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What do I need to ask the doctor tomorrow?


Sarah CB
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We have a follow up appointment with the paediatrician tomorrow.

 

As a recap - 11 yo ds has had a fever for about six weeks. It ranges from normal temp (only a few times) to 105 (40.5 C) but it only went that high once. So far, the doctor has run a bunch of tests but everything has come back normal.

 

Since our last appointment, ds has developed weird toes. The ends of his toes are red - purplish in some areas. They look a little bit swollen and they hurt like crazy whenever he bumps them against anything. He woke up one night with his toes throbbing. They are also peeling. 

 

Paediatrician was out of town so I took ds to our regular doctor who told me that, yes, the toes were concerning, but that we should be able to wait the 5 days until the appointment with the ped. 

 

I am kind of tired of being told that they don't know what is wrong. Something is clearly wrong. I just don't know what. Any ideas? I'm totally open to crazy internet diagnostics at this point. I'm open to anything, really. I'll be taking ds straight to the naturopathic doctor if there are no answers from the ped. I'll try Chinese medicine.  I really will try anything. The kid is still tired. Has no energy and would like to get back to his life at some point soon.

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I am worried about your son too. I really wish LMV would read your thread; she is a pediatrician and her advice is always spot on.

 

Do the toes look like this?

 

https://www.bing.com/images/search?q=endocarditis+purple+toes&view=detailv2&qpvt=endocarditis+purple+toes&id=43AAC4FC138A1D4D633F64359F79757D88B6DD79&selectedIndex=2&ccid=prnY4VaZ&simid=607987462861884657&thid=OIP.prnY4VaZ_u6qv2ekM9x2WwEsEP&ajaxhist=0

 

This onevis a slideshow; go to the slide for janeway lesions:

http://reference.medscape.com/features/slideshow/hand-signs

 

Does he have any other cutaneous symptoms such as spots on his hands or nails?

 

My first thought was endocarditis, which can manifest in the skin such as spots on hands or toes.

Edited by trulycrabby
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I would ask a *qualified* (Board Certified Specialist) M.D. what kind of Infection your child has. I believe fever is a sign of infection. If the tests that have been given already came back with normal results, they need to do different tests, immediately. A fever going up to 105 is not something trivial.  Good luck!

 

ETA: I reread the OP.    6 weeks is a long time to have a Fever.

Edited by Lanny
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If the toes are not always like that, bring the pictures with you.

 

Take the time to write down any/all symptoms you know of.

 

The blue/purple toes makes me think something to do with circulation....but the fever sounds like something else.  Maybe it is two different things?

 

If your pediatrician is unable to diagnose, I would consider referrals to a cardiologist and an infectious disease specialist.  

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Maybe Kawasaki disease? I believe the symptoms of that include high fever and reddish-purplish hands or feet.

 

 

Here's a link about Kawasaki disease.

http://www.childrenshospital.org/conditions-and-treatments/conditions/kawasaki-disease/symptoms-and-causes

 

I'm glad you're going to a children's hospital for the appointment. Prayers.

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With those symptoms I would be at the nearest pediatric hospital and not leaving until I had some answers.

 

Have you reported these latest symptoms?

 

I had a pediatric patient once with purplish toes for no reason, and we would not let him leave the office until we spoke with pediatric cardiology, who I think squeezed him in for an echo, if I recall correctly. I don't recall the diagnosis as it was so long ago but my point is that patient did not go home from our office until cardiology reviewed his case.

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Hey Sarah, just thinking about you and your guy. Hope you have gotten some answers or at least have some firm direction about where to look next. Hope your son is feeling ok.

 

Thank you. We had the appointment with the ped and he felt like the best way to get to the bottom of things was to admit ds to hospital so they could monitor him and administer tests.

 

So he spent two nights in hospital and had more blood work done plus a chest x-ray and an ultrasound. The ultrasound showed that his spleen was slightly enlarged so they think it was just a very stubborn virus.

 

His temp didn't go above 37.9 - which they don't actually consider a fever - so they felt he was on the mend. The week before it was up to 40, so it definitely has improved over the last week. Ds is going to try a half day of school today. The doctors said it might also take a while for his energy levels to get back to normal.

 

We saw another ped in hospital as well as a rheumatologist. Plus a slew of medical students and residents ;) And an incredibly nice male student nurse who was assigned only to ds for his shift. Everyone was very nice and helpful. It did help to be admitted as the tests were done right away - ds had his chest x-ray done before our room was even ready. And the ultrasound happened the next morning. 

 

Ds was fantastic. He loved the food. He had a great attitude the whole time he was in. He's looking forward to getting back to school but is nervous about having enough energy for it.

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