Journal Entry #7

Amita Raj

Abney

6^th Period

Journal Entry #7: Thursday October 7 and Tuesday October 12, 2010

                I spent both days with my mentor in her clinic. Since I was here last week, I knew what to expect with the kinds of cases she would receive. On Thursday, I saw a man who had just gotten a surgery for a fistula in his left arm. He was middle-aged and had very bad kidney failure. The fistula is used during dialysis. (Note: A fistula is formed when an artery is connected to a vein.) The doctor showed me that if I touch his arm, I will feel I slight buzzing because of this unnatural connection. It felt somewhat like a cell phone on ‘vibrate’. The rest of the time on Thursday, the doctor talked to me about some of the other interesting cases that she had at the clinic, describing in detail the kinds of medicines that were used in treatment.

                On Tuesday, I prided myself in being able to remember many of the medicines that I had previously learned about (although I cannot spell any of them). On this day, I was able to see one of the scariest cases of obesity that had led to Stage 3 (there are five stages, 5 is the worst and means they need dialysis) kidney disease. This woman had many other conditions like psoriasis, edema (caused by kidney failure, build up of fluid especially around ankles; is treated with diuretics), cirrhosis (caused by Hepatitis C rather than alcohol), and rheumatoid arthritis. In addition, she lost one of her kidneys some time ago and the only one left was barely functioning. However, the medications that she had been taking seem to have stabilized the kidney function.

                The second case I saw on Tuesday was extremely interesting. The patient was a 27-year-old man who had suddenly exhibited symptoms of kidney failure. He is not a smoker, a drinker, and never used illicit substances. He had slightly high blood pressure but was not obese. There was no family history of kidney disease either. The doctor was disturbed that a man so young would already have only 35% kidney function. She tested him for other diseases like HIV that would probably affect his kidneys. However, every test she ordered came back negative. This was when she decided she needed to do a biopsy on him. The results of the biopsy showed that the disease this man has is Focal segmental glomerulosclerosis (FSGS). This disease is normally found in children and adolescents, but can lead to kidney failure in adults. What scared me most was when the doctor said, “Kidney disease can never get better, it can only get worse. Our aim is to make the disease get worse slower than it would so you can put off dialysis for a long time.” The patient was nervous about the idea that he might have to start going for dialysis treatment within the next 5 to 10 years.