Beginning in Pathology, you begin to learn about some horrible diseases. You don’t know that they’re horrible, not really, since you haven’t seen someone with them. And medical terminology being what it is, there are some pretty nasty things hiding behind relatively innocuous words. E.g.
In Duchene Muscular Dystrophy, a child is born that will die around the ages of 18-24. Symptoms don’t appear until around the age of 3 when the kid is walking. The parents will tell the doctor that their son is walking around on his tip toes, his calves are enormous, and that he seems unstable. Whenever he falls over, he has a very strange way of getting back up (Gower’s maneuver). Eventually, this child will lose the ability to walk and the disease takes over his hips, shoulders, and spine leading to scoliosis.
Now all of that is pretty straight-forward-horrible. But then they throw in this gem: Contractures develop. Two words to describe a focal muscle tightening that will twist someone’s son into a shape that noone can unstretch. Contractures.
Of course I have my own list of horrible diseases that affected patients I cared for in my hospital days. Advanced Cystic Fibrosis makes me never want to work in an ICU and it’s generally accepted that Scleroderma is the worst disease imaginable. But today, today I learned about one that deserves special mention. Now I’ve never met anyone with this, but let’s try to imagine…
Imagine a guy. He meets a nice girl at a bar. Things go well and they go home together. A week later the girl calls him to say that she just found out she has chlamydia. No problem. Chlamydia is largely asymptomatic in men and there’s treatment for it. He goes to his physician and gets the infection cleared. Two weeks later, things get worse.
He’s pissing fire, his eyes are red and watering and his joints are killing him. His Achilles tendon is incredibly inflamed. Then things get much worse. He begins to get a pustulating rash on the soles of his feet and his palms, ulcers on the head of his penis and inflammation inside his eyeball.
No, this isn’t some horrible new venereal disease. This is a reaction that some people get after certain infections of their GI tract or the genito-urinary tract. To see Reiter’s Syndrome in my notes is to lose some of the shock:
Classic triad of arthritis, conjunctivits and urethritis post GI and GU infection. HLA-B27. Complications include enthesitis, keratoderma blennorhagicum, circinate balantis and anterior uveitis. Typically self-limiting course (3-12 months). 15% procede along Chronic, Destructive course. 10% progress to Ankylosing Spondylitis. HIV association.
All it’s really missing is “Pt may be descending into madness, believing God is slowly destroying his life. Promises to never have sex again. Identifies with the work of Hieronymous Bosch”
Back to the books.