The boy with an ouch in his haggis

The 2 year-old had been admitted with vomiting, and intolerance of his gastrostomy feeds. He also had a high fever that was put down to a red ear - otitis media. A course of co-amoxiclav seemed to be getting on top of things, when I was asked to see him because he had developed some abdominal pain.

*Matt sat on the bed watching the Fimbles on TV. He is small for his age, and was born with multiple anomalies, including a heart defect, which has been operated on, Pierre Robin sequence and an exomphalos, which has not yet been repaired. His exomphalos is covered in a thin skin, or epithelialised, and has been shown on ultrasound to contain part of his liver. The family have christened it his Haggis. One can imagine the resemblance, where it had once been covered in a moist, translucent membrane. I'm personally not a great fan of food analogies in medicine (such as 'cheesy' or caseous exudate, i.e. horrid smelly crumbly stuff issuing from an abscess), particularly before lunch, but I suppose it does help trivialise things.

Matt frowned when he saw me walk in. I knelt by his bed and asked what was wrong. "An ouch." he said, plaintively. "Where?" I asked. "Haggis", he said, pointing to the centre of his tummy. I looked over to his mom, who explained that Matt had been complaining intermittently of pain over the exomphalos over the past 2 days. "But he hasn't bumped it or anything, and it doesn't seem to bother him when he's watching TV." I established that the vomiting was getting less frequent and that he had been passing stool. Mom distracted him with a book while I felt his tummy, which was soft, including the Haggis.

I explained that it didn't seem serious, but that we would keep an eye on things. [APLEY'S LAW: in paediatrics, the further a recurrent abdominal pain is from the umbilicus, the greater the likelihood of an organic cause for the pain] - applying the principle in reverse; bit tricky in exomphalos as the lesion is right over the umbilicus! But on balance if the Fimbles can take the pain away, it's probably not serious. Matt continued to make a good recovery and was discharged home the next day.

too tired

have been constantly tired since August, too tired to do anything more than keep the house tidy and keep myself clean and fed. This rota is so anti-social (working 2 in 5 weekends and split nights) that many of my friends in Edinburgh think I am still living in London! Am too exhausted to write anything. Sometimes I feel as if I might die of tiredness.