ER room last night - Page 3

[Jen123]

I am soooo glad you stuck to your guns and didn't let the doc retract your son.

ER docs tend to run every test they can think of to rule out everything under the sun. Next time ask "what is the likelihood that THIS is what is causing the symptoms ?"

I have found that in all my ER experiences , they use big scary words and large hard to pronounce invasive tests to create fear in me so I am at their mercy. Then when I walk out with a pity prescription (normally an overprescribed antibiotic) I feel "grateful".

A paitent advocate is someone employed by the hospital to help communications between the doctor and the paitent. I've only had bad experiences with them , they were on the doctor's side and only there to persuade me to do whatever the doctor said. "They do know best afterall. They went to school. They know what they are doing". I always countered with "but they don't know MY child. I DO." However , I know many people who have had positive experiences with the very same PA.

I would highly recommend not going back to the ER and seeing only your regular ped unless it's an extreme emergency..and only you know when that is happening. IF you do have to go back to the ER for ANY REASON with a small child , do what I do..upon walking in DEMAND to see a pediatric doctor/nurse practioner. DO NOT settle for less. DEMAND IT. "I will not let anyone see this child but a LICENSED PEDIATRIC DOCTOR". It is your right. Use it.

All my babies ran short fevers when they were newborns. Sometimes climbed up to 101 , and all were brought down with tepid baths and frequent num-nums.

[Frankly Speaking]

Originally Posted by mamaverdi

Suprapubic aspiration is much more painful and more invasive than an injection. And it will scar your bladder which is a far more important organ in the scheme of things. It requires fluoroscopy and being strapped to a board to be held completely still.

I agree that it is more painful but less painful than a forcible retraction of an adherent foreskin and that is the point I was making.

I suppose there is some scaring as there would be with any injection. I certainly would not recommend it as a first line of treatment and not multiple times but with no other options, I would recommend it over a forcible retraction for a cath.

The weirdest thing though is that the DOCTOR wasn't gonna cath the baby in all likelihood. The nurse was. Talking calmly and gently to the nurse who was going to do the procedure, and explaining how to do what they need to do through the process is a much more effective technique than refusing treatment. In fact, first assessing the nurse's skill level, making sure it wasn't a student, asking how many intact boys they see, and perhaps offering yourself to show them just how much they may open the foreskin ever so gently.

The problem is that there was a doctor saying he was going to do something that the mother knew he shouldn't be doing and he was pressuring her. She was in a state of confusion and being pressured or at the very least, felt that way. She was uncertain of exactly what to do and was in no frame of mind to interrogate a nurse on his/her level of education and professionalism. Under the circumstances, I think she did the right thing to put it off. She could take the night to organize her thoughts, do some research and if necessary, take her son back the next day fully informed, prepared and confident.

I don't know Frank's cathing protocol, but I wouldn't want a nurse fishing around inside the baby's foreskin for the meatus.

In some boys, the preputial sphincter is so tight that the meatus can not be viewed and with these boys, almost all of them will have a meatus that lines up perfectly with the preputial sphincter and cathing will be essentially no different than cathing a circumcised boy. If it is not perfectly lined up, the foreskin opening is simply flared slightly and the catheter is gently inserted and wiggled until it finds the meatus. For a first timer, they may find this difficult but an experienced operator will have no problem.

Now the doctor I wouldn't trust to the cath because they aren't trained, unless they are a urologist. And geez, even the very pro-circ urologists that I know never retract the foreskin to cath.

Our experience here has been very different with urologists retracting the foreskin and scolding mothers for not doing it, instructing them on invasive cleaning regimines and more.

Nurses, especially in pediatric hospitals, usually respond quite well to gentle instructions and information regarding your baby and what you would like done.

You must certainly live in a charmed land!

I think the mistake is people think they need to convince the doctor of their point of view in order to the such and such procedure. This is not true. In the words of my urologist: "You don't have to convince anyone of anything. You just tell them what they can and cannot do."

Now, I know you live in a charmed land!

So in this instance, say, "I understand that there is a very high chance of a UTI in a baby with a fever and no other signs of infection. I'm willing to let you catherize the baby for the sample as it is more likely to produce a clean sample than a bag and is certainly less invasive than suprapubic aspiration. However, I would like for a seasoned nurse, not a student nurse, to do the procedure, and I would like to direct him or her on how I want my baby's foreskin to be handled in order to find the meatus and introduce the catheter into his urethra."

