PA Solves Medical Mystery, Correctly Diagnoses Whooping Cough
Posted by crougeauComment

An Oct. 29 story in The Washington Post’s Health and Science section shows yet again why physician assistants are a critical part of the healthcare system.

The article chronicles the painful struggle of Nancy Welch, a 47-year-old mother in Northern Virginia, whose youngest child Joseph, 13, was suffering from coughing spells that left him gasping for breath and vomiting mucus.

The coughing first surfaced during an annual checkup with Joseph’s pediatrician, who prescribed an inhaler. After a visit from the paramedics when Joseph couldn’t catch his breath, a return trip to the pediatrician for more meds, and a trip to a pediatric pulmonologist, Joseph’s medical problems persisted. After another coughing episode Welch contacted the pediatrician again, who told her to take him to the emergency room of Inova Alexandria Hospital.

At the hospital Joseph was seen by Lynette Sandoval, a physician assistant. After hearing a recording from Welch on her cellphone of one of Joseph’s episodes, Sandoval suspected whooping cough (pertussis) even though she’d never seen a case of it before and Joseph had been vaccinated against it.

After hearing the original pulmonologist’s insistence that whooping cough wasn’t the diagnosis, sending her son to a speech pathologist to check for vocal chord dysfunction, and putting her son through a bronchoscopy, the pertussis test results from Joseph’s visit to Inova proved Sandoval’s suspicion correct.

Welch’s family was put on antibiotics immediately and was told to stay home and avoid contact with other people for five days in case they were carriers. Joseph is now fully recovered, his mother said.

Sandoval said that the diagnosis may have been missed because some of Joseph’s doctors did not hear the recording of his tortured breathing, as she did.

“The recording was key,” she said, “because not everybody is going to use terminology in the same way to describe it.” And she speculated that some doctors may have been misled because Joseph had been fully vaccinated.

Welch was so grateful to Sandoval for listening that she called to thank her.

Whooping cough has made a major comeback in the past few years. Federal health officials say that this year is on track to be the worst in 50 years. So far, nearly 31,000 cases have been reported to the Centers for Disease Control and Prevention, almost three times the number for the same period last year.

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