An interesting week!

First of all, the best news: I got engaged last weekend!! My boyfriend came up to Montana to visit me, and we went skiing, and he had come up with the most amazing proposal that I was not expecting!! I was completely surprised and so, so happy!! :)

This week was full of interesting cases! Well, really just one very interesting case, and some other mildly interesting things. One (male, elderly) patient came in earlier this week, and the reason listed in the computer for his visit was "lump on left breast". Reading that, I thought it was going to be something like a lipoma, cyst, abscess, or some kind of dermatological complaint. So, I go into the room, all ready to take a look at it, tell him what it was and what to do about it, and get out of there in 10 minutes or so. When I get into the room, I start asking the patient about it, and he tells me that it's been there "Oh, for a while" and that he thought it would go away but it didn't, and his wife made him come in today. He said that it's "kinda red" and doesn't bother him really, but it itches sometimes. So, I ask him to pull back his gown so I can take a look, and there is a giant mass the size of my fist on the lower part of his left breast. It's red, lobular, and fixed, and there was nipple retraction...in other words, it looked exactly like a terrible, very advanced breast cancer. I went to get my preceptor after I finished the rest of the exam, and he came in, and was visibly shocked at what he saw. We ordered a CT scan, and it looked even more like cancer on that...and we saw a smaller lesion on his right side as well. We immediately referred him to a general surgeon for a biopsy. We'll see what happens, but it doesn't really look good.

Otherwise, this week was pretty uneventful, though I did see a baby with pyloric stenosis today. That's a condition that's pretty rare, and happens in babies when they have a congenital narrowing of the valve at the end of the stomach where food goes into the small intestine. These babies vomit up basically everything they try to eat, because there's not enough room for the food or formula to get through. They are also constantly hungry and parents report that they are "constipated," though it's really just that not enough is even getting through to be excreted. Anyway, one of the cool (for me to see) physical exam findings for pyloric stenosis is an "olive-shaped mass" in the epigastric area (from the dilation of the end of the stomach from all the pressure of the food not getting through), and this kid had it! It was pretty interesting.

I'm only here for four more weeks, and I'm starting to get a little sad about it. I don't think I would ever want to live here, but the clinic/hospital itself is really nice, and I like the staff a lot - even my eccentric preceptor. I will definitely miss it when I leave!