Thursday, May 26, 2011

Too Naval Hospital or not to

Abe has had diarrhea on and off since Saturday evening, well subsided today. This week has been so stressful. he just wants me to hold him all night and day. I took him to Naval ER Tuesday since peds had no openings and urgent care felt he was too complex for them. His physical exam was great, alert, not fussy, stable vital signs and fever so we went home. At the EFM meeting he was so cranky but we stayed there any ways. he calmed down on the car ride. He saw a PNP at Naval on Wednesday, my birthday, and felt it was beyond her expertise so off to Seattle ER we went. They also felt his physical examination was great but wanted additional testing of his stool like for c-diff and rotovirus plus stool culture if not already ordered. We really miss Dr. Gist and with Dr. Wilde retiring this summer I think it is time to switch him to a pediatrician outside of the Naval Hospital. Yes it is convenient, has xray, pharmacy,lab ect however all this is usually repeated at Children's any ways so why put my kid thru extra painful medical interventions if Seattle Children's repeats it any ways; like chest x-ray, blood cultures, ect. I got concerned about his VP shunt since he went from extreme constipation to diarrhea. He has been a little more clingy and irritable but other times is laughing and giggling. He might be losing weight too. Tricare would need to approve him getting switched to a provider in town if we stay prime. I really feel he needs a consistent provider or group of providers that can handle the level of care he requires. I don't expect them to manage everything like VP shunt, chronic lung, hypothyrodism, potential seizures, CP,ect but feel comfortable caring for him and feel comfortable making primary care decisions with parent input and make referral and write prescriptions. I asked for a few things at primary care for Abe and provider refused and my requests were basic things: rectal Tylenol since he has been so irritable and I can't get oral Tylenol in and triple diaper mix since the diarrhea has made his bottom red. I did not think my requests were too much to ask however we saw a PNP and not Dr. Wilde. As a former FNP student I always thought NPs were more likely to listen and order what the patients need unless it is an usual request but not in this case. We made a long trip to Seattle Wednesday, no hospital admission which I am thankful for. I guess it was better to have him checked out my experts that be at home not knowing what is causing his diarrhea. If he was a healthy 2 year old I probably would have not brought in to ER 2x this week but he is not a typical 2 year old and I would hate to miss something urgent. If this post does not make sense he has been waking up a lot more than usual and just wants me to hold him most of the day and night. I don't know how many times this past week I have woke up holding him. I only have a few respite hours left for this month. When he is 100% better I will be taking him back to the pool however him drinking the pool water or eating the dirt on the beach may have caused his problem. Yes I let him lick a toy that had been in the dirt on the beach. Who knows what all was in the water. We were searching for sea creatures. He enjoyed touching the sea weed but not the crabs. Once I mentioned "do they bite" he did not want to touch them. I think he touched the sea weed because I did. I was scared to touch the crabs. he won't go to sleep and after midnight. Still waiting for speech therapy referral too. I spoke with Children's over month ago about it and they want him to have weekly speech therapy. Oh well guess it will have to be added to IFSP after the fact since the meeting is next week and I doubt we will have the referral in place. It is hard work being a mom but throw in special needs and the job description increases.

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