Monday, August 9, 2010
Do not bring us your poop!
If your stool needs to be cultured for bacteria or looked at under the microscope for parasites, it needs to be sent to the lab. There are pathologists who work at the lab and they are trained to examine your poop and figure out a diagnosis. However, pathologists are the only doctors that are truly trained to do this. The rest of the medical community, by and large, has no idea how to examine your poop. So please, do not come into a clinic and show people a jar of your feces after lunch (or any time, really) because we will not be able to do much more than comment on the colour and smell. And really, we’d rather not have to do that either…
Sunday, August 8, 2010
Normocytic B12 deficiency anemia...not necessarily a nutrition problem
Sorry, this post is a little more technical than most, but I thought it was interesting enough to share...
I saw a patient today who had chronic normocytic anemia. The patient was an older man, so the most likely cause of his anemia was chronic bleeding.
The patient has had bladder surgery in the past and had high creatinine values recently, so his doctor's initial impression was that the bleeding was likely from the urinary tract, which is a very reasonable theory.
Urine tests found some microalbuminuria, but no hematuria (blood in the urine) or proteinuria. Basically, his urinary system had nothing to do with his anemia.
Initial test results showed that he was iron deficient, but his anemia was normocytic, not microcytic, so a CBC looking at B12 and folate was ordered. His folate was normal, but his B12 was low. Iron and B12 deficiencies explain why the anemia was normocytic, but why was he B12 deficient? He was not an alcoholic, nor was he malnourished...he should be getting enough B12.
My running theory is that the chronic bleeding is coming from the GI tract, specifically, the stomach. He has peptic ulcers that interfere with his production of intrinsic factor and prevent him from absorbing B12 from his diet. These ulcers are also bleeding, causing his anemia.
I saw a patient today who had chronic normocytic anemia. The patient was an older man, so the most likely cause of his anemia was chronic bleeding.
The patient has had bladder surgery in the past and had high creatinine values recently, so his doctor's initial impression was that the bleeding was likely from the urinary tract, which is a very reasonable theory.
Urine tests found some microalbuminuria, but no hematuria (blood in the urine) or proteinuria. Basically, his urinary system had nothing to do with his anemia.
Initial test results showed that he was iron deficient, but his anemia was normocytic, not microcytic, so a CBC looking at B12 and folate was ordered. His folate was normal, but his B12 was low. Iron and B12 deficiencies explain why the anemia was normocytic, but why was he B12 deficient? He was not an alcoholic, nor was he malnourished...he should be getting enough B12.
My running theory is that the chronic bleeding is coming from the GI tract, specifically, the stomach. He has peptic ulcers that interfere with his production of intrinsic factor and prevent him from absorbing B12 from his diet. These ulcers are also bleeding, causing his anemia.
Thursday, August 5, 2010
Caffeine, smoking, blood pressure, and headaches
Man has massive headaches that force him to stop doing whatever he is doing, sit down, and pray for them to end. These happen transiently and often.
He goes to see his doctor.
He sees doctor's med student instead.
Med student notes he has had blood pressures of 200/100 in the past. Last visit was one week ago and he had a blood pressure of 160/100. Med student decides to check his current blood pressure, it is 160/100. High blood pressure causes headaches.
Med student asks man if he takes his blood pressure medication. Man says no. Med student suggests he starts.
Med student asks man if he smokes. Man says yes, 1 pack/day. Nicotine causes vasoconstriction which increases blood pressure. Med student suggests he stops smoking.
Med student asks man if he has caffeinated drinks. Man says yes, 1 pot of coffee/day and 6 pepsis/day. Caffeine causes vasoconstriction which increases blood pressure. Med student suggests he stops drinking coffee and pepsi.
Med student is jaded because he has heard hundreds of stories about patients being given good medical advice and ignoring it.
Man comes back next week. He quit coffee and pepsi. He cut smoking down to 1/2 pack/day. He started taking his meds. His blood pressure is 130/90. His headaches are gone. His med student is not jaded anymore.
He goes to see his doctor.
He sees doctor's med student instead.
Med student notes he has had blood pressures of 200/100 in the past. Last visit was one week ago and he had a blood pressure of 160/100. Med student decides to check his current blood pressure, it is 160/100. High blood pressure causes headaches.
Med student asks man if he takes his blood pressure medication. Man says no. Med student suggests he starts.
Med student asks man if he smokes. Man says yes, 1 pack/day. Nicotine causes vasoconstriction which increases blood pressure. Med student suggests he stops smoking.
Med student asks man if he has caffeinated drinks. Man says yes, 1 pot of coffee/day and 6 pepsis/day. Caffeine causes vasoconstriction which increases blood pressure. Med student suggests he stops drinking coffee and pepsi.
Med student is jaded because he has heard hundreds of stories about patients being given good medical advice and ignoring it.
Man comes back next week. He quit coffee and pepsi. He cut smoking down to 1/2 pack/day. He started taking his meds. His blood pressure is 130/90. His headaches are gone. His med student is not jaded anymore.
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