###Input :Was I molested by my pediatrician? / Is this normal for a pediatric exam?This is going to be all over the place so I'm sorry for that.All I remember was being 14 and being at the pediatricians. I kept saying no. My Mom was in the room and kept saying yes. So my underwear was down and my knees were bent and I was sobbing and my male pediatrician spread my labia just to "look" (with his hands). I was sobbing and saying no and I was ignored.I've talked to various crisis types of hotlines including RAINN and personally found them of no help. ###Output :An external genital exam is part of a normal physical exam in child. I seriously doubt your pediatrician was doing this exam for some sexual purpose. However, I wouldn't force an exam like this on a crying kid, particularly an older kid with a sense of agency, unless it was medically necessary.Many pediatricians will limit their external GU exam on older girls to simply looking externally at labia, to assess pubarche. Doing an external while spreading labia is less common a "check up", unless there's a specific complaint like discharge, itching, rash, whatever. On the other hand, boy will typically have their testicles palpated looking for masses, hernias, varicocele, and assessing normal testicular development.Nobody here can say if the specifics of what your pediatrician were definitely appropriate in the circumstances, but an external GU exam isn't uncommon, and isn't "molestation" in and of itself. But it's something where assent from a 14 y/o girl should be obtained.


###Input :Sorry in advance for the long post!My 8 year old son has had significant trouble with bowel training since initiation of potty training in general. What I believe started as an aversion to pooping due to distraction or not wanting to miss out on anything exciting while he was on the toilet, evolved into chronic constipation and an aversion secondary to pain. This was initially treated with Miralax and pushing fluids. However, he continued to have various amounts of poop in his underwear on almost a daily basis, and struggled with having regular bowel movements, alternating between small pebbles to impossibly large logsBecause he spends half of his time with his father and half with myself, there have been some inconsistencies in addressing this. I recently had a long discussion with his father and we decided to give an impaction appropriate dose of Miralax to encourage complete emptying and then start on a consistent maintenance dose at both houses. Admittedly, we had both dropped the ball on this. My concern now is that my son has recently had a couple of episodes of full on incontinence while out running errands. When I talked to him about always letting me know he has to go so we can find a restroom, he explained that he does not feel and urge to go, and only realizes what has happened when he feels it in his pants. I recognize that prolonged constipation can decrease urge sensation and believe this is what has happened. I do think this is still a tiny bit related to not wanting to stop what hes doing and sit on the toilet for the appropriate amount of time to have a big poop. All of that background is basically to ask, should I seek out a pediatric GI specialist? Or is this something that can be solved by going back to the potty training basics (timed toileting and having him sit on the toilet for a while). Is Miralax an appropriate choice for his age/symptoms? Does this warrant a consult with a therapist? Of note, I am aware that some of these symptoms can be a trauma response, however I am very confident that is not the case with him. Despite our divorce, my ex remains a caring father to both of our children, and neither child is left in the care of any suspicious characters. Any guidance would be greatly appreciated! ###Output :Probably appropriate to see a peds GI at this point. The starting outcome will likely be Miralax and timed toileting, but it's good to make sure nothing else is going missed.


###Input :what to expect at pediatrics?16yo female. went to the doctors complaining about stomach issues, they took my bloods and done a checkup and nothing came back wrong.they made an appointment in the hospital for the pediatrician and im quite nervous. ###Output :A talk with you and your parent, and a physical exam. Any particular thing youre worried about?


###Input :Pediatric lower back painMy son broke his hip 4 months ago. He was non weight bearing for over 2 months. His doctor released him 2 weeks ago. His PT said his left side is super weak and lost muscle mass. He has a slight limp which the doctor said would get better with time. My question is, when he tries to run eventually his lower back starts to hurt. Could this be just from weak hip/ back muscles or some kind of muscle imbalance throwing things off? We are keeping a look out for hip AVN but OS told us that would cause hip pain and groin pain, not back pain. Any insight be help.Please ###Output :Could certainly be the weakness in his leg altering his biomechanics. That said, how did he break his hip? If there is any concern for a back injury that went unnoticed, discuss with his doctor.


###Input :We had a sledding accident. Im pretty sure they did a full trauma work up at the hospital. All sorts of X-rays. Couldnt they have seen something then? It all started after he started trying to run and stuff, which is why it makes me think its muscular imbalance? ###Output :Yes, I'd be very surprised if they didn't catch something more serious. The back pain should improve as his gait and running stride normalize, which PT can help with.


###Input :Good sub for pediatrics?The sub r/pediatrics isnt for medical questions. Im trying to find one thats appropriate.Ive got a sick four year old who has been fighting a sinus / ear infection for weeks, even after seeing four different doctors. So Im looking for a group with some potential SMEs or at least other parents who have been down this road. ###Output :Yes, there are a number of pediatricians, peds-EM docs, and a neonatal NP active on this sub.


###Input :Worried about my dads cardiac cath resultsMy father is a stubborn mule of a man, and I need to know if Im right in pushing this issue until he gets the care he needs. I am a pediatric ICU nurse, so adults are not my thing.My dads history: 63yo male, normal BMI, moderate physical activity 5 days a week, former smoker x 30+ years (quit in 2017 when my son was born). He takes Repatha, losartan, baby aspirin, and ambien (he works nightshift & sleeps during the day). Generally healthy and active, only pmhx is high cholesterol (we are Cuban and he eats a very high fat diet and a lot of red meat), and two stents placed in 2017. Extremely extensive family cardiac history as follows (this is tough to keep track of so bear with me):His father: quadruple bypass, 5 TIAs then full carotid blockage, heart attack = died in 10/2014His mother: quadruple bypass, years later had MI & stroke = died 4/28/2008Brother #1: quintuple bypass in his 40s... died of heart attack in his sleep 5/2019 @ age 58Brother #2: stent in his 40sSister: MI (widow maker) & triple bypass 4/2019Brother #3: 3/2023 bilateral carotid 90% blockages, persistent A-fib.And those are just his immediate family. That history extends to every branch of uncles & cousins as well. They should give us a discount for buy two get two bypass at this point.My dad recently went for his annual cardiac appt and failed his stress test (he was unable to complete it) so they had him go for a cath. That revealed 100% blockages in several areas (diagram drawn by his doc here: https://imgur.com/a/0adwYqA ) but they didnt perform any interventions. The doc said theyd have to compare this cath to the one he had in 2017 to see the changes and decide how to proceed, but that he felt ok just watching things for now. His next appt is in June, and my dad seems to think all is well. He said oh it went fine, they told me my body made other pathways for the blood to flow. Ugh.I am alarmed. Cardiac isnt my specialty, but wouldnt this warrant a double bypass? Isnt his personal and family history enough to be more proactive with intervention? I was very close with my uncle and he passed away in his sleep just months after a normal cardiac exam. I dont want the same to happen to my dad, and Im concerned that hes heading towards a major event. Any insight? Am I right to want to push him to follow up on this immediately? Thank you. ###Output :So obviously your dad has significant coronary artery disease. The family history at this point (which is ridiculously extensive) doesn't really matter since we know his anatomy.It looks like his left main coronary artery and left anterior descending artery (LAD) are open. His right coronary artery is blocked but past this it presumably backfills from the LAD through enlarged (collateral) vessels that wrap around the apex of the heart. This is why he had a positive stress test - with enough exertion the oxygen demand is too high for the left side to keep up.Almost all of the benefit for a coronary bypass procedure is with patients who have significant narrowing of the left main coronary artery or both of the immediate downstream arteries. These feed a large portion of the heart muscle, and not just your dad but anyone does poorly if they are blocked.However when these are open, which is the case here, the benefit is less clear and this is doubly true in the absence of significant symptoms. A left sided graft may not even stay patent in this setting, since there is competitive flow down the LAD. We would not usually do a bypass just for right coronary disease, the benefits do not appear to outweigh the risks in this scenario.The other blockages are being backfilled by the open arteries, and unless he develops new symptoms then medical management is at least as effective and safer. It isn't that the blockages aren't a concern, it is whether bypassing them is beneficial. In this case if it were my dad I would prefer aggressive medical management and lifestyle changes as much as possible.


###Input :This is an incredibly thorough reply, thank you for taking the time to explain all of that. My clinical brain cant function because all I can think about is getting another phone call and it being about him.So if Im understanding correctly, it sounds like the collateral vessels are more effective than I assumed. Hes a pretty active guy, is there danger if the left side cant meet the metabolic demands of the heart during exertion? Any risk of right sided ischemia?Ill be joining him at his appointment to take notes and make sure hes compliant with those lifestyle changes. He still thinks this is all routine and not a big deal. Your reply is helping me catch my breath a bit, so thank you again. ###Output :Yes the collaterals are presumably well-developed. The danger from over exerting himself through exercise isnt of much concern, he would be symptom limited well before there was irreversible damage. Other issues like sepsis could put some strain on the heart but unlikely to cause any sizable infarct.He needs to really maximize the medical management - strict risk factor control with high-intensity lipid lowering therapy (doesnt matter if cholesterol is high) and tight monitoring of blood pressure. If there is a hint of diabetes one of the newer agents also would be good.The medicines actually work quite well combined with lifestyle changes. CABG and stent are more bailout procedures if a lot of heart muscle is threatened by very narrow arteries, which is not the case here.


###Input :Pediatric low Creat level - Doctor ignoringMy 3 year old daughter went in for her check up/blood work, and has a .3 level of Creat and and 240 alphosi test results. The doctor is entirely unconcerned about this, but what Im reading on line makes me worried. Should I be concerned? If yes, what are immediate next steps I can take.Thank you in advance, Worried Parent ###Output :I cannot think of a situation in which a low creatinine in an otherwise healthy child would worry me.


