Friday, November 9, 2007
Ah...The Blissful Joys of Square One
Okay. That was neat.
We just returned from a trip to the doctor's office. I've been meaning to get Sophie established with a new pediatrician for quite awhile now. However, with the move and all the nifty hectic details that come with relocating to a new part of the country, I haven't yet tended to everything on my To Do List.
Since moving two and a half months ago, Sophie has had non-stop congestion. Along with sneezing and coughing and having sad little dark circles under her eyes. Her symptoms appeared almost immediately after we relocated and have been pretty persistent and allergy-like. ...Which makes sense. We moved from the dry, arid desert of New Mexico to humid, lush, green Arkansas. With the exception of the few vacations here during the summer and at Christmastime, Sophie really hasn't ever been around grass and trees and big, bushy plant life. Especially not for any extended periods of time. And from what I can tell, her poor little body isn't making the adjustment very easily.
So off to the doctor we went - to see if there was anything he could suggest to help alleviate her symptoms.
The visit started off okay. There was the normal, "What are you here for?" type questioning. Along with the usual "Look here. Poke there..." examination that usually follows such questions. We were doing fine. Discussing allergies and congestion. Looking up noses and down throats. Listening to lungs and checking reflexes. Talking 'bout curly hair and cuteness. Everything was going along just smooth and dandy.
Until the stomach poking part of the exam. At that point there was a pause, and I knew what was coming next. I knew it. The dreaded inquiry: "So, how is her diet? I'm guessing she's a pretty good eater, huh?"
[Vrrrrrrpp. Screech to a halt.] Ah. Yes. Here we go.
I said, "Well, since you have us in a fifteen minute appointment slot, I'm pretty sure you don't want me to answer that question right now."
Dr. L: "What do you mean?"
Me: "Well, the Lightning Round summarized version is that she's had severe reflux since birth. Until recently she has vomited every day, multiple times a day. She also has problems with dysphagia, delayed gastric emptying, and a crazy sensitive gag reflex. And until the past month or so, she has never eaten a single solid anything food-wise. As a result, she has been syringe-fed since weaning herself from sleep-feeding at eleven months. It's slowly getting a little better. But her diet is still very abnormal for a three year old."
Dr. L: "What do you mean? Syringe fed? ...Fed with a syringe? Fed what?"
Me: "Formula. And all of her free fluids - juice, water, pedialyte. And a multi-vitamin."
Dr. L (unable to hide his confusion): "Okay. Yeah. But what does she eat?"
Me: "Well. She doesn't really eat. Not much, anyway. She chews. But then she spits everything back out in a pulverized clump. She is just starting to learn to swallow some things without gagging: a few bites of yogurt, some cheese, bread and crackers, a little meat. The meat is a big deal; she never has had the oral motor control to handle meat before. I feel like we're really making big progress. But her daily food intake is still only equivalent to a few tablespoons."
Dr. L (his This-Woman-Is-Completely-Loco tone becoming ever-more obvious): "Uh. Okay. But she looks good. I mean, except for the obvious snot thing, she looks fine. Children with severe reflux, feeding aversions, and swallowing issues are almost always lethargic and emaciated. They're pale and thin. (In case I didn't know what emaciated meant.) They are also often severely developmentally delayed. They are on..."
Me (interrupting him): "...G-tubes. I know. And they usually have Nissen fundoplications to attempt to control the vomiting."
He stared at me.
Me: "Sophie wasn't a candidate for the Nissen due to the forceful nature of her retching and vomiting. And we wanted to avoid the g-tube, if possible, to keep her from becoming totally non-oral. Plus, she's crazy active and grabby. A g-tube would be a mess."
Dr. L: "But she looks so normal. Healthy. Is she working daily with a feeding therapist and an OT or SLP?"
Me: "She has seen various therapists over the years. Without any success. The therapists in NM admittedly hadn't really encountered a child with Sophie's issues. They were familiar with children who had anatomical issues preventing them from being able to eat. But they were not very knowledgeable regarding how to help Sophie, who just never wanted to eat - who has basically refused to eat since birth. For that reason, they've all pretty much just told me to keep doing what I've been doing. So, no, she isn't currently working with a therapist."
Me: "I'm a stay-at-home mom. I work with her. ...Oh, and God. He works with her. He's miraculously kept her healthy, somewhat chubby, in fact, despite everything."
(More silence and staring.)
Dr. L (slowly this time, so that I would comprehend what he was saying): "M'am, don't take this the wrong way, but children with gastric and feeding issues to the degree I think you're describing do not look like Sophie. They just don't."
Ah. Neat. A trip down Memory Lane. Perhaps I should locate the Projectile Vomit Video Tape Collection.
I could feel the vein on my forehead starting to pop out a teeny bit. That's when I suggested that I have her NM pediatrician and GI mail her records to his office. I explained that I had tried to do that prior to moving, so he would have them when we made an appointment. But, I explained, their office policy is to charge 75 cents per page, which with Sophie's geriatically thick record, would bankrupt me. I told him I would fill out a records release form and have everything sent directly to him.
He all but clapped his hands in GOODY! fashion and said he would look forward to reviewing her history. Translation: "You, my dear, are a total Kook. The records from the medical professionals will prove such."
Holy sweet moly. I had forgotten how "fun" it was to see a new doctor (insert as many quotation marks as necessary to convey the totally NOT FUN sarcasm I'm intending). Square One is never really a pleasant place to be where Sophie is concerned, in any matter. But Square One is a special kind of exhausting in the presence of a doctor unfamiliar with our sweet little pod and her oh so nifty little medical quirks. Quirks? Can boycotting eating and launching formula out one's nose be considered a quirk? Hmm. ...Probably not. Regardless. Square One kind of stinks.
The good news is we left the doctor's office armed with a prescription for an ear infection. (The bad news is it's an antibiotic, which will most likely have to be administered in injection form on Monday based on Soph's usual reaction to oral meds). He also gave her a prescription for some nasal spray. And a granular allergy medication that is supposed to be "sprinkled on food and eaten immediately."
I asked if it could be sprinkled in formula and syringed.
Dr. L: "Well... I guess. But it would probably be better to just put it on her food."
Okay. Check! Glad all the parts about how Sophie doesn't really eat food got through with such fantastic clarity. CALGON.
P.S If you made it to the end of this post without drifting into a coma, you will be awarded a Medal of Amazingness. Whoops. Apologies for the spectacularly long-windedness. I try not to do it often, but it seems, perhaps, I needed to vent.