London: The Falling Cyclist
This is a case that occurred while working in the hospital mentioned in 'The Visiting Patient' and 'The Working Hangover'. One lunch time in the cafeteria we were discussing in gory detail the work we had in progress. Not that we did this every lunch time, but that day we had a new lab assistant and while observing the colour of his face wanted to see how long it would take for him to make excuses and leave. He was doing well until Dr. R. came and sat with us and changed the subject.
He told us about a consultation that morning with an usual problem. The patient who was over two meters in height and obese, said that when he rode his bicycle he would lose his balance and fall off. That in itself wasn’t that unusual, but what was he always fell to the left never to the right. We speculated that the disequilibrium was probably caused either by problems with the inner ear, a neurological condition or through side effects from medications. Dr. R said that this had been looked at and found to be negative. Even the bike was looked at for defects but apart from the numerous scratches from the falling episodes it was perfectly in order.
We thought nothing more of it until a week later when two of the surgical staff turned up in histology, one having difficulty with a large glass container with something indefinable swimming in it and the other a 10 litre canister 3/4 quarters full. We checked the paperwork, it was a kidney and about eight litres of ascites from Dr. R's falling patient. The man had without knowing it developed giant renal cysts in his left kidney. The right kidney was fully functional and no abnormal biochemistry was found. As he was a large man the enormous size of the kidney wasn't visible and the extra weight on the left side was only problematic when he rode his bike!
He told us about a consultation that morning with an usual problem. The patient who was over two meters in height and obese, said that when he rode his bicycle he would lose his balance and fall off. That in itself wasn’t that unusual, but what was he always fell to the left never to the right. We speculated that the disequilibrium was probably caused either by problems with the inner ear, a neurological condition or through side effects from medications. Dr. R said that this had been looked at and found to be negative. Even the bike was looked at for defects but apart from the numerous scratches from the falling episodes it was perfectly in order.We thought nothing more of it until a week later when two of the surgical staff turned up in histology, one having difficulty with a large glass container with something indefinable swimming in it and the other a 10 litre canister 3/4 quarters full. We checked the paperwork, it was a kidney and about eight litres of ascites from Dr. R's falling patient. The man had without knowing it developed giant renal cysts in his left kidney. The right kidney was fully functional and no abnormal biochemistry was found. As he was a large man the enormous size of the kidney wasn't visible and the extra weight on the left side was only problematic when he rode his bike!
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