The week has been very productive thus far, and today was no exception. I was shadowed by Diana Dickenson, MD, who runs the "Independence Ave. Surgery" and who has been a driving force in HIV/AIDS diagnosis, treatment, and prevention in this community. Every October, she helps organize an AIDS conference that is important in the ongoing fight against this infection which is robbing the country of most of an entire generation. She wanted to know what exactly I do here. We reviewed the recent TB pericarditis patient I tapped, and, after nearly 4L of drainage, the catheter is ready to pull out. I'll do a follow-up echo soon. She pointed out the characteristic rashes of moluscum contageosum and herpes simplex infections. The dermatology fellow was informed and will consult.
We rounded on the postoperative valve-replacement patients being treated for infective endocarditis (4 wks of IV antibiotics for each). Both are doing quite well, but one, with a Hickman central line, has had to get her drugs via a peripheral IV because of the nurses' reluctance to infuse medicines through this port.
In the afternoon, the chief of medicine asked me to assess her friend, a local lawyer with probable thrombophebitis of the right lower leg. This problem led his doctor to discontinue statins and substitute "red rice yeast" to lower cholesterol for fear that there was a relationship between the statin and the swollen leg. I ordered an ultrasound and will anticoagulate the patient if DVT is proven. He also will restart the statin.
The former PMH superintendant asked me to see 2 patients, one with a pulmonary, not cardiac problem, and another who had an abnormal ECG and hypertension; the meds for BP had been stopped by his pharmacist because he had become normotensive. I got him back on his antihypertensives.
I also was asked by the surgeons to do an echo on an elderly man with an abnormal chest XRay (a "mediastinal mass"), which turned out to be a >7 cm aortic arch aneurysm. The pathology here is astounding.
Tomorrow we go to Cape Town and the wine district for the Easter holiday. More on this to come.
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This will be a real-time journal of our travel to Botswana, escaping the Maine winter to spend three months teaching cardiology and supervising medical residents and students at the Princess Marina Hospital, the teaching facility of the medical school created as part of the University of Pennsylvania and the Botswana government partnership ("BUP").
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