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October 30, 2010

Not everything is infectious

Not every patient I see has an infection as the cause of their symptoms.  My old boss used to say that the ID doc has to be the second best subspecialist in the hospital, since infections affect any organ system.  Second best cardiologist, second best pulmonologist, etc.  So I try and keep an eye out for a diagnosis that is not very interesting, er I mean, not infectious.

I am called to see a patient who is septic without a source.  He has widely metastatic cancer and chemo has given him severe mucositis so that he needs IV fluids.  He is leaving the infusion clinic when he collapses.  Rapid response is called and he is transferred to the ICU, hypotensive, hypothermic.

He gets the usual work up for sepsis, but all the cultures are negat...

Posted By: Mark Crislip  

October 28, 2010

Don't Just Do Something, Stand There

Finally I am back in action.  Hard drive replaced, backups transferred, what a royal pain.

When I was a fellow I had was up all night writing the final draft of a grant and accidentally pulled the plug. Word Not So Perfect did not have auto-back up and I lost all the work.  I wanted to cry.  As a result I always have three or four copies of everything, but getting th...

Posted By: Mark Crislip  

October 22, 2010

An Unexpected Belly Laugh

Busy day.  My partner is learnin' at IDSA, so I am in Orygun holding down the fort. Lots of cool cases to write about in the days ahead.  When I have to cover both practices I have to work at warp factor 9 to get all the patients seen in a reasonable amount of time.  It takes concentration and I pay a little less to my social environment.  Not a day for hoots and g...

Posted By: Mark Crislip  

October 20, 2010

0 to 60

When I awoke this morning I had one of that rare confluence of events where I had no patients to see.  None.  Lots of discharges and no new consults, and I took my time getting ready for work, figuring that  I would cruise through the day and maybe get home early and stack the 2 cords of wood that were delivered this week. 

Then, in 10 minutes, boom, five consul...

Posted By: Mark Crislip  

October 18, 2010

Which came first?

Back from the Grand Tour of the NE looking at colleges with my eldest.  Youth is wasted on the young as is college.  After touring the campuses, I told my son, the heck with him, I am quitting work and going back to school.  He can support me.  Back to the routine, but not the grind.  ID remains much too fun and interesting to really go back to college, but still.....

Posted By: Mark Crislip  

October 12, 2010

A Budget of Dumb Asses 2010 (Flu Vaccine)

It is October and that means two things return: The Great Pumpkin and a Budget of Dumb Asses. Since I am traveling the N.E. looking at colleges with my eldest,  it is time for a pre-owned podcast. 

This essay is, I would like to clarify, directed at healthcare providers, not patients.  Healthcare providers have no excuse to avoid the flu vaccine:...

Posted By: Mark Crislip  

October 10, 2010

All that is gold does not glitter, Not all those who wander are lost, All vegetations are not infected.

Don't take a temperature unless you want to deal with a fever. 

Wise old saying.  We get lots of tests in patients, and sometimes they have incidentalomas, unexpected lesions that you have to then evaluate.

Patient is admitted for pulmonary embolism after a transatlantic flight.  Seems simple, but the history has little hints that there may be more.

He is ...

Posted By: Mark Crislip  

October 8, 2010

Continuously sustained

Fever patterns are not usually all that helpful,  Sure, malaria has a pattern, depending on the species, but I do not yet live in a malarious area of the world. I remain hopeful that with global warming that Oregon will again be a center of malaria.  Most fevers are intermittent and do not have to helpful pattern and as a rule, fever patterns are not a help, at least not in the i...

Posted By: Mark Crislip  

October 6, 2010

A toehold in the shoulder.

Patient is an elderly male with numerous medical problems, not the least of which is cirrhosis and resultant cytopenias.  He also has a prosthetic aortic valve and a pacemaker, so the last thing he needs is a bacteremia.

A year ago he had an MSSA infection of the right shoulder.  Then 6 months ago he has an infection with a methicillin resistant coagulase negative staph i...

Posted By: Mark Crislip  

October 4, 2010

Old mans disease in a young mans body

My definition of young is a moving target.  I am now what I would have once have considered old. So the patient is a young male, younger than me, who has a week of fevers, headache, and a general sense of feeling poorly.

He has ankylosing spondylitis and has been on q 2 week adalimumab, a TNF inhibitor, with good symptom relief.  I was recently told that they try and make...

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 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

    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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