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.