Sam’s Story

Sam was born in 2017, and adopted by Nancy and Paul when he was two. He is a typical toddler: good-natured and very inquisitive. Typically, before the finalization of an adoption, children are required to undergo a routine examination by a physician. However, the required examination is not meant to be a complete health screening, and many conditions are not even checked.

Patient History

There was little information available about Sam’s biological parents. However, it was known that they died in an automobile accident when Sam’s father suffered a massive heart attack, just before Sam turned 2. In the past two weeks since Sam was adopted, he has done very well adjusting to his new environment. Moreover, he has had all the proper immunizations for his age.

Sam’s adoptive parents have noticed some greasy/oily stools in his diapers. In addition, they are concerned about his wheezing when breathing. Nancy calls her family physician and gets a referral for Sam to see a pediatrician.

Initial visit

The initial visit with the pediatrician consisted of a physical examination, blood work, and a chest x-ray.

Follow-up visit

The weather was very hot and humid, which made it almost unbearable to be outside. Sam’s parents parked their car and brought Sam into the air-conditioned comfort of the Medical Centre pediatric clinic. Sam appears to be breathing easier once he is in the cool air.

They were immediately seen by the pediatrician, and Nancy expressed her concern over the colour of Sam’s sputum. She was upset that she had forgotten to tell the pediatrician the other day about this fact. The sputum Sam has been coughing up was green and viscid.

While talking with Nancy and Paul about Sam’s sputum, the pediatrician looked over at Sam and noticed a white ‘frosting’ on his face, an indication of salty build-up on the drying edge of sweat. The pediatrician asked Nancy and Paul if they had noticed this salty-build-up before.

“That must be why his skin tastes a bit salty when I kiss him on the cheek,” Nancy replied.

The pediatrician then went over the blood count and chest x-ray results with Nancy and Paul.

After describing the chest x-ray results to them, the pediatrician had a hypothesis about Sam’s condition. To test her hypothesis, the pediatrician ordered a sweat chloride test.

Sam was diagnosed with cystic fibrosis. Nancy and Paul would have to make many adjustments to care for Sam. He would require chest physical therapy, exercise, medications, digestive support, and psychosocial care.

Sam will most likely face significant challenges: frequent hospitalizations, complications such as CF-related diabetes, depression, anxiety, and time-consuming treatment plans that can take 2-3 hours each day.