Moderator ventana Posted October 26, 2022 Moderator Share Posted October 26, 2022 20 years of practice This week takes the cake as the most strange week in 2 decades of work..... This week I am getting trampled by a herd of zerbra's... not just one (these are all patients that are my PCP patients where I am the ONLY one responsible for their care.) I consulted outside specialists, and ran all these cases independently except brief discussions after the fact for the two MRI neuro brain cases. Dx who was consulted Critical subclavian stenosis with cool hand - ER and transfer out urgently New Dx Lung CA (on LDCT on new patient that old pcp never ordered) - surgery and onc New lymphoma Dx (on LDCT on new patient that old pcp never ordered) - surgery, onc, cards, vascular, inpatient Vestibular Neuroma growing into the deep brain - presented with shoulder weakness - neuro surg and ENT Aortic Root Graft Infection from surgery 8 months ago - also new patient with vague complaints, ID, Vascular Surgeon, labs and ID follow up Some type of corpus callosum T2 enhancing lesion on MRI - sending to neuro after lab work up new onset schizophrenia in heavy cannabis user - MH taking over T supplement on a patient fired by Uro 8 months ago - post testicular ca years ago...... all me.... this is all on top of the regular run of the mill PCP issues with DM, CHF, MH, and the likes..... and now I am on call the entire week and weekend... 1 Quote Link to comment Share on other sites More sharing options...
SedRate Posted October 26, 2022 Share Posted October 26, 2022 Sending good vibes your way for your call weekend ahead. 1 1 Quote Link to comment Share on other sites More sharing options...
Photograph51 Posted October 26, 2022 Share Posted October 26, 2022 I read on an anti PA/NP Reddit thread that physicians were complaining that PA's shouldn't get independent practice because PA's aren't taught about any of the zebras. I was stunned, since I remember PA school teaching a large quantity of rare diseases and expecting us to know details of each one. But that's the assumption that physicians have of what we were taught. 1 Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted October 26, 2022 Administrator Share Posted October 26, 2022 Nope, I would have no idea what Wilson's Disease is unless it had been on an episode of House, MD. (eyeroll) 1 Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted October 26, 2022 Author Moderator Share Posted October 26, 2022 14 hours ago, Photograph51 said: I read on an anti PA/NP Reddit thread that physicians were complaining that PA's shouldn't get independent practice because PA's aren't taught about any of the zebras. I was stunned, since I remember PA school teaching a large quantity of rare diseases and expecting us to know details of each one. But that's the assumption that physicians have of what we were taught. funny because the two brain MRI that I reviewed with the FP docs got eyes roll and "I don't know send them to neuro" I know what I don't know, and I know when something doesn't present typically and when to start imaging/work up. I may not know the exact end Dx, but neither does the doc..... 1 Quote Link to comment Share on other sites More sharing options...
iconic Posted October 27, 2022 Share Posted October 27, 2022 The new onset schizophrenia sounds more like substance-induced psychosis Quote Link to comment Share on other sites More sharing options...
sk732 Posted October 27, 2022 Share Posted October 27, 2022 On 10/25/2022 at 8:34 PM, ventana said: this is all on top of the regular run of the mill PCP issues with DM, CHF, MH, and the likes..... and now I am on call the entire week and weekend... Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted October 27, 2022 Administrator Share Posted October 27, 2022 3 hours ago, iconic said: The new onset schizophrenia sounds more like substance-induced psychosis Maybe, maybe not, depending on age. It's looking like MJ use in youth is prompting schizophrenia to develop when it otherwise might not have. I'm interested to see where the evidence leads here... 1 Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted October 27, 2022 Author Moderator Share Posted October 27, 2022 8 hours ago, iconic said: The new onset schizophrenia sounds more like substance-induced psychosis Starts as that but turns perm. Now the 4 case I have seen. I am thinking this will not be a zebra in a few years but instead a broken down old mare that everyone knows. 1 Quote Link to comment Share on other sites More sharing options...
CAAdmission Posted October 27, 2022 Share Posted October 27, 2022 Interesting. Do you think substance abuse is altering brain chem and directly causing psych problems, or simply unmasking things that would have come to light later? Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted October 27, 2022 Administrator Share Posted October 27, 2022 1 hour ago, CAAdmission said: Interesting. Do you think substance abuse is altering brain chem and directly causing psych problems, or simply unmasking things that would have come to light later? Probably something like being the environmental trigger for a latent genetic potential. I can't say I have really studied it, but in Washington State it's pretty inescapable. Quote Link to comment Share on other sites More sharing options...
jmj11 Posted October 27, 2022 Share Posted October 27, 2022 Sounds like you qualify for your own "House" series. Of course, House has a whole team that have nothing else to do but to nail down a zebra diagnosis for a single patient, and you did it alone. 1 Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted October 27, 2022 Author Moderator Share Posted October 27, 2022 15 minutes ago, jmj11 said: Sounds like you qualify for your own "House" series. Of course, House has a whole team that have nothing else to do but to nail down a zebra diagnosis for a single patient, and you did it alone. not bad for an assistant...... 1 2 Quote Link to comment Share on other sites More sharing options...
iconic Posted October 27, 2022 Share Posted October 27, 2022 (edited) 9 hours ago, rev ronin said: Maybe, maybe not, depending on age. It's looking like MJ use in youth is prompting schizophrenia to develop when it otherwise might not have. I'm interested to see where the evidence leads here... Well if they are experiencing visual hallucinations it’s more consistent with substance use. But can’t r/o substance-induced psychosis unless they stay off the substance for 2 months.. marijuana can absolutely trigger new-onset schizophrenia or mood disorders with right (wrong?) family history/genetic predisposition. It really doesn’t have any sort of good evidence for anything mental health Edited October 27, 2022 by iconic Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted October 27, 2022 Author Moderator Share Posted October 27, 2022 First couple episodes seem to improve after DC of cannabis. But they go back to it like a moth to a flame. By 3-4 time they just live there. No coming back. So sad. 1 1 Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted October 27, 2022 Administrator Share Posted October 27, 2022 22 minutes ago, ventana said: First couple episodes seem to improve after DC of cannabis. But they go back to it like a moth to a flame. By 3-4 time they just live there. No coming back. So sad. Yeah, getting those habituated as youth off cannabis products is seriously challenging. I don't see such negative effects in my 50+ year old injured workers, but my teenaged through mid-20's eating disorders population does not seem to do so well with the pot. Again, recreational weed is legal and has been for almost a decade now in Washington state, so what we're seeing is likely a new normal... we just need descriptive stats to document it, because "data" is not the plural of "anecdote." Quote Link to comment Share on other sites More sharing options...
iconic Posted October 27, 2022 Share Posted October 27, 2022 (edited) Recreational weed is almost better than the idea that “medical” cannabis somehow has medical evidence for using it in psychiatric disorders Edited October 27, 2022 by iconic Quote Link to comment Share on other sites More sharing options...
sk732 Posted April 15, 2023 Share Posted April 15, 2023 On 10/27/2022 at 8:50 AM, CAAdmission said: Interesting. Do you think substance abuse is altering brain chem and directly causing psych problems, or simply unmasking things that would have come to light later? Yes? Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted April 16, 2023 Author Moderator Share Posted April 16, 2023 On 10/27/2022 at 9:50 AM, CAAdmission said: Interesting. Do you think substance abuse is altering brain chem and directly causing psych problems, or simply unmasking things that would have come to light later? 3 hours ago, sk732 said: Yes? I actually think it creates psychotic events with long term daily use.... with out having to have psych hx. Think it is more a genetic thing.... IMHO 1 Quote Link to comment Share on other sites More sharing options...
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