Wrong Diagnosis: Acute Otitis Media July 29, 2008
Posted by pjpajamas in medicine.Tags: acute otitis media, AOM, wrong diagnosis
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I previously mentioned that my daughter was sick right before our planned trip to China. Our flight was on a Thursday. On the Saturday before, she started to act a bit sick. She woke up from an afternoon nap and had a minor fever or 100.4. However, every temperature from then on was normal. She had this harsh sounding cough and quite a bit of snot that was making it hard for her to sleep. Otherwise she was acting pretty normal during the day. She played and watched TV. She was a bit sweaty, but otherwise just fine.
I explained all this to the family practice doctor that we took her to see on Monday. If we weren’t traveling, I wouldn’t even have brought her to a doctor. My mother-in-law was the one that brought it up and I agreed to help alleviate her fears. She was watching my daughter on Saturday when my daughter hit her head and she’s been worried about that ever since. Nothing I say has been able to truly convince her that a bump on the head does not lead to a upper respiratory infection.
The cough, by the way, I believe is due to post nasal drip, because she definitely had snot. And she only coughed whenever she woke up. So she wakes up from her afternoon nap and is coughing and my mother-in-law calls me saying she wants to take my baby to urgent care. We get there, and urgent care doesn’t open until 5pm. The only appointment we can get is with a family practice doctor.
So I explain everything to the FP, saying that I just want clearance for travel and to assure my mother-in-law that it wasn’t her fault. She does all that. Does the typical lungs, heart, ears exam and states my baby has acute otitis media. It comes as a kind of a sup rise, since my baby has not had a fever and has not been pulling on her ears. Plus she’s never had AOM. I’m sure it helps that I’m an osteopath and I work on her head whenever she’s sick.
Either way, I’ve learned a while ago that it’s sometimes easier to just go with the doctor instead of trying to be the family doctor. But as I’m leaving the clinic, I’m thinking about it and I really think the doctor pulled a fast one on me. I also know from rotations experience that FP’s tend to over diagnose AOM. It’s like they have to slap some diagnosis, it might as well be AOM.
What can I do anyways? My daughter was diagnosed and even if I don’t agree with it, it would still be wiser to just give her the amoxicillin (a pretty benign antibiotic). We give her the first dose right before she goes to sleep and once she’s asleep I decide to take a look in her ears. Her ears were so full of wax, I have no idea how the FP could have diagnosed AOM. So I try to remove a bit of the wax to get a better look and now I am really convinced that she doesn’t have AOM. I’m getting really frustrated with this doctor. I know sometimes doctors think that the patient expects an antibiotic, but I had clearly explained to her that I just wanted medical clearance for my daughter to travel.
So in the end we gave the antibiotic to my baby anyway. Until up to the flight and then we stopped. It gave her not too bad diarrhea. Otherwise she’s been pretty much “recovered” even before we left anyway. And now my mother-in-law is trying to get her to drink yogurt as much as possible.
I am never going back to that FP.
Traveling International with a 16 month old baby July 25, 2008
Posted by pjpajamas in family life.Tags: baby, china, travel
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My daughter is 16 months old today. And we’ve made it! We’re in Beijing, China. My traveling group consisted of my two grandparents (my in-laws), my husband, me, and my baby. Here’s the tough part, my in-laws of course are elderly. I’m 31 going on 32 weeks pregnant (huge basketball under my shirt). My baby was recently diagnosed with AOM (which I’ll write another post about how wrong i think that doctor was).
But my baby was definitely down with something, which she than gave to everybody else. (Knock on wood) – but I’ve been the most blessed through all this. Anyone can still imagine the stress of traveling with a group of sick people + old + baby + pregnant all the way from US to China.
Overconfident – we’ve done this before, when baby was 7 months old we took her to ShenZhen, China for 2.5 weeks in December. That was a successful trip! Thinking about how great that was, this should be easier right? Now that baby is older and walking.
NO! A walking baby is probably even worse on the plane. She was hard to control. A lot more fussy. My husband was still feeling sick and took a benadryl before getting on the plane – so he was pretty sedated. My mother-in-law wasn’t feeling too well either (which I will write another post about GERD and garlic and her). Then there’s me – who’s very very pregnant and my father-in-law still.
I guess I shouldn’t complain too much. She was a bit difficult while we were getting ready to take-off and I kept thinking “this is a bad idea, we should have stayed home”. Once the plane was in the air, she conked out for a couple of hours. Then she woke up again for maybe 5-6 more hours. Kept getting a nose bleed – freaking everybody out of course. But once she fell asleep again, she was asleep for good until we arrived in Beijing.
We got to Beijing around 5:30 staying at Grand Beijing Hyatt, who has the most amazing airport pickup service. I’m not huge on getting picked up by hotels usually, don’t really need to spend that kind of money. But this hotel’s service makes it seriously worth it.
First of all, they have runners that stay in the airport. Their job is to pick you up as soon as you literally get of the plane, even before going through customs. It helps a ton! Let’s just say Beijing Airport is a tad bigger than SFO (like 10x!) and even getting to customs and out can be confusing and it’s not easy with a baby. It’s nice that once we left the plane, there was someone to walk us through. He grabbed our bags for us then and at the luggage pick up of course. Then instead of going to the parking garage, we just needed to go down one floor to a special parking area where our car was waiting for us. They said they made sure we wouldn’t have to go to the parking lot - because it’s too hot for the baby.
The drive into town was maybe 30-40 minutes. Once we arrived, didn’t have to wait at the front desk. People were ready to pick us up at the front door. They grabbed our bags and a lady walked us up straight to our rooms.
This was definitely the smoothest check-in/transition I’ve ever experienced!
Gave baby a bath, we all showered right away. Baby fell asleep local time around 7:30/8:00 pm. The problem is that she woke up at midnight local time (since it is like 9 am her time). So now we’re just trying to keep her company.
The Start of A New Blog July 25, 2008
Posted by pjpajamas in Uncategorized.add a comment
It’s been 7 months since I last blogged. I used to blog for The Medscape: The Differential, you can find my old posts at this link: http://medscape.typepad.com/thedifferential/pinchieh_chiang/.
I’ve finally got some free time now to try and start writing again. I will just have to see how this goes. I always have great ideas when I’m not actually writing. I think this will be a bit easier than my previous blog since I’m not always interested in writing about medicine.
