Malaria Man

ID consults this month. The other day my fellow threw me a new patient- "middle aged HIV+ guy in the Obs unit with 5 days of fever and malaise: go check it out." Needless to say the differential diagnosis for this guy could stretch from here to the Indian subcontinent. I scouted out his records, checking his last CD4 counts and viral loads. Lingering in a healthy range and undetectable, respectively. I reviewed his admit and ED notes- some nausea (an equally nonspecific symptom), fever of 104, maybe a day of upset stomach. Nothing to grasp onto too tightly.

Then the story got strange. This guy was an academic, and as such he had traveled in recent years to Thailand, Myanmar (or Burma depending on your political persuasion) and remote regions of the aforementioned Indian subcontinent. He was a bit of an eccentric guy (I already told you he's an academic, right?) and had apparently eaten some pickled chinese mustard root and pork pot stickers earlier in the weak. What in the name of Buddha is pickled chinese mustard root, you ask? I have no idea, and apparently neither do the medical databases I searched in my over the top efforts to piece this dude together.

Then I stumbled on it: eosinophilia. The guy had two CBCs showing eosinophils in the 26-28% range, grossly elevated (should be around 3-5% or so).  Eosinophilia occurs in a few different scenarios, specifically:
1. Helminth infections (worms for the lay folk out there- we're talking blood flukes, hookworms, roundworms, etc.)
2. Fungal infections (your basic aspergillosis, coccidiomycosis, histoplasmosis, etc.- these can get real nasty, especially in an immunocompromised HIV+ guy).
3. Allergic reactions- (nuff said).
4. Eosinophilia syndromes (these are some oddball conglomerations of symptoms that constitute things like the infamous Churgg-Strauss syndrome)

The fact that his eosinophils were so elevated gave me something to work with- it allowed me to narrow my differential and cater my interview to specific risk factors and exposures (like caves and bat guano for histoplasmosis, for example).  But wait! What's that there? Another CBC? A CBC WITHOUT eosinophilia (2%)? Why are there two auto differentials showing elevations and one manual diff showing normal levels????

I phoned up the hematology lab, inquiring about the discrepancy. No explanation. The slides had been reviewed and the counts confirmed, but it made no sense. The nice lab tech on the phone offered to review the slides personally. Perfect. I marched off to the obs unit to interview the guy.

Halfway through the interview I get a call from the lab.
Lab: Is there anyway this guy could have malaria?
Me: Uhhhhh......yeah, actually, there is.
Lab: Good, because he has malaria.

Plasmodium vivax had been lying dormant in his liver for at least 9 months. He had no idea. The lab had missed it completely on three different CBCs that they allegedly reviewed. Had I not called about the eosinophilia discrepancy he would have likely remained undiagnosed for a long long time. As it is, he'll take some chloroquine for 3 days and primaquine for 2 weeks. That's it.

Malaria. Best day of med school yet.

Detroit Delight Ride

O'leary, Mack, and I leisurely cruised Detroit one fine day. Here's a glimpse.

O'leary in the lead. 

Atwater Brewery for an IPA.

O'leary and Mack with a storm a brewin'

Waterfront ride.

Gynecology Oncology: A Venting

I've had my fill of these smelly-vagina, blood-spatter-on-my-scrubs, 4:45-AM-wake-up-to-three-alarms, stand-in-one-spot-for-five-hours-without-a-piss, yessir-nosir-thankyousir-mayikissyourbuttsir, stickin-my-fingers-in-deep-dark-dank-unmentionable-places-to-say-i-felt-ovaries-i-didn't-feel kind of days.

Conversation w/ Psychosis

Student doctor Grizzle: sir, how are you feeling this morning?
80 year old Veteran: we're both deadheads right?
Dr. Grizzle: you mean like the band, the Grateful Dead?
Veteran: the Grateful Dead goes to my church.
Dr. Grizzle: what?
Veteran: we're going to give them the church because we have less than 35 members
Grizzle: what kind of church is it?
Vet: Presbyterian
Grizzle: so you're giving your church to the Grateful Dead?

Vet: Yes

Grizz: Who's in the Grateful Dead anyway?
Old Vet: There are about 120 children. They killed a lot of people in San Francisco.

Grizz: I see.....

A day in the life

My day:
Bike ride to work. Coffee.

substance abuse, borderline/paranoid personality disorder, generalized anxiety disorder, paranoid delusions with agitation sexual disinhibition and progressive psychosis with auditory and visual hallucinations. Quote of the day? "Kroger wants me dead."

Bike ride home. Glass of wine. Bedtime

Polo practice

Polo Practice. 5 stories up. 2 pbr. 1 bike 1 ball 1 mallet.

Rigor Mortis

This post is actually from a couple years ago when I was head over heels for anatomy and jogging, two equally horrifying pastimes.

There's nothing that can inspire you to run like a room full of dead bodies. I spent four hours today with my hands immersed in bowel and bile-- probing pancreas, massaging mesocolon, and oggling omentum. After standing in one spot over a semi-rotting body for so long, one feels the urge to move-- not only to flee the scene of decomposition, but also to exercise the right to exercise; a right that my donor no longer possesses. In a way, my run today was an homage to my benevolent instructor (the donor), who inspired me to "shake it while i got it."

However, for those of you who have not had the pleasure of jamming your appendages into the deepest darkest recesses of the human body...(I just realized that that introductory phrase could be misinterpreted as a euphemism for coitus. I am not referring to coitus, grow up)...for those of you who can not fathom the mystery of mesentery, you must understand that dead people, regardless of the preservation process, stink. The stench varies from body to body, and my donor emits (thankfully) a relatively tolerable odor. Relatively is the keyword. The scent is indescribable, but imagine an elderly recluse-- you know that musty "old person" smell?-- now leave that recluse unbathed for a solid ten years, add some feta cheese and fetid bacteria-infested sewer water, and you may begin to understand the complexity of this odor. Now, you must also understand that the smell of cadaver is remarkably clingy. It grabs your clothes, your hair, your skin, and sometimes it seems like it doesn't leave unless you scrub til you bleed.

That being said, I decided not to shower between my dissection and heading to the gym. Hence, I stanked. I stanked bad. I also have not washed my running clothes this week (and I have already put in a solid fifteen miles). So as I hopped on the treadmill next to a cute Middle-Eastern girl I became self-conscious of my stank. Would she notice the smell of death oozing out my pores with every stride? Would she mistake this nasty DBO (dead body odor) for regular BO? Luckily, I didn't care what this girl thought. As I reveled in my sweat, stank, and apathy for the girl next to me, my eye caught glimpse of a cute girl a few treadmills down. I had seen her the night before at the gym. She runs like a gazelle, and (though I've yet to be close enough) I presume she smells like cinnamon and sunshine. So the question soon begged itself: how far did my stench of death reach? What was my range? Would the gazelle be forced to suffer the DBO instead of my usual enticing musk? Would my passion for human anatomy and my overzealous approach to the peritoneum undermine my passion for beautiful women and my underzealous approach to flirtation?? My question was soon answered as the gazelle leapt from her treadmill and fled to an elliptical a few rows down. She had smelled me.

But who needs her? I have my education.