Tuesday, May 19, 2015

Rule of Threes

The rule of threes is a slightly superstitious, but real phenomenon in medicine (and plane crashes) that always intrigues me.  Our special this month seems to be on chronic renal failure and pica.  
The three renal failure patients (all from the same town, no less) have been diabetic, and the first one just passed away at the age of 70 after deciding she didn't want to go through dialysis.  The next two are in their 50s and deciding if it will be worth the expense of travel to get set up with the peritoneal system offered by the government health care. The family gets free dialysis workup and shunt placement and dialysis solutions for home care, but has to travel every 6 weeks to the city for labs and follow-up.  In addition, there are the other meds that are not covered and have to be bought by the family--eating through their financial resources quickly.  It is always a sad day to have to tell a family that we are dealing with end-stage organ disease of a medical condition that could have been better controlled.  Please pray for our diabetic patients and us as we work to educate them and their families on the importance of diet, exercise and medication compliance.
The other illness is pica.  This one always gets our attention as it is so dramatic!  A 40ish year old woman came in with complaints of fatigue, breathlessness and heart palpitations while working. "Oh, and by the way, I crave (and eat) dirt!"  This was a great teaching case for our health promoters, and we talked about pica and anemia.  I told Cesy, who was translating, to ask her what kind of dirt she likes the best.  She kind of looked at me funny but asked the question.  Sure enough the patient told us about the dark and red dirts and the some of the white dirts she has tried--all delicious!  On further questioning she has very heavy bleeding with her menstural cycles.  Her hemoglobin was 8 (about half of normal for someone living at high altitude).  
Our second patient who came in 4 days later, was a 14 year-old girl whose mom brought her because she likes to eat sugar out of the bag, and...likes to eat fresh adobe.  So far I can't find any evidence of excessive blood loss, so probably just nutritional anemia.  But we'll get some labs to confirm that.  
We are still waiting for the third pica patient to come in...they will come!  Maybe that's God's way of getting your attention and not missing something serious.  

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