someone's stolen my horse
i haven't been updating much lately, but you knew that. every day you come back only to find that drat, he hasn't updated in 1, 2, 3...7 days--what am i to do now? how can my day life be complete??? well, it hasn't been for lack of trying--okay well, a tiny bit. but i just didn't have the energy to do it. literally.
for many weeks now, i've no energy; i'd (barely) get up for work, slosh through the day, come home and pass out. i had no idea why. i had been dealing with a bought of depression but the lack of energy seemed out of proportion of the rest of my symptoms. thought it was from mononucleosis, perhaps. i haven't been kissing on anyone, much to my chagrin. i have been around patients with particularly bad mono though.
this one kid was helio'd in from bonham, texas after he passed out at a pharmacy and was resuscitated by two physicians, who just happened to be in the store. that was quite impressive--no, not the fact that he was revived by such experts but that there were three physicians living in bonham. even more impressive was that two of them had enough time to hang out at the apothecary's in the middle of the day. maybe i should move to bonham. they _do_ make blue bell ice cream there. mmm. mmm.
what was the kid doing there? he was trying to get script filled by the third doc, who diagnosed him with strep throat. i thought it was strange for a 17 year old kid to pass out from strep throat. this made the differential diagnosis that much more complex, obscure and more interesting. during the course of er workup, i noticed he was spilling some bilirubin into his urine. odd. i asked the nurse to draw some labs looking at his liver. sure enough, there were signs of hepatitis.
most of the lay public think that it's easy to diagnose disease. sure, many of the of the common conditions are easy to spot, however, they can have uncommon causes. also, the call isn't easy to make as there are literally over 2000 diseases and syndromes that have the same three symptoms. yeah, the waters can get a little murky at times.
so, now we have a young adult with syncope, sore throat and liver issues. there aren't too many things in that age population that can cause this presentation. many of them are viral: herpes simplex virus, epstein barr virus (the pathogen that causes mononucleosis), perhaps cytomegaly virus, etc. i sent off some serology looking for those and checked a mono spot test in the er, as it was quick and easy to do. the mono spot of course was positive. meanwhile, his spinal tap came back with signs of viral meningitis. well, that sealed it: he had ebv ("mono") meningitis!
nailing a diagnosis like that, when the presentation was at once unusual and vexing was especially satisfying. i consulted an infectious disease specialist just to be sure and she agreed that it was likely to be the case. to have such clarity of vision and conviction (which can be a downfall as it narrows one's vision, an effect akin to putting on blinders) to work it through to its conclusion strokes the ego in ways that it shouldn't be stroked. it got all aroused, and was particularly difficult to bed back down again. fueling the fire was a compliment from a cardiologist working the same case: i'm glad he had a real doctor because i was drawing blanks and had no clue what to do next. wow. cardiologists don't admit that very often, if at all. the testosterone flows--shoot i feel as if horses are more hung like me. yee-haw.
of course, it always comes with a price. large leaps come with harsh landings. i went on to diagnose another case of mono (just pharyngitis) and probably exposed myself too much to it. at least i hope that it's the case. now i can barely type this entry. i haven't been to the gym in weeks. all i want do is sleep. someone's stolen my horse, as the song says. and it's a long walk home.