A case of ‘Funny Legs’?
Another shift out on a ‘real’ ECP car. I was
aimlessly driving around on dynamic cover when a local crew called through on the bat phone. They were with an elderly gentleman who’d fallen earlier. He wasn’t injured but they were a little concerned that he seemed ‘confused’ and would I mind popping over to see if he had a UTI (urinary tract infection). Seems he’d had one previously and was at the end of his course of Trimethoprim, but they thought the infection may not have cleared up. “No problem, always happy to oblige”.
As I pulled up at the address there was that feeling of familiarity. “Hello, this is where Arthur lives. I wonder how he’s getting on?” Knowing the drill from last time I avoided the ‘hollering through the letterbox’ and headed round the back. As before the back door was open, the fire in the sitting room was still on ‘furnace’ though this time it was the radio that was turned up full blast. No sign of Arthur though. I found him, as before, on the bed in the front room. He was fully dressed this time.
“Remember me? I came to see you about a week ago. The crew that were here earlier asked if I’d come round and check your urine. Would you mind if we check it? I just need you to wee into this bowl.”
Well I never. Arthur was a changed person. He positively leapt out of bed and trotted into the sitting room. He turned the radio down and we had a little chat while I read through the clinical report form that the crew had left. Seems that the GP did, indeed, act on the letter that I’d left at the surgery. He’d popped round to see Arthur on the Monday and had apparently diagnosed a UTI and put him on a course of Trimethoprim. On a table, next to the crews’ form, there was also the daily log for the carers who came in to see Arthur. So, contrary to what he’d told me last time he did have a care package (or was this a new package?). More importantly though was how much more alert he was; the change was amazing. I did a urinanalysis which turned up negative on all indicators. So his UTI had gone then (if he’d ever had one). We talked some more. He was still fed up and not getting out. Not a lot more I could do really; I still think he’s depressed. Hopefully, given his age, the GP will continue to keep an eye on him. He certainly seems to be coping at home but if he becomes a frequent faller perhaps a care home might be more appropriate; at least he’d have some social interaction.
A few nights later I was asked to go and assess a patient who was complaining of ‘pains in his legs’. It was an elderly gentleman who lived with his son (I’m surprised at just how many middle-aged people still live with one of their parents). As with Arthur, the symptoms were non-specific. George described an ‘ache’ to both legs which had come on during the day. No sign of cellulitis, legs weren’t red, or hot. I thought about a DVT (deep vein thrombosis), but there was no localised pain, or any cyanosis or ‘cold spots’. To relieve the ache, George kept getting up and wandering about “I don’t know what to do with myself”. If he had a DVT this was certainly not recommended (it could dislodge a blood clot); but there was no getting him to sit still. It was almost as if he had restless leg syndrome. When he did sit down he continued to rub his legs all over. There were no other associated symptoms; no problems with his breathing, no chest pains, no headaches, nothing else to help with a diagnosis. He did have an infected toe, which was red, and for which he was being treated with a course of clarithromycin.
Then I remembered Arthur. He’d originally complained of ‘funny legs’ and the GP had diagnosed a UTI.
|I went out to the car to fetch the Multistixs….and did an urine dip (let’s see if the colours change)|
You compare the colour change on the stick with the corresponding colour chart on the tube, starting with the ‘bluish’ square at the bottom and moving up to the cream coloured square at the top. It takes 2 minutes to complete the whole thing.
|Nothing on the first set of indicators.|
|…then we came to blood. Wooo that’s a touch high!
(see the red arrow)
|and finally, the real clincher. His nitrite reading was near enough at max (green arrow),
while his leukocyte reading was nearly off the scale (red arrow). I just love that purple colour.
OK then. So it looks like George has a raging UTI; just like Arthur. I’ve never come across ‘funny legs‘ as a symptom of a UTI but there you go. Just to check things I rang the Doctor at HQ to see if I could give trimethoprim as George was also taking clarithromycin. She’s a very cautious Doctor. We couldn’t definitively rule out a DVT so she recommended that I send George ‘in’ just to be 100% certain. OK, point taken. The local assessment unit were happy to see him, so I ordered an ambulance to take him up as his son said he’d been drinking so couldn’t drive.
I wonder if I’ll get another ‘funny legs‘ patient who turns out to have a UTI.