I’ve seen a few; they’re very pretty.
This morning, I opened a Medscape Diagnostic Challenge in my email queue. These are clinical cases that present uncommon illnesses or uncommon manifestations of common conditions. Internal Medicine is basically a puzzle-solving specialty like detective work. This particular morning’s challenge had the odd title, “Weakness and Incontinence in a 24-Year-Old Hiker With Multiple Sex Partners Who Uses Whippets.” I read the title to Susan.
Susan: “Whippets? Does he have sex with them?”
Me: “One has to wonder. If they were pets or companions, the author would have used some verb other than “uses.”
Susan: “Well what does it say about the whippets?”
Me: “I haven’t read the case yet.”
So, I began to read the case. It told the story of a young fellow who was gainfully employed, drank 8-10 beers on weekends, was an avid hiker, and had multiple sex partners. The story didn’t clarify the species of his partners – only that he wore condoms faithfully.
His physical examination revealed neurological abnormalities in the lower extremities (weakness, poor balance, loss of sensation, and diminished reflexes) but was otherwise fairly unremarkable. His laboratory results were notable for a mild anemia with enlarged red-blood cells (a macrocytic anemia), normal vitamin levels including B12, Folic acid, vitamin E and a few others, and elevated levels of methylmalonic acid and homocysteine.
When I do these quizzes, I solve more than half of them. The remainder always have something interesting to teach me – most often about new drugs or illnesses that I have never encountered or even read about. Sometimes, I arrive at the correct answer and learn something as well. That’s the most fun, of course, because I get to learn something new without having to feel dumb, outdated, or otherwise inadequate as a retired Internist. That’s what happened today.
This fellow had a condition related to B12 deficiency despite his B12 level being normal. It’s a neurological condition that involves degeneration of the spinal cord. In my day, we knew it as Combined Systems Disease; today, it is called Subacute Combined Degeneration of the Spinal Cord. Mind you, even though I know this condition well, I have never seen a patient who had it. As I read about the condition, I learned that it can also occur in people who use Nitrous Oxide (NO) recreationally. Yep, NO is the dentist’s anesthetic aka “laughing gas.” I’ve had it once, and the effect, to me, was very much like a weed high. I didn’t enjoy it but not because I didn’t enjoy weed. Perhaps it was the fact that I was feeling high in a non-recreational setting. Who knows. I have had neither NO nor weed since.
In any case, inhaled NO is called a “whippet.” Why? because NO is used legally as a propellent in containers of, among other things, Whipped Cream! Now, had I been more into the party scene of adult beverages and legal inhalants, I would have known that. But I am too old for such frivolities.
So, now I feel competent to diagnose an uncommon complication of B12 deficiency, and I have learned something new about whippets. And I am relieved that this fellow was only abusing his body and not his dogs.