A medical puzzle for 7Aug06

[Guest guest]

You come home from a busy shift, when a neighbor, Mrs. Dincker, approaches

you and asks if you have a minute to talk. Though you're bone tired, she's a

nice lady and keeps an eye on your house while you and your spouse are at work,

so you say sure.

She relates that her 18 year old son, Duane, has a cough that won't seem to

go away. It started maybe 4 months ago and has been a dry cough up until a

week ago when he started coughing up blood-streaked sputum. He seems to be

coughing up more and more blood. She says that he's a heavy cigarette and

marijuana smoker, and he also has been caught sniffing gasoline fumes several

times

lately. Even though he's a slacker and doesn't work, she's worried that he

may have TB. He seems to be short of breath a lot, and just sits around.

She also mentions that he has complained of a burning sensation when he

urinates, and she has noticed that his feet look swollen some of the time.

She's

very worried, but she can't get him to go to the doctor.

She asks if you will talk to him. What do you think might be his problem,

and what other things would you ask and do if he will allow you to interview

him and do a history and physical on him?

Gene Gandy

[Guest guest]

HR = 74, RR = 18, BP = 128/70. Blood glucose is 106. Denies night sweats,

but has lost about 12 pounds in the last 3 months. No ability to do a UA at

this time. 12-lead shows sinus rhythm with normal axis.

GG

>

> A set of vital signs, a 12 lead ECG if you have access to it. Come

> to think of it a blood sugar check and UA if you have access to it

> would be a good idea too. night sweats? weight loss/gain? I'm

> personally thinking it almost sounds like the beginning signs of

> Congestive heart failure but can't rule out TB or damage to lungs

> from inhaling stuff he shouldn't have.

>

>

>

> --- In texasems-l@yahoogrotexasem, wegandy1938@, wegandy1

> >

> > You come home from a busy shift, when a neighbor, Mrs. Dincker,

> approaches

> > you and asks if you have a minute to talk. Though you're bone

> tired, she's a

> > nice lady and keeps an eye on your house while you and your spouse

> are at work,

> > so you say sure.

> >

> > She relates that her 18 year old son, Duane, has a cough that

> won't seem to

> > go away. It started maybe 4 months ago and has been a dry cough

> up until a

> > week ago when he started coughing up blood-streaked sputum. He

> seems to be

> > coughing up more and more blood. She says that he's a heavy

> cigarette and

> > marijuana smoker, and he also has been caught sniffing gasoline

> fumes several times

> > lately. Even though he's a slacker and doesn't work, she's

> worried that he

> > may have TB. He seems to be short of breath a lot, and just sits

> around.

> >

> > She also mentions that he has complained of a burning sensation

> when he

> > urinates, and she has noticed that his feet look swollen some of

> the time. She's

> > very worried, but she can't get him to go to the doctor.

> >

> > She asks if you will talk to him. What do you think might be his

> problem,

> > and what other things would you ask and do if he will allow you to

> interview

> > him and do a history and physical on him?

> >

> > Gene Gandy

> >

> >

> >

> >

[Guest guest]

A set of vital signs, a 12 lead ECG if you have access to it. Come

to think of it a blood sugar check and UA if you have access to it

would be a good idea too. night sweats? weight loss/gain? I'm

personally thinking it almost sounds like the beginning signs of

Congestive heart failure but can't rule out TB or damage to lungs

from inhaling stuff he shouldn't have.

>

> You come home from a busy shift, when a neighbor, Mrs. Dincker,

approaches

> you and asks if you have a minute to talk. Though you're bone

tired, she's a

> nice lady and keeps an eye on your house while you and your spouse

are at work,

> so you say sure.

>

> She relates that her 18 year old son, Duane, has a cough that

won't seem to

> go away. It started maybe 4 months ago and has been a dry cough

up until a

> week ago when he started coughing up blood-streaked sputum. He

seems to be

> coughing up more and more blood. She says that he's a heavy

cigarette and

> marijuana smoker, and he also has been caught sniffing gasoline

fumes several times

> lately. Even though he's a slacker and doesn't work, she's

worried that he

> may have TB. He seems to be short of breath a lot, and just sits

around.

