Wednesday, November 29, 2006

Of (medical) Zebras and Unicorns

Today I saw my 5th case of inn-sue-lynn-no-mah (intentionally misspelt*, but you know what I'm talking about) in the last 1 year. Something that comes up frequently on medical school exams just because it's rare and exotic enough. And probably something some of us here have begun to take for granted, because we see these rare conditions so frequently, because of the referral bias. The rule of "when you hear hoofbeats, think horses not zebras or unicorns" may not apply here.
It's pretty amazing, thinking about it. Incidence of 4 per 1,000,000 patient years. Many endocrinologists and most doctors never see a case in their careers, and this is my 5th in a year, plus a case of hypoglyc@emi@ from islet hyp_erplasi@ and another case of insulin @ntibodies. Not that I'm expecting these cases to be a part of my practice in the future, but it's nice to have seen some rare medical conditions. I do feel blessed and fortunate, to be able to work here, with some leading experts in these fields. After all, our patients travel the country, even across oceans, to see them.
He's gonna have surgery Friday. I pray things will go well, although the surgeon is undoubtedly one of the most skilled in the world, and if I was to have my pancreas screwed with, it would be by his hands. I remember that adage in my medical school surgical rotation:
Rule number 1- Don't f*ck with the pancreas
He'll be in good hands, so I suspect the patient will sail through this.
*Apologize for the intentional typos. These conditions are rare enough that I don't want a patient or a future patient Googling my blog.


Anonymous nesidioblastosis said...

being a diabetologist in training i have been given these words of wisdom - they have always been my bedrock, my reference point in all things diabetic, the battle cry of novo nordisk and something i use to educate the newly diagnosed:

"sugar bad, insulin good"

but i guess this wouldn't be helpful to your patient...

by the way, how did your turkey turn out? injecting straw coloured fluid into a turkey? gastroenteritis? tsk tsk - here is another adage:

primum non nocere

p.s. i find that if you chant "sugar bad insulin good" throughout your working day it makes you impervious to the smell of diabetic feet.

7:32 PM  
Blogger vagus said...

sigar bad insulin good sugar bad insulin good ... ommmmmm...
*assumes buddha-like position*

No wor. still smell my feet. :P

turkey came out great. didja see the addendum on my last post?
yea crazy place. we had 3 insulinom@s this week.

8:53 PM  
Blogger caryn said...

christmas turkey christmas turkey.. ommmmmmmm....


10:57 AM  
Blogger Kelly Siew said...

omg. why is that the case? it's so rare here noone ever talks about it, not even in exams! (or perhaps i never pay attention during my endocrinology rotation... hmm)

some kind of environment precipitant where u r at?

heheh diabetic feet. i'll keep that in mind.

8:31 PM  
Blogger vagus said...

what do you mean? no one knows why it's rare. but we see a lot of this because of the referral bias.

10:26 PM  
Anonymous George said...

So what happened? Any updates?

9:56 AM  
Blogger vagus said...

yea, CT and transabdominal ultr@sound were negative, but an endoscopic ultr@sound showed a 1.2 cm lesion on the tail of p@ncreas.
an enucleation was done 4 days later and he's doing well now, to dc home today.

11:26 AM  
Blogger sweetpea said...

hi, stumbled upon your blog. good read. aussie slogan 'only a little bit over? you bloody idiot!' no duit kopi here, which is good.
wa ipoh mali. mind if i put u in my 'blogs i read?'

6:43 PM  
Blogger vagus said...

sweetpea: sure

7:49 PM  

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