Chickenpox, and cannabis hyperemesis syndrome

The patient came down with some spots

All over, in multiple crops.

So I called up the State

To tell them this date

To watch out for chickenpox.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. Assignments in Nome, Alaska, rural Iowa, and suburban Pennsylvania stretched into fall 2015. Since last winter I’ve worked in Alaska and western Nebraska, and taken time to deal with my wife’s (benign) brain tumor. After a moose hunt in Canada, and a couple of assignments in western Iowa, I’m back in Alaska. Any identifiable patient information has been included with permission.

I saw a patient with chickenpox today (and received permission to mention it and more in my post). Though outbreaks came a couple of times a year last century, the varicella vaccine has made the diagnosis a rarity.

The characteristic lesion starts out as a red bump. The bump grows a blister, characterized by the poetic catch-phrase “dew drop on a rose petal.”  Then follows a pimple (doctors say pustule), which collapses in on itself (medicalese=umbilication because it looks like a belly button), and scabs over.  To make the diagnosis, the patient has to have multiple crops of lesions, coming successively over the course of several days, visible in various stages of healing.

A very small proportion of those vaccinated, less than 1%, will develop the disease from the shot, sometimes a year afterwards. Among the vaccinated, 5% will get chickenpox if exposed to the wild virus, but the infection may be so light as to be unrecognizable.

Still my strong suspicion and the public health laws made me call the Alaska State Epidemiologist, and I found out that, in fact, the illness is currently circulating. In the end, I based my decision not to medicate on the number of days elapsed since onset and the desire for the treatment not to be worse than the disease.

I saw two cases of cannabis hyperemesis syndrome today; if a person smoke a large amount of weed for a long enough time, they start to vomit and very little can help them besides stopping the marijuana. I went to my favorite physician’s social media site, Sermo, to research the problem and found, to my surprise, the tendency of those so afflicted to crave hot showers and baths.

I saw two men with astonishingly similar injuries from astonishingly similar circumstances.

One patient came to me after a specialist work-up and MRI and many, many primary docs over the years failing to help. I listened without interrupting. I came to a much different conclusion, and advised that the dentist had a better chance than anyone of fixing the problem.  At which point the patient told me the diagnosis.  Not in medical terms, but in plain English.