Pediatric Doctors, Surgery, and Stool

I am in the middle of attempting to get my 2yr old - now nicknamed the Menace - scheduled and in for a surgery he has to have done. Let me tell you, it has not been easy.

You'd think that the big issue would be collecting the stool and doing the blood exam. Surprisingly this was not an issue. First off, the Menace has taken to crapping on the floor. While absolutely vomit inducing and disgusting, much easier to get stool from hardwood floors than inside a toilet. Call me a cup half full kind of girl.

The blood test was also fairly easy, although traumatizing. Don't worry, he'll get over it.  I just took his little slip of paper from the doctor (with the warm cup of stool) to a nearby lab where everything was dropped off and drawn respectively. Great thing about Zona Sul is that there's as many laboratories as bread shops, at least in my neighborhood.

The hard part came in the form of doctor and doctor secretary cooperation. If you have tried to get an appointment with a specialist in Rio de Janeiro, you know what I am talking about. It goes to super pain in your ass status when they are in pediatrics as they are doubly special, or so they all believe.

I have to, and I say have because I have yet to manage it, get a surgical risk evaluation from a pediatric cardiologist. I thought this would be easy peasy since the Menace already has a pediatric cardiologist and had just seen him 95 days earlier. At that appointment, I explained that I was in the process of meeting with the pediatric surgeon and knew I would need him to update the form as no anesthesiologist will accept one that is over 90 days old. My appointment with the pediatric surgeon was over 6 weeks later as he is one of the best and is as hard to get into as a new NYC restaurant.

So being wide eyed and innocent, I jumped on the blood/stool tests and thought I'd just ring that cardiologist and be all set. Nope. He's never in. The man must be saving the pediatric universe because I sure as hell can't get a hold of him. His secretary has been stone-walling me for a month now and I finally gave in. I made a new freaking appointment. After finding a babysitter for Chatterbox, the Menace and I will be metro-ing over to Ipanema to wait for 45 freaking minutes just to hear the doctor say that I should have called and that he'll print something up. So be it.

That brings me to calling the pediatric surgeon's secretary. Figuring that I have the appointment with the cardiologist, I can reasonably say (dangerous none-the-less) that I will have all results the day following said appointment. I decided to count my chickens before they hatched and schedule with the surgeon before that becomes next to impossible.

The secretary did not agree with this plan. She informed me that the Prince of all doctors (which he really is) was booked through the month and they will not even open his September calendar until next week. I had to call back.

That was enough! I said no. We are not new patients. We are in the process of scheduling surgery and my child needs to be seen! I have test results.

Who knew 'test results' were the magic words? Of course she quizzed me first. Which kinds of tests? What kind of stool exam? By the way, I was very tempted to respond 'The kind that looks at poop from a child's ass' but I behaved myself.

Low and behold, I have an appointment for the Monday following the Cardiologist's appointment! Score 1 for this mother! Now I'm just waiting for the surgeon to say that I jumped the gun on the blood and stool and must do those over. Fair enough. I think by then I should have the Menace trained enough to go straight into the cup. That would win over both the hardwood floors and the toilet! 

Who are you calling white?

When I get pissed my Portuguese greatly improves. It's like a survival mechanism. I'm truly amazed by it. If you ever heard me arguing with someone, you'd think I was fluent.

I was proud of myself today as I bickered with our pediatrician over the blood test. He told me it was fine and obviously didn't want to get into the details. I wanted explanations for each variation.

Not only did I win, I asked questions and I questioned his answers. Bonus, I didn't make any blatantly obvious Portuguese mistakes!

Anyway, we settled things and I was on my way out until I remembered one last question. My son has seemed more pale than normal these past couples of weeks. I mean, he's white as hell but he's gotten a wee bit chalky if you will.

So I asked "Is it possible that his being so pale is because of the mild anemia?"

His response: "He's not pale, he's just very white like you are." *Smile*

Yeah, like your charming smile is going to make up for that little comment! But of course, I was thrown off my angry game and got embarrassed.

The lamest comeback ever:  "I'm not that white!"

And I was literally laughed out of his little office.

