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Thursday, September 28, 2006

Bubblegum flavored Augmentin (and other drug-related adventures)

Two pharmaceutical-related topics today (for the price of one).  Don't thank me... I'm a giver.

First up is the latest saga concerning our youngest son, Yonah.  He hasn't been sleeping well for the past week, and he woke up a few mornings ago with one side of his neck swollen.  No fever...no obvious tenderness (hard to tell since when he's in a bad mood, he doesn't tolerate poking and prodding anywhere), just a big goose-egg on his neck which looked suspiciously like a goiter

So Zahava took Yonah to the pediatrician for a look-see.

Our pediatrician happens to be an extremely personable man with a fantastic bedside manner with the kids.  Being able to actually get near the kids and gain their confidence is most of the battle, in my opinion as a parent and layman.  That he also happens to be a very competent physician and a respected diagnostician is just gravy.

Now it is a rare kid indeed who looks forward to seeing the doctor... and in this respect Yonah has a normal, healthy loathing of the medical community in general and the pediatrician in particular.  The moment he caught a whiff of that waiting room smell he basically tried to climb back into Zahava's uterus.  Not having one of those I can only speculate that this probably isn't a pleasant sensation.

He didn't have a fever and his throat looked basically OK, so the doctor decided that blood tests were in order.

How many people would you guess are required to restrain a 2-and-a-half year old for a blood draw.  Two?  Three?   Keep going...

Let's just say that there were more hands on that kid than there were square inches of exposed skin.  I'm told that the screams could be heard in neighboring communities.

However, just to show that there were no hard feelings, once the procedure was completed, Yonah walked calmly to the door... turned around to make eye contact with the doctor... and with a small sniffle said "Thank you much".

It would be a heartwarming anecdote if the story ended there.  But the next day when the blood-work came back, it showed his white count through the roof.  There was an infection there somewhere so the doc wrote out a scrip for antibiotics.

For non-Israelis reading this, I have to pause here to share a couple of things that may surprise you.    First of all, you need a prescription to buy something as simple as an aspirin in Israel.  Seriously.  Anyone can walk in off the street here and buy codeine over the counter... but if you want to take two aspirin and call someone in the morning?  Better have a prescription. 

Likewise, Israeli docs don't push antibiotics the way many American physicians do.  So fearful is the Israeli medical community of creating drug-resistant strains that you can't get antibiotic ointments (like Neosporin) here.  In fact you can't even buy antibacterial soap!

Anyway, back to the story.  Yonah... antibiotics... a fairly big deal.  But we had no idea how big a deal.  You see, while most kids on the planet looooove the taste of bubblegum flavored Augmentin... Yonah, um, not so much.   

Just for the record, getting fluids (such as blood) out of a struggling little boy is child's play compared to trying to get something into him.  This is because in addition to his ability to thrash, squirm and actually turn himself into a liquid, one also has to contend with his well-developed ability to spit.

When I got home from work on the day of his first dose I immediately noted that Zahava had a shiny, sticky sheen about her... and that she smelled vaguely of bubblegum.  Apparently the tag-team efforts of the pharmacist and Zahava were not equal to Yonah's ability to forcefully expectorate a fair amount of the first dose.  Since then we've been able to get subsequent doses into him in no small part because of the experience I gained on my high school wrestling team.  [For those of you out there who wrestled in high school or college, I have two words which will make everything clear:  'Banana Split'.]

OK, so much for the adventure of Yonah and bubblegum flavored Augmentin.  On to other pharmaceutical-rated stuff, courtesy of "The world's most popular blogging anesthesiologist"; 'Book of Joe'.

'Book of Joe' is actually written by a practicing anesthesiologist ... whose name is actually 'Joe'.  No kidding! 

Joe offers quite simply the most interesting (and eclectic) collection of product information about stuff you never imagined existed... but which once seen, you simply can't live without.   On top of this, he has a crack team of researchers who will quite literally (OK, maybe just figuratively) jump through fire to track down anything your little heart or mind might be wondering about.

I've written about Joe's eager minions in the past here.

