What could my pediatrician have done to recognize my symptoms earlier?
My pediatrician was an older man who had run the same private practice for probably the past 200 years. Yes I’m exaggerating but he was THE pediatrician in my town for a long time. He had been my mom and her sibling’s pediatrician back in the day and pretty much everyone else who grew up where I did. Thinking back I can see why he was so revered: he was personable, loved his job, methodical and had great clinical acumen.
By the time my siblings and I got around to being his patients he was definitely older and we affectionately called him “Ol’ stone hands.” Anyways, to answer the question fairly there was probably nothing he (or any other pediatrician) could have done to identify that I had IBD let alone Crohn’s. I forced myself to try and be as ‘normal’ as possible and I was pretty successful at it for like 6 years. Unfortunately my symptoms started at the tricky age where my first reaction was embarrassment and to turn inward. Had I been a little younger or a little older I think I would have told my parents right away but such is life.
Had I been asked about my symptoms by my pediatrician I likely would have just lied saying its all good down there. This isn’t to say there weren’t indications that I had something was amiss because I always had super low energy levels and I basically stopped growing in like 9th grade. I’ll never forget how many times my dad would ask me “are you feeling alright you seem a little….slow.” These two things alone though are too broad to have cued in my doctor to one thing let alone IBD as I had no family history.
One thing I do NOT remember my pediatrician ever doing was performing an abdominal exam (when the physician palpates the different quadrants of the abdomen). Had this been done there was no way that I could have hidden the pain. Firm pressing in the lower right quadrant (remember where the ileum is) brings on grimacing pain when my disease is active that I would not have been able to hide. I don’t know if such an exam was ever indicated because I never complained about GI problems, but it is something he could have (and probably should have) done as a part of any thorough physical examination.
I don’t think my insular reaction to the early symptoms of IBD are unique to me. These symptoms can be alienating among adults so imagine being a kid without a full understanding of the implications of delaying a diagnosis or that not everyone in life is perfectly healthy. Thinking back I attribute my delayed diagnosis on myself, not my pediatrician. I did just about anything to hide from the world but I did learn some valuable lessons.
My first lessons on how to be a caring and humble doctor came from this man. When I finally did reveal the symptoms he called a pediatric gastroenterologist immediately. He knew this was beyond his expertise, he knew his limitations (a rare and important quality in physicians) and this is a valuable lesson. All I can say to old stone hands is thank you for taking care of thousands upon thousands of kids across multiple generations in my town to the best of your abilities and teaching me the importance of recognizing the limitations in my knowledge and when to call for help.