Shadowfax finds a kidney stone in a “known drug seeker” and treats her with toradol. Success. I had a somewhat similar case with a “known homeless drunk” who had pretty severe electrolyte derangements after I bothered to check, despite nurse balking. Only re-iterates the point: trust no one.
In two common infections of the vagina, bacterial vaginosis (and sometimes in trichomonas vaginalis) your doctor may do a “whiff” test, where he or she takes some discharge, drops some potassium hydroxide on it (a base, KOH) and smells it for a fishy, foul odor. The base causes some foul-smelling amines to be released: cadaverine and putrescine. What great names.
Interestingly, some women will complain of foul odor after intercourse, and the reaction is the same: semen is basic, and when it mixes with the discharge, you get the same release of cadaverine and putrescine. Cool
Flea (RIP) used to talk about the medicalization of childhood–that kids don’t just run the spectrum of normal variation, that everything nowadays has to be a diagnosis or a pathology that requires treatment. I’ve started to come across the same thing in pregnancy.
There’s this strange phenomenon that several of the docs, nurses, and assistants have commented on–that women will come in, having missed their periods, taken several at-home pregnancy tests, all positive, and still want or need the doctor to “deem them” pregnant. (Plus often a number of the pregnancy changes: nausea, vomitting, breast tenderness, bleeding gums, etc.) Just seems strange that in some ways we’re so out of touch with our bodies–or at least the “natural” changes of them–that we need some “authority on bodies” (doctors) to concur with our own diagnosis.
I guess you can take this a step further and apply it to a lot of common complaints: a weird twitch somewhere, a strange sensation. In some ways it makes sense–you see plenty of patients who wait too long before they see a doctor for what turns out to be a heart attack, or cancer, or stroke, or out of control diabetes–and you wonder how they could possibly have waited so long. And on the other hand, you have people coming in for weird aches and feelings that are just typical, natural weirdness of our bodies.
Sometimes I wonder if a lot of the extremes are due to the break up of the extended family, and the more migratory lives of people. Had a newly-pregnant woman been living with her parents or grandparents, the mothers would just immediately recognize, “Duh, you’re pregnant.” Likewise, the guy who looks green and is clutching is chest might be convinced to seek medical care if his family members urge him to.
I volunteered this past Sunday at one of our free student-run clinics and was working with mostly pre-clinical students. We talked a bit about applying to residency, and we practiced blood pressures on each other. One student remarked, “I can never hear the sounds!” and I told him to turn his stethoscope around. It was adorable. And reminded me of when I had to have that pointed out to me, and that I had to remember “earpieces point TOWARD the patient!”
Another student practiced presenting to me about a guy with GERD, and I asked a couple follow-up questions and the student said he hadn’t asked my follow-ups. I told him that was totally normal, fine, and not a big deal. I guess anyone can probably learn most things if they’ve been at it long enough (4.5 years and counting for me), but it was still amazing to me that I’ve become fairly good at making diagnoses on my feet, multi-tasking differentials while still talking to patients, asking pertinent follow-up questions. It’s pretty cool. A similar feeling to mastering a foreign language, I think.