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)
Saturday, August 21, 2010
Wednesday, June 30, 2010
Madrid
Hi everyone! Considering that it is summer vacation, the number of medical stories that I have to share are greatly diminished. Instead, I thought I'd just write about summer. Starting with my trip to Spain to visit a friend of mine from college.
I arrived in Madrid in a hazy stupor, but immediately set off for the Prado, where we were going to meet another Swarthmore student who happened to be in Spain at the same time. I'm not a huge fan of art museums, but it was fun to be around Swatties after so long without them!
The whole time I was in Madrid, I slept on L's teeny-tiny magical couch that had me fast asleep almost as soon as I laid down. I can't exactly remember what we ate while I was in Madrid, but I know it was an assortment of tapas, falafel, pasta, and kebab. And I think I drank more soda there than like, my entire first year of medical school, because I didn't really want beer when we went to bars. (We watched many a world cup match in bars all around Spain.)
L had to go to work, so I was off to site seeing by myself, which was actually kind of nice. I went to the Thyssen where el Greco made me cry, and the Reina Sophia (but I basically speed walked the whole thing), the botanical gardens (which, unfortunately, didn't have that many flowers in bloom, but I found the greenhouse and this little nature photography exhibit at the back which totally made my day)(1) , the Egyptian temple (seriously, why is there an ancient Egyptian temple in the middle of Madrid?) and various other things like the plant wall, Plaza de Espana (2), Retiro (3) - I was obsessed with the clouds, Sol, Plaza Mayor...etc etc. Everything has kind of blurred together. Oh, and of course I can't forget the Cathedral in Madrid, which I have to admit, was pretty beautiful, even though all Cathedrals have kind of started to look the same to me (4).
Let's see. Then, we boarded a bus to Granada. We stayed at this awesome bed and breakfast that's run by a guy who made L's gaydar go haywire. The night we got there we walked miles and miles uphill (I'm talking like almost vertical streets) to get to San Nicolas, which has the best view of the Alhambra. And find it, we did. I was obsessed with it: the Alhambra with the Sierra Nevada mountains in the background. I probably took a hundred pictures and could have stayed there all night.
Luckily, though, the next morning, we actually went inside the Alhambra. The gardens had roses everywhere, which I loved. And the mirror pools reminded me of the Taj Mahal. And the ornate carvings of geometric shapes and Arabic verses took my breath away. I was a bit disillusioned by the Christian palace and Cathedral and whatnot, but I think I've sort of blocked it out of my mind. The thing I remember the most about it all is being utterly exhausted. We had been walking for like 8 hours straight by the time we were done. And the Spanish sun is not forgiving.
Then, we got on a bus to Cordoba. I was already in a bad mood when we got there because there was no place to lock up your backpack, so we had to carry everything we'd brought with us. Everyone (including our gay b&b owner) had warned me that the Mezquita was going to upset me, so I went in there prepared for the worst. And at first, I didn't mind it at all- I thought the arches were nice, and very reminiscent of Islamic art, but I was pretty used to all those larger-than-life Christian paintings of saints and Jesus on the cross. But then, at the back, was that one, small area, that for some reason was still preserved in all it's Islamic glory. I thought it was so beautiful- the arching verses in gold, the flowers and carved ceilings. And then I started imagining what the Mezquita must have been like, with all of its doors thrown open to the sun, all of its walls glinting with gold, and the call to prayer echoing throughout the hall. And all of a sudden I realized what had happened here. The arabic verses had been etched away from the thousands of pillars and arches. The mosaics on the floor had been overlaid with marble. The walls had been stripped of their former glory and covered with dark paintings. The doors were closed. And in the middle of it all was an offendingly bright cathedral. I couldn't even get myself to step inside of it.
Since there isn't that much else to do in Cordoba (I mean there IS, we just weren't going to do it) we went back to Madrid that evening, and my last night in Spain was spent in the comfort of L's apartment. This post is woefully bereft of all of the beauty (and cleanliness!) that is Madrid, Granada, and Cordoba. To really understand it, you'll just have to watch the way my eyes light up when I talk about them.
