Primary Complex Thread 2

[chooga chooga]

Thank u doc. Doc are u a pulmo-pedia? How can we reach you personally? Where po?

[lent0t]

@dra leletmd thank you sa reply.. it gave me an idea of what to expect. we'll be back later to his pedia-allergologist. thanks again 

[leletmd]

@chooga chooga:
Sorry I am not a pedia pulmo

[snowyice]

ano po ba ang ibig sabihin kpag direct bilirubin ang mataas? and gaano po kataas para sabihing mataas?  Thanks!

my sons is 9.5 umol/L he is 7 years old

[leletmd]

^ There is impaired flow of the bile to the liver which may be due to an obstruction or inflammation. If inflammation, it may be due to either infectious or non - infectious hepatitis. It would depend on the cause as to whether 2x or 3x elevation is needed for significance. You should bring your son back to his pedia gastro as soon as possible for re-evaluation.

[kumikosan_9]

hi doc lelet.  i've been backreading a lot to see if i could pick up anything that would help my two year old. Our pedia diagnosed my son with PC last month and we've been under medication (kidz kit 3) since June 22. The problem is, lalong pumapayat ang toddler ko, which is frustrating kasi ang alam ko dapat medyo gumagana sana siya kumain.

i brought this up with my pedia but he took it lightly and said i shouldn't worry...but i want to do something about it. After backreading, i narrowed down my possible options to three. Doc lelet i hope you could advise me which is most probably the best course:

1. switch my son's milk from Enfagrow to Pediasure. (he doesn't have allergies)
2. add Propan Appetite Stimulant to his vitamins which are currently (Cherifer, Pedzinc and Ferlin)
3. give him Mosegor Vita Plus in addition to his Cherifer, Pedzinc and Ferlin

...ang reseta ni pedia since my baby was born was only Cherifer. I asked him if its ok to give him Pedzinc too, he reluctantly agreed. After my son had a near encounter with dengue, nakapag pa CBC kami and his CBC revealed his hematocrit and WBC are low. Kasi nga, ayaw kumain ng anak ko. Still, it was me who asked if need namin ito iresolve for which he advised to give Ferlin. Bottomline is, i think my pedia is conservative sa meds and vitamins. Ang problem is, nakaka-bother makitang payat ang anak at ayaw kumain. Please help me regarding my three options po.

[teewee]

Hi, Doc Lelet! I'm so glad to have found this thread. My pedia is abroad so I can't contact her until this Saturday. My baby has been prescribed to take INH for three months because my aunt, who was taking care of her while I'm at work, was diagnosed with PTB, undetermined activity. If we miss one day of taking INH, are we back to zero? Do we have to count another three months?

Thanks!

[leletmd]

@teewee:
Hindi naman back to zero ang treatment, but I highly suggest that you give the medication religiously since missed doses increases the risk of resistance and allergies so baka instead na may medication ka for prevention ay hindi pa ito makaprevent and maka-full blown infection siya.

@kumikosan_9:
How old is your child? What is his height and weight? What does your pedia tell you regarding his height and weight? Is he below the 50th percentile? Is appetite the main problem or is he a picky eater? How is his milk intake compared to his solid feeding?
I do not agree with giving high calorie milk because this will just defeat the purpose of having him eat properly. You should be concentrating on changing his eating habits rather than giving something that will make him too full to eat a good meal.
He is already on double multivitamins. If this still doesn't work, that means hindi ang pagbigay ng vitamins ang solution. Adding another type of multivitamins will not solve your problem.
Also, what was his hemoglobin during his confinement? We do not give Iron supplement just because the hematocrit and wbc are below normal range. Aside from hemoglobin, tinitingnan din ang MCV, etc.
Since the CBC was taken when your son had dengue, you really expect the WBC to be on the low side since Dengue is a viral infection and in viral infections, the WBC really goes down, but will go up after resolution of the viral infection. Pwede rin bumaba ang hematocrit during the hydration.
Pasensya na, but giving medications is not as easy as just rattling off a few information. It requires a thorough history and physical examination leading to judicious use of medications. Hindi yung basta prescribe na lang. So, sorry, but I salute your pedia for not resorting to prescribing vitamins/meds just like that. Kulang lang siguro sa explanation...

[loline]

hi doc lelet,

last May nagstart magcough yung 1 yr. old baby ko. nagtake siya ng mucosolvan upon advice ng pedia namin. pero hindi pa rin nagstop yung cough niya. so binigyan na siya ng antibiotics pero wala pa rin effect. napansin ko na pag night or early morning lang yung cough niya. sabi ng pedia baka daw allergies. nagprescribe siya ng montelukast to be taken for 2 weeks before bedtime. effective naman dahil hindi na inubo ang baby ko during the night. pero hindi totally nawala ang cough niya. kaya sinuggest ng pedia namin ang PPD test and xray. turned out positive siya sa skin test pero negative xray niya. nevertheless, sabi niya magtake ang baby ko ng anti-TB meds dahil nagpositive yung skin test niya and pinastop na ang montelukast. kaya lang, nung day na magstop ang baby ko in taking montelukast, inatake naman siya ng asthma, this was last July 21. nagconsult kami sa ibang pedia (wala kasing clinic ang regular pedia namin nung inatake ng asthma ang baby ko). nagprescribe ng nebulization (asmalin & asmavent nebule) & asmalin syrup yung pedia. last day ng nebulization niya was July 24. pero umiinom pa rin siya ng asmalin syrup since may cough pa siya. then for maintenance daw, prescribed naman is allerkid (morning) & montelukast (evening) for 2 weeks to 1 month.  we haven't started on the anti-TB meds yet.
ano pong advise niyo doc?  natatakot na ako kasi ang daming meds na iniinom ng baby ko. baka ma-damage ang liver niya. hindi ko pa dinala sa regular pedia namin ang baby ko. gusto ko muna sanang tapusin ang meds niya for asthma before starting on the anti-TB. okay lang po ba yon?

