I haven't forgotten about the blog but I also haven't figured out how to present cases without infringing on the trust of National Jewish. My sponsers, Chuck Daley and Mike Iseman, are out of town this week so I am busy but without direction on how much I can discuss on a blog. I may have to stay more general , for the time being, in discussions of tuberculosis, non-tuberculous mycobacterium lung disease, interstitial lung disease and occupational diseases.
Interesting thoughts from occupational lung disease include a rising exposure of beryllium in this country and how our sarcoidosis patients may actually have berylliosis, rare but not nonexistent. The occupational clinic at National Jewish sees sarcoidosis patients, not the pulmonary docs. An odd distribution of disease, maybe due to suspicion of berylliosis exposure in these patients.
Sarcoidosis is rather common in clinic and strikes patients at a young age, 20-40. It is characterized by big lymph nodes that are usually uniformly distributed in the center of the chest and "lumps" in the lungs. It seems to affect African-Americans and people with Scandinavian decent in the United States leading some to believe that it may be related to a deficiency of vitamin D. But no one knows exactly why it occurs.
Berylliosis presents just like sarcoidosis in the lungs. Beryllium is a metal used in the aerospace industry, nuclear industry and sometimes manufacturing of radiologic equipment and dental equipment. If someone were to show up to clinic in Seattle with "sarcoidosis" and they worked for Boeing or in dentistry I may be inclined to test for berylliosis. It is estimated that about 800,000 people may have beryllium exposure, up from about 30,000 exposed in the 1970s. The test is for beryllium induced lymphocyte proliferation on BAL fluid or from blood. BAL fluid test is more sensitive. The treatment is steroids and removal from beryllium exposure. This is a workman's comp issue.
Denver is a little down since their baseball team, the Rockies, lost their chance to go to the World Series to the Philadelphia Phillies, Jamie Moyer's current team. I can see the stadium from my apartment with the Rocky Mountains in the background. It's good to have a view.
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In my years as an internet junkie I've run accross this ethical issue of posting medical anecdotes quite a bit. Google the topic and you'll find a lot of helpful guidlines and even more debate over the finer points of HIPAA. Here is one site that I found interesting. It addresses physicians using twitter to share information.
ReplyDeletehttp://www.kevinmd.com/blog/2009/04/doctors-who-twitter-in-acp-internist.html
You really can't beat that view from Coors Field. Too bad you just missed baseball season. :-)