Her mother has been taking her to many doctors. The girl was seen by an endocrinologist, an otolaryngologist, a neurologist- in short, by all possible medical specialties whom the mother found, who had remained in the city under siege at that time (most of the physicians fled the bombings). Why so many specialists? Because our patients are accustomed to running for a specialist. They apparently think that any generalist – a pediatrician, an internist, a family physician – is like a low-level medical manager, a gate-keeper, that he or she is good for requesting tests and consults, especially where free medicine is concerned - if invalids, pensioners and their relatives will request it and persist.
But let us get back to my patient.
She had endured a lot of testing – all results were nonrevealing, normal. The specialists, one and all, zoomed in on the most “fashionable” diagnosis of exclusion - autonomic dysfunction. However, each of the physicians prescribed some medication or other just in case – iodine, sedatives, vitamins, supplements, immunostimulants and homeopathy. The girl’s mother bought them all and gave them to the child - whose condition did not improve.
After a long interview I found out that the girl is experiencing nausea every morning. She also complained of stomach ache – without any connection to food intake.
Pain in epigastric and paraumbilical regions was elicited on palpation.
I offered the treatment of gastritis without H.pylori therapy, and gastric imaging by endoscopy - however, the family refused the latter.
The girl did well with treatment, however her symptoms were still occasionally recurring.
In a couple of weeks, I persuaded them to do FGDS. It was indeed a duodenal bulb ulcer. This time I prescribed eradication.
The girl is doing well, but continues to have occasional low-grade fevers. What is it? The ulcer not entirely healed? An infection? Thermoneurosis, an enteric dysregulation?
I cannot evaluate this, because the only children's hospital with relevant clinic capabilities was damaged during the shelling, and cannot be used.
Image copyright: hemeroskopion/thinkstock
Article last time updated on 06.11.2014.