Second Opinions

Today was Charlie’s second opinion with the new pediatrician. It went well and not well. This post is long, FYI.

What didn’t go well was how long we waited. Our appointment was at 11:10. I arrived fifteen minutes early to do paperwork. At 12:30 I was leaving because we seriously couldn’t wait much longer. Charlie was beyond needing a nap and really unhappy, I was starving, and my patience had fizzled out. The nurse was like “Eh, whatever.” But the receptionist actually stopped me on the way out the door and said she completely understood my frustration because I have a baby with NEEDS, but that something I needed to know about this doctor is that a) she is very thorough, so it is like her to sometimes run behind, though she tries to schedule her appointments in such a way that this is kept under control and b) they had had two emergencies that morning, both of which ended up requiring EMS to come and take the children to the hospital for being admitted. Both of those emergencies just happened to be with our doctor, and they were the two appointments before ours, so it was sort of the perfect storm to mess everything up.

So I said, as nicely as I could muster, that I needed to know how much longer it would be, because while I understood the issue and would never expect her to put us over an emergency, I had a child with NEEDS. She said to give her ten more minutes tops. So we stayed.

I’m honestly really glad we did. First the doctor came in and was very calm. She apologized and repeated what the receptionist had said about the emergencies. And Charlie and I had heard a couple of kids crying pretty hard. I just assumed it had been shots. Now I feel bad for being so frustrated when there were really sick kids, but anyway. I appreciated that she apologized. I’ve waited forever for some of my fertility appointments and never gotten an apology. Then we got down to the business of the appointment. Here were my main concerns:

1. Miralax is for adults and I don’t want my daughter on it long term without some testing done to find out WHY she needs it
2. Charlie will often eat a food one day, and then have it in her poop for several days after (this was a key detail so I’m glad I brought it up)
3. Miralax seems to be solving the issue of getting the poop out, but it does not seem to be making her feel better as she has been super clingy and cranky for the last week
4. What if there is a serious issue that we’re missing because we’re not running any tests?
5. Does she have to take the miralax in a liquid really? Because we can’t get her to drink the four ounces required from a cup.
6. Oatmeal? Yay or Nay?
7. Alternatives to Miralax

1. Miralax IS for adults, but it’s pretty gentle and she often prescribes it for her patients. However, it is not our only option. She would not want Charlie to be on it long term either.

2. There are three common things that could be causing Charlie’s constipation at this stage:
a. Not enough fiber. We know this isn’t the issue because the kid gets tons of fiber in all of the beans she enjoys so much and the fruit.
b. Not enough liquid. This is hard to measure since she nurses but she has wet diapers and the pee is clear, so that’s a good sign that all is well.
c. Slow transit time. This is what we think is the issue. She said that it usually resolves by 15 months. If by that time we have not seen an improvement she will want Charlie to see a specialist to diagnose further. This is probably why charlie eats black beans on a Tuesday night and I’m still seeing them in her diaper on a Thursday.

3. Miralax is not a one size fits all cure for everyone. If it’s making Charlie feel bad then it’s not doing it’s whole job. We talked about alternatives which I’ll address in number seven.

4. See the answers to number two.

5. She CAN take miralax in a solid, but because of the nature of the drug (drawing liquid into the stool to make it easier to pass) I need to be really letting her nurse whenever I can. she nurses on demand, but she gets distracted easily playing so probably I need to be stopping her more. Also we need to keep working on getting her to drink some clear liquids, even if that means a bit of juice here and there.

6. Oatmeal is hit or miss. For some kids it blocks them up and for some it keeps things moving. It’s hard to say what it’s doing for Charlie since she’s only been eating it under the influence of laxatives lately. She definitely said not to the rice cereal though.

7. There are two alternatives to Miralax:
a. Milk of Magnesia. For this Charlie’s dose per day will range from 1.5-4 teaspoons. It’s safe for her to be on until we can get further testing done if the issue doesn’t resolve.
b. Magnesium Citrate. This has to be mixed with water. You take whatever your dose is and add that same volume of water. This would lead to Charlie again having to be able to drink about four ounces of liquid from a cup or a bottle. So this is a no go.

What we both decided would be best is giving the Milk of Magnesia a shot. Chief got some today after work and Charlie sucked it down with enthusiasm. We put it in a dropper (took two, but thats ok) and she was like a baby bird opening her mouth for it. I can probably just give it to her by the spoonful from now on, and we can split the dose up over the day to spread it out which is probably what we’ll do. We started with just a single tsp tonight to see what the minimum we can get by with is. Magnesium is a dietary necessity so she said we can almost think of this as a dietary supplement, which she probably just said to make my “I DON’T WANT MY BABY ON DRUGS” mindset feel better.

