Charting on Sick Kids

Teenage Son (from here on out known as "TS") was still having abdominal pain yesterday. I called the doctor's office and left a message with the receptionist, describing his symptoms. (sidenote: I really like my doctor . . . but after going to several of my patient's doctors with her, I like his office less and less. SL gets into the exam room within MINUTES of walking in the door, and so do any other patients sitting there. It routinely takes more than 30 minutes to get into the exam room at my doctor's office, even if the appointment was set up far in advance.)


The nurse called back within an hour (another complaint; usually it's at least 2-3 hrs. before they call back), saying the doctor wanted to see TS for an office visit.


TS was very unhappy to have to go to the doctor; he's generally very healthy so not used to going. To make matters worse, the visit began with a blood draw. He HATES needles (which is much better in my mind than LIKING them!), but didn't want to hold my hand, or even have me near the table he was lying on when the blood was drawn. He DID, however, have his cell phone in a death grip . . . I guess somehow that helped him feel connected to and comforted by his girlfriend and other friends, who he'd been texting throughout the visit (when the doctor and nurse were not in the room, of course).


A few minutes after the blood was drawn, the doctor came in to examine TS. His tentative diagnosis leaned toward mono; his bowel sounds were normal, his WBC count was not up, and the location of the pain wasn't typical of that for appendicitis, although the doctor did say that often the appendix was in an atypical position, producing atypical pain. The doctor did a throat swab also, saying he'd had several cases of kids presenting with both mono and strep. YIKES!


A few minutes later the doctor was back with the diagnosis of mono; the pain was from his liver and spleen being enlarged and inflamed. The doctor talked about the importance of rest and avoiding any type of contact sport, like sledding (potential of running into a tree, but humorous as it's been 80+ degrees and any potential snow is months away!), belly flop contests, and bull riding. I appreciated that the doctor took the time to talk directly to my son, and answer any and all of our questions.


The strep test came back negative, but the rapid tests often give false negatives, so it's been sent to a lab. TS's throat isn't sore today, so I don't think strep is part of this illness.


Before the doctor left the room he said that he wanted to check liver enzymes, too. TS made a face at the prospect of another blood draw, but the doctor said that his nurses were used to him ordering additional tests after examining the patient, so they always drew extra blood right away--smart nurses! I was impressed.


The enzymes were up, so son is now on a decreasing dose of steroids. The instructions were not complicated--three tablets a day for three days, two tablets a day for three days, and so on . . . but I can't keep track of meds that have to be taken more than once a day, not to mention keeping track of how many days I've taken how many meds . . . so I made a medication chart. TS asked a very pertinent question; "Do I have to take them an equal number of hours apart, through the night, or just while I'm awake?"


TS has been happy to take it easy today. I think, however, in a few days he'll be itching to get back to his normal active routine! I'm thankful it wasn't something serious, or appendicitis . . . although TS did point out that if it would have been, he'd have been "better" much quicker.

Sick Kids

No, I'm not talking about Pediatrics in the hospital . . . I'm talking about the difference between sick "patients" and when your own kids are sick.

Thankfully, my kids have only been seriously ill or hurt a small number of times. The scariest was when our son was in 1st grade and developed asthma. When I got him to the ER his SpO2 was only 84% . . . very scary! A couple of nebulizer treatments turned him around very quickly . . . and I never forgot the lesson of going to the ER sooner rather than later when it comes to respiratory problems. Thankfully he outgrew the asthma but during the years he had asthma I had inhalers in every vehicle, every home he regularly went to, every purse I carried . . .

Our son rarely gets sick, but when he's sick, he's SICK, and not just a little bit. He's usually in bed for at least a day or two. Yesterday we were out of town and he complained about having a bad headache and a stomach ache. . . within half an hour he was laying in the truck, napping, which he did for several hours while our daughter participated in her events. Of course, being a nurse, I didn't think about him having eaten bad fast food or anything simple like that. I thought about pancreatitis, a kidney infection, stomach ulcers . . . sometimes nurses know too much!

It was difficult when the kids were babies, and couldn't tell us where it hurt or what was wrong. I remember feeling soooo helpless when they cried, and cried, and cried, and we couldn't figure out what was wrong. All we could do was rock, hold, and cuddle them. Those memories are bittersweet; of course I didn't want the kids to be sick, but there is something that touches a mom to the core to know that she, and only she, can comfort a sick child.

Now the kids can tell us what is wrong when they don't feel good . . . IF they feel like it. Our daughter is usually more than willing to detail all aspects of any ache or pain . . . while son is often reluctant to do so. His side of the conversation this morning went like this: "I don't know where I don't feel good, I just feel bad . . . yes, my head hurts . . . I can't rate it on the pain scale! . . . my stomach doesn't feel good . . . I don't know if I feel like throwing up . . . I don't WANT to rate it on the pain scale . . . OK, FINE, it's about a 5 or 6 . . . what do you mean by 'localized or general pain'? "

Five or 6 on the pain scale is where I start to get concerned, but it's been steady or decreasing since then so I'm not too worried. He's been eating and drinking a little throughout the day, and the pain has not localized, as it would with appendicitis or anything more serious. I will take him to the doctor tomorrow if it gets worse. He's been sleeping much of the day, so I think it's some type of virus/flu that's been going around.

Sick teenagers are crabby, just like sick babies. The only trouble is, my sick teenage boy won't let me "cuddle" him ("Mom, you're WEIRD!"). He has, however, kept his cell phone close all afternoon. In between questions about his pain, going to the bathroom ("Mom, that's SICK to talk about!"), and eating and drinking, I found out that he's texting his girlfriend. I guess when you're a teenager in 2008, texting your girlfriend when you're sick takes the place of cuddling with your mom.