I usually only deal with chronic pain subjects now but was begged by a Grandmother patient to see a 3 year old Grandson with recurrent croup symptoms. He had been going to medicenters much like the child in the movie “As Good As It Gets” with Jack Nicholson and Helen Hunt. They would prescribe antibiotics and he was left to whoop and cough. It turns out the father had been my patient with recurrent croup as a toddler and they remembered how dexamethasone had worked so well, and wanted some for this child as well. With treatments was better in two days. Now I understood how care can vary.
Croup is a condition of cough and larynx spasm that leave the victim with a harsh almost whooping like cough. Dexamethasone 0.6 mg/kg at onset can significantly reduce the problem:
A Randomized Trial of a Single Dose of Oral Dexamethasone for Mild Croup
Candice L. Bjornson, M.D., Terry P. Klassen, M.D., Janielee Williamson, R.N., Rollin Brant, h.D., Craig Mitton, Ph.D., Amy Plint, M.D., Blake Bulloch, M.D., Lisa Evered, M.D., and David W. Johnson, M.D.,
N Engl J Med 2004;351:1306-13. free article here
Child had a harsh unproductive cough with a relatively clear chest. No history of reflux issues – more infection based. He was prescribed a one dose dexamethasone 0.6 mg/kg, with extras to take next time this recurs. He was given some Singulair 4 mg samples as well. Arrangements were made for him to see a pediatrician with interest in asthma (free to see here in Canada), and perhaps environmental issues can be worked out as well. He was better in 2 days and loved his Pediatrician.
I had discounted the “As Good As It Gets” Movie – doctor need as pure hype related to needing a FP doctor. Now I understood that more family physician based treatment could make a difference.
This same need is even more critical for people with chronic pain but knowledgeable and sympathetic doctors are not easy to find ( not saying I’m necessarily great at that but I’m trying…). I find it difficult to suggest to distant pain victims how to deal with their FP who they may be stuck with but who is neither knowledgeable or sympathetic….
Any comments?