Wednesday, April 11, 2018

Pictures of Celebrities That Cannot Be Autographed AND How Many Fingers and Toes Do YOU Have?

Several exciting or at least mildly interesting things happened near me in the past ten days or so, and I really can't share any of them, which truly sucks. This is the first week in well over two years that anything in my life has been bona fide interesting enough be mentioned in a blog. Obviously a whole hell of a lot of things have been mentioned in this blog in the past two years or so, but even I don't pretend that any of them were honest-to-goodness interesting enough to have merited space in even a forum so obscure as this blog. 

In one instance, I read an X-ray of a  grandson of someone famous.  The radiologist was at home asleep when I first viewed the CT scan. I knew instantly what it was.  I called and woke up the radiologist of record because the surgeon would want a more precise reading of the images before cutting into the child. I then hand-carried the copies down to the first floor, alerting the E.R. physicians. 
When the lead surgeon arrived about fifteen minutes later, I managed to be strategically in his direct line of sight. he remembered me from my sub-internship and invited me to scrub in for the surgery. I called my supervising radiologist, who  graciously allowed me to vacate my shift about half and hour early in order to observe the procedure. The diagnosis was a volvulus or twist of the ileum, which is the final section of the small intestine, just before the reversal of direction of the intestines, where the ileocecal valve separates the ileum from the cecum, which is the very first portion of the colon,  near the appendix. 

What was interesting about the particular patient, in addition to her age of nineteen months, and her grandfather, who is famous and who shall remain nameless here because I do not wish to lose my license to practice medicine before I even have it, was that her internal organs were not in the customary places. She had (and still has; it's not a condition a surgeon is going to attempt to repair) situs inversus. In layman's terms, her internal organs are reversed. With situs inversus, it can be  a total mirror image, with all organs reversed, or just some of the organs can be out of the usual arrangement.  With modern medical technology being what it now is, a child in a first-world country doesn't typically reach the age of nineteen months without medical professionals bringing him or her into the world being aware that the orientation of his or her internal organs is reversed laterally.  The vast majority of the small number of babies  (one in ten thousand is the current rate of prevalence reported for the condition) who are born with reverse internal organs are now diagnosed as such prior to birth. Images obtained via ultrasound examination from mid-pregnancy on will usually allow the condition to be detected if the radiologist is alert depending also upon the quality of the ultrasound equipment or the number of organs involved. 

The nineteen-month-old child is an identical twin. If identical twins divide relatively late (Day 5 or later following conception; for reference, dividing at Day 10 or later results in conjoined twins), they have a greater-than-average chance of being mirro-image twins. This happens in roughly one-fourth of monozygotic, or identical, twins. in other instances, situs inversus can be associated with genetic syndromes or abnormalities. Sometimes it happens with no other abnormalities. Donny Osmond has lateral situs inversus; his reversal was discovered when he underwent surgery for pain on his left side, with turned out to be appendicitis. (Appendicitis more typically presents with pain in the lower right quadrant. Osmond's appendix ruptured before it was removed, most likely due to the situs inversus causing his pain to be on the "wrong" side for appendicitis.)

If an ultrasound exam takes place either at a physician's office or at a business that provides ultrasound exams for essentially novelty or recreational purposes, it may be that no radiologist ever reviews the footage.  A competent obstetrician -- even one who spent the bare minimum of time in radiology rotations during med school, should be able to spot fetal organs that aren't in their usual places from the mid-second trimester of pregnancy. The people running what are essentially portrait studios for the not-yet-born offspring of those among us who have more money than brains  and fall for all sorts of schemes designed to part the fools of whom I write from their money, should not be expected to contribute medical information based on the ultrasound exams they perform.  The training of these photographers, ultrasound technicians, or whatever one would care to call them, varies from place to place, but in no instance of which I'm aware are the people working these spa-like ultrasound studios actually medical doctors, much less either OBGYNs or radiologists. I would take even gender identification from them with the contents of a large scoop of salt and not merely the proverbial pinch.

I'm veering off-topic here, and I'm doing so without the blessings of any of my lecturing or supervising professors (I technically write this entire blog without the blessings of any of these people, but such is especially the case with regard to what I will say next).  It is my opinion -- and I'm very much a voice in the wilderness in this regard -- that both medical professionals and  expectant parents should approach the use of ultrasounds with more caution than is the current norm.   Ultrasound technology for prenatal purposes has been around since the 1950's, but didn't attain much popularity here in the U.s. until the 1970's.  Since that time, the medical community has studied potential cause-effect of fetal/maternal ultrasound exams against just about everything under the sun, and have yet to find correlation or causation between ultrasound examination and anything. That does not mean that some link won't be found in the future. It would be very sad, for example,  if a link were eventually found between ultrasound exams and autism.  I really doubt that such a link will ever be found; for one thing,  I suspect it would already have been found by now if there were anything linking the procedure with the condition.  Still,  if I ever become pregnant, I will have ultrasound exams only when medically indicated or maybe one extra exam to determine the baby's sex. As cool as it is to know who or what a baby looks like months before it is born, which is possible in 3-D and 4-D sonogram procedures, I'm personally not going to shoot for an entire album of prenatal photographs of the baby. I can wait until the child is born for that.

In another instance of prenatal ultrasound examination, I was able to point out syndactyly (third and fourth finger of the left hand were conjoined by skin) before my supervising radiologist mentioned called attention to the condition in a  twenty-nine-week fetus.  The radiologist and I  were, of course, not in the presence of the family when I made this discovery. (If we had been in the presence of a family member, I would of course have needed to have kept my moth shut and would have let a person more skilled in patient- or parent- communication broach the topic. The time for me to make brilliant and unexpected dianoses from the various images I see is not in the presence of patients or family members.)  This was interesting to me because I had, on several occasion in recent months, discussed the condition of polydactyly with a friend of mine. My friend has a physician friend who invented a device to sever a child's extra digit if there is no bone in the extra digit. (Sometimes the extra digit found in cases of polydactyly is essentially a full-formed digit with osseous and ligamentous tissue [bones and associated connective tissues], but in other cases the digit is little more than a skin tag.) It's obviously easiest to remove the digit if no osseous or ligamentous tissue is present.  The condition of polydactyly can exist by itself or can be one symptom of many in several syndromes. 

After stumbling across cases both of volvulus and syndactyly, I assumed that my excitement for the immediate future was over. Then I had a case that was not medically all that exciting, but small-town girl that I am, I could not help being at least a little bit excited to review the CT scan of an extremely well-known person. I cannot disclose the person's identity because in a civilized society,  hospital personnel do not exploit the sick and injured who come to us for relief. We can boast that we treated someone who is really famous.  We just cannot identify the famous person. I don't even break it down by category (politician, athlete, actress, singer, and so forth) because it would be too easy to give it away if the person on the other end of the conversation happened to guess correctly.  Perhaps when I reach the age of sixty, I'll be less scrupulous about this sort of thing, but for now I play by the rules. Trust me (or don't). She is really famous.

If it never occurred to you to express gratitude for something as simple as having been born with the usual number of fingers and toes . . .

.  .  . It's not too late to begin doing so now.