Haven’t blogged in a while now, but I thought this case was worth writing about.
A 16 year old female presented to the ER a couple of days back with severe intractable abdominal pain along with vomiting. She was febrile, looked pretty toxic and had severe epigastric tenderness on examination.
Her serum Lipase was through the roof, and her Amylase levels as well as her liver enzymes had shown a steep rise over the night. Our GI consultant came up with a diagnosis I would never have thought of. Considering the patient was from a poorer part of the country he suspected Ascariasis (Round worms) as a possible cause, although the abdominal ultrasound had not revealed any such findings.
The round worm being snared out of the duodenal papilla.
And sure enough, on ERCP we found a huge round worm trying to make an escape back up the Ampulla of Vater (which the pancreatic and biliary duct drain into). Another much smaller worm, perhaps the male worm, was found lazying around in the stomach and was taken care of too.
Look at the size of that thing!
After confirming there were no other worms inside the pancreaticobiliary tree and the rest of the upper GI tract, the patient was started on Albendazole. A day later she had already started showing improvement in her symptoms and her liver and pancreatic enzyme levels had started to drop again.
Walking out of the endoscopy room, the ecstatic Gastroenterologist, having got the diagnosis spot on even before the ERCP, said, “..this is what grey hair does to you, you don’t miss a lot at my age!“
Well, anybody out there just starting out on a blog, like I am, here are some wise words from Dr. Scepticemic himself –
1. find a less distracting theme. too much going on in the background distracts me from the reads. i am pro minimalism when it comes to blog design.
2. make a schedule and blog. once a week should be good enough.
3. add an email subscription widget and a twitter stream on the side bars so that people can find out what you are up to.
4. update the about page. we all wanna know more about you. and come on, it looks a little lazy (and not to say, spammy) if you leave this page unedited.
5. read and comment on more popular blogs in your niche. that will get you some readers.
Happy blogging people!
There’s this scene in the movie Patch Adams where Dr. Adams (Robin Williams) connects with a Pancreatic cancer patient. The patient, having not smiled in weeks, bursts out laughing, momentarily forgetting the excruciating pain he’s been suffering .
It was a thing of beauty watching Patch crack up the poor guy. And you’d think us doctors need to make such connections with patients every now and then, even if its with someone who has something as dreadful as terminal cancer.
Well, a couple of days back we had a patient with Pancreatic Adenocarcinoma admitted for a Whipple’s on my floor. He was to have the surgery the very next day and was undergoing all the tests required prior to it. I was assigned to do a quick H&P on him and make the necessary calls to have the OR prepped for next morning.
Throughout the encounter, he remained emotionless, numbed by the discovery of his illness (made only a week earlier) and the poor prognosis it carried. I tried hard to make him somehow open up to me, but he just wouldn’t. He never even made eye contact through the half hour or so I spent with him. It seemed there was nothing I could do to brighten up his day, if only for a little while.
As I got his signatures on the consent forms and walked out of the room after wishing him luck with the surgery next day, I wondered why I could not do what Patch Adams did for his patient.
Here it is..my first blog ever! Something I thought I’d never do, fearing my OC personality’s obsession with orderliness and perfectionism would make this an agonizingly conscientious exercise.
But I figure I could indulge in this when I find the time to do so. Here’s hoping it all doesn’t overwhelm me. Wish me luck!