>

> She also mentions that he has complained of a burning sensation

when he

> urinates, and she has noticed that his feet look swollen some of

the time. She's

> very worried, but she can't get him to go to the doctor.

>

> She asks if you will talk to him. What do you think might be his

problem,

> and what other things would you ask and do if he will allow you to

interview

> him and do a history and physical on him?

>

> Gene Gandy

>

>

>

>

[Guest guest]

Good guess but no trip to Opdyke West. Keep looking.

Gene

>

> Hmm...not real sure on this one. I am fairly sure that it is not TB.

> I'm thinking that this is most likely caused from his huffing

> gasoline. He's a bit young for Congestive Heart Failure but

> stranger things have happened. I think that I will go with chronic

> gasoline inhalation.

>

> --- In texasems-l@yahoogrotexasem, wegandy1938@, wegandy1

> >

> > HR = 74, RR = 18, BP = 128/70. Blood glucose is 106. Denies

> night sweats,

> > but has lost about 12 pounds in the last 3 months. No ability to

> do a UA at

> > this time. 12-lead shows sinus rhythm with normal axis.

> >

> > GG

> > In a message dated 8/7/06 11:25:30 PM, txladymedic@ In a messa

> >

> >

> > >

> > > A set of vital signs, a 12 lead ECG if you have access to it.

> Come

> > > to think of it a blood sugar check and UA if you have access to

> it

> > > would be a good idea too. night sweats? weight loss/gain? I'm

> > > personally thinking it almost sounds like the beginning signs of

> > > Congestive heart failure but can't rule out TB or damage to lungs

> > > from inhaling stuff he shouldn't have.

> > >

> > >

> > >

> > > --- In texasems-l@yahoogro --- In texasems-l@ya --- In te

> > > >

> > > > You come home from a busy shift, when a neighbor, Mrs. Dincker,

> > > approaches

> > > > you and asks if you have a minute to talk. Though you're bone

> > > tired, she's a

> > > > nice lady and keeps an eye on your house while you and your

> spouse

> > > are at work,

> > > > so you say sure.

> > > >

> > > > She relates that her 18 year old son, Duane, has a cough that

> > > won't seem to

> > > > go away. It started maybe 4 months ago and has been a dry cough

> > > up until a

> > > > week ago when he started coughing up blood-streaked sputum. He

> > > seems to be

> > > > coughing up more and more blood. She says that he's a heavy

> > > cigarette and

> > > > marijuana smoker, and he also has been caught sniffing gasoline

> > > fumes several times

> > > > lately. Even though he's a slacker and doesn't work, she's

> > > worried that he

> > > > may have TB. He seems to be short of breath a lot, and just

> sits

> > > around.

> > > >

> > > > She also mentions that he has complained of a burning sensation

> > > when he

> > > > urinates, and she has noticed that his feet look swollen some

> of

> > > the time. She's

> > > > very worried, but she can't get him to go to the doctor.

> > > >

> > > > She asks if you will talk to him. What do you think might be

> his

> > > problem,

> > > > and what other things would you ask and do if he will allow

> you to

> > > interview

> > > > him and do a history and physical on him?

> > > >

> > > > Gene Gandy

> > > >

> > > >

> > > >

> > > >

[Guest guest]

He was tested a month ago and it came back negative.

GG

>

> Gene, I believe your young man should get tested for HIV. His

> symptoms sound suspiciously like early stage HIV.

> Joe T

>

>

> > >

> > > HR = 74, RR = 18, BP = 128/70. Blood glucose is 106. Denies

> > night sweats,

> > > but has lost about 12 pounds in the last 3 months. No ability

> to

> > do a UA at

> > > this time. 12-lead shows sinus rhythm with normal axis.

> > >

> > > GG

> > > In a message dated 8/7/06 11:25:30 PM, txladymedic@ writes:

> > >

> > >

> > > >

> > > > A set of vital signs, a 12 lead ECG if you have access to it.

