Phone Visit
Narrative: SPRUCE MESSAGE VISIT Date: 2025-12-03 Encounter: Spruce text message with video review CC: Cough occurring exclusively during meals for several weeks, regardless of food type. HPI: Penelope, age approximately 8, had been coughing exclusively while eating for several weeks. The cough occurred with all food types — ice cream, french fries, cheeseburgers. It had always happened somewhat with ice cream but generalized to all foods over recent weeks. The cough lasted only during the approximately 15-minute duration of eating. No choking or gagging. No abdominal pain. No nocturnal cough. An at-home video was sent showing the character of the cough. A trial of an unspecified medication was tried between December 3rd and 10th with no improvement. On December 16th, Dr. Hobbs assessed two differential diagnoses and initiated empiric treatment. Assessment: Differential includes post-viral cough sensitivity (possibly resolving on its own or responsive to oral steroids) and mild gastroesophageal reflux disease (GERD) presenting as meal-triggered cough. Meal-only pattern and absence of abdominal pain considered. Empiric trial of Pepcid initiated. Plan: Trial of Pepcid (famotidine) 10 mg daily. Parent instructed to keep Dr. Hobbs updated on response. In-person auscultation offered if no improvement. Medications: - Famotidine (Pepcid) 10 mg daily (new) Key clinical quotes: "the list of possibilities are post viral cough sensitivity - which could resolve on it own with time, may be helped with some oral steroids, possible mild reflux, which can sometimes be helped with a short course of antacid meds" "If it were me, I'd start her on some pepcid every day 10mg" "has she complained of abdominal pain? reflux could present like that" Source: Spruce conversation t_27C02FVS44O00