cool cases

We had a really interesting week of patients. It all started simply enough. We had a case of a vesicular rash on a Marine’s neck that was causing a burning sensation. It was in a dermatome distribution. He was diagnosed with herpes zoster (shingles), started on acyclovir and is doing much better. (pic below)

Next up was a young Marine who sustained a foot injury as a child. Being that his family was poor and lived far from health care his father latched a 2x4 to his foot for a couple of weeks in an attempt to set it. You can see below the repercussions.

Soon after we got a call about a Marine having a seizure on the flight line. He was noted to have a fever and thus thought to have possible meningitis. He had to be medivac to the hospital where he had a normal head CT and normal lumbar puncture (thus not meningitis). He is now getting evaluation in Germany.

Right after that fellow, we had a fellow get a superior dislocation of his shoulder. I can relate to his pain and suffering as I too have had a shoulder dislocation. At least I can give him good info on rehab.

The past few days have been even better. We had someone show up with chest pain and a history of congenital dilated cardiomyopathy. He was quickly treated and evacuated to the hospital for possible early myocardial infarction. He is doing well, but will soon be in Germany as well for a catheterization.

Then there was the guy who has been impotent for the past 26 months. I know it is common, but not at my age (I hope not) which he happens to be. Apparently he has had this problem since completing a 100 mile long bike race. He had 6 weeks of bilateral lower extremity numbness for 6 weeks after the bike ride as well. He has some subtle neurological changes on exam. So he probably will end up in Germany as well.

But my favorite is the guy with right sided chest pain. Usually, this is not as concerning, unless your heart is on the right side. That’s right, he has situs inversus which means your heart and stomach are on the right side of your body instead of on your left. There is a condition called Kartagener’s that is associated with some of these individuals where you get recurrent sinus and pulmonary infections (due to ciliary defect) and also have high chance of infertility (same defect). Anyhow, he does not have Kartagener’s and thankfully had normal EKG. He instead had a history of recent chest trauma and on CxR I found a cracked rib. If the CxR was able to load, then you can see for yourself below.

I am going to rest my noggin now.

I included a picure of the clouds after a morning rain here. It just goes to show that you can even find beauty in a dustbowl.







Nice party trick.












I itch just looking at it.

Aaaahhhh.