Reflecting on this block's learning experiences, with a poetic form suited for each.
Pathology (the haiku, a form of infinite subtlety, that nonetheless comes down to just a handful of words--much like a path report).
Bridging necrosis
and Mallory's hyaline:
cirrhosis, but why?
Kill the eponyms?
But won't we hurt Cushing
and Virchow's feelings?
If I never see
One more liver biopsy
It won't make me sad.
Bullous pemphigoid
or mycosis fungoides?
Which one looks grosser?
Dermatology (couplets--short and sweet, and simple to write, just like prescriptions for Retin-A and steroid cream).
Your autoantibodies to desmoglein three
mean pemphigus vulgaris. Better you than me.
I'm sorry to inform you, your mole's cellular division
has crossed the line, and now it's time for a complete excision.
The necklace hubby bought you has given you a rash;
it's called contact dermatitis; next time, tell him, blow more cash.
(Especially for Dr. A. C. L. of dermatopath):
If the lesion is pigmented but the biopsy's a shave
expect at best an angry phone call and at worst an early grave.
Endocrine (Limericks--because everyone knows endocrinology is funny. Right? Um.)
A woman who hailed from Tacoma
had a sizable prolactinoma.
She started lactating,
but more devastating,
Her leg hair required a comb-a.
The doctor she saw told her, "Well,
I can see something wrong in your sell'
turcica--if you're keen,
Try this cabergoline,"
And she did, and it all turned out swell.
GI still to come...
Tuesday, December 15, 2009
Friday, December 4, 2009
African albinos
Part of a physician's duty, one could argue, is to help protect the vulnerable--whether that means reporting child or elder abuse, ensuring informed consent, or preventing the possible leak of someone's HIV/AIDS status. Currently, health care workers (among other social service personnel) are busy in Tanzania, trying to provide safety and care for albino individuals. See here and here.
There are two main threats to albinos in East Africa: one is skin cancer (what happens when you take a phenotype already prone to cutaneous malignancy and add tropical doses of UV light); the other is 'poaching,' a term usually reserved for animals, but which seems to capture the brutality of the attacks on these people. Local...um...I don't think there's really a PC word for witch-doctor...local animist and Voudoun practitioners claim albino body parts are powerful charms for luck and riches; others use albino blood in their spells. The world is a wide and strange place. But lest we assume that these people are (to quote a commenter on one of the sites) "superstitious, bestial savages," let's remember that--killing aside--a lot of people in the US still wouldn't want to shake hands with an HIV positive person, or someone with psoriasis. Suprisingly, albinism is exponentially more common in Tanzania than in the US.
What got me started on this train of thought? Why, studying vitiligo for my dermatology exam, of course.
There are two main threats to albinos in East Africa: one is skin cancer (what happens when you take a phenotype already prone to cutaneous malignancy and add tropical doses of UV light); the other is 'poaching,' a term usually reserved for animals, but which seems to capture the brutality of the attacks on these people. Local...um...I don't think there's really a PC word for witch-doctor...local animist and Voudoun practitioners claim albino body parts are powerful charms for luck and riches; others use albino blood in their spells. The world is a wide and strange place. But lest we assume that these people are (to quote a commenter on one of the sites) "superstitious, bestial savages," let's remember that--killing aside--a lot of people in the US still wouldn't want to shake hands with an HIV positive person, or someone with psoriasis. Suprisingly, albinism is exponentially more common in Tanzania than in the US.
What got me started on this train of thought? Why, studying vitiligo for my dermatology exam, of course.
Wednesday, December 2, 2009
Basically, Everyone's Crazy
It's like that song from Avenue Q, "Everyone's a Little Bit Racist."
