Friday, January 19, 2007

TGIF

Mood: ready for weekend
Weather: light snow, 30 °F
Drinking: coffee
Listening to: In the Dutch mountains - The Nits


What does TGIF mean?
Are you kidding?
Thank God It's Friday of course!
And you don't know the song I'm listening to? No big wonder, it's a Dutch band I suppose.:

I planned to sneak out early today but a consultation put a spoke in my wheel. Dr. Jordan from Boston asked me to see a patient and the case seemed to be quite interesting. First they thought he'd suffer from myalgic encephalomyelitis (better known as chronic fatigue syndrome I suppose) because he experiences profound, overwhelming exhaustion, both mental and physical, which is worsened by exertion, and is not relieved by rest. They tried everything on him, ANS stimulants and so on but he responds to nothing. CFS is difficult to treat and the causes may vary, I know, but they are sure that it must be something else.
And as James has a patient in the late afternoon I decided to 'take on business' and help Dr. Jordan together with my ducklings.

The morning was filled to the brim with boring clinic duty so I was really looking forward to a new puzzle and after a very pleasant lunchbreak I had a cup of coffee at my office when Dr. Jordan arrived.
A tall man in his thirties, nattily dressed, blackhaired and very self complacent at first glance. Besides that he looked somehow familiar and soon I would find out why.
I ignored the hand he offered and just nodded a hello to him while he examined me closely. Suddenly a broad grin appeared on his face and he laughed.
"Whoooohoooo! It's Greggo! Hey, where's your groupie?"
I raised an eyebrow and grinned. "So I know you from Baltimore, hm?"
He nodded and dropped into the visitors' chair. "Yes, and your speech was amazing. Do you still have that pink rabbit?" Again the corners of his mouth twitched and he laughed.
I snorted. "Yes, I still have it. Well, and my groupie is the Head of Oncology, you could visit him and ask for his rattle."
Jordan rubbed his chin and seemed to think about it. "Hmmm...I think I'll ask him for some tips. A friend of mine has to give a speech on Tuesday and I'd love to cheer there."
I shrugged. "Maybe he'll lend you the horn, who knows..."
Jordan snickered. "After all I heard about you I wonder why he's still alive..."
I leaned back in my chair and said "Come in", when Foreman and Cameron knocked at the office door. "After all you heard about me? Oh, I love my reputation!", I answered and aquainted everyone.
Cameron beamed at Dr. Jordan and Foreman and me winked at each other. Maybe that guy would lift her mood slightly. She was so bitchy of time it was hard to bear.
With her most beautiful smile she shook his hand and afterwards announced that she percolated coffee and everything was ready at our conference room.

So we all arose and sat down at our conference table again.
Well, the others sat down, I stood with my mug at the whiteboard and was ready to scribble down any information Jordan could give.
"Exhaustion, depression, muscle weakness, cardiac problems", I wrote down.
Suddenly the door opened and Chase came in to join us which caused Foreman to beam and Cameron to frown. I just grinned.
"So the wombat is fine again?"
Chase rolled his eyes and introduced himself to Dr. Jordan. "I'm not Dr. Wombat but Dr. Chase!" Then he turned to me and grimaced. "So nice to be here again. I really missed the pet names you give me."
I bowed and smirked. "I know you can't live without that! Fancy some munchies?", I asked and offered him a pencil.
Chase just raised his hands and dropped into the chair next to Foreman.
"Okay", I then began. "What do we have here? It's definitely not myalgic encephalomyelitis - they already tested this by diagnosis of exclusion."
"Myasthenia gravis?", Chase asked and I shook my head simultanously with Dr. Jordan.
"No...that would just explain the muscle weakness, not the other symptoms."
I flipped throught the patient's file and scribbled down some more symptoms.
"Low blood pressure that falls further when standing, depression, loss of appetite, craving for salt and salty foods..." Here I stopped.
"By the way...can anyone get me a bag of roast chicken flavor crisps?"
Three voices said "NO!", I sighed and continued.
"Restlessness and diaphoresis...ukk!"
"Could be hypotension", Foreman tried his luck.
"And the salty food?", I asked.
"And the diaphoresis?", Jordan asked.
Foreman sighed and shrugged. "Right..."
I turned to Dr. Jordan. "Was he tested for hyperkalemia?"
He shook his head. "Not yet."
"Hyponatremia?"
"Um...no."
"Okay...we should do that first and then meet here again", I proposed which meant I would study the file again and the others did the testing.

