So explain this to me.

[naomikritzer]

Kiera hurt her foot on Friday night; she was roughhousing with Molly and fell down. She was visibly limping really badly afterwards. I got out an ice pack and iced her foot while we ate dinner; initially, she removed the ice pack, but then asked for it back. She was still limping after dinner, so we called the nurse line to ask if we needed to bring her in. The nurse said that based on her symptoms, she didn't need to be seen that night, but if she was still in pain the next morning we should bring her in.

Saturday morning, she was definitely still limping, so we made her an appointment at the Urgent Care. (Also -- Ed's standard suggestion when someone hurts something is to cut it off. Right after getting up on Saturday, Kiera politely requested that I cut her toe off, as it still hurt.) The doctor had her X-rayed. (In one of those random coincidences, the X-ray tech told us that the only other X-ray she'd done that day was also the right foot of a two-year-old.) The doctor checked the X-ray and saw nothing broken, so she had the nurse wrap Kiera's foot in an ace bandage (which Kiera took off almost immediately, sigh) and sent us home. She thought it was probably a sprained ankle; while in the doctor's office, Kiera was pointing at her ankle, rather than her toe, when asked what hurt.

The clinic called this morning. The radiologist looked at the X-ray and saw a "subtle" buckle fracture in one of the bones of her middle toe. The nurse wanted to know if she was still in pain. I said she'd stopped limping. The nurse said she'd talk to the ped and call me back. She called back this afternoon to say that since Kiera had stopped limping, I didn't need to bring her in.

I said, "So if she were still in pain, you'd want to see her?"

The nurse said, "Yes."

"But, it's a broken toe. Would you cast it or splint it?"

"No."

"Do you do anything for broken toes?"

"No."

"So I'd bring her in..............why?"

I didn't really get an answer to that. I asked Kiera when she got up from her nap if her toe still hurt and she said "yep," even though she's walking normally. So if there were anything they could or would do for her, I guess it would be a good idea to bring her in. Except it sounds like her pediatrician thought I should bring her in, pay another $15 co-pay, wait a half hour to be seen, and expose ourselves to the viral wonderland that is a pediatrician's waiting room, all so that the ped could cluck her tongue sympathetically and tell us to give her ibuprofin or tylenol.

Does she also want me to bring my kids in when they have a virus so that she can tell me to give them Tylenol, and plenty of fluids?

Comments

[porphyrin.livejournal.com]

Not to make excuses, but... Phone nurses have a great big whopping book of protocols that they use. With flow charts.

In pain? No? OK.

In pain? Yes? Better come in.

They've got a low thresh-hold for asking people to come in, because they don't want to miss anything.

But yes, I agree: for a thinking parent, this is frustrating.

(Have you tried buddy taping kiera's toes?)

[amabaku.livejournal.com]

I second the buddy taping. That is pretty much all you can do for minor breaks on toes anyway. When i pretty baddly sprained a toe during martial arts it also helped cut down on the pain.

[skylarker.livejournal.com]

I think the rationale for bringing them in for relatively minor hurts is to verify that this is indeed all that's wrong and nothing worse is being overlooked.

I agree that for those of us on a budget, though, it generally doesn't seem worth the trouble.

[the--ivorytower.livejournal.com]

I can't *explain* it, but I know there isn't much you can do for a broken toe usually. There may be a concern if there's excessive swelling or it looks like there's something up with a blood vessel or somesuch. My friend broke his toe on a radiator and he just limped around for a while. I mashed my toe something nasty on a door and I just had to wear open toed shoes because my runners (not that I don't hate them anyway) hurt my toe.

[springbok1.livejournal.com]

I third the buddy taping. I also have a velcro on cold pack, if you think she'd be more amenable to that. Is it looking swollen? Kiera probably isn't going to be amenable to elevating her foot, but maybe you can try to get her to at night.

[fancythat2.livejournal.com]

I kicked a heavy leather briefcase (no, I wasn't mad until After I'd kicked it) the friday night of Memorial Day weekend (I do not recommend this).

My little toe was in agony. It swelled up and looked like I'd stuck a flesh colored pearl onion on my toe. It hurt. I waited to see what a nights sleep would do for me.

It was still swollen and sore the next morning. Everything annoyed my toe, socks, shoes were out of the question, touching down on the floor just everything. I called the 'phone a nurse' and she ran down her checklist and told me I should come in and have xrays cause it sounded like it could be a break.

