{"id":57,"date":"2015-05-13T03:35:47","date_gmt":"2015-05-13T03:35:47","guid":{"rendered":"https:\/\/inmedblogs.us\/garretthooker\/?p=57"},"modified":"2015-05-16T17:27:51","modified_gmt":"2015-05-16T17:27:51","slug":"two-difficult-ob-cases","status":"publish","type":"post","link":"https:\/\/inmedblogs.us\/garretthooker\/2015\/05\/13\/two-difficult-ob-cases\/","title":{"rendered":"Two difficult OB cases"},"content":{"rendered":"

I’ve been going in every morning to see that patient of mine who’s in respiratory failure. \u00a0The tap seemed to help somewhat and she’s breathing a bit more comfortably, but it’s sort of a temporary fix and she’s needing Valium intermittently to stay relaxed. \u00a0I don’t think she has much longer. \u00a0I got her labs back today. \u00a0Unfortunately, what we’re able to do at our facility is so simplistic it almost wasn’t even worth sending them. \u00a0Basically they were inconclusive, but there were a few signs that the effusion is secondary to some sort of malignancy.<\/p>\n

 <\/p>\n

Clinic was busy yesterday, as are most Mondays. \u00a0My patients were as follows:<\/p>\n

– 14 month old male with viral gastroenteritis.<\/p>\n

– 22 month old male with possible viral gastroenteritis. \u00a0He was recently treated for Giardia but couldn’t leave a stool sample at the moment, so I don’t really know.<\/p>\n

– 6 month old male with chronic cough…probably just GERD, but could be pertussis around here.<\/p>\n

– 19 year old male with patellofemoral syndrome.<\/p>\n

– 4 year old male with viral URI and a chalazion.<\/p>\n

– 38 year old male with GERD and a headache.<\/p>\n

– 1 year old male with one episode of hematochezia.<\/p>\n

– 47 year old female with constipation and a lumbar back strain.<\/p>\n

– 13 year old female with recent Chikungunya who came in for a follow up on her myalgias. \u00a0She had a white count of 27,000 about 4 days ago.<\/p>\n

– 44 year old male with constipation<\/p>\n

– 55 year old female with atypical chest pain, probably caused by a combination of trapezius spasm and anxiety. \u00a0Of note, she was also wearing a Yoda shirt that said “size matters not” and probably had not idea what the translation was.<\/p>\n

– 53 year old male with newly diagnosed COPD and hypertension. Started him up on some inhalers and Norvasc.<\/p>\n

 <\/p>\n

I was invited over to Mark and Heidi Merritt’s house for supper. \u00a0They’re both from Virginia and have been here for about 10 years. \u00a0Mark is a family doc who’s been working with me on that lady in respiratory failure. \u00a0A home cooked meal was appreciated since I’ve pretty much been eating like a bachelor for the last week. \u00a0Here they have an interesting version of Neopolitan ice cream that contains strawberry and vanilla, but lime instead of chocolate. \u00a0At the moment though, anything cold is nice.<\/p>\n

 <\/p>\n

This morning our ob\/gyn, Vance, had to run to La Ceiba. \u00a0So, the plan was for us to turn any OB patients away who weren’t imminently about to deliver since we didn’t really have coverage for c-sections. \u00a0I’ve done a number of them in the past, but apparently they don’t just hand the reigns over to people they just meet…probably a good policy I suppose. \u00a0Anyway, at no more than 12 minutes into the day, and 15 year old G1P0 at 37 weeks rolls in dilated to about 6 cm. \u00a0The nurse comes to let me know we have someone here, so I went and checked her. \u00a0She was actually more like 7 cm and her cervix was really thin, so I didn’t think there would be any way she’d be able to make it to another hospital. \u00a0I went back to clinic and tried to see people between visits back to check her. \u00a0After doing this for a couple of hours, she was complete and ready to start pushing. \u00a0She actually did a really nice job and got the baby out in about 45 minutes, which is pretty good if it’s your first rodeo. \u00a0Her pelvic outlet was pretty small, so she had a second degree perineal lac that I started sewing up…but blood just kept gushing down into my field of view and it was hard to get anything done. \u00a0I eventually gave her a dose of Methergine in addition to the Pit which she was already receiving in the IV. \u00a0This still didn’t stop the bleeding. \u00a0The girl weighed in at probably about 100 pounds, and knowing her reserve probably wasn’t as high as some of our fluffier ladies, I decided to subject her to a bimanual exam. \u00a0This is especially uncomfortable for somebody without an epidural. \u00a0I was able to retrieve a couple handfuls of clots, along with what appeared to be some retained tissue…likely the source of the bleeding. \u00a0After I got all that out, the bleeding stopped and I was able to go back to clinic. \u00a0I was a little concerned for a few minutes though.<\/p>\n

