November on the Wards

Wow.  Over a month since my last post!  I apologize for this outrage.  Things were going so well, but in between the month of November on the wards, and my spare time being taken up by sleeping, eating, drinking wine, watching prison break season 1, and facebook, I overlooked writing in my blog. 

As my month on the wards comes to an end, I have seen a lot of interesting stuff!  You non-medical folks may be bored by this, but it is quite interesting for us "med-nerds".  Take my one guy who came in with high fevers to 103, with headache and body aches.  No other symptoms really. He was sent home by another hospital ER, and told by his doctor he had a flu.  When I saw him, all his blood tests were normal.  Nobody seemed to know what was going on.  When examining him, my intern and I saw a slight vesiculopapular rash on his upper back and chest--small dark papules, that almost looked like chickenpox.  Then I found this 2cm, dark, swollen eschar on his left arm.  Right away I knew the diagnosis.  Ricketssialpox!  That's right.  A mite-born illness (the ones that live on mice), that is quite common in NYC.  Strictly diagnosed by physical exam. Started him on doxycycline, and he was better the next day!

We had another guy come in to one of the other teams with high fevers, headache,  myalgias, diarrhea, a petechial rash and thrombocytopenia on his blood tests (low platelets).  He had just come from Dominican Republic.  This was an easy one.  Dengue Fever!

I had another lady come in with swelling of her legs.  She also complained of muscle aches, weight gain, and headaches, and also had irregular menses.  On her exam, she was obese, had a lot of acne, swollen legs, a round face, and a lot of fat on the back of her neck.  Her blood tests showed hypokalemia (low potassium), and a high cortisol level with low sex hormones.  We did a dexamethasone suppression test, which was abnormal.  Given her headaches, we went straight for the brain MRI, and there it was. A sizeable pituitary tumor (part of the brain that makes hormones), consistent with Cushing's Disease!

And of course there is all the hype about MRSA (Methicillin Resistant Staphylococcus Aureus).  Despite all the airtime that MRSA gets by the press, I assure it has been around for many many years.  Even the "community acquired MRSA", meaning MRSA that healthy people get outside of the hospital, has been around.  And there is no disease called "MRSA".  That is simply the bacteria (just a very sly Staph bacteria that is resistant to many traditional antibiotics), that infects different things--cuts and wounds, urine, heart valves, blood, brain, etc.  It needs specific antibiotics to kill it (Vancomycin being the standard, which is intravenous, but many MRSA strains also respond to oral bactrim and clindamycin), and it can be very aggressive and life-threatning, but so long as you catch it early, you should be fine.  So don't worry about "getting the MRSA!" Unless you have a reason (cuts and injuries, indwelling catheters/lines, or prosthetic heart valves being the most common).