Tuesday, February 15, 2011

Update on the Pheo

I know, I know, I've slacked off. Haven't blogged for a week.
Combination of having been oncall for the week (I hand off tomorrow) and picking up the virus of the week from daycare.
But, one thing that did cheer me up was seeing my 62 year old pheochromocytoma patient doing well post-op.
She had an uneventful laparoscopic adrenalectomy today. The final pathology is pending, but both the surgeon and the pathologist agreed it looked classic. A good outcome is always a big relief- and stems from good teamwork between the endocrinologist, surgeons, radiologists, primary care provider, and of course the patient. And it was a good teaching case for my 4 medstudents and 1 resident too: all were surprised she was asymptomatic, and had none of the classic symptoms the textbooks all tell you about.
I started her on alpha blockade with Phenoxybenzamine 3 weeks ago. And told her to go nuts with the french fries, as most pheo patients are intravascularly volume depleted, contrary to what one might think. And so, water and salt loading is necessary.
And since she is from an hour away, she had been a real trooper visiting her GP twice a week for supine and standing blood pressures, and faithfully reported the results back to me. And, despite the cost of the meds, and the debilitating side effects, increased the doses every few days. And when she was ready, we started the beta blockade. She responded so well that I suggested we go ahead with surgery now, to which she wasn't keen for not wanting to miss out on Valentine's Day with her husband. I promised her I'd bring her chocolates.
Though she was still groggy and in some pain when I saw her in the ICU just now, she tried to sit up to give me a hug. And she remembers my promise to her.
I'm going to have to bring her some chocolates tomorrow.
A small price to pay, to see a patient do well.


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