Tuesday, May 24, 2011

Hanker for a Chancre?

Case of the century.

I received a consult for a GI biopsy recently. Only history was ulcers in rectum. The biopsy looked like chronic active colitis - architectural distortion, cryptitis - probably ulcerative colitis or Crohn's. History fit for UC. It was signed out as such.

The GI doc called back. "This doesn't make sense. It is a young person, but there is only one ulcer. And they have HIV."

Well, that certainly put a spin on the case. UC and Crohn's usually rat out the colon - they don't create a solitary ulcer. And with the patient's immunocompromised status, a bug hunt was in order. I threw on a silver stain for fungus, an AFB for mycobacteria, a Giemsa to hopefully highlight the mucus blebs that might be Cryptosporidium, and a Steiner for syphilis.

The bug stains were all negative. I have not yet performed a Steiner since I was in private practice, and they are tough stains to read. Dirty as hell - ochre yellow and muddy brown spattered in black paint. I didn't think I could see any spirochetes, but I sent the entire case to a GI expert for review. They agreed with me. I called the GI doc to give him our update, and he said, "Well, there is some new information. The patient has syphilis. So that could be a chancre. That would be a first, in our group's history."

I called the University and learned that there is a new, cleaner, much more sensitive stain for syphilitic spirochetes - an immunostain. I had the histo lab cut some unstained slides of the biopsy and sent them over. A couple of days later, I got an e-mail. "The immunostain is positive for spirochetes. What a great case - thanks for the consult."

Sometimes things that seem straightforward aren't, and it takes some extra phone calls and digging to get your answer. I jumped up excitedly and ran to the office next door. Two of my partners were discussing a refractory platelet patient. "Guess what!! I had a rectal chancre this week!" One of them said, with a lascivious smile, "Really, you did? Can I see it? Wait, let me get my iphone camera!" I smiled at him, glanced backward over my shoulder in the direction of my backside, and managed to look cheerfully confused. "Um, that might be tough?"

"Oh yeah, you said rectal." He tucked his iphone back in his pocket. "Oh well."

As I started to blush, my other partner said, "Giz, you walked right into that one. Now tell us about the case, that sounds really interesting."

Speaking of chancres, I had an oh so promising romantic interest at a concert I attended last Wednesday night. My friend and I were sitting down, and I looked over at her curiously. "Are you getting drops of liquid on your head?" She said, "Yeah, drops, but on my shoulder." I looked up. The ceiling was pretty far away for an air conditioner malfunction. I rubbed my finger on my head, and much more was now spilled on my shirt as well. "It smells like beer. Oh well, they say that is good for the hair, right?"

When the lights came up for intermission I glanced behind me, and there was an obviously drunk guy, sitting next to a ten year old. He slurred, "What! You got something to say to me? I'm just trying to show my son a good time here!" I turned around, reluctant to engage in any further interaction.

Later, after my friend and I had picked out t-shirts, I bumped into a pediatrician/ED couple I knew, and stopped to chat. Spilling beer guy was chatting with someone they were with, and I don't think he had any idea that he had ever seen me before. He lumbered over, and it was unclear whether he was talking to me or his friend. "I'm telling you, she's happy with her husband. Are you happy with your husband? I'll bet you are. With my luck, you are happy with your husband." I glanced down at the new t-shirt I had wrapped around my left hand, disguising my ringless finger. I smiled at him. "Yup, I am really, truly happy with my husband."

He walked away, and mumbled at his friend. "I knew it! Darn my luck."

And they say single life is fun. Be wary of chancres - both societal and rectal.

Friday, May 20, 2011

Small Pot

I don't usually share funny links, but I found this on the Arkansas Blog tonight, and I was laughing so hard I had tears running down my face. I had to stop at page 20 because my kids couldn't sleep and I almost gave myself a hernia.

The comical recipe: Here.

The wildly hysterical comment thread: Here.

Enjoy.

Tuesday, May 17, 2011

Saturday, May 14, 2011

Jumping On the Bandwagon

Adele. Adele. Adele. I'm addicted.






This reminds me of when I finally bought Amy Winehouse.

Nothing could be good if it is so widely recognized. I was soooo wrong.

Even Cecelia is enthralled. A sure sign of excellent music.