*PS. My little trouble maker is fine! Virus, mild anemia, and a culture for the blood in urine which he said is nothing to worry about.

You Think Cancer but You are Just Constipated

Today will be a long day for me. This is not because I have to do anything special. It's because I'm staring at my son's blood test results and they are not right.

I have a love/hate relationship with the Brazilian method of patients bringing blood test results to the doctors. The results stare you in the face for days before someone translates them. You think you have cancer and it turns out you are just constipated.

Do they really need to do that to you?!

So my youngest's blood test is a bit off. A very sweet friend of mine on Twitter took a general look at them and said its probably anemia and a cold/infection. I figured that too. It is rational and most likely the reason.

Then comes in Google. Freaking google and it's extensive searching mechanisms. Now my irrational brain is convinced that he has acute lymphoblastic leukemia. No his platelet count is not low, but I also found out that  they can be in the normal range in 17.8% of the cases.

Damn kick ass researching skills!  I think they should add disclaimers when handing over results with some variation from the norm. Something like: "No one is dying. Nothing here is really that serious. And no you do not need to call your doctor at 7am. Office hours will be fine!"

I forgot to mention the blood in his urine. What 2 year old boy has blood in his urine?!

And while my double personality disorder continues to develop as my mind jumps from rational to crazy hypochondriac, my 2 yr old is playing like normal.

I'm positive that I'm going to bring the results in to the doctor this afternoon, slightly freaking out over what he may say, only to get a prescription for iron and vitamin C.

Then I'll feel like an ass. That goes double because I'm sharing my craziness with all of you.

Then again, assness is the far lesser evil!

Doctor me Happy

So I have fallen into the Brazilian way of the doctor. Oh how the Brazilians I know love to go see them!

I mean look at me, I broke my baby toe. Given it hurt like a bitch slap to the foot, but still, it's just my baby toe! But no, like a good girl I went to the orthopedic and had it x-rayed and taped. The doctor told me I had to come back and get it taped professionally.  How often? Once a week for 4 to 6 weeks!

I find that a little surprising. I mean, it's been a while since I've used the American medical system but my old doctor would never have given me such care! Hell, I hardly got that much attention when I had a kidney infection.

Still, while it's good to be taken care of, it can also go overboard.  And you know what, I have. My poor boys are so comfortable with their pediatrician that they run into to say hello when we arrive at the office.  The routine of getting checked is so known that the doc might as well be cuddling with them on my couch, that's how big of a deal it is to them.

Stuffy nose for 2 weeks, go to the doctor. Sore muscle, go to the doctor. Cough cough, x-ray and go to the doctor.  Stub your toe because you are a damn ass, go to the doctor.

I'm starting to think that we're going a bit overboard down here.

That being said, my boys are lucky. Their pediatrician is mellow enough that he almost never orders any tests at all and goes it the old school way. Wait and see. Hell, I usually wait at least 3 days, if not 5, with a high fever before even taking them in.  FYI, in our pediatrician's office, it's only high after 102. Even then, that's not that high.

Compare that to my doctor. I went in with one funny level on a blood test and an irregular cycle and I had to do 2 ultrasounds and numerous blood tests. Numerous.  I'm glad she's thorough but sometimes I wonder if it's a bit too much. One of these days I may get cancer. Sure, it could happen. But at the rate she's going, it's going to be because of x-rays and ultrasounds!

I know I could choose another doctor for myself but my irrational maternal fear of dying and leaving my kids behind nips that in the butt. Where's my anal insurance coverage making sure I don't get the care I could potentially need without knowing it? Oh wait, I'm in Brazil. My insurance company actually takes care of me.

Then again, this is all coming from a Mother and wife who's dealt with fever seizures, stitches, pneumonia, ear infections, skin infections, foreskin/penis infections, staph infections, and a spontaneous pneumothorax. I guess anyone would fall into the "cautious" zone after that.

Which way do you go with your medical care? And does your insurance let you be as cautious as you would like? 

My Preschooler is Taking Illegal Drugs??

