Rubor, Dolor, Calor, Tumor
Blog Address: http://blogs.medscape.com/rdct
April 2, 2012

I have returned

Spring break is over.  Bummer.  I spend it on the Oregon coast, no television. A couple of years ago I went off for spring break and I returned to find out H1N1 had erupted in Mexico.  As  a result every time I get back from time off I fret that some new plague has cut loose in my absence.  Not this time.  Bummer.

First day back is always gruesome.  I am amazed at how much paperwork can pile up in a one week absence.  And trying to get caught up made me hate EPIC even more.  EMR may be the future, but so is global warming and the sun going nova.

At least the diseases remain interesting, if awful.  When I had left for vacation I had a patient the presented with headache and decreased mental status.  The MRI was r...

Posted By: Mark Crislip  

March 23, 2012

Say it, don't spray it

So often it is close but no cigar in ID.  Everything points to a diagnosis, but the damn bug doesn’t grow.  It’s there on the gram strain, but prior antibiotics or the host immune system finishes it off and I am eft close, oh so close to a definite answer.  It is smel the bread, but not getting a taste.

The patient has bacterial meningitis.  Fevers, he...

Posted By: Mark Crislip  

March 21, 2012

Life List

Infectious diseases is like birding, except interesting.  I do enjoy what birds have to offer, although I prefer the taste of condor to spotted owl.  I wonder what dodo what have tasted like.  But I digress.  Birders keep a list of birds they have seen, a life list, and I am not different, although my list shows up in a blog, not in a spiral notebook.

The number of i...

Posted By: Mark Crislip  

March 21, 2012

Life List

Infectious diseases is like birding, except interesting.  I do enjoy what birds have to offer, although I prefer the taste of condor to spotted owl.  I wonder what dodo what have tasted like.  But I digress.  Birders keep a list of birds they have seen, a life list, and I am not different, although my list shows up in a blog, not in a spiral notebook.

The number...

Posted By: Mark Crislip  

March 19, 2012

Mystery

I have been doing ID for 25 years now, if you include fellowship, and as I have alluded too in the past, it is still the most interesting part of medicine. Ever.  After all this time I still cannot understand the process that leads to a differential diagnosis.  It is a mystery how I have internalized information and as I take a history it is aggregated, analyzed and ideas as to the ca...

Posted By: Mark Crislip  

March 15, 2012

Old Habits in the New Medical Order

I am getting too damn old and rather than the prior understanding with a knowing smile at the foibles of medicine, I find I am getting increasingly irritated.  It is a sure sign that I am getting to the end of my career.

Maybe it is my increasingly discomfiture with the feeling that I never really know what is going on with patients.  People can respond to a perceived lack of ...

Posted By: Mark Crislip  

March 13, 2012

If you are not part of the solution, you are part of the precipitate

I see a fair number of formal consults, they are why my tuxedo is tax deductible.  I probably hear of log more cases in curbsides, phone calls and attending noon report.

The residents presented a case of hemoptysis in a patient with a progressive, cavitary pneumonia that, over time, developed the crescent sign on CT.   The crescent sign is a sure sign of Aspergillus</...

Posted By: Mark Crislip  

March 10, 2012

0 for 2

Part of the fun of the job is calling the bug before the cultures come back.  Part of the humility of the job is how often I am wrong.  Still, I would prefer to try and predict the infection rather than blather on with a differential diagnosis yet never commit.  A year ago I saw a series of acute bacillary diarrhea and I was 0 for three in predicting the organism.

Fi...

Posted By: Mark Crislip  

March 7, 2012

A Sigh. Then a Diagnosis or Two.

Sigh.  Parasites on the clinic schedule.  That can not be good. Parasites never are, or rarely are, actual parasites.  It is usually some other problem misdiagnosed by the patient or delusions of parasitism.

There is a sheath of papers from the referring provider, a naturopath.  So I knew that the diagnosis of parasites was likely fanciful.  Anyone that suggests...

Posted By: Mark Crislip  

March 5, 2012

Good time are slowing fading away

The patient has fever, chills and is completely on focal except for a right sided headache.  The ESR is greater than 100 but the rest of the labs are normal, and the primary is walking down the temporal arteritis road. As would I.

However, the patient is in their mid 50’s, a bit young for temporal arteritis, so as part of the FUO evaluation a CT of chest/abd/pelvis is do...

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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