Weird call with the pedi this AM (long)

[boiler717]

T’s pedi is OOT so we’ve been dealing with the back up pedi for all of his GI stuff. I had a really weird call with her this morning and I’m not exactly sure how to process or what to do. I guess I’ll take hugs and advice?
So, backstory is that he tested positive for C diff. They called on Thurs late afternoon to see if he was symptomatic because they wouldn’t treat if he was now asymptomatic. We had already stated the specific probiotic that is helpful for that infection and used bleach to clean our house, two other recommendations for treatment (although the office didn’t tell us that). He was definitely improved but not 100%, so they didn’t give us clear guidance on whether or not to treat. He had a history of getting better and relapsing so we decided to treat but it took until late Friday to get the antibiotic (couldn’t get it ordered, then had to transfer pharmacies to get one compounded, huge ordeal).
We started abx Saturday AM. We are having a hard time getting it in him — it’s 10 mL, four times a day. He’s not awake long enough to do 4 doses a day and the volume is so large. It’s the worst tasting abx ever, can’t disguise taste in anything. We’ve tried everything, best option is him in the high chair with my husband holding his hands down, me holding his head up and giving it in the back of cheek while blowing in his face.
His Sat AM l bowel movement was 100% normal (and all subsequent ones). Then another on call pedi called us because his lab was left in the in box. I took the opportunity to ask about treatment and he said we needed to treat since he was symptomatic at one point. So we kept going with the abx.
We still can’t get full doses in him. I would guess he’s maybe getting 1/3-1/2 of the prescribed dose. So I called the prescribing pedi this AM during phone hours to see what to do.
I was in tears by the end of the call. She was like “why are you treating him if his stool is normal now?” and told us to just stop the abx. She then started in on everything under the sun. She gave me a huge lecture about taking him to his allergist for asthma flares and not their office. She said I shouldn’t do that (even though his allergist prescribes his asthma meds). She said we shouldn’t have given him so many abx in December (that his allergist prescribed for multiple ear infections, not that she asked why he was on them). She said we shouldn’t get the immune testing his allergist ordered because there’s no point. She said we should keep him home with a nanny vs preschool if he’s getting this sick (but doesn’t think he needs immune testing). It was just so awful. I felt insulted as a mother and as a health care professional (she said one of the nurses told her I was a pharmacist).
Every time Teddy has had an ear infection I’ve asked if should wait for it clear on its own to see if it’s viral. My husband literally does antibiotic stewardship for his health system — we are not people who demand abx, are not offended by waiting to see if something is viral, etc. Heck, we don’t even take him in for cold symptoms unless they go longer than 2 weeks or he has a persistent high fever with worsening asthma symptoms (to make sure he hasn’t gotten pneumonia).
I feel both like I’m a horrible mother and that she went so far over the line. I’m not sure what to do at all. I also have no idea whether or not he needs treatment or what to do.

[ribollita]

I would personally ignore the doctor, keep treating him and review the literature and existing practice guidelines to make an informed decision on my own. I’d also not see her again.

[vtdiamond]

Yikes, that is so overstepping.

My son has been referred to specialists (pulmonary, allergist and urology) and our pediatrician has always deferred to the specialist. That seems really unprofessional for her to object to what the specialists are telling you to do.

I wouldn't want to see her any more. Are there any other physicians in the practice you could work with? Or would it make sense to call/see a GI specialist?

[boiler717]

Jan 29, 2018 13:58:36 GMT -5 vtdiamond said:

Yikes, that is so overstepping.

My son has been referred to specialists (pulmonary, allergist and urology) and our pediatrician has always deferred to the specialist. That seems really unprofessional for her to object to what the specialists are telling you to do.

I wouldn't want to see her any more. Are there any other physicians in the practice you could work with? Or would it make sense to call/see a GI specialist?

There are other peds but she is the assigned back up for my pedi. I will ask my son’s when she is back from vacation if we can call someone else in the future, though.
I called a local peds GI office and they won’t see him until his primary pedi submits a referral, so not something we can figure out today.

[ellipsis]

I'm sorry -- trying to get antibiotics in an uncooperative child is really really stressful enough.

I would ask not to see that pedi again. I would also possibly bring up the convo with your main pedi to see their opinion. If they are hesitant or restate some of the prior feedback maybe it's time to switch practices.

[lessel]

Yeah, I'd be done with this practice. Even if she's not your primary pedi, I'd probably write a letter to the main doc and practice manager and switch practices. (Assuming you're in an area you have other choices.)

I think you should get a GI consult too, if possible.

Hugs. You're doing (and have done) good for your kid. Don't let someone make you second guess everything.

[boiler717]

Jan 29, 2018 13:53:46 GMT -5 ribollita said:

I would personally ignore the doctor, keep treating him and review the literature and existing practice guidelines to make an informed decision on my own. I’d also not see her again.

It is confusing because it says for mild disease, if he still has symptoms after abx start he should be treated. He did have diarrhea after that, but also at a time when a viral gastroenteritis went through our whole family and after I had some inadvertent dairy (I nurse and he has a dairy allergy). So I don’t think we can say for sure if he really symptoms from C diff after treatment. He’s still in the age range where he could be colonized yet not causing infection. It is just all so confusing.

