Oyuntuya Gundjalam - Systemic sclerosis (Mongolia) Posted on July 31, 2012

Name: Oyuntuya Gundjalam            
Sex: Female
Country: Mongolia
Age: 38
Diagnosis: Systemic sclerosis
Admission Date: June 14, 2012
Days Admitted to Hospital: 28

Oyuntuya Gundjalam is a 38 year old female. About three years ago all of her fingers got cold and turned pale. The skin throughout the body became swollen and the skin on the face became tense. The range of motion of the joints was limited. She was diagnosed with scleroderma. Despite being prescribed medication, the symptoms got progressively worse. Additional symptoms included deformity of the joints and ulcers which did not heal for a long time. Oyuntuya often felt fatigued and had occasional palpitations. There was also shortness of breath, dry mouth, dry eyes, itchiness and swallowing difficulty. During the past 6 months, the symptoms rapidly got worse. Main symptoms: scleroderma facial features, generalized muscle weakness, restricted movement of the mouth and tongue. The skin became hardened, swollen and thicker throughout the body. The joints of all four limbs had restricted movement. All the fingers were flexed and deformed. The wrist joints were almost rigid. There were multiple obsolete ulcers on the surface of the skin on the fingers' ossa articularia, and there was swelling and congestion around them.

Admission PE:
Bp: 98/81mmHg; Hr: 90/min. Through auscultation, the respiration in both lungs was clear, with no dry or moist rales. The heart rhythm was regular, with no obvious murmur in the valve auscultation area. The abdomen was soft, with no tenderness. There were no palpable masses. The shifting dullness was negative. The skin on the ends of all four limbs had white marks, freckle like pigmentation, hypopigmented macules and patches. There was also hypotrichosis, skin thickening and shininess. All of the fingers and toes were deformed. (Not including the hallex)

Nervous System Examination:
Oyuntuya was alert, with fluent speech. Her memory, calculation abilities and orientation were all normal. The muscle tone around the mouth and eyes were higher than normal. She had restricted movement with opening the mouth or stretching the tongue out. Both pupils were equal in size and round, the diameter was 3.0mms, the eyeballs could move freely and the pupils reacted normally to light stimulus. There was no nystagmus or strabismus. The forehead wrinkle pattern was symmetrical. The bilateral nasolabial sulcus was equal in depth. The tongue was centered in the oral cavity. The muscle strength of all four limbs was level 5 and the muscle tone of all four limbs was normal. The coordinated movements were normal. The sensation in the distal end of all four limbs was slightly diminished. The tendon reflexes of all four limbs were normal. The bilateral palm jaw reflex was negative. The pathological sign of both lower limbs was negative.

Treatment:
Oyuntuya Gundjalam was given treatment in order to expand the blood vessels in order to improve the blood circulation and was also given nourishment for the neurons. She also received treatment to protect the heart and enhance the body's resistance. This was combined with physical rehabilitation training.

Post-treatment:
Oyuntuya Gundjalam has normal facial expressions. She feels stronger throughout her whole body. The endurance has improved. The heart sounds are stronger through auscultation. There is no longer any occasional ventricular premature beats. ECG: sinus rhythmia, mild S-T segment depression. The skin throughout the body is thinner and softer than before. The tightness of the skin has been reduced. The swelling throughout the body has been alleviated. The skin color throughout the body is almost normal. The pigmentation and depigmentation are not as severe. The eyelids are relaxed and the range of motion has increased. The skin around the mouth is less tense. The movement of the mouth and tongue is more flexible. The blood circulation in the distal end of all four limbs has improved. There are visible blood vessels on both hands. The color of the skin is ruddy. The skin temperature is closer to normal. The deformity of the toes is not as obvious. The limited movement of the four limbs is not severe and the movement has different levels of improvement, and both knee joints have had the most improvement. The ulcerative surface has scabs and has dried, with no exudation.

Oyuntuya's family member emailed to us:

2012-08-03

Terri,

Just a follow up note, we are still seeing slow improvements in Tuya's condition, the increase in weight has been very good, flexibility in the legs and strength has improved very much, the ulcers on the upper right arm have to an extent cleared and improvement in the skin condition colouring on both arms is improved.

The digital ulcers are still an issue however no new ulcers so that is good and seeing a couple of the ulcers reduce in size however nothing definitive on some of the others.  The ulcers are the primary concern at present and have the greatest effect on her quality of life and will see how they progress over the next 3-4 weeks then seek help from a provider to attempt to clear these up.

Tuya has had considerable rest and is taking and being taken good care of since her return to Mongolia from the 4 week SCT in Beijing.

I would like to send my most sincere thank you to Dr Wu and the staff at the hospital for looking after her so well during the treatment period and the efforts to attempt to make life better for Tuya.  The results have been good to date and hope we have further improvement in her condition.

I have included her latest test results and hope these are what are required for revision.

Best regards

Doug

2012-09-01

Dr Terri,

Please find attached Tuya's latest medical checkup on 30th of August
and her weight is today 56.4Kg and previous early August was 55Kg so that is
good, may be just seeing some relaxing of the skin on her upper legs as skin
was tight and now see some soft skin? Keeping our hopes high for improvement
and keeping a very good nutritional diet, warm and relaxed life for her as
possible and she continues with her exercises.

Best regards

Doug

2012-12-11

Terri,
    please find Tuya's most recent medical results, health is generally good considering and she will be in Beijing to go for her last IVIG in mid January, her medications will be running out down at that time and will be looking to resupply.

Pleae have a review of the results and advise if Tuya needs to make any changes to medications at present.

Best regards
Doug

Date:2015-6-17

Dr Susan,
Tuya is still appears to be making improvements with her general health, first time for 3 years have been able to take blood from the veins in her forearm, skin has softened in that location and can see the veins..... her flexibility has improved and the hard skin on the inside of the right arm is looking to be softening somewhat.  Right arm flexibility movement is improved and can nearly straighten that arm.... it is still amazing to see the changes over the last 12 months and quietly hopeful that improvements continue.

Please review the attached medical and advise for the next 3 months supply, our son in Beijing will make arrangements once have the review and medication requirement completed.

Many thanks and best regards

Douglas