Revisionist History
By WitchletsMom On August 21st, 2010Friday. The day that the witchlets return to me from WF’s house. Thing 2 arrives hoarse but otherwise well. Her theory is that she may be allergic to the horse she’s been riding all week. Good guess so I pack her up and bring her home to give her the Dr. Mom treatment.
Well-hydrated child in no apparent distress. Voice is raspy but she denies sore throat. Lymphadenopathy present in the posterior cervical and sub-mandibular chains but non-tender and moble nodes all. Ear drums both slightly dull but no fluid noted. Nasal mucosa normal. Posterior oropharynx normal with no drainage or erythema. So prolly allergies.
Now, all first year med students and other students of Dr. Google – tell me what’s wrong with my approach. Yup. I didn’t look at a damn thing below the neck.
So as we’re wrapping this up, Thing 2 says “This doesn’t have anything to do with the bruise on my leg, does it?” I love immediate feedback on exams, don’t you? Too bad I’m an idiot.
Thing 2 drops her drawers and shows me the “bruise” on her leg. Kinda a bruise, kinda burst blood vessels. And no matter how I asked, she swore that she did NOT injure herself. “No, mom, that part of my leg never touched the horse.”
I decide to go with my first impression, call this allergies and ignore the bruise as something that happens to children who don’t quit moving.
Fast forward to this morning when Thing 2 is ready to head to the pool and I get a look at her arms. (Told you I was an idiot. Yup, even with the hint the size of a former Soviet Republic I still didn’t look her over head to toe.) She has the same bruise/blood vessel thing on her arms. Worse on one side than the other but still there on both.
Stepping out of her swimsuit and back into my office I instruct my child that no physician should ever ask you to completely strip. Except me. Now strip. She does and the ONLY spots I see are her arms and leg. Nothing anywhere else. No other findings. No abdominal pain or masses, no murmur, lungs are clear, adenopathy is stable. And most importantly, she’s acting fine. Perfectly normally. For Thing 2.
At this point Dr. Mom is asking herself: “WTF?”
I’ve asked this kid every way I can about injury and she denies anything – so bruising/purpura without trauma opens up a can of worms. I start to run through the list, ruling out most of the infectious things. Somewhere in the middle of my monologue, I see the scrape on her arm.
No trauma? Scrape? Back this train up.
WM: How did that happen?
T2: Getting out of the pool?
~pause~
T2: Doing 53 belly flops wouldn’t have anything to do with this, would it?
WM: Go to your room.
You know. It’s hard to generate an accurate differential diagnosis without a good history. I wonder if anyone has told Dr. Google that?
