Sunday, April 1, 2012

On Toddler Ear Infections, Trusting Doctors, and Trusting Your Gut

It’s been a bit of a rough week around here. Nothing unmanageable, just a runny nose that turned into an ear infection. A trip to the doctor’s, some muddied advice about it being up to me whether we “watch and wait” a couple days to see if it gets better on its own before starting antibiotics, or whether we start them right away.

Well, of course, if you leave it up to me, and you tell me about the potentially adverse side effects of antibiotics like allergic reactions and diarrhea, and then I get online and find out that since 2006 the AAP has actually recommended the ‘watch and wait’ approach, since many ear infections do get better on their own, and since a tendency to over-prescribe antibiotics can lead towards increased resistance to antibiotics, then I’m going to choose to wait and see. After all, I’m someone who doesn’t even like to give my child Tylenol too often, especially with all that high fructose corn syrup. You might think this sounds silly, but my child gets itchy and rashy when he has too much processed GMO corn.

Anyway, so I waited on the antibiotics, and meanwhile started giving Cedar Ibuprofen around the clock, and he seemed to be feeling better. But, of course, that was probably because of the Ibuprofen. So how am I supposed to tell if he’s truly getting better if I’m suppressing all the symptoms (fever, fussiness, etc.)? He seemed better and hadn’t been pulling at his ear anymore, but he was still sleeping poorly and he still had a temperature (although it was hard to know if I was getting an accurate reading with a squirmy toddler and the under the arm approach). So two days after going to the doctor, I called the consulting nurse. She took notes on everything I told her, consulted with the doctor, and advised me to wait one more day, then call back. She also made some remark about antibiotics to the effect of, “Well, and you don’t even know if they’ll work for sure. And over-prescribing antibiotics has led to cases of resistance to Merca.” Or something like that. So, okay, let’s wait one more day. I’m all for natural healing if that’s a likely option.

That said, I’m also someone who ultimately errs in favor of Western medicine—especially when something seems bad enough that I want immediate results. So I still drove to the pharmacy that afternoon to pick up the antibiotics just in case things took a decided turn for the worse. I wouldn’t have much time the next day to deal with the pharmacy, and maybe my gut was already telling me that we were going to need them in the end.

On the following day, Friday, Cedar was still following the same pattern of being okay, but increasingly fussy once the Ibuprofen wore off and still sleeping poorly. We were on day three of Ibuprofen, and although Cedar didn’t seem worse, he also didn’t seem better. His temperature had gone down a degree—or so I thought, until I called the consulting nurse one more time, and was reminded that you needed to add a degree to the reading when doing the under the arm approach. Oh, right. I knew that, once upon a time. Cedar has never had a fever before, so I’ve only taken his temperature once since he was a baby!

In any case, I was pretty much thinking we should start antibiotics that night, but like a dutiful patient I was calling one more time as advised. Well, the nurse this time clearly though that I had already waited too long and that I had some irrational fear of antibiotics. “Is there some reason why you don’t want to give it to him?” she asked in a slightly exasperated tone.
“Well, just because of the various side effects that the doctor told me about and that the articles I read online mentioned.”
“Well, I don’t know what to tell you. Is there some specific question you want to ask the doctor?”
“No, I just wanted to call and tell you his symptoms since I was advised to do so by the nurse.”
“Let me see who was on yesterday when you called. Oh… Dr. X.” she said, with a clear note of disdain. “Well, it certainly doesn’t sound like he’s getting better. I’d say you’ve certainly waited long enough. It says here in the notes that you were told to wait 24-48 hours and to start antibiotics if things did not improve or got worse.”
Yes but, I think to myself, it says on my notes from the doctor to wait two or more days. “Yes, well, it’s hard to tell if he’s really getting better or not because we’re suppressing the symptoms with Ibuprofen, but I agree that it seems like time to start. I thought his temperature had gone down, but now I realize it hasn’t. He doesn’t seem worse, though. And I just don’t know how long it typically takes for these things to clear up when you are supposed to wait.”

Anyway, suffice it to say that the nurse I talked to that day was of a different persuasion than the one I talked to the day before. And the doctor I saw? He seemed pretty neutral on the matter, but I trusted that if it had seemed like a bad enough case, he’d have told me to start antibiotics right away.

Some quick research online also revealed that this is a source of debate in the medical community. Recent research that came out in early 2011 shows that toddlers may recover sooner and have less chance of having reoccurring infections when treated right away, so the current AAP advice or the general sentiments amongst doctors may likely swing back towards advocating immediate antibiotic treatment. But other previous studies have also shown that the problem may lie in diagnosis— “Doctors vary in their opinion of what defines an ear infection when looking at the ear drum. The enlightenment in this new research is the use of strict criteria for diagnosis: bulging eardrum, redness on the drum, pain, and an inventory of acute symptoms. The study highlights the essential challenge with ear infections–make a good diagnosis.” says Seattle pediatrician and blogger, Wendy Sue Swanson in this article

She goes on to say that parents should thus question the doctor about the nature of what they see in the eardrum to make sure it indeed looks like an infection. “When the pediatrician diagnoses an infection, push them on the appearance of the eardrum. It’s always okay to ask what it looks like! Ask if the eardrum is bulging, if it has pus behind it, or is red in color. It’s okay to ask the pediatrician to clarify and explain the difference between fluid in the ear and an ear infection. In combination with your child’s symptoms, it will be important for making a plan.” But who in reality does this? Or who has the forethought to read such articles before taking their child in to the doctor? Not me. My first response is always: go to the doctor. Second response: question what they say from the comfort of your couch and with Internet access.

