Wednesday, April 10, 2013

Think Like Dr. Mom: My Kid the Medical Mystery

The pains were so sharp they took my 7-year-old's breath away. She was doubled over, hands clutching her tiny chest, wincing. She was starting to cry. She looked to me, her face twisted up, all but begging me to make it stop. Then, after 20 seconds or so, it was over. Until it happened again, later that day, and then again the day after. Chest pain: in an elementary schooler? It didn't seem to make sense. Was she having a heart attack? I'd never heard of such a thing.

I never went to medical school, but I sometimes wish I had. My doctor and midwife friends know that I'm happy to listen to the gory, technical details of their messy medical cases. I'm an Atul Gawande--Jerome Groopman--NY Times' Think-Like-a-Doctor-column junkie. Plus, my dad is a doctor, the kind of doctor who likes to talk about his work and his cases (patients' privacy protected, of course). So I grew up with the most fascinating and colorful medical dinner conversation.

Perhaps because of my layperson's interest, or perhaps because it's just what moms do, I see it as part of my duty to try to diagnose my kids' ailments. I recognize that I still need to consult with an actual doctor to have them treated. But I'm the type of mom who doesn't call the pediatrician unless there's a good reason--and usually, a suspected diagnosis in mind (that drives you doctors crazy, I'm sure). Last week, it took several days of major sore throat complaints before I took one daughter for a strep test. (Sure enough, it was strep: both of my older girls have had it in the past month. No fever; just the sore throat. If only you could buy those swab tests in CVS.)

Infrequently, my kids present with medical mysteries. And it always throws me for a loop. 

With regard to the chest pains, I knew by looking at my daughter that she wasn't dying. But the pain was so excruciating that she was weeping, and the episodes were coming more frequently. She was becoming hysterical, and I had to do something. I consulted with my dad, who consulted with a pediatrician friend. They didn't know what it was, but because the pain was in her chest, Bella had to be seen. So we set off on a cross-city journey to an open weekend clinic. (This was three years ago, when we were living in London. Unfortunately, I was unable to contact our private pediatrician on the weekend, outside of office hours.) At the clinic, we waited a long while (of course), before Bella was examined by a young doctor, and then by her supervisor. They said it wasn't her heart or her lungs (i.e. not an emergency), and that if it continued to be a problem we should see her regular doctor. Basically, we learned nothing. Frustrating, and at the same time, unsurprising: I didn't know what was wrong with her, and neither did the professionals!

The pains thankfully lessened with time. At a sick visit to her pediatrician about a month later (tonsilitis), I mentioned the chest pains, the doctor examined her, and he knew exactly what the diagnosis was: something I'd never heard of! (Go figure). 

Before I disclose the solution to the medical mystery, I'll add that Bella has been experiencing the same breath-stopping pains recently, and it's been a cause of real distress for her, not least because I forgot, these years later, the diagnosis that the London pediatrician had so confidently told me. 

Last week, at a well-visit here in NYC, Bella explained her symptoms. I could tell that the doctor was a bit stumped. She asked: where exactly? and how often? Bella said: about three times a day, but just for short, twenty-second bursts. Because people (supposedly) eat three times a day, the doctor recommended that I take her to see a gastroenterologist. I knew this wasn't right--that it wasn't a GI problem, but since I couldn't remember the name of the diagnosis, I just had to smile and take the referral form. 

I also knew that until we found out what was causing Bella's pain, I would be unhappy and Bella would be worried. It's a mom's job to help a child at least know what's wrong with them, even if we can't always take away the pain.

I tracked down the name and email address of the London pediatrician, wrote to his secretary, and the next day had a copy of his examination letter from back in 2010. The diagnosis:
Costochondritis, also known as chest wall paincostosternal syndrome, or costosternal chondrodynia[1] is a benign[2] and often temporaryinflammation of the costal cartilage, which connects each rib to the sternum at the costosternal joint, and is a common cause of chest pain. [Wikipedia].
After reading several articles online about the condition including one written expressly for kids, I discussed the diagnosis with Bella, and gave her the article to read. We both agreed that it sounded like exactly what she had. And blessedly, the condition is benign. Believe or not, ever since, she's felt better. Less pains, and less complaints. Is there a relationship between having a diagnosis and the way a patient experiences symptoms? Perhaps a subject of inquiry for my friends the medical researchers.

In the meantime, this is Dr. Mom, signing off.


  1. Having grown up in a two-doctor/parent household, I know just where you're coming from on not shying away from gory details and taking your time to get to the pediatrician. Two times with my step-kids I waited a lot longer than I probably should have to take them to be seen. I often rely on calls to my mom and dad, and now to my brother. Sometimes I wonder how people without these human resources manage the little day-to-day pains and irritations.
    Hope Bella continues to feel good. Having an understanding of what is going on can really lesson one's fear.

    1. I know! What does one do without doctors in the family?

  2. A thoughtful addition to the discussion comes from my friend and family-doc extraordinaire, Mark Benor: "I'm absolutely persuaded that having an explanation (especially a benign one, but even a non-benign one) relieves physical pain. It reduces the anxiety of the "unknown." Pain is always perception, and interpretation directly impacts the experience of a perception. Giving patients a narrative in which to place their experience of pain is a profoundly important part of being a good doctor, in my opinion. That doesn't mean that pain isn't "real" or awful. Just that helping patients see a pattern in their pain makes it less severe."


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