> > Come

> > > > to think of it a blood sugar check and UA if you have access

> to

> > it

> > > > would be a good idea too. night sweats? weight loss/gain? I'm

> > > > personally thinking it almost sounds like the beginning signs

> of

> > > > Congestive heart failure but can't rule out TB or damage to

> lungs

> > > > from inhaling stuff he shouldn't have.

> > > >

> > > >

> > > >

> > > > --- In texasems-l@yahoogro --- In texasems-l@ya --- In te

> > > > >

> > > > > You come home from a busy shift, when a neighbor, Mrs.

> Dincker,

> > > > approaches

> > > > > you and asks if you have a minute to talk. Though you're bone

> > > > tired, she's a

> > > > > nice lady and keeps an eye on your house while you and your

> > spouse

> > > > are at work,

> > > > > so you say sure.

> > > > >

> > > > > She relates that her 18 year old son, Duane, has a cough that

> > > > won't seem to

> > > > > go away. It started maybe 4 months ago and has been a dry

> cough

> > > > up until a

> > > > > week ago when he started coughing up blood-streaked sputum.

> He

> > > > seems to be

> > > > > coughing up more and more blood. She says that he's a heavy

> > > > cigarette and

> > > > > marijuana smoker, and he also has been caught sniffing

> gasoline

> > > > fumes several times

> > > > > lately. Even though he's a slacker and doesn't work, she's

> > > > worried that he

> > > > > may have TB. He seems to be short of breath a lot, and just

> > sits

> > > > around.

> > > > >

> > > > > She also mentions that he has complained of a burning

> sensation

> > > > when he

> > > > > urinates, and she has noticed that his feet look swollen

> some

> > of

> > > > the time. She's

> > > > > very worried, but she can't get him to go to the doctor.

> > > > >

> > > > > She asks if you will talk to him. What do you think might be

> > his

> > > > problem,

> > > > > and what other things would you ask and do if he will allow

> > you to

> > > > interview

> > > > > him and do a history and physical on him?

> > > > >

> > > > > Gene Gandy

> > > > >

> > > > >

> > > > >

> > > > >

[Guest guest]

Excellent thoughts, but not the right ones yet. Keep trying. Re-read the

clues.

G

> Gene,

>

> What are the breath sounds? Any other medical history or drug allergies? I

> would love to see a chest film on this guy. Can't rule out CHF, but lung CA

> is also on the possible dx list too.

>

> Bernie

>

> A medical puzzle for 7Aug06

>

> You come home from a busy shift, when a neighbor, Mrs. Dincker, approaches

> you and asks if you have a minute to talk.   Though you're bone tired, she's

> a

> nice lady and keeps an eye on your house while you and your spouse are at

> work,

> so you say sure.

>

> She relates that her 18 year old son, Duane, has a cough that won't seem to

> go away.   It started maybe 4 months ago and has been a dry cough up until a

>

> week ago when he started coughing up blood-streaked sputum.   He seems to be

>

> coughing up more and more blood. She says that he's a heavy cigarette and

> marijuana smoker, and he also has been caught sniffing gasoline fumes

> several times

> lately.   Even though he's a slacker and doesn't work, she's worried that he

>

> may have TB.   He seems to be short of breath a lot, and just sits around.

>

> She also mentions that he has complained of a burning sensation when he

> urinates, and she has noticed that his feet look swollen some of the time.

> She's

> very worried, but she can't get him to go to the doctor.  

>

> She asks if you will talk to him.   What do you think might be his problem,

> and what other things would you ask and do if he will allow you to interview

>

> him and do a history and physical on him?

>

> Gene Gandy

>

>

>

>

[Guest guest]

The lungs sound crappy. Some diffuse crackles.

GG

[Guest guest]

No family history of cancer. Had tests for STDs a month ago, and they were

all negative.

He says that his urine is somewhat pink in color, though.

Gene

>

>

> >

> > She relates that her 18 year old son, Duane, has a cough that won't seem

> to

> > go away. It started maybe 4 months ago and has been a dry cough up until a

> > week ago when he started coughing up blood-streaked sputum. He seems to be

> > coughing up more and more blood. She says that he's a heavy cigarette and

> > marijuana smoker, and he also has been caught sniffing gasoline fumes

> several times

> > lately. Even though he's a slacker and doesn't work, she's worried that he

> > may have TB. He seems to be short of breath a lot, and just sits around.

