peds is peds here and then some...
pneumonia: lots of kids with respiratory issues, one, an eight year old, came in yesterday with pneumonia around noon and was dead by just after midnight – terribly sad. another newly admitted this morning with severe asthma. lots of coughing and congestion. on a good note, moses, the boy with the terrible chest xray who’s been here almost two weeks is finally improving with the combination of TB meds and antibiotics we’re giving him. his mother was complaining today that he cheeks looked swollen, the doc assured her it is simply that they’re filling in because he’s finally healthy again. it was pretty cute.
malnutrition: this one can be generalized to the maasai population though we see it in children from all over. but so many sick maasai babies, and their traditional medicine usually complicates the situation. the maasai baby I mentioned before, who was given lamande (a toxic herb used to help his diarrhea) passed away this weekend. very VERY frustrating because on friday when we rounded on him I had quite a conversation with dr. lace about what else we can do. he asked me what I wanted to do… of course I had no idea, we don’t have text books here to look things up, or internet, or experts of any sort, ugh! it just seemed like we were doing so little, or what we were doing was making the baby worse, and I wanted to bring in someone else to help him or take him to the OR or something! don’t just let him die alone without giving it everything we’ve got. unfortunately what we’ve got here is very limited and when we came in this morning I looked to the bed where he usually lays and there was an unfamiliar face, I was right to assume the worst, at least he’s not suffering anymore. so young… and disturbingly preventable. I just hope that mother goes back and shares the story with the others so that maybe lamande won’t be given to the next baby with diarrhea. our big malnutrition case today was frankie, a 7 year old boy weighing 14 kilos. along with malnutrition comes periorbital swelling (from protein deficiency) and usually severe anemia, both of which frankie had. we deworm these kids as a precaution, transfuse if their Hb is less than 5, and start them on the F-75 nutrition formula. frankie was getting the full treatment and then some. he was sent to the malnutrition ward. it is devastating to see the cases there, I don’t like when we round on those kids because it is so difficult to see... it makes you feel guilty for all you have, the nice meals you eat, parents who could care for you so well when you were growing up. there’s a lot to make most anyone feel a bit of guilt…
gastroenteritis: lots of vomiting and diarrhea. in these cases dehydration is a big issue. watched a little boy just vomit over the side of the bed this morning. mom cleaned it up with a khanga… those things have more uses here….
the mystery case: boy, age 9, comes in and dr. lace leaves rounds to see him, calls us over and at first all I see is a fidgety little kid. but a few seconds of watching him and I realize he’s actually having uncontrolled muscle movement sporadically across his entire body. how bizarre. apparently it started two months ago and has been getting progressively worse to the point where he can no longer talk and is having trouble feeding. I couldn’t take my eyes off of it. acute onset choriathatosis (im sure that is not how you spell it but google isn’t working here so I can’t look it up. actually, if anyone is able to research it at all it would be greatly helpful. we’re trying to figure out the cause but there seem to be a lot of things here that can cause neurological symptoms like this) and he’s degenerating. he could walk. we took a video. discussed some ddx. wild. I have never seen anything like it. he looked like a 9 year old parkinson’s or huntington’s patient. the doc is going to research it tonight, get a second opinion from another pediatrician. I wish we had a neurologist who could come take a look at him. we did a mini neuro exam and he did alright. it’d be nice to get a CT to see what’s going on in his brain but the chance of that happening is slim. anyway, ill keep you posted on this interesting case.
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