pneumonia & the new ped.

[Aura]

I'm a bit angry right now, so I this is a bit of a vent, and also an appeal for some advice.

 

Quick background (youngest ds, 22 mos.): Saturday night he came down with croup, which continued until about Monday night, when the croupy sound went away and left just an awful cough and a fever. Fever was 102.4 under the arm. I checked his ears Tuesday morning and they both looked infected to me. His condition hadn't changed by this morning. As long as I keep acetaminphen or ibuprofen in him, the fever stays down but even after 3 days, if he comes off them, the fever will spike, so I took him to our new ped. (assigned to us by Kaiser) this morning. (New insurance this year, so new drs. We didn't currently have a dr. anyway 'cause our old one retired.)

 

Kaiser just built their office in our area and so they're staffing it w/ drs from a nearby major city. What kind of dr. leaves his practice and his patients to go work in an office started by an insurance company? So, I didn't have a very high view of this dr to begin with.

 

So my dh meets me there, 'cause he wants to meet the new dr. too (and I was very happy that he came :D ). We get in the room, and after introductions, the dr. comments about vaccines. :roll:

 

(We don't follow the recommended schedule. We don't start vaccinations until the kids are 2, and then we only do selective vaccines. I've done lots of research and weighed the risks of the vaccines vs. the risks of the disease, taking into account my family's health patterns.)

 

After a very brief comment about vaccines, he examined my ds. I had already told him that I thought he had a double ear infection. After listening very thoroughly to his chest, he said that his right lung is okay, but he has pneumonia in his left lung because he can hear a little crackling in it. :( I wasn't completely surprised; a kid from church, just a little older than ds, was dx w/ pneumonia on Mon. Personally, though, neither dh nor I have no experience w/ pneumonia. This is the first kid (out of 6) where we have every dealt w/ it. So all we could go on at this point is what the dr. said. He said that we could do an xray but sometimes you can hear the crackling before the pneumonia shows up in the xray.

 

Well then, regardless of the x-ray says, he needed to be treated for pneumonia, so neither I nor dh saw any need to subject ds to an xray. The dr. seemed fine with that.

 

When he checked his ears, he said that he had ear infections in both ears. :? Ummm, didn't I just tell you that? But whatever.

 

He very quickly looked in ds's throat, and then sits down and starts telling us that since ds has pneumonia and hasn't been vaccinated, he's at risk for pneumencoccal disease and meningitis. He had another patient about the same age that had pneumonia and wasn't vaccinated and he got pn. disease and became deaf in one ear. And that it's these vaccines are very important to prevent things like this.

 

Then he prescribed amoxicillen for the ear infections and the pneumonia and sent us on our way. Other than his attempt at frightening us (which didn't work 'cause we could both see through that right away), he never said anything about pneumonia and put it in the same category as the ear infections. I know that pneumonia can be serious, but again, I don't have experience so at this point all I can go on is the dr's word.

 

I called my best friend on the way home and told her about it. She has experience w/ this and gave me an ear-full, in a very kind and informative way. So I get home and start looking into pneumonia. :evil: :evil: :evil:

Here's just two things Smart Medicine for a Healthier Child (my go-to book) says, that the dr. never bothered to tell me:

 

--a full recovery from pneumonia, no matter what the cause, may take several weeks, and a cough may sometimes last up to two months, even after the infection is gone. :shock:

 

--if pneumonia is suspteced, it is likely your physician will first want to look at a chest x-ray...as well as a blood test and/or sputum sample (to determine what type of infectiojus agent is responsibile.) THIS DETERMINATION IS ESSENTIAL FOR PROPER TREATMENT. (emphasis mine) :evil: :evil:

 

I'm sooo not happy about this. Surely the dr. wouldn't brush aside something like this just to "get even" with us for not vaccinating? :shock: But the other alternative is that ds doesn't really have pnemonia and the dr. is trying to scare us so that we get him his shots. :? I am not a happy camper. :evil:

 

I'm going to continue alternating between ibuprofen and acetominaphin, continue w/ the guaifenesn, and make sure ds gets lots of herbal tea and rest. And continue to watch him closely (he's been sleeping downstairs w/ me so I can keep an I on his fever). Anyone have any other recommendations?

