Lydia came to us about 1 week after delivering her baby at home. She came in unable to walk, with severe weakness of her legs. and only able to move her arms a little. Lydia was suffering from Guillain Barre Syndrome. This is an ascending paralysis that often starts in the legs and works it way up the body. If severe enough it can involve the muscles used for breathing, and require temporary intubation. Tha
nkfully Lydia's respirations never were compromised. She stayed with us for about 2 months.When Patty came to us in mid February and wondered if there were any patients that she could work with as a Physical Therapist, I told her about Lydia. After some work, Patty was able to help Lydia regain some of the strength she had lost. She was able to walk with a walker and transfer by herself. She was having difficulty with fine motor skills, but at the time of discharge had improved immensely in this area. She also was walking without a walker. What a blessing for Lydia to be able to recover almost completely from this illness which could have taken her life, and to be able to care for her new baby.
Cathy came in while I was on call with Ben, a medical student. The report was she had delivered at home, but was complaining of SOB, and had some neck and facial swelling right after delivery.
We found her somewhat uncooperative with many family members all around her. Given the frequency of domestic violence here, we started asking questions if she had been beaten or something, but the family denied it. Initially on exam, it seemed like the pt was overreacting. She was saturating 98% on room air, had equal breath sounds, but seemed to be in pain. The nurses were talking about her facial swelling, so I put my hand on her face and neck felt some crackling. At this point we got a stat portable CXR to confirm our presumed diagnosis of subcutaneous emphysema. The CXR did show air above both lungs and into her neck.
So she ruptured something inside her respiratory system to allow air to leak out into her soft tissue (face, neck, shoulder area). No pneumothorax (collapsed lung) was initially seen. I reassured the family that she would be alright, but it w
ould take sometime. I presume she developed this while delivering her baby. The father (I presume) was suggesting some sort of evil spirit caused this to happen, I assured him no evil spirit was involved. This didn't stop the family from asking a village guy to come in that night and check her out himself. He too concluded that air was leaking into her body somehow. We have been following her CXR to make sure no pneumo developed, and today she had a pneumopericardium (air around her heart), which was interesting to see. Thankfully she is doing well, sitting up in bed, no longer complaining of severe pain or SOB. She will probably go home soon, however her baby was a bit premature, so she will stay with us a little longer in order to get her weight up before going home.
