i very rarely write about my life as a primary health care provider here on the old blog.
there are too many reasons to list (in brief, there is HIPPA, liability, the fact that i still cant believe i'm actually doing this, and mostly that there is an entire subculture in the blogosphere devoted to writing about nursing and medicine written by others who are amazingly articulate about their roles, their trials and their experiences in the world of health care).
but the main reason really is that this is a journal for my friends and family across the country and none of them want to hear me go on about how i've overcome my fear (and even gotten pretty darn good) when lacerations come through the door, or about how cool it was that i had to drain an abscess, or hear me bitch about people who come in for cold symptoms demanding antibiotics because "i just need to nip it in the bud because its just not getting better after 4 days and ive got shit to do".
gets old, i'll admit.
but, i was feeling pretty good about diagnosing a little virus thats been going around this week. this groovy little rash can make a kiddo look like they really dont feel good, although the majority are still bouncing around the exam room.
moms hate rashes. daycares hate rashes more. i can say with great conviction when its says "rash" on the nurses note, i also feel a sense of dread.
failure is more like it. about 75% of the time, i am unable to pinpoint what might have caused a rash. (thats really being generous. at the risk of sounding completely inept, its realy about 90% of the time).
we joke and say its idiopathic. i explain, smiling thin lipped, that an idiopathic rash means i'm an idiot and the rash is pathological.
makes me look real smart, doesnt it?
truth is, rashes happen, and although there are some that are big and bad and worrysome out there (i feel pretty confident that i know how to pick these out), the great majority are a nuisance that simply go away with time and antihistamines.
today i had two patients with the same symptoms several hours apart. they were aged 4 and 9. both had sudden onset of very reddened cheeks, no fever and a "weird all over rash". neither complained of itching, had been noticeably ill prior or had fever.
fifths disease, or erythema infectiosa, is caused by the human parvo virus. its called fifths disease after four more common viral rash illnesses seen in kids, which are measles, scarlet fever, rubella and scarlatina. the sixths disease is roseola.
its hallmark is a lacy pink, macular, blanching rash on the extremities and trunk and generally bright red patch over the cheeks with clearing over the mouth. the rash typically itches only about 50% of the time, which makes it markedly different from your run-of-the-mill urticaria.
diagnosing this and reassuring these moms made me look like a hero.
and who doesnt like to look like a hero?