Friday, August 20, 2010

The Appointment

Warning, this is probably going to be a LONG post!

We had our appointment with the Nurse Practitioner at the Gastroenterologist yesterday afternoon. Prior to this, like I said, Brendan had not been on any solids since Monday and had only had the hypoallergenic formula. His poop had become totally watery diarrhea (sorry, gross, I know) because of only being on that formula and so it was hard to tell if it was still black or not but I thought it looked more brown by yesterday morning. Anyway, we went to the appointment at 3:00 and I really did not like the NP at all. She pretty much totally got on my nerves. She came to the conclusion (after talking with us for less than 5 minutes) that he FOR SURE has a milk protein allergy and will need to stay on the hypoallergenic formula and avoid all dairy products in solids. She did say most babies outgrow this allergy by the age of 1 and there was no reason to think he couldn't be started on regular milk at age 1.

She said she did not believe at all that he had a bleeding ulcer because that is very rare in babies. This was one thing I actually agreed with her on because, when I tried googling it this past weekend, I couldn't find any information on ulcers in babies. However, after thinking about what our pediatrician said, I think that he was actually saying he thought the lining of Brendan's stomach got irritated and caused a bleed, rather than that he actually had an ulcer. I'm not sure if he just used the wrong word or if he was just trying to explain it to us.

Here is why she annoyed me and I am uncomfortable with her diagnosis.

1. She had no prior medical history of Brendan whatsoever. She didn't even know how much he weighed prior to them weighing him at this appointment. She told me he has had this allergy his entire life. I don't believe that's true and here's why:

  • I told her he had a lot of gas when he was little, which she said was a sign of this milk protein allergy. But, I tried eliminating dairy from my diet whenever I was breastfeeding and it didn't make a difference. Our pediatrician said babies often just have to work out their systems because they've never had food, etc before when they are born and just have to get everything worked out. Sure enough, Brendan's gas decreased dramatically, pretty much becoming non-existent, after a few months and he had no gas when he was on the sensitive formula. His gas only returned when I put him on the Earth's Best Organic formula which was full lactose.
  • He's never had a black stool in his life until we started the Earth's Best, signaling to me that the problem didn't start until then. When I put him back on the Sensitive, he went back to normal for awhile and then the blood came back. To me, that means that the Earth's Best was irritating him, it got a little better whenever I switched him back, but the irritation was still there so he had bleeding.
  • She said the blood in his stool was caused from constipation. This was AFTER I told her that, prior to only being on formula this week, he pooped about 3 times a day. When she said he was constipated, I said "he was constipated when he pooped 3 times per day?!" and she just said "yes." I'm sorry, it seems a little strange to me that he could be constipated when he was going three times per day and a lot of babies don't even go ONE time per day and aren't considered constipated.
  • I don't know if I've mentioned it here before, but Brendan is a bigggg grunter whenever he poops. This started right before we started him on solids. I asked the pediatrician about it and he said if I didn't notice it only occuring whenever I ate something specific (this is when I was still pumping and giving him breastmilk) or notice it with a specific solid whenever he was eating solids, that that might just be the way he goes. He said some babies are just like that and it's not abnormal. So Tim told the NP at the appointment yesterday about Brendan grunting when he goes. Her response was "yes, that's because he's constipated because of the allergy" (by the way, not to be gross again, but his poops are very, very rarely hard or small pebbles like he is constipated. They are usually a very normal consistency). Well, she gave us the go-ahead to give him solids again as long as he didn't have any dairy. So, last night, Tim gave him carrots, sweet potatoes, and a plum/cherry purree for dinner - all of which I made myself so I know that they have no dairy whatsoever in them. This morning, after Brendan gets up, he's sitting on the floor playing and what does he do? He starts grunting when he's pooping (Oh, and his poop wasn't hard at all, it was totally soft). he still grunts when he's not having any dairy and hasn't had any for the past five or 6 days? Strange....

Ok, I realize it probably sounds like I am being snotty and that I am possibly ungrateful for the fact that he has a minor allergy rather than an ulcer. That is not the case AT ALL. I am extremely happy that, if something is wrong, it is just an allergy and he doesn't have some terrible medical condition or a bleeding ulcer in his tummy. But, if he doesn't actually have an allergy at all and just had an irritation that will get better (or might even already be better) and he doesn't have to be on special formula until he turns 1 and doesn't have to completely avoid dairy until he turns 1, I would rather go ahead and know that. It doesn't help the situation for me when I feel like the NP just latched onto that conclusion that he has an allergy and wouldn't listen to any of Brendan's history that might tend to point to the fact that that might not be the case. She didn't even act like it was a possibility that he could have just had an irritation.

I do realize she likely has more experience in the area of digestion than my pediatrician but he knows a heck of a lot more about Brendan's history than she does. So, I think what we decided to do is go back to our doctor in about a week or a week and a half, bring a dirty diaper for him to test for blood (she said the diaper I brought from earlier in the day yesterday wasn't fresh enough and she just stuck her finger up Brendan's bottom then rubbed her finger on a card that apparently came back negative for blood....which didn't seem as accurate as testing an actual diaper and which my pediatrician told me last week wasn't as accurate as testing a dirty diaper) and, if it comes back negative, talk to him about my hesitation with her diagnosis and talk to him about possibly introducing the sensitive formula again and seeing if Brendan has a reaction to it. I by no means want to cause Brendan any pain but re-introducing the sensitive to really see if he had an allergy was my pediatrician's first recommendation when we went to him last Friday - get the irritation healed and then try reintroducing the sensitive and, if he has a problem, we will know he has an allergy.

If he has an allergy, it's no big deal and we will go back to the hypoallergenic formula and avoid any dairy in his diet until we try it when he's 1. But, like I said above, if he doesn't have an allergy, I think it would be better to go ahead and figure that out so he can start having dairy (like cheese and yogurt) slowly and then adjusting to regular milk won't be as big of a leap when he turns 1. Oh, and because of the fact he was irritated by the full lactose formula, I do admit he probably has a sensitivity to lactose. But, if it's just a sensitivity, that's what the sensitive formula is for.

Ok, if you're still with me after ALL that, I'd love to hear your opinions. If you think I'm being totally unreasonable, by all means, tell me! I'm not going to be offended because I realize I'm not wanting him to have this allergy so I may not be reacting appropriately. Sorry it took me so long to give y'all an update and sorry I haven't done a fun weekly post this week, but I promise, promise, promise I will this weekend!


Tami said...

I'm sorry to hear that the appointment didn't really give you the answers you were looking for. I think it's a great idea that you are going to go back to the pediatrician for a second opinion. I'll pray that it goes well and you get the right information.

YaYa said...

Lauren, I agree, I would get a second opinion....there is nothing wrong with disputing what a physician tells you...been down that road many times...while I have the highest regard for the medical profession, they are just like anybody else and don't always make the right decisions. I hope Mr. Brendan gets to feeling better and you too!!!! Hope to see you soon.