[Brigitte]

I was diagnosed with pneumonia this fall. The doctor did not do an xray nor a blood test. He felt that based on my symptoms and listening to my breathing that it was pretty certain. Besides, the treatment would have been the same. Personally, if it had been my child, I would have been happy with the same treatment (no xrays or blood test). The kid is pretty miserable and those things would only add to his misery.

 

I really don't think that doctors are out to exact revenge on parents who don't vaccinate. He is doing what he is trained to do. And, if he didn't tell you his experience and your child did come down with the conditions that he talked about, you would be pretty mad that he didn't tell you about it in the first place.

[LMA]

My daughter and 5 month old son both had pneumonia in January. They did not have x-rays. The antibiotics took care of them both. My elderly mother had plenty of pneumonia and the pulmonologist did not always order x-rays and he never ordered the other tests. She had x-rays to check that it cleared.

 

If you have doubts about the treatment, go see a pulmonologist.

[GoVanGogh]

I was diagnosed with pneumonia this fall. The doctor did not do an xray nor a blood test. He felt that based on my symptoms and listening to my breathing that it was pretty certain. Besides, the treatment would have been the same. Personally, if it had been my child, I would have been happy with the same treatment (no xrays or blood test). The kid is pretty miserable and those things would only add to his misery.

 

I really don't think that doctors are out to exact revenge on parents who don't vaccinate. He is doing what he is trained to do. And, if he didn't tell you his experience and your child did come down with the conditions that he talked about, you would be pretty mad that he didn't tell you about it in the first place.

I had pneumonia 15 years ago and my DS had it four years ago. Neither time did we have x-rays, as our doctors both said they would prescribe the same meds.

In my son's case, the doctor said it was impossible for such a young child to remain motionless for the x-ray.

 

--a full recovery from pneumonia, no matter what the cause, may take several weeks, and a cough may sometimes last up to two months, even after the infection is gone. :shock:

I thought this was common knowledge?

Honestly, that is why pneumonia has such a bad reputation - it is an awful disease and very hard to recover from.

My mother has been in the hospital with it for the past week and they told her to expect (at her age and disability) that it would be months before she was over it.

 

:grouphug:

[Perry]

What your doctor did is completely standard and routine. :chillpill:

[LisaKinVA]

--a full recovery from pneumonia, no matter what the cause, may take several weeks, and a cough may sometimes last up to two months, even after the infection is gone. :shock:

 

--if pneumonia is suspected, it is likely your physician will first want to look at a chest x-ray...as well as a blood test and/or sputum sample (to determine what type of infectious agent is responsible.) THIS DETERMINATION IS ESSENTIAL FOR PROPER TREATMENT. (emphasis mine) :evil: :evil:

 

On point #1, this is *very* true. It can also be true of severe bronchitis, or even a really bad cold or sinus infection.

 

On point #2, this is NOT true. cillians or mycens are typically enough to deal with most types of bacterial pneumonia. You will know if the antibiotics aren't working within about 3-4 days. I've had 5 kids with pneumonia, none were x-rayed. They weren't x-rayed the first, second or third times they've had it. I've had pneumonia more times than I can count (since infancy), and I've *never* been x-rayed for it, nor had a sputum sample taken...not ever. Not in CA, GA, FL, AR, VA or DC. Not with any doctors (Kaiser, private (no insurance), university, urgent care, Blue Cross, Cigna, or anything else). I've never had the antibiotics not work. The *only* time I've had anything grown for more specific antibiotics is an UTI.

[kathkath]

several of my kids have had pneumonia and my understanding is that the first course of action is abx and if that doesn't take care of it, then they will proceed with xray, cultures etc.

[oraetstudia]

Three of my children had pnuemonia last summer. I go to the same wonderful practice and see the same ped that we started with when my oldest was born. They did a chest X-ray only after a long period where pnuemonia was suspected in one kid, but no crackles were heard. Nothing showed on the X-ray, but the crackles showed up a few days later. According to the pediatrician, the crackles are more definitive. No kid ever gave a sputum sample. Usually, different types of pnuemonia present in different ways -- one lung or both? Sudden onset or slow? Etc. Those things tell a lot about whether it is probably bacterial or viral, although they do almost always treat with antibiotics just in case.

 

I hope your little one recovers quickly.

