This morning I drove a short 5 min to the VA for journal club. I was supposed to meet Dr. O downstairs but fortunately ran into Puneet, one of the 1st year fellows, and followed him to the conference room. Dr. O came by shortly afterwards, relieved to see me since she'd forgotten her cell phone and thought I'd gotten lost. The journal we covered was published last week and spoke of using gene therapy to treat children born with an adenine deaminase (ADA) deficiency leading to fatal SCID. It was pretty interesting, since I understood some of the molecular bio behind the project (putting a working ADA gene in a viral vector and then injecting those into the patients). Afterwards, I stayed at the VA with Puneet to see patients. Several patients came in for skin tests, which can be done by the scratch test or intradermally (more specific). One woman didn't react very much to the scratch test, but when the allergens were actually injected UNDER her skin, huge wheals popped out. That's not a test I'd want to have, since I broke out in huge hives twice in my life and never want that experience again. Some of the patients came to the allergy clinic treating it like a well-check, saying that they needed refills on certain prescriptions and leaving Puneet totally confused since this was not what he signed up for. There were only two doctors present at clinic today (Puneet and the attending), so they easily ran one hour behind schedule. Puneet actually had to leave by noon b/c he was having lunch with fellowship interviewees, so I stayed behind to interview a patient while one of the older attendings (who stopped by briefly) offered to see my patient after I finished. This lady had new-onset tingling and facial swelling starting in September that was easily treated and controlled by Claritin, so our goal was to see whether this was urticaria or angioedema. So these were my takehome points:
1) Angioedema does not cause itching.
1) Angioedema does not cause itching.
3) When treating chronic urticaria, it's important to prescribe both an H1 and H2 antagonist, not just one.
The only "downside" to this rotation so far is the poor structure; since Dr. O hadn't been expecting a medical student, we're just making up the schedule as we go. Tomorrow, for example, I'm supposed to return to Ben Taub for pediatric allergy clinic, but right now I don't know the name of the attending or who the fellow is (though I'm hoping it'll be Roshni, the fellow I met yesterday, since I know her name). I just know to be there at 9:00 a.m. After clinic, there's noon conference, and after that, I had no idea what I'll be doing.
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