Clinical diaries pt 2

In my last week at the hospital I sat in on some interesting cases/consultations. 

1. Delusional parasitosis (aka Ekbom’s syndrome or Mogellons)

At times, I wonder if medicine has failed patients when we start labelling them as crazy. Epileptics were once ‘crazies’ too. Only 3 months ago, this ~40yo lady was ‘normal’. Since she started having the sensation of worms crawling underneath her skin, especially around the time when she has sex, she’s been documenting her discomforts in a diary and sending them nearly daily to the doctor. She’s been through all the normal tests for parasites (blood, stool, skin) and has repeated courses of anti-parasite medication, so if she ever had parasites, they should now be gone. <insert argument with the doctor> Her neighbour advised her to start taking MgCl2 to fix the problem, but it had limited effectiveness on her symptoms and she’s getting diarrhoea. The doctor’s advice was to stop her self-prescription of MgCl2 and see a psychiatrist.

     2.  Miraculous bone marrow biopsy without extra pain relief

My first encounter with a bone marrow biopsy last year led me to believe that it could also be called prescribed torture (we drill into the back of the hip and take out a ~1.5cm piece of bone marrow). The poor patient was trying to refrain from crying out in pain, and despite the ‘green whistle’ analgesic he let out blood-curdling cries that made me persevere and watch the whole procedure because for some warped reason I feel that patients deserved to have us know their pain as a reminder of why we should work our butts off.

Having had only one traumatic experience of just watching a bone marrow biopsy, my heart rate increased significantly when one of my colleagues told the 30yo lymphoma pt that he wasn’t going to be having any patient controlled analgesic (the green whistle). She’d just anesthetise the area locally and that they’d proceed. I was really worried for him and not looking forward to watching. 

Miraculously however she managed to retrieve a perfect piece of bone marrow with the patient telling her that she could push harder if she wanted! The technique is apparently slow and steady, but you have to be forceful to drill into the bone and then to snap the piece from its base. Make sure it is completely dislodged from the base by aspirating the drill piece with a syringe so that when you remove the drill piece, the piece of marrow is in the drill piece and not left behind (what a scary thought that you’d have to repeat the procedure!).

I was seriously so impressed. I wish I will be able to do biopsies like that one day. 

      3. pyoderma gangrenosum on her shins – a systemic presentation of Crohn’s disease (a systematic inflammatory disease that commonly affects sections of the bowel). Painful pus filled 1cm wounds that burst out all over her shins, treated with corticosteroids because it’s an inflammatory reaction. Pretty horrible!

     

     4.  Erythema nodosum – bruise like skin lesions all over the arms and thighs of a scleroderma patient.

     

     5. Subcutaneous metastases that started bursting through skin and from under toe nails in a terminal prostate cancer patient. Varied from small white lesions through the skin of the arch of the foot to red and black bulbous ‘angry’ ones from under toe nails. 

sign on the door of the office for medical staff

2 specialists, 2 specialists to be and me in the medical office. All doctors wear white coats, and a lot of the allied health workers wear white scrubs so it's near impossible to tell who's who! 

nurses' room