###Input :Is there anything to be concerned about with the high level of the alkphosi? ###Output :Probably not, but thats something to ask the pediatrician


###Input :NAD but I understand that higher alkphos in children is considered normal because of bone growth. Could be the kiddo just had a growth spurt. Alkphos is an enzyme found in bones, liver,kidneys, digestive tract. Def talk to your pediatrician so they can ease your worries. ###Output :Those are both normal results for a patient her age. The doctor is ignoring them because your lab likely has a reference range that's for adults, not kidsThe creatinine level roughly reflects the muscle mass. Normal for kids is always low. If it's "normal" for a kid, I look twice and think about things.High alk phos (alkaline phosphatase) level in kids is almost invariably correlated with a low Vitamin D level. It's more typical these days to have a low Vitamin D than not, at least for kids. Maybe it's all the sunscreen plus much less non-screen time. Fewer sunburns but lower sunshine. I don't know that we have good guidelines for what to do with vitamin D levels these days, but if you wanted to pursue something, that would be it. Or give her a multivitamin with at least 400 IU of Vitamin D and consider rechecking in the spring.I'm curious, though -- we usually don't check these labs as part of routine blood work. There's the CBC or hemoglobin level, and lead, and then lipids and diabetes (but only for children at particularly high risk). Do you know what the physician was looking for, or why they were checking extra things?


###Input :Dont worry- I totally believe in them and support vaccination.Im an infant/toddler nanny, and have been working with them for over 20 years. Today I encountered something new.The Little One I take care of (18 month F) got a couple of shots today. The pediatrician advised her parents not to use Motrin or Tylenol for fever or discomfort unless her temp goes over 103.5 or she absolutely cant sleep. The reason given was having a fever and letting it do its thing means she will have a greater immune response from the vaccines. (These were standard 18 month shots- not the COVID vax, for what its worth. She has gotten the first 2 COVID shots- waiting on the 3rd next month.)I have never heard this before. Can anyone weigh in on this? Sounds crazy to me, but Im not a doc. ###Output :Current data is a bit conflicting from studies Ive read, but I generally caution against prophylactic use of antipyretics because there is some evidence that it blunts the immune response.Use of antipyretics about 4-6 hours post-vaccine have shown mixed results in terms of immune response but generally patients still gain immunity. Id rather have a happy patient and family that returns for all vaccines than tell them not to give Tylenol/ibuprofen. I try to make sure they wait 4-6 hours though before the first dose if it is needed. We have multiple doses of most childhood vaccines, so its likely there wont be an issue with immunity, even with Tylenol/ibuprofen post vaccine.


###Input :Thank you so much. Ive just never heard this before, and Im always open to learning! We obviously want her to get the best results she can from them, but we also dont want her to be needlessly uncomfortable. She made it through to nap time comforted with snuggles and her favorite lunch, and we plan on letting her play in the tub this afternoon to soak the bandaids off her legs.Thats another question- is there a legit reason to put bandaids on after shots? Ive never seen more than the tiniest drop of blood on a bandaid after a child gets a vaccine, but they are so hard on their legs. They stick super hard, and she tends to get little welts where the bandaids were. She also cries now anytime she sees bandaids bc they hurt so much to take off.Are they needed? Is it to prevent infection? To put pressure on the injection site? We would MUCH rather just have the tiny drop of blood on her pants than go through this every time- but if theres a legit reason Id love to know about it.Thanks for taking the time to give an answer. Its much appreciated! ###Output :No, no good reason for the bandaids other than the drop of blood and to prevent them from messing with the area immediately after.It's not evidence based. https://journals.lww.com/ebp/Fulltext/2021/03000/Does_premedication_with_ibuprofen_affect_the.19.aspxThose meds can reduce immune response but not uniformly and the immune response is still enough to be protective at minimum. There's no basis for that fever number that she picked. Delayed acetaminophen or ibuprofen given after the vaccine rather than with the vaccine appear to have a lesser effect.


###Input :Just to clarify your last sentence- does delaying the dose lessen the effect of the med I terms of comfort/fever reduction? Or lessen the effect of how the vaccine impacts the immune system?We try to use other methods of soothing her in general when we can, but sometimes shes uncomfortable enough that it seems warranted. (We went with her favorite lunch and lots of snuggles between the shots and nap, and are planning on letting her play in a warm bath after nap if she wants.)Thank you for weighing in. I appreciate it! ###Output :I think there was a trend to lessening the effect on the immune response, but again, the immune response was still adequate regardless. I'd give my kid the tylenol after a vaccine. In my local children's hospital they do as well. I find the evidence saying not to give it is weak and mostly refers to giving it at the time of vaccination


###Input :Thanks!Edit: added question to the top. ###Output :Benzoyl peroxide is a rare allergen but a common irritant and can cause irritant contact dermatitis. As long as the latter does not occur, it is an excellent biocide.


###Input :Thank you. Would you have insight into how often benzoyl peroxide wash would typically be used in a situation like ours? ###Output :No examination details or images included, so no comment appropriate.


###Input :I hope this works for photos. Ive never used Imgur or posted a photo on Reddit before. The labeled photos are from tonight when the dots have pretty much dried up and are the best they get after a bleach bath. The other two are of times when the folliculitis is more flared up. Let me know if there is anything else for a physical exam you would want. Thanks!Edit: looks like the photos require being over 18 to view. Two are of his bottom, this is probably why, though I censored what was necessary. ###Output :Mild folliculitis present. Using the benzoyl peroxide wash a few times a week may maximize efficacy and minimize irritation.


###Input :Would you indulge another question? Just curious if selsun blue would be a viable option as an occasional body wash for my sons situation given its anti-fungal properties. (Im thinking the benzoyl peroxide will be sufficient, but just curious.) ###Output :Selenium sulfide is an antifungal agent but does not have antibacterial activity as far as I know. Not a good choice.


###Input :3 months later, doctors hypothesize TTPm seeking medical advice for my mother. She has her internal med and cardiologist following. She is now seeing a hematologist. We are interested in any additional advice or suggestions that can help with her diagnosis.My mother (62F) has a history of RA. She contracted COVID four times. Once was before she received the vaccine and three times after. It is our understanding that her medication caused the vaccine to be ineffective. With each COVID diagnosis, she received the antibody infusion.My mother was then diagnosed with AFib. She took Eloquist for over one year and had an ablation in October. In November, she had a watchman placed, was taken off of Eloquist, and began taking Plavix. She also takes 80mg ASA.After one week, she began to develop spots around her ankles that resembled petechiae. Her doctor advised her to continue Plavix. The spots then became larger and spread above her knee. After 1.5 weeks of taking the medication, she discontinued Plavix and began Brilinta bid.The spots started to look more solid, and one week after switching medication, the doctor advised her to cut back on Brilinta to qd.The sores on her legs were somewhat better off and on, but during this time, they spread as high as navel. The cardiologist advised her to discontinue Brilinta and resume Eloquist. She also took a round of Augmentin which caused her legs to look better.Since that time, the spots have remained on her legs, and after days in which she is walking quite a bit, the spots sometimes become solid and encompass the entirety of her lower legs.She has now been off of blood thinner for two weeks. Seeing little to no progress, her cardiologist and internal med doctor have now referred her to a hematologist to assess for TTP.After the watchman placement, my mother has routinely had labs drawn each week. She has also had a platelet function analysis. Labs have remained WNL.She has recently started seeing the hematologist. He ordered additional lab work in which the results should be back at the beginning of the coming week. He explained to my mother that she seems to be healthier than most patients who have been diagnosed with TTP although some of her symptoms seem to correlate with that of TTP as well as another disorder that is typically only diagnosed amongst pediatric patients.The hematologist also explained that recently, he has observed many different disorders and symptoms that were not observed prior to COVID, and considering that my mother had COVID four times, this could be one of those occurances.Im curious as to if any of you have recommendations or if any of you have encountered anything similar. Any suggestions are greatly appreciated. Thank you so much in advance for your help! ###Output :It would be helpful for you to post the labs results but if her cbc is normal as you're pointing out above then it's extremely unlikely for this to be TTPThe pictures you showed look like a vasculitis


###Input :6 year old re-cauterized day 5 post tonsillectomyMy 6 year old had her tonsils and adenoids taken out on April 6th, she was what I thought, healing well. In good spirits, never complaining of anything more than  a little pain . Popsicles nonstop, ice cream too. Tuesday night, after a full 5 days post operation, she wakes up and starts vomiting blood. We panic, call 911, go the nearest pediatric hospital. They tell us well have to recauterize. Cue second round of fear for the night. I couldnt imagine putting her through anesthesia again in less than a week. Thankfully it went well, and the left side had active bleeding in one spot which they cauterized and the right side had some tiny vessels that the doctor recauterized too. They kept her for another 8 hours for observation and she was doing well. I guess now were all so traumatized, including her, that it could happen again. She hates the taste of Tylenol but pediatrician warned about Motrin possibly triggering the bleeding. Of course, she prefers Motrin. Im writing this terrified of it recurring and praying it wont.Im so terrified of her hemorrhaging again and I dont know how to calm myself. I was told it would be rare to happen again but it was rare to even happen the first time. Were officially 7 days post initial procedure and Im wondering at how many days post op can i be confident that shes healed?Any possible words of encouragement or advice would be so very appreciated. ###Output :Its not that uncommon after tonsillectomy actually, I agree unlikely to recur and should be ok. Did they check her blood counts to know how much she had bled?


###Input :Ive got her lab results with me but unsure of what its telling me. ###Output :Fairly common , frankly not a big deal that is just bad luck. Rate of postoperative bleed is 1%, so chance it happens again very rare.You can get a rebleed at 7-10 days but rare. After that it becomes extremely unlikely


###Input :Thanks for your comment. The pediatricians drilled it in our heads that it was rare that it happened in the first place, even at 5 days. But I cant help but shake the feeling that even though its rare to happen again, we were already one of the rare ones it happened to the first time around. They made it seem as its way more unlikely for it to happen to children and more common in adults. When we saw her vomiting fresh blood we thought we were going to lose her.Will the recauterization of the spot where they found her active bleeding (noted as left superior tonsillar fossa) reset the clock on healing the whole area? Diffuse oozing in the right, clots bilaterally were also listed on our discharge papers. ###Output :In 25 years of practicing ENT Ive only seen one re-bleed.The cautery sets the clock back just in that one specific spot. Theres no evidence postop bleeding is more common in adults, thats an old wives tale.Big picture here, this was a small setback your child will be fine.


