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Published: August 27th 2011
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So that Nephrology rotation I did prior to coming here has really been coming in handy. It seems that much like in the US, the doctors here are a bit baffled by Nephrology. A little girl was admitted with edema, 4+ protein in the urine, and hypertension and the MO decided that since she had hypertension it must be glomerulonephritis even though she didn't have any blood in her urine. I insisted that it must be nephrotic syndrome and sure enough the labs confirmed my diagnosis. That little girl is crazy cute too. She doesn't speak English but always gives us a big smile when we examine her. There is another little girl on my ward who is 11 years old and this is her second admission this month for "intractable headaches" that miraculously disappear as soon as she enters the hospital. She can't even reliably describe the headaches and her neurologic exam is absolutely normal. She clearly has a behavioral/psych reason for these headaches. However, she is going for a head CT tomorrow, "so that she will stop coming back to the hospital" I questioned this reason for irradiating the child but was overruled which is a shame for the
little girl. Dad, I'm sure you feel the same way!
When we were doing the blood draws this morning, one of the German medical students gave a piece of candy to one of the kids after being stuck and another little girl saw. Later that day she came up to me and starting searching my pockets and squeezing my belly asking me for candy which was a little strange. We did bring some sticker activites for the kids, so we handed those out then and it was fun to see the kids excited about it. There is no such thing as child life here and the kids usually spend their days lying in bed, roaming the hospital or torturing the nurses. Two of the younger nurses liked the stickers so we gave them some too 😊
Katie gave a lecture on UTI and minimal change (kidney) disease which went really well. The standard here is to use bagged urine specimens instead of cath or suprapubic so she explained why that wasn't a good idea. She's also been on a mission to get them to stop using antibiotics for bronchiolitis which is what many of the babies on her
ward have. There is a baby on her ward with really severe marasmus (malnutrition) who was sent down to our hospital without any parents he has been here for 3 days now and still no visit from the parents.
Chest physiotherapy to help kids clear secretions from their lungs is usually done at home anywhere from every 2 hours to 3 times a day for kids who need it. Here, however, it is a speacial order that you have to place a day in advance and they take the kids down to physical therapy and do it once a day. We're not really sure how effective this is, but I guess at least its something.
In the clinic in the afternoon I didn't have any admissions which was a nice change. I did see a baby who has what looked like herpes lesions on her mouth. Her Mom is HIV positive and the baby's initial test was negative but with this new change in her condition, I am worried that she may have HIV. Katie saw a lot of ear infections today so it was kind of refreshing to see kids with less severe and chronic diseases than
we often see here.
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