An 8 yr old boy with an arthritis affecting both elbows and his left ankle. Marked pain swelling and restirction of movement.
symptoms and inflammatory markers settling after a course of herbal medicine and anti-inflamatories.
Bloods: 6/9/08:
CRP: 384 mg/L
ESR: 55
Rheumatoid factor: Positive
30/11/08
CRP: "negative"
ESR: 40
Rheumatoid factor: Negative
WCC: 8.9
I'm not sure how reliable the labs are nor what a constitutes a negative CRP?!
On examination he has marked swelling of a his right elbow and right ankle, only a little warm to the touch and moderately painful on all movements. Just about a ful range of movement at both.
Also He has an ejection systolic murmor radiating to his carotids, with no signs of symptoms of heart failure.
What is the next step: all ideas welcome............... further questions............?
Thursday, January 8, 2009
La concepcion
is a volcano on the northern part of ometepe, and stands at 1610m tall. Fot the walking geeks amongst you that is 266m higher than be nevis.
Its a long climb. we started 2hrs late having found our guide laid out asleep in the bus shelter distinctly hung over. He called himself a guide, and to be fair he did know the way. However he struggle to keep up, was laid down and trying to sleep every time we stopped, and hadn't brought any food or water with him.
So we fed him and watered him and got him to the top, muttering and grumbling and looking more than a little sorry for himself. I don't think a canter up a mountain made for a good hangover cure.
The top was an incredible change of climate. Enshrouded in a near permanent cloud, we were drenched with what felt like a sharp sleet-like rain, driven by gale force winds up towards the crater. This while it was a still sunny day down at sea level.
The crater's edge was covered in warm ash, and the air was sulphorous and difficult to breathe - not a pleasant place.
There were some good views though
Friday, January 2, 2009
Who believes that prayer works?
On the 30th december, brendan and I (with many people at home in the UK) spent the day praying for, and visiting stephen. A man who lives a couple of roads up from us in quinton but happens to be in prison here in nicaragua.
While praying that day, I felt that It may be really good to do some medical work in the prison. We had heard from stephen that healthcare there was not all it could be.
This thought kept nagging at me through the day.
We asked friends working here, and those who have visited the prison previously what they thought. We were told that the prison is incredibly beaurocratic and it can take a very long time to get anything organised. We had also seen for ourselves how unhelpful the staff can be, and had heard that the prison governor, whose permission I would need, can be particularly unhelpful.
We prayed some more and still considered it an idea worth pursuing, so the next day we went back with the prison armed with a letter explaining my ideas in my rather sketchy spanish.
I was met at the gate by the guards who called the prison doctor. He came straight away and seemed very pleased to meet me. He introduced me to the prison governor and we had lunch together (quite a tasty chicked dish with iced tea!). After lunch I explained (again in my most "fluent" spanish) my idea: I would be working three and a half days a week in ometepe, so would be free on fridays and could come and do a joint clinic with the doctor in the prison.
They semed very happy to accept this offer and all was agreed. The only problem being that they have few medicines in the prison, and not many of the prisoners can afford to buy them from outside.
There was minimal paperwork to be completed, and I was only in the prison for 40 minutes.
I have not heard of anything happen so quickly within the nicaraguan public sector, and I was amazed at the prompt and welcoming response of the governor.
It is to me too much of a coincidence that we spend that time praying and then this opportunity opens up in such a way.
We believe we are seeing the influence of God.
As such i am very excited about this opportunty - lets pray again and see what happens next!
While praying that day, I felt that It may be really good to do some medical work in the prison. We had heard from stephen that healthcare there was not all it could be.
This thought kept nagging at me through the day.
We asked friends working here, and those who have visited the prison previously what they thought. We were told that the prison is incredibly beaurocratic and it can take a very long time to get anything organised. We had also seen for ourselves how unhelpful the staff can be, and had heard that the prison governor, whose permission I would need, can be particularly unhelpful.
We prayed some more and still considered it an idea worth pursuing, so the next day we went back with the prison armed with a letter explaining my ideas in my rather sketchy spanish.
I was met at the gate by the guards who called the prison doctor. He came straight away and seemed very pleased to meet me. He introduced me to the prison governor and we had lunch together (quite a tasty chicked dish with iced tea!). After lunch I explained (again in my most "fluent" spanish) my idea: I would be working three and a half days a week in ometepe, so would be free on fridays and could come and do a joint clinic with the doctor in the prison.
They semed very happy to accept this offer and all was agreed. The only problem being that they have few medicines in the prison, and not many of the prisoners can afford to buy them from outside.
There was minimal paperwork to be completed, and I was only in the prison for 40 minutes.
I have not heard of anything happen so quickly within the nicaraguan public sector, and I was amazed at the prompt and welcoming response of the governor.
It is to me too much of a coincidence that we spend that time praying and then this opportunity opens up in such a way.
We believe we are seeing the influence of God.
As such i am very excited about this opportunty - lets pray again and see what happens next!
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