That is a good approach but this mother wouldn't have had a clue of how to do that until she came back here for instuctions.

Throw in a couple of Latin words and they are good to go.

Now, that I will agree with! They get so many clueless people that any indication that you know what you are talking about is likely to get a reaction . . . either that you've been on the internet and might have some good information or that you're trodding on their turf.

But maybe I just spend too much time in the ER.

That experience can be invaluable for many reasons but most Moms just don't have that experience and have to deal with it as best as they can.

Sorry I cross posted with you Frank. Would you mind posting a link to your info on how to cath an intact penis?

I read it years ago and didn't save the link but I think it was probably at www.nocirc.org or at www.cirp.org. Both are invaluable resources.

Why not just refuse the cath IF the foreskin was quite adherent. Isn't it easy enough to tell. Ya barely have to move the foreskin to find the meatus to cath.

Just because the foreskin is adherent doesn't mean the child can't be cathed but it seems that the vast majority of doctors think the foreskin has to be fully retractile to cath the patient. Heck, I know of two cases where adult men in their 50's went into surgery for abdominal surgery and came out circumcised (Ky and NJ). The doctors claimed that they couldn't cath an intact penis and circumcised the men.

Usually the meatus is easy enough to find but occasionally the preputial sphincter is so tight that the meatus can not be viewed. That makes it much more difficult for an inexperienced operator but only slightly more difficult for someone who is experienced as this doctor obviously was.



Frank

[mamaverdi]

I'm not sure that I live in a charmed world. It would be a lot more charming if I didn't spend so much time in the ER and with urologists. But.

I have been pleased with the three or four pediatric urologists I have used for my son. Now these are world reknowned urologists though...not meaning they know anything about intact penises....But still..actually, never never never did they retract his foreskin. They admonish the residents to be gentle with the baby.

Heck the Jewish guy I use wants to try to save my son's foreskin and NOT have to use it to rebuild his urethra.

And all these docs are pro-circ, or at least, they think it's fine. But all of them have been nothing but gentle with my son.

And if anyone circ'ed my son in surgery (he's 20 months and has had 3 surgeries) they would be sued in a heartbeat.

ETA: the method you describe is what I have seen each time my boys have been cathed. At a regular hospital ER as well as at different children's hospitals. When did ask though they also told me that they get a lot of intact boys because of the large Mexican population here.

mv

[shaylahc]

Originally Posted by sunflower_mommy

Not to contradict you, but what exactly does "SO" common mean? 50% of babies? 25%? 10%? 5%? 1%?

This article puts the risk of neonatal meningitis at .25% per 1,000 births: http://www.emedicine.com/neuro/topic239.htm

This information from the AAFP says, "Bacterial meningitis has an incidence of about 20 to 100 cases per 100,000 live births during the newborn period." http://www.aafp.org/afp/990515ap/2761.html

To me, that doesn't qualify it as "SO common".

I know it's a bit OT, but if anyone has any other info showing a significantly higher risk, please share because I'm interested in learning more about this topic.

Jen

The article that I quoted said that the risk of having a serious bacterial infection in a febrile newborn was about 5-6%. That means out of every 20 febrile newborn babies that show up in the ER, 1 will have a serious bacterial infection. That sounds "pretty common" to me! And even though the risk of it being an actual meningitis is low, since the chances of having meningitis are so high at that time it makes sense to be conservative and treat as such, rather than wait and risk losing a baby.

Newborns have very weak immune systems. You can't treat them the same way you would, say a 6 month old presenting at the ER with the same symptoms.

Kidney reflux, a very common and often undiagnosed/undertreated cause of UTIs in babies and young children, can cause permanent kidney damage. 25% of all kidney transplant recipients have kidney failure as a result of having this problem. One of my own DDs has it (no family history) and having a simple cath to rule out a UTI certainly beats the alternative!!!!

ETA a link:
http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

it says:

"Acute bacterial meningitis is more common during the neonatal period than at any other time of life and is accompanied by a high incidence of mortality and long term significant sequelae. The incidence of neonatal meningitis is variously calculated at between 0.25 and 0.32 per 1000 live births depending on the inclusion criteria"

[shaylahc]

OP, I wanted to add that I was thinking about your lil guy last night....please keep us updated on how he's doing ((((HUGS))))

[njeb]

to you and your ds!
How is he doing this morning? Hope he's feeling better.
Actually, I'm not surprised at the treatment you received, considering that you live in Omaha. We in the Midwest have the highest circ. rates and the least informed doctors and nurses in the nation when it comes to caring for intact babies. You may have trouble finding a nurse in Omaha who knows how to cath an intact baby without retracting him.
Good luck finding competent medical care!