Yeah, right. Putting on shoes, driving for two hours one way and rotting in the emergency care clinic exposing myself to the 'viral wonderland' that is a hospital waiting room.

About a week later I was OK'ed to see a local doc and went in and he told me that they can't do anything for dinked up toes. wrapping doesn't help and may annoy the toe even more. My toe had shown improvement in the seven day interim and he said it showed that it wasn't broken but just a bad sprain. He also said a bad sprain can take as long to heal as a break.

So, I ran around in thongs (they are called flip flops nowadays) and had a sore toe for weeks.

I'm like your daughter, I can't stand to have bandages and what not on me either.

[mrswebchik.livejournal.com]

My brothers were prone to breaking their toes. Something about kicking each other and everything in sight. Mom was a nurse's aid for years, an acquired a bit of insight into things. Taping is all they ever did for any of 'em. I'm just glad my doc doesn't require people to come in to get silly things checked. He'll tell me over the phone "Don't bother - all I can do is x, and you can do that at home." I hope her toe is feeling better!

The nurse was wrong...

[(Anonymous)]

...about there being no specific reason the doctor would have wanted you to come in, and also about there being no treatment for broken toes.

If the child was still limping, the pediatrician would have done a more focused exam on the problem toe (which s/he probably barely looked at since your daughter was indicating an ankle injury during the initial exam). While you can't splint or cast a toe, you can buddy tape it, and you can wear special shoes to protect it. The doctor would also want to make sure there were no other complications that wouldn't have shown on an x-ray. S/he would do this by physically manipulating the nearby toes and foot muscles and tendons.

On the other hand, it's possible your pediatrician isn't that bright, in which case you need a new doctor.

My wife's a pediatrician. Trust me, she doesn't have patients come in for no reason. She has infinitely more work to do than she can possibly finish in time to get home and see her own daughter before dinner. She's not looking for busy work.

Oh, and under no circumstance would she want you to bring in a child with a simple virus. Further to the same point, she also doesn't want you to demand antibiotics to deal with a viral ear infection (the vast majority of ear infections are viral; the vast majority of parents don't believe antibiotics won't help cure a virus.....).

Rob McDonagh
www.CaptainOblivious.com

[callunav.livejournal.com]

I had to pop over when juliansinger read me this. I hope you don't mind.

When I was twelve, I tripped and fell and hurt my left big toe. I cleaned it up. It swelled some. It hurt. I said to my mother, playing for sympathy, "You think it's broken?" My mother, who does not win mothering awards, said, "Probably not," and I, who hadn't really thought it was, said, "Yeah, probably not." Four days later, a man whose daughter I babysat was so bothered by my still-swollen toe that he bet me ten dollars that it was broken, just to get me to get it checked by a doctor. (He had to reassure me that I wouldn't have to pay him if I lost. I was very anxious about it.) So I talked my mother into it.

We went to see my pediatrician, who asked me questions and poked around a little, and said he though it was probably fine, but that they would check it out. So he wrote an order for x-rays, and my mother and I trooped downstairs, through the underground walkway, and upstairs again to radiology, where they x-rayed it and sent me back (down, over, up) to my pediatrician, who looked at the x-rays and said they hadn't come out properly and so weren't clear, so he sent me back (down, over, up) to radiology (you can see where this is going already, can't you?) who took a second set of x-rays and sent me back (you know the drill) to my pediatrician with them who popped them on the light board, examined them, and said, "It's broken! You shouldn't be walking on that!" and put me in a wheelchair.

Because, when I do a thing, I like to do it thoroughly, I turned out to have knocked a chip off the end of the bone in such a way that it interfered with a growth point, so - for a broken toe, mind you - I underwent full anaesthesia, got four steel pins through my toe, and was in a cast and on crutches for three weeks. Then I had another operation to take the pins out again.

It's fine, now.

On the other hand, a few years ago I kicked something wrong in a karate class, and after a day of ice suspected that my third toe might be broken. I taped it to the second toe and kept taking pain-reliever and anti-inflamatories, and icing it periodically. After a while, it occurred to me that I should call someone, just to check. I spoke with the nurse at the urgent care clinic, and told her which toe, that I thought it was broken, and what I'd done about it. She, bless her, said that that's exactly what they would have done if it had been broken, complimented me, and just told me to come in if I wanted to, or if it didn't seem to get better in the next few days.

It was one of my favorite moments in health care.

(That one's fine now, too.)

I hope your daughter's toe feels better soon.