Three year old(almost four) son has pnuemonia, wtf??

[89911]

What people (and LAWYERS) sometimes fail to realize is that Doctors are Human beings and are subject to incorrect decisions at one point or another. This may or may not be the case in your situation. Not far from now, I would venture to guess, you may never get a diagnosis for fear of it possible not being the absolutely correct one.

[HardDrive]

Originally Posted by JeremyD

My son went through the same think Len - and I felt exactly the same - unfortunately you have to get agressive with some doctors these days...

Yeah, thats REALLY going to help the situation, because after all, your a fellowship trained doctor too, right? After all, medicine is just like operating a microwave oven! The doctor obviously wasn't pushing the right buttons. You better 'get aggressive' with them, and tell them who's boss! Wave some American flags around while your at it! Kick Ass! Take names!

[livi]

Sorry to hear about your experience. Rick has got it covered completely, leaving nothing for me to add. I was curious however, you say your son got a shot of antibiotics. Was that just an initial doses, followed by oral antibiotics ? In that case, what is the generic name of that oral antibiotic ?

In a previous thread we were discussing the alarming trend of resistance among common bacteria so I would be interested to know what kind your son got. As I said before, here in Sweden we still have a pretty native bacterial flora and common simple oral penicillin is usually the drug of choice for a community acquired pneumonia in children here in Sweden.

Hope your son gets well quickly. They usually do.

Yeah, one thing. The stethoscope is many time completely useless as a diagnostic tool with preschool children and airway symptoms. I would say that, perhaps paradoxically, the less you here with a child that has fever and rapid breathing - the more likely it is a bacterial pneumonia.

Sometimes it is helpful to have a CRP taken. A capillary blood test. Generally bacterial infections will provoce a higher value than viral infections.

[lendaddy]

Originally Posted by livi

Sorry to hear about your experience. Rick has got it covered completely, leaving nothing for me to add. I was curious however, you say your son got a shot of antibiotics. Was that just an initial doses, followed by oral antibiotics ? In that case, what is the generic name of that oral antibiotic ?

In a previous thread we were discussing the alarming trend of resistance among common bacteria so I would be interested to know what kind your son got. As I said before, here in Sweden we still have a pretty native bacterial flora and common simple oral penicillin is usually the drug of choice for a community acquired pneumonia in children here in Sweden.

Hope your son gets well quickly. They usually do.

Yeah, one thing. The stethoscope is many time completely useless as a diagnostic tool with preschool children and airway symptoms. I would say that, perhaps paradoxically, the less you here with a child that has fever and rapid breathing - the more likely it is a bacterial pneumonia.

Sometimes it is helpful to have a CRP taken. A capillary blood test. Generally bacterial infections will provoce a higher value than viral infections.

No fevers last night or this morning

Thanks Livi, my wife is checking on the name of the antibiotic and he goes in today for another shot and he'll be getting a script.

Rick, thanks again! You did get me thinking about the antibiotic and I know the doc left me with the impression that this one was somehow different than most and we would see him "perk up"(her words) within a couple of hours. I specifically said "really, just a matter of a few hours" and she confirmed by telling me a story of how it relieved her own daughters ear infection within two-three. I told my wife to get a clarification this morning when he goes in as I have also always heard 24-48 hours which is why I pressed her on it. I'll let you know what she said.

Finally, all of you docs on here are amazing and I speak for all of us when I say thank you, deeply and sincerely. Being docs yourself you are void of the frustration and pain that ignorance in these matters causes and likely don't realize how valuable your gifts to us have been. If any of you ever need anything please ask (maybe some stainless tube for exhaust or something welded or fabbed, whatever...just ask.)

[berettafan]

not a doctor here but have been through the same anguish a time or two (son is 3). there are two things i don't want my ped. doing every single time we visit: x-ray and antibiotics. in the long term odds are both will do him more harm than good.

if you can accept this premise then you learn to semi-trust the peds judgement. it's hard, but i think we all kinda learn to do it.

[berettafan]

btw, when our son gets a fever he gets a FEVER! per ear thermometer (confirmed at docs) it is not uncommon for him to run 103. he has been to 105+ on several occasions.

[KFC911]

No kids, but I know where I'm going when I get sick...PPOT ! You guys are great, and I really mean that...

[JeremyD]

Originally Posted by HardDrive

Yeah, thats REALLY going to help the situation, because after all, your a fellowship trained doctor too, right? After all, medicine is just like operating a microwave oven! The doctor obviously wasn't pushing the right buttons. You better 'get aggressive with them, and tell them who's boss! Wave some American flags around while your at it! Kick Ass! Take names!

Well Harddrive - you took that wrong - What I meant by aggressive is to ask questions - determine what next steps are -

What I mean by aggressive - is be very participatory in the process. Ask why a medical direction and a next course of action.

[Palum6o]

I agree, the comment by HardDrive is silly. You can't just go into the doctor and play stupid and not say anything. There has to be a relationship. If everyone keeps their mouth shut during a visit, you'll see health care costs go even higher because as soon as something goes worse, it turns into an ER visit.

[gr8fl4porsche]

I agree with being aggressive - assertive. During any consultation with a professional in any field, I ask lots of questions and take notes. I then do my own research and return with follow up questions and ideas. While these ideas are usually shot down, I have on occasion came up with an additional theory that is worthy of consideration.