After we got all of that out of the way I asked her what red flags she looks for developmentally in a nine month old. Hers were:

1. Not rolling well.
2. Not being interested in picking things up off of the floor
3. Not babbling at all
4. Not sitting up from a laying down position

She said those are the big ones for her. Charlie is doing all of that and more now. I told her that she started to crawl and sit up within a day of her last appointment. She said she wouldn’t recommend OT for those things anyway, that she recommends OT for the fine motor skill issues, like pincer grip.  She said she was absolutely NOT worried about her not speaking yet-that her own daughter didn’t say “mama” until 15 months and she wasn’t worried about it. She said by 18 months they should have some words for sure, but that nine months is pretty early to worry about it. She said 2-3 books a day is stellar and more than most kids get for sure. She said all the right things, and she listened.

She actually said that’s kind of her downfall, she listens a lot because she doesn’t want to make a mistake. Finally. She said she actually seems about 25% fewer patients a day than her colleagues because she wants the extra time. She wasn’t knocking them-she said she knew lots of parents who didn’t have time for that and WANTED a fast doctor, but she straight up said that’s not her and she wouldn’t be offended if I wanted to trial someone else in the clinic. I said that as long as the wait we experienced today was not typical I was sticking with her because I left the appointment feeling reassured and on track with our plan. So she is our new doctor officially. She even works one day a week as the medical director of a local program here for developmentally delayed kids, so she is very knowledgeable about those issues, which means I’m not just going to sit in a doctors office and have a form checked off about my kid ever again now that we’re with her. She sees true delays every week so she’ll know if Charlie has one pretty quickly.

She even went over how their clinic handles everything. I told her about my issue with the two nurses at our old office and she told me about the difference between what an LPN and an RN are allowed to do and assured me that only one nurse would ever be answering questions from their office. We talked about after hours calls and about how it’s handled when she’s out and Charlie gets sick (let’s be honest, it’ll happen at some point). I was satisfied with everything and ready to sign on the dotted line.

So that’s a LONG post, but guys I am really glad I stayed. I feel bad for getting frustrated and hope they won’t judge me too harshly for that. I have resting bitch face on a good day so I’m sure I was not pretty looking as I was walking out.

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14 thoughts on “Second Opinions

  1. Sorry you had to wait so long, but sounds like it turned out pretty well. Hopefully this works to help clear the belly issues up, and at least she likes it!

  2. Don’t beat yourself up about getting frustrated- you had no idea about the situation until you were informed and you primary concern was making sure Charlie was getting what she needs! I would of done the exact same and I also have a stellar resting bitch face on a good day :). I’m glad there is a plan for your little girl! I hope it helps and she starts to feel better!

  3. I am SO glad you got to see a doc who you feel good about, although that wait sounds rough. I prefer doctors who take their time, and who after thoughtful. Sounds like you got a good one!

  4. So glad you had a second opinion and it seems like the wait was worth it. We went straight to Milk of Mag with our son and have been using it daily for a few months now. Works for him 95% of the time. Our dr described it as him having a very large colon that sucks all the water out of his stool. He has 10-14 ounces of water a day plus about 18 ounces of milk and we still have issues but they are much better managed. The only thing we can do is wait for the rest of his body to catch up to the size of his colon.

    • I’m glad to hear of someone else using it daily! I was a bit nervous when all I could find online were adults using it every day and all the babies were using miralax, but the miralax just didn’t make her feel better.

  5. I’m so happy you got to meet with a doctor you like. I guess it was worth the (horrible) wait! The nurse at Charlotte’s doctor’s office told us to do a half a cap of miralax and four ounces of prune juice, but there is NO way I am giving C four ounces of juice. That’s a lot of juice. Usually I give her two ounces of juice diluted in two ounces of water. These nurses just aren’t very helpful sometimes. It’s interesting to me that they said that sitting up from lying down was a developmental thing they’re looking for by 9 months. When did Charlie start doing that? Charlotte is just over 8 months and isn’t doing it yet. She will pull herself up if we give her our hand, but she’s not doing it on her own. I guess I need to work with her. Maybe we’re helping her too much.

  6. So sorry about the wait. It sounds like the doc was worth it though. I’m so glad you got some results out of this and are feeling better and more reassured and have something else to try to help Charlie.

  7. Send the office a note and express your appreciation that you were told the why of the delay.
    I am clear that being the person waiting for the doctor is better than being the person that the doctor has to take extra time with; perspective helps. It is also good to know that if you are the emergency problem the doctor will take the necessary time. Then remember to politely ask next time the doctor is running late what the status is at 10 mins after the appointment time. Helps everyone. POLITELY! (And be prepared with a snack and extra diapers.)
    SUPER GLAD you got help and a new doctor!!!

  8. Full disclosure, I have only read a few posts, so maybe this is something you have talked about previously, or maybe even in this post and I missed it. I just wanted to offer that my niece was getting constipated all the time as a toddler and she was taking milk of magnesia. Turns out she is allergic to cow’s milk protein. Now that she is completely dairy free she is fine. Dairy free is really hard though. I don’t know if she had any other symptoms or not. I just know the biggest issue was the constipation. Unfortunately before they figured out the problem, my brother and sister-in-law were putting the milk of magnesia into cow’s milk to get her to drink it and compounding the problem.
    I hope the issue gets better soon.

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