One of my favorite features on 'Book of Joe' is an ongoing series he writes called 'Behind the Medspeak' in which he demystifies and clarifies most of the inherent (and in my opinion deliberate) opacity of issues related to the medical world.

Joe recently published a post with the unlikely title: 'Benadryl — World's Best Sleeping Pill'

Huh?  Yeah, I had the same reaction.  So much so that I just had to share the whole thing (with Joe's generous permission of course), since this is the kind of thing most doctors don't (or won't) tell you. 

As Joe would say, "not one word has been omitted":

"Medicine's Greatest Hits — Episode 1: Benadryl — World's Best Sleeping Pill

Benadryl_1

Why is Benadryl (generic name diphenhydramine hydrochloride) the world's best sleeping pill?

1) It works

2) It's cheap

3) It's available without a prescription anywhere in the world

4) It's the least likely of all sleep-inducing drugs to result in catastrophe as a result of an overdose — intentional or accidental

5) It's non-addictive

6) It's got a long track record of safety

So why isn't it the first drug recommended for insomnia?

See number 2 above — there's no profit for Big Pharma there.

Not at $4.99 for 24 tablets (21 cents apiece).

Bonus: even if it takes a while for you to drop off, if you've got a runny nose, itchy throat, watery eyes and find yourself sneezing, Benadryl's intended effects will lessen those symptoms."

************************

Now do you understand why I've become such a devoted 'Joe-head'?  Go add him to your blogroll/favorites right this very second!

221_16_5_136

Posted by David Bogner on September 28, 2006 | Permalink

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as an amateur hypochondriac...or so my kids tell me... i am thrilled to add book of joe to my list...and the more i read your blog the more i love your yonah...what a kid!!! refuah shleymah...someday yonah, when you grow up, you can become a pharmacist and invent pizza flavoured antibiotic stuff for kids and become a gazillionaire...how's that? until then, i'm afraid you're going to have to make do with the yukky stuff your parents are trying to get you to like...feel good

Posted by: marallyn | Sep 28, 2006 2:33:26 PM

hee, hee .... my son has a bad dust mite/grass allergy which we seem to have left behind in California, BUT he used to take Benadryl daily with no ill effects. One pollen-heavy day, I was moved to take a tablet also, even though I rarely suffer from hayfever symptoms. BIG mistake---I fell asleep at my desk. Yes, it is a FABULOUS sleeping pill. Probably knocks out hayfever, too, but since I was asleep, I don't remember....

Posted by: aliyah06 | Sep 28, 2006 2:44:02 PM

I hope Yonah feels better soon.

Posted by: seawitch | Sep 28, 2006 2:45:23 PM

Y'know, reading posts like this and thinking "hey! That's gonna be ME pretty soon" alternately makes me go "aww" and then run to go obtain some medicine of my own.

Way back in my rapidly-disappearing youth, I took a toxicology/pharmacology class. If memory serves, antihistamines and sedatives act as antagonists for the same neural receptors. In fact, several sleeping pills are simply higher dosage antihistamines. By the way, it's a wee bit unfair to criticize "Big Pharma" for not marketing diphenhydramine as a sleep aid. Tylenol's "Simply Sleep" contains diphenhydramine, and a quick search at drugstore.com found it retailing for the same price as Benadryl.

Posted by: efrex | Sep 28, 2006 2:46:42 PM

Kids are certainly strange. My younger one struggles with any form of medication. For that matter, so does my wife, maybe it's hereditary. My older daughter will always point out every single cough or sneeze and suggest now would be a good time for the (grape or cherry flavored) cold medicine. Maybe I should find a less pleasantly flavored one for her.

Get well soon Yonah

Posted by: Nighthawk700 | Sep 28, 2006 3:21:35 PM

OK, now you got me curious, and I'd love to hear Psychotoddler and Wanderer weigh in on this. Two questions (1) did the blood work check thyroid function? What was the result? (2) Is the big bump on Yona's neck tender? meaning does it hurt to mush on?

If his thyroid hormone levels are high (which would be discovered by a LOW value of a blood test called TSH) and his thyroid is enlarged and tender, then he probably has lymphocytic (also called viral) thyroiditis, which typically goes away by itself, and is not improved by antibiotics. Of course there is no harm in soaking Zahava's clothes in the antibiotics as a precaution. Oh, you've already done that...

