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Dr. Phil, MD
Dr. Phil, MD, Medical Doctor
Category: Pediatrics
Satisfied Customers: 52519
Experience:  Medical Doctor Trained at a Top Academic Institution
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U.S. licensed physicians, only please. Two nights ago, my

Customer Question

Hello,
U.S. licensed physicians, only please. Two nights ago, my 5-year old developed a sore throat and a mild fever of 99.9. The following day he was feeling quite a bit more miserable with an extreme sore throat. I looked into his throat with a tongue depressor and a flashlight. His tonsils were extremely swollen, and I am quite sure that I saw just loads of tiny clear blisters -- not pustules. I wasn't too concerned, thinking that it was probably viral (perhaps herpangina based upon Google images), but took him to the express care to be on the safe side. The express care physician, looked in his throat without the use of a tongue depressor and thought that what I perceived to be blisters was just mucus, but did express that she thought she saw yellow streaks in his throat. He also had extremely swollen, but non-tender cervical lymph nodes. Based upon the temperature and yellow streaks, she diagnosed him with Sinusitis and prescribed Augmentin, which we are having a terrible time getting him to take but were able to get some of the medication in him today. Today he has been worse, but still played some until this evening when he just broke down crying. I took his temperature, which measure 102.6 I called the on-call doctor who said that they are indeed seeing a lot of viral cases, and just advised me to call them if his temperature got above 105 degrees Fahrenheit. I will say that when I Google "When to call a doctor for tonsillitis" he gets a check for almost every sign and symptom. His voice is muffles, he has extremely inflamed and swollen tonsils in the neck. He is sleeping now and breathing through both his nose and mouth, but is sounds labored and congested. I do have a video that I can provide. The on call physician didn't feel that it was necessary to have prescribed the augmentin, and I completely understand the rationale for NOT prescribing antibiotics unnecessarily. He is up to date on all of his immunizations and is responding to the small amount of ibuprofen that we were able to get down him. I just received two very different points of view from two different physicians and thought that I should confuse myself more by adding in a third. Honestly though, I do want to make sure that I do everything that I am supposed to do. He is usually a very energetic and lively little boy and I am not used to seeing him like this. He has only had to be on antibiotics once for an ear infection. I appreciate any recommendations.
Submitted: 1 year ago.
Category: Pediatrics
Expert:  Dr. Phil, MD replied 1 year ago.

any other medical issues?

Customer: replied 1 year ago.
None. Just the sore throat. I am trying to figure out the accuracy of our digital thermometers. They both measure my husband and I similarly, but are about two degrees off with him. One just gave a reading of 104.6 and then went down to 103. I know that anything 105 is of concern, and since we are getting ready to go to sleep, I am afraid that it is going to spike.
Customer: replied 1 year ago.
Correction. He has had a dry cough. No abdominal pain, but does have very swollen lymph nodes, again they are non-tender. The doctor on call told us that is fairly normal with viral infections.
Expert:  Dr. Phil, MD replied 1 year ago.

Did they test for strep in urgent care?

How is he doing today?

Customer: replied 1 year ago.
The didn't test him for strep in the express care. The doctor said that she didn't need to test him for strep and that she suspected sinusitis. The next day his fever increased to 103+ degrees. I spoke with a nurse at my pediatrician's office who said that if he had seen an urgent care physician, that he didn't need to be seen by the pediatrician. I made an appointment anyway to address the allergies that the express care physician felt led to the sinusitis. That evening he was feeling miserable. I spoke with the on-call doctor at the pediatrician's office and she said not to bring him in unless his fever went over 105. However, we have two digital thermometers and one registered 104.6 and one measured two degrees less, although both gave the same reading for my husband and I. I took him back to the Express care just to have him checked out and the doctor became angry with us. I expressed to her that I thought I would just have him checked out again since his fever had increased and stated that I thought we might go ahead and get the strep swab. She yelled at me, "I told you that he doesn't have strep, I told you what he has!" SO, we left without being seen and I woke up every hour to check my child's fever. The next day, we went to the pediatrician who was SURE that he had strep. They did a strep swab, it came up negative, but she was STILL sure that he had strep. Neither doctor used a tongue depressor to actually LOOK in his throat. I did. You can't see much without the tongue depressor. At any rate, he received an antibiotic shot in the leg, and is doing better, but still running mild fever (100.4) today which I would not expect if it was actually strep, but maybe you can clarify. His throat is still extremely sore. I expressed to the original doctor that, based upon the appearance of his throat, that I suspected that it might be herpangina. We were at the zoo the day before and I doubt that they sanitize their surfaces very often. I realize that the incubation period is typically 4+ days, but could onset occur much sooner? Also, would the non-tender lymph nodes also be consistent with that? I know that non-tender lymph nodes are a cardinal sign of lymphoma. I would appreciate clarification and recommendation on some of the things that I have experienced.Please don't provide information that I can just look up from valid sources myself. I really would like your insight from your practical experiences.
Expert:  Dr. Phil, MD replied 1 year ago.

