10 July 2021

 

During the week, we had a lot of the usual musculoskeletal pain, gastritis, likely parasitic infections, and people looking for the magic vitamin that will fix all their problems.  But mixed in with this, there were several more interesting cases.

 

One middle-aged lady gave his history of low platelets, she said she was admitted to the Quiché government hospital with vomiting blood and bruising on her skin.  Given her history, she likely has ITP (idiopathic thrombocytopenic purpura).  She says that they gave her 6 transfusions of platelets and there were no more left, so they told her to go to another hospital.  Due to her lack of finances, she did not go to the other hospital, but she was given a high dose of steroids (prednisone) which she continued to take faithfully for months.  Side effects from this include swelling and sometimes growing a buffalo hump (yes this is real medical term), which she had.  We were able to check her platelets in the lab which were now normal, and the plan was to wean her slowly off the steroids and continue to follow her closely. 

 

 

This gentleman works on his knees putting in floors.  I could feel some bumps below his kneecaps on both sides.  Interestingly, the frontal x-ray looks pretty normal, but the side views reveal what is going on:  calcific prepatellar bursitis.  This is simply caused by continuously working on your knees.  We recommended wearing knee protection with he does this, but he didn’t seem so convinced.

 

In the rash department, this albino man went into the cornfield and came out with this rash.  It is primarily on his trunk and some on the arms and not really on the legs.  It doesn’t itch or bother him.  I think this is pityriasis rosea, even though I could not find the classic herald patch.  This is is thought to be caused by a virus, but is not very well understood.  We gave him a little antihistamines it case it were something else.  It should go away on its own but can take up to 3 months to do so.

 

 

In the procedures department, I was able to remove a fleshy mole from a woman’s scalp, cut a skin tag of a young lady’s eyelid, inject a few knees, and I got this out of a decent-sized synovial cyst on a lady’s ankle.

 

 

 

It is quite fitting that the last patient of today and of my time here was a case of “everything hurts”, and she was taking a lot of different medicines.  This reminded me of several of my patients in Detroit.  I didn’t know where to start.  However, the interesting things with this 50-year-old lady is that all of these medicines were prescribed 4 days ago in another clinic when supposedly she had a blood sugar of over 800 and was prescribed two high-does diabetes meds along with a cocktail of vitamins and stomach meds.  She said she felt weak and wanted to pass out when she injected her vitamins.  However, we noted that her sugar was normal today without having had her medications that day, and thanks again to our lab we were able to do an A1c which was normal.  This meant that she almost certainly did NOT have diabetes and she was severely overmedicated.  My understanding is that the injectable vitamins were doing nothing to her, but the low blood sugars were making her feel terrible.  We had her stop all of these meds and invited her to return to check her sugar again at a future date to make sure.

 

We did not have any inpatients while I was here, but this lady spent several hours in observation receiving treatment for her bad asthma attack.  She eventually was feeling much better and wanted to go home.

 

 

There was much more but I will stop there.  Overall, it was full week and as time goes on, sicker people show up—especially at the hospital site.  We’ll see how things are next time.