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September 18, 2012

Looking for patterns in all the wrong places.

I tend to operate as if the world, and infectious diseases, has patterns and is predictable. That, of course, is a delusion.  Any pattern I put on the world is a temporary paradolia. The bugs certainly ignore patterns, why don't I?

Endocarditis in non-IVDA is usually left sided.  Right sided disease is reserved for shooters and people with central lines. If it is right sided disease, it is going to be on the tricuspid valve, not the pulmonic.

Left sided disease in the elderly is usually a viridans strep; right sided disease is almost always a Staphylococcus of some sort.

So  I see an elderly male with a history of both a VSD repair and a aortic aneurysm repair 30 plus years ago, but still has native valves.  He has had 7 days of fever and...

Posted By: Mark Crislip  

September 16, 2012

Dodging Bullets

I do not like repeat business. Most businesses thrive when the customer comes back, but after my patients finish a course of antibiotics I never want to see them again, at least not in the hospital.  Maybe run in to them at Starbucks.  That would be OK.

As an aside, it still rankles when a nurse refers to one of my patients as a client.  Lawyers and accountants have ...

Posted By: Mark Crislip  

September 13, 2012

Other Explanations Are Needed

I am asked to see a patient for a positive syphilis serology obtained for peripheral neuropathy: the FTA is 2+, RPR is 1:2.

But it is never simple.

First, it is a classic diabetic neuropathy by exam and history and she has no findings of syphilis.  She is 70, from rural southern Mexico, having been in the US for a decade.  She has only been sexually active with her hus...

Posted By: Mark Crislip  

September 11, 2012

I'm back but do not want to be

Four days in Vegas with my wife, our first vacation in 19 years without a kid.  So much fun, but back to work and looking at the EMR trying vaguely to remember how to order a CAT scan and spell iliopsoas so I can link a diagnosis to a test and blah blah blah.  I just want to be back pool side in the heat.

I started the day with a lecture to the second year medical students on ...

Posted By: Mark Crislip  

September 5, 2012

Things fall apart

Things fall apart; the centre cannot hold;

Mere anarchy is loosed upon the world,

The blood-dimmed tide is loosed, and everywhere

Are emboli.


Posted By: Mark Crislip  

September 1, 2012

Feel Bad Yet?

The patient is a middle aged male with lung cancer, getting his first round of chemo.  He comes in with severe nausea, vomiting, sore mouth, headache and fevers.  Is admitted to the hospital and started on the usual therapy and mostly gets better.

The call me when the fevers persist, barely, when the WBC returns. 38 is a fever. ROS is negative except for an improving head...

Posted By: Mark Crislip  

August 29, 2012

Tricky Yeast

Candida are tricky, and I have been tricked by a few of them this month.

The first was a curbside from afar.  A patient with short bowel on TPN who had Candida in the blood. The line was pulled, the tip was positive, and it was identified as C. parapsilosis.

She was on micafungin and I suggested that they continue it for two weeks since she has no bowel to abs...

Posted By: Mark Crislip  

August 28, 2012

Forgetful or Atypical

I have to read the textbooks and the journals.  It is how I learn about diseases and how they present.  I have mentioned in the past that shortly after learning about a new disease I see it. The one version of the Secret that may be true. Maybe.

Problem is that shortly after seeing a case I promptly forget about it. And then the patient doesn’t read the textbook and...

Posted By: Mark Crislip  

August 24, 2012

My Arch Enemy Surprizes Me Again

If I were a superhero my arch nemesis would me S. aureus.  Few pathogens have the virulence and variability to cause disease as S. aureus.  I used to say that S. aureus pays my mortgage, but so many patients with Staph infections lack insurance that is no longer the case.  Why pay for health care when you can buy heroin instead?

The pa...

Posted By: Mark Crislip  

August 22, 2012

Bactrim Creep

While I know a tonne about ID, compared to what I could know, I know nothing.  The real purpose of this blog, and the rest of my growing multimedia empire, is to educate me.  It is amazing (or an indication of just how ignorant I really am) that every other day I find a topic to blog about that almost always adds to my knowledge base.

Today after Grand Rounds an intern hit ...

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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