Wednesday, February 23, 2011

Snake Oil Redux

I'd like to start by saying that we generally like our pediatricians' office. The doctors we've seen are amiable, good with kids, and competent. I doubt this little incident will cause us to change offices. However, after this recent event, I think we'll think twice before trusting the opinion of a certain PA (physician assistant).

Our youngest daughter, who recently turned three, has been suffering from the same flu that I had gotten just a few weeks ago. She seemed to get it about a day after Son of Atomic Spud did, but it hit her a lot harder. After a few days her cough and fever seemed to get a little better just before getting worse again. And for several days she had woken up repeatedly during the night and complained of headaches. These seemed to be worse at night and in the morning but got a little better during the day, although she would continue to complain about them occasionally. Of course, since she's only three she can't really describe what's wrong with her.

Now, with my recent experience with the flu and the following infection, I suspected that our daughter also had a secondary infection. So yesterday (Tuesday) my wife took our daughter to the pediatricians' office and saw the PA (the office was too busy for her to see a doctor). I was out of town at the time, as I mentioned in a previous post, and ended up getting a call from my very distraught wife. It seems that the utterly unthinking PA had actually said to my wife that the nighttime headaches concerned her because they can be a symptom of a brain tumor and that, had there not been signs of an ear infection (the probable cause of the headaches), she would have recommended that our daughter have a cranial CT scan. She further said that if the headaches didn't go away with antibiotics within a couple days that she should still have the scan. However, she gave the option of having the scan done as soon as possible.

Honestly, what in the world would possess this woman to actually say such a thing to a child's mother? What possible outcome other than panic could she have possibly expected? Why didn't she simply say "if the headaches aren't gone in a couple days, give us a call"? Why would she even utter aloud the absolute scariest thing a parent can hear, even if she did amend it with, 'but it's probably an infection'? Why would she make such a thoughtless and terrifying statement to a toddler's parent?

Since I've lived with headaches all my life, I've done more research on the topic than the average person. Thus, I know that nighttime headaches can have a variety of causes, the majority of headaches do not indicate a tumor, and headaches are usually not the first or only symptom of a brain tumor. Additionally, the probability that a tumor-related headache would start at exactly the same time as a flu and a secondary infection must be vanishingly remote. Several websites suggested that a sinus infection in toddlers might cause them to wake up with headaches because sinus pressure increases when one is lying down. Given our daughter's symptoms, why would "brain tumor" pop into the PA's head before "sinus infection"?

With the PA's statement about tumors outweighing her tepid assurances and my layman's understanding of the subject, we decided to have the scan done right away. We therefore accepted the PA's offer to make an appointment the very next morning. Today (Wednesday) found my wife sitting next to the phone all morning. At 11 AM, expecting to have heard something about the appointment by then, she called the doctors' office. The nurse apologized, saying that she had intended to make the appointment shortly after the office opened (8 AM), but that they'd been swamped and she hadn't made the call yet. I can't help but to emphasize this point: the PA at their office verbally expressed that one our daughter's symptoms is sometimes an indication of a brain tumor (and in so doing terrified the child's poor mother), offered to make a an appointment for a CT scan first thing the next morning, and then the nurse failed to make the five minute call because she was swamped with kids with fevers and sniffles. Did anyone at this office understand that an offhanded statement by a member of their staff drove their clients into a panic and now their apparent unwillingness to act with alacrity was making the situation worse?

Fortunately for our sanity, they were able to make a 3 PM appointment for our daughter. Apparently she became upset upon arriving in the radiology office because it was not the kid-friendly place she was used to, but a sweet grandmotherly woman helped to calm her down. They were able to do the scan right away and our little three year old held still enough for them to complete it in a single pass. My worry was that she would panic and squirm and they would have to expose her to X-rays again and again to get the images. I'm not afraid of the amount of radiation produced by a typical medical procedure, but I do respect it.

So in the end we irradiated our daughter's brain to eliminate the possibility that her headaches were caused by something serious. Approximately 150 millirem later (which is about 15 times as much radiation as I've received during the past five years working as an engineer in the nuclear industry) and hundreds of dollars later, we found that there is absolutely nothing wrong with her head. I'm still not sure if my relief outweighs my anger that our family was put through this ordeal. And I take an extremely dim view of people who make my wife cry.


  1. I actually really like the PA at that office, and am glad that she is quite frank about what could be the problem. She's been very helpful to us with everything we've had to go through with Abigail, whereas the actual Dr. we saw was not helpful at all and wouldn't answer our questions. I can understand how upsetting this could have been. At the same time, Carl's cousin was having severe headaches (when she used to have none) and it turned out to be a Stage 4 brain tumor that needed to be operated on ASAP. So even though the PA gave you the worst case scenario, I'm sure it's a relief to know that isn't the problem, even though your little girl was exposed to some insane radiation. Again, with Abigail, I wish her surgeon would have ordered a CT scan sooner, so we wouldn't have had to go through so many helmets without any change to her head. But this is all just MHO.

  2. I have to say from experience of being told something frightening and and thrust into medical procedures that it is something to be infuriated by. I have a lengthy 8" scar on the back of my neck and permanent numbness because of it. Had we taken the time and not felt so rushed and panicked by a doctors suggestion, I am not sure we would have taken the same path. Its over, paid for and now I have peace of mind, but the word Doctor pulls a lot more weight than maybe it should.

  3. Had our daughter started having headaches with no other probable explanation (i.e., the flu and an infection), then the PA would have been justified in seriously suspecting a tumor. But brain tumors in children are rare; there are about 3 cases of brain tumors per 100,000 children. And a tumor almost always has other symptoms, too, such as visual effects, dizziness, personality change, etc. If any of these other symptoms had been present, I would have fully agreed with the PA's decision to suggest the presence of a tumor. However, two obvious causes of headaches were present and there were no other signs or symptoms indicating a tumor.

    The relief is little consolation given that it took a significant amount of money and radiation to obtain it and because we shouldn't have been given reason to panic in the first place.



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