Tangentially (and far less cool than Book of Joe), I hear there's a very nice concierge doctor in Beverly Hills who has a website on which he posts kind-of-interesting medical news once a week....

Posted by: Doctor Bean | Sep 28, 2006 4:32:45 PM

Ooops. I meant subacute (also called viral) thyroiditis. Lymphocytic thyroiditis is something else which also gets better without antibiotics but causes a painless goiter.

Posted by: Doctor Bean | Sep 28, 2006 4:36:36 PM

PPS: My aunt worked as a pediatrician in Jerusalem her whole working life. I know how hard she worked, and I can guess how little she made. You're blessed to have found a caring pediatrician whom you like and trust.

Posted by: Doctor Bean | Sep 28, 2006 4:42:06 PM

"Thank you much"
Now that part was really funny... does it come with a heavy Hebrew accent? in our days everything was herbal, it was either the greenish yukish stuff or the needle, we’d down it like it was strawberry juice and pray that everything would be fine afterwards.

refuah sh’lemah Yonah

Posted by: pk | Sep 28, 2006 4:44:12 PM

Here is a trick i use when in the pediatric emergency room. I use a dropper or syringe ( without the needle of course!) and get the liquid in, then i ask the parents to blow hard on his / her face. In most cases this causes a swallow reflex and the child will automatically swallow the medication......
Good luck! feel better Yonah

Posted by: David | Sep 28, 2006 4:45:24 PM

Marallyn... To know Yonah is to love him... but he can be a handful. Thanks. :-)

alyah06... It has the same effect on me, but until I read about it in Book of Joe it never occurred to me that this side effect would actually make it useful as a sleeping aid. We are so ingrained not to take medicine for any purpose except what is specified on the label...

Seawitch... Thanks. He is actually being a pretty good sport (other than the twice daily wrestling matches over the medicine).

Efrex... I have a similar medicine of choice, but you can't get it here. If anyone ever wants to make me a happy boy, a few cans of Boddingtons Pub Ale or Bitter would do the trick. :-)

Nighthawk700... The big kids were like that and loved the flavored medicines. Go figure.

Doctor Bean... I'll have to ask my wife about which tests were done. As to the tenderness it is hard to say as he doesn't like to be touched anywhere when he isn't feeling well. BTW, if you have a link to this Beverly Hills Doc you'd like to share please feel free.

pk... Exactly how did they get the herbs in the syringe? :-)

David... we use a medicine syringe for him already and it is still torture. I think blowing in his face would actually make his head explode.

Posted by: treppenwitz | Sep 28, 2006 5:03:49 PM

It wasn't that bad. It was either the Bitter stuff or a visit to the doctors where the needle would test the cheeks. :-)

Posted by: pk | Sep 28, 2006 5:14:23 PM

Careful - when my son was on Augmentin it gave him the worst diaper rash of his life, poor little guy. I think he had more pain from that than the recurring ear infection. Might want to have some Aveeno or other sitz bath stuff on hand, just in case. Refuah shlemah, Yonah!

Posted by: Kayla | Sep 28, 2006 6:06:00 PM

In a prior life a very dear friend and I were very big on weightlifting and spent a substantial amount of time working out.

Said friend went on to medical school and has been a pediatrician for many years.

But early on in his medical career the doctor who could bench press over three hundred pounds was thwarted by a screaming two year old on several occasions necessitating the assistance of a couple of nurses.

I can't tell you how much fun we had teasing him about that.

Hope Yonah feels better soon.

Posted by: Jack | Sep 28, 2006 6:10:14 PM

Dr. Bean, part of the blood work included a thyroid test -- the results of which were negative. As Trep already told you, it is impossible to determine if it actually hurts him.

David, while I respect your skills immensely, and would be inclined to try whatever you suggest, I have to agree with Trep on this one -- blowing on Yonah's face would, I fear, have less than the desired results.....

Posted by: zahava | Sep 28, 2006 6:55:47 PM

Trep: OK. Here's the medical news site.

Zahava: Got it. Wishing a speedy recovery to Yonah.

