An uplifting one

Today I spent the morning with an oncologist in clinic, then went to the cardiology floor to see a patient with endomyocardial fibrosis (probably non-existent in the US and I would be surprised if it was ever mentioned in med school), then went to the solid tumor ward to do a history and physical on a patient with esophageal cancer.

In the morning, we saw patients with prostate cancer, ovarian cancer, colorectal cancer and a couple of leukemia cases.  This whole week I was particularly curious about how chronic myelogenous leukemia (CML) is managed here because it's an example of a disease for which very effective, and typically expensive, targeted therapy exists in the form of tyrosine kinase inhibitors like imatinib and dasatinib.  This morning we saw a patient with CML who had been diagnosed in 2005.  He had been receiving imatinib since his diagnosis and was doing great.  It's uplifting to see quite sophisticated medications making a major impact on people's lives in a place that's physically and economically so far away from where those advances were made.  I think the company that made imatinib (Novartis) was initially quite reluctant to invest in the drug because they didn't think it would make any money.  Fortunately the company succumbed to pressure to keep developing the drug.

During one discussion this morning, someone mentioned the acronym 'EMF'.  I wasn't familiar with the term so I asked about it and the attending told the students that they had to take me to the cardiology ward to see a case because it's so common here. 

After clinic, one of the students took me to the to see a 41 year old man with endomyocardial fibrosis (EMF).  He had massive abdominal distension from ascites (fluid in the abdomen), but no leg swelling, which is "classically" how EMF presents.  Apparently it's a common cause of heart failure here and typically affects relatively young patients (peaks of prevalence at 10 and 30 years of age according to my quick internet search).  Patients with EMF are "classically" people who immigrate to the Luwero district of Uganda, which is just north of Kampala (it's the district where the current Ebola outbreak started).  This district grows and consumes a lot of cassava, and one idea is that toxins from cassava cause EMF in people who have some susceptibility.  The only "cure" is a heart transplant, but that's not really done here.  It's been 3 years since our patient was diagnosed and he's being managed with periodic paracenteses (drainage of the abdominal fluid) and diuretics to try to slow down the rate at which the fluid builds up.

I'm off to Thanksgiving dinner with two Americans, one Swede, two Germans, and one Swiss.  We're going to an Indian restaurant and then watching the new James Bond movie. 

I hope everyone has a great Thanksgiving!