Diagnosis via Cell Phone (Pedcast)

Topic Introduction

Doc Smo here with another installment of Portable, Practical, Pediatrics. It seems all we hear these days is how screens and technology are hurting our children’s health. Many think these digital devices are putting childhood on hold and ruining what should be a thrilling time in a person’s life. Cyber bullying, sexting, obsession with friends, and replacement of real human interaction with virtual social discourse among other things. Well, I’m here to tell you about a use for cellphones that actually was very beneficial to one of my patient’s health. Let me explain.

Musical Introduction

A True Story

The other day I was talking to a mother and her nine year old child about this child’s episodes of vomiting that she was experiencing. We had talked about this symptom in previous visits but all I had gotten from Mom and the child was that she was having spells of vomiting and not eating that lasted 1-2 days. On this particular day, this visit was part of this child’s well checkup and we were reviewing all her health problems. The child was struggling to answer my specific questions about her vomiting episodes as most nine year olds would be when her mother pulled out a notebook and started reading from her notes, detailing, in very specific ways, the dates, length of episodes, time of day, and associated symptoms that came with each event. It was amazing. Instead of me fumbling through my usual litany of questions and getting a lot of “I don’t knows”and blank stares, this mom started giving me an exact reproduction of all the child’s symptoms for the past four months. When I asked this mom how she did this, this mother told me it was easy- she had interviewed her daughter with each event and recorded that interview on her cellphone.  This mom had decided to take matters into her own hands and made a first person account of each attack of vomiting her daughter was experiencing, in real time. I’ve been asking parents to keep diaries of recurrent health problems for years but few actually do. I don’t know why they don’t but they just don’t. But in a flash, this mom had solved that problem by using the convenience of her cellphone to record her daughter’s symptoms at the moment they were happening. Cell phones are turning out to be a great medical tool.  Simple and beautiful. Many of my patients have been using their cellphone cameras to record rashes that can be very helpful to me for diagnosis. I have also had quite a few who have made videos of baby spells of shaking or eye rolling and similar things that are also very useful.  The other day, I had a mother show me video of her daughter dancing and developing chest discomfort. When this mom and I watched the video, we could see that her dancer daughter developed a cough as she danced. Eureka– diagnosis exercise asthma. Using a audio recorder to create a diary of her child’s symptoms at the time the symptoms are occurring, I just thought that was brilliant and extremely useful.

 

So here is what we discovered from this detailed history. It turns out that the child was having a vomiting spell monthly for the past 4 months. Some of these attacks were associated with a headache, and all were associated with fatigue and a severe loss of appetite. Two of the  attacks came with some disturbance in vision, what the chiild called “seeing colors” . Abdominal pain was not a big part of the attacks. Diarrhea never occurred. Light and noise sensitivity were also part of each attack. After about 36 hours of fatigue and nausea, the child suddenly would get hungry and begin to return to normal. These attacks had been going on for two years without treatment and our diary revealed that they were getting more frequent.  Elementary my dear Watson!  With all this detailed information it was obvious that this child’s vomiting attacks were actually the end of a series of migraine events. Listen to her description again- monthly attacks of fatigue, headache, visual disturbance, vomiting with complete recovery in between spells.  In older women we call this menstrual migraine. But, this child hadn’t started the outward signs of puberty yet?  How could she have menstrual migraine you ask? Well, puberty doesn’t just start one day when your child’s periods begin or penis starts to grow, it is a gradual process of their bodies making more and more estrogen or testosterone until finally, levels are high enough for tissues that react to those hormones. In this case, we know that estrogen makes the blood vessels at the base of the brain more reactive in some women, especially when those levels fluctuate a lot, like they do near a woman’s period. Prepubertal girls have monthly waxing and waning of their estrogen levels just like the big girls do, just without the outward signs their big sisters get! I think this child is actually truly having menstrual migraines because of monthly surges in estrogen, long before her first period!  Wow, all that gleaned because this mom was smart enough to get a detailed record of her daughter’s symptoms while they were happening!  I love it.

The Importance of a Good History

Ask any pediatrician what is more important to good diagnosis, the history of a child’s illness or the physical signs of illness,  and I think most will tell you that it is the history. In Bill Clinton speak, “It is the history stupid”. So the lesson I learned from this child’s mom; why not use a readily accessible technology that almost everyone has in their pockets, a cellphone, to get a real time description of a recurring illness to help their doctor sort out the illness. Simple, elegant, inexpensive, and right on!  It’s starting to look like the most essential tool for pediatricians of the future will be cellphones since these devices are able to record detailed history of symptoms like this mom was able to do, capture pictures and video of health events, function as high tech stethoscopes and ultrasound machines, and link doctors to sophisticated databases of current information in an instant.

Outro

Thanks for joining me today. If you enjoy exploring pediatric health topics with pedcasts, take a moment to subscribe to my blog, at www.DocSmo.com or follow my podcast on iTunes, Facebook, Twitter, or Google+. If you have some stories of how you used a cellphone to help your child’s health, make sure to send a note to my blog and share that story with my listeners. This is your pedcast host, Dr. Paul Smolen,  reminding you that the next time your child has a moan, don’t forget to get out your phone.  Until next time.

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