C-P wrote:
> Saturday morning surgery, first patient - apparently a pleasant enough dad
> with his 12 year old daughter. The daughter, a known asthmatic on MDI
> beclomethasone and salbutamol, has gone a bit wheezy; parents have,
> reasonably enough, increased steroids, and come for advice. Examination of
> the girl reveals no specific focus of infection, temp is normal, ENT - NAD,
> and chest has a few wheezes, but nothing spectacular. I explain all this to
> dad, agree the next step up the BTS guidelines, about to say cheerio, when.....
>
>
I have had a "similar" situation with a little 9 yr old girl who has a diagnosis
of asthma ( not mine , the asthma clinic) and father *always* demands abx ( ceclor
is his preference) in addition to trad asthma Rx for URTI+flare ups . I repeatedly
cave in, especially since she once developed a pneumonia. Subsequent CXRs have
been disappointingly unremarkable .
Father always swears that she has an excellent response to my treatments! ( I
expect that reinforced my co-dependancy). Eventually I 've become fed up and sent
her to a local pulmonolgist who suggested she has a R middle lobe syndrome ( based
on her history and prior RML pneumonia ) and went on to perform a bronchoscopy to
find ( to my horror) an external pulsatile obstruction affecting the R main
bronchus and she is now waiting for an ECHO.
A case of doing the right thing for the wrong reasons!
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