Tuesday, March 3, 2015

The winter of the cough (and reflections on the Dutch healthcare system)

Waiting for the doctor
On Monday December 8, right after the weekend of Sinterklaas celebrations, baby girl woke up with her first cold. A stuffed nose, extra clinginess, general malaise. And a stupid dry cough. At the end of that same week she got her first tooth, so I was confused as apparently, sometimes mucus + cough + crankiness (duh) can be symptoms of teething. After a week and a half the cold went a way, but baby Y. kept coughing, mostly at night and during her naps.

By then the December festive period was full on and at some point we went to a Posada. To which we forgot to bring her snowsuit. To top it off we made the  mistake choice of taking her out for the piñata, wearing only her jacket and a blanket over the baby carrier. The next morning the stuffed nose and the snot were back. And from then on I kind of lost track of what happened. The cold seemed to come and go, I am not sure if it was the same cold, or if she kept catching new bugs. She did not really have a fever, and the symptoms seemed to get better, except for the cough, that always remained.

The morning after her birthday party (mid January) she woke up feeling off again. During this almost 2 month period we went to the family doctor at least 3 times. All we got from the doctor was random advice and home-remedies like: "give her paracetamol if she seems in pain or uncomfortable", "shower with her so she breathes the steam", "put an onion under her mattrass", "incline her mattrass a bit", "get a humidifier", "use saline solution and a syringe to clean her nose" and my favorite"just pull through it and wait until the Spring comes, because kids are sick the whole winter".  We did all of those things and then some more*. At some point the cough became wet and she began vomiting phlegm during some of her night feeds. Her ears and lungs were checked, and luckily, though those were fine. Medical doctors here seem to go by the Mexican saying: "enfermo que come y mea, el diablo que se lo crea" (something along the lines of "let the devil believe a sick person who eats and pisses"). At some point her nose was so stuffed she was not able to breastfeed properly because she had to constantly stop to breath through her mouth. She was also not accepting solids, because her throat was hurting so much. All she would accept was very smooth purées and yoghurt, sometimes. This coming from a baby who was already happily eating pieces of all kind of food, by herself.  But her diapers were wet, and she was drinking milk, if with some trouble, so no, this situation was not deemed important.

 This awful cough that would wake her up in the middle of the night, that would sometimes be so strong it made her cry was supposed to just disappear by itself. By now,at some point, she did present a very high fever, for 3-4 days, but we were told, this is normal in infants. Once they even suggested we take her out for a stroller walk in the cold so she would chill. (Yeah chill, and get a pneumonia).

I know one of the most basic principles of Pathology is that every form of disease naturally tends to recovery. It is one of the first things you learn in Medical school. And yet, if you can make a patient more comfortable, if you can accelerate the healing process, why wouldn't you? I understand the advantages of conservative medicine. I know antibiotic resistance is a very big medical issue, one caused largely by the abuse of these miracles of science Fleming discovered. But this kid had been ill for 2 months, some of the symptoms had never disappeared, and we had tried all the home and over-the-counter remedies we had access too. At the end of it we begged the family doctor to please give us a pass to the hospital so a pediatrician could see her. The pediatrician did see her but it was more of the same. "Sit and wait and watch your sick kid suffer. Everything we can see is fine."

 We went to Mexico in February and obviously, one of the first things we did was set an appointment with a ped over there. Sit and watch the kid suffer I was tired of doing, and waiting it out for 2 months was enough waiting. It turned out she had a rinosinusitis. The difference in care was just unbelievable. Only at that moment did I realize that in 4 doctor appointments, not once was a tongue deppressor used. I am a vet, I should have noticed this, but I trusted the doctors and it did not come to my mind. We had been complaining of symptoms affecting the airways, including refusing food, and her throat had not once been checked. It turned out she was full with mucus (we could hear that all along from her breathing). Luckily her lungs and ears were still clear (I was worried about the latter after a transatlantic 12 hour flight with the kid). The mucus was becoming thick and she was on the verge of it getting infected. The doctor then took her time to explain the treatment that would be needed and why each of the steps was necessary, even the most seemingly simple things like: "she really needs to drink at least 4 ounces of water per day to fluidify all that mucus". She explained we needed to be systematic about things, she advised using a saline spray, as they did in NL, but clarified it specifically needed to be an aerosol because that way it can reach all the way to the lungs, even if it'd be uncomfortable. She told us this needed to be done twice per day. She also prescribed something for the pain and inflammatory process, antibiotics (necessary at this point, after waiting for so long), a decongestive to help her breathe (which we only used for 3 days) and something else to help her bronchioles dilate while she is asleep at night. Almost immediately after starting proper treatment she felt better. It was like having a different baby, she was smiling, playing and eating like herself again. It felt like magic. (She also discussed all kinds of things like her general behaviour, eating and sleep patterns, and so forth.)

After going through this, I really don't know why kids in Holland are forced to power through and suffer for so long just for the sake of  an all natural and conservative medicine. I am not saying every single ail must be treated in an aggressive manner, but a balance between the two could be found?

*mandarin and garlic tea, homeopathic cough syrup, Vick VaporRub on her chest, massage in her back.

**Our (bad) luck would have it that the Friday before coming back to NL, she got another cold at a playdate (most probably). It started with a high fever for 2 days and now we are back to snot and a wet cough. We did get treatment, the vomiting stopped and she really does seem to be getting better. I hope this time it won't extend forever. It was never clarified if her 2 months of cough were different infections every time, or one that came and went, that got better only to get worse.


  1. Paloma has been battling the sniffles all winter... haven't taken her to the Dr once! Maybe I should?

    I did IVF in Mexico twice and was extremely happy with the service!

    1. Yeah doctors in Mexico are good, they study very hard and get lots of practice. But yeah, over-medicalization is also a thing.

      I hope that Paloma feels better soon! It should go by itself, but maybe they can do something to speed up the recovery process. A Humidifier and the saline solution spray definitely did help, as the steam baths.

  2. Poor little poppet. Baby Tide got his first cold, a horrid virus, when we went home to the UK in January. He was a wreck for 3 weeks. It was so tough to watch, but also really draining as a mama. I'm glad you could get help you felt comfortable with.

    1. Yes, it is very tiring. It was nice to see her recover and enjoy food and playtime... be less tired. It is so sad to see them seek.

  3. Wow... I don't even know what to say. I had read stories about doctors there being rather hands off but I would have thought things would be different with children. This worries me a little to be honest.

    1. It is weird, I can't complain for specialist care... she received the best treatment when she was at the hospital for a month after her early birth. But getting attention from the specialists is hard.


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