A good day

As doctors we get surprisingly little feedback on our performance. My hospital interviews a sample of patients about their satisfaction, but we see results twice a year in confusing bar graph form.

So today I got two pieces of great feedback. First, a parent wrote us a letter saying how pleased they were with everything during their visit. It's always nice to hear this kind of thing and she also praised the nurses and administrative staff which means there happy and smiling as well.

Second, I saw back a very unusual patient. She had recurrent episodes of life-threatening throat swelling. You can imagine how unnerving it would be to walk around knowing you could start suffocating at any time.

There is an unusual genetic disease called hereditary angioedema which can present with similar symptoms, although it usually starts earlier in life. She saw an outside allergist/immunologist whoe tested her, but they were normal. I knew there were rare cases in woman only thought to be associated with estrogen, but with no defined cause or abnormality.

There is no known treatment for this rare type, but I found one case report of a patient treated with androgens, which are male sex hormones. Androgens are effective in the more typical . Testosterne is the natural angrogen, but other drugs have been designed to have less side effects in women (which are typically unpleasant things like increased body hair, deeper voice, and acne as well as some toxicity to the liver).

Well it has been 18 months and she has had zero problems. We've slowly lowered her dose from 3 pills a day to one pill every other day and she is doing great.

Of course I'm skeptical enough,to wonder if she'd have gotten better even without treatment. At some point (not yet) I'd consider taking her off, but don't think she'd agree.

Obviously she is thrilled to be free of this and I'm happy for her. It is also nice to (apparently) pick up a rare disease.