SAVE GENERAL HOSPITAL

http://www.savesfgeneral.com/

San Francisco voters, please vote YES on Prop A to make San Francisco General Hospital earthquake-friendly.

SELECT trial halted!

As a prostate cancer/oncology geek, I have to let you know that the huge trial examining whether selenium + Vitamin E prevents prostate cancer (results were due in 2013) was closed permanently yesterday!

Researchers found that there was a small but significant increase among vitamin E users to develop prostate cancer, and a small but significant increase in the incidence of diabetes among selenium users.

Juicy oncology gossip!

Discuss.

Intersession 2 and a Really Nice Weekend

Big Sur from the Lucia Lodge restaurant porch

best fish and chips ever

The MS3's are midway through Intersession 2, a week-long break between 3rd and 4th block. It's interesting that even though I had more free time during Family Medicine, I actually ended up blogging less. During Intersession, the students engage in a variety of touchy-feely small groups and lectures about medical ethics and professionalism. It's actually a good time to unwind and reflect on how we are changing on our journey to becoming doctors.

Last weekend after the Family Medicine exam was also extremely nice. To start, I spent an hour walking around Lake Merced by myself before sunset, which is something that I wanted to do for six weeks after glimpsing the beautiful lake through a window at the Janet Pomeroy Center (a fantastic center for children and adults with disabilities that FCM introduced me to via a community project). Lake Merced is beautiful; there are so many areas of the city that I haven't explored yet (the SF Zoo is nearby too).

Gingivostomatitis

I diagnosed my first case of gingivostomatitis this morning in a 2-year-old girl who had reported to the ED 5 days ago with a fever of 104 degrees. The ED thought thought that she had OM, and gave her amoxicillin. The next day, the patient presented with mouth sores and continued running a fever. Her gums were swollen and purplish, and she had oral lesions in her buccal mucosa, on her tongue, and soft palate.

After checking her normal TM's b/l and ruling out HFMD (oh, Coxsackie, I know you well after catching you during my peds rotation) and chicken pox (vaccinations UTD, no rash), the leading diagnosis was herpetic stomatitis caused by HSV-1.

Even though it was a relatively simple case, it feels good to have a solid differential and coming up with a diagnosis. One of the things that I enjoy most about the outpatient clinic is seeing new patients with fresh eyes, being the first person to examine a patient and figure out what's going on. For instance, last week, I saw a 3 y/o boy with a 6 cm cervical LN. I find myself enjoying acute/urgent care more than routine physicals/WCC/healthcare maintenance (but predictably enjoy the Pap smears, FOBT, PSA, and other cancer screenings).

In family medicine, I have also found myself having an irrational fear of pregnant women (having not yet done OB-GYN, pregnant women are a black box to me), and an extreme fondness for taking care of children who are acutely ill.