"Is your abdominal pain worse when you eat?"
"Well, what makes the pain worse?"
"Bright light and loud noise."
"Well, OK. That's tetanus."
I've seen about 3 or 4 tetanus cases in the last five months. Which is 3 or 4 more than I've ever managed at home. This past week, we had the pleasure of discharging a tetanus patient home. He had come in with a dirty finger wound, the inability to open his jaw, and severe abdominal muscle spasms, mostly in his abdomen. What saved his life is that he never had spasms of the diaphragm, the muscles that enable the lungs to get air, which is what kills tetanus patients. In fact, it kills 70% of them in places without a mechanical ventilator to breath for them. (And I would apply that statistic to us, since, though we have ventilators, the average tetanus patient needs one for 23 days, and our patients don't survive on a ventilator that long.)
Thus, when I say we had "the pleasure of discharging" him, I mean it. He is the type of victory that we need to publicize to ourselves, since our insufficiencies often overshadow our many victories.
His abdominal pain was concerning, though, and we tried not to neglect the possibility that something else was going on in his belly. Thus, we had the above conversation about what made his pain worse, and he gave me an answer I've never heard before. Tetanus spasms are brought on by light and sound, and I can't think of a single thing in the abdomen that would otherwise be made worse by those stimuli.
I hope our blog never degenerates into a public service announcement, but I do want to make it known that the bacteria that causes tetanus lives in the soil of the western world just as much. The reason we don't get this problem is that we get that pesky tetanus immunization every 10 years. So, if you're not up to date...
The medical community reading this may be trying to remember how to take care of these people. The management is as straightforward as it is perilous: Metronidazole, Tetanus immunoglobulin (which we have), vaccine series, valium for the spasms, and as quiet and dark a room as you can find. Then, lots of supportive care.