Monday, January 26, 2009

Cold Sores = The Kiss of Death

In PBL last week we learned about the kiss of death. Apparently, if you have a cold sore, you are a very serious risk to newborns.

Cold sores are caused by the herpes virus. The herpes virus has the ability to travel through nerves and infect the brain, which is called herpes encephalitis. This normally doesn't happen because healthy people have an immune system that is strong enough to prevent the virus from entering the brain. However, a newborn's immune system is still developing, which means that babies are extremely vulnerable to herpes encephalitis (among other things).

We were told the story of a resident who had a cold sore and kissed his 2 week old son. Within the next two weeks the baby had herpes encephalitis and died.

Many people carry a herpes infection; however, they are normally do not spread the infection because the virus is not actively replicating in their bodies. Cold sores are indicative of active, replicating herpes virus. Moral of the story, don't kiss a baby (or anyone really) if you have a cold sore.

Friday, January 16, 2009

No You Can't Leave...I'm Not A Real Doctor

I'm writing this post to beg everyone to remember that a 1st year medical student is NOT a real doctor. Make no mistake about it, you are doing US a huge favour when you let us see you in the clinic. You are helping us learn how to interview, give shots, perform a head and neck exams, etc. The most we can do for you is give you pleasant conversation and maybe a laugh.

This week in the clinic, I saw a man who was diagnosed with bronchitis during his previous visit, he wanted to know if he was getting better. I took his history and listened to his lungs. I haven't been formally taught how to do a respiratory exam yet, but my preceptor told me to give it a shot. How hard can it be? I know both where the lungs are and how to use a stethoscope. Anyways, I took my best guess and his lungs sounded fine to me. Unfortunately, I have no idea what they would sound like if they weren't fine, so my opinion is relatively worthless at this point and I made sure to let the patient know as much. I would hate to make him think that he was getting better only to have the preceptor see him and tell him that he needs to go to the hospital immediately.

Anyhow, I left the patient in the exam room and waited outside for my preceptor, who was seeing another patient. Eventually, my patient got tired of waiting and tried to leave. He told me that I checked him out and that was good enough.

No, it really wasn't good enough. I had to twist the guy's arm to get him to stay. Maybe next time I should tell the patient I think they have SARS, that way they'll probably wait to hear an opinion from a real doctor.