I arrived in Madrid in a hazy stupor, but immediately set off for the Prado, where we were going to meet another Swarthmore student who happened to be in Spain at the same time. I'm not a huge fan of art museums, but it was fun to be around Swatties after so long without them!
The whole time I was in Madrid, I slept on L's teeny-tiny magical couch that had me fast asleep almost as soon as I laid down. I can't exactly remember what we ate while I was in Madrid, but I know it was an assortment of tapas, falafel, pasta, and kebab. And I think I drank more soda there than like, my entire first year of medical school, because I didn't really want beer when we went to bars. (We watched many a world cup match in bars all around Spain.)
L had to go to work, so I was off to site seeing by myself, which was actually kind of nice. I went to the Thyssen where el Greco made me cry, and the Reina Sophia (but I basically speed walked the whole thing), the botanical gardens (which, unfortunately, didn't have that many flowers in bloom, but I found the greenhouse and this little nature photography exhibit at the back which totally made my day)(1) , the Egyptian temple (seriously, why is there an ancient Egyptian temple in the middle of Madrid?) and various other things like the plant wall, Plaza de Espana (2), Retiro (3) - I was obsessed with the clouds, Sol, Plaza Mayor...etc etc. Everything has kind of blurred together. Oh, and of course I can't forget the Cathedral in Madrid, which I have to admit, was pretty beautiful, even though all Cathedrals have kind of started to look the same to me (4).
Let's see. Then, we boarded a bus to Granada. We stayed at this awesome bed and breakfast that's run by a guy who made L's gaydar go haywire. The night we got there we walked miles and miles uphill (I'm talking like almost vertical streets) to get to San Nicolas, which has the best view of the Alhambra. And find it, we did. I was obsessed with it: the Alhambra with the Sierra Nevada mountains in the background. I probably took a hundred pictures and could have stayed there all night.
Luckily, though, the next morning, we actually went inside the Alhambra. The gardens had roses everywhere, which I loved. And the mirror pools reminded me of the Taj Mahal. And the ornate carvings of geometric shapes and Arabic verses took my breath away. I was a bit disillusioned by the Christian palace and Cathedral and whatnot, but I think I've sort of blocked it out of my mind. The thing I remember the most about it all is being utterly exhausted. We had been walking for like 8 hours straight by the time we were done. And the Spanish sun is not forgiving.
Then, we got on a bus to Cordoba. I was already in a bad mood when we got there because there was no place to lock up your backpack, so we had to carry everything we'd brought with us. Everyone (including our gay b&b owner) had warned me that the Mezquita was going to upset me, so I went in there prepared for the worst. And at first, I didn't mind it at all- I thought the arches were nice, and very reminiscent of Islamic art, but I was pretty used to all those larger-than-life Christian paintings of saints and Jesus on the cross. But then, at the back, was that one, small area, that for some reason was still preserved in all it's Islamic glory. I thought it was so beautiful- the arching verses in gold, the flowers and carved ceilings. And then I started imagining what the Mezquita must have been like, with all of its doors thrown open to the sun, all of its walls glinting with gold, and the call to prayer echoing throughout the hall. And all of a sudden I realized what had happened here. The arabic verses had been etched away from the thousands of pillars and arches. The mosaics on the floor had been overlaid with marble. The walls had been stripped of their former glory and covered with dark paintings. The doors were closed. And in the middle of it all was an offendingly bright cathedral. I couldn't even get myself to step inside of it.
Since there isn't that much else to do in Cordoba (I mean there IS, we just weren't going to do it) we went back to Madrid that evening, and my last night in Spain was spent in the comfort of L's apartment. This post is woefully bereft of all of the beauty (and cleanliness!) that is Madrid, Granada, and Cordoba. To really understand it, you'll just have to watch the way my eyes light up when I talk about them.
