Cellulitis

I was about to take my siesta on a Sunday afternoon when my husband rushed into our room telling me I have a patient waiting in the living room. I was really tired but I had to put up a smile. I saw a two year old boy playing with my son's toys, apparently not in pain but with obvious hyperemic and edematous left foot. The swollen foot to me looked like cellulitis.

The parents said it started as two small vesicular lesions on the lateral aspect of his foot and because it was itchy the child would scratch it. The next day, the whole foot became swollen and the child would limp when he walks probably because of pain. They brought him to the nearest hospital and were told that their son needs to be admitted. They were surprised because they knew how much it'd cost them if they have the child hospitalized. So, they decided to see me for second opinion.

On examination, I noticed several weeping, crusted wounds on both his feet. The biggest one was on the lateral aspect of his left foot which was swollen. It was very warm and hyperemic. The child does not complain when I move it, apparently he can tolerate the pain. My initial impression was right, it was cellulitis.

Cellulitis is an inflammation of the soft tissues of the skin brought about by bacterial invasion. The vesicular lesions (which was scratched) became portals of entry for the Streptococcus or Staphylococcus bacteria. Entry to the skin gives these bacteria access to several blood vessels hence, the chance of it spreading in surrounding tissues is fast. The worst that could happen is infection of the bone which could lead to osteomyelitis, which would be harder to treat.

I had to tell the patient that they were advised admission because of three things: 1. cellulitis spreads fast, 2. IV antibiotic may be necessary to control the spread and 3. they cannot stop the child from scratching the lesion much more from playing in the soil. They understood me very well but they're concerned about the expenses. The husband is unemployed and the mother works as a crew in a fastfood chain.

Times like this, I always feel bad about the Philippine healthcare system. While the rich enjoy the very expensive hospital suites, the poor are left in the streets and the middle class could not afford the cheapest room. Sometimes you want to admit them and take care of the costs but you also know that they will not be spending hundreds only but thousands as an IV antibiotic costs more than a thousand.

With strict intruction to the mom (and prayers), I prescribed an antibiotic, Paracetamol and topical cream. I told her to give the drug every 6 hours and not to miss a dose. She has to wake the child if need be. I also advised them on proper wound cleansing and to keep the child inside the house. I told them to observe for fever and check the swelling. If the swelling reaches the lower leg at midnight, they have no choice but to bring the child to a hospital. If not, I will see them today in my clinic.

Is it me or God doesn't want me to take my rest? I am not complaining, it's just that my work really demands that I stay on my feet 24 hours a day, 7 days a week. I know God gives this to me because He knows my capacity. I just hope all doctors get up on their feet and smile at their patients even if tiredness seem to cripple them.

Here's to hoping that the child gets well and would not need hospitalization. I'll keep my fingers crossed until I see them this afternoon.