>

> He's at-risk for lung cancer - all of the symptoms here point to that.

> Definitely needs a CXR, and will probably end up with a CT

> w/contrast.

>

> > She also mentions that he has complained of a burning sensation when he

> > urinates, and she has noticed that his feet look swollen some of the time.

> She's

> > very worried, but she can't get him to go to the doctor.

>

> The burning sensation on urination points to possible bladder cancer.

> It may be that he's got lung cx bad enough that it's metastacized into

> other places, including the bladder. The swollen feet could be

> related to pressure on the heart from a tumor. Typically, tumors

> double in size every 120 days.

>

> > She asks if you will talk to him. What do you think might be his problem,

> > and what other things would you ask and do if he will allow you to

> interview

> > him and do a history and physical on him?

>

> Honestly? There's not too much I can do for this guy. His H & P is

> clear enough now that he needs to be convinced to see his doctor. I

> might ask for family history of cancer, ask if he huffs anything else,

> ask if there appears to be blood in his urine, what his sexual status

> is (active, virginal, etc.) to rule-out STD... but this guy needs some

> films and lab work... stat.

>

> Mike

>

>

[Guest guest]

If it were an autoimmune disease, what are some of the possibilities?

GG

[Guest guest]

Hmm...not real sure on this one. I am fairly sure that it is not TB.

I'm thinking that this is most likely caused from his huffing

gasoline. He's a bit young for Congestive Heart Failure but

stranger things have happened. I think that I will go with chronic

gasoline inhalation.

>

> HR = 74, RR = 18, BP = 128/70. Blood glucose is 106. Denies

night sweats,

> but has lost about 12 pounds in the last 3 months. No ability to

do a UA at

> this time. 12-lead shows sinus rhythm with normal axis.

>

> GG

>

>

>

> >

> > A set of vital signs, a 12 lead ECG if you have access to it.

Come

> > to think of it a blood sugar check and UA if you have access to

it

> > would be a good idea too. night sweats? weight loss/gain? I'm

> > personally thinking it almost sounds like the beginning signs of

> > Congestive heart failure but can't rule out TB or damage to lungs

> > from inhaling stuff he shouldn't have.

> >

> >

> >

> > --- In texasems-l@yahoogrotexasem, wegandy1938@, wegandy1

> > >

> > > You come home from a busy shift, when a neighbor, Mrs. Dincker,

> > approaches

> > > you and asks if you have a minute to talk. Though you're bone

> > tired, she's a

> > > nice lady and keeps an eye on your house while you and your

spouse

> > are at work,

> > > so you say sure.

> > >

> > > She relates that her 18 year old son, Duane, has a cough that

> > won't seem to

> > > go away. It started maybe 4 months ago and has been a dry cough

> > up until a

> > > week ago when he started coughing up blood-streaked sputum. He

> > seems to be

> > > coughing up more and more blood. She says that he's a heavy

> > cigarette and

> > > marijuana smoker, and he also has been caught sniffing gasoline

> > fumes several times

> > > lately. Even though he's a slacker and doesn't work, she's

> > worried that he

> > > may have TB. He seems to be short of breath a lot, and just

sits

> > around.

> > >

> > > She also mentions that he has complained of a burning sensation

> > when he

> > > urinates, and she has noticed that his feet look swollen some

of

> > the time. She's

> > > very worried, but she can't get him to go to the doctor.

> > >

> > > She asks if you will talk to him. What do you think might be

his

> > problem,

> > > and what other things would you ask and do if he will allow

you to

> > interview

> > > him and do a history and physical on him?

> > >

> > > Gene Gandy

> > >

> > >

> > >

> > >

[Guest guest]

Gene,

What are the breath sounds? Any other medical history or drug allergies? I

would love to see a chest film on this guy. Can't rule out CHF, but lung CA

is also on the possible dx list too.

