Saturday, September 25, 2010

Doctor Mom

It's been over a month since I wrote about Tarana's w-sitting problem and life has been pretty eventful on that front since then. At her tenth month appointment, our paediatrician recommended that we get her evaluated by a physiotherapist.

Easier said than done, since he didn't strongly recommend anyone and paediatric physiotherapy is a pretty narrow field. The incredibly well-connected Mad Momma came through and got me the name of a reputed therapist. We went to see her and she did a very detailed appraisal. She concluded that the w-sitting was an issue in itself and had also led to something she referred to 'instability of foot', which basically means she is not placing her feet firmly on the floor when she stands and they turn in a little bit. She asked me to get a second opinion from a paediatric orthopedic and he concurred with her diagnosis.

We started the physiotherapy immediately with a plan of three half-hour sessions a week. I had a few initial doubts about the set-up since it is a 45-minute drive from where we live. But then I am currently living the SAHM life and I have a chauffeur-driven car, so I decided I didn't really have a reason to whine about the commute.

The next doubt to assail me was therapists themselves. It turned out that the main physiotherapist (the one who had done the initial evaluation) is a hugely over-scheduled doctor with three clinics spread across Mumbai and most of the actual therapy is done by her assistants. I considered switching doctors but since I had yet to find an alternative, I decided to stick with this practice till I did. It's been over two weeks now and I have come to see that the assistant working with Tarana is very good and the main physiotherapist comes in once every week or so to monitor progress and change things around if necessary. So we are staying put for now.

In the first couple of weeks, we had a lot of trouble getting Tarana to settle down. She would start bawling her head off at the word go. She clung to me and even the physiotherapist so much as looking at her was enough to send her into hysterics. At this point, I was asked a bunch of questions (which required me to rate Tarana on a 5-point scale on her comfort with various things and situations) and was told that the results indicated that Tarana had 'some sensory issues' and was finding it hard to 'balance and regulate herself in new situations'. When I asked the doctor what exactly these sensory issues were, she said that they would have to work with Tarana to identify these issues and work on them accordingly. This vague diagnosis made me extremely uncomfortable but I decided to give them some rope.

In the next session, instead of focussing on the exercises for her posture, the assistant spent most of the time in rubbing her feet with pieces of cloth with varying textures. I went home and thought about this new development and after talking to a few friends who have seen Tarana in action, I came to the conclusion that this sensory issues business was simply not true. I know my baby and her discomfort at those early sessions was nothing more than stranger anxiety. She, like her brother before her, has been shy and wary of new people right from the start. Till date, she gets upset if I hand her over to my maid, who she has known for almost a year now. She is a shy and sensitive baby. That's just her personality.

Anyway, so I spoke to the assistant at the next session and conveyed my discomfort about going down the sensory route. I told her that I was thoroughly unconvinced that Tarana's behaviour was a result of anything other than a slightly elevated level of stranger anxiety. I was all set to walk out if they didn't either agree with me or convince me about the sensory issues. Thankfully, they backed off and are back to focussing on the sitting and standing exercises now. The only change was that we have upped the frequency to six times a week for now till Tarana gets familiar with the therapist. And it has worked to a large extent - she smiles at the therapist when we reach there and the amount she cries is coming down with every session and she actually has fun when she's not busy being upset. There is a marked improvement in her w-sitting as well and she often plonks herself down with at least one leg out in front of her.

To make a larger point, it makes sense to balance out medical advice with instinct and research. Doctors are not omniscient and infallible. It has taken me a while to reach this place.

Over five years ago, I was a brand-new and nervous mother. Our first paediatrician came on his rounds and held forth on range of topics - from how to care for the umbilical stump to what soap to use for the baby - essentially Keeping The Baby Safe and Healthy 101. I hung on his every word and actually whipped out a notepad and took copious notes (yes, I was THAT mother). I felt wholly unprepared to be entrusted with the care of something as seemingly fragile as an infant and the doctor was my lifeline. I religiously took Ayaan in for his monthly check-ups and followed the doctor's advice to the T.

The turning point came when the same paediatrician diagnosed Ayaan with enlarged adenoids. The diagnosis was absolutely correct but he advised a very extreme course on action involving four weeks of antibiotics, and surgery to remove the adenoids if the antibiotics did not work. At first, I mutely accepted his recommendation and started the antibiotics because after all, 'Doctor Knows Best'. By lucky chance, we happened to go for a family wedding where an uncle, a doctor by profession, remarked on the prescription and suggested that that the extended dose seemed wholly over the top. Days later, we were at my mother's place, when Ayaan caught a nasty stomach bug and the Jaipur paediatrician asked if he was on any other medications and, on being told the whole adenoids story, was a lot more specific and vehement than my uncle in his disagreement. Some research on Google further confirmed this and needless to say, we soon found ourselves a new paediatrician.

Anyway, to cut a long story short, that pretty much ended my phase of blind faith in the medical profession. Here's what I believe now:

  1. I may not not know the science as well as the doctor but the flip side to that is that the doctor does not know my children as well as I do.  
  2. If I have even the slightest doubt about a course of treatment, it is worth getting a second opinion.
  3. Doctors are not infallible. If they were, two doctors would not diagnose and treat the same set of symptoms differently.
  4. Doctors are not above profit motive, especially if they work in the private sector. A recommendation to operate on a two year old might hide the fact the doctor has inpatient targets at the hospital he is affiliated with. Identifying sensory issues that need work translate into more therapy session and more revenue. Call me a cynic, but doctors are businessmen too.
  5. I have the right to question my doctor. Especially in India, doctors can be somewhat dictatorial in their attitude. I prefer to find doctors who are open to queries and who are willing to take the time to explain stuff to me in layman's terms. 
  6. I have Google and doctors in my family on my side - these are quick and easy ways to double-check.
  7. However, if I constantly feel the need to double-check every prescription, I probably need to find a new doctor.
  8. In the end, the decision is mine. Friends and family may give advice, doctors might recommend a certain route. I have no obligation to do anything but what I believe is the best for my children.

Saturday, September 18, 2010

Plane madness

You know your son is still obsessed with planes and air crashes when:

You are curled up in a corner reading your book, while he plays with his ever-increasing store of toy planes. You suddenly tune into his monologue and realise that he is doing an almost-perfect imitation of an airhotess: "This plane is about to crash. Please put on your seat belts. Thank you for flying Jet Airways." And then slams the plane into a nearby wall.

You get suspicious at the unusual silence emanating from his room and walk in to find him perusing an airline safety card (which he decided to appropriate on his last flight for detailed analysis)...

You decide to get him excited about the upcoming family holiday in Mauritius by showing him pictures on Google Images and he barely looks at all the lovely beach and ocean pictures before asking to see a picture of the aeroplane we will go in. He then proceeds to stare at the aeroplane, comment on its size and colours and wonder if it is going to land in the water...

You tell him about the weekend plan to go meet a friend and he decides to make her a present - a 'newspaper' about aeroplane crashes:

This is the artist's explanation:
On Page 101, the first picture is a plane flying in the clouds but the pilot has forgotten to put the wheels back inside. The second is a plane that has crashed its nose into a brick wall.
On page 202, the first plane has crashed because it landed on its nose. The second plane landed on the runway but then crashed into the jungle (the big black thing on the side). And the third plane has landed without the wheels coming out).