Wednesday, December 24, 2008

My complaints about common complaints Day 3

I work pediatric urgent care on evenings and weekends mostly so that I can be home with my kids during the day. I want to go home at the end of my shift cause my kids don't really care how late I was up the night before. There are a lot of times when I am there quite a bit later then we close for legitimate reasons. I don't mind staying with a child who has bad croup or lacerations or dehydration. What I do mind is a parent who brings in their kid right at closing because their child has had abdominal pain for a week, or anything that has been going on for a while and is not acutely worse tonight. Then frequently after I've stayed to see a patient after closing and I given them a prescription for their ear infection or strep or whatever, the parent says "great I'll fill this tomorrow" There are 24 hour pharmacies, 2 within 10 minutes of where I work. If your childs problem is serious enough to keep me late, then at least have the decency to fill the script and start the medication tonight.

Tuesday, December 23, 2008

My baby is messing with my head.

While I was pregnant with my fourth child, I told anyone who asked that I WAS fanatically done with having children.  She was to be my last.   Here's the problem; she is so darn cute!  I find my self thinking all the time "Maybe I should have another one".  She is barely six months old.  I hate being pregnant.  Hate,hate,hate.   So what is wrong with me?  Why can"t I think like a rational human being?  Granted she has her moments, but seriously my baby has made my brain turn into a pile of baby-loving mush.

Sunday, December 21, 2008

My complaints about common complaints Day 2

I frequently see kids who have fairly high fever and when asked if they've had any medication for their fever am told " Well I wanted you to see their fever." I don't want your kid to suffer. Please give them some Tylenol or ibuprofen if they are miserable with fever. I would like to know what it was, so having a thermometer that actually works is extremely helpful. I don't believe anyone that says, "They felt like they were 102." (Sorry mom), she does this too, but if you can tell me their maximum temperature, I'll believe you. The whole process will go much better for everyone if the sick child has had some medication.

One more complaint tomorrow.

Saturday, December 20, 2008

My complaints about common complaints

"He's just been so lethargic" the kid is of coarse already pulled apart the exam room and tried to change my password on the computer. Generally I say to parents "Tell me what's been going on with Suzy." , then as they talk I type. When they say they've been lethargic I type decreased activity. True lethargy is a serious problem. When your child barely opens their eyes when you say their name and lies in your arms and doesn't cry because the doctor is examining them, that is truely lethargic. Listless is a better word, sleepy, somulent, but please try to limit the use of the word lethargic. I understand that when your child is sick they are not as active. I have yet to meet a child who is sick who is as acitve as normal. Most adults when they are sick are as active.

Tomorrow another complaint about common complaints.

Friday, December 5, 2008

Boys and Girls

When I was a junior in undergraduate I wrote a paper for my psychology class called "Boys and Girls, Stereotypes and School".  It's basic premise was that most of the difference between boys and girls had more to do with nurture rather then nature.  Boy was I wrong.  

My son who is 6 (and a half he would say), has managed to lose 2 light sabers in the last two years.  He keeps begging me for another one, I have told him that he has lost the other two and I'm not buying him a new one.  So he started using the piece of pvc pipe with some duct tape that was functioning as part of a t-ball stand for a light saber.  He convinced his younger sister to fight with him, her weapon being an old curtain rod.  This has never ended well.  She starts crying within 2 minutes every time.  It wasn't long before that they were taken away as well.  

He has seen Star Wars the same number of times as my oldest (10 year old) daughter and she has yet to make weapons out of legos, pvc pipe or curtain rods.  

Thursday, December 4, 2008

The real purpose of bouncy seats

I have uncovered the real purpose of bouncy seats, and it has nothing to do with gross motor skills or hand eye coordination.  I bought a "kick and play"  while we were living in Nebraska at a yard sale, I even had to sew on two of the toys back on.  Three of my children have been entertained by it.

