Sunday, February 22, 2015

Hot Hands

The other day a lady presented to me in the emergency room.  She was is her 30’s and complained of pain of all her joints.  Laying my hands up against hers the overwhelming heat radiating from her joints made her diagnosis obvious to me.  I asked a couple other questions to clench the diagnosis of rheumatoid arthritis and then began to explain her diagnosis and treatment.  Usually I’ll confirm the diagnosis with several lab tests including a rheumatoid factor, but we were out of the reactive we needed to run the test.
                Rheumatoid arthritis is when your own immune system attacks your own joints mistaking them as a foreign bacteria that needs to be killed.  The best treatment we have here is Methotrexate, a medicine that suppresses the immune system and slows if not halts the destruction of the joints.  There was only one problem: her baby was 7 months old, and she was still breastfeeding.  Her pain was so severe, with marked stiffness in the mornings that she was nearly incapable of completing the numerous household chores each day.  And what she was able to do, she did with excruciating pain.  I counseled her on the risks and benefits of weaning her baby.  She decided to do so, and we started treatment.  I also sent her home on a steroid taper to give her relief from her pain until the Methotrexate had time to kick in (usually takes up to 5 weeks to have full effect).
                This week she came back after 5 weeks of treatment without pain.  We checked her labs and her rheumatoid factor was still sky high (750; normal is less than 14). She complained about her hair falling out, but all her labs where normal other than her rheumatoid factor.  The most likely cause was stress.  So I talked to her about her life and how she felt.  She described the common state of worrying and getting very angry about situations and people she couldn’t control that I hear about every day from my patients.   She said she felt a little sadness.  When I asked about it, she replied that she missed her baby.  She’d weaned her baby like I’d told her too, and consequently left him at home for the 15+hour trip to the hospital for her appointment with me.  She left God a great foot hole for him to reveal himself to her.  The people, and especially the women, feel so much stress and anxiety because they can’t control things.  I can’t control things either, but I trust in a God who is in control.  She believed in God, but as is common here that’s different than trusting that God cares about your insignificant cares and will provide your needs.  I explained that many people here thing about God like their president, Ollanta.  Ollanta wants them just happy enough they vote for him again, but he doesn’t really care that she’s hungry, hurting or in need.  I explained that’s not how God feels about us.  This feeling she has about leaving and missing her baby is how God feels about us.  I watched her heart melt and eyes light up with joy realizing how own God feels about us.  He longs to be with us, talk with us, and walk with us.
     Overwhelmed with a desire to show her appreciation and share the love of God she felt, she asked me what I wanted her to bring me when she returned for her next appointment in 3 months.  I asked what she had.  She said, "Aloe."  So looks like I might have some aloe the next time she comes. :)

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