1)yes it could occur sooner

2)No, they would be tender with most infections

How do you know they aren't tender?

Customer: replied 1 year ago.
The express care physician asked him while she was palpating them. I was alarmed at the time and asked him, "What, they don't hurt." She interrupted and said, "He clearly said that they don't." I shut up. I was feeling them later and he insisted that they weren't tender. I did clarify, "They don't hurt or feel sore?" He said, "No."
Customer: replied 1 year ago.
He also doesn't react when I touch them. He tends to react strongly to any pain, but did not when I felt his lymph nodes.
Expert:  Dr. Phil, MD replied 1 year ago.

was he getting any medicine that can mask the pain at the time?

Customer: replied 1 year ago.
No, that has been a frustration. We cannot get him to take ANY medicine. We have tried both liquid acetaminophen and ibuprofen, along with the meltaways. He ABSOLUTELY refuses to take it. We have begged, bribed, and coerced. This was also something that I discussed with both physicians.
Expert:  Dr. Phil, MD replied 1 year ago.

I would think the lymph nodes have to be related.

It can't be a coincidence that he has a sore throat and swollen lymph nodes. Painful or not.

Customer: replied 1 year ago.
Of course. I don't think that has been argued by anyone. I know that the lymph nodes drain the lymph from adjacent tissues, which would certainly imply their relation to the sore throat. But, how concerned should I be about the non-tender lymph nodes? If this were your 5-year old what would you be watching for, when would you take additional action, what questions would you be asking and what would you be requesting from his physician?
Expert:  Dr. Phil, MD replied 1 year ago.

I would simply monitor over time. The fever is breaking, he seems to be doing better. I would watch all the symptoms over the next few days

Customer: replied 1 year ago.
that is my plan of course, but would you mind answering my other questions? What things would you monitor for? I would really appreciate it. In retrospect, he keeps saying that "he is too tired" to do things that we ask him to do (including fun things), he doesn't feel like doing activities, he has a persistent dry cough, and doesn't eat a lot. His weight is normal, but has gone down a couple of pounds. Quite honestly the "too tired" may be from hearing us say that we are feeling tired. I just want to make sure that I am not missing something or dismissing something that I shouldn't. I and am paying the money to become more informed and less concerned. I certainly have made the decision to monitor him over time on my own.
Expert:  Dr. Phil, MD replied 1 year ago.

1)monitor the swelling, sore throat and fever. It is not as complex as you are making it seem. Any symptoms, he has....they should resolved over 7-10 days.

2)watch for any new symptoms like rashes, belly pain, etc

3)I would get tested for mono too. EBV can do this

Customer: replied 1 year ago.
Perhaps it isn't as complex as I am making it seem, but I am not a physician. I would assume that there are treatment guidelines that should be followed by physicians, based upon specific signs and symptoms, and to have two very different approaches and opinions regarding diagnosis and treatment is frustrating.
Expert:  Dr. Phil, MD replied 1 year ago.

At this point, if it were my child I would continue supportive care and let the body heal

1)fluids

2)medications to help with fever if possible

3)rest

4)monitor symptoms.

That is all you can do

Expert:  Dr. Phil, MD replied 1 year ago.

Please don't forget a positive rating. If you have more questions, just reply