March 13, 2008

Diagnosis Happy

Doctors who are diagnosis happy should not communicate with parents who are google happy. It makes for a very unpleasant relationship and two very stressed out parents.

On Monday, our daughter’s doctor diagnosed her with ITP, despite the fact that her rash was clearing up, despite the fact that her platelet levels were on the rise. She insisted that Big I be treated like a pin cushion once again. Yesterday she had more blood drawn, and we’re not sure if there was more blood or tears leaving her body. It is a traumatic thing for a kid, one that I didn’t want her to have to endure more than once.

Today, Big I’s doctor called with the results. She’s a DO and she’s brand spanking new. Our regular doctor left the practice and we’ve been seeing anyone who will have us lately. We’re usually very happy with the doctors there but for now, we’re without our main one. She started the phone call by telling me that Big I’s platelets have returned to normal levels. In fact, they were really quite good. The normal low range is 150,000. Her reading was 300,000. Fabulous.

Then she went on to say that she tested for some other things and of course, something turned up. The air temporarily left the room and I had to sit down because I felt like the weight of the world was just crushing my chest. She started talking about elevated liver enzymes and an elevated ANA level which signifies "rheumatoid disorders." She told us she wanted us to see a pediatric rheumatologist specialist in a nearby city and that levels like these can be indicators of early-onset lupus.

I didn’t know what to say. I was in shock and devastated all over again. I called Mr. BBM at work and I called my Mom. My Mom is an RN and she works with two excellent doctors. While we were discussing things, I mentioned to my Mom, "Couldn’t her liver enzymes be elevated due to her being on antibiotics? Can’t antibiotics do that?" My Mom quickly pulled out her PDR and what we found in the side effects section of Big I’s antibiotic was nothing short of a list of her problems: ITP resulting from the antibiotic, elevated liver enzymes from a reaction to the drug. And why wouldn’t she be allergic to this drug? The entire family, me, Mr. BBM and Lil C, are all allergic to penicillin, severely allergic to penicillin.

I called Mr. BBM and discussed Ackam’s Razor: the simplest solution usually applies; and we decided together that this doctor is diagnosis happy. She diagnosed ITP on Monday; then admitted she doesn’t have it today. She’s insisting we cart Big I all over the state to meet with specialists when the truth is, the kid doesn’t have a single symptom of the disease. Not one. Isn’t it at least possible that her messed up levels are due to an allergic systemic reaction from the antibiotic?

When Lil C reacted to a drug in that family, she swelled up like the Pillsbury Dough-boy and had our doctors asking if we had any history of lupus or Juvenile Rheumatoid Arthritis in the family. We have no family history of anything like that in our family. A dose or two of steroids and Lil C was back to normal. Isn’t it possible that Big I’s reaction stuck to her insides? Wouldn’t elevated liver enzymes indicate a reaction to the drugs?

The doctor admitted it’s only a small chance that something is wrong with Big I, but still went ahead and scheduled an appointment for her that, truth be told, we will probably cancel. Submitting your child for testing when they need it is one thing; submitting your child to a lifestyle of doctors appointments and diagnoses that immediately jump to the worst possible conclusion is not a road we’re interested in traveling. We took her off the antibiotic and think she should have a retest in a couple weeks when she’s entirely better and the drug is out of her system completely.

So, my question is, why did it take two stressed out and concerned parents and an RN Grandma to see the most obvious potential problem here? We are definitely asking to see a different doctor next time, and I am definitely laying off the google. Talk about needing a break from a "drug."