# Anyone recognize this condition?



## RedBlanketRunner (Nov 18, 2019)

Female, 40s, slightly overweight, healthy, active lifestyle. She has had this condition since childhood, as long as she can remember. Never diagnosed.

She walks with toes pointed out almost to 45 degrees. Very short steps. (Duck walk). She keeps her pelvis noticeably thrust forwards, shoulders very far back. I gave her a full body assessment and found no abnormalities or deformations. No scoliosis, bone and musculature side to side uniform even. Possibly unrelated, she suffers near constant mild chronic fatigue. No other symptoms.
She cannot afford to see an ortho specialist.

Ring any bells?


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## joshrunkle35 (Nov 18, 2019)

Genu Valgum?

Send them to be evaluated by a medical practitioner.


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## CCCSD (Nov 18, 2019)

I think you meant Medical Professional...as in NP/PA/MD.


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## DesertMedic66 (Nov 18, 2019)

Why did she call 911?


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## CCCSD (Nov 18, 2019)

Traumatic bilateral otitis media with sympathetic gait dysmorphia.


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## joshrunkle35 (Nov 18, 2019)

CCCSD said:


> I think you meant Medical Professional...



No, I didn’t.


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## RedBlanketRunner (Nov 19, 2019)

joshrunkle35 said:


> Genu Valgum?
> 
> Send them to be evaluated by a medical practitioner.


Certainly seems a likely place to start. 

It should be kept in mind, this is strictly third world. Anything beyond basic medical care is ignored and unaffordable. In this instance, typical, a facilitator contacts one or more NGOs to obtain financial assistance. Then physicians that may be able to diagnose the condition and accept the patient are screened. Further negotiations progress until a physician establishes a price tag for the diagnosis. Then funding is set aside, an appointment is made and transportation is arranged. Repeat the process as diagnosis then treatment progresses.


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## joshrunkle35 (Nov 19, 2019)

RedBlanketRunner said:


> Certainly seems a likely place to start.
> 
> It should be kept in mind, this is strictly third world. Anything beyond basic medical care is ignored and unaffordable. In this instance, typical, a facilitator contacts one or more NGOs to obtain financial assistance. Then physicians that may be able to diagnose the condition and accept the patient are screened. Further negotiations progress until a physician establishes a price tag for the diagnosis. Then funding is set aside, an appointment is made and transportation is arranged. Repeat the process as diagnosis then treatment progresses.



I guess I just don’t understand that system. I lived in a 3rd world country (Guatemala) for 2 years and access to doctors, pharmacists and even a few physician’s assistants was expensive but still affordable for just about anyone. If you couldn’t pay, there was always some connection to get medical care.


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## RedBlanketRunner (Nov 19, 2019)

joshrunkle35 said:


> I guess I just don’t understand that system. I lived in a 3rd world country (Guatemala) for 2 years and access to doctors, pharmacists and even a few physician’s assistants was expensive but still affordable for just about anyone. If you couldn’t pay, there was always some connection to get medical care.


The system here is complex. Very complex. Needlessly so. Read on if you want to work on a classic migraine.
First, all Thai's that cannot afford their own insurance, roughly 80% of the population, are assigned a hospital according to their location. Thus they get what services that particular hospital offers. Then the government implemented a form of socialized medical for that strata of the population. 30 baht, a bout $1, deductible, at that particular facility. The physicians that perform services under this program get, as you can imagine, chump change pay for their services. So every center of population has one or more welfare hospitals which are very often bare bones. The hospital local to me is typical. Acute care but no regular PoD. All emergencies brought there go into a holding pattern until the doc shows. Their diagnostics are limited to an x-ray facility and what the nurses have been trained to do. They can do 12 leads as example, as the most sophisticated cardio run up.
Then there are several million transient workers that are not Thai nationals. If the worker is highly valued, the employer buys insurance. Common laborers however go to the welfare hospitals where they go into a queue behind the Thai nationals, first come, first served. The queues can be several days long for non emergencies.
Then there are a few million hill tribe peoples. They are stateless but may apply for temporary status with immigration where they could qualify as a Thai for the 30 baht medical. My mother in law as example.
And then a LOT of illegal immigrants. The conflicts in Burma supply a never ending stream of these people. They are all considered hill tribe and thought of government wise as trying to bilk the system.
The above is somewhat simplified.