Posted by: Doctor Bean | Sep 28, 2006 7:25:40 PM

I had the same problem this week trying to get some acetominophin into a squirming, upset, feverish two-year-old. I think we ended up wearing more than she actually swallowed. But however much she got, it did the trick.

When I think about the wondrous effects of modern medicines, I can only thank G-d that I live in the present. I can't imagine what it must have been like in the old days.

(You might need a perscription for asperin, but, as i remember it, paracetamol (i.e. acetominophin) is as available as, and cheeper than candy.)

Posted by: The Observer | Sep 28, 2006 7:52:34 PM

Hi David / Zahava,

I totally understand, when i first heard of this I was sort of horrified....

then on a trip to Israel last year, my daugther got a pretty bad infection, and very high fever... and would not for the life of her keep the medicine down which lead to simmilar wrestling moves.

out of sheer frustration i tried the " blowing" to my surprise, beside for the stunned look on her face she swallowed it immediatly and the whole nightmare was over in 2 minutes rather than 10....

buy hey, all kids are different, who knows how Yonah would react....

good luck and refuah shelemah!

P.S. ? cervical adenitis

http://en.wikipedia.org/wiki/Adenitis

Posted by: David | Sep 28, 2006 8:02:19 PM

pk... There's that charming expression again. Whatayaknow? :-)

Kayla... I hope that won't happen. For one thing, whenever any of the kids are on antibiotics we try to make sure they get some yogurt with acidophilus so that they're digestive tracks aren't completely devoid of natural flora. Other than that, all we can do is hope.

Jack... I was no slouch in the weight room myself (ok, 240 was my best bench ever), but kids somehow grow extra arms when they don't want to take medicine. It's weird.

Zahava... Thanks honey... but you should know that David is not who you think he is. Yes he's a Doc (and probably a good one) but not the one who used to be our neighbor. I think there are more Physicians per capita her on treppenwitz than in the average investment seminar! :-)

Doctor Bean... Thanks for sharing the link. Much appreciated.

Observer... Whenever I see one of those period films set during the civil war or earlier and there is a sick child/infant... all I can think about is how helpless the parents must have felt back then. It was assumed that out of 5 or 6 kids you'd lose a couple. I can't even imagine.

David... Thanks. Look, I'll try wearing Zahava's hats if it will get him to take his medicine. :-)

Posted by: treppenwitz | Sep 28, 2006 8:39:01 PM

I admit that I haven't taken the time to read through all your comments, but let me give a word of caution - benadryl is a wonderful choice if you want to get drowsy, but for some children, especially very young children, it has the OPPOSITE affect. It will make them very HYPER. So proceed with caution!

Believe me, I've learned my lesson, though, we now know my daughter has ADHD.

But who knows, maybe how Ritalin or other stimilants calm them, perhaps, depressants hypes them up.

Posted by: jaime | Sep 28, 2006 10:24:40 PM

Sounds like Yonah has an adenitis as David alluded to above.

A word of caution re: Benadryl. In older males especially (i.e. with enlarged prostates) Benadryl can sometimes cause severe urinary retention, which can be very uncomfortable and even lead to kidney problems. I'm surprised "Book of Joe" doesn't mention it, but in any case for the real medical news I would go with the site Doctor Bean linked anyhow.

Not that anyone with an enlarged prostate reads (or writes) Treppenwitz, of course...

Posted by: wanderer | Sep 28, 2006 11:00:24 PM

I am so ashamed to admit this but when our oldest was younger she suffered from terrible ear infections and had to take the white (regular flavor) Augmenten. It was really ghastly even the smell made me want to puke. I had to pour it into her mouth while holding her nose so she had to swallow in order to breath. I learned that trick from the movie Indiana Jones and the Temple of Doom where that savage priest makes Indie drink the blood.
I hope she never finds out.

Posted by: Shifra | Sep 28, 2006 11:37:29 PM

First and foremost, refuah shlaymah to Yonah.

Second, antibacterial wash: Dr. Fischer's "Dermax", contains 1% triclosan. No prescription needed, but you have to buy it from the pharmacist at the various Pharms.