Sunday, May 8, 2011

Happy Mother's Day

You can read it if you click here: MiM

Nail In My Coffin

Song of the Month - this whole album is incredible






I am no better at this than you are
Unfinished business maybe, do love
I can't change myself into you dear
What you are to me is far too unclear

Quit being a nail in my coffin and I don't need another one
Quit being a nail in my coffin and lord knows I ain't ready yet
Quit being a nail in my coffin and I don't need another one
Quit being a line I'm crossing and I am never gonna get back from

Oh oh oh oh oh
Oh oh oh oh oh
Oh oh oh oh oh
Oh oh oh oh oh

I am no better at this than you are
Loneliness never truly leaves me alone
I have made mistakes I can't take back home
I love you just not the way you want

Quit being a nail in my coffin and I don't need another one
Quit being a nail in my coffin and lord knows I ain't ready yet
Quit being a nail in my coffin and I don't need another one
Quit being a line I'm crossing and I am never gonna get back from

Oh oh oh oh oh
Oh oh oh oh oh
Oh oh oh oh oh
Oh oh oh oh oh

Oh oh oh oh oh
Oh oh oh oh oh
Oh oh oh oh oh
Oh oh oh oh oh

Quit being a nail in my coffin and I don't need another one
Quit being a nail in my coffin and lord knows I ain't ready yet
Quit being a nail in my coffin and I don't need another one
Quit being a line I'm crossing and I am never gonna get back from

Quit being a nail in my coffin and I don't need another one
Quit being a nail in my coffin and lord knows I ain't ready yet
Quit being a nail in my coffin and I don't need another one
Quit being a line I'm crossing and I am never gonna get back from

Oh oh oh oh oh
Oh oh oh oh oh
Oh oh oh oh oh
Oh oh oh oh oh

Saturday, May 7, 2011

The Sleepover

I helped my daughter host one last night. I promised her for her birthday, which was a whopping two months ago, so it was time I cashed in on it.

I don't do these very often, as it throws me all out of whack and can be overwhelming. I just basically worked two weeks in a row - having had call last weekend with a record number of marrows, and lots of tissues to boot. It makes me feel good that a weekend like that would have sent my GI tract into hyper overdrive a couple of years ago and now I can take it all in stride.

I had my tarot cards read about a six weeks ago, by the Mom of one of my great friends. It was pentacle after pentacle after pentacle (or was it oracles? I'm not too tarot card savvy). Anyway, it was about work. She remarked at one point during the reading, "You might think there are no more pentacles in my deck of cards. But with you they seem to be multiplying. You must be doing really well in your job." I replied, "Yes, I'm doing great. Bonuses are rolling in. I made partner last fall. I feel really good about what I do." She said, "Sometimes these readings aren't so much a prophesy for the future, but simply a validation." I guess it is nice to be validated every now and again. No cups, unfortunately. Sigh.

Anyway, Cecelia and I picked up her friend after I got off work, around 5:30. These are some new neighborhood friends - she and my daughter are in dance together and it was a bonus to find that they live a block away. Mom is a transport EMT and dad is a cop - not just any cop, but a special one that works at the Governor's mansion. This kid is obviously more worldly than my own daughter, but I like that she is extremely polite, ordered lots of veggies at dinner, and kept centering plans around me when C just wanted to whisk her away for herself.

This one cracked me up. "Cecelia, let's spin for your Mom." She started spinning, and spinning, and spinning in the living room. I was settled into the couch with my book and my SOBE water. Cecelia joined her for about five minutes, then said, "Sydney, I'm sick of spinning. Why don't we just go upstairs and dance?" She said, "No, I want your Mom to know that I can spin. I once spinned for 25 minutes straight." I told her, "It's Ok, Syd, I believe you - you can really spin."

"No, I want to show you." She kept spinning. C rejoined her. Sydney said, "Do you think you could give your cat a wedgie?"

I looked over at Katybell, then at Cecelia. C's mind was whirring with her body. I said, "I don't know, Syd, I don't think a cat's butt would work too well for a wedgie."

C said, still spinning, tripping over my big feet, "Yeah! And they don't really even wear underwear! And their butt is just so, um, circular. Circular butts can't get wedgies." They both giggled uncontrollably and collapsed on the floor.

A couple of fashion shows later, they corralled me into YouTube. Sydney was much more computer savvy than C, and was working my laptop like a pro. "I want to show you ET, by Katy Perry. But we can't watch the video, because the guy is n-a-k-e-d. Just look at the lyrics, they're ok." Later on, when C was playing "Imma B (sp?)," Sydney barged in on me while I was brushing my teeth. "Um, there have already been three bad words. We didn't listen to the whole thing, but I think we had better stop." I asked her, "Would your parents let you listen to it?" She said no. "Then don't." Despite the fact that she knew the bad words, and could spell them for me - B-I-T-C-H and S-H-I-T - I know C has no idea about these words - she was still checking in, which was good in my book.

They had lofty plans to stay up until 1 or 2 a.m., but they fell asleep at 11:00, thank goodness. They were being so rowdy in the room right next to mine that I almost sent them upstairs, but I liked to listen to their rowdiness, with all of its wonderful eight year old innocence. As I alternately read my novel and berated them through the wall for being too loud, I thought that maybe I could do this again, before another year. Because how much longer is it all going to be so innocent? So full of giggling about cat wedgies, and playing games, and listening to music without too many bad words on itouches, and falling asleep with the anticipation of morning cinnamon rolls and water balloon fights. Not much longer, I imagine.