Just an AGE? Not Really!

Weekend tagging is not easy. Have to do rounds of 2 wards, but on-call is even worse, covering the rounds of 4 wards. But luckily this tagging is coming to an end...31st is gonna be my last-day tagging!

I remember there's this case during weekend round, my houseman presented to me, "This patient just came in this morning, complaining of vomiting and diarrhea for 1 day. Currently treated as acute gastroenteritis (AGE) with mild dehydration. Otherwise he's stable." I think if I were really in rush, and fully trusted him, I'd have missed something big.

Luckily I didn't. I took a look at the abdominal Xrays and ya, you know what it is.

Multiple fluid-levels seen.

And really dilated small bowels!

Just an AGE? He's having intestinal obstruction! A surgical referral was made and patient's planned for emergency op.

So the moral of the story, must see the patient by yourself!

Heartache

Early morning at 7am, got a call from mom that she's feeling strange of her eyesight. She woke up and noted that she couldn't see the right-sided objects, both eyes.

My heart sank. Knowing that mom has been having hypertension for few years, though has been well-controlled, this is a big warning sign: Homonymous hemianopia. Very likely a stroke event.

I asked dad to bring her to hospital stat. Full workup was done and CT brain/ ECHO were normal. So she's treated as a mild stroke and luckily there's no associated limb involvement. Her visions improve throughout the hospital stay.

This is the 2nd time that I had this major heartache since the last one. I sincerely pray that this would be the last one.

Thanks Everyone!

Ya, I'm one year older;)

For the wishes that I received (via smses, messages in friendster/ facebook or even in my chatbox etc), THANK YOU EVERYONE!!! I'm truly glad of it!

So birthday wishes? Quite a few actually hehe..well mainly wish myself luck on the coming big thing, or big things probably ha. Hopefully a smooth year ahead!

Anyhow, I'm still gonna tag on-call today! Please give me a not-so-busy call! That's one of the wishes too I guess. Ha.
Alright then, thanks again to you all!^^

Chronic Symptoms...Don't Overlook!

Sorry for the lack of updates. Tagging period is really tiring!
Just to share some thoughts...from the cases that I came across recently:

#1
A lady who had an appendicectomy done, having recurrent admissions for abdominal pain, treated as adhesion colic but symptoms never really improves despite adhesiolysis done twice and analgesic treatment over 2 years. Somehow she got to be admitted to medical ward. You wanna know what's the diagnosis? Porphyria. Solved the myth of her chronic abdominal pain!

#2
A young female with history of bronchial asthma, having multiple episodes of exacerbations (with a normal-looking chest Xray) despite stepping-up of treatment. Finally someone sent the sputum for acid-fast bacilli. She's got pulmonary tuberculosis!

#3
This man with chronic right hypochondriac pain, admitted before and ultrasound abdomen showed no abnormality. Not much of respiratory symptoms though. But when he came again, a simple chest Xray was done:

Multiple right lung abscess! And it's the right basal one which causes the diaphragm irritation hence the RHC pain.

There are many more instances. The simple message is, there are always atypical presentations of diseases. So, do not overlook chronic symptoms!

Lesson 1: Be Fierce!

There's a theory that fierce MO will get less referrals.
Now I know that it's quite true.

Case "Bully" 1

HO from other unit called me after office hour, "Hi Dr, I have a case to refer to you..."
Me: "Huh? Why are you calling me? I'm not on call..."
HO: "Can I present the case to you?"
Me: "Why? Today MO on-call is Dr X and you should call him..."
HO: "Ya but...he's very fierce. I'm scared of him la...can I refer the case to you?"
(How can like that??)

Case "Bully" 2

MO's seeing a case with a new HO who's still tagging.

MO: "Hey you review this patient 1 hour later ok? Just see whether his hydration improves."
HO: "Hmm...CAN'T la. I'm going back to take shower."
MO: "Now it's only 5.30pm. 1 hour should be enough for you to take shower right? What about you come and review him at 7pm?"
HO: "NO...the earliest I think I can come is 7.30pm. It's ok la, if I can't make it, I'll ask the HO on-call to review him."

WTH????
I would say all of his anwers are very surprising. New HO, rejected orders and thinks that his personal stuff is much more important than patient's condition.

Is it all because I'm not fierce enough?
Sigh...think have to "pretend" to be fierce a bit dy...forced by the environment!

Tagging Tagging Tagging

Yes, I'm back to a tagger again. My 6th day in Medical, going to tag every other day, 8am to 8pm, until end of this month. MO tag is no joke. Seriously. Hehe. Just some random updates:

1. My first referral's already causing me big headache. A 70 year-old man with acute abdomen suspected to have perforated viscus, noted ST elevations over inferolateral leads on ECG. Wanna manage as AMI? Wait, can't thrombolyze, can't give aspirin/ clopidogrel (impending op), can't give morphine/ beta-blocker (BP needs inotropic support). WHAT CAN I DO THEN? I sweated...

2. Going to have "Medical night" on this coming Sunday. Ya, magic performance time!=)

3. Guess there's too little time to waste now. Come back after a tired tag, still have to do reading and revision (Ya, it's a doc's life). And my another "big thing" is just getting nearer...

4. But I think I really enjoy medical. Guess what I'm feeling is quite similar to what photophobia felt. ;)

There are quite some interesting cases to share...hope I'll have time to post them up! ;)

Why Hypoglycemia?

A 70 yr-old man was admitted for hypoglycemic attack. So I was asking his wife the history.

Me: "Is he on insulin or oral medication?"

Pt's wife: "He's on insulin. I'm the one who give him injection coz he can't see."

Me: "Then what happened actually?"

Pt's wife: "I also dunno la...yesterday he didn't take his dinner coz he said no appetite, then at night after I gave the insulin injection, this morning he's unresponsive!"

Me: "Did you do anything then?"

Pt's wife: "He usually wakes up early at 6am. Today he slept until 9am! I just let him sleep...waiting for him to wake up..."

Me: "Then he regained consciousness at 9am...then what did you do?"

Pt's wife: "Oh I scolded him, aiya why today you slept until so late? I'm waiting for you to wake up ah! You're late for your morning insulin injection already!"

Me: "THEN?"

Pt's wife: "Then I injected him the morning insulin...then he fainted again!"

Me: "......"

Diagnosis: Hypoglycemic attack secondary to...his wife! ;)

See this is a real example of diabetic patient with inadequate education on insulin use.
The patient probably suffered a hypoglycemic attack since last night due to missed meal, so long only he regained consciousness this morning and he was "induced" another hypoglycemic attack! I really pity the old man.


p/s: Certainly I'm not blaming the wife...it's us who didn't give enough patient education!

Back to Medicine!

Today's my first day, in Medicine again. Walking in the wards, talking to the staff nurses, writing on the bed head tickets...I can't help but keep thinking back my past days as a Houseman in medical. Gosh it was...around 2 yrs back! I started in Medical as my first posting - I think the workload can almost make a HO collapsed ha.

So I sort of read back the posts that I wrote during that time:
Day 1 of life (It's my day 1 as a HO, I can't believe that I had time to blog! Haha)
Too off tagging, KIV on call later (Start to be on call after tagging)
My "Jonah-ness" (Had a damn Jonah 1st call)
Medical "consultant" (Funny story!)
Entrapped (Bad experience but good lesson)
I'll be back, Medicine! (Yeah now I'm BACK!)

6 posts throughout my 4-month medical posting. Not many but I'm really glad that I wrote something, esp. now I can look back and recall how I felt during my day 1 as a HO and first time on call. Think the experiences are precious!=)