Night Float II
Sorry for the delay. I have returned to Anchorage, but will finish up the stories of my stay in Bethel for all who are interested.
9 p.m.
Blood in sputum, possible tuberculosis reactivation. Always a good start to an admission. Oddly enough, Alaska has one of the highest rates of TB in the nation. This is likely due to its prevalence in the native villages, and its propensity to be spread in close quarters. Many of my patients have 10-15 people living in their small homes. Our patient, a 48 year old woman came in, coughing up a fair amount of bright red blood. For some reason this is almost always disconcerting. There had been a recent reactivation in her village, and we were afraid she was an extension of that reactivation. To complicate things, she had a history of kidney failure and was on peritoneal dialysis. (This is an alternative to hemodialysis where the patient is hooked up to a machine that cleans their blood. In peritoneal dialysis, the patient simply hooks a back of a specially formulated IV solution to a port that goes directly into their abdomen and then drains it by gravity into a second bag.)
Haven’t had enough? The patient was also my first with Wegener’s Granulomatosis. A disease that affect the kidneys, lungs, and nasal passages with granulomas (a type of reaction usually to infection), causing dysfunction and bleeding. So, was she bleeding because she was infectious, having a flare of her Wegener’s, as a complication to her dialysis, or simply because she had a cold and coughed enough to injure the blood vessels in her lungs? Nice and easy question. I have to leave you hanging, because we didn’t get the sputum cultures back before I left. I believe it was either the cold or the Wegener’s. I haven’t converted to a positive TB test yet.
Was the night over? No. A young man in Chevak had just overdosed on Vicodin. I prepared for the Medivac flight without delay.
9 p.m.
Blood in sputum, possible tuberculosis reactivation. Always a good start to an admission. Oddly enough, Alaska has one of the highest rates of TB in the nation. This is likely due to its prevalence in the native villages, and its propensity to be spread in close quarters. Many of my patients have 10-15 people living in their small homes. Our patient, a 48 year old woman came in, coughing up a fair amount of bright red blood. For some reason this is almost always disconcerting. There had been a recent reactivation in her village, and we were afraid she was an extension of that reactivation. To complicate things, she had a history of kidney failure and was on peritoneal dialysis. (This is an alternative to hemodialysis where the patient is hooked up to a machine that cleans their blood. In peritoneal dialysis, the patient simply hooks a back of a specially formulated IV solution to a port that goes directly into their abdomen and then drains it by gravity into a second bag.)
Haven’t had enough? The patient was also my first with Wegener’s Granulomatosis. A disease that affect the kidneys, lungs, and nasal passages with granulomas (a type of reaction usually to infection), causing dysfunction and bleeding. So, was she bleeding because she was infectious, having a flare of her Wegener’s, as a complication to her dialysis, or simply because she had a cold and coughed enough to injure the blood vessels in her lungs? Nice and easy question. I have to leave you hanging, because we didn’t get the sputum cultures back before I left. I believe it was either the cold or the Wegener’s. I haven’t converted to a positive TB test yet.
Was the night over? No. A young man in Chevak had just overdosed on Vicodin. I prepared for the Medivac flight without delay.
posted by rob at 5:09 PM
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