Bernie

A medical puzzle for 7Aug06

You come home from a busy shift, when a neighbor, Mrs. Dincker, approaches

you and asks if you have a minute to talk. Though you're bone tired, she's

a

nice lady and keeps an eye on your house while you and your spouse are at

work,

so you say sure.

She relates that her 18 year old son, Duane, has a cough that won't seem to

go away. It started maybe 4 months ago and has been a dry cough up until a

week ago when he started coughing up blood-streaked sputum. He seems to be

coughing up more and more blood. She says that he's a heavy cigarette and

marijuana smoker, and he also has been caught sniffing gasoline fumes

several times

lately. Even though he's a slacker and doesn't work, she's worried that he

may have TB. He seems to be short of breath a lot, and just sits around.

She also mentions that he has complained of a burning sensation when he

urinates, and she has noticed that his feet look swollen some of the time.

She's

very worried, but she can't get him to go to the doctor.

She asks if you will talk to him. What do you think might be his problem,

and what other things would you ask and do if he will allow you to interview

him and do a history and physical on him?

Gene Gandy

[Guest guest]

Gene, I'm curious how the lungs sound.

-Wes

A medical puzzle for 7Aug06

You come home from a busy shift, when a neighbor, Mrs. Dincker, approaches

you and asks if you have a minute to talk. Though you're bone tired, she's a

nice lady and keeps an eye on your house while you and your spouse are at work,

so you say sure.

She relates that her 18 year old son, Duane, has a cough that won't seem to

go away. It started maybe 4 months ago and has been a dry cough up until a

week ago when he started coughing up blood-streaked sputum. He seems to be

coughing up more and more blood. She says that he's a heavy cigarette and

marijuana smoker, and he also has been caught sniffing gasoline fumes several

times

lately. Even though he's a slacker and doesn't work, she's worried that he

may have TB. He seems to be short of breath a lot, and just sits around.

She also mentions that he has complained of a burning sensation when he

urinates, and she has noticed that his feet look swollen some of the time. She's

very worried, but she can't get him to go to the doctor.

She asks if you will talk to him. What do you think might be his problem,

and what other things would you ask and do if he will allow you to interview

him and do a history and physical on him?

Gene Gandy

[Guest guest]

Gene, I believe your young man should get tested for HIV. His

symptoms sound suspiciously like early stage HIV.

Joe T

> >

> > HR = 74, RR = 18, BP = 128/70. Blood glucose is 106. Denies

> night sweats,

> > but has lost about 12 pounds in the last 3 months. No ability

to

> do a UA at

> > this time. 12-lead shows sinus rhythm with normal axis.

> >

> > GG

> > In a message dated 8/7/06 11:25:30 PM, txladymedic@ writes:

> >

> >

> > >

> > > A set of vital signs, a 12 lead ECG if you have access to it.

> Come

> > > to think of it a blood sugar check and UA if you have access

to

> it

> > > would be a good idea too. night sweats? weight loss/gain? I'm

> > > personally thinking it almost sounds like the beginning signs

of

> > > Congestive heart failure but can't rule out TB or damage to

lungs

> > > from inhaling stuff he shouldn't have.

> > >

> > >

> > >

> > > --- In texasems-l@yahoogrotexasem, wegandy1938@, wegandy1

> > > >

> > > > You come home from a busy shift, when a neighbor, Mrs.

Dincker,

> > > approaches

> > > > you and asks if you have a minute to talk. Though you're bone

> > > tired, she's a

> > > > nice lady and keeps an eye on your house while you and your

> spouse

> > > are at work,

> > > > so you say sure.

> > > >

> > > > She relates that her 18 year old son, Duane, has a cough that

> > > won't seem to

> > > > go away. It started maybe 4 months ago and has been a dry

cough

> > > up until a

> > > > week ago when he started coughing up blood-streaked sputum.

He

> > > seems to be

> > > > coughing up more and more blood. She says that he's a heavy

> > > cigarette and

> > > > marijuana smoker, and he also has been caught sniffing

gasoline

> > > fumes several times

> > > > lately. Even though he's a slacker and doesn't work, she's

> > > worried that he

> > > > may have TB. He seems to be short of breath a lot, and just

> sits

> > > around.

