How Do Doctors Get Fat?

Also titled: Doctors Have No Imagination

Or: How do doctors manage to have an apetite?

This is not a judgemental post. It is just an example of why I think doctors have deep-seated love-hate relationships with food.

When you have scarlet fever, you get a strawberry tongue:

Babies born to mothers with Syphilis can get Blueberry Muffin Syndrome:

Upper gastrointestinal bleeding can lead to coffee ground vomiting (and this is just a picture of real coffee grounds, because apparently nobody has ever been intrigued enough by their coffee-ground vomitus to photograph it):

And lastly, Granuloma Inguinale (an STI caused by Callymatobacterium Granulomatis) causes a characteristic beefy-red ulcer. And no, I won’t post a picture of that.

Could Computers be an Infectious Risk?

My dad works a lot with Health Informatics, and is very involved in the digitalising of South African health care systems, especially when it comes to tele-health.

Recently, one of his colleagues mentioned something genius in its simplicity:

There has been a big push to computerise the administration of hospital wards – and with good reason. Even in rural South African hospitals, there are several large mobile computers (we call them COWs – computers on wheels) to be found in wards.

So, what does a computer consist of? A screen, sure, some network cables… and a central processing unit with a motherboard, which generates heat. Lots of heat.

Because of that, it also has a fan. And this fan draws air inwards to cool the CPU down.

I have a point, stay with me here:

Hospitals, as we know, are full of sick people. Obviously. And by far the greatest percentage of those are infectious diseases. And where do most of those pathogens thrive (apart from inside humans)?

In nice warm environments.

In the normal office, this is not such a problem. But in a hospital, where many different pathogens congregate, creating such a comfortable environment for bacteria is nothing short of ludicrous.

It would be interesting if sombeody did some sort of study on this. I’m sure someone in my dad’s department will, in due time. I know for sure that I don’t want to expose my patients (especially not the immuno-compromised ones) to such an onslaught.

I know that in more privileged countries, tablets are becoming the new best way for digital solutions in hospital.

Could this perhaps be the safest way out?

Mad Genius, or Simply Genius?

The latest worldwide Armageddon scare is man-made: Scientists at the Erasmus Medical Centre in the Netherlands have created a mutation of the Bird Flu virus (H5N1) that could literally wipe out half of Earth’s population.

Bird flu kills more than 50% of all people it infects. The reason it hasn’t caused mass annihilation thus far is because it is not transmissable from human to human.

But this new strain is.

Sometimes we do something just to prove that it can be done.

Sometimes we do something for the greater good. These scientists claim that their research can assist in manufacturing a vaccine. Can it? Probably.

Two things are scary here:

1. The fear of bioterrorism
2. The fear of forced population control

I have no doubt these scientists are brilliant, but is it really in the globe’s best interest to design this thing?

What do you think?

 

We See a Light

As part of Infectious Diseases, we must learn about Syndromic Management. It is not the best approach for a qualified doctor, but it is important to understand – especially in a primary health care setup.

During one of these tutorials, the doctor in charge made us close our books and asked us about our approaches to the full waiting room and the possibly accute patient.

We answered well.

She told us we had good seventh senses. The seventh sense? Common sense.

Then she said: “Going by your answers, you are pretty much safe to go work in a clinic.”

We just sat and stared at her. Eventually we realised, “This woman has just complimented us. She just called us almost-doctors.”

I wish someone could take an f-MRI of our brains at the time. I bet you it would be alight and a-buzz and happy.

This doctor probably gave us enough motivation for the rest of the year. Why can’t they all be that nice?

Antibiotics: So Now What?

Reuters reports that antibiotics are not useful for most sinus infections. Excessive prescription of antibiotics has lead to large-scale resistant organisms.

Okay, this I know.

But now what? Antibiotics make patients feel better. A frequent sufferer of sinusitis, I know this. So now my patients walk away from a consultation feeling that their doctor doesn’t care about their suffering. I don’t see many doctors being happy with that.

Secondly, complications of untreated bacterial sinusitis are sever. Think meningitis, abscess formation, cellulitis. What if that happens because I didn’t prescribe antibiotics?

The logical solution seems to be taking a swab. But state healthcare simply cannot afford to process a swab for every sinus infection. Even my own medical aid can’t afford that.

So I ask again: NOW WHAT?

The Anti-Valentine #4

It’s STI/Condom Awareness Week! I find it mildly amusing that it is during Valentine’s Week. Am I trying to be a buzz-kill? Maybe… Nah. In reality, I just want to minimise the number of people I deal with who have STIs. It’s hella embarassing for them, and I’d much rather treat a strep throat.

So in all honesty, I also tend to shut down when somebody starts talking about STIs and condoms. We’ve heard it all.

But maybe not. Funny thing about gonorrhoea: Initially it was treated with penicillin. About ten years down the line, it became resistant. So we moved on to the various cephalosporins. Yay for pharmacology!

Last year, a strain was cultured from a Japanese man which was completely resistant to all cephalosporins.

So what’s next?

There isn’t something next. We don’t yet have a drug that can treat these resistant bacteria.

Maybe I’m a nerd, but that scares me more than most horror films do.