###Input :11 month old with fatty liver11 month Male Multivitamin with iron 6 weeks premature Uncircumcised 29 inches 24.5 lbsOn March 30 he woke up with a fever. We headed to urgent care and they diagnosed him with UTI. Got a call from them a week later saying to follow up with his pediatrician. While there she said his bacteria numbers werent high enough to indicate a UTI but its possible we just caught it super early. She said she was going to do research and possibly want further testing. She ended ordering a renal ultrasound. The findings of the ultrasound indicated that his renal system is unremarkable! But his liver is showing echogenicity and fatty infiltration of the liver. What could cause this? Should I be worried about it? ###Output :Some infants have fatty liver on US or CT scans done for other reasons, as in your case. There's no consensus on what to do in this situation, but I tend to just follow it, because it often goes away. We think it's often a consequence of fetal environment, and has some association with maternal obesity, maternal gestational diabetes, and also seems to happen more often to preterm babies. But overall, the problem hasn't been well studied. In the setting of a recent infection, there's also a decent chance it's a consequence of the immune response (although it's usually from a gastroenteritis with things like adenovirus, not a UTI).These cases come to my clinic every now and then and most of the time it resolves. I usually do two things: repeat the ultrasound in a few months, and get a blood test (called a CMP) to look at the liver numbers.We don't know how this relates to long term risk for fatty liver, which has more significant health consequences. Some people have genetic causes for fatty liver, and it can start at a young age, but this is fairly rare, and not the cause of fatty liver in infants in most cases. Either way, it's worth keeping tabs on it to see if it goes away over time.


###Input :Should I look into dietary changes? He breastfeeds 5+ times a day and has a meal 3x a day. The meals typically consist of a protein, fruit/veggie and some form of starch (sweet potato, wild rice, veggie pasta). He drinks probably 1 cup of water a day. ###Output :Likely not necessary in the short term. But I would still discuss with a pediatric gastroenterologist.


###Input :Please help me understand this. Scared19, Male, 60, 180 lbs, Usually healthy, Works-out 5 days a weekHi there, I went to hematology for a low WBC count and while there I mentioned to them that I have had palpable lymph-nodes in my neck for 3.5 years and I have already been checked previously by 4 doctors including a pediatric oncologist and had multiple ultrasounds which suggest its non-concerning. However, she took an ACE level test and it came back elevated and she said something along the lines Youre ACE levels came back elevated and it could suggest sarcoidosis and if youre concerned go to a GP and get it measured again  ANYWAYS! I didnt think much of it and let it be for 6 months & I went to a Nurse Practitioner to repeat my CBC out of curiosity which showed everything was normal and my WBC was 5.6 which was great. I also asked for the ACE level test to be re-measured and they didnt know what that even was. They had me come back after they researched it and then they took a small vile of blood. They sent it off and it came back high at a 135 and cut off for that lab was 80. I am freaking out because he contacted the hematologist doc and they said I should go to a pulmonologist. I feel perfectly healthy and better than I ever have. I am freaking out because google keeps saying ACE levels being high indicates: Lymphoma, Multiple Myeloma AND Lung cancer. I am absolutely plummeting right now and nothing makes sense to me. Please give me some advice OR knowledge. Its hard to find stuff online speaking about ACE levels. ###Output :ACE level is a very nonspecific test. It is not recommended for exactly this reason. Positive tests have <25% chance of having sarcoid, especially if they aren't sent for a good reason.I would followup to make sure but this is a good example of why we don't just send off a bunch of tests for no good reason - you end up with anxiety and chasing down a number of things that are not real.


###Input :okay thanks. ill meet up with a pulmonologist most likely. how likely would something malignant cause this? ###Output :Very unlikely. We dont use it as a test to look for malignancy.


###Input :okay thanks for the responses. my NP i seen doesnt even know what the ACE levels mean and has no knowledge on it. think i should go back and see my actual GP? or is this something i can just let be elevated ###Output :I would be hard-pressed to know how to deal with this nonspecific test without seeing you and your lab records and getting a full medical history. So again I would followup. Depending on the level of suspicion a chest x-ray, chest CT or even biopsy might be warranted.It is generally more productive to wait until there are some symptoms but I can't reassure you that you definitely don't have sarcoid or a different autoimmune disease. It does not seem like you have cancer based on the lymph node surveillance


###Input :what is this rash on my toddler1.5 year old, male, 24 pounds,I just noticed this rash on both my sons feet legs and bum. theres been no change in detergent, or soap. Hes recently been on antibiotics for an ear infection but broke out in a full body rash on day three of amoxicillin. so they switched him to azithromycin and same thing happened. hes been on cipro/ dex. drops since wednesday. what the heck is going on. why is he covered in rashes? he doesnt seem to notice. acting fine, no fever, not itching. Any ideas? Picsedit: sorry the pic kind of sucks but 1. hes a toddler and does not sit still 2. the flash dulls the color of the rash ###Output :Does this rash cover his whole body? It looks like Roseola to me, which is a very common viral infection in pediatric patients.


###Input :no not this time. but the other 2 times it did. googling roseola - thats exactly what his rashes have looked like.i had brought him in to ER with a fever of 39.7 (went to 40.5) and lethargy, which is when they said he had quite a bad ear infection (membrane retracted with ++ pus) he hasnt been tugging on his ear or anything. could that have been an accidental finding and the fever was actually the roseola? i understand its hard to say over the internet but thought id ask ###Output :Exactly. We see this in the ER all the time. Roseola is infamous for making the ear drums look infected when they're actually not. I suspect his fever was from the Roseola, and he was falsely diagnosed with an ear infection at that time given his constellation of symptoms. The rash infamously comes after the fever breaks. It's not itchy or uncomfortable for the child.


###Input :that is so interesting!!! a coworker actually suggested this but i basically brushed it off, but it makes sense! so maybe hes not allergic to penicillin and azithro after all.its been about a week with on and off rashes. is that normal? i keep taking him back to the doctor thinking its the meds ###Output :I highly doubt he's truly allergic to either :)


###Input :Good to know!! he doesnt seem bothered by the rash at all! He does still have a bit of a rash though and its been like 7 days since it first showed up. its kind of comes and goes tho is that normal for roseola? ###Output :Hand foot mouth is a possibility too.As an ER pediatrician, I ignore whatever urgent care diagnosis was given regarding ears. They usually suck at examining them, and think every flushed ear drum in a kid with fever/crying is infected. That, or frequently find that they're outright liars, and couldn't have possibly seen the TM, because of the enormous amount of wax (or even foreign bodies) that is in the way. The people doing these evaluations and making these diagnoses are almost never pediatricians, and usually aren't even physicians.


###Input :Advised by nurse line to give my 3 month old a glycerin suppository?Male. 3 months. 15 pounds.possibly milk dairy allergy. He usually goes 1 to 2 times a day but hasnt gone in 4 days. He is exclusively breastfeed. I started a probiotic 5 days ago that I discontinued since he hasnt gone. He has been having diarrhea for weeks everyday so this is a big change. Hes been passing gas and fussy starting today whenever he passes gas.I called our pediatrician hotline and was told to use 1/4th if a suppository for him. Im a little hesitant but cant get in touch with his doctor until Monday. ###Output :Exclusively breastfed infants can go up to 9 days between poos. If he is eating, not vomiting and passing wind I dont know why you would give him a suppository


###Input :why does everything feel fake?history: im 16M, have no existing medical issues, nor am i using any medications, and i dont smoke, drink, or do drugs.occurrences: this has been getting progressively worse the past month, at first it was only something i could notice but it never really bothered me, but now it makes taking tests, reading (even this), and programming really difficult without full concentration. it kindof comes in waves where i can read whole chapters with no problem to having to re read a sentence multiple times to understand it (this happened in my ism test where i got stuck on a really easy problem because it felt like whenever i read one part of it, part before it disappeared). sometimes it gets so bad to where i get dizzy spells in the middle of class, and other times when im about to sleep it feels like im "slipping" and jump up (not the kind where you feel like your falling in a dream and wake up). also the past few days its kindof always been on very slightly.when it gets bad it feels like passing out without actually passing out, you know how you technically CAN see, but dont really understand anything? it feels like that, or like those pictures where you cant identify anything, or waking up suddenly from a deep dream, and my mind goes blank and i feel like im "spiraling", and it feels like im about to fall through the world? i dunno how to explain it, but i usually get jumpscared by it and it brings me back to normal, but if i focus i can point things out and describe things. another way i can describe it is it feels like im looking through my peripheral vision at all times, theres a certain lack of clarity to what everything looks like, and sometimes when im reading it feels like im being sucked into the monitor, if i really focus i can read, but it feels trying to read on a rocky boat, yeah i CAN do it, but im not really understanding it because im too focused on reading the words. sorry if im explaining this poorly, i dont really know what it is or whats causing it, im thinking its a mix of brain fog and anxiety? i wouldnt say im an anxous person but idk, and it feels kindof similar to the brain fog i get when i drink coffee, and ideas would be apreciated! ###Output :Needs detailed in person. Pediatric psychiatric evaluation.