So as an example, my wife, Thai national assigned to a reasonably upscale hospital. She required a CAT scan. Only the upscale hospital has one. I took her there and they required a 5,000 baht up front deposit. Quite normal.

Another example. We have one hospital in the area that handles HIV positive or active AIDS patients. If no private insurance, the population for about 100 miles in all directions has to go there.

But on the bright side, Thailand is miles above Laos next door, and much of Cambodia. We have a constant stream of border jumpers trying to sneak into the Thai medical system. Then down in Malaysia it's first world more or less and below that, Singapore which beats all medical systems in the US cold. So it's all about locale to locale.

So, for this woman mentioned in the OP. She's on the 30 baht medical. Her condition is off the books. Childhood diseases are purely live with it. She makes decent money, $15 a day, but has a family to take care of. All totaled about 12 people. So she has no savings and no spare money for any medical care. She was brought to my attention, a facilitator, and I threw her hat in the ring with some NGOs. Fishing. If one or more of those are willing to take her on she goes on their waiting list. When she comes up to the top inquiries with physicians will start. The physician usually wants to know what s/he will be getting into. So I got a heads up. She will be coming up on the waiting list. Start the wheels turning. Thus my fishing here, getting some vague idea of which physicians to canvas for when her name comes up.
Since the physicians will almost certainly be working on a limited budget, we do doctor juggling. Some will take in any patient we send. With those there is always a waiting list and prioritization is required. Avoiding wearing out his good graces. This in itself can get pretty complex as I'm sure you can imagine. Maybe one doc will see her and instantly want to toss her to a specialist. Another doc is a qualified specialist but his gratis work is back logged for months. Some docs work gratis, but any diagnostic equipment supplied by a hospital has to be paid for up front. And so on.
Then in the case of this low priority woman, she will probably need therapy. Repeat the canvassing there and logistics will probably enter into it as she may get a therapist a hundred miles off.


PS Snivel and ***** time. And recently a monkey wrench tossed into the works. We utilize clinics a lot for rudimentary diagnostics. Then a certain president implemented the Mexico City Policy, the global gag rule, and we lost about 80% of the clinics. Many had to shutter completely, numerous others severely curtailed what services they offer.


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## akflightmedic (Nov 19, 2019)

Is your name Ed?


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## Summit (Nov 19, 2019)

Bow leg? Knock kneed? Wide wrists? 
I mean rickets is not a perfect match but the presentation varies widely and you don't have to have scoliosis. A picture of the patient and gait would be revealing. 
My best guess is rickets because it's not ringing a bell for inherited syndromes like Legg Clve Perthes or childhood infectious sequela so I'm thinking developmental nutrition. If I thumbed through my Netter books it would probably fill out a longer differential.


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## FiremanMike (Nov 19, 2019)

CCCSD said:


> Traumatic bilateral otitis media with sympathetic gait dysmorphia.



Thankfully Red was able to give a quick few mouth-to-mouth breaths and re-inflate her pelvis..


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## Scott33 (Nov 19, 2019)

akflightmedic said:


> Is your name Ed?



Well, it's becoming increasingly evident that his last name is 'Brown'.


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## RedBlanketRunner (Nov 19, 2019)

Summit said:


> My best guess is rickets because it's not ringing a bell for inherited syndromes like Legg Clve Perthes or childhood infectious sequela so I'm thinking developmental nutrition.


Always a possibility. The diet of some groups of people is outright frightening. Offsetting that in much of S.E. Asia is people are very big on fruits and veggies which are extremely abundant and very cheap in all local markets. One major watch for is the greasy pork and rice 3 times a day groups.

Reminded me of this one woman. Childhood toe walker. Had surgery. Minor improvement and called it good. They missed rickets, CP and Musc. Dys.


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## GMCmedic (Nov 19, 2019)

Its Lupus


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## RedBlanketRunner (Nov 20, 2019)

Summit said:


> A picture of the patient and gait would be revealing.


I got her to pull her skirt up above her knees. (Thai's are extremely modest), Knees touch together, ankles some distance apart. I don't understand why her toes are pointed so far to the sides. Time for an ortho doc to give her a full once over.


RedBlanketRunner said:


> Reminded me of this one woman. Childhood toe walker. Had surgery. Minor improvement and called it good. They missed rickets, CP and Musc. Dys.


My comment was presumptuous. They may have known and were just trying to give her a few functional ambulatory years.


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