Saturday, October 17, 2009

Elsie's Walking!

It seems like I often remark that we don't know an exact diagnosis, or the exact cause of a problem. This is another case like that.

Elsie is 5. She and her mother got sick about the same time. The family did not bring them to the hospital. They were coughing, short of breath and confused. Elsie's mom died. It was still about 2 weeks before anyone brought Elsie in.

In the hospital she had fever, a cough, and was confused. Her malaria tests were negative. So was an HIV test. It was clear that there was something going in her central nervous system. We were treating what we could treat. We just had to wait, but I was quite sure that she would die.

During the times of confusion she would scream. Loud, piercing, persisting screams. I would sedate her cautiously.

Then slowly she started turning around. As she became more alert and her movements became more purposeful it became obvious that she was not moving her left arm and leg normally.

She also became more difficult to deal with. Her confused screams turned into temper tantrums. The aunt who was taking care of her was unable to deal with the tantrums in any way except hitting. I tried, and several nurses tried to help her find other ways of responding. Finally she "lost it" and gave little Elsie a beating that left bruises, then left the hospital, abandoning Elsie. Within a few hours Elsie's father showed up, and has been with her ever since.

All of Elsie's symptoms resolved, except the weak left arm and limbs. She looked exactly as if she'd had a stroke. In fact that may be exactly what she'd had. The challenge now became rehabilitation. Her left food tended to fold under when she tried to stand on it. After experimenting with several possibilities, we found a brace that would keep it straight when she stood. I thought she could use a walker. We didn't really find a child-sized walker, but as I looked through the stock, I found one that was a bit smaller than average. With the adjustable legs set to the lowest level she could hold on well with her right hand. She didn't have enough grip strength in her left hand to hold on.

She continued to throw tantrums from time to time, but her dad was able to control her most of the time. At the same time, a very cute, gregarious side of her personality emerged.

As I was trying to design some support for her left arm, she just started walking on her own! She drug the left food, but she would balance on it long enough to take the next step. But once she started walking, she started becoming very intrusive to the other patients on the ward, going from bed to bed greeting everyone! There wasn't much that we could do for her that had to be done on the ward, but she needed to complete a course of TB meds that included a daily injection. I decided to send her to the TB ward until that was done.

We'll see how well she does in long-term follow-up. I'll try to remember to report to you how she's doing.

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