Never Seen It Before

Come to think of it, most of my blogs could have the above title--anyway, we admitted a patient from the jungle to the hospital the other day with a strange story.  Her name was Mrs. L.  She had developed shingles around her eye, and around the same time had developed increased confusion and difficulty walking.  Upon presentation, she knew her own name but didn't know where she was.  When asked if she knew the name of the lady with her (her sister), she named a fish.  Just having shingles around the eye can be an important problem for sure, and it can be vision-threatening.  Fortunately the eye situation seemed to be under control, but we couldn't figure out what was going on with her other symptoms.  Mrs. L had some resources and was able to get a CAT scan of her head, which revealed that her brain was small in size.  This finding is definitely not normal for a lady in her early 40's.  On further questioning, we learned that Mrs. L had actually been pretty confused for several months now, often losing her way in the jungle or forgetting what she set out to do--for example, going to get a machete and bringing back a banana.  We decided to withdraw a significant amount of spinal fluid from Mrs. L, and we found that she probably didn't have an infection around her brain (therefore there was probably no link between the shingles and the confusion).  However, just pulling out the spinal fluid seemed to make many things better for her within a few hours.  Now Mrs. L recognizes her sister, walks almost normally, and knows that she is in the hospital.  She appears to be suffering from a condition known as normal pressure hydrocephalus (NPH).  I've never seen a patient with this problem before.  In NPH, the increased fluid makes it difficult for the brain to function normally.  This is normally treated by surgically placing a tube that leads from the brain into the abdominal cavity (a ventriculoperitoneal shunt), and many times the symptoms are greatly improved with treatment.  Mrs. L has been sent to Quito for consideration for placement of the shunt.  Please be praying that it will go well for this young lady.

A Big Surprise

Because Kristina was so sick during her pregnancy with Jael, we thought it was unlikely that we'd try to have more children.  However, God has different plans in store for us...we are expecting our third child in December!  We are excited about the news and are praying for an easier pregnancy this time around.  Kristina has been feeling quite sick some days, but thankfully her parents are here right now and have been helping tons with Caleb and Jael.  We had plans to come home for Christmas this year, but these plans with have to be changed as our little one is due December 24.  We will have to obtain a visa and documents (the baby will have dual citizenship) before we can make our trip to the states.  Our news made the decision about Kristina teaching a lot easier; this work will have to wait another year or two.  Please pray for the baby, Kristina's health, and how God will use our family here in Ecuador as it grows.

A Priceless Smile

Yesterday was a really busy day.  Since Matt Kappen (my buddy from med school) and I are the only family docs here right now, there's a lot for us to do each day.  There was a lady in labor, two admissions to the hospital in the first couple hours of the day, hospitalized patients to see, stuff going on in the ER, I had a full outpatient clinic scheduled, and Matt and I were hanging out in the endoscopy suite for much of the morning as Matt works on honing his endoscopy skills. 

Amidst all the craziness, I saw a lady in my clinic who was 75 years old and about 4 foot 3.  The nurses got a kick out of seeing us walk side by side because of our height difference.  Many of the indigenous folks are pretty short, yet they still like to call me "Doctorcito", which means little doctor.  She came into my office and her granddaughter translated for her.  The elderly woman did speak a little bit of Spanish, but she was much more comfortable with her native indigenous language.

The ladies were very stoic during the interview, as is the custom of many of the folks from deep in the jungle.  They told me about how she was suffering from worsening pain in both knees, her right hip, and her right shoulder.  Her knees bothered her more than anything.  You could tell by looking that those little joints had done more than their share of manual labor during 75 years of hard life in the rain forest.  An exam confirmed that she had horrific osteoarthritis, with not much more than bone-on-bone in her knees.  Those little knees sounded like a bowl of Rice Krispies when she bent them.

We talked about treatment options, and she decided to have her knees injected yesterday, and to bring home some Ibuprofen to be used as needed.  I got everything ready and she bought the injectable steroids ($2.00).  After the injections, the stoic lady from deep in the jungle came down off the exam table.  Since an immediate effect is provided by the Lidocaine in the injection, you could tell that she already felt a huge relief.  I explained to her that it would take a couple of days for the steroids to kick in, but you could see a huge smile creep across her weathered face.  It's not a perfect treatment, but it will give her many days, and hopefully months, of relief from her pain.  As they left, I told them, "God bless you".  The ladies were so happy at this point that they were practically laughing.  "Yes," they answered, "we do trust in the goodness of God!"