Sunday, June 23, 2013

1473. Sunday Jun 23, 2013's interesting cases

I rehearsed with my assistant Nia and intern Terrence on videoing this case. Hands-on practice makes them more engaged and interested in the patient, rather than the patient being just a patient number.

"Practice by putting the paper towel roll on the receptionist counter and use the camera to focus on it. Then walk around it, making sure no obstacles." I said to Terrence, now sunburnt brown from National Service full time, thin and crew cut hair, black framed spectacles. "Nia will bring the cat out on the counter. You have only a few seconds to video the runny nose and the cat will scratch and struggle."

We rehearsed. When Nia went to pick the cat from the crate, she hissed and so there was no filming. Instead, Terrence practised filming the cat in the crate.

Earlier the owners came complaining about the cat not eating again after being cured one month earlier. "Did she really eat?"I asked as this cat is very old and had runny nose at that time. Dr Daniel sedated her and took blood sample for analysis. The total white cell count and high neutrophils showed a bacterial infection. Use of evidence-based medicine is important for a proper diagnosis, rather than just giving antibiotic injection for this old cat, assuming a bacterial infection, as is normally done.
"Yes, she ate a lot and was OK for some weeks."
What causes this URTI to recur?
"Could it be the haze?" the owners asked.
"Yes, it is possible. The last 2 days had the city shrouded in smoke such that the outline of buildings could not be seen. The Pollutant Standards Index, an indicator of air quality, was over 400. A figure over 200 is considered hazardous. The cat did not go out but windows of the flat were opened and she did go to the balcony. So she breathed in the smoke particles and is now sneezing.

When Terrence videoed, he did not see the runny nose. "I had given injection when the cat came in." I said. "Nia was able to scruff the cat when he took out of the carrier and I injected her. However, you can video the cat's tongue licking the nose. This is like people using tissue to wipe the nose. So, the cat does have runny nose and your video should capture the evidence!"

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