Thursday, May 14, 2009


Sam had a doctor's appointment today with the ear, nose, throat specialist. Every other time we've seen him (all 4 times that is) I've been very happy with this doctor. Today I'd like to write a letter of complaint to him. The only thing stopping me is that I'm worried I'm PMSing and possibly took things the wrong way. 

Two weeks ago I took Sam to his pediatrician because he was complaining that his ear hurt. Since he has tubes in his ears I was worried that this meant he had lost a tube and now had an ear infection. Before he got the tubes Sam had such a bad infection it bulged the ear drum out. He was asymptomatic. No fever. No tugging at the ear. No complaining of pain. Just speech delayed. 

In Sam's entire life he's been on oral antiobiotics three times. He took them when he was six months old and had a sinus infection in conjuction with his bout with yersinia enterolytica. After  his surgery to place the tubes Sam took antibiotics for 10 days. Two weeks ago, after using a CT scan to diagnose, Sam was given two weeks of antibiotics to treat a very bad sinus infection. Sam turns five next month.

Today we returned to the ENT office for a follow-up on the sinus infection. Three days ago Sam's nose started to run again. As each day passes the mucus gains a bit more color. I mentioned this to the P.A. He told me (after examining Sam's adenoids) that we needed to keep Sam on a nasal spray (Veramyst) and "irrigate" his nose with saline at least three times a day. I asked him how to go about "irrigating" Sam's nose without having to hold him down.

He told me that he was the wrong man to ask. The gist of his comments concerned lecturing me about overuse of oral antibiotics (because apparently parents like me are at real risk of overusing antibiotics). He also told me that he'd physically restrain his daughter (the same age as Sam) in order to treat her. Saline works as well as oral antibiotics in fighting chronic sinus infection- this is good to know. It wasn't until the end of the conversation that he finally thought to describe the process of "irrigating" the nose. 

You have to understand that the last time a medical professional mentioned irrigation to me it was as I was using much of my own body weight to hold down a pygmy goat undergoing a c-section. When she talked of "irrigating" she meant, "pour a couple gallons of warm, sterile, saline over the incision so that I can look for bleeders." The doctor today apparently meant "moisten by spraying bottled saline up his nostril for half a second."

Did the man start out telling me how to treat Sam's nose? No, instead he lectured me about my parenting skills (since I'm opposed to holding my children down and treating them- instead I like to treat them as creatures of reason) and about overuse of antibiotics (yet, the bulk of antibiotics Sam has taken were prescribed by him- twice).

Central to my parenting philosophy has always been a deep respect for my children. I will not hold any of them down three times a day for medical treatment. They deserve better. Doctors should be able to offer advice about treatment that doesn't include physical restraint for almost five year olds. I didn't ask for a different solution- just advise about how to implement his instructions. 

Twenty years of working with horses has taught me that brute force is rarely needed and often causes way more harm than good. Sam won't be five and weigh 42 pounds for very long. I need to establish a relationship with him that is founded on trust. Sometimes he needs to do things that are scary or unpleasant. How can I get him to do those things once he's as big as I am if I treat him as if his fears and needs don't matter now? Sure, in an emergency I have no problem restraining him when it's for his own good- but three times a day, every day? No way. There has to be a better way to gain compliance. Of course it would be helpful if the doctor explained the treatment better. Irrigate. Moisten. Totally different actions. 


Mrs. B. Roth said...

Maybe a little PMSy.

Is it just me or are all these new PA (physician's asst.) just glorified male nurses? They are, right? Cuz nurse sounds to girly for them?

My doctor, rather than give me the antibiotic lecture, prints off the prescription and tells me to go home, watch the kid, and fill it if I think we need it. I respect a doctor who gets than moms know stuff.

On the other hand, when I took Sagan in for her 6 week check up, I wiped her dirty bum oh-so-carefully and he said "no, you really have to get that better to avoid diaper rash and bladder infections," then he showed me how to clean baby girl's parts correctly.

Maybe send the letter in a week, but let Dave have a once over first.

Amy said...

It's not really you, well maybe just a tiny bit, because what he described to you is not irrigating. Trust me I know.

When my ENT talkes about irrigating it is with a neti pot or (what I have) a small bottle with a top like the squirt bottles water you can buy. I fill it with warm water and a small amount of salt, and mix. Then bending forward, I gently squirt half the bottle into one nostril and it flows out the other, and then reverse it for the rest of the bottle.

So no it doesn't sound like he was communicating very clearly.

I'm glad though that what he meant for Sam was easier.

j4luck said...

This YouTube video has a three year old using the squirt bottle netti like Amy mentioned:
There are several other videos as well. Maybe you could watch them with your son and talk about trying it, then do it together and he won't feel as scared and you won't have to use force.
It probably will take a few tries to get comfortable for him, but if he sees that other kids do it, maybe it will make him feel more courageous.

Jake camping in the living room

Jake camping in the living room