Third, go read this about a sleeping pill doing something (amazing and wonderful) that it wasn't intended for.
http://www.guardian.co.uk/medicine/story/0,,1870279,00.html

Posted by: jennifer | Sep 28, 2006 11:47:20 PM

Refua Sheleima to Yonah. I have found that Simply Sleep is a great pill for occasional insomnia. Benadryl dries me out too much if I am not sick.

Posted by: Essie | Sep 29, 2006 12:08:11 AM

When I need it, 2 Tylenol or Advil let me sleep pretty soundly, although I tend to wake up feeling groggy (and feeling how nice it would be to go back to sleep), but that passes as soon as I get myself out of bed.

Kayla: Augmentin uses a form of penicillin. The "rash" may have actually been an allergic reaction to penicillin, so I would suggest treading carefully the next time antibiotics are needed.

Posted by: jeffrey smith | Sep 29, 2006 1:03:40 AM

Hope Yonah is feeling better already. I share his feelings about doctor's visits, and pretty much react the same way he does, only without the spitting - usually.

Interesting about the benadryl, but I try to avoid all drugs, if possible, especially when voluntary...

Posted by: mcaryeh | Sep 29, 2006 3:03:30 AM

Refuah shleymah to Yonah! I can so totally sympathize with him = when I was his age I didn't take too kindly to that nasty powder and drops "they" put up my nose... Ugh. : ( Bubble gum flavor can be kind of nasty. Maybe there's an alternative?

Posted by: Irina | Sep 29, 2006 4:26:40 AM

Do they have chewables in Israel? One of my boys hates medicine and will hold it in his mouth until we think he's swallowed it and then spit it across the room. He takes everything in chewable form now.

Posted by: Anne | Sep 29, 2006 5:23:16 AM

Photo Friday is a picture of a box of Benadryl. Oh my.

Posted by: Jack | Sep 29, 2006 5:55:33 PM

i wish you would have posted the benadryl stuff before Wednesday. This week I was in California on a business trip and I took the red-eye to come back home. I had the benadryl in my knapsack, but i was afraid it would have the opposite effect and leave me hyper the whole flight, so I decided not to take it. i was able to sleep maybe an hour or two, but I guess the benadryl would have helped me more.

Posted by: David S | Sep 29, 2006 8:12:18 PM

What are you talking about? You can buy antibacterial soap in Israel, just in any supermarket. Maybe you can't always find it - it's not so popular as in America and doesn't get advetised, and there is only one local brand, ie you may not find the ones you are familiar with from the states, like Safeguard, but it still exists, I bought it myself. Also, you can buy an antibiotic oinment for wounds, I currently have two kinds in my drawer. And certainly you can buy aspirin and ibuprofen - I have both.
Are we living in the same coutry?
Good luck to your son.

Posted by: Israeli | Sep 29, 2006 9:39:17 PM

One of my most intense early childhood memories is trying frantically to escape the clutches of my mother, a nurse, a secretary, and a doctor with a flu shot.

You cannot run once you have been lifted up from the floor.

But you can still kick.

Forty four years later, I can still taste the rainy afternoon half-light, feel the painted woodwork, and smell that doctor-office aroma, mixed with afterthoughts of cigarette and different soaps.

My fondness for that memory is probably not shared by the other participants.

Posted by: The Back of the Hill | Sep 30, 2006 3:25:31 AM

Wow now I know why I, like bears, really do practically hybernate in the winter -- I have a severe allergy to the cold and have to take Benadryl several times a day when it is chilly (we are talking anything less than about 68 degrees if exposed to it for more than a few minutes). I am constantly beyong exhausted in the winter.

Good luck with medicating little Yonah!

Posted by: Yael | Sep 30, 2006 2:02:43 PM

Dear Sir:
Next time have the Pharmacist remove the bubblegum flovor and add another flavor. I am a Pharmacist and have seen Pharmacies that can do it here in NYC.

Posted by: Alan Levitt | Oct 1, 2006 1:35:50 AM

I vote for drugging the parents before making them watch medical professionals hold down his/her kid for IVs or drawing blood.

I'm really good at shutting off my emotions in those moments but it still tears me up. Ohhh the guilt.

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