Trip to Urgent Care

Henry woke up at 4AM yesterday. Jeff gave him a bottle and became concerned when he felt Henry. Henry was cold (head, hands, and feet). He took his temperature. It was 95 degrees under the arm. I called the nurse hotline on the back of Henry's insurance card. I explained Henry's situation (e.g., vomiting, diarrhea on Friday night, 9 oz weight loss, and feeling cold). The nurse said "get a new pediatrician" and that we should probably take him to Urgent Care. However, seeing as that it was 4:30AM by this point, she said we could wait until morning, call his pediatrician, and then see if his ped could arrange for appointments with specialists (rather than spending 6-8 hours in urgent care/ER).

We waited a little while. Henry still felt cold. I decided to call his pediatrician's office and get the telephone number for triage (which eventually gets you in contact with a pediatrician on-call). Jeff talked to the triage nurse who recommended taking another temperature reading in 30 minutes after bundling him up. 30 minutes later, we took another temperature and the nurse called back. Still cool. His temperature had increased to something like 97.3. She then called the on-call pediatrician. Explained the weight loss and feeling cool. I figured that we would be told just to keep an eye on things. A temp in the 97s isn't as concerning to me as a temp in the 95s. But the on-call pediatrician (a Dr. McPherson) said that we should take Henry to the ER. The triage nurse said that we should go to TMC or UMC. She said that it shouldn't be crowded at that time of the morning (it was about 6AM by this point). I asked if it was OK to take him to Northwest Hospital (the one closer to us). We knew that the neonatalogists and nurse practitioners at UMC's NICU rotate into the Level II nursery (handles neonates at 30 weeks or older and babies not needing a vent for more than 24 hours) at Northwest. We also know that Northwest has questionable billing practices. We heard that the NW staff has competitions to see how much money they can swindle out of people beyond the co-pays. They double and triple bill the elderly (e.g., my grandmother on several occasions). They have tried to press my mom several times and lied about the co-pays (her doctor uses Northwest), which of course resulted in my mom threatening them with a lawsuit (they backed off). They have lied to my mom's friends about what is due. In an emergency, Jeff and I aren't afraid of their billing practices as long as the doctors are good. The triage nurse on the telephone said that "under no circumstances" should a parent take a baby to Northwest. So it was back to UMC.

We arrived at UMC around 7AM. Just a couple of people were in the large waiting room. It was a completely different scene less than 24 hours earlier. A nice nurse named Wendy saw us almost immediately at the registration area. She did a thorough job recording our concerns. Wendy is the mother of a 2 year old and a 6 year old. She was the complete opposite of Ashley the day before. Wendy gave us to the option to weigh Henry with or without clothes. She said that the doctors wouldn't use their scale weight as the assessment benchmark of whether or not Henry's weight was declining. We decided to keep his clothes on (7 kg, which is where he was the previous day on their scale with clothes on). She measured Henry's head at 43 cm and his length at 64 cm. She handled all of the registration (no two part registrations this time of the morning). She decided to sign him into Urgent Care. The doctors would arrive at 8AM. Henry was first in line.

We waited in the near empty waiting room for about 20 minutes. It looked clean, which was nice to see. We were then called by the next nurse, Chuck. Chuck took us and two other patients to some waiting rooms in the back. Even though the doctors weren't coming into the hospital until 8AM, he wanted us ready so that we could be seen immediately. Henry was seen by a Dr. Beskind (an assistant professor). I have to admit that it was really nice not to have to go through the whole resident thing and to see a "real" doctor right away. I'm all for the teaching hospital thing, but we have seen a lot of residents in Henry's short life already, and a lot of them truly don't know much (Dr. McLain from May and Henry's resident from August, whose name I have already forgotten, being strong exceptions). For the stressed out parent, it is nice to cut to the chase.