###Input :3 months later, doctors hypothesize TTPIm seeking medical advice for my mother. She has her internal med and cardiologist following. She is now seeing a hematologist. We are interested in any additional advice or suggestions that can help with her diagnosis.My mother (62F) has a history of RA. She contracted COVID four times. Once was before she received the vaccine and three times after. It is our understanding that her medication caused the vaccine to be ineffective. With each COVID diagnosis, she received the antibody infusion.My mother was then diagnosed with AFib. She took Eloquist for over one year and had an ablation in October. In November, she had a watchman placed, was taken off of Eloquist, and began taking Plavix. She also takes 80mg ASA.After one week, she began to develop spots around her ankles that resembled petechiae. Her doctor advised her to continue Plavix. The spots then became larger and spread above her knee. After 1.5 weeks of taking the medication, she discontinued Plavix and began Brilinta bid.The spots started to look more solid, and one week after switching medication, the doctor advised her to cut back on Brilinta to qd.The sores on her legs were somewhat better off and on, but during this time, they spread as high as navel. The cardiologist advised her to discontinue Brilinta and resume Eloquist. She also took a round of Augmentin which caused her legs to look better.Since that time, the spots have remained on her legs, and after days in which she is walking quite a bit, the spots sometimes become solid and encompass the entirety of her lower legs.She has now been off of blood thinner for two weeks. Seeing little to no progress, her cardiologist and internal med doctor have now referred her to a hematologist to assess for TTP.After the watchman placement, my mother has routinely had labs drawn each week. She has also had a platelet function analysis. Labs have remained WNL.She has recently started seeing the hematologist. He ordered additional lab work in which the results should be back at the beginning of the coming week. He explained to my mother that she seems to be healthier than most patients who have been diagnosed with TTP although some of her symptoms seem to correlate with that of TTP as well as another disorder that is typically only diagnosed amongst pediatric patients.The hematologist also explained that recently, he has observed many different disorders and symptoms that were not observed prior to COVID, and considering that my mother had COVID four times, this could be one of those occurances.Im curious as to if any of you have recommendations or if any of you have encountered anything similar. Any suggestions are greatly appreciated. Thank you so much in advance for your help! ###Output :It would be helpful for you to post the labs results but if her cbc is normal as you're pointing out above then it's extremely unlikely for this to be TTPThe pictures you showed look like a vasculitis


###Input :Low alkaline phosphatase and low ALT(SGPT)My Child, 6 years old,18kg, male, kept complaining about sore legs (mostly around knees) for the last 4-5 years. Talked to our Gp about it few times only to be told is due to growth.It could happen all of sudden and last for a week every day or evening and then he is ok for few more weeks and then starts again. We also had months of no pain too. It is very irregular.Pain stops only after giving him pain medication along with massage.Sometimes is so bad that he is shaking from pain.We also went abroad to an private orthopedic pediatrician. Checked him and also said is probably due to growth and that is very common.Few weeks ago had another episode. He would also wake up during the night because of this pain just like before. Decided to se our gp again and asked for a referral to a specialist. It will most likely take months to get an appointment. In the mean time we did some blood tests.Results came and I'm scared. Google gives me the worst scenario for low alkaline phos. And low ALT (SGPT). I will see our gp in few days but im very concerned. Should i be that worried? He also has low eosinophils and low (0) Basophils.What other blood tests should we ask to do until we get the specialist appointment. ###Output :The low alkaline phosphatase and low ALT (SGPT) levels may suggest an underlying inflammatory process, perhaps JIA.I recommend a referral to a pediatric rheumatologist.The low eosinophil count may be related to his immune system response to inflammation.


###Input :Thank you for your answer. I called the gp to talk about the results until I see her next week. Shes telling me results are ok and should not be worried at all. She is actually telling me that low reading of alk phosphatase and Alt is no concern and would have been a problem if it was high.I kept insisting by telling her that it must be a reason for these to be low. She did not know what to say.I will insist for a referral anyway which will take months? but should i be asking for another set of blood tests in the meantime but this time to check magnesium, zinc and b6 or b12? Could this be a cause for his pains? ###Output :High levels can indicate liver or bone issues, yes, but low levels could still warrant further investigation, especially if your child is experiencing ongoing pain.Nutrient deficiencies, while they can cause muscle and joint pain, are only one of many potential causes


###Input :Could her delayed growth be a byproduct of the IUGR? Or is it more likely shes just not taking in enough calories per feed? Additionally, are there any questions that youd recommend I ask the pediatric GI doc? Thanks so much! ###Output :Both. IUGR babies are prone to have poor growth. Most continue to have slow growth in the months after birth, often leading to GI interventions such as increasing nutrient density of formula. This is to make up for the nutrient deficit present that an average infant's daily intake typically cannot surpass on its own.While the vast majority (80%) of IUGR and/or SGA (small for gestational age) do catch-up to reach sizes comparable to other children, this typically takes about two years. Many factors affect growth and stature, including any medical problems that led to her being small. For instance, this nutrient deficit and propensity to growth failure tend to be worse in infants who were also preterm (at 37+1 weeks, your daughter was born just two days further along than what we would consider "late preterm").The main things you can control and monitor at this point are her nutritional intake and feeding habits. For now, the baby's goal is to be improving in her percentiles, not worsening. I recommend working with the GI team on this goal. They will likely have you see a pediatric dietitian as well to help figure out how many calories she should be getting.Don't despair - this is more common than you would think. It doesn't mean you're doing anything wrong. You are working very hard and doing everything you can right now. Getting more hands on deck by bringing in a specialist's perspective only means more people in your daughter's corner trying to get her growing better.Most babies born with IUGR do catch up their growth by this age, so I agree with your pediatrician's concern. Increasing the concentration ("fortifying") her formula is a great first step, but it's worth seeing the pediatric GI to make sure there isn't something else going on. I'd suggest keeping track of about how much she eats in a 24-hour period as well, so the doctor can assess whether she's getting enough calories.


###Input :Pediatric question: For an 8mo baby with hypotonia and delayed gross motor milestones, how much could diagnosing the cause impact the PT/OT she is already receiving?We are talking about an IUGR baby who was born 0.03rd percentile at 38 weeks and is now 13th percentile weight, still has low BMI and diagnosed at 6mo with overall hypotonia. Currently working with PT in person weekly and OT via video-chat weekly.Skills being worked on in PT/OT include:rolling front to back (emerging, working on efficiency)rolling back to front (she never does this unassisted)weight-bearing on elbows in tummy time (often lifts arms and arches back)weight-bearing on hands in tripod sitting positionshifting weight and reaching while in prone/various seated posesbuilding lower abdominal strength with targeted exercisessensory brushing and joint compressionsimproving one and two hand grabsreconditioning oral aversion (from extensive craniosacral mouth work and tongue tie revision w/ post-surgical exercises around 4-5 months old)eating solid foods (baby will touch foods, but never bring to mouth, accepts spoon feeding enthusiastically)neck and shoulder stretches for mild torticollisIm probably leaving something out, but this is an idea of our therapy focus. We live in an area with only one pediatric neurology practice, so we cannot begin to diagnose or rule out anything until our scheduled visit in 2 months.My questions are: Is the therapy we are doing appropriate regardless of diagnosis? How could delaying diagnosis until 10 months (or later) affect her long term outcomes? Would there be any reason for us to travel out of state to a larger facility if we could be seen sooner (on our own dime, eight hours away)?TLDR: Is diagnosis of the cause of mild to moderate infant hypotonia urgent when PT/OT is already underway? ###Output :A proper pediatric neurological evaluation will better guide PT/OT, as well as if any other necessary treatments if the underlying cause is treatable.


###Input :UTI or Kidney Infection?My daughter 14F, 57, 150lbs, was diagnosed with a UTI at the ER on Thursday afternoon. It caused her to have hot/cold flushes and high HR, which is what brought us to the ER. She has been taking antibiotics twice per day, starting Thursday afternoon. NITROFURANTOIN MONO-MCR 100 MG CAPSULE. She has horseshoe kidney, which is why Im worried. Pediatric nephrology sent her urine from the ED for more tests and they came back this morning to MyChart.Urine Culture Your Value 20,000-29,000 cfu/ml Enterococcus faecalis Flag AUrine Culture Your Value 10,000-19,000 cfu/ml Mixed Contaminants X2Friday night she felt awful and had shakes for an hour. We called the Capital Blue nurse hotline and she said that its just my daughters body fighting the infection and she needs more time for the antibiotics to kick in.Its now Sunday afternoon and she is feeling bad again with a low fever (she didnt have a fever before). She doesnt feel well enough to get up and shower.Is there anyone who can offer help until we can call the nephrologist Monday morning?The ER doc dismissed her high HR and hot/cold body flushed as a panic attack, so now when she starts to feel bad she starts to panic. She has finals tomorrow and has an after school commitment starting this week. I need to figure out what is wrong and help her feel better. ###Output :Is her temperature over 100.4?Macrobid (nitrofurantoin) will treat enterococcus very well. However macrobid will not treat kidney infections, only bladder infections. If her temperature was truly >100.4 she may need another antibiotic. You can wait till tomorrow to call your nephrologist to check in.


###Input :Is a prolonged QT wave on one EKG significant? (Pill overdose)Could my incident of one abnormal EKG I received as a teenager following pill overdose need to be reported to docs 10+ years later/in the future?Or if since then I have had 2 other EKGs and a 48-hour holter monitor and only found tachycardia, am I clear? The specific abnormality was a "borderline prolonged QT wave, poss / positive for RVH." Context and other lesser abnormalities to follow.I am currently 29F with sinus tachycardia, fibromyalgia, bipolar disorder. I requested hospital records of my pediatric suicide attempt because my parents and current psychiatrist are not sharing consistent information with me about my diagnosis(es) and prior care, and I would like to get more help. I was never told that I had particular diagnostic tests run or that any came back abnormal, and I want to know whether these should be chalked up to error/a fluke/exclusive to that overdose, or whether it's something I should've reported to my doctor when my tachycardia was being investigated or should report in my future medical histories or if I were to have more concerning cardiovascular complications.As a 14-year-old, I attempted suicide by ingesting 50 ibuprofen and an unknown # of Sonata, best estimate ~10 pills. The ibuprofen # could be higher technically, since I was still taking it when I lost memory/began to hallucinate. The tox screen was also positive for caffeine.14 F 110 lbs, 5'3", on 0.5 mg Risperdal, 25 mg Zoloft, unknown if any particular mental disorder diagnosis was made at that time, "asthma," white, no drug/alcohol use.I was taken to a hospital and an EKG, head CT, and labwork were done ~4 hrs after ingestion. I presented with normal exam/vitals/labwork in the first 6 hours except for visual and auditory hallucinations and ataxic gait. After about 4 hours I was transferred to the children's hospital ER. While the initial ER noted no new symptoms and stated my EKG was normal, I did see that shortly before I was transferred my BP went from 115/80 -> 114/55.Cardiac Consult:The children's hospital notes by 2 different care team providers state that my EKG by the outside hospital had a borderline prolonged QT and poss / positive for RVH. They repeated my EKG 7 days later, and the consulting cardiologist said they were happy to report this present EKG came back completely normal. He did state that I was "admitted to [the] eating disorder program," so I hope misunderstanding why the EKG was being performed wouldn't affect his conclusion? He also offered to do an exercise treadmill test if they desired. Another note by a care team provider said they recommended I do an outpatient stress test after discharge, but I don't believe my parents ever had it done.Other noted abnormalities post-ER EKG after I was transferred to children's:1/6 systolic murmur, diastolic BP was hypotensive for 12 hrs (98/38, 101/35, 94/45, for example), bpm was 70 - 130, 2+ pulses on extremities, somnolence - at one point only arousable with painful stimuli and then immediately falling back to sleep - and a lot of vomiting later on. Seems like I went back to baseline by about 18 hrs post-ingestion.I think my parents and doctors were so worried about my mental state that they didn't even touch on the physical symptoms. Do I need to consider them at all? Or is it fair to assume that the EKG was a result of the overdose or emergency situation, but that it wouldn't have any long-term ramifications?Throwaway due to sensitive details. ###Output :An abnormality on an EKG one time in the context of a medication overdose is not worrisome, especially as it normalized later. This is an expected consequence of the medication overdose, as were your symptoms.


