Tuesday afternoon, January 8th “Wai, honey, maybe you should go to Med-Way Drugs to see if they have something besides isatis root that will help Ying’s fever.” Ying was sitting in the family room crying louder by the minute. He had been this way for a few days. “I am starting to worry because he seems hotter than he was a couple of days ago and he’s complaining about not being able to swallow because of the pain,” Min exclaimed. “I don’t want to talk to the pharmacist about any of those ’New World’ drugs, if that is what you are suggesting, Min. I just called my Mom and she said that her herbalist in Beijing always recommends yarrow for a fever. Maybe we can try that instead,” Wai suggested. “His teacher told me that lots of other kids in his kindergarten class have been staying home due to illness. She said that they are usually out for a week, so I think we need to think about a more aggressive treatment,” Min added. “Aggressive? These are the strongest herbs that I can find! Let’s give him some hot mint tea as well. That always helped my sore throats when I was a kid,” said Wai, as he started for the door. “In the meantime, I’m going to our herbalist for something more specific for his fever.” Wednesday morning, January 9th Ying’s fever had spiked even higher despite the use of a variety of Chinese traditional treatments. His throat was red and swollen and he was refusing to eat. His parents continued to worry about his condition and monitored his progress over the week with continued encouragement for food and fluids as well as the herbal medications Wai was recommended by his local herbalist. Admittance, Friday, January 11th Over the next couple of days, Ying’s condition exponentially worsened. Wai’s herbalist had run out of options and encouraged them to rush Ying to the Neumann Hospital ER. Both Wai and Min were very worried and anxious, especially Wai, who disliked having to resort to conventional treatments for Ying. But they ultimately decided to go. A senior medical student made the following notes from the initial physical exam and lab tests: Ying Chen – Initial Report DOB: 11-16-2006 Gender: Male - Weight: 45.2 lbs. - Height: 42 inches Patient History: 6 yo Chinese male presents to ER with complaints of throat and ears hurting. Patient very agitated and fussy, complaining that he cannot swallow, with a persistent cough. Parents report onset as 6 days ago with a focus on throat only, with persistent and progressive pain every day. The mother reports increased sickness of kindergarten classmates. Pain is described as burning and scratching by the child with nothing alleviating any pain beyond the mint tea parents made. Parents practice Chinese traditional medicine in the home and this visit marks the first for Ying in a Western institution. Parents came to the hospital because they ran out of options. Allergies: No known drug allergies Med. History: Untold herbals, no Rx/OTC; Mother noted to contact local herbalist for list Family History: Nothing disclosed by parents (some inherent distrust of Western medicine and slight language barrier); patient lives with parents and attends kindergarten Vitals: T 39.9 degrees C, BP 110/71 mmHg, RR 40bpm, Pulse 110bpm Physical exam: (+) Drowsiness, agitation, rhinorrhea, cough (-) Epiglottitis, flushing, impetigo, circumoral pallor, rash, erysipelas Pharyngeal erythema with petechiae and dark white tonsillar exudates, tender, hypertrophied cervical lymph nodes Initial Laboratory Results: WBCs: 11,800/uL, Differential: 78% PMNs, 18% bands, 4% monos Chest X-ray: clear Urinalysis: hematuria, proteinuria Throat and blood cultures pending Plan: Consult Pharmacy for optimal treatment Case Study Guiding Questions: In addition to isatis root and yarrow, what are other medicinal plants that some traditional medicine practitioners claim have an effect on alleviating fever? List and research at least two. Explain the probable mechanism of action for each of the plants you describe (in other words explain why/how they are supposed to treat fever). Mint tea is sometimes used to relieve the pain of a sore throat. What other botanicals are used for patients with pharyngitis? What OTC medications are similar to mint’s action for pharyngitis? List and describe at least two. List the potential pathogens you think Ying may have and the rationale for including these options. Be sure to discuss at least three possibilities. What tests can be utilized to determine the most likely pathogen? Explain your rationale for all possible pathogens. What treatment options should be considered given the resident’s report? Fully explain your rationale. Min and Wai are anxious about using conventional medicine. What can be done to assuage their concerns?