But it's real purpose is  it is small enough to be put in the bathroom where you can see it so you can actually have a shower.    If the baby is in the bouncy seat and buckled in, it is less likely that the 4 year old will try to pick them up or put blankets or pillows over their head. Notice that I said less likely.   However I still utter phrases I never thought I would, especially while naked.  "Immy, don't put your fingers in her nose".    Who knew going into this motherhood thing, that showering would be such a public event.   

Friday, November 28, 2008

After Thanksgiving

Kids throw up, they just do, sometimes only once and sometimes for a few days. After your child throws up, their stomach is irritated, so although they are thirsty don't give them anything to drink or eat for an hour, then give them small amounts of fluid frequently. For example; a sip or 1/2-1 tsp every 5-10 minutes, after they keep that down for a hour, then give them 2 tsp every 5-10 minutes for an hour. After 2 hours of the small amounts of fluid frequently, they can have normal amounts of fluid. If you let them drink normally too soon after they throw up, they are just going to throw up again. It's your job as a parent to be amazingly annoying and say, " Here take a sip, here take a sip". Good signs that they are getting enough fluid are at least 2-3 wet diapers a day, making tears when they cry and when you look in their mouth it is pink and moist.

I am fine with children drinking whatever they would like during the first few days of illness. That can be in frozen form like popsicles or in solid form like jello. We use popsicles a great deal in the clinic to get a child who is otherwise not taking fluid to take something. There is nothing magic about pedialyte, it won't make the vomiting stop. It has some electrolytes in it and is good to treat acute dehydration, but that is about the extent of it.

Good reasons to take your child to the doctor:

You've tried the small amounts of fluid frequently and they continue to throw up

They are having blood in the vomiting.

They have vomiting for more then one day without diarrhea.

Vomiting without diarrhea is accompanied with a high fever.

They seem to be dehydrated.

Sunday, November 23, 2008

Don't freak out because your kid has a fever

I see a lot of people who come in because their child has a fever.  There are a lot of reasons kids have fever.  Most of the time it's not anything to get too excited about, simple infections like viral, ear infections, strep, gastroenteritis (stomach flu).  Sometimes we don't know why they have fever.  

This is my fever talk:  
As long as we know why they have it, Fever in and of itself is not necessarily a bad thing.  Your body puts your temperature up on purpose to help fight off infection.  You're not at risk of having brain damage unless you have a fever of 108.  As long as your brain is functionally normally, your body isn't going to allow that to happen.  Some people are predisposed to febrile seizure, we don't know who they are until they deiced to have one.  Even then it's scary to watch, it doesn't cause brain damage.  

If a kid's runny around with a fever of 101 or 102, but is otherwise doing well, that's OK in fact actually a good situation.  When  your child has a high  temperature and fells miserable, that is the best time to given them an antipyretic.  You want to make sure you give your child an adequate dose of Tylenol or ibuprofen and stick with the one they respond to better.  Even if their fever doesn't come all the way down to normal, that's ok as long as they are feeling better.  If they have at temp of 104 that is not responding to Tylenol or ibuprofen, then they should be seen.  Anyone who has a fever for more then 5 days should be seen and any child who has headache, fever and neck pain should be seen immediately.  Kids who are sick usually don't want to eat a whole lot, and that's alright as long as they are getting adequate fluids.  What your mother told you about pushing fluids is true.  There is nothing I can do to make your child eat when they don't want to.   Any child who is not responding to you needs to be seen immediately.  But you don't need to wake a sick child to give them fever medication, let them sleep.

