Tuesday morning began with another lecture to the medical staff, this time given by Jackie on the evaluation of the floppy baby. I will tell you that I have always seen children as part of my practice, but I draw the line when it comes to floppy babies. Mostly because it is a very complicated science that involves a myriad of disorders that are often very rare and requires one to revisit his biochemistry to remember all the various metabolic and genetic disorders that can afflict an infant. And that doesn’t even include all the neuromuscular and neurodegenerative disorders that exist. I’ll leave this to the pediatric neurologist any day and am glad that Jackie chose to tackle this topic as I certainly wasn’t going to do it.
Jackie giving her lecture on how to evaluate a floppy baby with Jess demonstrating
Reception was again a mass of patients, many of whom were our neurology patients who had been told to return today along with patients who had only come this day to see us and were unaware of the volume. I decided to increase the number of patients we could see as Jess and Jackie were now veteran Tanzanian neurologists prepared to tackle anything that came their way.
Daniel and Jackie taking a history
It was really a jumble of patients and hard to recall who we saw that day, though several were follow up patients from prior years. Jackie saw a young girl with a clear syndrome who Payal had seen last March and Jess evaluated a young girl who I first saw four or five years ago with epilepsy and a spastic hemiparesis who sees us every six months and continues to do remarkable well.
A follow up patient previously seen by Payal with a syndrome of corneal opacification and developmental delay
We ended up seeing our full quota of patients this and then some as I was pulled to the other side of the clinic (we were seeing patients in the night office and emergency room close to the wards) to see a few patients that included a patient who appeared to have suffered a small stroke that had occurred weeks prior and didn’t need to be admitted. There was no need for a CT scan and I referred him to the rehab center for some physical therapy.
Daniel and Jackie evaluating a patient
The other was a young woman of 16 or 17 who had come from the Mbulumbulu region where she is attending a boarding school and reports that she had developed numbness and tingling in her legs 3-4 days prior to coming and then had developed weakness in her legs the day prior. She had a very odd affect and wasn’t fully cooperative with the examination so I could confirm the amount of effort she was giving on motor testing, but she was completely areflexic for me which was quite alarming for Guillian-Barre syndrome or acute inflammatory demyelinating polyneuropathy. There is really no treatment here other than support which is often necessary if the patient develops respiratory distress or swallowing difficulties. I didn’t feel comfortable sending her home to the Mbulumbulu district in case she progressed and developed respiratory problems, so we elected to admit her to the ward to observe her overnight.
In the end, Jess saw 18 patients and Jackie 16, which was a record for our clinic here and with the two I saw, our grand total for the day was 36 patients! And there were still more that were sent home to return for tomorrow’s clinic which is really amazing.