When our pediatrician in Brazil recommends a medicine, it never crosses my mind to see what the United States thinks about it. I mean, a medical professional told me it is the best thing to give to my kid, can't be that different, right?


Wrong. I have given my children two different medications that are illegal in the states.  Say what?!  The first time this was pointed out to me was during a visit to the states, shocker.


My youngest had Infant Reflux and was on Motillium (Domperidone). He had pneumonia, awesome during vacation, and I had to inform the US doctor of all medication he took on a regular basis. Her response was that Motillium is not allowed in the US, she hoped I brought enough for the trip (I did, duh), and that it works wonderfully for gastrointestinal issues.  


Not too bad.  Of course, I got online to search why. And you know, it was nothing too shocking. Just the American system taking care of it's people and anything that may be questionable. Heaven forbid let the people it could really help use it. Of course not, we are not responsible, nor are our doctors, and nor are our pharmacies. No, I'm not being sarcastic.  The nation of pill poppers needs to be watched by big brother.   


The second medication is a smidgen more alarming.  My oldest suffers from fever seizures, still at 4 yrs old.  And it is a freakin' scary ass thing to see. Not to mention, how quickly his fever can go from 99 (37) to 103 (39.4).  It just shoots right up like Hugh Hefner after a Viagra.  


Our Pediatrician recommended we ditch the Ibuprofen and give him Nolvagina (Nolvagine).  Ok, I really didn't want to experience the fright again so I was on it. When my 4 yr old had one while we were walking home from school, we were sent to a pediatric neurologist.  


I was ready to hear anything she had to say. And you know, it was good. Tests came out clean. We just couldn't let him run a fever.  Give Nolvagina at 99 (37) and repeat it every 4 hrs if need be, every 6 if the fever stayed under control. 


So we're in the states for an extended vacation and low and behold, both kids get sick. No biggie but we have a fever situation for the oldest. Since it's not his first fever this trip, we are running low on our Golden Fever medicine. I figure, we must have it in the states, maybe it's just prescription or something.  


Oh no it's not prescription.  Nolvagina/Nolvagine (Metamizole) has been banned in the US since 1977. 30 other countries followed suit.  And while Brazil isn't the only country that still allows it, it is one of the top users.  


I bet you are wondering, well what's the problem.  The story is that Metamizole causes Agranulocytosis. Agranulocytosis is an acute condition involving a severe and dangerous leukopenia (lowered white blood cell count), most commonly of neutrophils, causing a neutropenia in the circulating blood. It represents a severe lack of one major class of infection-fighting white blood cells. People with this condition are at very high risk of serious infections due to their suppressed immune system.


Well there you go.  That's peachy with a side of pear.  With a little more Wikipedia research, I found that the incidence rate of metamizole-induced agranulocytosis is between 0.2 and 2 cases per million person days of use, with approximately 7% of all cases fatal 


Ok, nothing too shocking. Not 1 in 4 or anything crazy like that. 


What now?  I think I'm going to go with my doctors back in Brazil.  At the very least, both these medications were given as a last resort after other things didn't work.  And you know what, they do work well. Nolvagina kicks my kid's fever's ass every time, and that is not an easy feat.  


Eventually, as my youngest, my oldest won't have the seizure issue, fingers crossed. Then it won't even be the issue. For the time being, it seems the lesser of two evils. 


How would you feel about this?  Would it freak you out if you were prescribed a medication that is banned in your home country? 

Can I have my Meds, Pretty Please!

 I really need to start reading Brazilian papers.  At the very least, I need to listen to the radio.

I went to the pharmacy to buy some just in case antibiotics for my youngest's penis. Long story short, here's the blog post: To circumcise or not to circumcise.

The Pediatric Urologist gave me the name of an antibiotic and antibiotic cream to bring with us to the states, just in case the little penis once again blows up like a Puffer Fish.

Per normal, I went in with my list, the antibiotics and other items.  The pharmacist was collecting like a good little man when he mentioned he needed the px for the antibiotics. I laughed. Seriously, a good belly laugh. Right. I know you do but I don't have one so please, can you just get it for me anyway.

No.

