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.

21 comments:

  1. "To make a larger point, it makes sense to balance out medical advice with instinct and research. Doctors are not omniscient and infallible."

    Couldn't agree with you more. Hope Tarana is better very soon.

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  2. Agree totally with you Ro. I've changed 6-7 pediatricians, 2 gynecs, one family physician when I felt they did not consider me a partner, but just a patient or patient's parent who had to mutely obey their diktats. I walk out when doctors mock my questions and need to understand diagnoses, treatment/interventions and prescriptions.

    I like our present pediatrician, he spends ages with us at each appt, has not prescribed an antibiotic for over 18 months, encourages us when we say we use homeopathy (!!) and talks to my 8.5 year old about her health, like she's a person. He even praises my management of the kids' health and has told me to buy a stethoscope!!!

    Good to read about Tarana's progress...you do know your child better than anyone else.

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  3. I used to be 'THAT' mom too! Thankfully I have a team of pediatricians I trust. And it is absolutely important to take a second opinion - not only for children but for everyone.

    Hope Tarana recovers soon...

    # 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. - Agree completely!

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  4. hi there. .

    both my kids sat like that. no one on my side of the family did that.. but apparently my wife used to do just that per my MIL.

    they are both doing fine.

    as for doctors.. reminded me of an incident a few years ago..

    http://sundar72.blogspot.com/2006/08/what-is-worse.html

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  5. As Uttara has quoted (from your post), that to me is the crux of the matter. I have seen many, many doctors while bringing up my children, particularly since one of them had quite a serious physical problem. It took me quite a while to absolutely trust my gut instinct on it and now I advice all new mums--"go with your gut".

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  6. Hope she gets okay soon. And a big pat on your back for sticking to your instincts.

    That has often saved my kids. Really I have so many examples. And I have found the docs in India more willing to listen to my doubts actually.

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  7. Hope Tarana is better now...and like you say...we do need to find a balance..and a mom knows her kids the best..

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  8. ello,
    Agree with everything you ve written. I had a ped who diagnoised a heat rash as an eczema rash and prescribed a steroid cream! Didnt use it and the rash disappeared just as I thought it would.My 17 month old does tend to sit in the W pose sometimes and I didnt notice it till I read it here:)I notice that he does it more often when he s had his diaper on for a couple of hours or has pooped. No idea why. He seems to be doing ok so far as per his ped but I guess I ll pay more attention to it now.You may want to take a look at the Bumbo baby seat but I think Tarana may be too old for it now. I havent used it but most parents here used it when their kids started sitting up.

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  9. I couldn't agree more with you Ro. Doctors are certainly no Gods, and we cannot trust them blindfolded. Always good to consult if you have a doctor in the family. I call up my aunt abroad for everything and so far her diagnosis has been much better than any doc here, though she gets to see us only once an yr. Moreover, just think about it, who go on to become doctors- ppl like us who took biology in Senior secondary instead of Maths. The education system allows every one who can pay the fees to graduate as a doctor and set shop if they have money. Doesn't mean they have any more aptitude for the thing than us, I know some of my friends from school who went on to become doctors and I wouldn't consult them to save my life :D Also, I believe pediatricians manipulate parents and unnecessarily blow up simple stuff to appear important. Long rant.. you take care!

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  10. - So True
    - Except for a few, all docs are made that way...
    - Going for a 2nd or 3rd opinion is a must
    - And moms know their babies best
    - Tarana will be fine..Hugs

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  11. Thanks for the wishes, people.

    [Starry] 6-7 paediatricians?! Whoa! Glad you found someone you like. I got lucky at strike two.

    [Sundar] Lollipop???! What an idiotic doctor.

    [Choxbox] Really? I always felt that Indian doctors were more dictatorial. Just a prejudice though since I don't have any experience with non-Indian doctors.

    [Ariel] i don't think w-sitting is a problem if it is just of the ways he sits. Tarana would only sit like that

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  12. Anonymous7:21 am

    Delurking...have been reading your blog for a very long time.
    If she mouths her toys of different kinds, eats food of different textures, you need not worry at all, atleast that is what my doctor told when I went with a concern that my child does not want to self feed, kids are different, I thought self feeding was natural and not a learned process but in my son's case I had to teach him that, I worked on him for 1 week and he got it.
    Don't worry, go with your instinct.