Ode to my Husband

I thought I'd write a bit about Dr. Valentine, not me and not Mark, the other Dr. Valentine.  He is an excellent husband and father.    He makes pancakes on Sunday with eggs in the middle.  He takes a very long time to fix all kinds of electronic things, but once he does it works really well and does things you didn't even know you wanted it to do.  He motivates the kids to pick up by making it fun.  He arranges his work schedule so that he can be home with the children when I go to work.  He is not jealous when I go to the ballet with my "boyfriend".   He brings Mila so she can nurse when I'm at work sometimes several times in a shift the whole time carting around  a baby bag that looks like a large purse.  He makes beds for the kids and paints walls in several different layer of very good faux.    He thinks I'm interested in what Mac is coming out with now and tells me all of his plans for his business.  He talks more then any man I know.  He's a good man that Dr. Valentine of mine

Sunday, November 2, 2008

Working out with children

So the other morning I'm trying to do a mother baby yoga/pilates video. Imogen, my now 4 year was watching me. I had to stop shortly after starting to feed the baby. While I'm nursing Immy tries to immitate the yoga on my mat.

Finally I turn the video back on. Immy decides she wants to do it too. First she needs a mat, so I go out to the car to get my spare mat. 2 mintues later she needs her "baby". I go up to her room and get her doll. 2 mintues later she needs a blanket for her baby. Then she needs a toy for her baby. Then she decides she likes the color purple of my mat better then her mat ( they are both purple), and we need to switch mats. Next she decides that it would be best if we both were on the same mat.

One hour later, it's time for Millie's nap. Thus concludes my excercise for the morning.

Monday, October 20, 2008

Why you should get a flu shot

It's that time of year again when we are headed into flu season. This is my view of why you and your children should get a flu shot. I know my kids hate getting them, and I will admit I procrastinate it myself.

Those most at risk of dying from the flu are the elderly and the young. Most of the elderly are immunized, but have a hard time mounting an adequate immune response to the immunization. Children mount a good immune response to the flu shot or flu mist. Children less then 6 mo are too young to get it. Making sure older children are immunized will help protect young infants. Children pass the flu more then any other population. The best way to protect grandparents and great grandparents is to immunize children.

The flu is becoming more and more resistant to the anti-virals given for the flu. When given they really don't do much for the person who is sick, they do make you less contagious to other people.

The flu pandemic of 1918 killed 20-50 million people worldwide. It was especially targeted to the lungs and caused swelling and bleeding in the lungs. It killed many otherwise healthy people because they would mount a good response to the flu and send lots of cells that would ordinarily help fight off bugs, but in the case of the flu of 1918 with 40,000 times more viral particles than normal flu, those cells that would normally fight the virus (cytokines, macrophages) just helped to destroy architecture of the lungs and made them sicker. Those people who were originally well sent even more cells to fight off the infection and died in 24-48 hours. People basically drowned. There is still no medical intervention to stop that process once it has begun. The H5N1 avian bird flu seems to be very similar to the Spanish flu of 1918 in animals. Although it is most likely to happen in a pandemic setting this year, this sort of thing still kills about 20,000 people a year.

I know the flu shot doesn't always cover the strain that is currently infecting people. Often times there are multiple strains and the vaccine covers most of the strains but not one or two. It is impossible to predict how the virus will mutate, but the best educated guess is made. Even if the vaccine doesn't cover 100% of the current strains, it still decreases your chances by 50% of getting the flu.

Stay healthy, protect those around you. Get a flu shot.

Sunday, October 12, 2008

Not Uncommon

When I was in my first or second year of medical school I remember hearing one of my professors or clinical faculty saying "not uncommon" about something  associated with a condition.  I thought it was the stupidest thing I had ever heard.  "Why don't they just say rare?"  I thought to my self.  Now 6 years after residency, I find myself saying "not uncommon" all the time.  Turns out it's the perfect thing to say when something is not common and not rare, but indeed not uncommon.  

Say for example your infant has conjunctivitis (pink eye), it is not uncommon for them to have an ear infection as well.  If not common, meaning most, but not rare.  Getting a rash with a viral illness or a viral exanthem is not uncommon.  

I was inspired to write a blog by Stephanie Nielson "Nie Nie Dialogues" . She is my sister-in-law's sister-in-law.  I hope to write about the things in life that are not uncommon; they may not happen daily, but they are not rare.  Some medicine, some motherhood, some marriage, some life.