 <\/p>\n

The patients I saw in clinic today included the following:<\/p>\n

– 53 year old female her for an ER follow up from the other night. \u00a0She came in with hip pain that I thought was probably just due to a strain. \u00a0Turns out it was.<\/p>\n

– 73 year old female here for a follow up on COPD and CHF<\/p>\n

– 66 yo F with diabetes and osteoarthritis in multiple places<\/p>\n

– 59 yo M with newly diagnosed hypertriglyceridemia<\/p>\n

– 63 yo F with constipation<\/p>\n

– 48 yo F with something I can’t recall<\/p>\n

– 12 yo M with an elbow abnormality that’s been worsening over the past 3 years. \u00a0Whenever he extends his elbow, the olecranon slides laterally over the humerus rather than into the olecranon fossa. \u00a0I took an x-ray of it and will be sending him to one of our surgeons. \u00a0I’m concerned it could be an osteosarcoma and he’ll need to have his arm amputated. \u00a0Here’s a picture of it:<\/p>\n

\"169.possible<\/a><\/p>\n

 <\/p>\n

 <\/p>\n

Right as I was finishing up with clinic, Peter came to tell me there was a 20 year old G1P0 at approximately 20.5 weeks with a threatened abortion in the ER. \u00a0She’d been bleeding for about 2-3 days. \u00a0Apparently yesterday she had an ultrasound done at another facility and everything looked normal. \u00a0I got out the ultrasound and was able to find fetal heart tones, but it looked like the baby was breech and some of its contents were already outside the uterus. \u00a0I moved her to the OB room and did a sterile speculum exam on her. \u00a0Right away I could see her amniotic sac at the introitus and knew delivery was pretty much imminent. \u00a0So I explained in broken Spanish to these people that basically the baby was about to deliver and would die within a few minutes of being outside mom. \u00a0They of course were upset, but took the news surprisingly well. \u00a0I’m thinking down here maybe people are just more accustomed to having\u00a0a poor pregnancy outcome now and then. \u00a0I ended up delivering that baby a little while later. \u00a0Just to add to the excitement, it was breech. \u00a0I’ll spare the details, but suffice it to say that didn’t help matters.<\/p>\n","protected":false},"excerpt":{"rendered":"

I’ve been going in every morning to see that patient of mine who’s in respiratory failure. \u00a0The tap seemed to […]<\/p>\n","protected":false},"author":34,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[1],"tags":[],"class_list":["post-57","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/inmedblogs.us\/garretthooker\/wp-json\/wp\/v2\/posts\/57","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/inmedblogs.us\/garretthooker\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/inmedblogs.us\/garretthooker\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/inmedblogs.us\/garretthooker\/wp-json\/wp\/v2\/users\/34"}],"replies":[{"embeddable":true,"href":"https:\/\/inmedblogs.us\/garretthooker\/wp-json\/wp\/v2\/comments?post=57"}],"version-history":[{"count":0,"href":"https:\/\/inmedblogs.us\/garretthooker\/wp-json\/wp\/v2\/posts\/57\/revisions"}],"wp:attachment":[{"href":"https:\/\/inmedblogs.us\/garretthooker\/wp-json\/wp\/v2\/media?parent=57"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/inmedblogs.us\/garretthooker\/wp-json\/wp\/v2\/categories?post=57"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/inmedblogs.us\/garretthooker\/wp-json\/wp\/v2\/tags?post=57"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}