[Jennifer3141]

What your doctor did is completely standard and routine. :chillpill:

 

 

:iagree::iagree:

[Spryte]

I have limited experience with pneumonia, but will share it. DS has had it twice. Both times pedi sent him for X Rays to confirm her suspicions. I don't know that it's necessary, but it did just seem normal procedure for our pedi. However, DS also has asthma & his blood oxygen level was low. (Did the doc check that on your DC? How was it?)

 

With pneumonia, I worry most about breathing issues. The first time DS had it, he was hospitalized & we came home with a nebulizer. That helped the second time, because we knew what to do to support his breathing.

 

As far as practical advice... On breathing (that's all I can offer, as you have much more kid experience than I)... Watch for labored breathing, retractions at the base of the neck, etc. Other than that, if it's bacterial - the meds should help soon.

 

 

 

 

... When are you switching docs? ;)

 

Just kidding, of course. :)

Edited March 8, 2012 by Spryte

[indigomama]

When I had pneumonia 6 years ago, I was newly pregnant after a very recent miscarriage. The DR. said he could hear it in my lungs, plus, fever and insane cough. We both didn't think an xray was warranted. He said it was most likely "walking pneumonia" and that I would be fine with antibiotics. They had me feeling better in 48hours.

 

Give the antibiotics a try, and watch closely. If no change at all in 24 hours, I would go back, but I'm pretty sure you'll see improvement.

 

Hope your little one feels better quickly!

[ssavings]

DD5 gets pneumonia yearly. Never had a blood test, xray, or fluid sample.

 

My thoughts are, if the doc knows its pneumonia and it responds to a broad spectrum abx, I don't want invasive testing. Even an xray can be difficult for a little one, being held down & miserable.

[TeacherZee]

 

Kaiser just built their office in our area and so they're staffing it w/ drs from a nearby major city. What kind of dr. leaves his practice and his patients to go work in an office started by an insurance company? So, I didn't have a very high view of this dr to begin with.

 

 

 

Ummm...why does anyone leave one job for another one? Maybe this job gives him a shorter commute so that he can be home more with his family?

 

It seems from your tone that you didn't want to like this doctor so you are bound and determined not to.

[AK_Mom4]

I have just finished getting over my traditional mid-winter bout with pneumonia. Rest, plenty of fluids, steamy showers to help with the cough, and a course of antibiotics are what my doctor regularly prescribes. DD10 had a nasty round of it when she was about three -same treatment. My doc only does the xrays if the lungs sound exceptionally bad - bad enough that she is considering hospital rather than home care (SIL had this recently too and got the xrays).

 

Sounds like he ticked you off with the vaccination discussion, but his mentioning his past experience with it is not unreasonable. And the treatment sounds in line as well, though you can always get another opinion (even with Kaiser) if you think it isn't aggressive enough - you know your kid best!

 

:grouphug: It's tough when kiddos are sick! :grouphug:

[abbeyej]

Ds had pneumonia as a toddler. Also diagnosed via lung sounds *not* x-ray with the same justification -- pneumonia can be tough to spot on toddlers via x-ray until it is very advanced. We treated right away, and ds got better, though as in the material you read, he had a cough that lingered for about 6 months. (I *have* wondered if the pneumonia played a part in his later asthma development).

 

I know you were frustrated by the ped's attitude toward delayed vaccination, but the *treatment* he offered fits with what I experienced with ds and have seen with other friends. The "P" word is scary, but in young ones it *can* often be treated with antibiotics at home.

[melissad2]

What your doctor did is completely standard and routine. :chillpill:

 

:iagree:

A pneumonia dx does not require an x-ray to confirm. It doesn't sound like he did anything questionable to me? What do you feel he should have done differently? FWIW a sputum specimen is difficult to obtain in an adult much less a child and is usually only done if resistant infection is suspected.

[OH_Homeschooler]

Last year I was diagnosed with pneumonia. This was after being on antibiotics for several days. The day I started on antibiotics I told the doctor I thought I had a sinus infection, so they just went with that. My fever went really high a few hours after starting antiobiotics. I called the clinic to ask about this, never heard back. The next day (3rd day of treatment), I went back in because I was still feeling bad and still had a high fever. The doctor told me to stay on the antibiotics at least another day and come back if I still didn't feel better. That night I started getting pain in my lower ribs and collar bone, so the next day I went to the ER, had a few preliminary tests then the x-ray to confirm pneumonia, they switched my antibiotic to the RIGHT one and I started feeling better the next day.

