Sunday, March 19, 2006

follow-up

There has been one silver lining to this ambulatory month...the ability to schedule patients for follow-up. Usually, in our weekly continuity clinic, we hope to see our own patients for well-child care or some neat, easy-to-address-in-30min problem, like ADD or thumb-sucking. Most of the time, we end up seeing some other resident's patient and then never see that family again. This month, however, since I am here every day, all day and some nights as well, I have been able to do the quick follow-ups for sore throats, ear infections, etc. I've even been able to manage a kid with recurrent nephritis secondary to Henoch Schonlein purpura.

What the heck is that, you ask?

The short answer is that it's a systemic small vessel vasculitis, or inflammation of the small blood vessels in your body, from your skin to your intestines. No one's really sure what causes it, but it may be triggered by infections such as strep, chicken pox, or hepatitis. It usually gives you a characteristic rash on the legs/feet, as well as joint pain, abdominal pain, and blood in the urine. The blood in the urine is caused by small vessel inflammation in the kidneys, or nephritis.
Usually, it goes away in 4-6 weeks, but can recur. That's what happened with this kiddo. She had it in September, including the nephritis. Six months later, she had similar abdominal pain that prompted a trip to the ED, where they dipped her urine and found a lot of protein and a lot of blood. Recurrent HSP nephritis.
I've been able to see her twice weekly for the last 3 weeks. Once, I was unable to see her and she ended up seeing my senior resident. She thought he looked like Mr. Tumnus from The Lion, the Witch and the Wardrobe.

To his credit, his ears aren't that big, but the hair is quite similar. That, and I'm pretty sure he's not a faun. We now call her Lucy, which amuses her to no end.

That's the best part of medicine, getting to know these great kids and their families.
Next month, I go back to the inpatient floor, which has its own rewards, as well as frustrations.

3 comments:

sister smile said...

Very interesting - medicine sounds in some ways like detective work. That rash looks awful, though. I can only imagine how uncomfortable that poor kid was.

Heatherly said...

My daughter has hsp. can you direct me to more info?

girl MD said...

heatherly,
there's lots of info on the web, a lot of it aimed at the medical provider level. but if you google "henoch schonlein purpura parent information", the first thing that comes up is from the American Academy of Family Physicians. it is a good place to start.
hope that helps.