Friday, June 12, 2015

Chinkungunya (or Breakbone Fever)

When we heard that Katelyn was sick, we felt the need to find out what was happening with her. We had heard from her Mission President's wife on Monday that she was doing well and that they were more concerned with the weight loss.  Then on Thursday, President Curtiss called us to inform us that Katelyn was in a clinic getting help because her platelets were too low.  This gave Scott and I quite a concern.  Scott started emailing doctor's to figure out what was the course of treatment for Katelyn.  Here are those emails.

Hello my name is Bro. Scott Hansen. Last night my wife received a call from Pres. Curtis in regards to my daughter Katelyn Hansen’s condition and her being admitted to the local clinic. I am assuming that the president has seen her first hand to know of her real condition. I do have a medical background and had some questions.
First how was her condition diagnosed? Her companion is ill as well with Dengue. My daughter was diagnosed with Chikungunya. I understand that her platelet counts are low. I want to know why and make sure that she is not misdiagnosed due to the risk of bleeding with Dengue. Second what kind of facility is she in? Are the doctors competent? Even here in the states I see doctors who are, let’s say not at the top of their game. Thirdly she has had constant battles with parasites while she has been there. She is very obedient as per the mission president’s wife and I know that she has always been very clean and conscientious about that. With this and her previous weight loss, will this be an issue to her health.
Please understand I am not a worrier but I did lose my oldest in an unfortunate accident years ago and I’m not about to jeopardize her health and wellbeing. She does not need long term GI problems or liver dysfunction. I would like her to finish her mission at all possible so she has that felling of accomplishment. On the other hand she does not need a life time of illness or effects.
Please contact me and let me know of her immediate condition.
Dear Brother Hansen, First I want you to know how much we appreciate the sacrifice that your family and Sister Hansen are making. We realize that she was under no obligation to go on a mission, let alone to Central America.

I have been in constant contact with the Curtiss' and mission nurse and a senior missionary couple, the Bakes, who are in that area of the mission. Chinkungunya and dengue are diagnosed with blood work, a rather sophisticated method call ELISA. We check for certain immunoglobulins that are producing antibodies against the infection. The IgM is an acute one that appears in the blood in the first 4-5 days of the symptoms. This was positive in her. there is an IgG that is produced later on during the course of the illness, around ten days. It tells us that the infection was sometime in the past: it could be 10 days or a year. Her IgM was positive. I order both IgG and IgM in both dengue and Chickungunya when the missionaries get sick with fever body aches, weakness, etc. She was negative for dengue IgM and IgG, The facility is not up to US standards.

The MD taking care of her seems competent. I disagreed on a minor point. When the platelet count dropped below normal, the doctor wanted to give her platelets. I did not, for a couple of reasons. Platelets have to be given in large quantities, 10-15 units at a time( from 10-15 donors). I am not sure how competent the screening is down here for hepatitis B and C and HIV. She was stable and showed no signs of hemorrhaging. The platelet counts were below normal, not at a dangerous level 127,000(Normal being 150,000-400,000 depending on the normal for labs). In my internal medicine practice, I dealt with platelet counts below 50,000 quite often. She is also young and otherwise healthy.
Platelets don't last long in the blood stream either. I was treating your daughter as I would my own. If there had been any worsening of her condition or if I had had any serious questions of the care, she would have been sent to Guatemala City.

As far as the parasites, as Area Medical Advisor, we prefer that the missionaries cook their own food. But that is not done. Often the missionaries have "comedores", people who are given money to prepare the meals for a pair of missionaries. Generally they are fair, but there is a question of how well the vegetables, fruit and meat were cleaned before preparing, the cleanliness of where the food is prepared, and especially the hands that prepared the food. There is also the question of how well the missionary washed their hands and where they washed their hands. One third of the missionaries in Central America are off the streets at anytime because of gastrointestinal infections . Members won't support the missionaries with referrals unless the missionaries eat in their houses(same sanitary worries as mentioned above). It is a constant battle to keep them healthy.

We request that the missionaries use mosquito netting that is sprayed with permethrin, spraying their clothes with permethrin and using DEET(like off) to keep the mosquitoes away. I checked with Sisters Bake and Curtiss and your daughter and companion have been diligent in use of Permethrin and  DEET. Unfortunately, they are not 100% effective.

The first thing I did this morning was ask what your daughters platelet count was and it was up, so the MD was releasing her. To the MDs credit, I think she was being cautious about the transfusion and wanted to be on the safe side. We also don't normally admit the missionaries for Chikungunya, but that was the MD's decision, being on the safe side. We will be monitoring your daughter and her companion closely in the near future, monitoring the blood counts.

I hope this helps you and relieves some of your concerns. I hope it wasn't overkill. I know it is hard when you are not at a child's side when they are sick. I felt the same way when he served his mission, though it was stateside(sort of) in California.

I am a Board certified internist and had the honor of taking care of the missionaries in the Indianapolis mission for thirty years, while in private practice. I knew Dr. Doty quite well when he was over the Area Medical Advisors for the Church. When my stake president submitted my papers for a mission on a Thursday, Dr. Doty called me personally the next Monday morning(not being proud, please understand). As an MD that had worked with the Church and knew Spanish fluently, I was hoping that I could serve him in some area of His vineyard.

Warmest regards,

William D. Province II, MD, FACP
Area Medical Advisor for Central America

No comments:

Post a Comment