What? Now I was just confused. It was cute at first but it was getting annoying. Well, turns out we are enforcing yet another law, prescriptions. Someone forgot to send me the memo.  I actually had to go to my kids' doctor and pick one up to go and get the "just in case" medicine. The guy wouldn't even sell me the cream. I get that it's all about controlling antibiotics but seriously, the cream?  It's R$40 for a tube the size of travel toothpaste. And it's for skin infections. I seriously doubt anyone is getting off on buying this stuff and lubing up their whole body.

Then again, people are crazy.

I'm starting to get nervous. Next thing you know, we'll be getting tickets for j walking. Popcorn and churro vendors with have to have... gasp... permits!  And I will leave this country the day they outlaw drinking on the streets. That is where I draw the line. That and public urination. No no, line drawn after public urination and before drinking on the street. 

I'm all about the development of Brazil.  You go you rock stars!  But I do have an issue with it turning into the US. I would like that it not do that please.

But really, truly, madly and deeply, let's keep some perspective.  Fresh corn on the cob sold from a vendor on the street = good! Random guy selling soda and water out of a Styrofoam box, also good. Creepy old dude selling snacks at the park is super good. Hey, I have to carry around enough crap, you also want me to bring snacks? 

So let's not get too out of hand with this whole "control" thing. It's an evil drug that can take a country over.  And if you start getting petty with legislation, I'm going to get petty too.  You know, like stop focusing on j walking and maybe make it illegal for children under 17 to be out of school. Mandatory education for all kids, and that would require you to build enough schools and have enough teachers. Who's getting annoying now?

To circumcise or not to circumcise

Brazil is not as circumcise happy as the US of A.  They just don't feel the need to snip off that extra skin and I have yet to meet a Pediatric Urologist down here who is willing to do it to a newborn. They feel it's barbaric to strap a kid to a board and take a scalpel to an non-anesthetized kid's penis. 

When you put it that way, who wouldn't be against it!

But I am for circumcision. Call me old fashion, but I think it's cleaner. And as a Mom of boys, it's not as easy as it seems to get them to clean down there correctly.  Being a balanced person, I find the middle ground partial circumcision the most desirable.

So why write about it on my blog. Well, we've yet to circumcise our youngest as we are waiting until he's out of diapers.  It's easy to get infection when poop get smashed around an incision.  You asked, didn't you!   And for other medical reasons, it has been recommended he have one.

Well, those medical reasons bit me in the ass this morning when I went to change his diaper and found his penis swollen 3 times the normal size, and not in the good way!  Emergency room visit and bam, circumcision is needed as soon as the swelling and infection are under control. And NO, my kid is not dirty! They are Brazilian boys. They take like 2 to 3 baths a day for goodness sake!  And I do make sure those little hidden pieces are washed and clean thank you very much.

This situation only confirms two things for me, that circumcision is good and that the private Brazilian medical care is great!  I, yet again, had wonderful treatment at Copa D'Or in Copacabana. I spoke personally with my our pediatrician who also spoke with the Emergency room doctor. Our pediatrician will follow up with us tomorrow and we are being referred to a Ped Urologist asap.  I have to say Bradesco health insurance and their doctors ROCK!

And note to self, if you have a little boy and he's feverish and cranky, check the penis. I never thought of that. I looked at teeth, belly, throat, glands, toes, hair, and whatever else possible.  I never looked at the penis. Not until morning.  Oh the power of a penis.

I plead Vagina ignorance on that one.

* More available at : Copa D'or from the inside

** UPDATE** Emergency Circumcision was avoided and 5 months later, we have still yet to get the procedure done.  During the wait our son's pocket of smegma under his foreskin has grown to a point that you can see it very clearly from a distance. This makes the area a great place to grow bacteria.  As for poo poo-ers who want to automatically talk smack and compare me to a penis executioner, all extremists are bad. Just because everyone in the country where you are at gets an automatic circumcision doesn't mean that's how it rolls in other parts of the world. And just because too many people do it and it's rare to actually need one, doesn't mean it's impossible... not at all.  So instead of just being a pile of soapbox throwers, understand where this Mom is coming from. Heaven forbid I try to joke around about a penis and make light of a tough situation. 

