COTW: Pott's Disease

(by Eric)

Continuity of patient care is a major reason why a lot of doctors choose to join my field of Family Medicine.  It is, on the other hand, a rather poor reason to go into missionary medicine in Africa, since the constraints of travel for most patients mean that they will not come back just for the sake of giving you good news.  Despite these travel constraints, I do have a number of patients that I've been treating now for a couple of years, and it's a great pleasure for them to come back and tell me how much better they are doing.

Yesterday, I saw a young mother that I had first met about a year ago.  She was in the emergency room with a gradual onset of paralysis of both her legs.  It was one of those rare medical moments where I could walk in and make the diagnosis in literally a matter of seconds.  I took a quick look at her back and saw this:

The similar back of a patient from Google.  I didn't get a photo of my lady.

This kind of a bump in your spine in Africa means that you have tuberculosis of the spine.  The bump even has a special name: a gibbus.  One of the vertebrae gets crushed in an angulated way, resulting in a spine that pinches the spinal cord.  It causes a lot of pain, and when it is severe enough, it causes paralysis of everything below that level of the spinal cord.

Tuberculosis of the spine is called Pott's disease.  It's an ancient disease, with old skeletons of Egyptians mummies showing the same deformity.  Percivall Pott was a brilliant British surgeon from the 1700's who lived in the era where the pinnacle of legacy was to have some terrible disease bear your name.  The treatment is standard tuberculosis therapy, which is thankfully available for free to our patients thanks to the government and foreign aid programs, but they need to continue the treatment for a full year instead of the standard six months.

I've been on a bit of a rant recently with my students regarding Pott's disease, because I have seen about six of these cases in the last two months, most of which have gone undiagnosed for a long time, for lack of someone who both looked at their back and understood what that bump means.

We started this lady on this treatment, along with some steroids.  She lives pretty close to Kibuye, so despite her obvious mobility problems, I saw her several more times.  The next time she was walking with a cane, and the next time with no cane, but still with considerable back pain.  We worked through those issues one at a time, and she steadily improved.

Yesterday, she came back for a last time to tell me that she is finishing her year of tuberculosis treatment today.  The bump is still there on her back, but the pain is minimal.  She can farm at her home with no significant difficulty.  There wasn't much to do from a medical standpoint, but I wanted to savor the moment with her.

I asked her how long she had the problem before she was put on treatment.  She had increasing back pain for three years before she was diagnosed.  I asked her if she had thought she would ever walk again.  She covered her mouth with her hand and let out the characteristic "Yooooo!" of Burundians.  Everyone was convinced that she would never walk again.  I told her that she has a lot to thank God for.  She agreed.  I told her that I also have a lot to thank God for, because of her.  And I thanked her for giving me a reason to rejoice.

***

It's not everyday that I get to be a part of a paralyzed person getting to walk again.  The surgeons do this on a fairly regular basis, but less so for me.  In Luke 7, Jesus mentions lame people walking again as a sign to John the Baptist of God's kingdom coming.  It is not the totality of the good news that Jesus brings, but it's part of it, and yesterday we understood together that God has been good to us.

Most of the time, we don't see the end of the story.  I often feel like some kind of Johnny Appleseed, wandering throughout the population scattering seeds, hoping that some of them take root and grow as intended, but not often getting enough chance to retrace my steps to know if it's actually the case.  So yesterday was a good reminder.

Of course, the Bible has lots of good seed imagery as well.  Here's the one that keeps coming to mind:

Those who sow with tears

will reap with songs of joy.

Those who go out weeping,

carrying seed to sow, 

will return with songs of joy,

carrying sheaves with them.

(Psalm 126:5-6)