Monday, April 30, 2012

Reminiscing about Pediatrics

This entry is backdated: January 25th, 2011

Today i was thinking about how feeble my memory is. and how likely i would be to forget all the cool cases i had a chance to witness while i was doing my inpatient tour in the peds ward. and just to prevent that from happening, i wanted to jot a few really cool patients and cases down:

1. a 6 year old hispanic female who suffered a seizure and a stroke. She had a hemiplegia and had a very interesting neurological exam, with deficits on her right side. She even had a positive babinski. The most striking of which is that her parents had a very all hands on deck approach. Obviously, i saw her after her stint in PICU, so I'm sure that all the anger and difficulty, guilt or blame they may have felt has already been blunted by some time. But it was refreshing to see their family dynamic
2. A 20 year male, who is hardly a pediatric student, who as a child had an unknown kidney disorder which warranted him to get a bilateral kidney transplant at the ripe young age of 5. I meet him 15 years later in the emergency room as a new admit because about 5 years ago, he had the transplanted kidneys failure. They were then taken out and he now relies on dialysis two to three times a week. This was going well, until one of his fistulas that was put in two weeks ago did not take and led him to having severe bleeding. He called 911, and as part of the paramedics protocol, they infused him with a bolus to keep his blood pressure up. Unfortunately, he has a 1 L fluid intake maximum per day. Over the course of a few hours, the bleeding from the fistula had stopped, but he also had a different problem: he had developed hypertension. but since most antihypertensives work on the kidneys and the RAAS system, it became difficult to manage his blood pressure. He normalized eventually, but had to wait until the following monday to recieve dialysis.
3. A 13 year old white male who had kawasaki's disease as a child and had a 7 mm coronary artery aneurism when he was only 5 years old. He was lost to follow up and failed to reestablish cardiology care once moving to pensacola from texas. He presents to the ER in Fort Walton with chest pain that radiated down to his left arm. He was worked up as a rule out MI case, but was transfered over to the care of the pediatrics residents in pensacola due to the Nemours 
4. Little W***t, a 5 years old boy with Hurlers; who has fevers and CRP that was trending up. He also has a metal plate placed in his left ankle. could his fevers be due to a myriad of reasons, but the most likely culprit was this ankle plate. Coincidentally, his pediatric orthopedist was not  in house, but instead in Oklahoma, who is a specialist in his field.
5. A 3 year old girl with rectopharyngeal abscess. Obviously not an extremely interesting or unique case, but she proved to have an extremely difficult physical exam. Clinging on to her father's neck and not letting go because of the barrage of white coats that entered through her door during morning rounds, it makes sense that she was scared and intimidated.
6. E***, a 3 year old who has a new onset ALL; which was worked up due to his leg hurting. (interesting side note: I interned for the American Cancer Society, and found that E was definitely plugged into the system, getting access to incredible resources)
7. A 9 year old who had a desmoid tumor secondary to Familial adenopolyposis
8. A 7 month old boy who has hemophilia A, (lacking Factor 8), who then develops clotting in the tube despite the administration of recombinant factor 8. It was found that his Anti factor 8 was high, indicating an immunologic response to the recombinant factor. The brilliant people in Nemours decided to infuse him with activated factor 7a, which is further down on the cascade. However, this medication is extremely expensive. a previous case has shown that a child has used up half a million dollars worth of this medication. The same baby had a very interesting history: he also presented at 6 weeks with an olive sized mass and projectile vomiting, and was immediately worked up for a classic case of pyloric stenosis. He tolerated the procedure well, however his post op recovery was complicated by the fact that he was indeed a hemophilac. 
9. Two babies with hyperbilirubinemia. little baby K*** was going to be discharged on the second day after triple photo therapy. however, her mother, who was preeclamptic during her pregnancy started having visual disturbances and was seen in the emergency room and was worked up for a possible stroke. 

Thats all i can remember for now. I can't believe how exciting that time was. Theres a small part of me that wishes i could just know what i could be happiest doing. i'm afraid that there has been very few cases that stick out in my mind this much in adult medicine. and maybe this is an indication that i would be happiest (and the most challenged) being a pediatrician.

The previous post was written on my live journal account over a year ago, while doing my third year pediatrics rotation. Reading this post in retrospect gives me such a funny insight: kind of like stepping stones that eventually led me to family medicine. Obviously, I did not pursue pediatrics, but I continue to have a strong desire to take care of children and families.

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