We spent today in the outpatient clinics again, but with different preceptors. We joined Dr. Wu (吳秋文醫師) in the morning and Dr. Wong (王怡人醫師) in the afternoon. Like Dr. Ho from TCM before, as the director of the pediatric department, Dr. Wu has a heavy patient load and worked past lunch to see all of his patients. Unlike yesterday, where most of the patients were here for the doctors' specific specialties, many patients are just here for general complains unrelated to Dr. Wu's specialty, which is pediatric immunology. Especially after the clouding agent problem started, many of the patient were here for testings to determine possible exposure to the clouding agents. The clouding agents were found in many different type of food/health supplement in Taiwan. Among them, the most worrisome for parents are the contamination of certain brands of probiotics and even a syrup of Augmentin, since many were consumed regularly by their children in an attempt to improve their health. The crisis this time created such scare largely because clouding agents over stimulates femalization of developing children and thus, in a culture where continuing the family bloodline is of the utmost importance, created unprecedented panic among the parents. I have been following the news for the past week on the new development and was quite curious to see the actual effect of the clouding agents on the pediatric patients. To my surprise, contrary to the news coverage, out of the 20 patients examined for the sexual organ abnormalities throughout the last two days, only one patient seemed to have underdeveloped genitals. However, that patient also suffer from hypothyroidism, so the actual effect of the clouding agents cannot really be ascertained at this point without further testings. We also notice several interesting points about clouding agent testing. For example, we were surprised to found out that the test for sex hormones in pediatric children is often inconclusive, since most of the children will be prepuberty, their testosterone levels will be inevitably lower than the normal amount for adults and thus not entirely reliable when it is lower than expected value and require obtaining separate list of standard values for each age group to accurately determine the results.
Other than the clouding agent testings, we also saw many interesting cases. We begun the day with a case of hip dislocation where the child was too old that tissue has grown between the gap that surgery is the only option now. Remembering our training in our pediatric physical exam lab, we were reminded again the importance of early diagnosis of congenital abnormalities like hip dislocation. In addition, Dr. Wu also pointed out that when asked about abdominal pain, many children tend to just point to the umbilical region for diffuse pain and it should not be taken literally as a sign of localized pain around the umbilical area. Similarly, when the child specifically point to a place far away from the umbilical area, it is usually a good indicator for localized abdominal pain.
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