Monday, May 30, 2005

Robin and the public health system

Things were moving along at their normal pace this morning; breakfast had been consumed, animals fed, snack prepared. Robin was getting dressed for school. She said she had an itchy spot on her leg and wanted me to put something on it. It looked like a mosquito bite at the very top of her leg. Except that it was as big as my hand.

ASIDE: She's sitting on my lap right now, watching me type. I intentionally didn't start with her name, but as soon as I wrote it she asked why I had. Just now, she sat up and pointed at the last paragraph and said "That says big." And when I just wrote that, she informed me that it said big again.

So I put stuff on her leg, then pulled up the elastic of her little school bloomers to check along the top edge and see if I'd gotten all of it. Um, nope. That was when I noticed another one just like it at the top of her other leg, and glory be they were actually just two extensions of one big spot that started just below her belly button and which I was beginning to think wasn't really much like a mosquito bite at all. She had small blotches on her abdomen and most of her back was involved. Okaaaay.

I called Yolanda to find out what you have to do to go to the local clinic. Here's what you have to do: you go to the local clinic. Then you wait in line. So that's what we did. We got there at ten of seven, and they opened at seven. There were about 35 people ahead of us in the line. Some had appointments for this morning and some were making appointments for today. I wasn't sure whether to try to get an appointment, or ask them to see her as an "emergency" case. When we were just about up to the window (about an hour later), the secretary told the lady two places ahead of me that they were all out of appointments for today. So I asked them to see her as a "caso urgente." There was a sign on the window outlining some things that are and are not considered emergencies, but allergic reactions (which I figured this was) weren't on either side of the list.

(In case you're wondering, "injuries more than 8 hours old" are not an emergency. "Elderly people" apparently are.)

In any case, the secretary didn't ask why I wanted her worked in, just asked for her age and next of kin (well, emergency contact) and had us go back and wait again. We were called in around 8:15. The doctor was very nice, but didn't actually DO very much, like even take a close look at her. I lowered her pants a little to show him the spots on her legs, and he could see the spots that had spread from her back to her upper arms because she was wearing a sleeveless shirt, but he didn't actually lift her shirt to look at her chest or back.

He listened to her lungs (through the shirt) and pronounced her a "very allergic child." He prescribed an injection, a course of steroids (one pill at night for 10 days), and a liquid antihistamine. It seemed like a lot of medication to me, and I did ask what each thing was, but he was brisk and didn't seem inclined to explain beyond "it's a steroid" or "it's anti-allergic."

He did say that the fact that the reaction is symmetrical indicates that it was something she ate, not a bug bite. He mentioned chocolate and tomatoes, which have never been a problem for her, and then said artificial coloring is sometimes a problem. That sounded more likely, since she did have a very cheap ice cream cone at a street fair in the Bajo yesterday, so we're operating on the assumption that it had some particularly evil version of pink food coloring in it. (Which just now made me wonder if the reaction would have been more severe if she'd gotten a straight-up strawberry cone instead of strawberry/vanilla twist. Julia had the exact same thing but did not have a reaction to it.)

He also told me to make an appointment to bring her in for a regular visit so they could set up a file on her and establish her as a patient to keep track of it.

We were sent back to the waiting room and after ten or fifteen minutes were called in for the injection. The girls' vaccinations were a major tragic event last year, and Robin started to get anxious, then was distracted by the lego toys on the table. I told her Mom's dad's advice about relaxing the relevant body part, and she seemed willing to try it. But when the nurse came in and got the shot ready she got panicky again. I got her on the table but she wouldn't turn over, and got a death grip on her pants. There was no screaming though, and the whole thing did seem to be a shade less traumatic than the vaccinations. I noted that her back was starting to clear up, but the nurse may have thought I was hinting that she not get the injection because he said no, this was a "strong" allergic reaction. I asked him about the fact that she's never had anything like this before, but he said it's not that unusual for something like this to happen even if there's no history of it.

The other two medications were apparently things that the public health system doesn't carry, so we had to go to the pharmacy. Fortunately, there's a new one right up here in our neighborhood so it was a good excuse to stop by there. The pharmacist was the most forthcoming of everyone we dealt with today, and took the time to discuss the situation, likely culprits, etc.

He agreed that the ice cream was likely to have been the source of it. It was soft ice cream from a machine, but he said that at a street fair like that it's possible that the vendor had prepared the stuff himself, maybe using cheaper colorings that are not as common in more commercially prepared foods.

He called the clinic to see if he could give us a syrup instead of pills, which Robin has never had to swallow before. The doctor said yes, but it turns out the pills are quite small and the syrup a lot more expensive, so I got the pills (10 for $1.90), which the pharmacist said can be crushed and mixed with something or stirred into water. I mixed the first one into a little jelly for her. She didn't make too many faces, but she thinks we need more jelly for tomorrow's pill.

The antihistamine is a weensy bottle of syrup ($7.60), which he said often has one of two effects on children: it can wind them up or knock them out. Oh goody. He said to give it to her for at least four or five days, longer if necessary, and that the rash would take several days to go away. (Except that it's 6:30 p.m. now and the thing is pretty much gone.)

He also made me feel better about "so much medication," particularly the shot. I know respiratory distress (which Robin did not have) can be part of a severe allergic reaction, but I didn't know that it often follows the skin reaction. He said it was good that she'd already had the shot.

Anyway, we had left home at 6:45, the exact time we usually leave for school, and got home at 10:00, 15 minutes before I would normally go back to pick her up.

She had her first dose of the antihistamine at 1:00 p.m. I had forgotten about the possible side effects of the stuff, until she up and went to sleep for two hours. Now I don't mean to put this on a par with rediscovering an entire branch of the family, but I'd be lying if I said my gut reaction to medicine that does not make Robin hyper wasn't WooHoo!

Wonder what the nightly steroids will do.


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