Brought to you by the Letter 'C'
Working at the VA means that the patient population is relatively homogenous. I've only ever seen one female patient during my past three weeks here, although that should change as the current generation of military personnel ages.
Coincidentally, for some weird reason, all the patients I've been given to follow have conditions that all begin with the letter 'c':
Coincidentally, for some weird reason, all the patients I've been given to follow have conditions that all begin with the letter 'c':
- Chronic Obstructive Pulmonary Disease (COPD): Probably one of the most common conditions we see in the VA, you often see this in smokers. This isn't merely a bad smoker's cough, between 10-15% of smokers will develop COPD which refers to a trio of pulmonary conditions: chronic bronchitis, emphysema, and mucus hypersecretion. Most COPDers probably have some combination of all three of these. The poor people really have trouble breathing - you and I have O2 saturations of 99% breathing normal air, which is only 20% oxygen. These guys desaturate into the 80's breathing normal air, and some will never get higher than 92% breathing pure oxygen. I'm not sure what it feels like to be at chronically 92% O2 saturation, but I'm going to find out - I'm gonna grab one of those fingertip O2 saturation monitors and hold my breath and see how low my O2 saturation can go before I pass out. Experimental results to follow shortly.
- C. difficile colitis: This one's pretty disturbing. It used to be that C. difficile was a relatively uncommon infection - a year ago, they'd only see 2 cases per month. There were 7 admissions for C. difficile colitis in the last week alone. To make matter worse, there seems to be a new strain of C. difficile going around, which produces another toxin which leads to worse symptoms - like double the amount of diarrhea people were producing before. And C. difficile is community-acquired. I'm not sure how we're passing the bug to each other, but all I can think of is the chapter from Eric Schlosser's Fast Food Nation that describes how our nation's beef is prepared. Just a thought.
- colonic bleeding: That about says it all.
- cutaneous candidiasis: Probably one of the more boring cases I followed, an overweight 90-year old veteran came in with macular lesions on his trunk, abdomen, and pubic area, mostly in areas where skin folds overlapped and created a nice little environment for this infection to occur. Boring because all it really involved was for me to take the patient history, then call for a dermatology consult. Um...what else...yeah, it was kinda gross.
- coronary artery disease: Well, I didn't actually see this. I had to work up a patient who came in with chest pain and send him for a stress test, but really we think he was having a bunch of panic attacks.
posted by Mikey at 9:21 PM
14 Comments:
Be sure to post when you get to the letters Q and X. Those should be fun to read! ;)
X: Xanthomas - see them all the time.
Q: Uh oh - that one's hard.
Certain central neurological defects in the occipital portin of the brain can result in a quandrantanopia, in which a fourth of the visual field in one or both eyes is wiped out.
A Quincke's Pulse is found in chronic aortic insufficiency, where capillary pulsations occur at the base of the nail beds. I may run into that sooner or later.
Other than that, the only thing that may occur - and this is a stretch, I know - is a quinolone-induced side effect. Groan.
Idly wondering, and I apologize if this has been discussed before. What precautions do you take to avoid breaching patient confidentiality? Is it sufficient to simply give false names, then go into detail about your interactions, clinical observations, etc, of these people? I'm struck by the thought that, if a member of my family were being treated by you, I might be a bit uncomfortable with you writing about them in your blog.
I'm not a doctor or lawyer, so I'm wondering about this? Thanks.
It's a fair question. One part of medicine is that you're always learning, and part of that learning process includes discussing real-life cases, not hypothetical ones. Still, patient confidentiality is always protected - you're never given identifying information, only pertinent facts.
Same thing applies here. I describe the interactions sometimes, when I feel like it's pertinent. And never enough information for anyone who comes across this blog to identify any of these people. I also decline to specify the hospitals in which I meet these patients, and I also change the names of the people I work with.
I'm certain that's enough to be in compliance with the HIPAA legislation.
As far as the non-legal aspects, where the family might feel uncomfortable, the area is gray. I get along well with my patients, and I hope that comes across a little in my posts. If they somehow identified themselves and felt violated, then they're welcome to request that I remove the offending post or, if they feel the need, sue me.
Thoughts, Kinjo? (As per usual, I'll pay you in beer).
Oh, Mikey, you know I don't offer legal opinions online. In any case, your reading of HIPAA is probably more recent and comprehensive than mine since I gave up suing doctors. ^_~
*pokes Mikey's Blog to make sure Mikey's still there ;-).
He might actually be dead. He helped me move last Saturday and pack my book boxes a little extra heavy just so I can see the funny facial expressions.
Still here. Just haven't had time to write anything lately.
Ah, so now you miss grad school...
What do you think of the cheatin' MIT guy? That story floored me - not that someone in academia might not tell the truth exactly, but this isn't some minor league level guy on steroids making it big in baseball, this is someone with all the brains, connections, motivation...and still he decides that's not enough?!
I'm completely off-topic, sorry, or maybe the comments above touch lightly on ethics.
What, now I have to verify my comments?
sejeeoq, indeed.
Ah, so now you miss grad school...
Whoa. Now that's crazy talk.
Anyway, I'm not sure what to make of van Parijs (I'm assuming that's the scientist you're talking about.) I don't know him, of course, but I could only assume the pressure to produce/win grants may have been a component of his conduct. I think I've even read papers by him while in grad school - perhaps it's not good enough to be a successful nerd, but one must also be the Alpha Nerd, as well.
hey mikey, I hope you're doing well - i'm lost in 'don't have a computer' land. things here are going well, I just started looking for work today - a little late but better than never. i'm having fun for the most part. I was placed in a complex in BFE - it's a colorful social experiment. to put it lightly.
anyway, things are looking up.
on zoloft - so up isn't so far away up there somewhere anymore. tough losing everything - community, home, job(s), relationships...just tough.
anyway,
everyone keep hurricane victims in your thoughts. if you can continue to help, please do.
much love
kat
Kinjo: you rock! You are so professional and cordial. Way to go. I wish I could have helped that guy out. I know how it feels to lose your cool: thus, Vipassana! It works. That would be good advice.
On another more Mikey-related note, *PING*.... you alive out there? We hope you have not become a lab subject!
Yes, still here. I hope to post sometime this weekend. Thanks for asking. As for what I'm doing now, I refer you to this picture right here:
http://mikeyslab.blogspot.com/2005/09/drinking-water-from-firehose.html
Kat --
As someone who is living in my fourth city in three years, I can certainly sympathize with how tough it can be starting over again. Be patient -- rebuilding your life will happen in its own time. I know you'll land on your feet!
Jocelyn
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