Monday, March 6, 2017

Differential Diagnosis


Justin has been sick ever since since he started his drive home from Texas almost three weeks ago. At first, it was a sore neck and headaches every night, then it progressed to a sore throat, fever, and malaise, and finally to fevers approaching 104° and a throat so swollen that I was afraid he wouldn't be able to breathe.  

I took him to the doctor and despite a negative Rapid Strep. test, the doctor was sure his throat looked "very streppy" and prescribed amoxicillin. I asked if he could please do a Monospot test because I had seen first hand how much Justin was sleeping and how difficult it was for him to even get out of bed, but the doctor assured me I was just a worried mother, infectious mononucleosis wasn't a possibility, and Justin would begin recovering from his Strep. throat in 24-48 hrs. 

Seventy-two hours later with no improvement and worsening symptoms we were back at the doctor's office. Another negative Rapid Strep. test, another request from me for a Monospot test to no avail, but we left this time with a prescription for Augmentin and an assurance that this more potent antibiotic would do the trick. 

Two days later when Justin began his 104° fevers and was having trouble breathing, we went to the doctor one last time before heading to the ER. I insisted on a Monospot test, and you can likely guess the result - positive.

So after three visits to the doctor within five days, three different antibiotics, seven different medications prescribed, nine different lab. tests, and a demand from a very worried mother, we've finally got a real diagnosis. 

I understand that doctors are busy, don't need or want patients telling them how to practice medicine, and can't respond to every request from every worried mother, but I think that with a little more listening this could have been more easily resolved with the second visit. Justin is now on steroids to control his throat and tonsillar swelling, and I would be far less willing to be forgiving of the doctor's inability to listen if Justin was in the hospital on a respirator, which would have been the next step without the steroids. 

I originally intended to write a weekending-type post, but this is what I did this weekend. I feel a bit guilty because this is what I went to school for (to be able to identify those atypical lymphocytes in the photo above that are a pretty good indicator of infectious mononucleosis) and I should probably have taken charge more at the second doctor's visit and insisted upon a Monospot test. But I didn't, Justin is not in the hospital on a ventilator, and will recover with time and plenty of rest. Hopefully I will learn my lesson to be a better medical advocate for my loved ones in the future. No matter whether your kids are 3 or 23, mothers worry and should be listened to. 

17 comments:

  1. It's absolutely ridiculous that the doctor didn't listen to you in the first place. I'm so glad you finally got the right treatment for Justin and I hope he's feeling way better really soon.

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  2. I hope Justin will be well soon.

    I would have had issues with the dr on the second visit, and likely just gone to the ER and skipped that last visit. I have extremely high expectations of drs who I see, and no patience if I feel they are putting me off. I'm glad it all worked out without being a worse result.

    At least in the end, Justin is getting what he needs. Take care of yourself, too.

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  3. I would love to say I am surprised by this, but sadly - I am not. Gone are the days when the doctor had time to sit and listen to you. AND even more gone are those days when the doctor actually asked how things were going! Do not beat yourself up about not advocating louder - you did advocate, but sadly, women are the last listened to today. I hope Justin is on the road to recovery and will soon be breathing easier and feeling much better.

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  4. Oh no!!! I am just relieved that this story ended with appropriate treatment. Thank goodness for mothers.

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  5. Oh, Bonny. How frustrating! I'm so glad that your persistence paid off -- and Justin is on the road to recovery. Sadly, we went through a similar medical nightmare with Brian a few years ago . . . and that one ended with surgery at the Mayo Clinic. Not only was your doctor blowing YOU off --- but I'm betting he was making some assumptions about Justin, given his age. I'm sending all the healing juju Justin's way. XO

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  6. Ugrrrggghhhh...so frustrating. I'm happy to hear you've gotten to the bottom of it though and that Justin feels better soon.

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  7. May Justin recover quickly! Few of us are surprised by what happened to Justin and you. I have had to fire doctors for lesser infractions than this. There really isn't an excuse that works for that kind of treatment. I hope you let the doctor know he was wrong. Sending healing thoughts to Justin and comfort to you.

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  8. There is no excuse for the doctor not doing the monospot on the 2nd visit; it's a good thing you advocated for him & got it done. I hope Justin has a good recovery!

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  9. I am so relieved this ended with a good outcome! Sometimes I want to smack doctors upside the head! I went through this a few years ago. I couldn't figure out what was wrong with me - fever, so tired, I couldn't get out of bed - fell down the stairs - on and on. Kept going to the doctor, asking for a blood test (because 3 people told me I had Lyme's disease). But no go - the doctor wouldn't do it. I finally called and said - I'm coming over - give me a blood test, or I will stand in your waiting room screaming until you do! Got one done... Got a call two days later - yep, Lyme's disease.

    Linda in VA

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  10. Yikes! What a frustrating and scary time. Just glad that Justin is now receiving the treatment he needs and hope he is feeling much better soon. We had a similar issue with our son back when he was in college...ended up he had Lyme Disease which no one could believe because "they don't have ticks there." Failing, of course, to realize that our son came home periodically and we have a ton of ticks. Gggrrrrrr.

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  11. How lucky is Justin to have you for his mother? VERY LUCKY. I don't know why doctors, in general, don't just order the test in this case. They order a lot of things I don't want! I am a nurse married to a doctor that actually listens, so I have no sympathy for the error. But, I am glad Justin is on the mend, and I hope he feels much better soon. Just think how difficult is how for people who don't understand healthcare!

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    1. I appreciate hearing your opinion as a medical professional! I still wish I had demanded the Monospot at the second visit, but I've learned that in the future I need to be demanding enough to be heard; I've also learned that I need to look for another doctor. I have wondered about the very unfortunate patients that don't have family or friends that can act as their medical advocates or just go along to appts. as another set of ears and eyes. Healthcare seems fraught with issues for both providers and patients.

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  12. I'm so sorry to hear that it took three trips to get the Mono diagnosed. I hope Justin is healing well now. As a person with several health issues I know it can be difficult to get a doctor who will listen to you. All I can suggest is to always advocate for what you feel is going on. This can and is a fight some of the time, but you were right and even if you weren't it would have eliminated a possible source of the infection. Good luck and good advocacy in the future.

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    1. Thanks, Melissa. I did learn that I need to persist enough in advocating to make sure that I'm actually heard, like you suggested. Next time I won't give up so quickly! Wishing you the best of health and healthcare with your health issues.

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  13. So glad Justin is home!!! Doctors can sometimes be really stupid, glad you persisted.

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  14. Oh Bonny, I'm glad Justin is on the mend, but what a scary and frustrating time for y'all. ugh. ugh. ugh. (and good luck finding that new doctor - seems like the good ones are getting harder and harder to find...)

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  15. Good healing thoughts & wishes to Justin!!

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