The Original Guinea Pigs

We are currently doing our Infectious Diseases and Clinical Immunology theory block – which means lots of freaky latin names and difficulty staying awake in class.

Occasionally though, our class is graced by a lecturer with some spunk.

This is South Africa: needless to say, Tuberculosis was one of the first things discussed.

You know how we refer to test subjects as guinea pigs? Pretty good reason for that.

Apparently little Guineas share a whole lot of biology with humans – including susceptibility to TB.

Way back in the dark ages, transmission of disease was kind of a grey area. The pathogenesis and transmission of TB went around in circles – from being considered non-infectious, to congenital, to sexually transmitted.

Eventually somebody had a aha-moment and placed a bunch of guinea pigs in a hospital. They were not in contact with any patients, but they were in contact with the ventilation system. And not long thereafter, the little furries had all contracted TB.

Fun times. Poor little guineas (I hope they were treated), but it sure helps to know how to protect myself when examining a patient with TB.

Internal Week 1: Many many sick people

I don’t really know how to start this post. The past week on Internal has been interesting, but I am not sure I have an opinion about it. I’m not sure if I like or dislike it. It is busy, it is very educational and there are many sick people.

I haven’t been able to get IV-access from a single patient on this block. Apparently that is to be expected because they are so sick, but it does not do much for confidence. I am certainly not going to put in an intercostal drain if I can’t manage an IV. And nurses can do it with their eyes closed.

We have seen quite a few people coming in with ODs. Tile cleaner, alcohol, antihypertensives, insulin, anti-epileptics. We don’t get to sit in on the psych consults so I don’t know how many of them were para-suicidal.

I’m getting to read many ECGs. It is good practice. X-rays and CTs too. We have had lectures, but it seems that the real things is a much better teacher. We have seen some CTs with severe cerebellar atrophy, all but one due to alcohol misuse. That’s quite a common thing in the Western Cape, apparently.

A young patient taught me to trust my gut. She came in with decreased level of consciousness – GCS 8. When she was awake she was confused, resistant and agitated. She resisted tests for meningism so I didn’t know if she had neck stiffness or if she was just tensing her muscles voluntarily. A more senior student told me she didn’t think there was meningism. I was worried about meningitis, but because nobody else seemed worried and the patient didn’t actually have a bed yet, plus the doctor was busy with patients on ventilators, I assumed that I was being paranoid.

When I finally presented, the doctor concluded that there was meningism and he seemed extremely irritated with me. And with good reason – in the two hours between the patient’s admission and finding her an open bed, she could have died. If it was meningococcal we all could have been infected. I wanted to make excuses – and there are plenty good ones – but the only truth is that I should have trusted my gut.

Incidentally we think it probably is not meningitis, but renal encephalopathy. Again something I should have put together when I noted the little urine in the catheter bag and some proteinuria and haematuria. But I probably won’t know the diagnosis as we sent her back to the secondary hospital for a lumbar puncture – we need the beds for tertiary patients.

Brudzinski's Sign of Meningitis, courtesy www.health.allrefer.com

But so we learn. I suppose that is why they don’t just let us loose. I have learnt more in the past week than in the whole of my second year, I think. Just not how to get IV-access in a shocked patient – yet.

In honour of good consultants

Tomorrow starts one of the most difficult (apparently) theoretical blocks of med-school: Musculoskeletal System.

In honour of the first two weeks of Paediatrics, which were awesome, I decided to post a few hilarious quotes made by unwitting consultants.

“I’m not interested in the wars in Iraq and Afghanistan. I’m interested in the collateral damage right here in our wards.”

Infectious consultant ranting about the prescription of fluoroquinolones and 3^rd generation cephalosporins when other antibiotics will suffice.

This was on our first day in her ward and I thought, “Great, another doctor who thinks that medicine is the only thing that matters in life.”

Before the end of our time with her, she redeemed herself by telling us about the importance of weather patterns in disease – for example, did you know that there have been links drawn between the incidence of Kawasaki’s disease and international wind patterns? Also, haemorrhagic fevers are moving slowly more towards the south of Africa due to increasing temperatures.

“Oh, this child is the petri dish.”

Infectious consultant about a young child with – among others – Cytomegalovirus, Adenovirus, Clostridium Difficile and Cryptosporidium.

“My dear, as far as I remember, this little one is a bit of a factory error…”

Sympathetic surgery consultant after being asked the diagnosis of a child with obvious congenital abnormalities. He was hypotonic and had some severe facial dysmorphic features, but not those suggestive of Trisomy 21.

“You know, of course, that life is nothing more than an infectious process.”

Infectious consultant explaining that not only does life start out as a parasite, but those that often end life, such as atherosclerosis, have now been proven to have infectious links.

“Most of the time when we are in the room patients scream because I am ugly and you people stick them with needles.”

Infectious consultant explaining how “extreme irritability and screaming” can be considered a diagnostic criterion for Kawasaki’s Disease. In other words, if the child still screams when you give her to her mother and leave the room, something is wrong.

One of the guys in my clinical group mentioned that he wished he had a Dictaphone to record all the craziness that transpires when we are doing clinical work. I do too – some of the hilarious things we do just aren’t the same when written down.