Radio silence

MrKnowBody3 Comments

It’s been a while since I’ve last been here.   First a bout of gastro that had us fighting for the bathroom and then lethargically sick for days (3 out of 4 of us violently ill) kept me away.   Then a quick trip across the pond for my hubbie and oldest (leaving me a single, full time working mom to a non sleeping two year old) and then this: 

 
A call from our daycare about our two year old. Any guesses?  What are the signs the arrows are pointing at? 

Boo for the last few weeks.  Feeling grateful it wasn’t his neck 

Back to school and boobs!

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holy moly it’s been a busy…and sick last couple of weeks with our family being hit with one thing and then another.   So while we all recover from the back to school stress here is a stellar article on breast feeding. Makes me feel much better about my quickly shrinking mammary glands all in the name of long time nursing
The Totally Insane Way That Breast Milk Works http://gizmodo.com/the-totally-insane-way-that-breast-milk-works-1729434047

Vomit ish

MrKnowBody5 Comments

the best part of having food poisoning/gastro is when the last vomit has been had and you know you just might very well survive

That was me last night

Learning to stand again this morning

Hope none of you get this 

Don’t ask your doctor to do this

MrKnowBody10 Comments

  

Real conversation today

Fourth one in sixth months

Four different patients 

Patient: “so I want to get out of my gym contract to go to a different gym”

Me: (inside voice thinking “ok……what does this have to do with me medically”)

Patient: “they say I don’t have to keep paying but only if there is a medical reason”

Me: (in my most chipper voice) “but you don’t have a medical reason”

Patient: “can’t you make one up?”

Me: “Umm…no, sorry”

Patient: (very angry tone)  “Why not?  This is going to cost me like $400 all because of you”

Me: “well that’s called fraud so, sorry”
Anyone else have something ridiculous to add from their own day? 

Delusions of Parasitosis

MrKnowBody9 Comments

(Kudos to “I Am Real Jazz” for getting it right)

“Delusions of parasitosis is a rare psychiatric disorder in which the patient has a fixed, false belief that he or she is infested by parasites”

I was two weeks into my new practice when one of the medical secretaries brought me a small box that was taped shut, saying that a patient had dropped it off for me saying “get this to my new doctor right away”.  They had taped their name to the top, handing it over with the explanation that they didn’t have an appointment for another few weeks and did I want to consider seeing them sooner?

The beginning of a practice is an overwhelming experience for a myriad of reasons, one of which being that you literally start from having no one under your roster, to having hundreds of people trying to get into your practice for their “Meet and Greet” first appointment.

Not to mention you are shitting your pants, wondering if you were one of the few people who might have “fallen through the cracks” during exam time, not actually really smart enough to look after people’s real medical problems.

So, in those first few weeks, I was sorting out a lot:

a new practice

my new nerve induced daily diarrhea

trying to get my new office door key to work

and sorting through the myriad of stuff that people were dropping off

so, the box wasn’t really shocking…..but it jiggled, so out of interest, I opened it.

To find…..

Jars

lots of small jars, each containing little things.

Most I couldn’t recognize, but a couple were obvious objects;  a very small button, a piece of tinfoil.

The secretary had mentioned that the patient had looked anxious and stressed out while dropping off the boxes.  I had her call and fit them into the end of the next day.

The patient was a small older man who arrived looking shy and nervous, but ever so thankful that I had met with him sooner.

“Did you get my jars?”, he asked

I reassured him I had received his jars.

“It’s hard to believe, isn’t it?”

What was hard to believe?

“That all of those things are coming out of my body”!

I had a brief, concealed moment of looking around. Was this part of the continued experience of me in medical school? Was there a camera somewhere?

But then I remembered “Janice” (let’s call her), a woman, I briefly learned about in my residency during ward rounds.  I never did see “Janice” but I heard about “Delusions of Parasitosis” after Janice had presented after trying to cut off part of her ear to get a bug out.

“It is an incredibly rare diagnosis- you will probably never see it in your career”, remarked the Senior Staff.

I found it curious and then tried to throw it out of my long term memory- it was really rare, and I was barely figuring out and remembering the common stuff.

But five minutes into my current conversation and I was very aware that delusions of parasitosis was not as rare as that liar had told me 😉

My patient was convinced that he was infested by bugs.  He wasn’t convinced however, that the things he had brought me were bugs.  For example he pointed to one jar and said “That’s a button, I know. But…it wasn’t a button when it first came out of me. That’s what it changed to after it came out of me- the bugs are really clever like that”.

A half an hour later, and I still hadn’t convinced him that there was no way that he was infested by bugs that turned into skin scabs, small pieces of tinfoil or a button.

And that’s because I was an idiot; a good intentioned idiot, but an idiot none the less.

Delusions are difficult.  And after seeing him yesterday (he is doing awesomely well on meds all these years later), I was having a quick ponder about my naiivity.   As I was driving, I was wondering what I would think if someone was beside me trying to convince me that I wasn’t driving.

I wouldn’t believe them.  And these bugs were just as real for him. There was nothing that I could “logic” with him about, and being an incredibly smart man, he was the first to admit that it was really hard to explain.  But the facts stood that he was infested with bugs.

Bugs that turned into buttons.

Delusional diseases are difficult to treat and must be terrifying for the person whose brain is tricking them into the delusion.

The condition was not from anything that he had done wrong…..it was just the way it was.  Some connection somewhere in his brain was misfiring somehow, and no one at this point, is smart enough to figure out why or how it can be fixed at the source.

However after some tricky thinking, and some honest outlaying of information, my patient decided to take a leap of faith and start treatment.

His bugs cleared up.

If he goes off of his meds (as we tried once), they come back.

I have since had two other patients present with the exact same condition- I was less surprised when I received both of their boxed collections pre “meet and greet”

Brains are such interesting things, they always blow me away.