> > > >

> > > > She also mentions that he has complained of a burning

sensation

> > > when he

> > > > urinates, and she has noticed that his feet look swollen

some

> of

> > > the time. She's

> > > > very worried, but she can't get him to go to the doctor.

> > > >

> > > > She asks if you will talk to him. What do you think might be

> his

> > > problem,

> > > > and what other things would you ask and do if he will allow

> you to

> > > interview

> > > > him and do a history and physical on him?

> > > >

> > > > Gene Gandy

> > > >

> > > >

> > > >

> > > >

[Guest guest]

>

> She relates that her 18 year old son, Duane, has a cough that won't seem to

> go away. It started maybe 4 months ago and has been a dry cough up until a

> week ago when he started coughing up blood-streaked sputum. He seems to be

> coughing up more and more blood. She says that he's a heavy cigarette and

> marijuana smoker, and he also has been caught sniffing gasoline fumes several

times

> lately. Even though he's a slacker and doesn't work, she's worried that he

> may have TB. He seems to be short of breath a lot, and just sits around.

He's at-risk for lung cancer - all of the symptoms here point to that.

Definitely needs a CXR, and will probably end up with a CT

w/contrast.

> She also mentions that he has complained of a burning sensation when he

> urinates, and she has noticed that his feet look swollen some of the time.

She's

> very worried, but she can't get him to go to the doctor.

The burning sensation on urination points to possible bladder cancer.

It may be that he's got lung cx bad enough that it's metastacized into

other places, including the bladder. The swollen feet could be

related to pressure on the heart from a tumor. Typically, tumors

double in size every 120 days.

> She asks if you will talk to him. What do you think might be his problem,

> and what other things would you ask and do if he will allow you to interview

> him and do a history and physical on him?

Honestly? There's not too much I can do for this guy. His H & P is

clear enough now that he needs to be convinced to see his doctor. I

might ask for family history of cancer, ask if he huffs anything else,

ask if there appears to be blood in his urine, what his sexual status

is (active, virginal, etc.) to rule-out STD... but this guy needs some

films and lab work... stat.

Mike

[Guest guest]

If this guy smokes that much pot and it is treated with some type of

pesticide? What about acute pesticide poisoning?

The burning upon urination and sudden weight loss could indicate an

autoimmune disease. But could also be a systemic infection too.

This guy needs a labs (CBC, chem. panel, HIV, etc), chest film, UA, and

complete physical exam in a hospital!

Bernie

Re: A medical puzzle for 7Aug06

Gene, I believe your young man should get tested for HIV. His

symptoms sound suspiciously like early stage HIV.

Joe T

> >

> > HR = 74, RR = 18, BP = 128/70. Blood glucose is 106. Denies

> night sweats,

> > but has lost about 12 pounds in the last 3 months. No ability

to

> do a UA at

> > this time. 12-lead shows sinus rhythm with normal axis.

> >

> > GG

> > In a message dated 8/7/06 11:25:30 PM, txladymedic@ writes:

> >

> >

> > >

> > > A set of vital signs, a 12 lead ECG if you have access to it.

> Come

> > > to think of it a blood sugar check and UA if you have access

to

> it

> > > would be a good idea too. night sweats? weight loss/gain? I'm

> > > personally thinking it almost sounds like the beginning signs

of

> > > Congestive heart failure but can't rule out TB or damage to

lungs

> > > from inhaling stuff he shouldn't have.

> > >

> > >

> > >

> > > --- In texasems-l@yahoogrotexasem, wegandy1938@, wegandy1

> > > >

> > > > You come home from a busy shift, when a neighbor, Mrs.

Dincker,

> > > approaches

> > > > you and asks if you have a minute to talk. Though you're bone

> > > tired, she's a

> > > > nice lady and keeps an eye on your house while you and your

> spouse

> > > are at work,

> > > > so you say sure.

> > > >

> > > > She relates that her 18 year old son, Duane, has a cough that

> > > won't seem to

> > > > go away. It started maybe 4 months ago and has been a dry

cough

> > > up until a

> > > > week ago when he started coughing up blood-streaked sputum.