 

So my point is, I think you should be glad they assumed pneumonia (to me, a worst case scenario) without the x-ray. I had to get an x-ray to confirm mine after days of suffering and asking for help, and I wonder what would have happened if I waited any longer for a diagnosis.

 

Last year when one of my kids had an ear infection and the doctor also suspected strep, he didn't bother testing for strep since the treatment was going to be the same (due to the ear infection) regardless of whether she had strep or not. Why put a kid through a culture if you don't need to? And yes, my kids are vaccinated right on schedule. There's really no discrimination going on with you.

 

And I think the doctor telling you the kid has an ear infection was just him giving an official diagnosis. I'm sure parents come in all the time saying they suspect something and guessing about what that might be...of course it's up to the doctor to confirm or deny that suspicion. Did you not want him to say anything at all about the ear infection? Wouldn't you just be mad that he DIDN'T confirm your suspicion?

 

It also seems like you don't expect a doctor to tell you the risks associated with not vaccinating. That's what they do, they're doctors.

Edited March 8, 2012 by OH_Homeschooler

[Aura]

Thank you all. I have taken your advice and swalled the :chillpill:.

 

:tongue_smilie:

 

It is a relief to know that what the dr. did was pretty standard. I really appreciate your sharing your experiences!

 

I was very nervous going in, yes. I don't like HMOs, and so far, I have found very little reassurance that this is not just some other large corporation that can't see past the end of their nose. :glare: They remind me of a medical version of dh's employer. He was formerly part of a regional company that got bought out by a huge international firm. The longer he's with them, the more it's obvious their only concern is their shareholders. They're an engineering firm which operates illogically. :001_huh:

 

Ummm...why does anyone leave one job for another one? Maybe this job gives him a shorter commute so that he can be home more with his family?

 

It seems from your tone that you didn't want to like this doctor so you are bound and determined not to.

 

Although I was nervous, I was trying to be positive and give the dr. the benefit of the doubt. I was hoping that maybe he was considering relocating to our area, but in our introductions, he actually said that he would be leaving soon and we would be getting a "permanent" ped. here. It did not help that from the start he was condescending, and then there was his scare tactics about vaccines...:glare: I honestly think if dh hadn't been there, he'd have said more than he did.

 

Okay. Swallowing another :chillpill:. :D

[Jan in SC]

I'm sorry your son is sick. Maybe you are tired and frustrated, but I don't see why you are so upset.

 

As you said, he didn't need to order an x-ray to diagnose, so why would he? He lectured you on vaccines, because as a physician, he believes they are the right way to prevent future illness. He cannot have been the first doctor to question your beliefs. He didn't threaten you, or call child services, he told you what he believed.

 

Of course he told you his ears were infected. Should he take your word for it? I can't imagine you would have been happy if he had handed you a prescription for antibiotics without needing it.

 

As far as the job goes, maybe his wife wanted to stay home with his children and this provided a more secure and higher paying job...who knows?

 

Eta- ok - you are relaxing, so just ignore my frustration, too!! I hope your child feels better, soon!

Edited March 8, 2012 by Jan in SC
Change of heart

[SebastianCat]

My DD had pneumonia when she was 3, and it was so severe she was sent to the hospital and was admitted for 8 days (3 of those in ICU). That has been our only experience with pneumonia, but it was bad enough that when they checked her oxygen saturation level in the ER, they brought her back to an exam room and immediately put her on oxygen.

 

I agree with others that the treatment your Dr. offered seemed standard for a typical case of pneumonia.

 

I would watch very closely for signs of labored breathing. If you suspect breathing problems, take your child right away to the ER and let them know that you've already had a diagnosis of pneumonia. The first thing they'll do is check his oxygen saturation level (it's a little clip the put on a fingertip, and is painless), and that level is key to knowing how bad the infection is.

 

I've known friends and family, and from our DD's experience I would agree, that pneumonia takes a LONG time to full recover from. I'd be cautious about exposing a child recovering from pneumonia to viruses and colds during that time, because the immune system may be compromised for a while.

