Day 13

Blog Entry 11: 10/03/08

This is the third day of my rotation, and I'm slowly starting to like it more and more. For the past two days, it was getting pretty boring, but I realized that was mainly because it was hard for me to understand Spanish, and in turn Dra. Ana Maria. Today, I was able to understand much more, and therefore the experience became immediately more enjoyable. It's interesting how fast I was able to understand her because it only took me 2 prior days of 4 hour sessions to really start deciphering her diagnoses. At this rate, I should be able to fluently understand, and hopefully speak Spanish within a few weeks, at least for medical Spanish. Also, the cases themselves were more exciting than yesterday.
The first patient of the day was a middle aged woman, who was 45-50 years old, with scoliosis. Although the lady looked pretty normal, the x-ray really showed how distorted her spinal column really was. By tracing the spinal column from top to bottom it made this very apparent S-shape, and I was surprised that it didn't really manifest itself in her posture; however, maybe if we looked at her much closer we could've noticed it superficially. Dra. did not recommend surgical intervention to fix the problem, so she prescribed painkillers (analgesics) for the patient. Looking back, I think the main reason the patient would not be able to get surgical intervention with scholeosis can be attributed to the fact that her insurance coverage is Seguro Popular, or the state's social security program. Due to expense, my guess is that surgeries are reserved for life-threatening conditions. Although, she said that if the scoliosis did get worse, in terms of pain, they would consider surgery as an option, but I doubt that being that it's classified as a cometic surgery. It was odd to see an older woman with, what looked like a bad case (looking at factors of pain, and the obvious distortions in the x-ray) of scholeosis. In the U.S., they had free programs in my elementary school to check for scholeosis, before it becomes harder to correct. I'm interested in finding out whether there are programs in Mexico in observing the presence of scholeosis during child development.
I also wanted to comment on something cool I learned today. I was carrying a certain opinion that was critical of prescription practices of doctors at the clinic. My opinion was that they over prescribed antibiotics in dealing with bacterial infections, being that every other prescription I wrote for Dra. Ana Maria was one for Amoxycilin. I still somewhat have this opinion, but I'm glad there's some counter evidence to it. It turns out that she prescribes Loratadina, which is antihistamine (for symptom control), instead of an antibiotic, for minor infections that are relatively asymptomatic in terms of fever and inflammation. This then makes the cold more manageable for the patient, and just allows the body's immune system to fight off the cold on it's own. I was a bit afraid that antibiotics were prescribed for all infections regardless of intensity, but this wasn't necessarily the case. Don't get me wrong though, there is an overuse, and over-access of antibiotics in the community due to the fact that there isn't a need for prescriptions for Amoxycilin at a lot of pharmacies (something I found out from Dr. De La Torre); which results in patients taking them erratically, or for every small problem, and developing antibiotic-resistant strains of common bacteria.
Also, I'm finally able to interpret lab test results relating to the presence of diabetes mellitus and bacterial infections. For bacterial infections, I look for elevated levels of leucocytes and nitritis(nitrates?), which indicate possible infection. It makes sense to see elevated leucocytes because they're responsible in developing a response to pathogens. For diabetes mellitus, I look for high levels of blood glucose, triglycerides, and blood pressure. Pretty cool stuff.
One case that I was able to deduce on my own (Yes, I'm proud of myself!!), was a case of rheumatoid arthritis. A thirty-one year old woman came in complaining of pain in the joints of her legs, and said that she's had this pain for about 8 yrs. Right off the bat I guessed that it was either osteoarthritis or rheumatoid. What gave it away, was that she also complained of pain in her wrist and neck, which have been occurring for a years also. Due to the fact that rheumatoid arthritis is an autoimmune disease, in which antibodies attack the joints (specifically the synovial membrane, I think), people get pain in ALL, or most, of their joints.
Those were just a few of the cool cases that came in today. There was a kid who we figured out had a parasitic amoeba within his intestine, due the pain in the intestinal area when we were pressing his abdomen. I was also able to see cataracts in some patients eyes, which was really interesting also. But tomorrow, I'm pretty psyched about seeing another surgery at 9:30!!!!!
Reflections for the day... After somewhat overcoming the language barrier, I was starting to understand and enjoy the rotation. Knowing about various identification factors that allow you to deduce diseases and conditions makes primary care analogous to being a detective, which is why it's so interesting. I realized that not all factors are biological indicators, and that a doctor also needs to be aware of people lying about their conditions, which adds another extremely hard dynamic to diagnosis. I definitely can see why people want to be primary care physicians, but I still don't know if it's for me. My heart is still in surgery.
Also, I also wanted to note how amazing Dra. Ana Maria is. She's really patient with me while I'm learning. Student's on other rotations told me how impatient and apathetic some doctors were to them, and it just made me realize how lucky I was to get paired with her. Even through I yawn and slouch, she never seems to get annoyed or offended, when most doctors would! Many times, when a patient is on the bench, she lets me examine them with her, telling me what to look for. She also spends the time during, in the middle of the appointment, explaining the patient's condition to me, even through at times she knows I have no clue what she's saying. My lack of understanding never frustrates her, and she's always glad to see me the next day. I really got lucky, she's awesome and I'm glad I was able to learn from her.