I reveiwed Sarah in my medical outpatient clinic today with her Mother Karina. Sarah is now aged 18 months and has had a relatively good period in recent times. She has had a couple of months without incident, but over the last month there have been a few annoying problems such as an episode of of gastroentroenteritis, followed by an episode of tonsilittis that seemed to roll on to some upper respitory infection with cervical lymphadenitis. This all settled down then came an episode of Apnea with associated peri oral mottling while she was asleep. She had episodes like this about 12 months which I believe were very similiar and probably the same mechanism.
Sarah has had some seizures in the past and has had a videa EEG which was normal. Karina does have Buccal Midazolam at home to be administered should she have a prolonged seizure lasting more than 5 minitues.
Developmentally Sarah is doing Brilliantly. Her communication system is evolving well, with 5-10 single words, a lot of babble and good verbal responsiveness to verbal commands emerging. She commando crawls for effectively now, and sits stably. She pulls to stand and is beginning to cruise the furniture. She eats everything and is sleeping quite well.
The Endocronologists of course, are monitoring her diabetes and her recent HbA1c in July was 9.6, and I understand that her basal rate has been increased to try and bring this down a little. She is having some hypo's but these havnt been terribly troublesome.
Sarah is about to commence childcare two days a week which I think will be excellent for her Social development. Karina is trying to access an aide and I have sent a letter of support.
Sarah looks excellent today. She was happy and interacting delightfully, and played at a developmentally appropriate level on the floor. Her weight was 7.5kgs which is an increase of 220 grams over the past week.
Sarah has developed acholic stools (known to have schleriosing cholangitis). She is anicteric and remains well. I have asked for urgent review by gastroenterologists.
t is wonderful to see how well Sarah is doing. I am on sabatical for a few months and I look forward to seeing her again when I return.
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