He

> > > seems to be

> > > > coughing up more and more blood. She says that he's a heavy

> > > cigarette and

> > > > marijuana smoker, and he also has been caught sniffing

gasoline

> > > fumes several times

> > > > lately. Even though he's a slacker and doesn't work, she's

> > > worried that he

> > > > may have TB. He seems to be short of breath a lot, and just

> sits

> > > around.

> > > >

> > > > She also mentions that he has complained of a burning

sensation

> > > when he

> > > > urinates, and she has noticed that his feet look swollen

some

> of

> > > the time. She's

> > > > very worried, but she can't get him to go to the doctor.

> > > >

> > > > She asks if you will talk to him. What do you think might be

> his

> > > problem,

> > > > and what other things would you ask and do if he will allow

> you to

> > > interview

> > > > him and do a history and physical on him?

> > > >

> > > > Gene Gandy

> > > >

> > > >

> > > >

> > > >

[Guest guest]

I'm going with Lupus.

-Wes Ogilvie

Re: Re: A medical puzzle for 7Aug06

If it were an autoimmune disease, what are some of the possibilities?

GG

[Guest guest]

Sounds a little like benzene poisoning.

[Guest guest]

also acute renal failure with rabdomylosis

wegandy1938@... wrote: If it were an autoimmune disease, what are

some of the possibilities?

GG

[Guest guest]

Pneumocystis carinii secondary to HIV infection?

-aro

>

> HR = 74, RR = 18, BP = 128/70. Blood glucose is 106. Denies

night sweats,

> but has lost about 12 pounds in the last 3 months. No ability to

do a UA at

> this time. 12-lead shows sinus rhythm with normal axis.

>

> GG

>

>

>

> >

> > A set of vital signs, a 12 lead ECG if you have access to it. Come

> > to think of it a blood sugar check and UA if you have access to it

> > would be a good idea too. night sweats? weight loss/gain? I'm

> > personally thinking it almost sounds like the beginning signs of

> > Congestive heart failure but can't rule out TB or damage to lungs

> > from inhaling stuff he shouldn't have.

> >

> >

> >

> > --- In texasems-l@yahoogrotexasem, wegandy1938@, wegandy1

> > >

> > > You come home from a busy shift, when a neighbor, Mrs. Dincker,

> > approaches

> > > you and asks if you have a minute to talk. Though you're bone

> > tired, she's a

> > > nice lady and keeps an eye on your house while you and your spouse

> > are at work,

> > > so you say sure.

> > >

> > > She relates that her 18 year old son, Duane, has a cough that

> > won't seem to

> > > go away. It started maybe 4 months ago and has been a dry cough

> > up until a

> > > week ago when he started coughing up blood-streaked sputum. He

> > seems to be

> > > coughing up more and more blood. She says that he's a heavy

> > cigarette and

> > > marijuana smoker, and he also has been caught sniffing gasoline

> > fumes several times

> > > lately. Even though he's a slacker and doesn't work, she's

> > worried that he

> > > may have TB. He seems to be short of breath a lot, and just sits

> > around.

> > >

> > > She also mentions that he has complained of a burning sensation

> > when he

> > > urinates, and she has noticed that his feet look swollen some of

> > the time. She's

> > > very worried, but she can't get him to go to the doctor.

> > >

> > > She asks if you will talk to him. What do you think might be his

> > problem,

> > > and what other things would you ask and do if he will allow you to

> > interview

> > > him and do a history and physical on him?

> > >

> > > Gene Gandy

> > >

> > >

> > >

> > >

[Guest guest]

Another excellent guess, but not the right one.

Gene

>

> Sounds a little like benzene poisoning.

>

>

[Guest guest]

Lupus is in the ballpark, but it's the ballpark next door to the one with the

right answer.

GG

>

> I'm going with Lupus.

>

> -Wes Ogilvie

>

>

> Re: Re: A medical puzzle for 7Aug06

>

> If it were an autoimmune disease, what are some of the possibilities?

>

> GG

>

>

[Guest guest]

Is Goodpasture's syndrome more in the ballpark?

