Friday, December 3, 2010

3 Year Old Well-Child Visit

Nolan turned three in August, but we're just now getting in for his well-child visit. Visits to the pediatrician are generally unhelpful, since we only see them for the required vaccinations (we see his ENT nearly every month; the pediatrician, once per year). We haven't seen Nolan's actual primary care provider in over two years: the problem with a group practice is that the child is punted to any available medical professional, which means we have to re-educate the staff on his history every time we visit.

The lab techs came in before the nurse arrived, and poked his finger for blood. This was not a good way to start off the office visit, since Nolan was understandably upset after this procedure. They weighed him (30 pounds!!!) and measured him (36.5 inches), and then the nurse asked the question.

"Have there been any updates since your last visit?"

I took a deep breath and said:

"He had a sleep study that found severe obstructive and central sleep apnea and recurrent ear infections. He had a tonsillectomy and adenoidectomy in April, along with his third set of PE tubes. Then he had an 8 week long ear infection that wouldn't clear and they cultured it and it was fungal, and his tubes fell out. Then he had another sleep study and his obstructive apnea got WORSE since the tonsillectomy so the ENT did a bronchoscopy and found severe laryngomalacia. He had a fourth set of PE tubes placed in October along with the bronchoscopy. They want to do surgery to correct the laryngomalacia, but won't do it until we verify his reflux is under control. So they did a pH probe in November and he failed it and they diagnosed him with laryngopharyngeal reflux disease.* So now they've added Zantac and we are going to do another pH probe next week to see if it is helping. We don't know what to do if he fails it. Oh, and his feet turn out when he runs and he trips and falls a lot."

The nurse smiled and left, then the random-nurse-practitioner-of-the-day walked in.

"So, I heard he has some reflux and it is under control. That's great! Oh, your bandaid matches your earplugs!"

And this, folks, is why we stay away from the pediatrician's office at nearly all costs.

After I corrected her, and went back over the same history I gave the nurse, she wrinkled her brow and said, "well, it sounds like the specialists are on top of everything."

Since we haven't really addressed the whole feet-turning-out thing (which might be perfectly benign), I mentioned it. She told me they don't worry as long as their feet are in alignment when they are walking and standing. She wanted to see him walk, then furrowed her brow some more.

Then she put him back on the table and checked out his hips, and told us that it is probably nothing, but we should keep a sharp eye on him. If his gait gets worse (or doesn't get any better) over the next year or so, we'll be referred to Shriner's Hospital to some orthopedic specialists. Since we're perfectly happy to ignore this issue for the moment, I'm happy to watch and wait. Unfortunately, since Nolan's issues have only gotten worse over time and not better, I have a feeling we'll be seeing an orthopedist sometime next year.

We left the pediatrician's office after the little guy got three shots (Prevnar 13, Hepatitis A, and the flu shot).

The great news from today: his iron levels are normal, his urine sample was fine, and his growth is slow-but-steady (with a small dip in height).

*Laryngopharyngeal Reflux: a whole 'nother blog post.


Julia said...

Good gracious. Y'know, you need to put a sidebar on your blog like Jess's with the title, "Nolan has what?", and a list of all his Issues. And next time you are forced to set foot in the pediatrician's office, you might as well just write up the whole rap sheet and hand out copies rather than having to give the oral performance over and over.

Ben's feet tend to turn inward. We've noticed it since birth. He was an early walker and is generally pretty steady, but we do see it affecting his gait a little when he runs. We ask about it each year, and get the same response you did -- too soon to worry about it, keep an eye on it. Maybe we'll end up at the same orthopedist office!

Joey @ Big Teeth and Clouds said...

I'm really annoyed when pediatricians are clueless about hearing aids. I switched because I had this doofus lady that kept asking me if Julia had a cochlear implant.

That finger prick test is no fun! Glad you have another appt. out of the way!

Melanie said...

What Julia said. Even better: have the nurse give the doc-o-the-day the rap sheet before he/she comes in the room so that it can be read before Nolan is seen. Sorry you have to deal with that.

Terena said...

oh yeah... trips to the doctor... so fun. the same thing happens to us every time... sigh.

but it sounds like it was all happy news, so that's great.

Herding Grasshoppers said...

Oh my word... that is just unbelievable that they're so CLUELESS!

Sorry you have to put up with that!

And now laryngopharyngeal reflux disease???


xraevision said...

I'm often stunned when medical professionals refer to X's hearing aids as earplugs. It leaves me almost speechless and doubting their abilities. No wonder you don't see Nolan's pediatrician very often. Besides getting his shots, it sounds like a frustrating and pointless trip. I am extremely grateful for X's pediatrician. He is keenly interested in the complexity of X's case and stays on top of our appointments with specialists. We visit him 4-6 times a year, plus bump into him in our local ER!

I'm going to study the anatomy of whole trachea and esophagus area. You've got me very curious about different kinds of reflux now.