Saturday, January 14, 2012

Unusual Patient 1

When I saw Terry -not her real name , she was a nurse who worked in PCU and ICU . She was quite good , knew medicine and was quite concered about patient's wllfair.She lived with her boy friend and was golng to get married soon . She was married and her first marrriage was not a good experience. So she was was careful - to stste in her own words.Ihad worked with her without knowing any medical history  about her .
  So when I was called to see her in ICU I was surprsed.I did not expecy her to be admitted to ICU. In fact even before I saw her I had 2 phone calls , one from admitting doctor, telling me her' story' and asking me to look at her and see if she was ready to be discharged. Other call came from her Insurence com. doctor asking me to give him a call if I " find " anything , otherwise get her out soon 
   I went to see her in ICU . I still remember her room no. My consultation was to evaluate for 'low' respratory rate. Usually I get consult because some one is breathing too rapidly , not too slow. When I entered the room I saw her siting upright , not in any ditress with eyes open , She talked to me , answered all questions , though slowly. She was not on any drugs, narcotics  and her urine drug screen was negative . Her lungs sounded cler and heart sounds were normal , Her heart rate was 48 per min anad respiratory rate was 5. Oxygen saturation was 98% . There was no positive finding in her labs. She had seen a neurologist as out patient for passing out spell, and his work up which included cat scan of brain and some blood work was negative .  She was seen by cardiologist for low heart rate , his evaluation was negative . Echocardiogram was normal and she had not shown any cardiac arrythmia during her stay in ICU.
   I was not too sure what would Lung specialist   do .There was something wrong . One can not reduce heart rate and respiratory rate --unless you are Yogi . Something struck me . I don't know why , but I thought of vertebro basiler migraine or something to do with centers of respiration and heart rate . As I was sitting at the desk pondering on what to do , I thought of something , I had allready talked to local neurologist whom she had seen , he had not much to add. There was asocial worker siting next to me . I asked her if she had Mayo clinic tel no . She said I don't have it now but I will get you the no in no time . True to her word she came back in less than 5 mins and handed me the no . I dieled the no. hospital operator piched it up . I told her to connect me to chief of neurologist office . She did . That must be my lucky day as not only I got throgh but he was there and came on phone . I explained him my concers and told him that I was thinking about vertebrobasiler migrain. I asked him how could I confirm it . He said it was a good thought and told me to get EEG -a brain wave recording . This was  exciting . I called EEG tech. I knew her well  as I had ordered sleep studies through her . She came to do EEG very quickly and it confirmed the diagnosis.
  Ltter on work up showed that she had antibody positjve for phospolipids/cardiolipids, so she must be throwing small clots which was causing her symptoms , both black out spells and low respirstory rate----for which I was consulted. She was put on anticoaglent and did very well.


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