Not too much has been happening at the clinic, but I figured I should at least post something since I haven't in about a week! This past week was really fairly slow, and I think I was only actually at the clinic for about 28 hours total. Tuesday and Thursday were long 12-hour days, Monday was a half-day, and I didn't have to go in on Wednesday or Friday! Not bad...I could get used to the primary care lifestyle. :)
Last week was mostly regular check-up visits - there weren't even that many procedures. I did some trigger point injections into sore back/neck muscles for a few people, and cut off a skin tag or two, but that's about it. There was one pretty remarkable patient that came in on Thursday, though: she hadn't been to a doctor in about four years, except for one brief visit to our clinic back in March where she got some labs drawn but nothing else. She was complaining of fatigue, headaches, significant weight gain despite good diet and exercise, constipation, being cold all the time, trouble with her memory, hair being dry and falling out, irregular periods... pretty much all of the textbook symptoms of hypothyroidism. Turns out, she had been diagnosed with Hashimoto's thyroiditis when her son was born...11 years ago...and was never on medication for it. In Hashimoto's thyroiditis, the thyroid gets all inflamed and secretes too much thyroid hormone for a short time, but then the thyroid gets burnt out and can't produce enough thyroid hormone for normal function anymore - hence the resulting hypothyroidism like this patient was experiencing. Hypothyroidism is both miserable and potentially deadly for the patient, so it was good that this patient came in! The way you officially diagnose hypothyroidism is by checking a thyroid-stimulating hormone (TSH) level - if it's high, that means that the thyroid isn't producing enough thyroid hormone, so the brain is "stimulating" it to make more because it thinks the body needs it. Normal levels are typically between 0.5 and 4.5 mIU/L, depending on the laboratory and the guidelines you use. Turns out, her TSH level had been checked when she was in the clinic in March, and it was...are you ready? 29.4!!! This is absolutely unheard of, and it's amazing that she was still functioning at all with levels that high.
Anyway, that was pretty much the only excitement at the clinic last week. This coming week will probably be more of the same. My last day is Thursday, and I head back up to Pittsburgh on Friday morning! I'm excited to be back in Pittsburgh with some of my friends from school, and to see what medicine is like in a city environment. My next rotation is part ER, part urgent care...so the entire experience will be basically the complete opposite of what I've been enjoying in Kentucky! I'm looking forward to it, though, and I think it will be a good experience.
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