Boy 2.0's urgent care doc, you are NOT OUR FAVORITE

Miscellaneous and Personal Stuff I Must Share
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Boy 2.0, age 11mos, was sick a week ago with a virus. High fever, runny nose, sore throat (I saw the blisters in the doctor’s office–yowch!), the whole shbang. After three days, the fever broke, and after five days, he was his normal self.

After seven days, he spooked us. In the middle of the night, his fever shot up and he developed an odd, moany cry and a deep, disturbing cough. He was still able to rest, and the ibuprofen kept the fever sane, so we opted to wait a few more hours until morning. We took him to urgent care as soon as they opened, where one nurse got a lowish O2 level of about 92-93. His fever was back to 103 and change, and he looked weak and pale. His ears, throat, and chest seemed fine. The doc was confused by the low O2 levels since his lungs were clear, and disagreed–he had them redone. That time, he scored a 97, and the doc marked it up to nurse error.

The urgent care doc was distracted by a benign rash Boy 2.0 has on his face–it’s a genetic condition, and makes little bumps but isn’t red. I told him what the pediatrician had called it–keratosis pilares. We reiterated our concern was with the odd cough, and I pointed to Boy 1.0 (also with us) and said, “This isn’t our first time around. We’ve dealt with a sick kid many, many times, but this is different. I’ve never heard a sound like that.” The doc remained focused on the rash and the fever and felt it was parvovirus/fifths disease. Huh? I looked it up when we got home, and it seemed a mismatch as the rash wasn’t angry red, wasn’t there after the fever, and well–he’s had this rash for months and it seems completely unrelated. But hey, I didn’t go to medical school.

Boy 2.0 saw his pediatrician today, who almost immediately made the diagnosis: croup. It makes total sense. The barking cough, getting worse at night, worse when upset, etc. It can be dangerous in the first few days when the airways are most constricted, but now, the danger is past and he’ll likely just have a runny nose and cough for a few weeks.

The urgent care doc was looking in the wrong direction. Sure, his lungs were clear–because the problem was in his trachea. It can cause low O2 levels, in which case treatment is urged.

Croup is often treated with steroids. Had Boy 2.0 had a steroid shot on Sunday, he could have been much improved in hours instead of days.

I know doctors make mistakes. It’s just unnerving when it’s at my infant son’s expense.

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3 of us 4 kids were born in Vermont; I am quite familiar with what croup sounds like, and don’t think I could forget if I wanted to. At least one of us got it every year.

It was treated with fluids and bedrest and a humidifier, if I recall correctly. Maybe some Vicks; lots of Vicks! On the chest, under the nose, in the humidifier…
I never thought about it being dangerous, just scarier than your average cough.
Hrm.

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It’s dangerous-ish, and less so now than it once was. I use the word, btw, because the doctor did–saying that it can be dangerous in the early part of the illness, and then saying that now Boy 2.0 is out of danger. Still, I’m sure he wasn’t saying Oh Noes!, and I’m not either. FTR, it’s not like I’m angry over a grievous misdiagnosis; I’m just irked that the urgent care didn’t identify this so my son could have had a little easier recovery. I’m not going to throw rocks or even write a strongly worded letter–just grumble in irritation on a message board.

Humidifier sounds good–and oooh, Vick’s. I have some, though I dare not awaken the Little Sleeping Giant to rub it on him tonight. I shall tomorrow night, though! Totally forgot about that.

Thanks for the reminder!

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the home remedy for croup here is to take the kidlet outside, especially in winter - cold air helps to open the breathing passages. some friends of ours had that experience and took their little one outside while waiting for the ambulance, and it seemed to help. their little guy was okay, because of the quick diagnosis and treatment.

agree it’s scary when there’s a misdiagnosis like that - glad that Boy 2.0 is doing better.

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Not disagreeing with other posters comments, but I’d add that croup can still be pretty dangerous. From the age of 2-14 (or so) I had croup (or, after a certain age, a form of bronchitis with the same symptoms) every year. In fact, my earliest memory may well be being about two years old and dancing (whilst singing Zippidy-Doo-Dah, actually) when I was no longer “bubble boy” in an oxygen tent. That was about 30 years ago.

During the remaining years I had it (every goddamned winter), I was given cough syrups with codeine after being spending a day or five in the hospital. Every goddamned year. And I’d sound croupy until about March. Fortunately, my mom was a nurse - so at least there was good at-home care for me (heh… I’m probably the reason she quit nursing for a decade - too much nursing at home).

Keep an eye on the kiddo and good luck. It’s a really unpleasant experience. I remember many times feeling like I was going to suffocate because I couldn’t breathe in between coughing spasms. Poor little Boy 2.0.

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Many years ago, I found a small, superficial lump during a breast self-exam. I went to the university’s health center, they sent me to “a specialist”, and he did something similar to what the OP describes, in that I was worried about “a small lump I got recently” and he kept saying “you have cysts” - yes, they’ve been there for about 12 years, which is how long I’ve had tits! The small lump of fat dissolved by itself, the cysts are still there 17 years later.

