Dr. Ou had outpatient clinic today and consequently, I was able to see many patients he either has or will operate on in the future. Most of the day was relatively uneventful because a lot of the patient interaction was just viewing CBCs and other tests to see if a patient's condition was adequate. However, a handful of patients led to some interesting experiences.
The first patient that stood out to me was a young female who was recently in a motorcycle accident. All her injuries were very superficial, a bunch of bumps, scrapes, and burns. However, one of her skin lesions on her knee was not healing correctly. Dr. Ou decided that he needed to remove some of the necrotic tissue, take out the stitches, and just let it heal on its own. Normally, local anesthetic isn't given to remove stitches, however, the patient would cry and complain about pain... so the doctor gave her anesthetic for this simple procedure. Even after the anesthetic was given, the patient continued to cry and scream about the pain. She would always slowly stop the doctor. There was never any sudden jerks from the pain. In my opinion and I think Dr. Ou as well, her pain was psychological because she kept watching and anticipating severe pain. Despite the situation, Dr. Ou handled her very professionally and addressed the patient's situation as her own. In other words, every patient has different pain sensitivities and psychological situations that must be dealt with on a individual basis. This reinforced a maybe not so obvious fact that each patient must be dealt with differently and seen in their own personal situation.
The second patient was a middle aged man with a direct inguinal hernia. The patient and Dr. Ou allowed me to palpate the hernia, which was extremely prominent. When the patient coughed, the hernia would protrude much more. The only time I have seen inguinal hernias was in the anatomy lab, actually seeing it in a live person was actually pretty intriguing.
The last patient that really stood out was actually more impressionable because of the method of treatment instead of the actual individual. This old male patient presented with CAPD (continuous ambulatory peritoneal dialysis) that resulted in sclerosing encapsulating peritonitis (generally a bad prognosis). The primary agent of his treatment was tamoxifen, which is an estrogen receptor antagonist drug generally used for ER/PR positive breast cancer patients. The idea of a drug that is normally used in females for something entirely different really took me by surprise. This just reiterates the importance of a holistic approach to medicine. Pathways in our body are intricately intwined. Even targeted therapies like tamoxifen can be applied to other diseases. I asked Dr. Ou about the reasoning for the use of tamoxifen and he could not give me a clear answer. I tried researching it myself and there does not seem to be a clear consensus on why it is used. Papers seem to say that it may interfere with TGF-beta receptor but the drug does not lead to recovery in all patients. This just makes me wonder how the use of tamoxifen in this scenario was even discovered. Maybe someone who had concurrent breast cancer used the drug and had an improved condition? I think it is pretty crazy how some therapies can be employed without a clear cut reasoning behind its use. I always thought evidence-based medicine meant we needed to know exactly what each drug was doing, but apparently, sometimes, if it works... it works...
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