###Input :Im not going to lie -- between these heart rate numbers, her complaining about "heart pain" when she was younger, and otherwise being healthy and on-target (if slightly smaller than average) for height/weight/BMI...Im concerned. But I'm not a medical doctor. So here are my questions to those of you that are:Should I be concerned? If so, how concerned should I be?If this is concerning, what steps need to be taken? Do we need to take her back to her primary doctor and get a referral to a pediatric cardiologist? Should we insist that she be allowed to (as needed) walk during runs in cheerleading practice / school?Aditional Info and DetailsMy little sister does pee-wee cheerleading, and they start every practice by running 2 laps around a football field, which is ~1/2 mile (i.e., ~0.8 km). She is not quite "sprinting", but is running the whole time at (Id guess) 80-90% of her maximum running speed (with no walking breaks). When she ran it earlier tonight, at the end of the 2nd lap her Fitbit watch said her heart rate was 213 beats per minute. Her heart felt like it was literally beating of her chest, and she said that she felt like she was about ready to pass out.From what I could find online, 213 BPM for a 10-11 year old girl could be dangerously close to her maximum heart rate, though (especially at that age) maximum heart rate is somewhat variable.Ive also measured her resting heart rate a few times (e.g., after sitting down watching tv for 30+ minutes) and it has been in the 100-110 BPM range, which from what I could find online is not unheard of, but is pushing the upper limit of "normal". These measurements were in the evening (close to bedtime, before taking the 50 mg trazodone). I ran the numbers and, at this point, all the vyvanse from her morning dose has been converted into dextroamphetamine, which (on average) has gone through ~1 half-life (~50% has been metabolized, assuming a 1:1 metabolic conversion for Vyvanse --> dextroamphetamine).Note: to check the Fitbit's accuracy, one of these times I also measured her heart rate manually using my (surprisingly effective) homemade double-walled stethoscope. Over a 30-second interval, the fitbit pegged her at between 99-102 BPM, and I counted 50 heartbeats (meaning 100 BPM), so the measurements it takes seem accurate.She isnt the most "active" person -- left to her own she would sit and watch TV and play on a tablet all day -- but between cheer (3x 2-hours practices + 1 game every week), dance (2x 1-hour classes every week) and school (PE, recess) she gets at least an hour or 2 most days whether she likes it or not. And she certainly isn't overweight -- this growth chart suggests she is in the ~30th percentile for weight and ~25th percentile for height. This BMI calculator for girls puts her BMI at the 53.6 percentile (z=+0.09). ###Output :Agree with /u/muchtwojaded. Normal resting heart rate for her age/size, and the >200 HR with exercise isn't concerning to me. Sounds like she gets a good amount of healthy exercise, more than many kids her age.Nothing here sounds dangerous. If she's not complaining of symptoms with exercise, I wouldn't do any kind of workup.


###Input :Is it PPA or is there something wrong with my 9 week old son?I want to mention that Im not a FTM. This is my second baby. My first didnt sleep consistently through the night until 2.5. But I really feel like this isnt normal and no one is taking me seriously.Around 2 weeks he started refusing to sleep on his back. Weve had to resort to bedsharing(not what I want to be doing) and he still will only sleep in 30-60 min max increments. He breathes through his mouth a lot. And sounds like a pug when he breathes sometimes. He will stop breathing for a few seconds and then wake himself up with coughing/gagging noises. He frequently gags/chokes when breastfeeding as well. My pediatrician thinks the breathing is normal and that hes working us by crying when we put him to sleep on his own (told us to keep putting him on his back in his crib and hell figure it out. But he screams immediately).Hes had his tongue and lip tie removed a month ago. Chiropractor appointments. Hes on reflux meds. And Ive been dairy and soy free (was having green mucousy diapers) for 2 months. All of this has greatly improved his colic/fussiness- hes usually happy now. But not his sleep.My last resort is maybe an pediatric ENT. But idk what they would even do. Everyone keeps telling me his breathing is normal but I just have a feeling its not. I dont want to waste anyones time.Ill link a video of him breathing and screenshot of his owlet sock showing oxygen lvl and how frequently hes waking (orange is awake). I really really appreciate any advice. ###Output :See the pediatric ENT.The breathing sounds to me like he may have a "floppy" airway and could have a condition called laryngomalacia or tracheomalacia. It's fairly common, often does not require medical intervention, and typically improves with age, but you should have him evaluated particularly given the nighttime coughing and awakenings, which are likely because of the condition causing temporary drops in oxygen (as you saw on the owlet) resulting in the body's response of cough/awakening to bring oxygen back up. The pediatric ENT can use different techniques to determine whether this (or another) condition is present and responsible for the symptoms.Interestingly, children with this condition are sometimes recommended to sleep on their stomachs as it helps relieve the upper airway obstruction caused by the floppy larynx and/or trachea, so by refusing to sleep on his back, your son might just be telling you what his airway needs right now. The ENT will provide guidance on how your child should best sleep as well as any other recommended modifications to help with the condition.If bedsharing, practice safer co-sleeping techniques as much as possible as described here. Most important is firm mattress, no pillow/blankets present that could possibly obstruct the face during sleep, no smoking, drinking, or siblings.


###Input :NAD, but came here to say my child had Laryngomalacia as an infant. He was a squeaky breather but ceased showing signs at 18 months. I hope you get answers soon, OP. ###Output :Do not take your baby to a chiropractor. Chiropractors are not medical professionals, and they are especially not pediatric professionals. They are at best harmless and at worst lethal.I am not a pediatrician, I have no idea how reliable or useful Owlet monitoring is (I suspect not very), and that minimal video doesn't sound concerning to mebut I can barely hear and I am again not a pediatrician.This is something to discuss with your baby's pediatrician. If the doctor involved is not concerned, it's probably okay. If you're still very concerned, you could try getting a second opinion from another pediatrician, including bringing all of this information.


###Input :Can I ask my doctor to request pharmacare to cover Zofran?26F, 195 lbs, white, current meds are Mirena IUD, cipralex, wellbutrin, and pantoprazole. Current diagnosis of IBS.For the last four years or so have been dealing with awful and disruptive GI problems. Rectal bleeding, diarrhea, distention, nausea, vomiting, pain etc. Blood work has only ever shown anemia, which I've dealt with before, and calprotectin, fecal occult, and scopes have all been given, only finding is enlarged internal hemorrhoids but not so large to warrant a banding procedure.I saw my doctor today as nausea and vomiting were controlled by pantoprazole for almost a year, but nausea and vomiting has worsened, and I've been having increased pain localized to LRQ that will stop me in my tracks, and feels like a rolling intense cramp, or intense pressure. She wrote me a prescription for Zofran, and it was $272 for 90 tablets. I have provincial coverage, but since I'm not a pediatric patient or undergoing chemo or radiation I'm not eligible for coverage.Could I ask my doctor to petition pharmacare to get me coverage and explain that I've already been on meds that have failed to control problems? How likely is it that can be covered ###Output :Zofran has been off patent for a little while now, ask for the generic, it should be at least half that price


###Input :I did get the generic , don't know what I would have done if got the name brand ###Output :Yea right, interesting. 10 wafers generic in australia is around $14 so youre still getting a solid premium over there


###Input :1 year old sudden loss of visionOn Thursday, my 15 month olds babysitter noticed that she wasnt making eye contact like normal. At home, I noticed the same thing. Normally, if I look at her and smile she smiles back. But it looked like she was looking right past me. Along with that, she was not tracking objects with her eyes.I took her to the pediatrician on Friday who was concerned and wanted her to see an ophthalmologist right away. So we did that, she had a full eye exam with her eyes dilated and there was nothing wrong (like far sightedness or strabismus etc) with her eyes. The ophthalmologist was concerned too and called a neurologist who wanted us to go to the ER so we could be admitted into neurology over the weekend.The ER did a lot of blood work, a spinal tap for fluid (I cant remember the name- Im sorry.) and the doctors there just generally said they were stumped.We are on day 2 of being in the pediatric neurology unit. Shes having an EEG done for 24 hours and hopefully an MRI today. The neurologist says hes fairly confident she isnt having seizures but wants to cover everything.I hope one or both of those things gives us an answer but in the mean time all I have to do is think. What could possibly have caused this loss of vision seemingly overnight? She responds to sounds but not objects. Shes had hundreds of lights (from nurses doctors etc) flashed right in her eyes and she does nothing like youd expect. They shined a light in my eyes to show me how abnormal it was that she did nothing because I instinctively moved my eyes.Also... no falls, no high fevers, no recent illness, her birth was normal, shes developmentally normal.Does anyone have any idea of what this could be? ###Output :Sorry to hear about your daughter. It is hard to know the cause without all the test results at the current time, especially the MRI, as this seems to be something less common. If she looks well in other aspects (except for the vision loss), and has already been evaluated by a pediatrician, ophthalmologist, and a pediatric neurologist, you are doing everything you can, and it seems that everything necessary is being done. Vision requires normal eyes, normal optic nerves connecting the eyes to the brain, and normal function of the visual cortex of the brain, and of course normal response to vision requires good function of the rest of the brain. Generally most problems affecting the eyes affect only one eye at a time, and can be seen by the ophthalmologist (either anterior chamber problems such as cataracts or posterior chamber issues such as retinoblastoma). Problems affecting the optic nerves (e.g optic neuritis) are more often seen in older kids (e.g with multiple sclerosis) and are very rare at 15 months. Rarely, there can be problems near where the optic nerves come together just behind the eyes (optic chiasma) when masses (eg. craniopharyngioma)/cysts push on them and can cause visual loss. It is also rare for things to affect the visual cortex of the brain. I suspect that the MRI will be of help. If it does find something, it might need other specialists (e.g. neurosurgeon) to provide further information on management.


