So I calmly said, "It also could have been aspiration pneumonia. The radiographs had a pattern consistent with inflammation and infiltration in the right upper lobe." Any seasoned nurse or doctor will look for aspiration with the key words of inflammation, infiltration and right upper lobe. It's a no-brainer. And I had his attention. (Dang I love knowing the jargon!) He examined Jack while I explained about having switched to the other doctor because we'd gotten a notice to choose a group. The doctor we chose was not the one assigned, but we decided to try him out. I explained what I'd told the other doctor about Jack having developed a wet congested cough mid-way through each bottle that persisted for 30 minutes afterward and that I'd asked for a swallow study. By now the doctor has sat down and is actually listening to me instead of reaching for the door. While I dress Jack I explained that the swallow study was denied and the doc had said instead of feeding him 6 ounces every three to four hours, feed him 3 ounces every two hours. Now the doc is shaking his head, and said, "That's bad advice." I explained that the nasty cough was progressively getting earlier into each meal and lasting longer after ward. I nearly toppled over when he said, "You might be right about the aspiration. He probably is aspirating or has some GERD and he's aspirating that. But it sounds like aspiration." Yeah. I knew that. Pneumococcal infection would not have been isolated to the right upper lobe.
"So what are you doing now? He looks pretty good and his lungs are clear." So, I explained the slow flow nipple to reduce pooling and keeping him upright for feedings and for 30 minutes afterward with thorough burping. "Keep doing that." I was hoping that he'd write a script for Simply Thick so our plan would cover it, but he said to add cereal to the formula. That wasn't the answer I wanted but I did expect it. He asked if I'd started feeding him solids like he'd recommended at the last visit. I said no, the aspiration issue started shortly after that, then the pneumonia and that "I didn't want to start solids until after I'd spoken to you." Sometimes it doesn't hurt to dirty your nose just a little. So he said to try the cereal in the bottle to thicken it, and start him on solids. "If he still has problems we'll investigate further. Almost all these kids have GERD. Many outgrow it by six months. Let's see how he does." Now I hate that he generalizes Willie as one of "these kids," but I find I am disliking him a little less than I did before. And I have to admit, he didn't say "these kids" with malice. Or even unkindly. And he looked at Willie when he said it. That helps.
Having switched groups I had to make sure Willie could still see the cardiologist for a 6 week follow up, and the neurologic opthamologist on June 15th. He said yes. I completely forgot to ask for the nebulizer orders and I had to call his nurse back the next day. The doc got on the phone himself. Yep, disliking him a little less. He said to keep using the MDI and to come by tomorrow and see him and he'd give me an aerochamber with a mask. If that didn't work, he'd investigate a nebulizer.
So then...feast your eyes on the cute pics I got of Billy-Joe-Jim-Bob while we waited for the doctor!
After the doctor's visit and a bottle and didee change, Will was up for some vigorous play!
"Moose! I love Mr. Moose!" 
"Yummmmy! Moose Rump Roast!" 
"Mmmmmm...Moose rib meat!" 
Will also likes to pound his Moose on the toy tray! 
"Ohhh, I love my Moose!"And I guess I'll try feeding him solids. A gal from the Ds board on BabyCenter.com mailed out 80 packets of Simply Thick to me today and I should have it within a few days. I won't do the cereal in his bottle. If we have to, we'll pay for the Simply Thick out of pocket.
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