[sparkythelawyer]

You are a wonderful mother and that doctor is a complete asswagon.

[mrssandro]

I would try speaking with your primary Pedi and tell them about the conversation. See how they react or provide you feedback. What the back-up pedi did was not professional or helpful.

If that doesn't work to your satisfaction you may need to move to a different pedi.

I have been there with a very stubborn child when it comes to meds. Maybe try a chaser after the nasty meds. Something really good like a milkshake or cola. I also bribed a ton.

[marie]

Our practice has 4-5 pedis and they all back each other up. There is just one that I do not care for, and I think I would leave if I was forced to deal with him as a back up.

Was the back up questioning your pedi's advice? Or only that of the specialists? If he was questioning what your pedi said and/or did, I would be inclined to tell them.

[loira]

Ugh, I'm so sorry! What an awful experience.

If he's not getting all of the dose anyway, would it be worth trying to put it into something like chocolate milk (I know he's non-dairy but something similar) to see if he'd drink it that way?

[akafred]

Fuck that chick right in the earhole.

I would absolutely let my primary pedi know ASAP (maybe even on vacation I am so mad!) and get a backup plan for when they are next on vacation that doesn't involve that crazy bitch or switch practices.

(I PROBABLY wouldn't interrupt vacation since it isn't an actual emergency, but I would be sooooooo tempted!)

[pinkpeony08]

Ugh, she probably was having a bad day and took it out on you, sadly. Totally unacceptable. I would not hesitate to let the clinic manager know and your normal doctor.

I can attest that oral vancomycin (presuming that's what you have to give) tastes AWFUL - I worked as RN on a floor where we had to give it to patients with c diff and they essentially needed to be bribed to take it. Grown adults. And it's worse because you have to take it so often.

I would talk with someone else - another pediatrician in the office maybe as it sounds like obviously this person is unhelpful. It doesn't sound like you can connect with GI as you need a referral, but you could ask the pediatrician to contact GI and ask for recommendation if it is recommended you stop the vanco. No need to put yourself through all of this if it isn't needed, but you don't want to stop it if you should be continuing it either.

So sorry, ugh.

[nicolewi]

That's awful. If she is with a large organization, they probably have a patient services department. I would call and explain what she said and that you felt it was extremely inappropriate, insensitive, and at odds with the advice you had received previously from other providers.

[akafred]

I've heard of some foul abx being mixed with pure Hershey's syrup. Not sure if that has dairy but it is a thought if you need to continue.

[boiler717]

Jan 29, 2018 15:08:16 GMT -5 akafred said:

I've heard of some foul abx being mixed with pure Hershey's syrup. Not sure if that has dairy but it is a thought if you need to continue.

That’s always what we were taught to recommend as well! Doesn’t help with this one unfortunately. I made him a milk shake with tons of Hershey’s and non-dairy ice cream and it still was awful.

[pinotgrig]

You’re not a horrible mom. At all. I’m so sorry she made you feel that way. I wouldn’t work with this one any more - you don’t get to come in halfway through and criticize a plan that was already laid out and agreed upon. Hugs.

[boiler717]

Jan 29, 2018 14:25:43 GMT -5 marie said:

Our practice has 4-5 pedis and they all back each other up. There is just one that I do not care for, and I think I would leave if I was forced to deal with him as a back up.

Was the back up questioning your pedi's advice? Or only that of the specialists? If he was questioning what your pedi said and/or did, I would be inclined to tell them.

She was the one who prescribed it, then got upset I gave it to him. So questioning her own?
She also questioned us seeing our allergist (referred to by our normal pedi). The reason why I go see him instead of our pedis office is because the back up pedi twice under dosed him for abx and refused to change doses when questioned by the pharmacist filling the RX. I don’t want to risk seeing her so I call the allergist office now always (trust me, I’d rather have a $25 copay than a $60 one).

[lolo]

Jan 29, 2018 16:12:03 GMT -5 boiler717 said:

Jan 29, 2018 14:25:43 GMT -5 marie said:

Our practice has 4-5 pedis and they all back each other up. There is just one that I do not care for, and I think I would leave if I was forced to deal with him as a back up.

Was the back up questioning your pedi's advice? Or only that of the specialists? If he was questioning what your pedi said and/or did, I would be inclined to tell them.

She was the one who prescribed it, then got upset I gave it to him. So questioning her own?
She also questioned us seeing our allergist (referred to by our normal pedi). The reason why I go see him instead of our pedis office is because the back up pedi twice under dosed him for abx and refused to change doses when questioned by the pharmacist filling the RX. I don’t want to risk seeing her so I call the allergist office now always (trust me, I’d rather have a $25 copay than a $60 one).

She sounds terrible. I think I'd draft a strongly worded email and then sit on it for a couple of days to decide whether to send it or not. You can also use it later to refer back to and get taking points for your pedi.

