedures were necessary as well as just having a documented recording of what was done.

The number of ICD 9 codes were 14,315 codes. ICD 10 will be bringing that number to more than 69,000 distinct codes.

Now why would they do this? I can list several reasons.

1. Not specific enough.

Some of the codes get very very specific. Down to the exact location. In the old ICD 9 codes some of the pain in XYZ place codes were very generic.

2. Reducing redundancy.

For example, vaccines had a CPT code and a corresponding ICD 9 code. Now they just have one vaccine code along with those CPT codes removing those ICD 9 codes.

However, there have been some transition troubles. With our EHR some of the codes we cant find on the system and our medical management software has some of them or doesn't have some of the codes. Some of the lab companies have had problems as well. We have a phlebotomist that can't find some of the ICD 10 codes that correspond with the ICD 9 codes. However, these are transition issues that I believe will resolve themselves over time as people adjust.

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.