Today we talked about 'functional somatic syndromes' in our doctorin' class. These are syndromes, ahem, "defined more by suffering and symptomology than by any consistently demonstrable pathophysiology." Which sounds a lot like saying "it's all in your head." Which, to me at least, sounds kind of paternalistic and dismissive--medicine as an entity and doctors in particular putting the burden of 'un-understandability' on the patient rather than admitting that Western medicine doesn't totally have its shit together with the whole mind-body connection. A little like hubris, I feel. In one of the articles we read for today, the authors listed 'side effects from silicone breast implants, irritable bowel syndrome, repetitive stress injury and vaginismus' as among these functional somatic syndromes. The paper was written ten years ago. In 2009, we have official diagnostic criteria for IBS and fibro; everyone and their sister knows that carpal tunnel DOES, in fact, exist; and I'm gonna go out on a limb here, but I doubt that even in 1999 a reasonably intelligent person would say, "Have 500 ccs of potentially allergenic, if not carcinogenic, material pumped into each of my breasts? Don't mind if I do!" As for vaginismus being an issue of mind over body--yeah, possibly, but that doesn't mean the suffering isn't real, and telling women to just relax about it doesn't address the problem. I guess what I'm saying is, we don't know everything there is to know about the world, and it's kind of pompous to say that if we don't, it's the world's fault. After all, just 50 years ago doctors were still telling women that dysmenorrhea was all in their collective heads (and had, apparently, been a form of mass female hysteria since time immemorial).
Our group leader described his thought processes well--when prescribing a tricyclic antidepressant for a woman with irritable bowel, it's common to be met with the dismayed cry, "Doctor, you think I'm crazy! I'm not crazy!" At which point he then points out, "Your gut is very special--it's the only organ system that has a complex 'brain' of its own...(explain about the enteric nervous system, neurotransmitters, la ti da ti da) and I think that these drugs, even though they were originally prescribed for depression, might have some usefulness here." Meanwhile, he says, 'I'm thinking, yeah, I do think you're a little bit crazy, but so's everyone.' So that's a nice message to keep in mind next time someone's acting like a whack job and being really frustrating--everyone has their own particular flavor of crazy. It's like the world is a huge Baskin-Robins, but with neurosis instead of ice cream.
Today we talked about 'functional somatic syndromes' in our doctorin' class. These are syndromes, ahem, "defined more by suffering and symptomology than by any consistently demonstrable pathophysiology." Which sounds a lot like saying "it's all in your head." Which, to me at least, sounds kind of paternalistic and dismissive--medicine as an entity and doctors in particular putting the burden of 'un-understandability' on the patient rather than admitting that Western medicine doesn't totally have its shit together with the whole mind-body connection. A little like hubris, I feel. In one of the articles we read for today, the authors listed 'side effects from silicone breast implants, irritable bowel syndrome, repetitive stress injury and vaginismus' as among these functional somatic syndromes. The paper was written ten years ago. In 2009, we have official diagnostic criteria for IBS and fibro; everyone and their sister knows that carpal tunnel DOES, in fact, exist; and I'm gonna go out on a limb here, but I doubt that even in 1999 a reasonably intelligent person would say, "Have 500 ccs of potentially allergenic, if not carcinogenic, material pumped into each of my breasts? Don't mind if I do!" As for vaginismus being an issue of mind over body--yeah, possibly, but that doesn't mean the suffering isn't real, and telling women to just relax about it doesn't address the problem. I guess what I'm saying is, we don't know everything there is to know about the world, and it's kind of pompous to say that if we don't, it's the world's fault. After all, just 50 years ago doctors were still telling women that dysmenorrhea was all in their collective heads (and had, apparently, been a form of mass female hysteria since time immemorial).
Our group leader described his thought processes well--when prescribing a tricyclic antidepressant for a woman with irritable bowel, it's common to be met with the dismayed cry, "Doctor, you think I'm crazy! I'm not crazy!" At which point he then points out, "Your gut is very special--it's the only organ system that has a complex 'brain' of its own...(explain about the enteric nervous system, neurotransmitters, la ti da ti da) and I think that these drugs, even though they were originally prescribed for depression, might have some usefulness here." Meanwhile, he says, 'I'm thinking, yeah, I do think you're a little bit crazy, but so's everyone.' So that's a nice message to keep in mind next time someone's acting like a whack job and being really frustrating--everyone has their own particular flavor of crazy. It's like the world is a huge Baskin-Robins, but with neurosis instead of ice cream.
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