Phone Visit
Narrative: SPRUCE MESSAGE VISIT Date: 2024-09-11 Encounter: Spruce text message followed by Phone Visit CC: Prolonged abnormal bowel movements with rectal pain, possible constipation or GI infection. HPI: Jack had been having abnormal bowel movements since approximately 8/3, with the parent actively monitoring since 8/26. Stools ranged from hard pellets to soft and stringy. He had sharp rectal/butt pain, particularly when seated. On 9/11, he was sent home from school for refusing to wake from nap and was uncomfortable when sitting on his bottom. Two children he swam with all summer were subsequently diagnosed with E. coli and treated with 3-day antibiotics around 9/19. Jack was having 3-4 bowel movements per day. Assessment: Dr. Hobbs assessed Jack as having an unsettled GI tract — possibly constipation with overflow, post-infectious gut dysregulation, or potentially a shared GI pathogen (E. coli considered after two contacts were diagnosed). Perianal strep was raised as a possibility given rectal discomfort. Dr. Hobbs elected to call the parent to discuss the E. coli connection. Plan: Increase fruit and water intake, reduce dairy. Miralax considered but deferred given variable stool consistency. Probiotic recommended. Close monitoring. Phone call initiated to discuss possible E. coli connection on 9/19. Key clinical quotes: "Sounds like things aren't quite settled in there." "Constipation can cause that intense, deep pelvic pain" "Could. What happened to not waking up?" Source: Spruce conversation t_226ST10QO3800