Tuesday, May 25, 2010
Miracles
I really did not so much believe in miracles until one very, very late Christmas Eve night 12 years ago. You see I was a rational, clear-thinking, scientific kind of person (except for that weird superstitious streak when anyone said "this is going to be a really easy call night" - I KNEW that brought down the chaos). But I digress.
That Christmas Eve morning I was working in the pediatric ICU. There was no fellow so it was just me and a poor peds resident trying to care for 31 very, very, very sick patients. Not very holiday like but I had healthy children back at home waiting for Santa Claus so I absolutely had nothing to complain about. And there were many sad stories to tell that night but one was especially difficult.
A 3 year old girl had fallen between the bed and wall of her new bunk bed 3 days before Christmas, cutting off oxygen. She had had a full cardio-pulmonary arrest and was really critically ill. Her lung disease progressed until she was at the point of not being able to be oxygenated or ventilated. Her brain function deteriorated until she was near brain-death status. A horrible situation made worse as her parents made their final good-byes.
I took over her care that morning and was told that all treatments had been attempted and the family knew that it was just a matter of time until she died. I was told that I was to expect her death sometime in the next 24 hours. That was tantamount to saying "Don't spend much time at her bedside since there is nothing that you can do."
I was always one to believe in taking care of things that should be taken care of and knowing when to step back. Well that endless day, I could not seem, even with the best intentions from coming back to her bedside, altering the ventilator settings, putting in yet another chest tube for yet another pneumothorax, transfusing her when her hemoglobin dropped, and generally not "stepping back" at all. This was in the midst of taking care of all those other sick children as well. But no matter what, she seemed to be getting worse. Finally by 3 am, I was beyond exhaustion but strangely (for me) intent on saving her life. It made no sense to me then but I just could not stop. Something was pushing me beyond the limits that I had set for myself.
At 6am she seemed a little bit better but "was that my imagination?" I called my partner who was the real expert on ventilator therapy at 7am (boy was he thrilled to hear from me!) and made a few more changes. "Maybe I was making a difference", I thought. To make a long story short, she left the hospital 3.5 weeks later, looking almost like her old self. I will never know what pushed me that night, made me go against common judgment, but for me she will forever be my first "miracle.
That Christmas Eve morning I was working in the pediatric ICU. There was no fellow so it was just me and a poor peds resident trying to care for 31 very, very, very sick patients. Not very holiday like but I had healthy children back at home waiting for Santa Claus so I absolutely had nothing to complain about. And there were many sad stories to tell that night but one was especially difficult.
A 3 year old girl had fallen between the bed and wall of her new bunk bed 3 days before Christmas, cutting off oxygen. She had had a full cardio-pulmonary arrest and was really critically ill. Her lung disease progressed until she was at the point of not being able to be oxygenated or ventilated. Her brain function deteriorated until she was near brain-death status. A horrible situation made worse as her parents made their final good-byes.
I took over her care that morning and was told that all treatments had been attempted and the family knew that it was just a matter of time until she died. I was told that I was to expect her death sometime in the next 24 hours. That was tantamount to saying "Don't spend much time at her bedside since there is nothing that you can do."
I was always one to believe in taking care of things that should be taken care of and knowing when to step back. Well that endless day, I could not seem, even with the best intentions from coming back to her bedside, altering the ventilator settings, putting in yet another chest tube for yet another pneumothorax, transfusing her when her hemoglobin dropped, and generally not "stepping back" at all. This was in the midst of taking care of all those other sick children as well. But no matter what, she seemed to be getting worse. Finally by 3 am, I was beyond exhaustion but strangely (for me) intent on saving her life. It made no sense to me then but I just could not stop. Something was pushing me beyond the limits that I had set for myself.
At 6am she seemed a little bit better but "was that my imagination?" I called my partner who was the real expert on ventilator therapy at 7am (boy was he thrilled to hear from me!) and made a few more changes. "Maybe I was making a difference", I thought. To make a long story short, she left the hospital 3.5 weeks later, looking almost like her old self. I will never know what pushed me that night, made me go against common judgment, but for me she will forever be my first "miracle.
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