Occasionally Preposterous, Repeatedly Scrutinizing, and Sporadically Egotistical: My Two Cents

The patient is a 60 something female with a history of a ureteral stone, left ureteral stent, kidney stones, HTN, CHF, obesity, pyelonephritis, and type 2 diabetes. The stent and stone was supposed to be removed a few weeks after the initial visit and scope. However, one thing leads to another as it often does, and you don't keep your date with the urologist (I get that, seems it could be kinda weird) and get sepsis. Happens to everyone. So in to the hospital it is with a fever of 105F, 30 breaths per minute, and tachy to 120. The ED and ICU do their magic and then the stone and stent are removed, the patient is still alive, and the world seems calm for a minute.  Then the cultures come back from urine, E. coli, K. oxytoca,  & E. faecalis ; and blood, Bacteroides fragilis and more K. oxytoca. The PCR shows CTX-M gene and the susceptibility results show resistance to ampicillin/sulbactam, cefazolin, cefepime, ceftazidime, ceftriaxone, gentamycin, tobramycin, and TMP/SMX; ...

There are a few things in the world that truly have a lot of utility. The above mentioned Swiss army knife. My 1998 Taco, may she rest in peace. A frying pan. Metformin. Pembrolizumab. It is this last one, pembrolizumab (PB from now on) that I want to look at today. As I started off in healthcare, one of my jobs was to get a health history on patients and take down all the medications they were using. Even without any formal education and not having any experience, certain medications started to stand out. Statins, metformin, baby aspirin, metoprolol, and others. Keytruda is one that I remember seeing not infrequently, but always in folks with a history of some sort of cancer. Being a little bit more educated now days, I know that Keytruda, the brand name for PB, is quite a jack of all (cancer) trades.  A look at the lists of FDA and off label indications for PB is pretty impressive. PB is FDA approved for certain types of melanoma, NSCLS, head and neck squamous cell carcinoma, ren...

Not even joking. No cap. The solemn truth. On the record. The truth, the whole truth, and nothing but da truth. Bacitracin was named after bacteria from a lady named Margaret Tracey. How is that for useless knowledge taking up space in your brain? Before we get into that story, me thinks the three of you reading this have probably used, or had been the target of use for, bacitracin as a kid. The little packets are ubiquitous in first aid kits across the world. Got a cut? Bacitracin. Burn or scrape? Bacitracin. Ran out of toothpaste? Bacitracin. I really hope that sarcasm was evident, the lack of humor nowadays is stunning. Please don't eat bacitracin.  In 1943, a young girl named Margaret Tracy was seen at a hospital in New York, the precursor to Columbia-Presbyterian Medical Center. She had been hit by a car earlier that day and suffered a compound fracture of her tibia, which collected dirt from the road. The doctors cultures the wound which grew Bacillus subtilis and Staph aureu...

Flying whales, Gojira, primo music. This is how my mind works, and as such I bet you know where this is going? Today is about light chain amyloids.  No not really, lead. Not the heaviest metal but it was used for sinkers for a while so it’s heavier than a fishing bobber. See? It all makes sense now. Heavy, lead, whales, Gojira. But let’s be serious now (yeah right….), and talk about lead.  As I was recently looking for a new digs I saw quite a few homes. One of the topics always brought up, besides asbestos (which I will cover), is lead. Usually in the context of pain. The news of kids eating lead paint and the subsequent health issues stuck with me for some reason. Probably because of all the people who get sick, it’s especially “wrong” when kids get sick. Regardless, all ages have been affected by lead.  Lead or Pb, yummm peanut butter……. Oh yeah, lead has been used throughout history as a (relatively) heavy metal that is soft, has a low melting point, and is easy to wo...

No, not you, I like you if you're actually reading this, low back pain (LBP) is the object of my ire. My old friend LBP, we meet again. As a former early 20 something male and Marine, I was obviously strong enough that I didn't need to take care of my body. My ego was about 7.64 times bigger back then too, which puts a lot of strain on the low back as well. After all, I was going to be the strongest and most hardcore (if you missed the sarcasm I have pity for you). All that and suddenly, like divine intervention, I have a constant companion. No, not Abby, though she is too. Back pain.  Back pain is one helluva problem for a lot of people. Ranging from slight annoyance to shooting, debilitating pain. I will now quote myself because retyping is for suckers:           " Back pain, specifically low back pain (LBP) is pretty common with worldwide estimates of 7-8% of people suffering from some level of LBP. Likely an understatement, especially because some ...

Yeah, I know, it's been a long day and my creative juices have been reducing to a creative glaze but then got burnt. So you get that title instead. It's a pretty common trope, wash your mouth out with water for saying bad words as a kid. Or was that just me? Either way, my palate is exquisite. I can taste the difference between Dove bar soap, great value moisturizing bar soap, and every day essentials moisturizing soap. You wine connoisseurs have nothing on me. Funny think is, I never got my mouth washed out so take that as you will. It might be why I enjoy crayons so much.  Without further ado, bladder irrigation, wash that sucker out. The patient is a 50ish year old male with a history of a TURP a few years ago but no other history. A few months back, he started to have some trouble with urinary retention and started to pass some clots before becoming totally plugged. I can't even imagine that, one of the great parts of life is being able to relieve yourself of a full bla...