Comments on: Physical Exam: Sticking out your neck (part 1) http://distractible.org/2008/03/19/physical-exam-sticking-out-your-neck-part-1/ Thoughts of a moderately strange (yet not harmful) primary care physician. Sun, 01 Aug 2010 02:44:35 +0000 hourly 1 http://wordpress.org/?v=3.0.1 By: Peggikaye http://distractible.org/2008/03/19/physical-exam-sticking-out-your-neck-part-1/comment-page-1/#comment-1059 Peggikaye Fri, 28 Mar 2008 21:04:31 +0000 http://distractible.org/2008/03/19/physical-exam-sticking-out-your-neck-part-1/#comment-1059 when my son was 6, he had fever, high fever (107) and they wanted to do a spinal tap. They kept telling me that they didn't think it was meningitis, but they needed to rule it out. Then they'd keep him over night in the hospital, give him fluids and let him go home in the morning when being rehydrated would bring down the fever. I kept saying, well, give him the fluids, then tomorrow if the fever's not down, THEN do the spinal tap! An hour later, they had me convinced they needed to do the spinal tap. However, I could not get the words "yes, you may do the spinal tap on my son" out of my mouth. "I guess so" "do what you have to do" "if that's what needs to be done" all of those ..but not "yes, you may do a spinal tap on my son" They needed those words ... so after 2 hours of my beating around the bush (???) my pastor finally said "She's giving you her permission!" He had to sign the forms as well since I couldn't verbally say the words they needed to hear LOL They kept assuring me the tests would come back clean. They did the tests ...they said the fluid looked good. They admitted him ...then the doc came in the room white as a ghost. It was a good thing I'd not talked them out of doing the spinal tap. A very good thing. Their instincts to rule it out were spot on ... because they couldn't rule it out ..he had it! when my son was 6, he had fever, high fever (107) and they wanted to do a spinal tap.
They kept telling me that they didn’t think it was meningitis, but they needed to rule it out.
Then they’d keep him over night in the hospital, give him fluids and let him go home in the morning when being rehydrated would bring down the fever.

I kept saying, well, give him the fluids, then tomorrow if the fever’s not down, THEN do the spinal tap!

An hour later, they had me convinced they needed to do the spinal tap. However, I could not get the words “yes, you may do the spinal tap on my son” out of my mouth. “I guess so” “do what you have to do” “if that’s what needs to be done” all of those ..but not “yes, you may do a spinal tap on my son”
They needed those words … so after 2 hours of my beating around the bush (???) my pastor finally said “She’s giving you her permission!”

He had to sign the forms as well since I couldn’t verbally say the words they needed to hear LOL

They kept assuring me the tests would come back clean.

They did the tests …they said the fluid looked good. They admitted him …then the doc came in the room white as a ghost.

It was a good thing I’d not talked them out of doing the spinal tap. A very good thing. Their instincts to rule it out were spot on … because they couldn’t rule it out ..he had it!

]]> By: Rob http://distractible.org/2008/03/19/physical-exam-sticking-out-your-neck-part-1/comment-page-1/#comment-1033 Rob Wed, 26 Mar 2008 13:26:16 +0000 http://distractible.org/2008/03/19/physical-exam-sticking-out-your-neck-part-1/#comment-1033 There are very few ways to diagnose encephalitis other than through the symptoms (you don't stick a needle in the head). So I would say that is right. Yes, it is Tick borne - similar to Lyme disease (without the rash). Other spirochetal diseases are also prone to give a Meningoencephalitis (even Syphilis). There are very few ways to diagnose encephalitis other than through the symptoms (you don’t stick a needle in the head). So I would say that is right.

Yes, it is Tick borne – similar to Lyme disease (without the rash). Other spirochetal diseases are also prone to give a Meningoencephalitis (even Syphilis).

]]> By: Ellie http://distractible.org/2008/03/19/physical-exam-sticking-out-your-neck-part-1/comment-page-1/#comment-1032 Ellie Wed, 26 Mar 2008 13:20:05 +0000 http://distractible.org/2008/03/19/physical-exam-sticking-out-your-neck-part-1/#comment-1032 Let's see if I have this right...meningitis = meningitis, but meningitis + seizures/hallucinations/crazy/other = meningoencephalitis? And if my googling is correct, ehrlichiosis is tick-borne, right? Let’s see if I have this right…meningitis = meningitis, but meningitis + seizures/hallucinations/crazy/other = meningoencephalitis?

And if my googling is correct, ehrlichiosis is tick-borne, right?

]]> By: Rob http://distractible.org/2008/03/19/physical-exam-sticking-out-your-neck-part-1/comment-page-1/#comment-1018 Rob Tue, 25 Mar 2008 00:28:43 +0000 http://distractible.org/2008/03/19/physical-exam-sticking-out-your-neck-part-1/#comment-1018 Don't really make much of a differential between the two. Meningitis with mental status changes is probably meningoencephalitis. There are certain diseases that are usually meningoencephalitis, such as ehrlichiosis and other like diseases. Don’t really make much of a differential between the two. Meningitis with mental status changes is probably meningoencephalitis. There are certain diseases that are usually meningoencephalitis, such as ehrlichiosis and other like diseases.

]]> By: Ellie http://distractible.org/2008/03/19/physical-exam-sticking-out-your-neck-part-1/comment-page-1/#comment-1015 Ellie Mon, 24 Mar 2008 22:54:46 +0000 http://distractible.org/2008/03/19/physical-exam-sticking-out-your-neck-part-1/#comment-1015 Dr Rob - Since you were talking about meningitis...how often do you see meningoencephalitis? Have you ever seen it in your practice? Dr Rob – Since you were talking about meningitis…how often do you see meningoencephalitis? Have you ever seen it in your practice?

]]> By: Rob http://distractible.org/2008/03/19/physical-exam-sticking-out-your-neck-part-1/comment-page-1/#comment-987 Rob Thu, 20 Mar 2008 11:44:25 +0000 http://distractible.org/2008/03/19/physical-exam-sticking-out-your-neck-part-1/#comment-987 That sentence was 100% sarcastic. That sentence was 100% sarcastic.

]]> By: Dr. David http://distractible.org/2008/03/19/physical-exam-sticking-out-your-neck-part-1/comment-page-1/#comment-986 Dr. David Thu, 20 Mar 2008 04:34:35 +0000 http://distractible.org/2008/03/19/physical-exam-sticking-out-your-neck-part-1/#comment-986 Rob, I found this sentence troubling: "My guess is that they are being paid off by the big drug companies to convince us to throw lots of money at their vaccines that cause autism." Are you implying that these vaccines cause autism? Surely you aren't, and I've misunderstood. Even if you buy the thimerosal/autism link (which I do not), neither the H flu nor the pneumococcus vaccines have thimerosal in them. In my practice lifetime, I have seen H flu meningitis vanish (believe me, you're lucky never to have treated a case) and pneumococcal sepsis almost vanish. The effect of these vaccines on what used to be common causes of childhood death is staggering. These vaccines are life savers! Rob,
I found this sentence troubling: “My guess is that they are being paid off by the big drug companies to convince us to throw lots of money at their vaccines that cause autism.” Are you implying that these vaccines cause autism? Surely you aren’t, and I’ve misunderstood. Even if you buy the thimerosal/autism link (which I do not), neither the H flu nor the pneumococcus vaccines have thimerosal in them. In my practice lifetime, I have seen H flu meningitis vanish (believe me, you’re lucky never to have treated a case) and pneumococcal sepsis almost vanish. The effect of these vaccines on what used to be common causes of childhood death is staggering. These vaccines are life savers!

]]>