I apologize in advance for the length of this post, but it will likely be a week before writing again due to a busy schedule at the moment. So sit back and digest this in pieces if you like (although, if you want to know when you can see Dr. Peppers in action, scroll down to the last heading). I've provided some headings for breaking it up a little bit.
Today was the second time my APD (read: advanced physical diagnosis) group met over at the VA hospital. This time however we were actually able to see patients, thanks to Dr. K, who is the resident paired with the attending in charge of our APD group. Dr. K had a talk with us about how she understood we needed to see patients in order for this to be a learning experience at all, and we proceeded to the second floor wards. Today we saw three cases.
This week's cases: VA Hospital
Mr. H was an elderly man who had developed pneumonia and a pleural effusion in his left lung. He was cooperative with allowing student doctors to examine him, however did not seem to be feeling very pleasant in both mood or health (and who could blame him for either, sick in the hospital?). One physical exam sign to look for when listening to a patient with pneumonia and/or a pleural effusion is egophony. Egophony is E to A changes when listening to the lungs with a stethescope; while listening, when the patient makes a long drawn out E sound, the difference in density in the affected lung causes the sound to come out as an A. Mr. H had a very notable egophony.
Mr. B was a robust man who had interstitial lung disease. Mind you, there are several hundred interstitial lung diseases of distinct etiologies, making that a very broad disease specification. His lung disease was due to exposure to metals and chemicals from a history of polishing aluminum engine blocks on racecars. He also had a year's worth of asbestos exposure. Mr. B was in a far better mood than Mr. H, and welcomed the attention of students come to examine him. Listening to his lungs, I could hear the tell-tale velcro sound of a restrictive interstitial fibrosis, and his breathing was rapid and shallow. At the apices of his lungs on both sides was a faint wheeze. I mentioned this to his attending, Dr. O, who proudly put a hand on my shoulder and proceeded to give a mini-lecture on how that was likely due to a superimposed respiratory infection, which Mr. B affirmed by speaking of a chest cold that drove him to the doctor. Dr. O then played the "guess my age" game by asking us to guess how old Mr. B was. We guessed he was roughly 60, 61 years old. We were only off by about 22 years; his actual age was 83, but boy did he look young and energetic.
The third case was Mr. J. Mr. J had chronic obstructive pulmonary disease (or COPD). Whereas a restrictive disease prevents you from filling the lungs, an obstructive disease prevents you from being able to get air out. Try taking a deep breath, as deep as you can, and then making due on short, shallow breaths without fully emptying your lungs. This is what Mr. J feels like. The air trapping is due to airway collapse during expiration, so that air in the lungs gets trapped (hence the term air-trapping). People with COPD will attempt to counteract this by pursing their lips, creating a pressure that helps keep the airways open and allows them to empty their lungs. You also notice more accessory muscle use in their breathing; their sternoclinomastoids and intercostals are visibly engaged in trying to help them breath.
My cousin's diagnosis
Over the weekend, I received a call from my parents passing along some news about my cousin B. She had been having some long standing swelling and pain of her knees and ankles, and had seen the doctor about it recently. Initially the doctors thought that she might have rheumatoid arthritis, an autoimmune disease that affects the distal (far from the central body) joints and is more common in females. Bloodwork apparently was negative, and so they tested her for SLE, or systemic lupus erythematosus. SLE, or lupus as most people know it, is an autoimmune disorder characterized by immune complexes composed of antibodies and compounds called complement settling out of the blood in the vessel lining, causing inflammation of the vessels. After the diagnosis, they presumed that some other symptoms she had involving gastrointestinal distress were likely due to SLE as well.
I was shocked to hear about the diagnosis. My parents seemed to think that all would be just fine, and I agreed, provided that she (my cousin) doesn't develop a severe case of SLE. The most serious complication of SLE is kidney damage; most patients who die of SLE will die of kidney failure due to the overwhelming loss of kidney function. Luckily, with close monitoring and control, this is rare in mild to moderate cases of SLE. I asked if she was on prednisone (a steroid anti-inflammatory drug), and she was. Interestingly, I know that you can also use hydroxychloroquine, which is an anti-malarial drug, to help prevent flare ups of SLE.
The other thing that concerns me about this is that my cousin is only 16. If you read up at all on SLE, you may find that it affects females more than males, and starts during the prime childbearing years (16 - 40); and a concern of mine is how early it is starting for her. That'll be something to be in prayer about.
Health Science Research Day, Thursday Nov. 9th, School of Medicine
After a very straining weekend of work, I've finally finished my research poster presenting my summer research in the pediatrics department. It'll be displayed in the School of Medicine Atrium on Thursday starting at 9 a.m., and will hang until 1 p.m. (just a plug, in case you have a chance of dropping by to see it).
Towards the end of this project, I've begun to grow more disgruntled in having to do it. I have been thinking about all the other things needing to be done (mostly study for school) and my lack of being able to enjoy as much free time as I would if I weren't working all weekend on the poster. The other aspect that has had me disgruntled has been due to my own lack of experience in participating in research, and simply not knowing what goes into making a good poster presentation, and being expected to know what does by my boss/mentor. Some misunderstanding via email led to me receiving a scathing email from my mentor about the precious time wasted correcting discrepancies found in my data, the fact that accuracy should have been a priority of mine, and the confidence that I will one day mature into more than a simple data-gatherer. It was perhaps only meant to motivate (and it did, as I turned out a far better and more complete write up for the poster content that very same day), but the content and wording has still left me feeling less than amiable towards my mentor.
There is a first prize of $500 for the best project and presentation, with smaller prizes for second and third. I am not expecting to win, but am excited to be able to have a chance at the very least. My research will be alongside posters from other M1's, M2's, and some M4's who are doing research before graduating.