###Input :Are there different sized tools for transvaginal ultrasound?Female, Canada, 27.I think I'm expecting to get a transvaginal ultrasound sound done today, my first ever. Problem is that although I'm an adult, my body has stunted growth and I also barely have any experience putting something in there. I've only put something in there long ago that's really small and the last was like 2 days ago when I had my pap exam. She used the pediatric sized tool and even that was on the painful side. So I'm really nervous about the upcoming one because I'm worried it will damage me if they don't see where to stop at. Will they be able to see where to stop the end of it and do they've different sized ones? ###Output :The probes used for transvaginal ultrasound aren't that big, and are smaller diameter than a pediatric speculum like you would have had used for the Pap smear. Another thing you can do if you're comfortable with it is ask to insert the probe yourself, since it's more comfortable for many people.


###Input :13 year old athlete EKG results - Sinus bradycardia and Intraventricular conduction delayMy 13 year old is 5'11, 188lbs, was complaining of chest pain on the 29th that every time he took a deep breath it hurt. No pain when breathing normally, pain located almost directly in the middle of his sternum and a little to the left. He does play sports year-round - Football and wrestling. I cannot get an appointment until Monday with a cardiologist and I am having a hard time understanding what this means! ###Output :Would need to see the actual ECG. This may be the auto-interptetation by the machine. They are notoriously wrong.


###Input :1 year old Male, question about delayed passage of meconium as a newbornMy son (1yoM) has had chronic constipation since early infancy, beginning when he was exclusively breastfed. After no success with dietary remedies, ped prescribed Miralax, which has significantly improved his constipation. But it has not gone away, so ped had a barium enema performed. This test was normal, but he was referred to pediatric GI since the constipation has remained, and GI said that Hirschprung's is not ruled out and is wanting to conduct further testing.My question - part of why they're suspicious of Hirschprung's is that my son did not pass any meconium/poop at all from the time he was born until he was 4 days old. I understand this is very delayed passage of meconium. However, he was an out of hospital birth, and my mom, who was present at the birth, is sure that meconium was passed during delivery, because she said the amniotic fluid coming out as he was born was brown. The midwives never mentioned this. Obviously my mom is no medical professional, but I don't want to be raising false alarms with the doctors by reporting that he did not pass meconium if in fact he did during labor.So - if he passed meconium during labor, and then did not poop at all for four days, then passed a large volume of meconium, would this be considered normal, or still qualify as a risk factor for Hirschprung's? I've struggled to get a clear answer from his doctors, and I want to be sure that he isn't getting more testing than he needs due to me misreporting information. ###Output :Even if he did pass it during delivery, not having further meconium passage within the first 4 days after birth is abnormal. Sounds like further workup would be warranted.


###Input :displaced acute supracondylar humeral fracture with dorsal and radial displacement - 1/16/23My daughter fell off the monkey bars today. She landed on her back and elbow. I could immediately tell it dislocated. I called rescuer and they put a splint. I took her to the ER and they did X-rays. Based on the X-rays they said she had a displaced acute supracondylar humeral fracture with dorsal and radial displacement - the pediatric orthopedic was not available to come in but the PA said she spoke to him on the phone and they determined she needed surgery. I really dont want her to have surgery unless its absolutely necessary. Shes only 5 years old. Please help. Id like another opinion. Is there another non-surgical option? We were admitted and will stay the night in the hospital. ###Output :She absolutely needs surgery. Its a very small surgery in the realm of orthopaedics. It will be 2 or 3 pins placed through the skin and then a cast or splint applied. Theyll be able to take the pins out in the office after it heals. The only type of supracondylar fracture thats amenable to non-operative treatment are those that are non-displaced. If you elect for non-operative treatment for this fracture pattern, your daughter will have permanent, long-term elbow dysfunction.


###Input :I (23F) keep sleeping through my doctors appointments due to a sleep disorder.Caucasian, 95lbs, 54. Diagnosed PTSD, Anxiety, Depression, Essential Tremor, Hypoglycemia. Taking 150mg Oxcarbazepine 2x/Day, .5mg Clonazepam 1x/Day. Vape nicotine and cannabis.Im currently dealing with several medical issues but am unable to get them treated/diagnosed because I sleep all day, every day. The sleep issues have been ongoing and worsening over the past decade.I sleep 16+ hours every day, cannot sleep at night, nothing and no one has been able to wake me up (incl. medical professionals in a hospital setting, my partner, assorted alarms, resetting my sleep schedule, etc)I had an appointment with my PCP on the 26th at 8 AM that I had to pull an all nighter for to be able to go to. I got an abnormal EKG reading and needed labs. They proceeded to try to draw blood..but my veins are tiny (they used pediatric needles) and kept collapsing, so they requested I come back today (the 28th) at 10 AM, extra hydrated and rested (they said my not sleeping couldve been partially to blame for labs difficulty).Well, thats about 2 hours past my bodys chosen bedtime, so I accidentally fell asleep (and woke up at 8 PM today).Everyones getting frustrated with how many appointments Ive missed (myself included). If I continue to miss appointments (especially therapy) I could be labeled as non-compliant, which could royally fuck everything up.How can I make my appointments? How can I treat my condition myself enough so that Im able to get professional care (for this and other issues)? At the very least, how can I show/prove that Im invested in my care despite my repeated missed appointments? ###Output :Taking a sedative (clonazepam) whilst also smoking a sedative (cannabis) certainly wont help you to not fall asleep.


###Input :[26][F] I have moved to a new state and have WA State Health Insurance. Questions about choosing my PCP.I previously had a PCP who helped with various issues but mainly helped me with my medication management for my mental health issues. We have found what works for me (see 'Current Medications' below) but I want to have a PCP that is versed with medication for mental health issues in case changes are needed to be made (It took many years, several doctors, and many different medications to come to my current Rx and I am very thankful to my previous doctor for helping me get to such a point). But I also am 26 and am more aware of my women health needs and want to be sure I'm addressing those and staying healthy. I also have an IUD that needs removal soon, at which I will likely get another inserted.I was assigned a doctor that works at a "Pediatrics Associates" place with the credentials (MSN, ARNP, NP-C). I am confused as to why I was assigned to go somewhere for pediatrics, as it was my understanding that it was for children, though I am not discounting my assigned PCP's credentials. I looked into other PCPs that were on the directory and found an MD in Family Medicine and Obstetrics. Seeing this doctor would be a further drive for me but it intrigues me since I have never been to an OBGYN. Since I am getting older and leaning more into health women's health, should I request to begin seeing this PCP instead? -- Note that requests for doctor changes are allowed. -- or does the assigned doctor seem to have plenty credential/ knowledge for me to establish care?Hope this doesn't seem undermining at all, I just want to make sure I'm making a good decision since I will likely establish long term care with my next doctor!TIA :)Height: 5'4"Weight: 110-120 lbRace: Asian AmericanPrimary Concerns: Vaginal Health & Mental HealthExisting Medical Issues: Diagnosed ADHD, MDD, GAD. Prone to overproduction of yeast leading to BV or Yeast InfectionsCurrent Medications: Venlafaxine 150 mg, Vyvanse 60 mgOccasional drinks weekly. No smoking. No drugs. ###Output :Yeah, no idea why you would have been assigned someone who works in a pediatric office. I'd switch to the family medicine MD.


###Input :Childs swollen elbow normal?4.5 years old 37lbs 43in.My daughter fell and hurt her left arm on Sunday evening. We took her to urgent care early Monday morning. Got X-rays and there are no fractures. They determined it was a Nursemaids Elbow and tried a few times to reset it, but they werent sure they were successful because she was resisting, even though we were (safely) restraining her (the absolute worst worst WORST for my heart omg).They told us that we should bring her to an pediatric orthopedic doctor today if she wasnt using it by the end of the day (yesterday, Monday).I did notice her using it a little bit more, though not much. She complained it hurt for the rest of the day (when she went to wash her hands and used it to push down on the soap dispenser, she screamed out in pain).Today she woke up and I noticed its a bit more swollen than her other elbow. Shes still complaining that it hurts and is using her other hand to hold her arm close to her body, but she turned a page in a book with it as I typed this, which is way more than shes done in the past day and a half.Im not sure if its just from being a bit manhandled by two different doctors trying to reset her elbow yesterday, and so we should let it be, or if its worse and I should take her to the orthopedic doctor this morning. ###Output :I would definitely take her to get checked by the pediatric Ortho. The injury is not consistent with nursemaids and these are typically very easily reduced. Worth a second look for sure.


###Input :Could they have seen it in an X-ray? They didnt show us the X-ray, but said there were no fractures. ###Output :The elbow can be tricky in kids. Sometimes they hide fractures very well there and we may not see them initially on x-ray.


###Input :Pediatric Dentist ? 5yo needs dental work.My son 5M 55lbs no medications or health concerns besides this one.Hoping theres a pediatric dentist on here? My son has a tooth thats got an abscess on the gum above it. That tooth has to be pulled and he also needs a crown on another tooth that has a bad cavity. He doesnt do well at the dentist and they suggested IV sedation for him.They do this in their office (pediatric dentist plus dentist anesthesiologist) which I found unsettling and wanted to know if thats normal? Is this general anesthesia like where hed be intubated? I always thought that needed to be done in a hospital setting.I already feel like the worlds worst mother so I know its my fault for letting his teeth get so bad. So adding this anxiety to my guilt. Just worried about his safety and if an emergency should arise we wouldnt already be in a hospital.My next question is that they didnt schedule it until mid October and thats over a month and a half wait with an abscessed tooth. Im afraid its going to get much worse in that time. They prescribed an antibiotic but Is there anything I can do at home to keep it from getting worse?If anyone has any advice for this terrified mom I would truly appreciate it. ###Output :You probably won't find a pediatric dentist on here (this is AskDocs, not AskDentists).IV sedation isn't the same as full general anesthesia where he'd be intubated. They'll use IV medication to calm him down and make him sleepy, but he'll still be breathing on his own. WIth proper monitoring (cardiorespiratory monitor, O2 saturations, etc) this is very safe. Similar to the sedation that's given for many people to get their wisdom teeth removed.Besides ensuring good brushing and taking the antibiotic, not much you can do to keep this from getting worse. Stuff happens, don't beat yourself up.


