Breathless . . .

Few days back, one of my friends reminded me that I'm yet to post much about patient management at KCH. There have been quite a many . . . but I've been busy . . . 

Today was a significant day for the hospital as we had more than a 200 outpatients (227 to be exact) for the first time in 2015. 

Very similar to one of my first posts when I was at NJH . . . a small account of some critical patients. Though the volume is not yet up to NJH levels, I'm sure all five cases would interest you . . .

5 patients . . . all of them breathless . . . a glimpse into patient care today . . . I'm sure an medicals student would have been overwhelmed . . .

1. AAH, a 70 year old gentleman who had been with us since the last few days. Surprisingly, he had been going from hospital to hospital with a pneumothorax since the last 2 months. And after he came here, he was not allowing us to put a chest tube. The relatives initially told us that if we can give them a guarantee, we could insert a chest tube. I was not very confident considering that his pneumothorax was 2 months old. However, within 48 hours of his admission, he became quite sick that the relatives realised that it may be better to give us a chance. The procedure was uneventful and he is doing well. 

2. BH, a 60 year old gentleman came in with history of fever and cough since the rains 10 days back. He attributed his illness to the wet weather. He was not very much willing to take our diagnosis of a miliary tuberculosis. In fact, he continues to be so sick that he needs regular oxygen. 

3. CH, a 50 year old gentleman came to OPD today. He was in severe pain and was breathless. He had a X-Ray Chest taken 3 days back. There was a effusion. An aspiration showed empyema. The interesting aspect - he wanted to take a second opinion with some doctor he knew before starting treatment here. He promised to return tomorrow.

4. DDH - a 35 year old young man was brought in a confused state, gasping and frothing from the mouth. He had tried to commit suicide by hanging. The relatives had cut down the rope and brought him. He appears to have some amount of brain hypoxia. We've tried our best to refer him for elective ventilation. They are too poor to even afford the vehicle to Varanasi. I wish we had a better ventilator. He's till in the ward. He's a bit better, but, I'm sure that a ventilator would have done him a lot of good. 

5. SH - a 80 year old elderly lady was brought with breathlessness since 2 months. Since 2 days, she developed severe left sided chest pain. An ultrasound showed cholelithiasis as well as a massive pericardial effusion. I wonder how she's still alive. The relatives were given the option of taking her to a higher centre for pericardiocentesis. They've left after quite a long discussion on further course of action. I've a feeling that most probably, she would be brought back to us in a couple of days. 

I'm sure many will ask on how to help out . . . 

Well, 227 with 3 doctors (one Junior doctor, one Clinical Pathologist and one Community Health Physician) and one nurse practitioner is no small work. I wish we had more experienced hands to help out. 

And of course, some more equipment in the ward . . . the immediate need - couple of more multipara monitors and couple of ventilators . . .

More of that sometime later . . . 

Tuberculosis . . . The Affair Continues

It’s been couple of months since we started to serve at Kachhwa.

One of the things that that has followed us here from NJH is the high prevalence of Tuberculosis. I only wonder if the prevalence is a bit more higher than Palamu region as the density of health care institutions including tertiary centres are more here. 

I personally saw 4 pulmonary tuberculosis patients, 2 abdominal tuberculosis, 1 tuberculous lymphadenitis and 2 tuberculous meningitis. The experience in NJH has been such that we have the diagnosis of tuberculosis in the back of our mind once the patient complains of cough or comes with vague complaints. I’m sure many would echo my view.

Couple of interesting cases . . .

DES, a 45 year old lady came to us about couple of weeks back with pain on passing urine and vague abdominal pain. We sent her for routine urine examination which showed a bad urinary tract infection. She was started on oral antibiotics, but did not respond to treatment. She came back. Ultrasound showed features of early pyelonephritis. She was admitted and started on intravenous antibiotics.

She did not improve. Rather, after admission, she started to complain of breathlessness at night. Later, on probing, she told us she has been breathless since the abdominal pain started. We took a Chest X-Ray.

Miliary tuberculosis was the diagnosis. She was started on treatment. And the recovery was dramatic. DES is at home now.

The second story is that of a little boy and his grandmother. MS, a 2 year old boy was brought with history of long standing cough. MS weighed just about 5 kilograms and on probing gave a history of exposure to probable tuberculosis. His grandmother was a chronic cough patient and had taken 2 months of tuberculosis treatment.

Meanwhile, in another cubicle of our hospital, another doctor was examining his grandmother and had made the diagnosis of tuberculosis. The parents did not think it wise to tell to the doctor who examined MS, that his grandmother had also come and was being examined at another cubicle.

Below is MS’s X-ray. We were quite taken aback at the extent of the disease.

Meanwhile, MS’s grandmother also got her X-Ray. Later, her sputum was also positive.  

It took some time before we realised that both MS and his grandmother was diagnosed to have tuberculosis the same time in our hospital without the knowledge of either doctors.

When, we told the family that MS should have got the disease from his grandmother, the family was not willing to believe stating that MS visits his grandmother only once a month.

This is nothing uncommon that we see when we try to educate people about the spread of the disease. 

There is one more patient whose story I wanted to narrate. That would be in another post . . .