Unlocking The Italian Doc's Heart. Kate Hardy

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СКАЧАТЬ other than a professional relationship with her new colleague. After Danny, as far as she was concerned, love was completely off limits. She didn’t trust her judgement any more, not after she’d got it so badly wrong with him. She had a family she adored and a job that fulfilled her. She was lucky. Wanting to have the same kind of closeness with someone that Lucy had with Will, and a baby of her own—that would just be greedy.

      * * *

      Jenna’s first patient in clinic the next morning, eight-year-old Maddie Loveday, was a puzzle.

      ‘It started six weeks ago,’ Maddie’s mum said. ‘She’d been at football club and came home with really red cheeks. It looked a bit like windburn, but it seemed a bit odd because it’s not that cold and windy at the end of April. Then she went down with a really nasty virus. It hit the whole family and even I was in bed for three days with it.’

      A rash and a virus. Two things that were really hard to narrow down, and half the time there wasn’t an effective treatment and you just had to wait it out. Jenna smiled and waited for Mrs Loveday to continue.

      ‘The rash didn’t go away and it spread down her arms and legs. She said her legs hurt, she had pains in her tummy, and it hurt to swallow.’ Mrs Loveday grimaced. ‘Then she was really down and a bit weepy—which just isn’t my Maddie. I took her to the doctor.’

      ‘What did your GP say?’ Jenna asked.

      ‘He thought it might be allergic eczema, but my youngest has eczema and I’m really careful with laundry detergent and conditioner. Maddie’s never had any kind of reaction to food, and that rash didn’t look like any eczema I’ve ever seen.’ Mrs Loveday sighed. ‘I think he referred Maddie here just to shut me up.’

      Seeing that she was close to tears, Jenna put a reassuring hand on her arm. ‘Mrs Loveday, when our mums tell us that their kids aren’t right, we listen. You’re the experts on your kids, so you know when there’s something wrong. It’s our job to listen and help you.’

      ‘Thank you.’ Mrs Loveday swallowed hard. ‘I know you can’t believe everything you read on the Internet, but I wondered if the rash was some kind of autoimmune thing.’

      ‘That’s a possibility,’ Jenna said. ‘Rashes have lots of different causes and they can be really tricky to diagnose. And you’re absolutely right not to believe everything you read on the Internet, because there are a lot of scaremongering stories out there.’ She turned to the little girl. ‘Maddie, is it OK if I examine you?’

      Maddie nodded.

      Jenna looked at the rash. Coupled with the pain in Maddie’s legs and tummy, and her difficulty in swallowing, the rash could well be a sign of an autoimmune problem, but Jenna wasn’t sure quite which one. ‘I’ve not seen a rash like this before,’ she said. ‘I think you’re right, Mrs Loveday, and it’s very likely an autoimmune disease. Do you mind if I have a quick discussion with one of my more senior colleagues?’

      ‘As long as you can find out what’s wrong with Maddie and make her better, then do whatever you need to,’ Mrs Loveday said.

      Jenna headed for the offices. None of the consultants was around, but Lorenzo was in his office. Given that he was her senior and had three or four years’ more experience than she did, there was a chance that he’d seen a condition like Maddie’s before. She rapped on his office door. ‘Renzo, have you got a minute, please?’

      ‘Sure,’ he said.

      ‘How are you on autoimmune diseases?’

      ‘I’ve treated a few in my time,’ he said. ‘What are you looking at?’

      ‘I’m not entirely sure.’ She filled him in on Maddie Loveday’s medical history and symptoms. ‘I can see you’re busy, so I’m sorry to ask, but I’m a bit stuck. I don’t suppose I could borrow you to come and have a look at her, could I?’

      ‘Sure,’ he said, to her relief, and saved the file he was working on.

      After Jenna had introduced him to the Lovedays, Lorenzo examined Maddie’s skin. ‘Mrs Loveday, has anyone talked to you about juvenile dermatomyositis or JDM?’ he asked.

      Mrs Loveday looked surprised. ‘No. The GP just sent me here.’

      ‘It’s pretty rare, with about three in a million children being affected, and girls are twice as likely as boys to have it,’ Lorenzo said. ‘Basically “dermatomyositis” means inflammation of the skin and muscles, and from what Jenna’s already told me and what I can see here, it looks to me as if that’s what’s happening to Maddie.’

      ‘What causes it?’ Mrs Loveday asked.

      ‘We don’t actually know,’ Lorenzo said. ‘Jenna told me about Maddie’s virus, and in the cases we know of there was a virus involved.’

      ‘So how long does it last? Will it ever go away? Is she going to get worse?’ Mrs Loveday asked.

      ‘Sometimes a child has one episode of JDM that lasts for a couple of years and then goes away for ever; sometimes it comes back again after a few years of remission; and sometimes it doesn’t go away at all and needs managing for the rest of the child’s life,’ Lorenzo said. ‘I’m sorry to be so vague, but the way the condition develops really varies. What I can promise is that we’ll sort out some treatment so Maddie can live her life just as if she hasn’t got JDM.’

      ‘So what does this JDM do?’ Mrs Loveday asked.

      ‘It makes the muscles weaker and causes pain, so that’s why Maddie’s talked about her legs hurting and having tummy pains,’ Lorenzo said. ‘The inflammation tends to affect the large muscles around the hips and shoulders, so that means it’s harder for Maddie to walk, climb the stairs, get up from the floor or lift her arms. And it’ll make you tired, Maddie.’

      The little girl nodded. ‘Since I got the rash and tummy pains, I can’t run as fast when I play football, and I’m really tired by the end of the match.’

      ‘So how do you treat it?’ Mrs Loveday asked.

      ‘Medication and physiotherapy. I’d like to admit her to the ward for now,’ Lorenzo said. ‘Maddie might need to stay for a couple of weeks so we can get her condition under control—we can give her some medication to help, but there will be other treatments as well. We’ll start with steroids at first and that’ll really help with her muscles and her skin.’

      Mrs Loveday looked shocked. ‘Steroids? Isn’t that the stuff bodybuilders use?’

      ‘No, these are corticosteroids,’ Jenna explained. ‘They’re naturally produced by the body, too, and we use them to bring down inflammation—that will stop Maddie’s muscles hurting and it will also sort out the rash.’

      ‘We’ll also need to do some tests, including an EMG,’ Lorenzo said. ‘That’s a special scan which shows us the electrical activities in your muscles—and I promise it doesn’t hurt, Maddie.’

      ‘Good,’ the little girl said. ‘Because I really, really hurt right now and I hate feeling like this every day. I just want to play football.’

      ‘We’ll make it stop hurting,’ Jenna promised.

      ‘We СКАЧАТЬ