###Input :My 6 year old is sick every other week. I need advice.I need advice! My 6 year old is in kindergarten and has had strep, pink eye, and bronchitis every other week! He's well for a week then gets hit with a new fever, and sick again. I am not sure what to do. Care is the worst around us and we are on a waiting list for a pediatric ENT for possibly getting his adenoids out. Anything I may be missing or what I can do? It breaks me how sick he is all the time and the amount of school he keeps missing. ###Output :How are his growth and development? Every child has been getting sick constantly for about 9 months, so probably he is just like every other child. But without any information no one can say.


###Input :Low alkaline phosphatase and low ALT(SGPT)My Child, 6 years old,18kg, male, kept complaining about sore legs (mostly around knees) for the last 4-5 years. Talked to our Gp about it few times only to be told is due to growth.It could happen all of sudden and last for a week every day or evening and then he is ok for few more weeks and then starts again. We also had months of no pain too. It is very irregular.Pain stops only after giving him pain medication along with massage.Sometimes is so bad that he is shaking from pain.We also went abroad to an private orthopedic pediatrician. Checked him and also said is probably due to growth and that is very common.Few weeks ago had another episode. He would also wake up during the night because of this pain just like before. Decided to se our gp again and asked for a referral to a specialist. It will most likely take months to get an appointment. In the mean time we did some blood tests.Results came and I'm scared. Google gives me the worst scenario for low alkaline phos. And low ALT (SGPT). I will see our gp in few days but im very concerned. Should i be that worried? He also has low eosinophils and low (0) Basophils.What other blood tests should we ask to do until we get the specialist appointment.Thank you! ###Output :The low alkaline phosphatase and low ALT (SGPT) levels may suggest an underlying inflammatory process, perhaps JIA.I recommend a referral to a pediatric rheumatologist.The low eosinophil count may be related to his immune system response to inflammation.


###Input :Thank you for your answer. I called the gp to talk about the results until I see her next week. Shes telling me results are ok and should not be worried at all. She is actually telling me that low reading of alk phosphatase and Alt is no concern and would have been a problem if it was high.I kept insisting by telling her that it must be a reason for these to be low. She did not know what to say.I will insist for a referral anyway which will take months? but should i be asking for another set of blood tests in the meantime but this time to check magnesium, zinc and b6 or b12? Could this be a cause for his pains? ###Output :High levels can indicate liver or bone issues, yes, but low levels could still warrant further investigation, especially if your child is experiencing ongoing pain.Nutrient deficiencies, while they can cause muscle and joint pain, are only one of many potential causes


###Input :21 year old female with GI issues for years but they keep getting progressively worseI cant remember if I always had these issues, but I remember being 12 years old and starting to have very consistent diarrhea. All throughout middle school and high school I had mostly diarrhea BMs, with a few episodes of constipation. I always assumed it was how my family ate. Around 18 it got worse. I started to become constantly nauseous and lost over 50 pounds from throwing up and diarrhea. I went to the doctor but they told me change my diet. Since moving out last year and making changes to my diet to be healthier and adding more probiotics and fibers, nothing has changed and it feels like its getting worse. Now I have constant painful gas that bubbles in my stomach and honestly smells so bad. Im embarrassed to leave the house most days in fear my coworkers will notice. My joints have started to have unbearable pain, mostly in my hands and hips. I get sick once a month and it leaves me bedridden at least one day. I feel like my body is falling apart on me.I drink lots of water and try to keep my diet to standard to help my stomach, but Im not sure what else to do. I recently aged out of pediatrics and am unable to find any doctor near me that both accepts new patients and takes my insurance. I just feel so lostIve never had a diagnosis before other than for mental illnesses. Ive considered it being stress, and while it does get worse when Im stressed, its always like this no matter what my mental state is.For family history, we have no diagnosis of IBS or Crohns, but my mother had really bad undiagnosed stomach issues and died from breast cancer. All the women in my family have had breast cancer. My sister has diagnosed rheumatoid arthritis (she is 30, was diagnosed at 26) ###Output :Have you been tested for celiac disease? You should see a GI doctor if your PCP isn't doing any meaningful work-up. There are many possible causes


###Input :Is antibiotic resistance some thing I have to worry about?I have a daughter who is four years old. She has no pertinent or obvious health problems, except for a lingering cough she had for about eight months after we had Covid last year. She is almost 4 feet tall and about 55 pounds. She has been having recurring vaginal discharge for over a year now. She has been on amoxicillin, Cefdinir, and keflex. Finally, after so long of not having any answers, they finally sent her to a pediatric gynecologist. She did an internal swab and found the strep bacteria. But, after a phone call with her, she told me that all of the antibiotics she has taken so far should have killed the bacteria. Each time she took antibiotics it was for 10 days.She prescribed her another, fourth kind of antibiotic, and said that if this doesnt kill it, that she will have to have a check up inside her vagina under sedation. I am not against this procedure, but now I have become a little worried about antibiotic resistance. If these previous antibiotics were supposed to kill the bacteria and she took them for 10 days, is this a bad sign? Or is it really possible that these three different kinds of antibiotics that she took for 10 days each didnt really kill the bacteria? Id love another doctors opinion on the matter. ###Output :It's probably fine.It's not clear to me she has an infection that needs antibiotics.


###Input :Would a swab that shows strep not indicate antibiotics? ###Output :If you swab a human's orifice, it will grow bacteria.Whether that bacteria is the cause of an infectious pathology is a different question.Are you talking about group A or group B strep?


###Input :Any pediatric GIs who are familiar with intussusception? Or something that presents as such symptomatically?Any pediatric GIs who are familiar with intussusception?My 15month old son who was full term at birth was diagnosed with a small bowel intussusception when my husband and I brought him to the emergency room yesterday, 12/21/2022. The ultrasound report read, There is a 1.1 x 0.9 cm small bowel small bowel intussusception in the left hemiabdomen near the umbilicus. No evidence of ileocolic intussusception in the right lower quadrant. No free fluid in the abdomen or pelvis.After this was found on ultrasound, after 2 hours, an ultrasound was repeated, and the intussusception was gone.I have to say I wasnt surprised by this diagnosis, and I am GLAD that it was found on ultrasound.Since my son was six weeks old, he has experienced what I intuitively thought was GI distress. He would scream inconsolably, turn red in the face, and grunt as if he were trying to bear down. This wasnt infrequent; it was all happening all the time. Every week we would visit the pediatrician and an urgent care 1-3 times. At these visits, they would tell my husband and me that it was colic or gas or fussiness. We tried different formulas with cutting everything out of my diet because he was getting breastmilk too. We tried gas drops, bicycles, probiotics, and the colic holds we were shown. You name it; we tried it.After six months of torture for my little guy, I finally said ENOUGH was ENOUGH, and I brought him to the emergency room. The imaging at the emergency room showed that he had a lot of gas in his abdomen, and it was recommended that we try a hypoallergenic formula. (Before this, my son was getting breastmilk supplemented with formula.) We switched to Similac alimentum. Once we discovered that all of the formula we had given our little guy was recalled, we changed to Nutramigen. Since being on the hypoallergenic formula, the CONSTANT crying and screaming had subsided but hadnt completely gone away.He would have bouts of inconsolable screaming that would last 20 minutes, and then he would calm down. Sometimes he would have bouts of screaming that would last 20 minutes, calm, and then crescendo into more extended periods of crying with bearing down, turning red in the face, shaking, and vomiting.With that said, I am looking for some guidance. Has any pediatric GI seen or heard of small bowel intussusception reoccurring for this time? The Emergency Room doctor said he couldnt answer this question because he sees the acute visit of patients. He recommended that we follow up with a pediatric GI surgeon and our pediatrician.I spoke with the pediatric GI Nurse Practitioner, and she said they do not perform surgeries on small bowl intussusceptions. She said that they only perform surgeries on small to large bowl intussusceptions. She also said that this should subside when he is 5 -- she said this as if I could look forward to relief for him in 3 1/2 years!!The pediatric GI Nurse Practitioner and the Emergency Room Physician told me that I should bring him to the ED anytime he presented the way he did when I brought him in when he was diagnosed. This cant is the answer. This is not sustainable for us or our child. Since he was 15 months old, we have brought him into the ED, pediatricians office, and urgent care countless times for the same issues. It just so happens that they FOUND the cause THIS time.I would like to know if anyone has guidance or familiarity with this. Some questions I have are, has anyone ever seen a re-occurring intussusception? If this is re-occurring, is our only option to keep bringing him to the ED? Could something else be missing? Who else should I talk to? What else should I do?I am so frustrated with all the conflicting information and advice I have been given over the last 15 months. I feel so discouraged and not heard.I am so worried and heartbroken seeing my son constantly go through this.Any suggestions would be helpful. I am following up with our pediatrician, and hopefully, they will FINALLY put in a referral to a pediatric GI. I am a registered nurse, so I have a general background in the medical field. ###Output :Transient small bowel intuss is a common finding in kids with belly pain or GI distress.No, it essentially never needs intervention.Kids get it all the time when they have stomach bugs. You just don't have an ultrasound on their belly the whole time.This may or may not be related to his prior issues of belly pain at all.A possible, but unlikely possibility is some sort of pathologic lead point that causes recurrent intuss. Like a Mekels, a real bad Peyer's patch, vascular anomaly, or even less commonly malignancy. I know of these being implicated more so for recurrent ileocecal intuss, but I suppose there's no reason they can't occur higher up.I think referral to peds GI is appropriate.Another possibility is Deitls crisis. It's recurrent, transient UPJ obstruction that causes episodes of pain, similar to intuss. It's rare, but also underdiagnosed, because nobody fucking knows about it. Small kids that have it are actually experiencing renal colic, but can't communicate it, and are presumed to have actually have abdominal pain. It's something to consider in the child with chronic episodic belly pain that self resolves and has no other symptoms.


