Wednesday, 16 January 2008

Hokkaido Revisited In The Snow!!

Dear Bloggers

Yesterday saw my return to Hokkaido to teach the resident doctors on history and physical examination.

On arriving I was delighted to see it snowing. It has been many years since I have seen real snow and to see the beautiful white blanket covering much of the terrain was very pleasing.

The afternoon started with rounds seeing all the medical inpatients with a short medical history and discussion of the current problems. It was good to see medicine being practiced to a good standard. I was able to provide my alternative opinion on several patients which I hope my have helped with their future workup.

Moreover, the second session was composed of a case history and physical examination. I cannot reveal the case on this blog due to anonymity but suffice it to say, it was a rare problem and something that you as physicians may only see once in your working life times! Through history and physical in addition to review of the laboratory results and radiological scans, I was able to offer an informed opinion on this complex problem.

Lastly, I provided a lecture on the serious problem of acquired severe cardiac valve disease. This was supplemented with a case vignette from a real scenario. The purpose was to show the residents what is expected when asking about non-specific symptoms. Because the specificity of such symptoms is low, one has to ask many varied questions to ascertain some idea of which system is contributing to the problem. In doing so, one may then focus of potential positive areas of the physical examination.

After this 5 hour total session, we went out to enjoy a nice evening with great food, great beverages and of course, great people.

We ended the evening with a trip to an open air onsen with the outside temperature of minus 7 with snow all around us on the ground and also falling from the sky....The perfect way to end a perfect day.

Today involved contributing to the elucidation of a fever of unknown origin in a bed ridden patient who was otherwise asymptomatic. After many investigations and scans, a cause had not been identified. No history of relevance was obtained from the patient but physical revealed digital finger clubbing, leg edema, and probably urinary tract infection. Hence, the possibilities of infective endocarditis came to mind despite the absence of an audible murmur.
Moreover, malignancy was a possibility as well. The patient also had bilateral effusions although too small to sample. However, one should always entertain the possibility of chronic pulmonary embolism which can cause a fever and mimic infection.

Finally, I returned to the warmer climates.....a whirlwind trip with great delights.

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