[prettybarbie]

^ Parang ganan din yung sa anak ko, pero binigyan lang sya ng ventolin and beclazone inhaler, hindi na sya binigyan ng ibang gamot sa asthma, and for the tb infection isang gamot lang din yung binigay, yung INH lang.... Nung una 3 gamot ang binigay sa kanya nung first pedia na pinuntahan namin, pero yung second pedia sabi isa lang daw ang kailangan kasi nga ok naman yung xray.

[leletmd]

@loline:
Since skin test positive and negative ang chest x-ray niya based on what you posted then your child will just qualify for exposure and not for actual disease. Kapag exposure lang, 1 to 2 meds lang ang ibinibigay (2 meds if there is a risk of resistance) for at least 3 to 9 months. Did your original pedia explain as to why she opted to treat as actual disease? Baka kasi may nafulfill pa na criteria ang anak mo sa criteria for diagnosis.
Also, did you disclose to the 2nd pedia the findings of the 1st pedia? Ano ang sinabi ng 2nd pedia regarding the findings?
I suggest a consult with a pedia pulmo for clarification kasi baka hindi PC ang cause ng cough ng child mo if he responds to montelukast. Kaya lang, baka hindi enough ang montelukast for treatment.

[loline]

hi doc lelet,

thank you for your reply. sabi lang ng original pedia namin na symptomatic daw baby ko for TB dahil matagal na ang cough niya and hindi totally nawawala. and medyo mababa weight ng baby ko, at 1 yr. & 2 months, 9 kgs. lang siya. kaya ayun, 3 meds yung prescribed niya. yung 2nd pedia naman sabi niya okay lang to take the 3 meds kahit na negative ang x-ray.

if ever, okay lang po ba na magtake ng montelukast & allerkid along with the 3 anti-TB meds. kawawa naman kasi baby ko dami iniinom na gamot. 

[leletmd]

@loline:
No problem with taking allerkid and montelukast with the 3 anti-Tb meds. Allerkid is metabolized by the kidneys, hindi ito dumadaan sa liver and based on safety studies, pwede ito ibigay for 18 months na dirediretso without any problems/bad effects. Ang montelukast naman, kahit na sa liver minemetabolize, based din sa safety studies, can be given for 1 year straight without any bad effects.
May source of TB sa house niyo? May pedia pulmo ba sa 2 pedias na pinagdalhan mo?

[lovely_carrot]

happy to learn that my daughter has been cleared. it's really important to religiously follow doctor's orders and kahit magiyakan na kami ng anak ko talagang sapilitan ang pagpapainom ng gamot.

we even came to a point na sabi ko sa kanya mamamatay sya pag di uminom ng gamot, effective naman kasi nakatapos kami ng 6 months medication na konting konti lang ang palya sa schedule ng pag inom.

thank God talaga..

[teewee]

Hi Doc,

I have a question. My baby is going through INH Prophylaxis for three months. I was told by our pedia na kelangan walang laman ang tyan kapag uminom ng INH. However, my 4 month-old daughter drinks milk every three hours. Ok lang po ba na uminom sya ng INH two hours after nya magdrink ng milk? Then wait for another hour bago magfeed ulit?

Thanks!

[leletmd]

^ Yes, that is acceptable. INH is better absorbed on an empty stomach which is why it is recommended to be taken first thing in the morning, when the stomach is most empty but for those who cannot do this, INH can be given 2 hours after breakfast then next meal should be within an hour pa. 

[glyzza026]

schedule bukas ng ppd skin test ng baby ko.hayy kakakaba.

[Gailcee]

hi mga sis! I was able to find this article kase last week nagpositive ang baby ko sa ppd test nya. It really crushed our hearts when we found out. nagstart na kami ng meds nya, kaya lang we're having a hard time sa schedule dahil walang oras kung dumede sya, so most of the time my laman ang tyan nya. Can you suggest a sched for her? Working mom kase ako, at the same time nagbbreastfeed pa din, kaya sa morning gusto ko na mabreastfeed ko muna sya before i go. Please help me.

Another thing, bakit nageextend yung iba ng treatment, nagiging 9 months? Ano po factors nun? Salamat.

[lovely_carrot]

^based dun sa pedia namin, di ba after 6 months of medication, you need to come back para ma xray sya ang ma compare if lumiit yung kulani. pag nakita nila na meron pa or konti lang yung niliit, the dr. will advise to extend the medication for 3 more months.

nung nagpa 2nd xray daughter ko, ang diagnosis is meron pa rin koch infection eto yung term nila for PC diba, pedia advised me to bring the 1st xray, and have it compared with the 2nd xray, kasi ayaw niya maniwala na hindi gumaling. So nung binalik ko ulit sa clinic, nagbago yung diagnosis, it was stated na cleared na sya.

sis, importante talaga na on time and on an empty stomach ang inom ng gamot, otherwise hindi magiging ganun ka effective.

[leletmd]

@Gailcee:
It is best to give Isoniazid and rifampicin on an empty stomach first thing in the morning for better absorption. This is the time kasi na most empty ang tummy. If this is not possible, it is acceptable to give the 2 meds at least 2 hours after breakfast (when the tummy is again empty of food).
Reasons why there is a need to extend meds which means the infection did not resolve within the 6 month period:
a. Poor compliance with the meds (hindi naibibigay araw araw or may laman ang tummy kapag binigay ang Isoniazid and rifampicin)
b. The source of infection didn't undergo treatment.
Have you taken steps to find the source of your child's PC? Nakapagpaxray na ba lahat ng household contact?