###Input :Pediatric Psych patient dosage9 F Caucasian 93 lbs 4ft 6?My daughter was prescribed Lexapro 5 mg and everything I'm reading online says it's not for children under 12. I reached out to her pediatrician and he says to contact them because it's their expertise. I've been trying but am not getting through. In the mean time, is this something I should hold off on giving her or is the dosage small enough? ###Output :Its likely safe but there is limited evidence to show efficacy (limited number of trials). Id hold off until you speak to psych, 1-2 days while you wait to speak to a psychiatrist for more clarification wont make a difference. It takes 6 weeks of consistent use before you really start to see much in the way of improvement to begin with, for most patients.


###Input :Thank you for your reply! She was given it starting on Saturday and seemed to do fine. I did end up getting through to someone and they said it was fine to give because she had been monitored while on it. I can't find any info as to why it's not recommended for children under 12 but they seem to find it appropriate, so I'm going to assume it should be? ###Output :They dont recommend against it. Its just the lack of evidence and a strong benefit/risk analysis that prevents them from recommending it in patients under 12 at this point.


###Input :(Pediatrics) 24 month old white female with discordant bone age. 31" tall, 21 pounds. No meds, no surgeries.(Pediatrics) 24 month old white female with possible short stature. 31" tall, 21 pounds. No meds, no surgeries.My 2 year old hasn't been getting very tall as she's gotten older. She's dropped to the first percentile for height. Her first pediatrician wasn't overly concerned, but we saw a new pediatrician and she was concerned and had her x-rayed. I got the report back, but the doctor is out of the office so I won't be able to talk to her until next week.The radiology report says:FINDINGS: A single radiograph of the hand was provided for evaluation of bone age. The patient's chronological age is 24 months. The hand bone age according to the tables of Greulich and Pyle is approximately 2 years. The wrist bone age most closely approaches that of 1 year and 3 months. The standard deviation for the patient's chronological age is 4.64 months. No structural abnormalities are identified.IMPRESSION:Discordant bone age between the hand and wrist, but both are within 2 standard deviations of chronological age per the age and gender matched standards of Greulich and Pyle.Is the discrepancy worrisome?https://flic.kr/p/2nS9y6S ###Output :Worrisome probably isnt the right term. It isnt indicative of anything dangerous.It can sometimes indicate a hormonal issue that requires endocrine referral.But will also say that pediatric endocrinologists and radiologist often disagree on bone ages.Bone ages are pretty subjective. Basically they x-ray the hand in a specific way and then compare it to a book with known bone ages and say eh, I think it looks like this one the most.


###Input :Disagree in what way? Just generally, or does one group tend to say bone age is more/less advanced than the other? ###Output :Just generally. I dont do bone ages but have heard a few endocrinologists say I never listen to radiologys reads on bone ages. Then they proceed to do it themselves.


###Input :6 year old with hallucinations currently hospitilized. Is this autoimmune encephalopathy?Age: 6Sex: MaleLocation: New England, USAMy child has been in the hospital over the last week for suspected autoimmune encephalitis. I brought him to the ER on 4/11 per instruction from his pediatrician due to visual hallucinations. He was admitted after neurology came to the ER for a consult. The hallucinations have not been improving with treatment as of yet (4 days of IV steroids & 1 day of IV IG, see below for more specifics). I've been advised 90% of the labs will take a couple of weeks to get back. Is there anything else we should be considering? He's the happiest kid, he absolutely loves school and his friends and teachers and he can't wait to go home. He knows what he's seeing isn't real and I wish I could make it go away. Any insight/advice would be so appreciated. He's been a trooper throughout this process but it's not easy wondering every day what is going on. I can provide additional information if needed/requested.Assessment/Plan: Child is a 6 y.o. 5 m.o. male with PMH of hypnagogic hallucinations and asthma who presents for evaluation of 2 days of daytime hallucinations. Given acute onset of worsening visual hallucinations that started with nighttime awakenings on 4/7 and then progressed to daytime visual hallucinations on 4/10, we are concerned for autoimmune encephalitis. LTM EEG with left parasagittal and temporal spike wave epileptiform discharges, suggestive of underlying brain irritability. However, patient is very well appearing with no other classic features of autoimmune encephalitis- no encephalopathy, no weakness, no abnormal movements. Given that he is very well appearing and is not demonstrating significant decline from day to day, we will plan to first obtain CSF and brain MRI with contrast prior to starting immunosuppression. If CSF is bland, we would likely still recommend treating with immunosuppression given clinical concern and patient meeting diagnostic criteria for autoimmune encephalitis.EEG is abnormal but no definite seizures. Frequent and sleep activated left temporal and parasagittal spike and wave epileptiform discharges. Brain MRI normal. LP overall bland with 1 nucleated cell in tube 1, 2 nucleated cells in tube 2. Other labs pending but does have ANA positive at 1:320.Has been on IV steroids since 4/14 with no improvement in visual hallucinations. Will plan to continue steroids for total 5-day course and discuss case with our neuroimmunology colleagues. (This plan changed after neuroimmunology consult, began tapering steroids after 4th day to begin IV IG)Treatment:s/p 4-days of high dose IV methylprednisolone (30mg/kg daily)prednisone taper: 1mg/kg (max 60mg) prednisone tapering over 6 weeks (can roughly cut in half every 7 days) Week 1: 30mg daily Week 2: 15mg daily Week 3: 10mg daily Week 4: 5mg daily Offstart IVIG today for 2-days- IVIG 2g/kg divided over 2 days. Started on 4/17 treatment was well-toleratedResulted workup:EEG abnormal with frequent abundant spike wave epileptiform dischargesEEG continued to demonstrate frequent abundant left parasagittal and temporal spike wave epileptiform discharges -EEG from 4/12 -Frequent to abundant left parasagittal spike wave epileptiform discharges that occurred both independently and in brief 1-3 Hz runs lasting <10 seconds (BIRDS) -Occasional to abundant left temporal spike wave epileptiform discharges that occurred both independently and in brief 1-1.5 Hz runs lasting <10 seconds (BIRDS)quick brain MRI normalsedated brain MRI with contrast normal, incidental finding of likely arachnoid cystReassuring CBCd, BMP/Mg/Phos, LFT'sESR and CRP normalTSH elevated to 7.44, free T4 normal at 1.1B12 and folate normalRPR non-reactiveRhinovirus positiveCeruloplasmin normalUrine tox negativeUA normalANA positive 1:320, speckledSerum copper within normal rangeCSF opening pressure 15CSF cell count and total protein normalAnti-TPO antibodies negativeHIV 1/2 negativeCollected and pending: [] CSF culture [] CSF HSV PCR, CSF VZV PCR, CSF VZV IgM [] CSF oligoclonal bands, IgG index, beta-2 microglobulin, flow cytometry, cytology [] CSF autoimmune encephalopathy panel [] CSF anti-Glycine-R antibody [] Serum Glycine Receptor IgG [] Myelin oligodendrocyte glycoprotein [] 24 hour urine copper [] 24 hour urine porphyrins [] Double stranded DNA antibodies [] Antiphospholipid antibody panel [] Thyroglobulin antibody [] Serum MaTa Autoantibody test [] SPEP panel [] MS profile, serum and CXF [] IgG index/synthesis rate, serum and CSF [] EBV serology [] VZV IgG, IgM [] HSV PCR, HSV type 1,2 antibody [] Serum encephalopathy panel [] Mycoplasma IgM, IgG [] Lyme screen with reflex to immunoblot [] HSV PCR, serumMENTAL STATUS EXAM: Appearance: appropriately dressed Behavior: cooperative, eye contact good and pleasant Psychomotor Activity: normal Musculoskeletal: moves all extremities; no abnormal movements Station/Gait: normal Speech: regular rate, regular rhythm and regular volume Language: normal comprehension Mood: happy Affect: full range Thought Process: logical, linear and goal-directed Associations: no loosening of associations Thought Content: no delusions and no obsessions Perceptions/Experiences: visual hallucinations Orientation/Sensorium: alert Memory: immediate recall intact. Attention/Concentration: intact to observationImpression: Child is a cheerful and pleasant 6 yo boy, from X attending Kindergarten at X. He has a hx of mild OSA, hypogogic/hypnopompic hallucinations since early on, asthma, no prior past psychiatric history, presenting for worsening hallucinations since 4/10, admitted for medical work up on etiology. Psychiatry consulted for diagnostic clarification, support and medication management.4/14/23: Patient continues to be calm and cooperative, behaviorally appropriate for a 6-year-old boy. Continues to experience visual hallucinations, yesterday night described as "monsters," which patient is understandably afraid of. Most of patient's hallucinations are visual, vivid, and neutral with minimal emotional involvement. No auditory hallucinations. No clear seizure activity on EEG, other than minor blinking, clinical signs of seizure disorder not noted on physical exam. Pt age, onset, and symptoms are not typical of a primary psychotic disorder or normal development. We agree with pediatric neurology and primary team that the origin of hallucinations are organic. No emotional or behavioral dysregulation. Thus, we do not recommend scheduled psychotropic medications at this time. Pediatric neurology assess patient has underlying brain irritability from EEG findings (left parasagittal and temporal spike wave epileptiform discharges), likely secondary to encephalitis, as opposed to seizure disorder. ###Output :What were the CSF cell counts, protein, and glucose?


###Input :3y(f) Seeing Pediatric Pulmonologist - What to Expect and Genetic TestingMy (37F) daughter (3F) will be seeing a pediatric pulmonologist next week for suspected asthma. Her pediatrician has diagnosed it as "mild or intermittent" but from my observations, it is not mild and is getting worse. It was thought she had recurrent croup but we now suspect those croup episodes have actually been asthma attacks/flares. They only occur during viral illness, but each time she is sick she ends up in respiratory distress and needs an ER/hospital visit. She is prescribed albuterol, flovent, and decadron. Pediatrician agreed to allow us to only use flovent at onset of illness so it is not daily use.I don't know if there will be genetic testing performed, but I did sign a form agreeing to genetic testing.My question is, should I be thinking this is something beyond asthma and possibly genetic? Should I push for imaging and/or genetic testing? ###Output :Peds ER doctor here, sounds very much like asthma. No, genetic testing is not done routinely at all, i suspect they make everyone sign that form before coming in so that they can streamline the process if they need to test patients for anything.