My work here is done

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Yesterday everyone else went to Suzhou, while I gave a one-hour lecture on the Hypotonic Infant. Then Dr. Wong, one of the pediatric neurologists here, presented two kids for me to examine. One was a boy with mild weakness, elevated CK, who probably has a mild limb-girdle dystrophy. Another doc had recommended starting corticosteroids, whether for Duchenne MD or inflammatory myopathy I couldn't quite determine. I recommended genetic testing and biopsy before even thinking about treatment. The other was a 5 yo girl who was very weak, barely able to walk, wearing a brace for scoliosis, and a normal CK. The distribution of weakness seemed somewhat odd, and her spine seemed somewhat rigid, so I hedged a bit about the possibilities, but I finally committed to either a congenital myopathy or a later-onset motor neuron disorder. Then Dr. Wong gleefully informed me that she had already had a biopsy, which showed a congenital myopathy--specifically, "congenital fiber type disproportion" myopathy, which I've only seen in infants. I am impressed at the range of problems the neurologists here are capable of handling.

Then, the Rehab doc and therapists had me see four kids, who were basically similar, although their scans all looked different. They all had CP, with variations. I kept making different points with each one, and so the students would ask, "why would you do X with patient #1 but not patient #2?" and since I couldn't remember which was which it got confusing! Still, I think I gave them some new ideas about workup and therapy. And I learned something, too. With the first kid's scan, I remarked on how the frontal lobes looked small. Then the second kid's scan looked the same, then the third . . . I think it's an ethnic trait--their skulls are so short from front to back (brachycephalic) that the MRI slices catch them differently.

At the end of the day, I was pretty wiped. If I saw six new patients in three hours at Children's with an imperfect Chinese translator--or I should say, a Chinese speaker who speaks excellent English as well but is not a professional translator (like Drs. Jiang, Zhang, and Jin, who have been superb)-- I'd be asking for hazard pay. It would take me years to learn to work at their pace. Actually, it would require unlearning most of what we are trained to do in the US, and settle for taking a pulse and asking a single question. They seem to get it right here with that approach, so I think we have a lot to learn from them, in terms of time management. (Then again, the pediatricians here perform all the psychologic testing--there are no clinical psychologists in China! How would we handle that?)

Dinner was a change of pace--a busy "Brazilian" restaurant (Mark didn't think it was authentic) with continuous meat being served right at the table--like Sabor's, although with some weird items thrown in. Since the conference is now focusing on ADHD, the drug reps have a presence--Johnson & Johnson, who markets Concerta here, sponsored the dinner. Friday night in Shanghai was insane, traffic-wise. Our cab ride to the restaurant would have fit well into a car-chase scene from one of the Bourne movies. (It seems to me that a car-chase scene in Shanghai's older section would be a really cool idea for some future thriller--it's just a matter of time!) Getting a cab back took forever, and while waiting we were accosted by beggars, mostly women, old and not-so-old, some with little kids as props. They wandered away, but then one of the reps bought Lynn a little pinwheel thing from an old lady as a souvenier, and when the beggars saw that, it was like sharks tasting blood in the water. About five of them crossed the street, waving their cups and saying "hello, hello". We ignored them and they eventually went away. Oh well, so much for "to each according to his needs!"

Tonight was the culmination of the week-long conference--the three of us, Drs. Jin and Zheng, and a local school principal, met with about forty parents to answer questions about ADHD. Chinese parents have the same questions and concerns about making the diagnosis, medication side effects, behavioral approaches, etc., as US parents, they're just newer to the concept and have less information available in Chinese. We were not sure what resources to recommend, since we only know English language books. Then Ken mentioned Russell Barkley's book, and one of the psychology PhD students said that that someone had translated it into Chinese. As the parents wrote the title down, I wondered what sales could amount to in a market this size. Assuming the translation is within the copyright, I think Barkley should owe us a hefty royalty!

I tried to let everyone else talk because I HATE ADHD and don't devote any more time or attention to it than I have to (like, for example, when I have to give a lecture about it in front of fifty earnest Chinese students.) At one point, a mother asked whether meds for ADHD could cause brain damage. I took the mike and said, "No," then handed it down to Mark for further elaboration. Everyone laughed. That wasn't my sole contribution, but it was my most reliable one. I was happy for Mark and Ken to talk because this is what they spend a huge proportion of their time doing anyway.

Actually, I wouldn't mind treating ADHD patients in China--the kids are as cute as can be, and they are they best-behaved ADHD patients you could imagine! At least six families had brought their kids, and they all just sat there, fidgeting a little and playing with their parents' cell phones, but no acting out or making noise. One chubby little guy smiled at me through half the session, then fell off his chair. That was the most disruption there was. And I can't imagine a group of parents in the US staying at a meeting like this for three full hours, listening other parents hog the mike to ask questions that were answered in another language! These folks did.

I'll leave Lynn to describe her touring and shopping experiences--it will probably have to wait until tomorrow since she is fastasleep right now. I am still flying high on the several cups of tea that the students kept bringing to me up on the podium, which is why I am rambling on about stuff that has nothing to do with travelling in China--sorry!

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