How Many Doctors Does It Take to Screw in a Light Bulb?

As seasonal changes come into full swing, too many moms are visiting too many physicians, and getting too few answers.

Children with immunologic difficulties who suffer conditions such as asthma, severe food sensitivities, eczema,or frequent infections are more likely to exhibit an increase in signs and symptoms under periods of increased metabolic stress.

The patient’s underlying situation may become more chronic or recurring. Or, there could be subsequent problems; the consequences of energy depletion and additional inflammation. So, parents wishing to hasten improvement, seek professional assistance.

Here’s where it gets tricky.
While traveling through an allergist’s territory, for example, the topic of recurrent or persistent ‘attacks’ may arise. The ‘allergy shots’ probably haven’t changed anything. Antibiotics are prescribed.

The doctor suggests that, perhaps an immunologist could figure it out.

Enter the doctor merry-go-round.
When another consultant is suggested (or, sometimes requested), there should be a realistic expectation about effects and side effects.

In this case, the typical response is a battery of tests that reflect immune functioning, according to that doctor. Results only represent the patient’s state of ill-health. A proper evaluation requires comparison to the child’s healthy state. Furthermore, by the time the tests become available, the clinical situation has probably already changed.

Often, steroids are added to the medical soup. The child feels a bit better, so returns to school and catches a cootie from another student.

More specialists are added.
Perhaps a different virus, a sinus infection, or an underlying allergic condition appears. Typically, a pulmonologist is the next stop. Another battery of labs and tests. Another confusing data set.

More steroids are added – inhaled, through nebulizers, and breathing treatments. Sustained improvement may not be achieved. Nowadays, the diagnosis of gastroesophageal reflux (GERD) is offered as a possibility, perhaps explaining the chronic and recurrent nature of the child’s condition.

A gastro-enterologist is then consulted. More tests add to the confusion. Prilosec or Zantac, potent stomach acid inhibitors, are prescribed. What is the concerned parent to believe?

Back to the Pediatrician.
The child who hasn’t improved by now is given a different, more powerful antibiotic. A discussion takes place about whether a New York specialist can offer better advice. In the meantime, academics and socialization have taken a back seat as families seek solid answers.

The primary doctor appears as confused as the parents about the next step. By this time, the patient is taking multiple, potent biologicals that may interfere with each other, or even make things more serious.

There is a solution.
Modern medical care is under scrutiny for the multitude of consultants, rarely resulting in better health care. There are often medication errors, with anxious and baffled patients who display little improvement – or worsen. The specialty of Pediatrics has been customarily exempt from such criticism, because of fewer medical complications.

As a mother recently exclaimed, “Do you think that I want to spend all of December traveling from one doctor to another? It takes a lot of work!”

One well-trained pediatrician, willing to consult with the specific specialists, who takes the time to understand what all those tests and medications represent for this individual, is the best answer. The professional who has the knowledge to interpret and clarify the picture offers the best opportunity for measurable improvement.

When the medical helm is steered by an effective professional, Mom has a lot more time to enjoy the season.

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Brian D. Udell MD
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