The tests showed that his the sodium level in the plasma was below 135 mmol/L - therefor the sweating and nausea - and an elevated blood level (above 5.0 mmol/L) of the electrolyte potassium.
"Okay...now we get closer...", I said and rubbed my chin.
Without knocking Jim came in. "Greg, I wanted to...oh...I'm sorry", he blushed.
He thought I was still alone in here 'cause I told him so when the others were away doing the tests.
"No need to be sorry - they just came back a few minutes ago", I smiled at him and noticed my legs turn to jelly when he smiled back.
Jordan grinned like a Cheshire cat. "It's Greggo's groupie!", he chuckled and arose to greet James which made him blush again.
"Um...Dr. James Wilson. So you heard his speech..."
Jordan nodded. "Yes, I did. I wanted to ask you for a rattle 'cause a friend of mine gives a speech on Monday", he winked.
James grinned. "Oh...I might need it this weekend, I'm sorry."
"You might, hm?", I asked and offered him a coffee.
"So, my groupie, sit down here next to me if you'd fancy a coffee. We're solving a puzzle right now."
He 'accidentally' brushed my arm with his as he walked by and sat down. "With pleasure, my admired superstar."
Jordan shook his head and grinned. Looking from James to me and back he raised an eyebrow and gave us a questioning glance. "You know each other for long now, don't you?"
James leaned back in his chair and nodded. "More than 10 years."
"So that's settled now?", I asked and tapped the marker against the whiteboard. "We still have Mister Drowning-in-sweat here. And his number of eosinophils is increased."
James sipped his coffee and I felt the urge to hug him but held myself back. "Hodgkin's lymphoma?", he asked.
"That would explain sweat, weight loss and fatigue at least", I sighed. "But not the other symptoms", I gestured to the whiteboard with the marker again. "And his lymph knodes are normal."
He smiled at me. "I see that the gearwheels in your head are already turning and I bet you know what it is."
"I think so...." I turned to Dr. Jordan. "Does your patient like milk?"
"Huh? Um...I think so..."
"Let's visit him and let him drink some milk."
They all looked at me as if I was going mad (except James) and our caravan made its way to the patient.
The poor guy seemed to be scared of me but I'm used to this. He had his glass of milk and suddenly his hand began to flex once a second. "See?", I grinned and turned to the patient. "Never mind...this tetany is caused by phosphate excess... Do you feel numbness in your extremities?"
He did and he showed tremor every now and then. The most evident symptom was the melasma suprarenale - reddish darkened skin at his arms.
"I think I can help you, Dr. Jordan", I said and turned around without saying goodbye to the patient. The others left more politely and a few minutes later we were at the conference room again.
"You know what it is?", Jordan asked me.
I nodded and swayed my empty mug underneath Jim's nose to incite him to pour coffee in it. "Menace", he sighed and took the mug.
I kissed his nosetip when he handed me the mug again and ignored Dr. Jordan's puzzled look. "Addison's disease", I answered. "What about an assay for 21-hydroxylase antibodies?"

It turned out to be Addison's disease and he left highly pleased and thankful but without rattle.
I am waiting for Jim now and when he's finished with his patient we'll go home, have a shower, change clothes and then have dinner at Ganges, 33 Princeton-Hightstown Road. We both are in the mood for Indian food today and want to introduce a very pleasant evening with this dinner. I think I'll have Chicken Hyderabadi.

2 Comments:

Blogger Dr. James Wilson said...

I did vomit ... I think it was the damn fish!

January 19, 2007  
Blogger Dr. Gregory House said...

Poor honeybunny.
I'm so glad you are feeling better now.

January 22, 2007  

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