IgA level for IVIG

[bustbones26]

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Okay, lets see if anybody here has been in this boat. I have a patient with MG. I drew an IgA level on him prophylactically and it was 78, which is low, but the reference lab states that 81 is normal. So borderline low. The rate of anaphylaxis for IVIG is very low so does this really matter?

 

[lanzarlaluna]

Gammunex has tiny amounts of IgA, so unless the patient's level is zero, I would give it. That's the thought amongst my neuromuscular and MS attendings.

 

[DD214]

That is 3 points below normal. Have you staffed the case with your attending? You definitely don't want to go cowboying around with that and end up becoming the main point of discussion at the next education meeting.

 

[bustbones26]

That is 3 points below normal. Have you staffed the case with your attending? You definitely don't want to go cowboying around with that and end up becoming the main point of discussion at the next education meeting.

Ha Ha, fortunately I don't have to deal with that crap anymore! But what I do have to deal with now is the vision of me in a court room having to justify the action. I know that seems ridiculous, but I think we all know that good intentions can end up in 7 figure lawsuits.

On a side note, with a name like DD214, I know where you are coming from 😉
I had been there! Typically military residency staff have too much time to think about minutia. I once saw a case of a classic wallenberg stroke as a resident. The patient just so happened to have the onset of symptoms during orgasm while he was masturbating. The patient was a little strange and went into great details describing this event, but whatever? I became the subject of an education meeting because I failed to ask the guy if he used viagra before his masturbation sesson.

 

[DD214]

What? Did you ask him incessantly about abuse at home? How about motion sickness as a child? How was his clock drawing test? Dude, I'm surprised you graduated from residency given your serious lack of attention to detail.

 

[bustbones26]

What? Did you ask him incessantly about abuse at home? How about motion sickness as a child? How was his clock drawing test? Dude, I'm surprised you graduated from residency given your serious lack of attention to detail.

Yep! That's kind of how things went during residency. But hey, at the end of the day they did not complain to keep me around in the military on active duty for a bit before I ran away screaming.

 

[neglect]

Yep! That's kind of how things went during residency. But hey, at the end of the day they did not complain to keep me around in the military on active duty for a bit before I ran away screaming.

That's the worst sort of BS in training. Getting every historical detail to appease the whim of a Monday morning quarterback is no way to practice. If they can describe why it is relevant, then perhaps a resident could learn something: that in such and such case you should focus on this aspect of the history. It says much more about the attending in such cases than the resident.

Anyway, I never check the IGA levels. More likely to show up with some red herring like this case.

 

[bustbones26]

That's the worst sort of BS in training. Getting every historical detail to appease the whim of a Monday morning quarterback is no way to practice. If they can describe why it is relevant, then perhaps a resident could learn something: that in such and such case you should focus on this aspect of the history. It says much more about the attending in such cases than the resident.

Anyway, I never check the IGA levels. More likely to show up with some red herring like this case.

I asked my original question as I knew that there are a few attendings floating around that have dealt with this before, so I figured no harm in asking?

In true forum fashion, I got side tracked into another topic. But while we are on the topic, I do hear what you are saying and certainly agree. However, don't most GME programs (military or civilian) have at least a handful of attendings that are malignant? That is, belaboring inane aspects of history (e.g. are you sure that guy with paralysis after snorting cocaine just didn't get bit my his pet puffer fish? Did you even ask if he has pets? God you are stupid!) Or focusing in on esoteric pimp questions (e.g. which spinal subnucleus directly controls the autonomic innervation of one's anal sweat glands). etc. etc. etc.

I don't know? Maybe I was just indoctrinated into a malignant program or somewhere along the way developed "Stockholm Syndrome" but overall I just felt as if dealing with at least a couple of malignant attendings was a residency rite of passage?

As for DD214's prior comment about education meetings, well, my program had a monthly roundtable style meeting where all of the attendings would get together and talk about each and every resident. Whenever I was a PGY-4 and serving as chief resident (by force, not by honor) I had the privilege of sitting in on these meetings. I would rather had been doing something more useful like giving my goldfish a bath, but I typically had to go to my mental happy place during these meetings.

Anyways, enough said for that. I am happy to no longer be dealing with Monday morning quarterbacks.

 

[95439]

However, don't most GME programs (military or civilian) have at least a handful of attendings that are malignant? That is, belaboring inane aspects of history (e.g. are you sure that guy with paralysis after snorting cocaine just didn't get bit my his pet puffer fish? Did you even ask if he has pets? God you are stupid!) Or focusing in on esoteric pimp questions (e.g. which spinal subnucleus directly controls the autonomic innervation of one's anal sweat glands). etc. etc. etc.

I don't know? Maybe I was just indoctrinated into a malignant program or somewhere along the way developed "Stockholm Syndrome" but overall I just felt as if dealing with at least a couple of malignant attendings was a residency rite of passage?

As for DD214's prior comment about education meetings, well, my program had a monthly roundtable style meeting where all of the attendings would get together and talk about each and every resident. Whenever I was a PGY-4 and serving as chief resident (by force, not by honor) I had the privilege of sitting in on these meetings. I would rather had been doing something more useful like giving my goldfish a bath, but I typically had to go to my mental happy place during these meetings.

Anyways, enough said for that. I am happy to no longer be dealing with Monday morning quarterbacks.

I relate to the above all too well...

 

[Vader]

I asked my original question as I knew that there are a few attendings floating around that have dealt with this before, so I figured no harm in asking?

In true forum fashion, I got side tracked into another topic. But while we are on the topic, I do hear what you are saying and certainly agree. However, don't most GME programs (military or civilian) have at least a handful of attendings that are malignant? That is, belaboring inane aspects of history (e.g. are you sure that guy with paralysis after snorting cocaine just didn't get bit my his pet puffer fish? Did you even ask if he has pets? God you are stupid!) Or focusing in on esoteric pimp questions (e.g. which spinal subnucleus directly controls the autonomic innervation of one's anal sweat glands). etc. etc. etc.

I don't know? Maybe I was just indoctrinated into a malignant program or somewhere along the way developed "Stockholm Syndrome" but overall I just felt as if dealing with at least a couple of malignant attendings was a residency rite of passage?

As for DD214's prior comment about education meetings, well, my program had a monthly roundtable style meeting where all of the attendings would get together and talk about each and every resident. Whenever I was a PGY-4 and serving as chief resident (by force, not by honor) I had the privilege of sitting in on these meetings. I would rather had been doing something more useful like giving my goldfish a bath, but I typically had to go to my mental happy place during these meetings.

Anyways, enough said for that. I am happy to no longer be dealing with Monday morning quarterbacks.

True dat! 👍