Journal of Clinical & Experimental OncologyISSN: 2324-9110

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Commentary, J Clin Exp Oncol Vol: 2 Issue: 4

REACTIONS - A Memorable Patient

Vittal S R Rao1*, S Sugunendran2, and Kevin Wedgwood3
1Consultant Surgeon, University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom
2Consultant Endocrinologist in Derby NHS Hospitals Foundation trust, United Kingdom
3Consultant Surgeon in Castle Hill Hospital, Cottingham, United Kingdom
Corresponding author : Vittal S R Rao
Consultant Surgeon, University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom
Tel: 07719495560
Email:
[email protected]
Received: October 16, 2013 Accepted: December 14, 2013 Published: December 18, 2013
Citation: Vittal S R Rao (2013) “REACTIONS” - A Memorable Patient. J Clin Exp Oncol 1:2. doi:10.4172/2324-9110.1000117

Abstract

“REACTIONS” - A Memorable Patient

All of us at some point in our careers get enlightened by our patients regarding even the subtle aspects of the practice of clinical medicine. In one of our routine hectic outpatients, we had this routine referral regarding a lady in her mid fifties with carcinoid syndrome. As the lady was being ushered into the examination bays, I frantically tried to recap the classical symptoms associated with the condition so that I can touch base with the patient before deciding about further management. Mustering what I could from my memory, I went to greet my patient and initiate the consultation. Before I could proceed to elicit the symptoms which I could recollect, the pleasant lady thrust into my hands a neatly typed paper aptly titled ‘Re-actions’ to highlight her symptoms.

Keywords: Carcinoid syndrome

All of us at some point in our careers get enlightened by our patients regarding even the subtle aspects of the practice of clinical medicine. In one of our routine hectic outpatients, we had this routine referral regarding a lady in her mid fifties with carcinoid syndrome. As the lady was being ushered into the examination bays, I frantically tried to recap the classical symptoms associated with the condition so that I can touch base with the patient before deciding about further management. Mustering what I could from my memory, I went to greet my patient and initiate the consultation. Before I could proceed to elicit the symptoms which I could recollect, the pleasant lady thrust into my hands a neatly typed paper aptly titled ‘Re-actions’ to highlight her symptoms. I reproduce this ad verbatim as I felt this to match the classical symptoms of carcinoid syndrome to the proverbial T:
“ First of all a feeling of heat builds up then I can feel it tightening muscles as the heat builds up until flushing of the face occurs spreading to my neck, my arms and hands, body and legs producing big red blotches ranging from bright red to almost purple in more severe attacks.
Then my chest tightens and my heart starts to race, going faster and faster with palpitations and heavy and difficult breathing.
My head starts throbbing and banging. This can continue for anything from a few minutes to up to twenty minutes or so and there is tingling down my arm muscles and in my fingers.
As it starts to pass my heart starts and breathing slows down and the flushing starts to recede and the muscles in my arms start to ache and feel ‘prickly’ inside.
As my body starts to ‘cool down’ I develop shivers and become light-headed with some loss of concentration. I feel shaky and totally exhausted and pale.
It can take up to an hour (or more sometimes) for this to stage to pass completely and are usually accompanied by urgent watery diarrhoea, especially after a meal.
My whole body feels like it has been under attack.”
I was spell bound after reading this as I have never come across a more vivid and educational description of carcinoid syndrome even in the most reputed medical textbook. I thanked my very articulate patient for making my job so easy and referred her to my oncology colleagues for further treatment. I have kept the piece of paper for its educational content and show it to the medical students who frequent our surgical outpatients as an example of how our patients can be our teachers in refreshing our jaded memory.

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