I guess the basic rule of thumb is that if the baby looks alert, then they don't consider the problem terribly serious. Henry has been alert the last three weeks. He was very sluggish on Thursday and Friday, but when awake, he is alert, although not as active as a couple weeks ago. Clinically, Henry looked OK. The doctor did discover a rash on Henry's stomach, which neither Jeff nor I had noticed at his earlier diaper changes. Henry has had a rash on his chin, but Jeff and I figured that it was from all of the drooling that he has been doing over the last 2 months. His chin did look more aggravated than usual. On his stomach, he had a rash patch that looked rather angry, about an inch above his diaper on his right side. The doctor said that the rash suggested that Henry had a virus. Consistent with the "ick" that is going around. Given Henry's other symptoms (e.g., gagging during feeds and refusing bottles), Dr. Beskind thought that Henry's reflux was acting up. He told us to put Henry back on his reflux meds. I asked whether the dosage should be the same. He was taking 7.5 mg of Prevacid once a day. This dose was prescribed to him back in September when he was 6 lbs. Dr. Beskind said that he was going to call Henry's pediatrician to consult with him, but suspected that the dosage should be increased. In the meantime, Chuck brought Henry a bottle of Pedialyte. They wanted to see if we could get some liquids into Henry before we left. We tried giving Henry the Pedialyte, but it made him upset. We did manage to get some breast milk into however. A woman came by with a teddy bear for Henry. He played (chewed) on the bear for a while.

Around 10:30AM, Dr. Beskind came back with Chuck. Final prognosis: Henry has reflux and a virus. They would rather not run tests on Henry at this time, because there are RSV cases in the hospital, and it would be safer for him to stay away from it. Regarding his weight loss, they won't do anything about it until Henry loses 10% of his body weight, at which point he would be diagnosed as failure to thrive (FTT) and then be admitted. I completely understand the logic of keeping Henry away from RSV cases, but the logic on the last bit on waiting until the child is FTT before one takes action is...well...asinine. Here is a wild and crazy thought...how about try to figure out what is going on before letting the child turn into a FTT case. Sigh. I know that Dr. Beskind was just following hospital protocols, but I just find the logic of "modern" medicine screwy. I will say that Dr. Beskind and Chuck did have very nice bedside manners. They are both fathers to young children, which probably contributes to their sensitivity. Incidentally, Dr. Beskind's son had reflux as a 1 year old and required medication as well, so he is familiar with the problems and symptoms of reflux.

Our 3.5 hour trip (4.5 hour trip including driving time) to UMC wasn't a complete waste of time. Dr. Beskind did raise the dosage of Henry's reflux medications to 7.5 mg twice a day.

Henry had a pretty good afternoon. We gave him his Prevacid. Grammy came over and played with Henry. Henry loves to play with Grammy's hair. Henry ate a whole jar of pears at some point. Jeff and Grammy weighed Henry at 15 lbs 3 ozs. We were pleased that he didn't dip below 15 lbs.

In the late afternoon, we got a visit from Shelly, a UMC nurse, who was doing an evaluation of Henry so that Henry could be entered in their home health care program for physical therapy visits. Tara tried to get a PT through DDD, but none of the PTs want to work on the west side of town. Henry's insurance will pay for most of the PT visits from UMC. We'll have to take care of the co-pays, but in the larger scheme of things, that's no big deal. The important thing is that Henry will have a PT. Shelly was really nice and upbeat. She had a great personality. And most importantly, Henry liked her. His temperature was still in the 97s (can't remember the exact number), but he seemed to be doing fine. When she held him, he started gnawing on her shoulder. I hadn't really noticed that before. She observed two things: (a) that he was teething, and (b) that he was making coughing sounds consistent with a reflux diagnosis. With his teething, she said not to be surprised if he runs a little fever. She said that her children vomited and back end issues when they teethed. She had some good suggestions for his teething, things that had worked for her kids. She also suggested that we get a bed wedge so that Henry stays elevated when he sleeps, which is suggested for reflux babies.

Grammy and I went to Babies R Us after Shelly left. We got some Pedialyte popsicles and more pears for him. Got a bed wedge. Grammy bought Henry an early Valentine's Day gift. It's a dinosaur toy that has balls and slides for the balls. It's pretty cool. Grammy left in the evening. Shortly after, Grandpa arrived. Henry fell asleep around 8PM or so. Overall, I think that his milk intake was up a little (just up an ounce, but given that he has only been consuming 10 ozs a day, that's a 10% increase!). He didn't have as much to eat though. But at least he didn't throw things up. And, he had a couple feeds where he didn't choke or gag.

This morning, Henry woke up shortly before 2AM. Jeff gave him 2 ozs, while I pumped. Henry wanted more. He had an additional 1 1/3 ozs before going back to sleep. He had another 2 ozs when he woke up again at 7AM. So far, so good on the food intake. Well, maybe not good, but not terrible. It is an improvement anyway. Veronica is watching Henry now.