[pdx.mothernurture]

Shaylahc, perhaps I just have an optimistic perspective. I'm not suggesting that a young baby with a fever shouldn't be seen in the ER. I wouldn't hesitate to take my own son in at that age with a fever, especially if he didn't have any other symptoms. However, I don't consider .25-.35 percent *of every thousand* live births (which would include micropreemies) to be "SO common". And if you have a newborn that actually has a fever, there's a 95% chance it's not meniningitis. Meningitis is dangerous, so me, that's comforting to know. Again, I'm not suggesting a febrile baby shouldn't be seen or meningitis shouldn't be considered. It is important to make sure the fever isn't due to something more serious.

Jen

[babykaoss]

well, Tommie is doing much better today. he's been awake and alert all morning, eaten every hour so far (!) and his temp is down to 100.1. I'm now waiting for a phone call back from his ped's office and the results of the other blood workup and then they'll tell me whether to bring him in or not.....

he seems so much better though!

[calngavinsmom]

Sarah, Hugs to you and your little one hun for having to go through this.....very scary witha little guy! I for one think you did a great job standing up for your guy!

I have a question though for anyone who would know and care to share Would it not be prudent in this type of situation (arrogant doc, threatened forced retraction) to agree to do the bag sample first and then if that came back with an abnormal reading, then cath him? In my understanding, if anything the bag would produce a false positive right? But if the bag sample came back clean then that would be accurate?

If I am interpreting this wrong, please correct me but, I really am an advocate for taking the least invasive route first, to lessen the the cance of complications from a more invasive type test. Sometimes the "cure' is more of a problem than the actual problem was KWIM?

Take care,
Tara

[calngavinsmom]

Sarah, we posted two minutes apart and i just read your update. I'm so glad
he is doing better! I also though of something going back to my first ds. What kind of thermometer are you using? I have an ear one and according to our doc, they read a few degrees higher than an oral or rectal. Just a thought in case you were using that type and didn't know about the possible difference.

take care,
Tara

[babykaoss]

thanks Tara! it is a rectal temp i'm taking.....now i suppose i just keep doing the nursing and slinging and wait.........

[mattemma04]

//

[shaylahc]

Originally Posted by calngavinsmom

Sarah, Hugs to you and your little one hun for having to go through this.....very scary witha little guy! I for one think you did a great job standing up for your guy!

I have a question though for anyone who would know and care to share Would it not be prudent in this type of situation (arrogant doc, threatened forced retraction) to agree to do the bag sample first and then if that came back with an abnormal reading, then cath him? In my understanding, if anything the bag would produce a false positive right? But if the bag sample came back clean then that would be accurate?

If I am interpreting this wrong, please correct me but, I really am an advocate for taking the least invasive route first, to lessen the the cance of complications from a more invasive type test. Sometimes the "cure' is more of a problem than the actual problem was KWIM?

Take care,
Tara

I think the difference is the age of the child. In a newborn with a suspected UTI, you will ALWAYS want to do a cath. It would be very different if an older child was coming in with a suspected UTI.

The difference between the bag and the cath is that the bag will always be contaminated. So let's say, in the case of my 2nd DD who has a known kidney disorder, a quick urine dip might rule out a serious UTI right away. But in an infant with no known urinary tract abnormality history, if you suspect a UTI you would definitely want to cath because not all urine dips are accurate (you can get false negatives, when the child did indeed have a UTI). So say you bagged, send it to the lab and it turned out the baby DID have a low grade UTI. Now you have all these other germs floating around in there and there is no way to know exactly which one is the culprit, and if so, which antibiotic it is sensitive to.

Older children and adults are rarely cathed for suspected UTIs but it is very common in diapered babies, one of the reasons being that they sit in urine and fecal matter often and they are more likely to have contaminated samples (plus you can't get a baby to pee in a cup ). My DD was bagged often as a baby and they HATE it just as much if not more than the caths....the tape sticks to their skin, gave my DD a nasty rash, and she often held her pee for hours rather than pee in their baggie...a cath is fast, and over quickly, and IMHO can be less traumatic than a bag for some babies. A cath is also more accurate in identifying the offending germ.