I understand doctors looking at more than what the patient is worried about; they actually should: it’s important both because people aren’t made of legos (what hurts in one part affects the rest too) and because something a patient doesn’t see as important (it doesn’t hurt) can be - but yes, it’s terribly frustrating when you say “my arm is bleeding, I think this stuff sticking out is bone” and the expert (be it a doctor, mechanic or whatever) answers “oh my, you’re so tanned, are you aware that sunbathing without adecuate protection may cause skin cancer?”

Glad the kid will be ok.

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nm

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You can get keratosis pilaris on your face? Since it’s not red, I assume it’s the kind I have, alba…they claim “most people” outgrow it by 30, but I’m not most people then. sigh. It seems to get much better when I’m taking vitamin D (4000 IU/day) and flaxseed oil, and some people claim that vitamin a and b2 supplements help them too. I hope by the time Boy 2.0 is school-age there’s a real cure for it.

Anyway, I’m glad his real doctor figured out what was wrong :slight_smile:

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When you mentioned blisters on the throat, my first thought was Hand, Foot and Mouth, but that normally hits in the summertime.

It also sucks most wholly. My poor kid didn’t eat for a week.

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With symptoms limited to the mouth, I would suspect herpangina, both are caused by different strains of the Coxsackie virus (hehe, still makes me laugh).

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I love the Dope. Seriously. Does sound like Boy 2.0 had herpangina (giggle coxsackie giggle) two weeks ago. I’m unsure if this past weekend it was the same virus relapsing (he did have red tonsils, though I’m not sure if there were blisters), or if he had recovered from virus #1 only to get nailed with virus #2 days later. I’m thinking a family get-together is to blame–o Veteran’s Day, we gathered at my mother’s with my sister and her son. My nephew was just starting to get sick–two days later, Boy 2.0 fell ill, as did my mother. Four days later, my sister did. I think being teachers regularly exposed to everything, hubby and I were more or less unaffected. That’s my theory, at least.

With the exception of an occasionally seriously snotty nose, Boy 2.0 seems fine today. Geez, these little guys can get ridiculously sick quickly, then snap back almost as quickly.

elfkin, I’m not convinced he has keratosis pilaris–although he does have bumps on his upper arms and cheeks. I’m kind of hoping it’s infant milia instead. I suppose I should be listening to the one who went to medical school (and specializes in children) instead of myself, heh. Great tips–thank you!

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This thread is useless without pics. That was Boy 2.0 sleeping off the fever from the first round of sick–this was him the day before, flush with a 103+ fever on daddy’s chest.

You can see why daddy DeathLlama calls him The Sweetness.

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All together now:

“Awwwwwwww - what a cutie!”

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Parvo virus does come on really quickly - last year, in the space of a week, Mrs Piper, the Piper Cub, and I all got sick.

Mrs. Piper was diagnosed with flu - real flu, needing Tamiflu.

Then shortly afterwards, the Cub came down with parvovirus - and in the space of a few hours went from busy little guy to just wanting to be held, with fever and rash.

When I took him in to the doc, I said I wasn’t feeling well either. He looked at me and said: “You’ve just got a cold.” (Sub-text: “Man up you wuss - your family’s sick.”)

Worst part: it was Grey Cup week…

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It does seem odd that any Dr. familiar with kids couldn’t identify croup. Anyone who has heard a kid cough like that…it’s a very distinctive cough.

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And the baby ain’t ugly, neither!

(heh heh)

But seriously, I would write a letter to that doctor and tell him what the diagnosis should have been (make it clear that you don’t intend to pursue a malpractice claim though… unless you plan to file one!). Kind of scary that he didn’t recognize croup right off the bat. You might help another kid in the future :slight_smile:

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Posting from my phone now so no links. Croup is usually but not always caused by parainfluenza virus (not related to influenza except in name). It can sometimes be difficult to diagnose if the patient is no longer coughing (like if they were taken into the cool outsde air on the way in from the parking lot) or if there is no stridor.

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They never listen, either, doctors, even when you tell them! Glad your little rugrat’s OK. :slight_smile:

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Two years ago, I went to my primary (a DO) for what I suspected was carpal tunnel. I also suspected I had early Reynaud’s Syndrome and had read that carpal tunnel can cause that, OR it could be autoimmune related.

Doc tested me for autoimmune, but only at my insistence (“It’s never lupus!” :D) because autoimmune disorders run in my family. Thankfully, that came back negative but then the Doc became overly excessively concerned with my cholesterol, which has been high since I first had it tested at 24. She spent a year treating me for high cholesterol and never even addressed my hurty hands from the carpal tunnel. Not even a referral to a hand specialist or order for PT or anything. My hands still hurt. And my cholesterol is still too high. And I’m shopping for a new Doc.

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Oh, I know, right? And the baby’s pretty cute too. :wink: