Rubor, Dolor, Calor, Tumor
Blog Address: http://blogs.medscape.com/rdct
January 10, 2011

Empiricism?

If I have a flaw as a clinician (and, depending on who you ask, I may or may not have many), it is that I tend to focus more on diagnosis than treatment, and sometimes you need to treat before you get all the diagnostic data back. It  doesn't matter the site or the organism, if appropriate antibiotic therapy is delayed in the ICU, mortality goes up every hour and every day.  So sometime you have to pull the trigger before you know for sure what you are aiming at.  Be glad you do not hunt with me.

The patients is a young diabetic, renal failure on dialysis, with paraparesis.  Initially she has C. difficile and perhaps a line infection, but despite appropriate therapy the patient only gets worse.  Hypotension, leukocytosls but no fever.  F...

Posted By: Mark Crislip  

January 6, 2011

Who Needs The Influenza Vaccine? Guess My Answer.

This is a break from the usual short romp through pus that characterizes this blog.  Parts of this screed have been published over at Science Based Medicine.

Do Healthy Adults Really Need a Flu Shot

The evidence for influenza vaccination is like the evid...

Posted By: Mark Crislip  

January 4, 2011

What To Do Now?

Problems without a good answer.

A couple of years ago I treated a patient with chronic coccidioidomycosis pneumonia.

Over a year he slowly improved, both radiographically and by serum comp fix.  He is/was a diabetic, but did not have meningitis.

He had reasonably severe pneumonia, a very high comp fix and a low threshold for renal toxicity from amphoterin.  He ...

Posted By: Mark Crislip  

December 29, 2010

Billed As One Thing, Turns Out To Be Another.

The patient is a middle aged female with an issue with her hip.  It was replaced three years and kept dislocating, so she had two revisions over a year then a new hip.  Initially the second joint was fine, then she developed a tender ball over the incision that "squirted across the room when it ruptured"  While this volcanic boil was growing she had no fevers or chills.  She...

Posted By: Mark Crislip  

December 28, 2010

Pre-Owned and Recycled.




The first year or so of Rubor, Dolor, Calor, Tumor I blogged on my own.  These entries are the collected, rewritten, expanded, and are now an eBook.  All the typos removed. See. I can make a joke.
...

Posted By: Mark Crislip  

December 27, 2010

Not Quite an Explanation

The patient is normal.  Really normal.  No risks for anything, living the quiet live of a student.  He then as a week of a fevers that were ascribed to asthma/pneumonia due to a cough.  He was treated with a course of doxycycline, and then, because of ongoing shortness of breath, he received a course of prednisone.  While on the steroids he developed weakness in the lef...

Posted By: Mark Crislip  

December 25, 2010

Unlike Love

Several years ago I treated a patient with cryptococcal meningitis and fungemia.  She is normal, no immunological defects that I could find.  She did not tolerate amphotericin B and has been on fluconazole for two years now.   When I first saw her, her serum cryptococcal antigen was >1:2064.  Two years later it is 1:64.  She still has Cryptococcus.

Posted By: Mark Crislip  

December 23, 2010

Bad bug, bad bug. Watcha gonna do, watcha gonna do when I come for you?

There are the occasional infections I can't cure with antibiotics alone.  Patient in an 80 year old female with underling lung disease, recurrent hemoptysis from diffuse alveolar hemorrhage.  She has had an extensive work up at multiple hospitals, with every known test and no diagnosis.  Some sort of vasculitis, it is supposed, but no one has ever been able to put a name on it. I...

Posted By: Mark Crislip  

December 21, 2010

Three Thousand Words Plus a Few More

Let us start with the pictures.

 

 

Look...

Posted By: Mark Crislip  

December 19, 2010

A Return to the bad old days

Diseases come and go. Sometimes for unknown reasons.  Do you ever wonder what happened to the English Sweating Sickness?  I do.  There were six outbreaks between 1485 and 1551, it killed thousands, then disappeared never to be seen again.  What was it?  No one knows. Where did it come from and where did it go?  Also unknown.  Will it come back?  I sure ho...

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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