Childhood Obesity hits Rio

I have been noticing larger and larger people in the streets of Rio de Janeiro.  No, I'm not talking tall people, I'm talking large, and it's not just adults.

I'm starting to think that childhood obesity is really becoming a problem in Brazil.  If I, an American, is noticing overweight children, it's definitely entered into the "Situation" category. 

Seriously though, it is.  The childhood population in this city seems to go between either normal/slightly skinny to quite large.  It's like the class system with a very small group in the middle. 
 
And apparently I'm not the only one who has noticed.  BBC News says, and I quote "the most startling figures come from Brazil, where childhood obesity has tripled over the last 20 years."

I can say that I have met at least 3 different families at my pediatrician's office who have their kid(s) on a diet because they are over weight.  The diet my pediatrician usually puts them on is, no more fried foods, no McDonalds (for example), more fruit, and take them to the park! 

It seems like common sense but I can see how the slippery slope could happen. For one, this is a culture where a lot is based around food. Saturdays and Sundays alone can be a dietary nightmare with family lunches that go on for hours and are full of fatty treats. 

At the same time, Rio de Janeiro alone is a wonderland full of outdoor activities to keep the entire family active.  Of course, as BBC says (since they are British and thus are obviously infallible): "The researchers comment that in the same period, Brazil's per capita gross domestic product has also tripled, and television use has greatly increased."

Oh TV, how you always bear the brunt of our bad behavior.  I will say though, TV is like alcohol, it takes balance and is highly addictive.  I love you both you bastards.  

And now food is right up there with them.  I will say, after procreating twice, my body just doesn't digest my fatty snacks the way it used to.  My body has turned into a squirrel storing nuts in his cheeks, only it's fat in my ass. 

Now, I have to actually... gasp uggg dear goodness, eat right AND work out on a regular basis.  I skip the fries and eat a salad.  Funny thing is, I actually prefer the salad now. I don't know what that detox did to me but it set me right in some way. 

Anyway, kids are the same. If you overfill them their ass will too turn into a panicked little squirrel hiding away nuts for a winter that never comes. Moderation and the ability give a firm NO you don't need a third box of McNuggets will do the trick. 

What do you think?  Childhood obesity a problem or overly concerned skinny people are ruining the world with their blabbering? 

Oh you Americans

I remember when my oldest turned 1 year old. We went in for his 1 year check up and my pediatrician laid down the law.

Translated "Stay away from peanuts until Luka is 3!"

I was like, say what?  I´ve read the books. I know the rules.  But why is my super mellow pediatrician actually breaking them down for me when he never has before.

"Americans love peanuts and love to give them to their kids. No peanut butter!"

I didn´t realize he was a mind reader.  Honestly, I was planning on waiting until he was 2.  Three seemed a bit much.  So I ignored his request and gave him peanut butter anyway... at 2.  And you know what, it was fine!  Actually, my youngest sneaked a taste of his brother´s peanut butter sandwich at 9 months.  I was shocked, a little panicked, and sat and watched. If his throat didn´t close we´d be good.

5 minutes passed. Nothing. Sweetness, no peanut allergies in this house.

So when my going to be 4 years old this week broke out into hives a month ago,  I thought it was the cough medicine.  The Pediatrician suggested the peanut butter sandwich he ate for lunch. Impossible.  Plus, we all know he´s a peanut butter hater anyway. HATER.

When he started to break out into hives this evening, I started thinking.  The only thing he ate both times was a peanut butter sandwich. 

Damn it.  Maybe the pediatrician was right. Maybe the pediatrician was lucky.  Maybe peanut butter is evil.  I don´t know. All I know is that until an allergist proves otherwise, I´m mourning the quick lunch/snack that is the peanut butter sandwich.  One time screwed, shame on the sandwich. Second time screwed, shame on Mommy.  Until proven differently, I will give him rice and beans instead.

No you can´t see me naked

There are certain people in my Brazilian life that I do not need to remember are women and men. They are people, of course, but are non-sexual beings in my mind. Call me crazy but it works. 

