This Should be an Episode of House
Posted by Dr. Cason on Tuesday, August 12th, 2008
We have had so many diagnostic conundrums in my clinic lately that I’m convinced we’re on an episode of House. Not that I’ve ever watched it. ER was a staple in medical school but now I stay away from medical dramas. Maybe I should start watching- might teach me something. ( Like when Carter learned that “lasix” lasts for 6 hours and was originally a horse medication. I won’t ever forget that!)
Fevers without an identifiable source, now that’s a tough cookie to crack! One of my patients had 10 days of fever and little clues. I poked and prodded, drew labs, took history after history and read and read and there in the bottom paragraph of my HUGE green Nelson bible of pediatrics was this little pearl of wisdom- If there are no diagnostic clues found on physical exam then it is unlikely that any additional lab work will be helpful.
Um, that wasn’t reassuring.
Don’t worry I kept searching. They tell me that House goes to peoples houses and swabs. Believe me I was tempted. Instead I called daily and examined him every other day.
Fever, foreign travel and some leukopenia pushed us to start empiric treatment for presumed typhoid fever. Presumed. And you know what. Fever is gone. After 10 days. Was it bored? Did it just run its course? Or did it succumb to the antibiotics. No clue. But I do know that he smiled at me today.
Whew. I hope to tuck that little chart back in the files and wait for my next mystery to walk in the door.
And you wonder why I pray a lot.
Filed in My Life | 14 responses so far
John Hunter | Curious Cat Investing Blogon 12 Aug 2008 at 12:39 am 1I found your blog via http://bloggingwithoutablog.com/psssst-your-blog-is-showing/ I wanted to say I think your design is very good. It shows a focus on the content making it easy to find what a visitor would be interested without lots of distracting ads. Photos are a great personal touch in the design and in the individual posts. The “I’m about” message is a good addition.
I will leave one suggestion, the text in the header for: “The Pediatrician Next Door- A Peak into the Life of a Pediatrician” is a bit hard to read given the background image.
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Kylaon 12 Aug 2008 at 2:09 am 2I feel like calling Dr. House quite often! Of course, to get an answer on that show, the character always has to almost die at least once.
I hope the treatment did the trick and the illness won’t suspiciously resurface!
Kylas last blog post..Coffee and a glass of water, please.
Audubon Ronon 12 Aug 2008 at 4:13 am 3Congrats, another case solved. Don’t watch those hospital shows. I don’t think I ever saw an ER.
Dr. Casonon 12 Aug 2008 at 5:30 am 4John- Thank you for visiting. I have trying to work within CSS to change that but alas have been having problems!
Kyla- That’s what makes it dramatic right? I’m crossing my fingers about it returning.
Audubon- What about MASH? Now that one was my favorite! I grew up on it.
Bethon 12 Aug 2008 at 11:41 am 5Nelson speaks the truth…as does Oski and Rudolph.
One of my favorite House lines always rings true: “Everybody lies.” The corollary to this from my friend Sean is, “Trust but verify.”
Was it really 10 days of fever? And was it *truly* fever? Did the fever have a pattern (in time or space)?
Interesting. It’s good that it’s gone but if it comes back…well, House probably wouldn’t but I’d check an ESR and CRP. But that’s just me.
Beths last blog post..Because I clearly have no life.
tiffon 12 Aug 2008 at 12:43 pm 6Nice call!
I loved ER. When I was in nursing school,(it had only just started) one of our lecturers made it homework to watch it and pick out all the faults.
I just couldn’t do it.
and MASH was a fave growing up too.
tiffs last blog post..Weekly Winners.
White Hot Magikon 12 Aug 2008 at 1:23 pm 7Hey I mentioned you on my blog today.
I used to really love ER, not that I took it too seriously, but you know Doug *cough*
I don’t know if I have ever mentioned it, but I am a plant doctor, and sometimes I found this to be true in plants. I would not be able to get to a certain problem right away and it would cure itself. However there are far less diagnostics and quite frankly the attitude towards patients is totally different since I would often remove and destroy infected plants and that is not how I want my doctor to think at all….
White Hot Magiks last blog post..Magnetic Monday — Art y Pico Award
Nikkion 12 Aug 2008 at 2:44 pm 8See back to me and my love for the regular super hero! I love House, he is a witty, witty man that House.
I will say that Grey’s Anatomy is my favorite of the MD shows. My Dr loves to humor me so she explains things for me with examples from Grey’s but always ends it off by telling me how she doesn’t like the show as there wasn’t nearly that much sex in her residency!
OH and also I love Doogie Howswer! That was a great show too!
Nikkis last blog post..a whole crapload of cute!
Trishon 12 Aug 2008 at 3:17 pm 9Any West Nile in Guam?
Trishs last blog post..Sprinting Kitty
Dr. Casonon 12 Aug 2008 at 8:05 pm 10Beth- Truly truly! No real pattern just ever present. And the ESR and CRP were pretty unremarkable. Now if you want to talk shop we could talk about the case with the 3 weeks of a low grade fever with an ESR of 140!
tiff- Oh that’s funny!
White Hot- Thank you for the blog love!!
You made my day!I always took my dying plants to the ICU (my dad’s place) and he would cut and trim! Only surgeons think this is the best case scenario! 
Nikki- I never watch that either! I do have a friend that kept asking me, ” So what are you in relation to Carter (from ER) and I’d explain the training regimen.
Trish- No but we’ve been warned about Dengue fever (I found a flier about it tucked in my front door!). In fact for this last febrile patient we did the tourniquet test to rule it out.
Elizabethon 12 Aug 2008 at 10:25 pm 11Good morning from Illinois!
Mysteries abound! Our last household mystery was bright red cheeks…followed by a rash…that spread down… ah! Crap.
I think it’s written in kid’s DNA to occasionally gross out their parents and definitely to make them squirm. I’ll have to keep that in the back of my head the next time either child walks up with a cicada shell and shoves it in my face… “They can’t help themselves…”
Dr. Casonon 13 Aug 2008 at 5:40 am 12Elizabeth- You just gave a classic definition of Slapped Cheek Disease AKA Parvo AKA Erythema Infectiosum AKA B-19 disease AKA fifth disease! Whew that was a lot of names for one little virus. No treatment but watch for in utero infection it can cause a severe anemia and older children can get a pretty significant bone marrow suppression from it!
Ohhhh!! Don’t get me started with the cicada shells! They are huge and gross and I squeal like a little girl!
Barbara Swaffordon 13 Aug 2008 at 4:43 pm 13Hi Dr. Cason,
You sound like such a caring doctor. And yes, pray helps, too!
Barbara Swaffords last blog post..Blog Visitors – Like Kids In A Candy Store
Lisaon 14 Aug 2008 at 8:42 am 14First of all, I have to say don’t watch House. It’s frustrating to watch them do things we would never do. I only watched it once. It was an episode of a kid with fevers of unknown origin and it made me mad when the doctor ripped out the kids IV and carried the kids into a shower. As if I would ver do that to my patient….
But I did love ER.
Good Luck in your future investigations.
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