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.