Now Brazilian swimwear makes this quite difficult. There´s no hiding behind the 3 inches of fabric they give you.  I´m comfortable with that. I bust out the Brazilian bikini at the beach and pool without a problem, normally. 

The thing is, when you are sun bathing like a Carioca, everyone knows what God gave you.  It´s almost like being a tease with just the bits and pieces covered.  Of course, we can all tell what´s under there. 

So you can imagine how I felt when I saw that I was about to run into our pediatrician at the pool. Yes, I´m about to be 30 and am a mother of 2.  I should be somewhat mature. We´d all like to think that, wouldn´t we.  Well, I´m not. I took evasive action. 

Call it what you will but I´m not ready to have an idea of the fruits God gave the man that checks my kids´ ears. I have to be able to go to a doctors appointment without thinking about what lies beneath! 

I could not look.  Sure you would say that.  Of course I would look! Are you kidding me?! I´m that girl that if you say, oh don´t look Rachel, I`m a lookin´.  I´m also that person that slows down her car to stare at accidents, laughs at inappropriate times, and spills wine on children (long story). 

Think of me what you will.  But you know, deep down, you only love me a little bit more. 

To Nebulize or not to Nebulize?

As much as I love holding down a screaming child and nebulizing them, I wonder if it makes a difference.  My pediatrician swears by it, along with every single other Brazilian, even the childless ones. I swear, people in Brazil are raised with that thing stuck to their face.

Now, I'm a humidifier girl.  I was raised with the hot steam humidifier every time I had one of those horrible colds. Ordinarily, this would be equivalent to Brazilian Chinese water torture but the normally humid Rio de Janeiro is strangely lacking it's every day moistness.  I almost want to call up into the clouds and say 'You know, there's a cream for that'. 

And I've tried to use a humidifier here.  I bought an overpriced cold water one at Lojas Americanas and all it did was make the room rank and sticky.  Back to the nebulizer. 

So all you experts out there, what does it do? I hear it breaks up the snot, opens the lungs and sinus, and shortens the life of the cold.  I always thought nebulizers were a way to get medicine into the lungs and that without the medicine, it's basically a steam room for the lips. 

Of course, I'm still using it on my little one. He's a miserable snot factory, coughing and choking the night away.  Hell, I would bust out African dance - tribal circle, fire, and all - if I thought it'd make the cold go away. 

So what's your verdict?  To Nebulize or not to Nebulize? 

Charming Pediatrician

I wonder if it's wrong to fall for the charms of the pediatrician.  Of course these charms are directed towards my pre-schooler and toddler but that's all the more charming if you ask me. 

I have a total mini-crush on our pediatrician. It's a standing joke in our house.  My husband says he'll know something is up when I start referring to the doc by his first name.

I just can't help it. He's rescued me from child illness drama too many times to count.  He's also a great listener, never making me feel like a nervous Mom, even if I am.  Plus he's actually attractive and charming.  Ok, so he has very typical, large Brazilian features and is slightly balding but he pulls it off. 

He's not perfect.  He's never available at the home number he gives out to his patience. It's very common in Brazil to have your ped's cell and home number so you can reach them anytime. This spells nightmare, especially here. Brazilians expect every stuffy nose and scrape to get checked out. I understand his position completely.

But he has found early bronchitis in both boys when it's been missed in ER late the night before.  He has answered medical questions while playing tennis at the club.  He has compliment fat Mommy right after baby #2. That gets a BIG gold star in my book.  This Mommy was pretty damn fat after baby number 2 and my husband is required by household law to compliment during super fat phases.  It means so much more from a non-obligated male source.

The best part though is that my kids love going to his office. I hardly ever have to battle them into going to see the doc.  When I take in my toddler, he still checks out my pre-schooler, even if he's not the scheduled appointment.  When my youngest would go in monthly as a baby, the doc would make as big of a fuss about my then toddler. He would check, weigh, and measure just as he did the little one. 

What can I say, everyone feels special at our Ped's office and that's how this Mommy likes it.