Rubor, Dolor, Calor, Tumor
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October 11, 2017

Rate au Vent

Time to complain or perhaps, in medical terminology, vent my spleen.

Made rounds as usual. In the middle of the night a patient I was treating for endocarditis became more short of breath. No fevers, no increase in WBC and a CXR that, to my eye, was all CHF.

So of course, antibiotics had to be broadened and by broadened I mean the antibiotics she needed were mostly replaced with antibiotics that were not only niot needed but were of lessor efficacy for the primary infection.

Figures.

No harm was done as I found out within 8 hours. But.

I have come to the conclusion that antibiotics should be like cancer chemotherapy agents and limited to those who know what they are doing.

Some channeling of my inner

Posted By: Mark Crislip  

October 9, 2017

In the damndest places

The patient had a spider bit on the back of thigh many years ago. I do not believe in spider bites at least outside of Peter Parker. People never see said spider. And they always think was a brown recluse. Sorry. The brown recluse lives nowhere near the great Pacific NW.


the kno...

Posted By: Mark Crislip  

October 4, 2017

No other options? I think not.

The patient is admitted for an esophageal perforation and an empyema.

She has an esophageal stent placed to repair the tear and a VATS. The blood grows Lactobacillus and Bifidobacterium. The pleural space grows Candida albicans. They call me for final antibiotic choice and I see patient is on fluconazole, ciprofloxicin and metronidazole.

Cipro. What is...

Posted By: Mark Crislip  

October 2, 2017

Did Not Believe it at First

First a complaint. Or two.  Again. But I like to winge.

In the internet era I do not need to know the details of a study like I did when I had to slog through the Index Medicus to find a reference. I know the basic result, like fosfomycin has been used with success for prostatitis and it was in CID. But what dosing and for how long? I don't remember that. I don't need to. ...

Posted By: Mark Crislip  

September 27, 2017

Discordant

The last month of two have seen a deluge of cases of enterococcal endocarditis and liver abscesses. And like snowflakes, now two are alike. Well, that may not be true for snowflakes or liver abscesses, but both have remarkable variation.

One case was typical: middle aged make with fevers, RUQ pain, history of diverticulitis. I said it was likely S. intermedius with or without a...

Posted By: Mark Crislip  

September 25, 2017

Ampicillin Allergy and Listeria

The elderly patient presents with headache, nausea and protracted vomiting. She is not coherent, does not have stiff neck and is non-focal. Imaging is negative and her LP show 98 WBC, a normal glucose and a protein of 450. Negative gram stain. She is started of vancomycin, ceftriaxone and TMP-Sulfa with a well documented allergy to ampicillin.

I am called to see her the next day. It is ...

Posted By: Mark Crislip  

September 20, 2017

The sandfly is the vector but the gerbil is the reservoir.

There is mansplaing: "a portmanteau of the word man and the informal form splaining of the verb explaining and means "to explain something to someone, characteristically by a man to woman, in a manner regarded as condescending or patronizing."

Lucy had some splaining to do (not

Posted By: Mark Crislip  

September 18, 2017

That is no way to die

As some patients age and develop a disease that will eventually kill them they occasionally opt for no treatment. It is a reasonable decision.

I recently had a patient in their late 80's with metastatic pancreatic cancer. She decided against treating her cancer. Fair enough. But then she developed Streptococcus gallolyticus subsp. pasteurianus aortic valve endocarditis, perhaps...

Posted By: Mark Crislip  

September 13, 2017

Check Another One Off The List

I have said before that ID is like birding, only interesting. I have my life list of diseases I have seen, have yet to see, and a few (smallpox, measles) I hope never to see.

While Oregon is perhaps the best place on earth to live, as a source of Infectious Diseases it can be dull. We have little of interest in the Great Pacific NW to interest an ID doc. I have to wait for my patients t...

Posted By: Mark Crislip  

September 11, 2017

Threes

Over the summer vacation I let my beard grow back. It is 95% white. That's fine. Grey hair is hereditary: you get it from your children. Every medical group advertisement needs the old grey man. I am ready to be typecast. And being old has its advantages. A patient today said he could not believe how young all his doctors were and it was nice to have an old, experienced, doctor.  I get tha...

Posted By: Mark Crislip  

 
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About This Blog

For the Benefit of Mr Kite, there will be ID tonight. Infectious Diseases! Antibiotics! Viruses and Bacteria and Fungi! Oh my! Exclamation marks!!!!!! No trampolines, nor will any band be playing at 10 to 6. And Henry the Horse died of the Strangles. Sorry. That's the problem with infections.

The endless excitement that is the daily practice of Infectious Diseases in a Portland teaching hospital! The need for meta data!

Every day I make infectious disease rounds in the hospital and see at least one cool case or learn something new. 25 years and I still do not know everything. Why be selfish and keep all of that wonder and knowledge to myself? This blog will be a mostly qod account of days events, a cool ID case, a referenced pearl, and a minimum of 1 horrible, yet ultimately feeble, attempt at humor.

While usually written in the present tense, the cases are not necessarily current and all identifying information is altered or obscured as long as it is not absolutely pertinent to the case. Can't have a female with prostate infection for example.

I write these at night or in spare moments. There is always someone who will quibble about spelling, punctuation or grammar. My response is live with it. It's a blog, not Mandel.

Read and listen to more of me at my multimedia empire linked below.

The first 2 years blog posts have been collected and edited and are available on Amazon as The Puswhisperer, Volumes 1 and 2. Really. Perfect for the pus lover in your life.
Because The World Needs More Mark Crislip (tm).

Disclosure: Mark A. Crislip, MD, has disclosed the following relevant financial relationships:
Received income in an amount equal to or greater than $250 from: Pusware LLC
Have a 5% or greater equity interest in: Pusware LLC (owner)

  • Mark Crislip

    Mark Crislip, MD, has been practicing in infectious diseases in Portland, Oregon, since 1990. He is nobody from nowhere, but he has an enormous ego that leads him to think someone might care about what he has to say about infectious diseases. And so he blogs and podcasts and writes on the most endlessly fascinating specialty in all of medicine.

    Mark A. Crislip, MD, has disclosed the following relevant financial relationships: Owner, Pusware LLC. He as not talked to a drug rep in over 25 years and does not even eat the pizza provided at conferences. But he is for sale for the right price. Please. Someone. Buy me.

The content of this blog does not necessarily reflect the viewpoints of Medscape.
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