Gladys

“When you hear hoof beats think a horse — not a zebra.” This old adage instructs young doctors to think of common diseases first (the “horses”) rather than the rare ones (the “zebras”). The only problem is, Gladys never heard this adage.

Gladys is a 17-year old girl from a small, remote jungle community. Around the age of six, she began to experience fevers, pain in her hip and difficulty walking. Several evaluations and surgeries suggested osteomyelitis, an infection in the bone.

Over the ensuing five years, she was diagnosed multiple times with osteomyelitis, endured multiple treatments of antibiotics and surgery, and was even treated in the pediatric specialty hospital in Quito.

When she arrived at Hospital Vozandes-Shell in January 2008, Gladys had difficulty walking without crutches. Her x-rays showed significant destruction of both hips. She was initially thought to have recurrent osteomyelitis, but all of her tests including a bone biopsy were negative.

One day, she noted pain on the back of her head. She commented, “It was just like this when a hole formed on my forehead.” Indeed, palpating her forehead, there was a 2” x 2” depression in her skull, hidden by her skin and thick black hair that had gone unnoticed on prior evaluations.

An x-ray confirmed multiple “holes” in her skull. What was going on? This was not a “horse!”

Email consultation with various physicians helped narrow the diagnosis. Dr. Roy Ringenberg, a missionary doctor in Quito, suggested the final diagnosis: Langerhans Cell Histiocytosis — a rare “zebra” (three in a million).

Special pathology studies confirmed the diagnosis. In consultation with SOLCA, the national cancer hospital in Quito, she began her eight-month course of chemotherapy with a promising 95% chance of a complete cure.

Being from the jungle, Quito is another world apart for her and her dad — an urban jungle. Fortunately she’s been able to continue chemotherapy at Vozandes-Shell with monthly follow-ups in Quito, living in the free housing HVO provides and with the Charity Fund covering her care.

Gladys’ dad passes the time by volunteering on various construction projects around the hospital. And we frequently see Gladys’ smiling face and shaven head cruising through the hospital in her wheelchair. She now has a crop of jet-black hair creeping out like a crew cut. I’ve been tempted to shave a few stripes in it so she looks like the “zebra” she really is!