[Frankly Speaking]

Shaylahc, I'm going to disagree here but if I'm wrong with my argument somewhere, I want you to point it out to me. I was wrong once back in 1968 so, if I'm wrong once more, it won't affect my overall score much! :

First, I suspect that bagging a girl and bagging a boy might be somewhat different and could affect the results. When a boy is bagged, they first swab his penis with an antiseptic and the bag is taped or held on. Except for some bacteria that could possibly be missed in the foreskin opening, all of the bacteria would be from the bladder, Right? So, in this case, the doctor could examine the sample immediately under a microscope and if there were no bacteria present, it could be safely assumed that there was no UTI, correct? But, if there were bacteria present, it would be the cautious route to go ahead with a cath and a cultured sample, right?

Now, I can see how the difference in anatomy and the different make-up of the genital flora that it would be much more difficult to get an uncontaminated sample from a girl but with a boy, it seems that the chance of contamination is far less and a quickie bagging would be both the expedient and prudent way to go.




Frank

[keptwoman]

Originally Posted by shaylahc

The reason why they have to do a cath is because while a bag might potentially rule out a major infection if dipped right in the ER to look for the presence of blood or white cells, it is useless to culture because it's been contaminated by skin cells, poop germs, and whatever else might be hanging around. If the baby did have a UTI, or even if the dip came back negative, they would STILL have to cath the baby to know if there truly was a UTI, and if so, what the germ was that was causing it and what antibiotics it was sensitive to.

My daughter also has reflux and has NEVER been cathed (apart from during the VCUG), the bag has been sufficient to diagnose the infection and antibiotic each and every time (many times!) I think its a matter of what is normal, here in NZ it is not normal to cath a child with suspected UTI, the bag is fine. The only time a cath would be used is with a very severe infection or a child that is not peeing.
A good diagnostic lab can tell the difference between the poop germs and the infection. The reason the docs like to cath there (IMHO) is because they are too damn lazy to wait for the child to pee into the bag, the cath is instant and so they make up the whole "clean sample" excuse. Also the fact that you can sue your doctors (which we cant) means that they go to the nth degree to make sure there is nothing you can sue them for(Ive really noticed this around the whole area of pregnancy and labour), insisting on a cath probably reduces the chances of a lawsuit.
My boys have also been bagged a couple of times to check for infections that fortunately werent there.

[PuppyFluffer]

It seems to me that this is a place where Elimination Communication would be very helpful! For those not familiar, we have a fourm for it here under Diapering. It's a method of dealing with elimination without using diapers. Basically, you learn your baby's cues that they have to pee or poop and you hold them over a baby potty and they go! We did it with dd and it's really effective. We were diaper free a great deal when she was a baby. She's fidget, I'd know what that meant, I'd hold her over a sink, baby potty, toilet.....and she's go! It would be really easy to get a free catch sample on an EC'd baby I would think.

[babykaoss]

well I just got back from the pediatrician's office. When I told her my experience in th ER she was horrified. She told me that the next time anything happened or I was concerned about ds to just call her, and she gave me her home #. Then she proceeded to tell me she would speak to the chief of staff at Children's, and encouraged me to do the same, and gave me his number as well. She got a clean catch urine sample with the bag and said that everything looked perfect, his blood looked perfect, and that it was a virus he was fighting off, no bacterial infection anywhere.

i feel SO much better now!

[shaylahc]

Originally Posted by babykaoss

well I just got back from the pediatrician's office. When I told her my experience in th ER she was horrified. She told me that the next time anything happened or I was concerned about ds to just call her, and she gave me her home #. Then she proceeded to tell me she would speak to the chief of staff at Children's, and encouraged me to do the same, and gave me his number as well. She got a clean catch urine sample with the bag and said that everything looked perfect, his blood looked perfect, and that it was a virus he was fighting off, no bacterial infection anywhere.

i feel SO much better now!

I am glad to hear your little guy (and you!) is/are feeling better ((((HUGS)))

[royaloakmi]

Thanks for the info ladies!!! I didn't know anything about this topic; I'm glad to know what to do if this unfortunately every comes up.

[Kundalini-Mama]

Originally Posted by flyingspaghettimama

I hate doctor-bullies. Good for you for sticking up for your son. It's esp tragic that it happened in a Children's Hospital, for goodness sakes.

: That's what I was thinking.