Saturday, August 21, 2010

Weird Words

Trichotillomania. It sounds like one of those words people make up to
either impress or confuse other folks. But it is real and in fact, I
had a 20 month old patient with this problem earlier this week. She
was diagnosed with leukemia 6 weeks ago and sometime during her long
1st hospital stay she developed this in reaction to anxiety.

So what is trichotillomania? It is the compulsive pulling on hair that
leads to hair loss. It is found usually in children, is a reaction to
stress or anxiety usually, and most often is short-lived. So how did I
know that was the problem with my patient. I went to see her in Pre-op
and this cute little girl was stroking/pulling on her right eyelashes.
Mom confirmed that she had started it when she was admitted the 1st
time for her leukemia and it recurred whenever she came back to the
hospital. Today she was having a lumbar puncture with injection of
chemotherapy into the CSF. (The leukemia cells can invade the CSF and
chemotherapy does not cross the blood-brain barrier so to kill those
cells you have to inject the chemotherapy agent into the CSF itself).
My totally unreliable memory suddenly ejected the term
trichotillomania. Who would have guessed that that particular,
extremely esoteric word would surface? That is the great thing about
medicine. Even years later some of those weird things that you are
learning are useful.

(Guest story from Dr. MH)