Man unable to speak for 5 months, diabetes, other cases

Friday Aug 5 2011.

Rifka Stern, MD

Today started out slow but got busier and more complicated. I saw some very interesting cases.

    The first one was an elderly gentleman who stopped speaking about 5 months ago. His son said he was doing other strange behaviors like eating paper. He would wander off during the day but came home for meals. He seems to understand some things but did not have any expression or response. He did not seem in pain and could feed himself but he was incontinent of stool and urine. He had been very healthy before this happened and had no known medical problems but did drink a lot of alcohol. On exam he also had a large lump by the right hip. It had been there for years and felt partly soft and partly hard. Neither Angelo or myself had any idea about what was wrong with him. He clearly needed further testing but it was not something that could be done in the clinic.
   After that a man came into the clinic with an extremely high blood sugar. His diabetes had been out of control for so long that his muscles had wasted away. He had been refusing insulin. When we saw him today he could barely hold his head up and his sugars were over 600 (normal is up to 125).  Someone with a sugar that high is very dehydrated and we started an IV and finally he agreed to take insulin and it took about 3 hours to get his level down. Then we gave instructions to his family about giving insulin shots.
   The other providers had a women with HIV who was not on treatment and had  a one month old baby. The mom finally agreed to give the baby medication to prevent transmission of HIV and then the mom is waiting for more testing to see if she needs meds. The clinic staff had been trying for a month to get the mom to accept treatment, so we were all very happy.
Luckly, HIV is not a big problem here. There is only about 5% rate of HIV infection in the country and lower in this area.
   The last was a severly malnourished 5 month old baby with a mom who was only 19 y/o. The mom has some psychiatric problems and is not very capable of taking care of her children. The baby was so anemic that it was decided to take her to the hospital. We are still waiting to hear how she is.

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