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‘It’s that sixth sense we all have’

Fast-thinking physician assistant makes critical diagnosis of young boy

Nothing seemed terribly unusual the day last month when Bridget Wilkes brought her 7-year-old son, Nolan, to Novant Health Urgent Care & Occupational Medicine — Kernersville.

Nolan had all of the classic flu symptoms — a fever, cough and sore throat. The physician assistant they saw at the clinic, Nicole Vital, diagnosed Nolan with the flu, but that turned out to be only the beginning for what would be a very big scare.

Two days later, the mother and son returned to see Vital. This time with Nolan's younger brother who was experiencing similar symptoms. Nolan, who was feeling much better, was simply tagging along.

 “He said hi to me and he played on his tablet while I was seeing his mom and younger brother,” Vital said.  Later, when he stood up, “I noticed something wasn’t entirely right.” As he walked, Nolan appeared to be in pain.

Immediate intervention needed

That’s when it turned into Nolan’s visit, too. Vital and her clinic colleague Dr. Robert Beam examined Nolan. Based on the exam and Vital’s instincts, Vital called ahead for Nolan to go to the emergency room. Vital said she wasn’t certain that hospitalization would be necessary, but she didn’t want to take any chances.

“Sometimes it’s nothing, but in the case of Nolan, I couldn’t be more grateful that I stopped and took the extra time,” Vital said. “It’s that sixth sense that we all have.”

Nolan was diagnosed with rhabdomyolysis, (pronounced: rab-dough-my-oh-la-sis) a rare but serious condition that results from a breakdown in muscle tissue and releases a damaging protein into the blood. In some cases, it can also lead to death. Nolan was admitted overnight at the hospital for IV fluids. His mother was told that without immediate intervention, Nolan could have suffered significant kidney damage.

“Nolan had been complaining about how his legs were hurting, but he’d never had the flu before. I just figured that he had aches and pains,” Bridget said. “He’s a quirky, funny 7-year-old boy. He’s a great kid who is full of energy, but he tends to be a little on the dramatic side. I felt guilty when I found out something was wrong.”

Not easily diagnosed

Vital said it’s easy to see how these types of symptoms get missed by families, especially since Nolan, on his fourth day after first showing flu symptoms, no longer showed any symptoms associated with the flu.

“He probably got viral myositis, which is an inflammation of the muscle tissue. In children it’s something they can get after any viral illness,” Vital said. “It’s typically just painful and something you just have to get the kid through, but in some children, it causes such significant muscle breakdown that it builds up in the blood, and the kidneys filter that and get overwhelmed.”

Luckily, in Nolan’s case, everything turned out fine. Bridget said after spending one night in the hospital, she was able to take Nolan home and keep an eye on him, making sure he drank lots of fluids. He was back to normal and in school again that next week.

Nolan’s father, Dave, was also able to get a 36-hour pass to leave National Guard training to come back and see Nolan while he was in the hospital.

Vital said it’s important for parents to remain observant, even after the initial symptoms pass because flu complications can happen to perfectly healthy people, regardless of whether or not they took Tamiflu in the appropriate window, as Nolan did.

Vital said in cases when kids die from flu-related illnesses, it’s often from complications that occur afterward, such as pneumonia, rhabdomyolysis complications or certain cardiac conditions. “You just have to be very, very mindful of changes,” Vital said.

The power of social media

Nolan’s tale also turned out to be a powerful one on social media that caught fire online. Bridget shared her son’s story in a public Facebook post, which quickly garnered more than 1,000 shares.

“I figured I could help someone else by sharing his story. That was my intention,” Bridget said. “I actually received emails from women in Georgia, South Carolina and Tennessee, saying that because of the post, they brought their children in and they also had rhabdomyolysis. So I told Nicole that through Nolan’s story she may have helped save more lives.”


Published: 3/7/2018