Phone Visit
Narrative: SPRUCE MESSAGE VISIT Date: 2026-03-11 Encounter: Spruce text message followed by in-person clinic visit (2026-03-14) with ongoing Spruce text message follow-up CC: Fever, cough, and malaise following school exposure, with progressive worsening over several days including respiratory distress symptoms and calf pain. HPI: Max is a school-age child who came home early from school on 2026-03-10 with fever of 99°F, cough, and malaise. By 2026-03-11, fever had risen to 101.3°F. Parent reported a known exposure: Max had a sleepover on Saturday with a friend (Ted) who was subsequently diagnosed with Flu B, and another friend from the same sleepover was sick by Sunday. At-home combo test was initially negative for COVID and flu, though a faint Flu B line was later noted on repeat testing. Parent declined Tamiflu due to concern about side effects. By day four (2026-03-13), Max experienced worsening cough with difficulty breathing while lying down and pulse ox readings occasionally dipping into the 92% range, prompting parent to monitor overnight. By 2026-03-14 (day five), Max was coughing hard enough to gag, still febrile at 102°F, and not improving. He was seen in-clinic on 2026-03-14. On 2026-03-15, Max awoke with fever of 100°F and new complaint of severe bilateral calf pain with difficulty walking, consistent with viral myositis. Assessment: Flu B infection consistent with known household and sleepover exposure. Respiratory symptoms including noisy breathing and positional difficulty were assessed as expected and consistent with influenza. Calf pain on 2026-03-15 assessed as viral myositis, described by Dr. Hobbs as very common with flu, with calves being the most commonly affected muscle group. Plan: Initial management with rest, fluids, TLC, alternating Tylenol and Advil for fever. Delsym and Mucinex recommended for cough; honey cough drops suggested. Tamiflu discussed but deferred per parent preference and Dr. Hobbs's agreement that it was not an unreasonable call given symptom trajectory at the time. Pulse oximetry and respiratory rate monitoring guided reassurance. In-clinic visit on 2026-03-14 at 11:50 AM. Post-visit, a prescription was sent (100mg, 1 pill, twice daily as needed). For viral myositis on 2026-03-15, parent advised to monitor urine color for darkening (rhabdomyolysis watch) and reassured that if urine remained normal in color, it was not a crisis. Medications: - Advil (ibuprofen) Alternating with Tylenol for fever management (ongoing) - Tylenol (acetaminophen) Alternating with Advil for fever management (ongoing) - Delsym Not specified (new) - Mucinex Not specified (new) - (Prescription sent — specific medication not documented in Spruce) Key clinical quotes: "We can get him going in some tamiflu too" "I'm a big food dragger, in general. Less meds is always my preference." "Very very common and calves are most impacted. Dehydration can add to that — Watch to make sure his urine doesn't get too dark" Source: Spruce conversation t_230AM8QV9Q800