Posted by: notdeaddinosaur | November 15, 2014

Assume Nothing

Patient with multiple medical problems (diabetes, COPD, hypertension, hyperlipidemia, headaches, arthritis; you know, your basic Baby Boomer) comes in with a new symptom: food gets stuck going down. It’s been going on for a while now and getting worse. Liquids are becoming problematic as well.

I’m worried. Esophageal cancer is the main concern here, so off he goes to endoscopy.

Good news is that there’s no cancer. Bad news is that brushings show infection with candida. It’s a yeast infection of the esophagus. Treatment begins, but now we have another problem: Why did this happen? Esophageal candidiasis isn’t something that happens to people with normal immune systems. Sure, the diabetes leaves him a little immunocompromised, but not enough for this.

Yes, he’s on an inhaled steroid for his COPD, but he specifically tells me that he’s very careful to rinse out his mouth every single time he uses it. Every single time. Very carefully.

Let’s see; what else? HIV? Nope (I tested.)

I’m puzzled. I run through the possibilities again. Is he sure he rinses out his mouth after using his inhaled steroid?

Yes indeed.

And then what?

He swallows it.

Epic WTF.

The whole point of rinsing after using inhaled steroids is to get rid of whatever medication may still be in your mouth. By swallowing it, it’s going straight down his esophagus instead of down the drain. Instead of being safely flushed away (and contaminating the sewage system, but that’s another issue) those steroid remnants are priming his esophagus for little yeastie-beasties to take hold.

“Should I not be doing that?” he asks.

Um, no. You shouldn’t be doing that.



  1. Oh, wow….

  2. This reminds me of that House episode where he’s forced to be nice to clinic patients–one woman SWEARS she’s using her inhaler correctly, but she’s been through three and they’re not working. She then proceeds to spray her inhaler over her neck like perfume. LOL.

  3. I was specifically coached by my doctor to spit the water out! Sounds like he needs my pulmonologist. He’s a genius!

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