demooo

Why exactly were you the one to be telling the mother this (it sounds like you're still training)? I imagine you don't have the authority to pronounce someone's death, and medical professionals/legal professionals should be the one's doing so.

I can answer question one for you: endocarditis tends to involve the left side predominantly. There is an exception, and that is seen in IV drug abusers who are more likely to have right sided endocarditis (typically the tricuspid valve).

You were the text book case for IV drug abuse: young, male, right-sided endocarditis.

http://en.wikipedia.org/wiki/Vesicoureteral_reflux. Haven't combed through OP's posts, but I would venture primary that presented itself through repeated UTIs at a young age. Basically, it's a congenital defect where a natural valve in the ureter doesn't function correctly. (Ureter is the tube that connects the kidneys to the bladder, and as this tube enters the bladder, it is embedded within the bladder muscle. This creates a valve mechanism). Secondary causes include posterior urethral valves (unlikely this, as he presented at age 5), steatosis (narrowing) or urethra/meatus (pretty rare), and nerve issues (could be likely if he/she has cerebral palsy or some type of neurological defect (i.e. from transverse myelitis) where the bladder isn't functioning like it should).

There exists several modalities to treat this, first medical (treating the UTIs), then surgical (1-injections:can use a 'bulking agent' that is a type of polymer that helps narrow the lumen of the ureter as it enters the bladder; 2-surgical: reimplant the ureter and create a longer section of ureter within the muscle.)

(Just finished medical school, entering Urologic surgery. These cases are fun to fix, and mean we can prevent kids from ever needing dialysis or transplants).

Unsure about Canada (and the standard of care has changed a ton in the 30 years since OP was born), but prenatal cares involves ultrasounds measuring the kidneys. If they look swollen or enlarged in the uterus, they are sent to pediatric urologists for further work up.

Disclaimer: I haven't read about any of this in over 10 months, and I'm oversimplifying things. 4th year of medical school is like a giant vacation before the storm of residency.

It's not that there are pushbacks, it's that there are consequences to treatment. For instance, removal of every lipoma on the face at the expense of scarring.

Medicine is rarely black and white, and when we hear stories like this, it seems the answer is obvious. It feeds into a confirmation bias.

I'm a specialist surgeon, so I don't have to make decisions like this too often. Usually a diagnosis is already made by the time they see me. If a patient desires a biopsy on something that I would rather observe (and in some cases, a biopsy is not possible to it requires surgery to remove), we have a very long discussion regarding potential side effects of that biopsy or excision.

She had subependymal giant cell astrocytoma. This is a benign process that probably would have presented with either an increasing headache (from obstruction of the flow of ventricular fluid as it was blocking outflow) or a seizure. Luckily, this cancer is benign, and the main worry is the fact that you have a slow-growing mass in the cranial vault.

I cannot figure out whether she had been diagnosed with tuberous sclerosis before or after, but as this tumor is seen in tuberous sclerosis there would have been monitoring for its development.