Dysphagia

Since the topic for today was dysphagia, I opened up the new Harrison's and there was were 2 tables that had more than 50 causes of dysphagia. The gastroenterologist discounted anxiety and thermal injury, but I swear they were in the book. Also, I seem to remember something about pts with GERD who develop a resolution of their symptoms and then dysphagia could have achalasia. However, the GI doc said that the two don't usually go together. I have to check. If I am remembering correctly, then it just underscores how much of medicine you can't learn from books because I trust the doc I am working with now.



I got to maneuver a colonoscope today which was interesting. It's a lot harder than it looks, let me tell you. There is a know to turn left and right, another to move it up and down, one for water, and another for suction. Not to mention that you are staring at the screen and trying to figure out where you are. But it was a good experience.
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Yesterday I saw that the latest NEJM had a case of endocarditis which was initially thought to be TTP. I was intrigued because my CPC is coming up and TTP was originally in my differnential. My case is someone with hemoptysis, palpable purpura, thrombocytopenia, and anemia who was thought to have ITP, refused steroids, got IVIG and then went into renal failure. At first I thought it was a pulm-renal syndrome and some sort of vasculitis, but all ANCAs are negative. Then again, there are other vasculitides that are ANCA-negative. Just not Wegener's. Or polyarteritis nodosa. And it's not Goodpasture's either. I thought about Kaposi's sarcoma, but the pt is HIV negative and then I was playing around with the idea of Sweet's syndrome but the skin biopsy was negative, too. Oh well. I guess I have to add endocarditis to my list with all the other great masqueraders.
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On a pop culture note, I just watched a Jason Mraz clip from a UK talk show. He talked about how he bought an avocado farm in San Diego and how he is a natural foodist. He also made this dessert for the hosts which was cacao mixed with avocado and agave nectar. A note on agave nectar - I heard about it earlier while reading a magazine in the gym about all the new sugar substitutes. It's being promoted as a more natural sweetener and I remembered that name because it's also a restaurant in NYC where I went on a fantastic date some time ago. Agave is a plant from Mexico that has a sweet nectar that can be tapped like maple syrup. Also, it supposedly has medicinal properties. But anyways, there's still sugar in his cacao mousse dessert, but more natural. And there's still fat - it's just avocado fat.
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Today's grand rounds was about a patient who responded well to Reiki therapy. In fact, there is apparently a hospital somewhere in the Northeast that trains its whole staff on Reiki therapy. I'm all for alternative treatments, but it difficult to find the evidence based medicine to back them. I remember working with a family doc as a student who did acupuncture every Friday afternoon. And you just need to take a course to get certified. Someone brought up offering patients red yeast rice if they refuse a statin and this makes total sense because red yeast rice is a statin, a weak one, but still a statin. It's just a marketed as an all natural product that didn't have to go through 17 years of scrutiny and 4 phases of clinical trials like prescription medications do.