More on Wendy and Herlyn

I finally got ahold of Wendy this weekend and she and her mom came to clinic today. Mom was sad and exhausted. Today was a day of a lot of pain. Wendy was crying, stiff, and guarding. Mom said today was one of those days when she wanted to give up on Wendy. Her crying and pain are just too much to cope with. I had to push on as I had a long line of patients waiting. I spent 10 minutes or so on more education, this time focusing on methotrexate and the importance of the folate. I also reiterated that Wendy would not show improvement for many weeks (I'm so afraid that when I leave, Wendy's mom, having not seen a positive effect from the MTX, will stop coming and no one will have the energy to track her down in her far away hamlet). I sat down with Flori (the sole clinic nurse) and taught her as much as I could about MTX and told her she would need to be mom's educator, supporter, and cheerleader in the weeks to come. Her eyes were wide as I explained how toxic MTX can be but how important it is. Wendy cried for her shot but she was happy with her stickers. She'll be back for her next dose on Monday.

Herlyn came today to repeat his pre-op testing requested by UNICAR. He'd come Friday for the tests and I was thrilled that the hospital director offered to cover the 400Q cost for the labs. I'm still upset that UNICAR requests so many tests that seem to have nothing to do with him getting a PDA closed (in addition to CBCD - warranted - he needed an ESR, hep B and C, HIV, VDRL, stool and urine exams). Why, why, why ask for all these tests? UNICAR doesn't even do transplants so what relevance is it that a child in heart failure might have hepatitis B? 400Q ($65) is a crazy amount of money here and for most patients seen at UNICAR. Just to bring emphasis to why it's so important to think before ordering senseless tests: Herlyn's hepatitis C test on Friday came back ever so weakly positive. Cesar, the lab technician, called the maker of the rapid test and they insisted that a new sample needed to be drawn (not just a repeat done on the already drawn blood). And now hepatitis A would need to be included and specific titers of A, B, and C would need to be done (outside private lab -- $$$). I had to break this bad news to Herlyn and his mom on Saturday morning. He would need another poke and she'd need to travel to San Lucas again. She was crestfallen and Herlyn was refusing to go. I gave her the money for the transport and a few Q for a present for Herlyn for after the test. Herlyn needed three pokes to get the labs. He told his dad afterward that he didn't like the doctora (me) anymore because she held him down to get the labs. Results of the confirmatory tests tomorrow...will keep you posted.