Thursday, November 4, 2010

Red Herring

Often we doctors go astray chasing the wrong diagnosis and causing avoidable distress to our patients. This is one such story which happened in my practice recently.

I am now treating the fourth generation of Pillays. The old man Pillay who came to Bangalore from the state of Kerala some 60 years back died many years ago. The young man in question is 25 years old Mr S is the grandson who is employed as an engineer in a private company. He suffers from stone disease of his kidneys and every now and then develops pain in his back and down the track of his ureter [the tube that drains the urine to the bladder] and ends up either with me or at the nearby hospital’s outpatient department.

He developed one such episode of severe backache and ended up in the hospital and a scan of his abdomen revealed Kidney stones though none was visible in the ureters. Going by the past story he was given pain killers and asked to come next day. He did not get better and developed urinary urgency and frequency and constipation. The physician thought the urinary symptoms to be due to possible infection and suggested a urine study. The patient’s complaint of constipation was attributed to taking painkillers and his feeling of tingling sensations in his legs to anxiety. Pending urine study he was given antibiotics and sent home.

He came over to see me next day. His pain back was localized and on both sides. He had abnormal pain and touch sensations and improper control of his bladder and was unable to evacuate his bowels. Examination revealed grossly abnormal neurological signs in both lower legs and there was bladder and bowel involvement. I was dealing with a serious illness called Transverse Myelitis which needed urgent expert management.

Myelitis is a general term used to describe all inflammatory conditions that affect the sheath [cover] of the nerves and nerve cells. It can be due to infection or immunological insult. The latter was the case with this young man and he was saved the dire consequences of possible paralysis of his body from navel downwards by massive doses of steroids and only a week’s hospitalization. At the time of writing the story he is near normal.

He still has stones in the substance of the kidney but sitting quietly for the present.

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