It's kinda chilly up here.

Theme music: "Roslin and Adama" from BS:G season 2

It's chilly and dark this evening, and for tonight, I am missing home. My cat, my best friend and husband, my partner in crime (ironic, as she is in law school), my Blockbuster, my family, my bed. Tonight, I want to be home, where I have clothes options if I decide I hate my interview outfit, where I have the perfect professional binder that I didn't think to bring, where I don't have to depend on a GPS to get me around. It's cold outside, and a nice fire burning with a cup of hot chocolate, reading a book on a love seat gifted from a best friend, sitting beside the one I love -- that would be a good night.

On a more positive note, I have been catching up on the fourth season of B:TVS. So much humor I had forgotten. Like the story leading up to the squashing of the fear demon. Or the background to Anya's line in the musical episode: "...got diseases from the Shumas tribe..." (for those who know the reference, I was trying to be tasteful, lol).

I shall have to air up my air mattress again this evening. This morning, I woke up with a sore back from the firmness of the floor. I think I may be getting to old for this. Yet, amazingly, I still have parents of patients who tell me they can't believe I'm older than high school.

Speaking of parents: my mom has started a weblog. Her name is now added to my blogroll. Check her out: http://ginawilkins.com

I want to tell you all why I love the Triple Board Program. But I promised interesting learning points. So...

Preadolescent patient presents to the clinic with new onset of bloody diarrhea. When attaining a history, this was an interesting case for a clinically significant phrase: "the stool is kind of like strawberry jelly." This is a huge warning flag. When a patient describes "currant-jelly stool", a clinician immediately leaps to the possibility of intussusception. Intussusception is telescoping of two segments of bowel inside one another. This is a medical emergency, as it can cut off circulation of blood to the telescoped bowel, causing death of the tissue. Death (necrosis) is bad -- dying spreads, and necrotic tissue has to be removed quickly. If you catch intussusception prior to necrosis of tissue, you can give the patient an air enema, which will un-telescope the bowel. It's both diagnostic AND therapeutic. Cool, huh?

Our patient turned out not to have intussusception, thankfully, but it was a good teaching point.

Same patient. Sent home with a diagnosis of gastroenteritis (inflammation of the gastrointestinal tract). Lab reported "shiga toxin" in the stool -- thereby signifying Shigella gastroenteritis. One week after diagnosis, mom calls. Patient looks "pale." Another key word. Pale is not good. Pale = anemic, or possibly even toxic. Rechecked the lab test -- it had been a slightly misleading report. The patient did not have shiga-toxin in the stool -- patient had shiga-LIKE toxin -- which is found in E. coli (O157:H7).

Though all the gastroenteritis bugs (Shigella, Salmonella, Escherichia, Clostridium, Yersinia) can cause hemolytic-uremic syndrome (HUS), E. coli is the most common. HUS has a classic triad: microangiopathic hemolytic anemia (RBC rupture within the blood vessels), thrombocytopenia (decreased platelet counts, which are responsible for clotting -- can cause DIC), and acute renal failure (which can lead to a myriad of problems, including the need for dialysis). Again, very uncommon. Ninety percent of cases resolve if aggressive treatment is pursued. What should you do? This is late in the evening -- do you send him to the ER to check labs, just in case? Or should they wait until tomorrow morning to have labs checked?

Could have gone either way. My resident sent him to the ER. And amazingly, his creatinine was elevated -- a sign for acute renal failure.

I learned something very valuable that night. Always examine a lab report yourself without trusting the verbal report. And I saw a common theme reiterated: Trust your patients and their parents, and respond appropriately to their concerns of change. That single point is one of the main reasons I entered medicine in the first place. It's something I never want to forget.