Tuesday, September 25, 2012

Another day in the UK.

Today has been a challenging day.Saw a patient with a florid ulcerative colites flare,a man apart from the steroids the doctor had put him on, was on steroids for body buiding.His bowels were giving him a hard time and he was having rectal bleed with serious discomfort in the abdomen.His CRP was normal and his X-ray abdomen did not show features of toxic megacolon ,stools were sent for routine and Cl.difficile toxins.We referred the patient to gastro on VTE prophylaxis.
The second patient I saw through was a patient on CAPD with CKD grade 5.
She told me that she had been anuric for the better part of one and half years and was on dialysis every night for nine hours.She had come to the regular clinic but had been sent to the A and E because she looked unwell.Her blood gasses and the electrolytes were fine.Her renal parameters looked unbelievable.She had bilateral wheezes with no evidence of fluid over-load.She did have a short history of cough with yellow phlegm for which she had been prescribed Amoxycillin by her GP.The renal consultant came over and took over the patient.
The third gentleman came in with DVT of the lower limb with sudden onset of pleuritic chest pain which was radiating all the way to the back.His troponins were normal.ECG showed LAD with Q3T3.Heart rate of 77/min on beta blockers for HTN.D-dimers were over 4000 and the CTPA showed bilateral filling defects of the pulmonary artery.Well's score for clinical probability of PE was high(9).His ABG showed low oxygen levels.
So a diagnosis of PE was made and the patient put on treatment dosage of LMW heparin(1.5mg/KG) with overlapping dose of Warfarin and the patient was simultaneously referred to the anticoagulation clinic.
Running after and settling three patients is enough work for one day.
I finished work well after my take was over but I felt satisfied,even as I bid my last patient of PE goodnight after a word or two of reassurance.He had been in the army,had seen the coronation of Queen Elizabeth first hand.I get amazed by the elderly.They come through with diseases one cannot even think of and yet even then they are more concerned about making life easier for us.He reminded me of my father.


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