It seems that the more you read and learn about your own health or children’s health, the more it teaches you to not blindly trust your doctor’s word or sometimes pithy statements of reassurance. We all want to just be able to trust and get on with it, to not have to play detective and doctor ourselves. And most of the time, this is probably okay if we have good doctors and fairly normal diagnosis. But unfortunately, this is not always the case. I have been given questionable information by my child’s doctor a number of times. And when Cedar was having so many problems with his body rashes and intestinal pain, it was ultimately through seeking out the advice of naturopaths that I was able to find any answers—with clear, tangible results—as opposed to the treat the symptom, not the cause (“We don’t know what the cause is”) approach of the Western pediatric dermatologist I saw.

Like I said, I still err towards Western approaches. I am fully immunizing my child (also after much reading and considerations towards alternate schedules, etc.). But we have also been relatively healthy and not been placed in situations in which your willingness to do your own research, seek second opinions, and make your own decisions might make the difference between life and death. 

Don’t get me wrong: I’m not trying to make it sound like Cedar’s ear infection is THAT big of a deal. But these recent interactions have just brought up for me these thoughts and feelings. And we are approaching 48 hours of Cedar on his antibiotics, and unfortunately, he does not yet seem to be getting better as he should. But again, this is hard to say because, after calling the consulting nurse one more time to see if it was okay, I started giving him some Ibuprofen again to help him in the meantime before the antibiotics take full effect. I guess if he’s not feeling better by tomorrow, I’ll need to bring him back in. Sigh.

The last two nights he’s been sleeping terribly, only seeming to find rest when attached to my boob or lying on top of me, and then waking up in 30, 60, or at most two hour increments. This has meant I have gotten very poor sleep myself. I would not be functioning, much less sitting here writing, if my dear husband did not let me catch up by sleeping in. I slept an extra three hours this morning until eleven, when I was brought a tired toddler to nurse back to sleep for his nap. I had just enough time to put on my robe, drink a cup of tea and have some cereal before said toddler woke up again. I tried to get him to go back down, seeing how tired he still was, but his nose was all stuffy and when he tried to nurse he was uncomfortable, and this—plus who knows what other discomfort—set him into a tizzy of screaming, which turned into a full-blown tantrum that lasted a full 30 minutes.

I usually am able to calm him down from a tantrum within a few minutes. This time, nothing helped. He did not want cuddling or soothing. He did not want to get up and look out the window. He did not want more milk. He did not want to watch Thomas the Train. Instead, he violently flung his body about, banging his head on the bed, and trying to bang it elsewhere—on the wall, even on the bookshelf. I’ve read that head-banging falls within the realm of normal toddler tantrum behavior, but it sure is scary to think of how he could hurt himself if he’d succeeded in hitting his head on the corner of the bookshelf. Finally, after 30 minutes, he decided he would try to have some milk again, and his nose had cleared enough for him to do this, and so we lay there for another half an hour, allowing our heart rates to go down and breathing to return to normal, before he finally decided to get up, a happy and perky little two year old again.

Big sigh. In the meantime, this was supposed to have been my morning to steal away and write, but I finally got out the door at 2:30 p.m. Thank God I was able to get away at all. A week of terrible sleep + worrying about your sick child + long days staying at home with him = one exhausted mama.

I also carry a slight trace of guilt knowing that Cedar might already have been feeling better by now if I’d started him on antibiotics right away, even though I know that I made the best decisions I could given the information I was given. This whole process has just been a reminder to me that you need to take everything any doctor or nurse tells you with a grain of salt, and remember that even though they are the “experts” their personal biases and training can and will slant the advice they give you in distinct ways. During this process, I’ve talked so far to three nurses and one doctor. They each have given me slight, yet still significantly different takes on what I should do. It was only the last nurse I talked to whose voice reached out to me with a tone of mothering compassion, who listened closely to what I told her, and who did not seem like she was scolding me for being “that type of paranoid parent” or whatever the previous nurse had been thinking.

Anyway. I have other things I’d rather be writing about, but I feel all pent up and angsty and sad, so I needed to get this off my chest. Access to the Internet and too much information can sometimes feel like a curse in our modern age where everyone can self-diagnose and prescribe if they wish.  And yet. I also will not apologize for being someone who does not just blindly trust what I am told. I will ask for as second opinion if I feel the need. And a third opinion at that.

But in the end, I always have to come back to trusting my gut—which to me, is not some wild, irrational stab in the dark based on fear-- but rather a decision that is the end result of a process that includes: careful questioning of experts, close observation of my child, as much additional research as I have time for (so, not a ton, mind you), and in the end, choosing the path that feels the safest and most sound.

Sounds easy, right? Right.

1 comment:

  1. Anne, my daughter suffered through multiple ear infections until I tried a home concoction that another mother told me about: half peroxide/half alcohol. it bubbles in the ear and eats up infection. I got an ear infection once as an adult and it was horribly painful, even when a wind blew I felt pain. OUCH! Good luck!



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