    AI

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  13. Preeti9:02 pm

    Hey Ro! Good to hear that Tarana is doing better. And absolutely agree with you on the follow ur gut theory. I do it all the time with my doc. Who incidentally, I really like. But still there are times that I feel L will get better on her own, or there's no need to over medicate, then I just wait and watch. Also, had an "experience" with a jerk of a doc when she was baby, and just kept insisting that there was a prob, till we got it sorted out(with our current doc).

    Just got back fm a trip to Goa, and we were in the first row with all the leaflets tucked in in front of us. Couldn't help thinking of Ayaan's flight fantasies which sure brought a smile to my face.

    Lastly, if u're considering using the bumbo seat, pls lemme know. I cld pass on U's seat to u.

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  14. You make total sense. We try and follow the same policy even with the adult patients we have:)

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  15. Excellent advice and big hugs and best wishes to you and Tarana in getting through this episode - first, second or 10th time mother, I'm sure its not easy to subject your child to any kind of medical treatment!

    About Tarana's stranger anxiety, wait till you meet Kavya! She bawls every time a stranger comes near. Needless to say that every time we see her doc, she screams so much that I am asked when we come out of the doc's room (every single time!) whether she was being given injections.

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  16. Hi Rohini, Glad to hear that the physiotherapy sessions are going better now and that Tarana is getting comfortable with the therapist. I'm also glad to hear that the therapist is good at what she does. That's wonderful. I'm still not very happy with mine but like you, I have been unable to find any other options reasonably close to home. Haven't been able to find anyone who does home visits either.

    I wish I could try out the clinic you're going to but that is just too far for me.

    About the 'sensory issues' thing, the head therapist at the clinic I used to go to in Vile Parle said exactly the same thing when he would cry and refuse to let them touch him. They made me buy sponges /loofahs of different textures and rub him with them everyday. But I stopped doing that very soon because I realised that he had no such issues, he was just a 13 month old baby who was in a strange place, having strange people turn his neck this way and that. He settled down in a couple of months and became much more cooperative. Now, of course, its a different story altogether. He's an active 2.5 year old and getting him to sit in one place to do the stretches has become a huge task!

    Anyway, my point is, I'm glad you're trusting your instincts. No one knows our kids the way we do. Dcotors can be really unscrupulous especially when affiliated to a private hospital as you said. We consulted a pediatric orthopedic at a big private hospital when my son was a year old who recommended immediate surgery!! Needless to say, we got a second opinion.

    Good luck with everything and please email if ever you need anything!!

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  17. Preeti10:47 am

    Hi Ro!

    Since I wrote last, L has been diagnosed with a flat feet prob, so I was thinking I would take her to a physiotherapist to see if there were any exercises we could do with her. Wld u pls give me ur physio's no as well as any paediatric orthopaedic doc if u visited any. my id is thattai@yahoo.com. Tx, P

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  18. Doctor Mom is the word! Not for nothing do they say Mom knows best. I think it is some instinct that we r blessed with. Hope Tarana gets fine soon.

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  19. [AI] Thanks for sharing that. Tarana self-feeds and has no problems with textures in food or toys...

    {Preeti] Thanks for the offer. I checked out the Bumbo seat on the net. Tarana's too mobile to stay put in it now. Have mailed you the doctor contacts.

    [Dipali] :)

    [Lawyeramma] That sounds just like Tarana :)

    [Nina] Thanks for your comment and for all your help.

    [LAK] Thanks. I hope so too

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  20. I agree with all u have written and as chox says a big pat on ur back to stick to ur instincts

    thankfully on strike one I have found a doc that is willing to listen to me, is easy going most of the times... hates to drown him with medicines etc etc but most of all what I like abt him is that he listens to and takes into account everything I say about my child

    tarana will be very well very soon

    hugs

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  21. Agree with you a hundred percent. The doctors may know medicine very well but we, as moms, know our kids like no one else can. I follow the same rules as you.

    Because of this attitude I was once able to recognize lactose intolerance in M while the doctors simply treated each episode of tummy upsets as stomach bug cases. When I brought it to the doctor's notice even she agreed that the symptoms strongly indicated lactose intolerance, we moved her to a soy based formula for 6 months or so and it made an immediate and huge difference!

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