As I jumped in the driver’s seat of Geoff and Sophie’s jeep, everything seemed “flipped flopped”. I hopped in the drivers seat, but it was on the passengers’ side- or at least that is how it appeared to me. Funny how you can just flip sides and everything seems completely different…. I know how to drive……….. just opposite the way it was done here. By the end of my short drive I was feeling more comfortable with my motor vehicle operation. By the last turn I even flipped on the turn signal without additionally throwing the windshield wipers on 🙂
But honestly driving on the opposite side of the road is not that big of a deal especially when you consider other things that could be flip flopped… such as your organs. Quite an odd transition into the clinical case which Geoff and I stumbled upon last week… but hey I’m in Botswana and odd transition or not … you learn to go with it 🙂
I remembered reading about situs inverses in Chiropractic College (aka when the organs are on opposite sides or “flip flopped” when compared to the anatomy of a normal human being) and how rare this condition was. Which is why we were surprised to discover a patient who had it amongst other uncommon health conditions. This young patient and her parents came to the World Spine Care Clinic, in search of answers. A young girl of six years she had an apparent cosmetic deformity of her right shoulder and neck. Her right shoulder was obviously elevated and appeared attached to the right side of her neck. Previous doctors told her there was nothing wrong and to not worry unless it became painful. However her parents were apprehensive with such statements and sought other opinions, finding their way to the World Spine Care Office. They mentioned their concern for the limited range of motion in her neck, and although her physical deformity went unnoticed at home, social settings were a different story. They just wanted an answer…. Something was different.
After a thorough physical examination, we sent her for Xrays suspecting a Sprengel’s deformity. After taking special views in order to get a proper view of the neck and scapulas, we were able to visualize multiple congential blocks in her cervical vertebrae and the absence of a fully formed omovertebral bone. This indicated that she also had Klippel-Feil Syndrome. Further questions for her parents about the cognitive development and specific health rated questions about the heart, kidneys, etc. We made a referral to a specialized pediatrician to oversee her condition and to make sure she gets the proper tests to rule out any potential complications.
But wait… There was more to uncover…as we were glancing at the Xrays, we noticed the heart shadow was on the right…… the wrong side. The Xray tech ran back to make sure he had put the marker on the correct side. After he confirmed he had placed the marker properly, we noticed the stomach gas bubble was on the wrong side too. This is where the flip-floppin’ part comes in…… we suspected situs inversus and sent her for an abdominal ultrasound. It was confirmed as her liver was found on her left and her spleen on her right. We found she had a horseshoe kidney that was dropped below the bladder. Another referral was made to make sure her kidney anatomy was intact and properly working. Also, it was advised that she wear a medical information band on her wrist to notify medical professionals that the organs are not in their normal position, which could pose an important piece of information, such as an emergency surgery.
After an exhausting couple of hours of information, at least the parents had answers. They were given direction on what to do next with their very special little girl. We sat down and had a long chat after all the test results and answered what questions we could. They were thankful for the answers and the time we took to thoroughly examine their daughter. Only my second week at the Mahalaype Hospital, this is an excellent example of chiropractors’ role as primary care spine specialists. It reiterates the reason I am here and completely justifies the time and money I have spent to make it happen. It is easy to forget about the ultimate vision in the demands of today’s’ world, but a simple moment of showing concern of others can bring you back to what really matters.