Friday, May 20, 2011
Thursday, May 5, 2011
If there is ever a problem with my eyes, please contact Dr. Charlie Agnone in Ohio. She is an amazingly talented ophthalmologist - eager to teach and to learn - and is very down to earth. Most importantly, she truly listens to her patients, finding the "zebras" that other providers miss.
This is the fourth time I've had the pleasure of working with Charlie, and it always ends up being memorable... She always finds the "starfish"...
She set up an eye clinic for the week, and has had a crowd waiting for her each day. Several days ago, a grandmother brought in her 3 year old grandson (Joseph Carl) to be seen for the photophobia that started three months ago. He buries his head into her - unable to open his eyes in the light without excruciating pain.
Joseph has a rash all over his body, worse on the extremities. It started when he was 6 months old as a black, raised, itchy rash. They tried to treat with calamine - no change - then tried galocur (sodium benzoate), thinking it was scabies. The itching got better but 2 and a half years later the discoloration is still present (but not raised). He's also clearly malnourished - orange-ish, brittle hair, dry skin, skinny and small.
The light was too painful; she had to have him come back the next day to be sedated to do the eye exam.
Charlie and I sat around the dinner table the night before the exam bouncing ideas off each other. Our initial differential diagnoses include: syphilis, leprosy, leptospirosis. My money's on the leptospirosis (caused by rat urine in the water http://www.cdc.gov/ncidod/dbmd/diseaseinfo/leptospirosis_g.htm).
In the exam we could see big white raised patches on his eyeballs. It came on too fast and the sclera was too shiny for vitamin A deficiency. Charlie did some corneal scrapings, and we started him on ceftriaxone IV (treatment for lepto).
No definitive diagnosis yet (lab cultures in Haiti are not easy to come by), but today he opened his eyes to look at me - in the daylight... It's amazing what a few days of the right medication will do. His grandmother smiled and put her hand on my arm. "Mesi anpil" she said, as her eyes welled up.
PS. One of the OR nurses asked to watch me make the antibiotics for Joseph Carl - she didn't know how to make a dose smaller than 1gm from a 1gm vial (very common in Haiti). Teaching moments like this are one of my favorite things about being in a hospital. Of course, the syringe pulled out of the vial in the middle of the "lesson", and I got sprayed with an antibiotic that smells like rancid cat urine... Another teaching moment - how to wash your scrub top in the OR scrub sink while still wearing it...
~PJ
This is the fourth time I've had the pleasure of working with Charlie, and it always ends up being memorable... She always finds the "starfish"...
She set up an eye clinic for the week, and has had a crowd waiting for her each day. Several days ago, a grandmother brought in her 3 year old grandson (Joseph Carl) to be seen for the photophobia that started three months ago. He buries his head into her - unable to open his eyes in the light without excruciating pain.
Joseph has a rash all over his body, worse on the extremities. It started when he was 6 months old as a black, raised, itchy rash. They tried to treat with calamine - no change - then tried galocur (sodium benzoate), thinking it was scabies. The itching got better but 2 and a half years later the discoloration is still present (but not raised). He's also clearly malnourished - orange-ish, brittle hair, dry skin, skinny and small.
The light was too painful; she had to have him come back the next day to be sedated to do the eye exam.
Charlie and I sat around the dinner table the night before the exam bouncing ideas off each other. Our initial differential diagnoses include: syphilis, leprosy, leptospirosis. My money's on the leptospirosis (caused by rat urine in the water http://www.cdc.gov/ncidod/dbmd/diseaseinfo/leptospirosis_g.htm).
In the exam we could see big white raised patches on his eyeballs. It came on too fast and the sclera was too shiny for vitamin A deficiency. Charlie did some corneal scrapings, and we started him on ceftriaxone IV (treatment for lepto).
No definitive diagnosis yet (lab cultures in Haiti are not easy to come by), but today he opened his eyes to look at me - in the daylight... It's amazing what a few days of the right medication will do. His grandmother smiled and put her hand on my arm. "Mesi anpil" she said, as her eyes welled up.
PS. One of the OR nurses asked to watch me make the antibiotics for Joseph Carl - she didn't know how to make a dose smaller than 1gm from a 1gm vial (very common in Haiti). Teaching moments like this are one of my favorite things about being in a hospital. Of course, the syringe pulled out of the vial in the middle of the "lesson", and I got sprayed with an antibiotic that smells like rancid cat urine... Another teaching moment - how to wash your scrub top in the OR scrub sink while still wearing it...
~PJ
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