15 Dec 2023

On a home visit yesterday to a village client, we saw him lying listless in bed, eyes open and following us but no interaction. It was 11 am. His mother said he was not getting up and she had given him water sips while lying down. Wait wait. I told her nothing is to be fed by mouth in the lying position to anyone. There is high risk of food entering the air pipe and lungs.

We had visited after over a month as we are short staffed. Human Resources in Punjab are a major challenge with the ongoing brain drain and the general mediocre standards of conduct in this city. A driver had rammed our van at high speed into a car. The van is still getting repaired. 

But back to the listless APAAR client . The mother said he is sometimes like this. But usually up and active. We talked animatedly to him as we had met after some weeks. We reminded him of the wheelchair outing he goes on with us. He showed no excitement. Twenty minutes into our visit, the mother revealed that he had a seizure this morning and yesterday as well. He had been seizure free with the Phenytoin we have started him on all summer , so I asked if he was taking the medicine. He does not to be honest the mother said.

There was one pill in the bottle she showed. We immediately messaged his sister to buy a bottle on way home today. Powder it and put in his tea. Shall we help you give him now ?

"But he has not eaten anything."

MYTH : only a handful of medicines need food to be had before them. MOST do not. Please don't skip medicines if no breakfast/ meal eaten. 

The mother had never seen him seizure free except this summer with this medicine and a short time before when he got medicines form approbate hospital. He had survived the seizures . So she has normalised them . She did not even tell us he has been having them. A post-ictal state is common after seizures- the patient is fatigued and just lies down or sleeps for some hours. 

I educated her on the risk of injuries with seizures as well as risk of mental health problems. Seizures must be treated medically. 

We have now added to our checklist for well being phone calls of CBR clients - when was the last seizure ? Is he taking seizure medicines ?