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January 7, 2003

An Apple A Day

If you're unlucky enough to be reading this from South-Western Ontario, chances are that at some point in the past month you've been hit with at least one of the many illnesses, seasonal or otherwise, that have been going around. Perhaps it's all across Canada, but all I know is many of the people I know have been inconvenienced, waylaid, or something in between over the past few weeks. Merry Christmas, and Happy New Year!

My family is no exception. My wife and I are usually a fairly healthy bunch, but any family with young children is guaranteed to have at least one pint-sized person in the house with a runny nose. After all, there are over 200 different kinds of rotavirus, the viruses that cause what is commonly known as the common cold. Each variety requires its own immune response, which is why you keep getting a cold every year. Starting out with no immunity to any of these 200 microscopic invaders, our children typically get anywhere between 6 and 8 colds a year for the first few years of their life.

In a surprising turn of events, my wife stayed relatively healthy over the holidays, and I was hit broadside by something in the latter portions of my vacation. My daughter caught something much earlier on, and stayed with her much longer than normal. She was also having terrible nights, which is unusual, so we decided that some professional attention for her might be required. My wife called our family doctor, who was unavailable until well after the holidays ended, which meant that we had to make a trip to our local walk-in clinic. Living in a "medically under-serviced" community can really suck at times.

Since we were going anyways, I decided to have a doctor look at me at the same time. Whatever had hit me came and left fairly quickly, but that particular day I was still coughing, but producing nothing, and my lungs felt congested. I figured it wouldn't hurt to be looked over.

First, it turns out that my daughter has her first ear infection. We've been very lucky in this regard, in that this is her first in her lifetime. Of course, it's still an ear infection, which means she's not having any fun, and doesn't really appreciate the fact that this is her first ever. The cure for an ear infection is a course of antibiotics; in this case a yummy variety called amoxicillin. It comes in liquid form, which she is to take three times a day.

For some kids, this isn't an issue. In fact, for some time we've been able to hand her a dose of medicine, which she would suck back all by herself and ask for more. Somehow, this is no longer the case, and we're having to find other ways to medicate her. The first thing we tried for her children's ibuprofen (to bring down her fever) was to make freezies, which she rather enjoys. Unfortunately, the novelty of this wore off rather quickly, and to boot we were advised against freezing her amoxicillin by our pharmacist. Next we tried putting it into her food - yogurt and chocolate pudding, to be exact. She loves both - normally. Hiding it in food didn't work either.

So, the course of action we're having to take is to pin her down and force-feed her three times a day. The biggest problem with this is that the dose we need to give her is one teaspoon, otherwise known as 5 milliliters, or "5 CCs" as you'd hear it on "ER". It doesn't seem like a lot to you or me, but when you're trying to force it down the throat of an unwilling and unusually strong toddler, it's a bunch.

My issue is why the amoxicillin has to be so dilute. I don't believe it has to be, and I would dearly love to only have to force (or hide) 2 mL of any given medicine onto my daughter. If you compare "infant" and "toddler" medications at your local pharmacy, you'll notice that the dose size for the "toddler" liquid is much more than an equivalent does of "infant" liquid. Why? Well, I can imagine that trying to give 5 mL of anything to an infant would be an exercise in frustration, as it would be quite a lot for a baby. But why do they have to bump it back up for older kids? Argh.

At worst, this entire issue is an annoyance, and is really only a problem if your kid is refusing medication. Friends of mine are lucky enough to have a daughter that actually enjoys her medicine, and will ask for it if she's feeling bad. Unfortunately, my story does not end at my daughter fighting and spitting antibiotics at me. The bigger issue actually evolved out of my visit with the doctor.

Two days previous, I had been feeling fine until that afternoon, so I took some vitamin C and zinc lozenges and went to bed early. Well, I didn't sleep well at all, and slept in until nearly 11, and felt like absolute crap. The bulk of the day was spent in a haze, trying to recover. Miraculously, around 8pm I started feeling like my old self again. I thanked my lucky stars, rang in the New Year, and went to bed thinking I had been pretty lucky to be inconvenienced for only a day and a half.

Not so. The next day I felt something I haven't felt since I was a kid. When I was quite young I was afflicted with asthma, and I made quite a few trips to the emergency room late at night to try and help me breathe easier. That day, my lungs once again felt asthmatic: constricted, and almost wheezy. This was the reason I figured seeing a doctor would be a good idea.

The doctor looked me over quickly, and gave a listen to my lungs. Sure enough, he heard something abnormal in my lungs, and diagnosed my lungs as being "irritated". He quickly wrote me a prescription, and let us get on our way. As we also had a prescription for our daughter's amoxicillin, we headed straight off to the pharmacy at our local grocer to get both prescriptions filled immediately.

I don't have a drug plan right now, so we were hoping that both prescriptions would be fairly reasonable. The amoxicillin was quite reasonable, at just under $10. My prescription, however, was anything but. It turns out that I was prescribed a fairly common medicine - if you're a chronic asthmatic. The prescription was for a steroid inhaler, to be used twice a day for one month. Yes, one month. After having symptoms for one day, and being looked at for less than three minutes, I was prescribed a $90 inhaled steroid that I was to use for a month. I declined the prescription, and left with only my daughter's amoxicillin. I was rather disgusted -this had to be one of the more blatant instances of overmedication that I have ever been involved with.

I needed a second opinion. Luckily, I have a doctor in the family that I can call and ask advice of. He mentioned that the steroid should help reduce the inflammation that my lungs were likely suffering, and that I might try a more common anti-inflammatory to being with - aspirin or ibuprofen. Gee, let me think about that - do I shell out $90, or do I pop a few painkillers that I already have?

I started taking some ibuprofen three times a day, and sure enough I started feeling better. My coughing goes away, my breathing gets easier, and all thanks to less than a dollar's worth of over-the-counter painkillers. I'm not sure if inhaling a month's worth of steroids would actually be bad for my body, but why should I subject myself to the expense or possible side effects if I don't need to?

On one hand, I'm glad that I had access to a doctor to diagnose my daughter's ear infection. On the other, I have to wonder how often people are overmedicated, especially when medical care is done on a walk-in basis with no continuity of care. Many people in my community (and others in Ontario) have no family doctor and must rely on walk-in clinics or emergency rooms as their front line in health care. I'm extremely lucky to have access to a doctor in the family, and to realize when something's amiss prescription-wise. The only advice I can give those reading this is to be aware of what you're being prescribed - half of my problem was that I didn't even read the prescription, or ask what I was being given until it was being handed to me at the pharmacy.

Now if you'll excuse me, I have to figure out how to fill a chocolate truffle with amoxicillin.



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