Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Tuesday, April 01, 2003
    Don't Forget Your Tetanus Shot!

    Here's a little moral tale for you. Today I saw a new patient who was complaining of hair loss. When a patient (especially female) presents with thinning hair, something that should always be checked is the thyroid. Her thyroid exam was normal, but as I was evaluating it I noticed a scar at the base of her throat which could only have come from a tracheostomy.

    "What happened here?" I queried, touching the scar. "Were you ever put on a breathing machine?"

    She'd grinned when I noticed the scar. "Yes," she said with the air of someone who knows they have something to say that will get your full attention. "I had tetanus."

    "Did you?" I echoed, stunned. I've never seen a case of tetanus or anyone who'd had it in the past.

    "I was eight. It was when we were living in Jamaica."

    "Didn't they vaccinate?"

    "Well, they did, but when they came to my school I had a fever, so they said they'd give me the shot next year. But I got hurt over the summer, before I could get the shot, and that's when I got it. I was out of school for three years."

    "I believe you. That's a really serious illness."

    Quick Internet fact: Eleven percent of tetanus cases are fatal. I try to vaccinate all my patients who haven't had a booster in the last ten years. If you don't know when your last tetanus booster was, go get one.



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