A Case of Respiratory Distress in a Down Syndrome Boy

12/06/2013 First Consultation – A young man with Down syndrome, age 21, came to see me along with his mother.

Presenting symptoms:

Shortness of breath with lips and fingertips turning blue after walking just a short distance. Eyes are blood shot. Has a dry hard and painful cough which is worse at night. He has to sit up and cough and has difficulty breathing with gasping on lying down. His pulse is fast and feeble. His normal breathing is “panting”. He has club nails and swollen ankles. His sleep is interrupted several times a night from coughing fits and a feeling of suffocation. He prefers to lie on his right side. He has a good appetite and prefers cooked food with vegetables. Loves carbonated drinks especially Coke. Very thirsty. Despite being obviously ill, he is always cheerful and playful and mischievous. He loves to dance and sing, laughs often and makes jokes all the time. He is cautious, neat and tidy and packs things away. Helps his mom with housework. He is also flirtatious and extremely affectionate towards his mother, literally leaning over to kiss and hug her every few minutes during the consultation.

He has a fear of the dark and to be alone. He startles at noise.

History:

-Teeth extracted at age two – teeth were crowded and decayed.

-Urological procedure (T.H.B)

-Contracted Tuberculosis in February 2010 and received treatment until August. Then contracted TB again in December and was on treatment for 6 months and had no improvement. The diagnosis of multi drug resistant TB was given and he got sent home with no further treatment or intervention.

-Course of antibiotics in April 2013 for a lung infection.

Prescription: Phosphorus 30c mornings and evenings.

03/07/13

The father came to collect more Phosphorus after noticing an improvement in his son’s breathing and energy. However there are more fits of coughing.

Prescription: Phosphorus 30c b.d. and Drosera 30c for the acute coughing fits.

17/07/2013  Follow up consultation:

The cough is much better, scarcely during the night anymore. He only coughs after eating, especially when eating too fast. He eats more than usual and prefers jam on bread. His dyspnea is 50% better and his lips are less swollen, normal colour. He has a cold at present with yellow nasal discharge tainted with blood. Plugs of mucous in the morning. He has cracks in the corners of his mouth and little ulcers inside his nose with bloody crusts inside the nostrils. His conjunctivae are still red.

The swollen ankles improved completely but lately only the left ankle became painful and edematous, preventing him from stepping on that foot. The pain is on the dorsum of the foot between the big and second toes. He has less gas than usual.

He has to sleep in a sitting position, bent forward over his crossed legs. He has become very sensitive to cold and shivers often. He has dandruff. He has a very dark discoloration of his face – similar to when he had the TB treatment.

Prescription: Kali carb 30c b.d. and a tissue salt combination of Kali mur, Calc phos and Ferrum phos to take t.d.s.

14/08/2013: Follow up consultation:

Sleeps lying down flat again and prefers to lie on his left side and on his abdomen. Feet are no more swollen and he walks normally with no more pain.

There is less coughing but still when lying down. He has to sit up to cough a bit before falling asleep again. There is sometimes coughing during the day but generally the cough is 50% improved.

He has red pimples on his back which he has had before on his face. His facial colour has returned back to normal. He can walk longer distances now with no more dyspnoea, panting or gasping. Slight redness inside his nostrils. He loves coldrinks and ice-cream which gives him mucous and aggravates his cough. He is averse to wearing a hat even when it’s cold.

He now has constipation with a large dry hard and dark stool which causes pain and bleeding. He fears to go to stool and doesn’t want to sit on the toilet for long.

Prescription: Silica 12c t.d.s.

11/09/2013 Follow up

Constipation improved much. Coughing only when talking loud and when it’s cold. He has joined a school for special needs adults during the day. Cough has been worse in the last week with cold weather. He coughed until he vomited. He seems more obstinate than usual – throws things against the floor in anger (not breakables but soft toys or clothes). He got angry when his parents brought him inside from the cold while he was watching the pretty neighbor’s girl from their porch outside. He seems more confident and sure of himself.

There are pimples on his forehead. His toes seem to get blue from the cold and his feet are painful in the evenings when coming home from school. This improves when his mom bathes him and rubs Arnica on his feet and puts his warm slippers on. His appetite has improved for cooked food and hearty meals.

Prescription: Phosphorus 30c daily.

So far there seems to be good general improvement. Next appointment in two months time unless acute condition arises before then.