This method works with lawyers, doctors, mechanics, contractors, etc.

[berettafan]

jeremy has it right. participate and don't be afraid to ask questions. i'm sure todays docs suffer quite a bit at the hands of todays parents who read up online then try to self medicate their kids or tell the doc what is wrong and 'we just need a prescription'.

[lendaddy]

Livi,

Here are the antibiotics:

The shot was Rocephin and he is now on Omnicef.

Rick, the doc stands by her comment that Rocephin works within a few hours depending on the infection. She said with Strep it is usually 24 hours for results as an example. I'm not sure this makes sense to me, but that's what she said.

[HardDrive]

Originally Posted by berettafan

jeremy has it right. participate and don't be afraid to ask questions. i'm sure todays docs suffer quite a bit at the hands of todays parents who read up online then try to self medicate their kids or tell the doc what is wrong and 'we just need a prescription'.

I'm sorry, I came on way to strong with my comments above. Not called for. You guys are correct. It is important to ask questions, and people should not feel afraid to ask questions. And doctors have a duty to explain whats going on.

But berettafan, you are on to something. I should explain the my wife is a pediatric anesthesiologist at a childrens hospital, but her specialty is pain management. The majority of familys are good natured folks, and they simply want their child to be better.

But sometimes....dear lord....she gets monsters. And the worst of these folks are people who have done their own 'research', and want my wife to write a prescription for some powerful drug. Because my wife is in pain managment, they are often asking for narcotics. Basically the parents have turned their kid into a little junkie, and they go beserk if you try and point this out to them. Even suggesting a family psych consult will cause a huge blowout.

Ya know what is WAY worse? Other doctors who have not had the guts to stand up to these familys, then try and foist their little junkies off on my wife! It happens at least a couple times a year. Some family practioner who has way over prescribed narcotics for way to long will try and make the problem go away by sending them to my wife, the 'expert'. She has had some very blunt conversations with docs at 2am after their patients parents have had my wife paged 15 TIMES looking for dope for their kid. Its ugly.

Sorry for the over reaction, but I have had my life disrupted by 'agressive' parents more than once.

[livi]

Thanks!

As I suspected. They are both very broad spectrum antibiotics. Won´t miss a thing, as it were. No harm in that for your son. As far as the advertised few hours until noticeable effect, that is debatable. Yes, given intravenously the drug will reach the bugs very quickly and likely even been able to kill or arrest quite a few in a few hours. That does not automatically mean you look or feel any better.

Pretty much all the symptoms during an infectious desease is due to the bodies immune defense system. Fever, couphing, rash, vomiting, diareea, pain...you name it. It is all different defense mechanisms. Now even after the antibiotics have helped killing off most bacteria, it takes time for the immune response reaction to cool down - during which time the symptoms will prevail.

Some infections provoke a more 'hard headed' reaction with prolonged fever and other symptom even after adequate antibiotics has been give. An example of that is urinary infections. The opposite can often be said about a simple strep throat, where just a couple of penicillin doses will have almost back to normal.

So depends what you mean. Yes the killing of bacteria will start within a couple of hours, but feeling that effect will usually take a day or two.

[berettafan]

HardDrive i figured it was a misinterpretation of 'aggressive'. Also, (and i've said this about Livi), please tell your wife that although i have never met her i appreciate her willingness to work with sick children and i firmly believe there is a special place in heaven for her and those that do such work. God bless your family.

[Nathans_Dad]

Originally Posted by lendaddy

Rick, the doc stands by her comment that Rocephin works within a few hours depending on the infection. She said with Strep it is usually 24 hours for results as an example. I'm not sure this makes sense to me, but that's what she said.

I would agree with what Livi said. If you look at the pharmacokinetics of Rocephin, it takes 3 hours from time of injection to peak blood concentration. So if her statement is that Rocephin is active in the blood within 3 hours, then she is correct. Will the Rocephin be killing some of those bacteria during that time? Sure. The problem is that "illness" is not just bacteria being alive, it is the inflammatory response by the body, reactions to substances produced by the bacteria AND the fact that bacteria are alive.

I am talking about time to clinical improvement though, which has been well established as 24-48 hours after initial administration of antibiotics. I tried to find the original article I have at home in my files, but I couldn't get it on the internet. This link is to a .pdf file from The Chest Journal that looks at time to clinical improvement. Their average time was 3.5 days in patients with moderate to severe community acquired pneumonia.

http://www.chestjournal.org/cgi/reprint/124/5/1798.pdf

I guess the bottom line is the little guy is feeling better!

[lendaddy]

Thanks Rick, though I'm doubt the doc again. A lack of such a basic understanding of the science behind what she's doing is upsetting to be sure.

[Nathans_Dad]

I'm not trying to bash your doc, len, I'm just saying that if your son felt 100% better within hours of the shot it probably wasn't the antibiotic that did it. More likely that the tylenol kicked in and broke the fever, etc. You probably have him on scheduled doses of tylenol and/or motrin to avoid fever, muscle pains, etc which is most likely why he feels better.

I wouldn't be too hard on your doc, most likely she knows the science behind the drug but just didn't take the time to explain it to you.