Hoarder

Hi,


I have finally caught up with myself, and this is last weeks blog. This means that, finally, from this Sunday onwards I can be posting that previous weeks bloggings. This will make it a lot easier for me, as I won't feel as though I am constantly trying to write my blog, and a lot easier for anyone who wants to follow me, as instead of having new posts constantly popping up, there will just be one a week to read, hopefully of a higher quality as it won't be so rushed...


I am getting into the neurology rotation properly now, though as this is the week before Christmas there is a short holiday in the middle of the rotation to break it up and let us have a Christmas. A little bit of a shame to have the rotation interrupted half way through, but if the alternative is missing Christmas, I know which I would prefer...


Despite having plenty of lectures this week, which while interesting are no-where near fun enough to write about here, I do manage to spend some time on the wards. One of the patients who I talk to is a lady who was admitted with intercranial hypertension, due to  blood clots in her brain. Here the pressure inside her skull increases due to the increased amount of cerebrospinal fluid (CSF) in the skull. This has been caused by some blood clots which have formed in her brain to block the normal circulation of the CSF. As it cannot drain properly, the pressure keeps building up, and she needs to have it drained every couple of days by having a needle put into her spine to let some of it out. This is because of something called the Monro-Kellie hypothesis, which means that the skull, a fixed volume, can only hold a certain capacity. The main things in the skull are brain, blood and CSF. In this case the CSF is increased, so the amount of blood in the vessels in the skull can decrease to a point, meaning that there are few symptoms for a while. Once this reaches a level where the blood can no longer decrease, however, the brain starts to become squished, due to the increased pressure and causes symptoms such as headaches and much worse. This works the other way around as well, for bleeds in the skull causing increased amounts of blood, and the CSF can decrease. I feel really sorry for this lady, as having to have the fluid drained every three days means she cannot go home to her family, and means she has to wait here until after Christmas, when the current plan is for a neurosurgeon to put a shunt into the brain, so the CSF can drain automatically down a tube in the neck into the abdomen, where if can be reabsorbed harmlessly. 


The other interesting patient I saw this week was interesting in a much more social way than medical. This was a 50 year old lady, who had been admitted for new onset seizures, to be monitored in the hospital to see if they could get an EEG recording whilst she had a seizure to see if they could diagnose epilepsy. While talking to her, she seemed relatively normal, chatty and friendly, and she clearly took care of her appearance, and was well made up despite being in hospital with leads attached to her head. While this in itself was unremarkable, what the doctor told us about her later was much more interesting. Supposedly, since she had come to hospital, her children had gone to her house for the first time in years to get some of her things to bring to the hospital. They had found her living in absolute squalor, with excrement all over the floor and piles and piles of hoarded items creating a maze throughout the house. They had no idea that she lived like this, as she always seemed so normal on the outside. Unsure what to do, they had called the GP, who had visited and been equally as horrified. The woman still doesn't know that the doctors and children know about this secret - as the children don't really know what to do. This is probably more of a job for social services if this lady seems not to be coping, or perhaps for the psychiatric doctors. She seems so... normal in other respects - personable, well dressed and holding down a decent job. It is a privilege as a doctor to be able to see under people's outer 'skin' and get to know them better. I hope she gets the help she needs.