-Wes

In a message dated 8/8/2006 10:04:57 PM Central Daylight Time,

wegandy1938@... writes:

Lupus is in the ballpark, but it's the ballpark next door to the one with

the

right answer.

GG

In a message dated 8/8/06 9:47:18 AM, _ExLngHrn@..._

(mailto:ExLngHrn@...) writes:

>

> I'm going with Lupus.

>

> -Wes Ogilvie

>

>

> Re: Re: A medical puzzle for 7Aug06

>

> If it were an autoimmune disease, what are some of the possibilities?

>

> GG

>

> [Non-text portions of this message have been removed]

>

> ____________ ________ ________ ________ ________ ________

> Check out AOL.com today. Breaking news, video search, pictures, email and

> IM. All on demand. Always Free.

>

>

[Guest guest]

TAA DAAAAAAAAH! WE HAVE A WINNER.

WES OGILVIE, EMT-B has correctly identified the condition. Goodpasture's

Disease or Syndrome.

Congratulations, Wes.

Your reservation in the back yard of Wayne-Bo's is made.

Gene

In a message dated 8/8/06 10:12:51 PM, ExLngHrn writes:

> Is Goodpasture's syndrome more in the ballpark?

>  

> -Wes

>  

> In a message dated 8/8/2006 10:04:57 PM Central Daylight Time,

> wegandy1938@... writes:

>

>

> Lupus is in the ballpark, but it's the ballpark next door to the one with

> the

> right answer.

>

> GG

>

>

> >

> > I'm going with Lupus.

> >

> > -Wes Ogilvie

> >

> >

> > Re: Re: A medical puzzle for 7Aug06

> >

> > If it were an autoimmune disease, what are some of the possibilities?

> >

> > GG

> >

> >

[Guest guest]

For those who want to know more about autoimmune diseases, of which there are

many, Goodpasture's being just one, Wikipedia has an excellent list.

Go to: http://en.wikipedia.org/wiki/List_of_autoimmune_diseases

It has a nice, short description of each of the standard autoimmune diseases.

Research is a tool that many EMS personnel don't do well; yet, it can open

the door to much knowledge. I saw my nephrologist today, and he pulled out his

Blackberry three or four times during my visit to look up things about drugs,

lab values, and so forth, and he's a board certified nephrologist. Nobody

can remember all there is to remember.

The same information is available to us, and all we have to do is know how to

access it and have the incentive to do it.

Much has been said on these lists about medic education recently. Blame has

been placed at the feet of the EMS educators, and to a great extent, that's

where it belongs. But students also have a responsibility to guide their own

learning processes.

The line between being a tradesman and a professional is not crossed until

one learns and accepts that one's education is one's own responsibility, not

that of someone else. Teachers cannot teach very much. They can assist a

student to learn, but to state an adage, " you can lead a horse to water, but you

can't make it drink. "

Some students simply do not have the intellectual tools to progress further

than a certain level, but many more have the tools but have never learned to

learn on their own.

If you're a student, let me say this to you: It is NOT my duty to teach

you. It is my duty to help you learn in every way that I can think of, but

learning takes place between your ears, not mine.

If you don't think you're getting a good education, then educate yourself.

The easiest way to do that these days is to use the Internet. Do a Google

search for any term or topic and you'll find a wealth of materials.

eMedicine Online is a great source, it's free to students and teachers, and

all you have to do is register. Yes, it's a site aimed at doctors. So what?

Doctors are just like us, except that they have taken more courses and,

yes, learned how to teach themselves. That's the big difference.

How many of you read JEMS and EMS Magazine regularly? If you don't you're

missing a wealth of information. And those are only trade publications.

You'll find REAL research articles through the Internet, and if you try, you can

read and understand them.

It's time we became professionals, not techs. But a profession consists of

the individual professionals who inhabit the discipline. If we are not

individually professional, then we'll never have an EMS profession.

Gene G.

[Guest guest]

A very good guess, but there's something going on that underlies the renal

failure. What is it?

G

>

> also acute renal failure with rabdomylosis

>

> wegandy1938@wegandy wrote: If it were an autoimmune disease, what are some

> of the possibilities?

>

> GG

>

>