Detective Eminent Doctor Engineer Jansen-Watson (part 2)

Well, today for 3rd and last dosis prenisolone.  While in the car on the way the engineer was pondering his latest blog entry, and wondered again about why they administered 40 mg prednisolone as an injection in the bum, and not 1 gram intravenously.

Also he remembered the phone conversation the doctor had with the neurologist, after the CT scan.

"No headaches?"
"No" 

I could sense their suprise. (Many people witn affected optical nerves experience pain when moving their eyes.)

The engineer researches optical nerve inflammation and optical discs, and finds Lyme

Reading up on optical nerve inflammation and optical discs:

The oftalmologist suspected: inflamed optical nerve, or Optic Neuritis, and prescribed the 3 days of 1 g prednisolone per day, intravenously. That is a wellknown treatment, to preserve the optical nerve prior to treating the cause.

After the CT scan the "efermedad actual" is: Papiledema, swelling of the optical disc (very typical for an engineer to have, an optic disc), which has a different course of treatment. 

Let's ask dr. Google AI, I guess that is dr. Google Ad Interim? Must be him (or her):

This suggests that 1 gram for papiledema is NOT the required treatment.

• With an inflamed optical nerve you usually have a headache when moving your eyes, I did not;
• Inflamed optical disc: “unilateral presentation is extremely rare”. I have that.
• Inflamed optical nerves are often caused by things like MS. That is: people with MS often have an inflamed optical nerve. I’m too old to start having MS, I think. The target group is women 20-40 years old. The engineer definitely is not that. (See impressive hairy chest photo in previous blog.)
•  “Unilateral papilledema can suggest a disease in the eye itself”. 

Well, Lyme quite possibly.

Elementary dr. Watson

What (possibly) happened: 

• The "enfermedad actual" now is not neuritis optica but papiledema. 
• I think they established that after the CT scan, in that phone conversation with the neurologist, because the optican nerve may not be affected.
• They decided to give 40 mg prednisolone in the bum.
• The paper still had 1 gram prednisolone per day, as prescribed by the ophthalmologist
• But, the ophthalmologist was never informed of the new "enfermedad actual'.
• The day after the CT scan, first day 1 gram treatment was a holiday, so oftalmologia was closed, and they did not communicate about engineer Jansen
• It now is the weekend, so no ophthalmologist around to discuss.
• And so they never changed or deleted the 1 gram per day.
• They blindly follow what is on the paper.
• Every step has another person, and they make mistakes because they don't think.
• Luckily Engineer Jansen still has a brain.

So there was dr. engineer Jansen in the chair awaiting the needle, but asked if he could discuss.

Doctor came, another one. (They have a lot of doctors here.) 

"My enfermedad actual is papiledema, not neuritis optica"

"But the ophthalmologist says"

"But after the CT scan it says papiledema, and 1 gram is not for papiledema"

"But the ophthalmologist says"

“I think they did not tell the ophthalmologist”

"And why else did they change to 40 mg after the CT scan?"

"I don't know. Did you not talk to the ophthalmologist after?"

"No, but I have another appointment there tomorrow. We were supposed to see him Friday, but they were closed for Maria Ascension Day"

"Dr. Google Ad Interim says: 1 gram is not for papiledema"

"But the ophthalmologist.."

"1 gram is a very heavy treatment, can we skip a day and see tomorrow?"

"Yes that is possible"

"Is skipping a day problematic?"

"3 days consecutive is standard"

"But will it harm to skip a day?" 

"I dont think so"

"I'll skip treatment today and talk to ophthalmologist tomorrow"

"OK" 

And what does she write on the Informe de Alta (release form):

"Patiente acude para continuar con tratamiento de prednisolona 1 gram (era dosis)  refere que no quiere poneria hasta hablar con oftalmologia porque no considera tener edema papilloma"

or:

"Patient comes to continue treatment with 1 gram of prednisolone (was the dose) and says he does not want to put it until he speaks with an ophthalmologist because he does not consider having papilloma edema."

She has swapped the enfermedades.

I don't have neuritis optica, I do have edema, and I don't need 1 gram for that.

I'm apalled. I understand now how medical mistakes come to be.

Tomorrow the ophthalmologist.

If they would not have been closed Friday we would have spoken with the ophthalmologist, and he probably would have cancelled the 1 gram treatment.  Now that has cost me two 1 gram sessions!