Wednesday, March 30, 2016

When All Bets Are Off

These past couple of months, as viruses are all'ultima moda in the city, we've been regular patrons at the pediatrician's office. Due to the quite unsavoury experiences my son has had at the office, from shots to caths (the main culprit being the latter), he immediately becomes sullen as we enter and gives me by now a perfected look that would strike guilt even in a non sentient piece of wood, its first conscious thoughts profoundly apologetic.

There are far few things worse than when your child is sick, shivering and moaning with a fever and you feel helpless to protect them. Only when Luca has been sick have we collectively cried, hugging each other, wishing we could take away his pain and bring him forth to full health again. When our son is sick, my husband and I become putty in his hands and he certainly milks it to the fullest. While we do not let him watch television, flights and illness are the exception to the rule and when he wails "Elmo" shivering with a fever, we deliver (Elmo, I may have mentioned before, from the toddlers I have perceived around me, is crack for kids- I wonder if he were designed after a thorough child psychology analysis). Albeit we've taken a hard line since sleep training him (which policy was necessary for us all), our collective front crumbles and either my husband or I sleep cuddling him during the night. He is acutely aware of our vulnerability and has finessed his tactics - and we have succumbed even when he's not sick. If he doesn't want to go to bed, he asks for "um" or purses his lips and licks them which in Luca language means I want food/I want water. When we rush to make food for him and give him water, he refuses. All he wanted to do was delay bedtime and he succeeded. It's difficult to admit, but there have been times when we've been outsmarted by our 17 month old.

In the pediatrician's office however, I would like to think that we have certain resolve. As our son has VUR, it's the same curse every time he gets sick - is it a UTI or not? (notwithstanding the fact that he has had only 3 of them in his life so far). Do we cath or do we not? When do we cath?

While both my husband and I suspected that last time he had a virus, this time, due to his high fevers and lack of other symptoms, we were inclined to believe that he did get another UTI. The problem with testing babies and toddlers, particularly pre or proto-toilet trained ones (as we are currently starting the process by acclimatizing him so that he pees in the toilet every night before bath time and has asked to pee on and off again during the day), is to obtain an uncontaminated urine sample. You can't simply direct them to wipe and then pee into a cup on demand. All of the available options contain their own list of issues. A bag sample can be contaminated by bacteria on the skin. Even if you bathe your kid, sterilize your hands and sterilize the groin area, a bag is only good for about an hour. A cup sample may likewise be contaminated by bacteria from the skin (albeit this must be negligible considering that they don't cath older children and adults but tell them to pee in a cup - after using a sterilization wipe). The only true test is a properly sterilized cath. Apart from the fact that this tortures the kid, it's also not reliable. After two dry caths, which we previously assumed were due to the fact that he has no liquid in his bladder, we've become wary of it.

 We bagged him, forced our poor little guy to drink and in the end, knowing that he hadn't peed for a few hours and had sufficient liquid, we opted for the cath (I had to excuse myself from the room, crying outside in tune to his wails). It was dry, a fact that speared our hearts. Not only did we put him through torture for nothing, but now we were prevented from cathing him in a short period to avoid irritation and worried we would treat based on a contaminated sample. Serendipitously, my son was so enraged by the torture, that he stood up and immediately peed and my husband caught it. He filled a whole cup and then peed all over the doctor's bed. How was it possible that they got a dry cath when his bladder held the Great Lakes? Apparently the cath was too short or they didn't go far enough.... Well, shouldn't they have stopped to think and reworked their method after the previous failed attempts? Meanwhile, worried whether he had drunk enough and/or absorbed enough liquid in his bladder in order to cath him, we were torturing the kid by imposing more liquid on him when he obviously had a bursting bladder.

Back at home, he downed his antibiotic but then refused to take any more medicine (such as his fever reducers). That's the other problem with babies and toddlers. You can't reason with them to take their medicine. You can't give them a pill to swallow. You have to be precise in delivery, because if they fight you and spit a portion out, you won't know how much they've missed - and giving too little can be as much of an issue as giving too much. Since physical force was not going to work - our son is as stubborn as we are and resisted all our machinations in trying to force medicine down his throat after cajoling him did not work - so we decided on trickery. We masqueraded the medicine with his milk. This is of course not without risk. We have to give him a small amount of milk (or water) that we know he will fully drink and have to ensure that he drinks it fast. There is always the risk that he may not drink all of what we give him, which means he would not have taken the full dose of medicine and we're back to the same problem of not knowing how much we gave. We're luckier than most - we have a routine with his nightly prophylaxis so we can simply follow the routine (kids love routine it seems, it provides them security) but when he have to provide more than is routine and when he's in a particular mood - such as he was yesterday - we're forced to work with what we can. I cannot wait until I can reason with him to take his medicine and have him understand that he is taking it for his own good so that he does not fight us...Hopefully that day will come soon.

By the way, on a completely unrelated note and since I've been watching a bunch of Sesame Street of late (which I adored when I was a kid and what helped me learn English), I'm glad they have more female muppets, but whatever happened to the oldies? Where's Oscar? (I suppose being a grouch may not be such a good role model). Where are Bert and Ernie? Big Bird? He only makes cameos now it seems. More importantly, they seem to have completely snuffed out poor old Snuffy. Now that's a pity.

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