Health Notes

Not Just A Cold…

I look at my schedule every morning with my assistant.  We troubleshoot things—who needs a lab test or an Xray before being seen, or an ECG or a wheelchair; would a patient’s needs be better met at an Emergency Room rather than our primary care office.

One day on reviewing the list, we found a 2 year old girl presenting with upper respiratory symptoms—a cold.  I’d seen this family before.  All of them actually.  This was when I used to deliver babies and this was one of them.  I met them when they were newly pregnant, excited, young, and ushered them through a normal pregnancy and birth.  They were a diligent, devoted couple, bringing in the baby for routine checks, getting vaccinations, asking the many questions new parents ask about their baby—when to start what foods, when to wean, what to expect at every stage of development.

They wanted to offer their child the most healthful experience they could:  whole foods, avoiding sweets, reading regularly.  I encouraged them to ask questions.  I gave them resources and guidelines and hand outs that they devoured. Medicines have a role, they recognized, but they would prefer to avoid them if not needed—a philosophy I have long encouraged. 

So I knew when they brought their child in today, they were really concerned.  It wasn’t something they could handle at home.

They brought in 2-year-old Mindy who was not her inquisitive, bouncy self.  She was grumpy.  More than grumpy, she was inconsolable.  Loud, crabby, crying.  Slight fever to just over 100F, a bit of a cough. But dry, not making tears when she cried.

They had tried the home remedies: cool compress, warm apple juice, lots of hugging and holding, hoping for rest.  I had reviewed with them that over-the-counter medicines—cough suppressants, expectorants, decongestants and the like—offer little help and, in very young children like Mindy, can be plain unsafe. 

The physical exam was impressive mostly for her cough and low oxygen saturation levels.  And the crying.  The crying without tears.

I let the family know she needed to be admitted to hospital—she was dehydrated and they would not be able to keep up with her fluid needs at home.  I contacted the hospital and admission was arranged.  As I did in those days, I later went to the hospital to fine-tune the orders and check in on the little family.  There they were resting, the child was not crying, and the young parents were finally able to get some sleep.

It took two days to slowly hydrate the child—go too fast with intravenous fluids and you risk brain swelling and death.  Within 24 hours, though, Mindy went from inconsolable to cranky to finally able to sleep and soon to her lovely little inquisitive self.  A final set of labs confirmed she was now stable enough to  go home.  The common cold had compromised her to the point that she could no longer fight off an infection that ultimately had become a pneumonia.  Finally, able to go home, the exhausted but exhilarated family hugged me at the door as I saw them out.

Never be afraid to ask for help, I thought.  We can’t always manage illness at home even armed with the best of intentions.  Be ready to step it up if your remedies aren’t working.  No telling if Mindy would have survived if her parents hadn’t come in when they did.  But then again, they knew me and I knew them well.  We trust each other to do the right thing and that’s exactly what we did.  

Dr Hoffman

Dr. Rebecca Hoffman is a Family Practitioner and works at Kaiser Permanente in Salmon Creek, which is in Vancouver, Washington. Interests include using diet and healthy living to stay healthy and attending to mental health and its physical manifestations. Personal interests include hiking, jogging, music (she plays the harp), dance, theater, storytelling and writing. She lives with her husband and two daughters.

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