We have had so many diagnostic conundrums in my clinic lately that I’m convinced we’re on an episode of House. Not that I’ve ever watched it. ER was a staple in medical school but now I stay away from medical dramas. Maybe I should start watching- might teach me something. ( Like when Carter learned that “lasix” lasts for 6 hours and was originally a horse medication. I won’t ever forget that!)
Fevers without an identifiable source, now that’s a tough cookie to crack! One of my patients had 10 days of fever and little clues. I poked and prodded, drew labs, took history after history and read and read and there in the bottom paragraph of my HUGE green Nelson bible of pediatrics was this little pearl of wisdom- If there are no diagnostic clues found on physical exam then it is unlikely that any additional lab work will be helpful.
Um, that wasn’t reassuring.
Don’t worry I kept searching. They tell me that House goes to peoples houses and swabs. Believe me I was tempted. Instead I called daily and examined him every other day.
Fever, foreign travel and some leukopenia pushed us to start empiric treatment for presumed typhoid fever. Presumed. And you know what. Fever is gone. After 10 days. Was it bored? Did it just run its course? Or did it succumb to the antibiotics. No clue. But I do know that he smiled at me today.
Whew. I hope to tuck that little chart back in the files and wait for my next mystery to walk in the door.