Page 54 oh? SM Alberta Health Services I Child Development Centre Suite 300. 3310-34 Ave NW Calgary. Alberta Mailing Addms' 2888 Shagannppi Trail SW Calgary. Alberta T313 6A8 Phone {403} 955 5999 Fax {403) 955? 5990 PHYSICIAN REPORT NAME: Ezekiel Stephan DOB: 2010/08/20 ACH 1032777003 DATE OF ASSESSMENT: March 15, 2012 LOCATION OF ASSESSMENT: Pediatric ICU, Alberta Children?s . Hospital PERSONS PRESENT DURING ASSESSMENT: Dr. Jenn D?Mello, Collet Stephan (mother), David Stephan (father). Various nurses and other family members in and out of room during interviewfassessment. INFORMATION OBTAINED FROM: Collet Stephan (mother) and medical chart HISTORY OF PRESENTING CONCERN: Ezekiel?s mother (Collet) describes that he was last completely well approximately 2.5 weeks ago on Feb. 26?" 2012..- On Feb. 27?? Ezekiel developed a fever and was whining a lot. Initially the parents thought he was teething but then later in the day he developed I breathing and had some increased di F?culty was-occasions". a. awn; w. daily basis. Page 55 of 6m 1 breathing which Collet imitates as soprasternal indrawing. They phoned a family friend who was also their birth attendant and is an RN according to the parents. Over the phone the friend could hear Ezekiel?s breathing and told the parents it sounded like croup. Ezekiel . did not have cough, runny nose, or congestion at that time but did have a decreased appetite starting that day. Collet subsequently looked croup up on the internet and saw that it was a viral infection and that the only medical treatment typically offered was a dose of steroids if it was severe. As per the internet suggestions, they treated Ezekiel's breathing dif?culty with cool air and a humidi?er. They also started Ezekiel on some herbal/naturopathic remedies which they believe help ?ght off viral infections and have given Ezekiel in the past when he has a cold. These included olive leaf extract, garlic, and (MSM). This is in addition to the daily herbal/naturopathic supplements that Ezekiel has been given by his parents since approximately 10 or 11 months of age. His routine daily supplements include EMpowerplus, Omega 3-6-9, whey protein, FermPlus, and a digestive enzyme (Collet couldn?t recall its name at the time of the interview). The parents ruin these ingredients with fruit and frozen berries into a smoothie and give one to Ezekiel on a Ezekiel?s ?croup?I continued over the next week although of note he never really had a cough. He continued to have a decreased appetite with minimal food intake over that week. He was only interested in drinking small amounts so Collet and David used an dropper to make sure he was getting enough ?uids and to give him his daily smoOthie. He had normal voiding and stooling. After the ?rst day of illness his fever never returned. i-Iis skin frequently felt hot but he was never sweaty or shaking and when they checked his . temperature with a tympanic thermometer it never went higher than about 37.8 degrees. Throughout the week Ezekiel had low energy and is described as not being playful and spending most days watching TV and cuddling with Collet. Ezekiel continued to have episodes of increased work of breathing which were usually worse at night but the parents felt he was gradually improving and responding to the cool air, humidi?er, and extra herbal remedies. By March 5Ill Ezekiel seemed much improved. [-lis energy was not yet back to normal but he no longer had any dif?culty breathing and was well enough to go to a prewschool type program he attends with Coliet. He played a bit that day and also had a bit of an appetite and ate some small amounts of solid food for the first time in the past week. Collet stopped his olive leaf extract, garlic, and MSM as he seemed to have recovered from his ?croup?. - Page 56 of 6M The following day (Mar Ezekiel was unusually lethargic- more so than he had been during any of the days in the week prior. He laid in bed the entire day and his only response would be to moan unhappin when Collet left the room. He again would not eat or drink and was 0 3 2 7 7 restarted on his extra herbal remedies. Collet also describes noticing an unusual ?neurological that day where Ezekiel had repetitive movements of his right arm where he would pull at his diaper or rub his cheek and these movements seemed unusual and involuntary to Collet. She wondered if these were related to starvation as he had eaten so little the week before. The following day (Mar Ezekiel seemed a bit better. His abnormal movements had stepped and he was not quite as lethargic. He was still far from Lplayful but would at least watch a bit of TV that day. From Mar 8?!0 he seemed to gradually improve and regain a bit of his appetite but he was never active and pla?y?rl. Due to his improvement his extra herbal remedies were stepped again. On Mar ll?h Ezekielis worsened again. He would not eat or drink, was lethargic, and they noticed his body to be very stiff. These persisted on Mar 12?? and he started being so stiff that his back was arched. At that time they called their family friend/birth attendant again who came over to examine Ezekiel by checking his vitals and listening to him with a stethoscope. According to Collet their friend concluded that Ezekiel?s could be from meningitis. Collet then looked up meningitis on the internet; specifically she mentioned looking at the website. She came across the Kernig and Brudzinski?s test for meningismus and tried them on Ezekiel. She reports the tests were obviously positive, further indicating to her that Ezekiel was suffering from meningitis. Based on her reading she felt he more likely had viral meningitis than bacterial as he hadn?t really had a fever. Ezekiel?s parents began treating him by resuming his olive leaf extract, garlic, and MSM. They also ensured he was getting lots of fluids with the dropper as he would not drink on his own and they additionally started him on Total Reload (an electrolyte and amino acid supplement). Within 2 hours they felt he?d had some improvement and was less lethargic. The called their naturopath in Lethbridge to ask for recommendations for treating viral meningitis and were advised to start him on something called BLAST. Collet reports that during this second week of illness Ezekiel remained afebrile with no return ot?dif?culty breathing. He had no cough, congestion, vomiting or diarrhea. He was having bowel movements less frequently than usual but continued to have a few voids each day. "