Rubor, Dolor, Calor, Tumor
Blog Address: http://blogs.medscape.com/rdct
December 28, 2009

Big MAC Attack

The patient is a middle aged male who presented with fevers and three months of wasting.  His HIV was elevated and his CD4's were in the 20's.  He was, as best as could be told, OI free, and was started on HAART.

His viral load fell to zero and his CD4's popped up into the low two hundreds.  At satisfying response, but, clinically, the patient worsened.

Head, neck and groin lymph nodes exploded, figuratively speaking.  But the size of the lymphadenopathy was in the extra large egg size, they were painful and the fevers returned.

Biopsy showed lots of AFB that were identified as MAC and he was given a short course of predinsone and a long course of antibiotics, again with improvement followed by a marked worsening of symptoms when the pred...

Posted By: Mark Crislip  

December 24, 2009

Life keeps one busy.

Between work, preparing for the holidays, and my wife's Birthday (Dec 25.  Her picture is in the OED, under the entry for 'long suffering'), I have no time to write.

See you next week and I offer a generic non-denominational seasonal greeting to one and all.

Well, execept for the one who called me fat.

Posted By: Mark Crislip  

December 21, 2009

Kobayashi maru

There are no win situations in medicine. On occasion, the choice is to decide what the least bad option is. There is a rock and hard place. Choose. MRSA bacteremia.  A standard consult. And one everyone should consider, since the self serving ID literature shows that patients who get an ID consult for their S. aureus bacteremia have better outcomes.

"All 4 standards of ...

Posted By: Mark Crislip  

December 19, 2009

Mai? Oui? Peut etre?

I often get asked questions for which there are no answers.  For example.  A young, at least by my standards, since I am 364 in dog years, female has a colonoscopy as part of screening for cancer.

Her ileum is inflamed so a biopsy is done.  It shows granulomatous ileitis  consistent with Crohn...

Posted By: Mark Crislip  

December 17, 2009

Passive Voice

I like to read op notes, and it is amusing how in many notes there does not seem to be anyone doing the operation.  It is all in the passive voice:  the abdomen was entered (by whom?), the vein was transected (divine intervention?), the spleen was removed (transported out by Mr. Scott?). I guess there is no 'I' in surgery. I am glad I am not a surgeon, my ego is too ginormous to be co...

Posted By: Mark Crislip  

December 15, 2009

Ick

Or maybe ech.  Ick is that stuff that grows on guppies.

Patient presents with chemotherapy induced neutropenia and fevers. That is common enough.

But he has these painful lesions on his left arm and hand, including the palm and the middle of the middle finger.

The middle of the lesions is black-blue, surrounded with erythema and are, as mentioned, very pain...

Posted By: Mark Crislip  

December 13, 2009

Sore Throat

It Sunday morning, I am on call and waiting for the ice to melt so I can get in to round. It is one of the reasons I live on a hill, it provides me with the occasional legitimate reason to take my time getting into work.

One of the cases I have to see is a severe sore throat with lymphadenopathy and early abscess formation on CT.  Patient is barely out of his teens and no risk f...

Posted By: Mark Crislip  

December 9, 2009

Cold and Cold

It is cold out. Twelve degrees this morning in what should be the mild Pacific Northwest.  Where is global warming when you need it?  I did my residency in Minneapolis, and that was cold.  There was one month where the temperature did not get above zero.  12 degrees would have been short pants and sandals weather back in the day, but now?  It is too cold for me.
<b...

Posted By: Mark Crislip  

December 7, 2009

It Wasn't the Cigarettes

Busy today in a slow way. The blog is about the weird and wonderful cases I see, but today was cases with vague problems and uncertain answers.

I think it would make the entry too 'Jack Torrance' to write "I don't know' over and over.  The one symptom all my patients have is fever.  I have an ongoing interest in fever and temperature regulation.

Fever, of course,...

Posted By: Mark Crislip  

December 5, 2009

With three letters I predict the future.

Chemo for cancer has its side effects, but the side effects are usually better than death.  Usually.  The patient has cancer and HIV, with CD4 counts hovering just above the magic mark of 200, the point where you have to worry about opportunistic infections. Or do I?  That s part of the problem.  Is a CD4 count of 200 reliable when there is ongoing cancer chemo?  Not if...

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 as The Puswhisperer, Volumes 1 and 2. Really. Perfect for the pus lover in your life.
Because The World Needs More Mark Crislip (tm).
Flies in the Ointment: Essays on Supplements, Complementary and Alternative Medicine (SCAM).
A carefully selected and edited compendium of my best blog posts from sciencebasedmedicine.org. The sections have been edited for redundancy, updated for 2017, and classified into themes including my influenza rants.

All on Amazon.

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. Links to his multimedia empire of blogs, podcasts, books, apps and tweets can be found at www.edgydoc.com

    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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