[statgirl]

I would change pediatricians or ask that your back-up be a different doctor when your primary ped returns. I know changing doctors is not fun (we had to do it twice in the last year, so I am pretty sure that we are now considered "problem patients"), but in the long run, I think you will be more comfortable. We are finally at a place where the doctor listens to us, sees us on time, and is ready to address issues that my children have. Our first pediatrician (we used her for 4 years) essentially was there in name-only, so we never got to establish a relationship once her NP left (and was replaced by a revolving door of NP/PA/new doctors). Every time we would get a relationship going, they would leave. Our second pediatrician (9 months) was also a PA/NP heavy place and we left due to insurance issues, but the new PA tried to OD my son on steroids, which really threw my confidence in them (and then the insurance issue happened the same month, so we left). I am kicking myself that we didn't leave earlier for the slightly less convenient, but more hands-on doctor. I think that unless your ped is a rockstar who is THE BEST in the medical issues your son is experiencing, I would switch to another doctor who can manage his care and refer you to specialists as needed. I don't think this back-up ped is a rockstar.

[boiler717]

Update: I talked to my boss who is a gastroenterologist. He said it’s fine to stop and observe, and he’d get us to a peds GI if needed.
Thank you all so much for your kind words of support. I was feeling really down on myself and you helped a ton.

[Dumbledork]

Ooo, I would have hung up on her.

I did that once ages ago when a doctor was being an ass to me and he proceeded to call my husband (my emergency contact on file) and tell him to basically get me under control.

My nice response would have been ending it with “I understand. Could you please transfer me to the mailbox of our primary pedi?” and then just repeated that until they either did it or hung up themselves.

I’m sorry she forgot to treat you with basic respect.

[CloudBee]

Huge hugs. I'm sorry you were spoken to that way.

When you're dealing with both specialists and a pediatrician, it can be common to feel caught in the middle. Often the pedi puts their hands up and wants to completely deflect to the specialist. Especially if they feel ill-equipped to treat.

You shouldn't have been spoken down to. Doctors are your "village". They should always be on your team.

[starburst604]

She sounds awful. I would definitely write a letter to the regular pedi, once I calmed down a bit. Stick to the facts and don’t pour too much emotion into it, but the regular pedi should know of your experience. She seems off her rocker and you probably won’t be the first one who has complained. Even if you decide to leave the practice, let them know why. I don’t think I could stay, knowing I’d ever possibly have to deal with her again.

[jorja]

Is he on oral vancomycin? I’ve heard from patients that chasing with orange juice helps with the nasty taste.

That doctor sounds completely out of bounds. Are there other pediatricians in the practice? Could you possibly speak to someone else and get their opinion if you feel like you need to before your pediatrician is available?

I would not want to be dealing with that doctor again and I’d let them know exactly why.

[obladi]

I didn’t want to read and not respond since I just mistakenly responded to an old post of yours. I am so sorry you are having a rough time with this doc on top of the issues your kiddo is having. It sounds like we are in similar situations, my daughter was tested for c diff today and we are working closely with our ped but also with her polmonologist as DD has very severe asthma. Hugs

[boiler717]

Jan 29, 2018 20:02:34 GMT -5 jorja said:

Is he on oral vancomycin? I’ve heard from patients that chasing with orange juice helps with the nasty taste.

That doctor sounds completely out of bounds. Are there other pediatricians in the practice? Could you possibly speak to someone else and get their opinion if you feel like you need to before your pediatrician is available?

I would not want to be dealing with that doctor again and I’d let them know exactly why.

He was on metronidazole (even worse tasting than vanc). I didn’t try OJ but will keep that in mind if he needs it again.

[boiler717]

Jan 29, 2018 20:52:53 GMT -5 obladi said:

I didn’t want to read and not respond since I just mistakenly responded to an old post of yours. I am so sorry you are having a rough time with this doc on top of the issues your kiddo is having. It sounds like we are in similar situations, my daughter was tested for c diff today and we are working closely with our ped but also with her polmonologist as DD has very severe asthma. Hugs

I’m so sorry we are in the same situation!! PM if you ever need it. I recommend florastor and lots of bleach!

[patches31709]

I'm sorry the dr made you feel so bad. I find it really frustrating when doctors have opinions that completely contradict each other, especially when you're just trying to do what's right for your kid.

To get yucky abx in my dd, we squeeze around 1ml at a time, then give her a chocolate chip. It takes a while, but if we do it any faster than that, she will cry and gag until she pukes it back up. And the chocolate chips are a special enough treat that she'll put up with the medicine to get them.

[boiler717]

Jan 30, 2018 8:39:43 GMT -5 patches31709 said:

I'm sorry the dr made you feel so bad. I find it really frustrating when doctors have opinions that completely contradict each other, especially when you're just trying to do what's right for your kid.

To get yucky abx in my dd, we squeeze around 1ml at a time, then give her a chocolate chip. It takes a while, but if we do it any faster than that, she will cry and gag until she pukes it back up. And the chocolate chips are a special enough treat that she'll put up with the medicine to get them.

Thanks! We did chocolate chips before / after but not a mL at a time. I’ll keep in mind if we give again.