Sunday, January 25, 2009

The beginnings of adolescence

Last Sunday after my oldest, Giselle, gets out of the shower. She is normally my very obedient, helpful, no attitude child. I tell her she needs to blow dry her hair before going to church. " But I don't like to blow dry my hair!" "Well I'll do it" I say. She protests loudly, so I say, "If you want to have the stacked hair cut, you have to blow dry it." She says "I didn't want my hair cut like this, you made me get it" "What did I say when they asked me how I wanted your hair cut? However she wants it, it is her hair." "Oh" she says. 1 point for mom. She tries again. "I didn't want to take a shower this morning, you told me I had to." " No honey, what I said was, 'If you are going to take a shower this morning you should probably do so, so that you have enough time.'" another "oh".

Hopefully this is not a pattern of things to come, but I dare say it probably is. And thank you to whomever invented the stacked bob haircut that has to be blowed dried or it looks awful.

Saturday, January 17, 2009

I torture small children

My life became a lot easier the day I realized my job is to torture small children. I was the supervising resident one evening when I was called down to the Emergency Department for a consult on a 5 year old with alteration of consciousness and fever. The patient had been at school when it was observed that he was lethargic ( see previous post) and febrile (fancy for has a fever). The patient had been seen by the resident in ED and had had blood work, urine and spinal tap and a CT scan (CAT scan), all of which were normal. I went to look at the patient and really had to fight him, he was no longer lethargic, to get a good look at his ears and throat. Mom was not happy with me because she didn't want me to hurt him and did not assist at all with holding him still for the exam. His throat was nasty looking. I swabbed him and went to talk to the resident who had already seen him. I asked her what she thought of his throat and she said " Well I didn't get a good look at it because the mom was upset." The patient's strep came back positive. Here's what happened: The patient had a febrile seizure that was not witnessed and then was post-ictal. After seizures people are usually quite out of it. The poor kid had been put through a whole battery of tests for something really quite simple. I concluded that my job was to make sure I got a good look at kids ears and throats regardless of how mad I make a parent. Especially in pediatrics a lot of infections are in the upper respiratory tract. I don't try to hurt kids and I try to make the exam as fast and fun as possible, but my job is essentially to torture small children.

Tuesday, January 6, 2009

But he's got white stuff in his throat.

Currently we are seeing a lot of strep going around. It is most of the time a very easy diagnosis and treatment. I tell my MA she gets a raise everytime she has a postive strep. Of coarse I have actually nothing to do with her salary, but it makes her happy. Beta-hemolytic Group A Strep (Strep throat) is treated with antibiotics for one purpose; to prevent Rheumatic Heart Disease. Sorry, but you feeling better pretty fast is just a added bonus. There are other bacteria that sometimes come back postive on throat culture but they don't cause Rheumatic Heart Disease and usually they are not treated. There is some evidence that Group C strep and a couple of other "groups" might also need antibiotics so if it one of those it is treated. Contrary to popular belief exudate or white stuff on the tonsils are not very consistant with strep. They are alot more consistant with adenoid virus which is very good at mimicking strep. Having petechia on the soft palate and tonsilar pillars, the skin in front of the tonsils, is more consistant with strep. Usually cough and runny nose do not accompany strep. Sometimes people have headache and stomachache. Unless you have a strep rash the only way me or any doctor can tell if you have strep is to do a rapid strep antigen test or culture. The rapid test is about 93% accurate which is remarakably good as far as rapid tests go.