[kalanamak]

 

I'm sooo not happy about this. Surely the dr. wouldn't brush aside something like this just to "get even" with us for not vaccinating? :shock: But the other alternative is that ds doesn't really have pnemonia and the dr. is trying to scare us so that we get him his shots. :? I am not a happy camper. :evil:

 

 

No, I don't think the doc would brush it aside to get even with you, but, and I hope you don't take this badly, I'm awfully glad I'm not your doctor.

 

As to "what kind of doctor would leave his practice to work for an insurance company", sometimes it is a doctor who wants to move, or wants specific hours rather than the long days and non-stop on call a private practice can entail. Maybe he has kids he'd like to see while they aren't asleep.

 

I hope your child feels better. Sincerely. But a doc HAS to document you have understood the risk of not vaccing, and chart on it. His malpractice would be all over him for this, as a parent could Easily sue when child has brain damage from a preventable childhood virus, claiming "they didn't understand the risk."

[JFSinIL]

What your doctor did is completely standard and routine. :chillpill:

 

I agree, and I have had pneumonia four times

[Harriet Vane]

FWIW, I too chose an alternate vaccine schedule for my children. I too waited until age 2 to start the course, and we only do selected vaccines rather than all the recommended vaccines.

 

First of all, my doctor told me quite a few years ago that pneumonia can almost always be heard before it is seen on the xray. The xray is there just to confirm what the dr thinks. I personally would be overjoyed with a dr who is willing to treat the pneumonia without subjecting my child to the radiation.

 

Second, the only opinion I have of a dr who works part-time for an insurance company is that the doctor is a working man who is trying to provide for his family, just like the rest of us. I would not judge that choice alone--I would meet the dr FIRST and then make my own decisions about his/her competence, just like I do with drs who do not work for insurance companies.

 

Third, it is true that any form of pneumonia or bronchitis can last for quite a while. Sure the dr could have told you this, but I do NOT see it as negligent or incompetent that he did not.

 

A reasonable discussion of the risks vs. benefits of vaccination is okay in my book. What I object to is when a dr refuses to treat an unvaccinated child or when a medical professional acts like the parent is abusive for making a carefully considered vaccination choice. Both my current dr and my previous dr are pro-vaccine, and yes, both have discussed it with me. I have been grateful for their willingness to discuss. They are both intelligent men who have studied this. Their opinion of what is the best course of action is different from mine, but they are also willing to respect my right to make this decision, my intelligence, and my research. This is in stark contrast to an ER nurse who was horrified that my just-turned-2yo was unvaccinated, and who called the hospital social worker to refer me for investigation. Both my husband and I were interviewed, and yes. My conversations both with that nurse and with the social worker were frightening. Thankfully, my pro-vaccine dr went to bat for me, and the social worker chose to drop the matter.

 

My point is that it doesn't sound to me like your dr did anything offensive. He did not refuse to treat your child. He attempted to share his perspective on this issue, a perspective he could reasonably consider relevant since your child is sick. Especially since you are a new patient for him, he has NO WAY of knowing about your research. It is reasonable to expect a dialogue, and it is just as reasonable for him to hold an opinion as it is for you. It is also reasonable for you to be comfortable with your choices knowing that you have weighed the risks. If you do not want to discuss it with him, just say so, sweetly and politely.

 

Honestly, your post makes it sound like you walked into this appointment with some prejudgements on the dr.

[LizzyBee]

One of my kids has had pneumonia twice, one kid has had it once, and my dh has had it 3 times. First dd had an x-ray the first time, but it was completely unhelpful because the pneumonia was caught early enough that it didn't even show up on the x-ray yet. The 2nd time, she didn't have an x-ray. Second dd has never had a chest x-ray. Dh did not have an x-ray to diagnose pneumonia when the dr could hear the crackling. He has had an x-ray to help sort out whether his breathing issues were being caused by pneumonia, asthma, or something else.

 

All that to say, I don't think an X-ray is necessarily standard procedure for pneumonia, so I wouldn't be upset with your ped about that. Also, if there is a risk of not being vaxed that he's not sure you're aware of, I can see why he might feel compelled to inform you of the risk. Now, if he threatens to call CPS if you refuse to have your kids vaxed after your dc is well or otherwise tries to exert his "authority" inappropriately, that's another matter. But providing information is part of his job. And if he's seen cases like your dc's end badly, he may feel worried for your child, not just trying to throw his weight around, kwim?

 

I hope your dc recovers quickly. :grouphug: