Doctor's Appt & Seizures Revisit w/new 2010.11.12 Dateline info

[Pensfan]

As I posted in post #34, absence seizures can resemble some complex partial seizures. Because complex partial seizures can have deadly etiologies, no competent physician would tell Terri to bring Kyron to his office in a week or so to be evaluated.

http://www.epilepsy.com/EPILEPSY/seizure_absence

 

[JBean]

"the doc thinks he might be having seizures" doesn't sound like a diagnosis. Sounds more like a "these things can indicate seizures but I can't tell over the phone so let's just get him in here at such and such a date."

exactly

 

[Pensfan]

exactly

But that is not exactly what she said. Please check her exact wording in the reference that I posted from CBS. She said MINI SEIZURE.

 

[Pensfan]

Yeah. Mini-seizures. This doesn't take into account what Terri might have used to describe them. still doesn't sound like a diagnosis but sounds like a possibility the doctor believes the symptoms Terri describes MIGHT include.

Still not a diagnosis. Just a reason to make the appointment.

Incorrect. Mini seizure is a diagnosis, debs, but it didn't come from Ky's doctor unless he diagnoses seizure patients over the phone. If this is true, he is not following standard of care for his specialty and he won't be in business for very long.

 

[JBean]

But that is not exactly what she said. Please check her exact wording in the reference that I posted from CBS. She said MINI SEIZURE.

Yes, but as you and I both agree, it would be impossible for the doctor to make that diagnosis over the phone . I don't think for one minute he did,but rather he suggested it as a possibility that warranted further investigation. Prudent and wise.
If the quote was from the doctor diagnosing him, then i would agree that the doctor is incompetent. but the quote from Terri and I think it is dramatized.

I remember my doctor talking to me about another son's symptoms on the phone. he said it could be cystic fibrosis or it could be an respiratory infection, we have to test and find out. But I don't go around saying the doc thinks he has CF, but i could have. KWIM?

 

[debs]

As I posted in post #34, absence seizures can resemble some complex partial seizures. Because complex partial seizures can have deadly etiologies, no competent physician would tell Terri to bring Kyron to his office in a week or so to be evaluated.

http://www.epilepsy.com/EPILEPSY/seizure_absence

Isn't this an example of attempting to diagnose Kyron's seizures without ever seeing him? Not only that, but through a "the doc told me this, so we're gonna do that.."

It wasn't a diagnosis.

 

[Pensfan]

We are in agreement on several things.

But I have only live in Seizures Palace for 23 years :floorlaugh:. Here is more info though:

http://www.intelihealth.com/IH/ihtIH/c/9339/9400.html


Earlier I posted that I suspect she called the doctor, described what she was seeing and he threw out some ideas as to the cause. he may have said he could be normal or having mini seizures, could be preoccupied or distracted with other issues. I also suspect the doctor said we won;t know unless we do a full evaluation. here are forms for school and you so we can schedule an appt for more diagnostics and see what is happening.
I think Terri jumped on the seizures because they may have served a purpose or because they sound more dramatic.

My only point is that this does not sound like an emergency situation and because of course the Dr cannot make any kind of diagnosis over the phone, he/she was in the process of seeing the chikld and evaluating what may be going on.
hence we have a3rd option and that is she called the doctor, told him/her what she was seeing and the doc said then bring him in because it could be this that or the other.

I didn't state that this was an emergent (rush him to the ER) problem. It is a problem that could be serious and a competent health care provider would want to evaluate it immediately and not a week or so.

 

[debs]

Incorrect. Mini seizure is a diagnosis, debs, but it didn't come from Ky's doctor unless he diagnoses seizure patients over the phone. If this is true, he is not following standard of care for his specialty and he won't be in business for very long.

I truly don't see it like this at all. There was no diagnosis, there was Terri stating what it was she heard from the doctor, and a follow up plan from that doctor to assess and diagnose the issues Terri brought to the doctor's ear.

I don't think it's illegal for a doctor to set an appointment when a parent calls in about a problem with their child's health, is it?

 

[Pensfan]

Isn't this an example of attempting to diagnose Kyron's seizures without ever seeing him? Not only that, but through a "the doc told me this, so we're gonna do that.."

It wasn't a diagnosis.

Are you are stating that this proves that Ky's pediatrician practices medicine over the telephone?

 

[JBean]

Mini seizures are correctly termed complex partial seizures. In my professional opinion, TH either lied or she contact an unbelievably incompetent pediatrician about Kyron’s partial seizures.

Below is information that pediatricians follow when pediatric patients are experiencing partial seizures. Because the etiologies can be LIFE THREATENING PROBLEMS, no competent pediatrician would tell any parent to bring the child into the office in a week or so. Notice that one cause of non-febrile seizures is MENINGITIS. No competent pediatrician would blow off Kyron’s supposed symptoms when it could infect his ENTIRE school and community and maybe even the pediatrician and his/her own family. The etiology could also be drug/toxin overdose which could result in immediate death if not immediately assessed and treated.

New Onset Non-Febrile Seizure


Etiologies include:

Infectious- meningitis/encephalitis, abscess, shigellosis, parasite

Idiopathic

Metabolic- hypo/hypernatremia, hypoglycemia, hypocalcemia, inborn errors

Drugs/toxins- a very long list!!

Congenital structural abnormalities- neurofibromatosis, malformation, atrophy

Anoxia

Trauma- subdural hematoma, epidural hematoma, concussion, shaken baby syndrome

Vascular- stroke (embolic/thrombotic), collagen vascular disease
Tumor


Laboratory tests should be ordered based on individual clinical circumstances that include suggestive historic or clinical findings such as vomiting, diarrhea, dehydration, or failure to return to baseline alertness. Laboratory evaluation may include electrolytes, glucose, calcium, magnesium, and phosphorus; urine drug screen; CBC.

A lumbar puncture is of limited value in the initial evaluation of children with simple afebrile seizures, UNLESS there is concern about meningitis or encephalitis. Consider a CT scan/MRI if the exam or seizure is focal.



An EEG is recommended as a part of the neurodiagnostic evaluation. It aids in predicting the risk of recurrence and helps classify the seizure type.

The risk of recurrence after a first unprovoked seizure is higher (>50%) for remote symptomatic cases (e.g. prior insults such as static encephalopathy, head trauma, intracranial bleed) or with Todd's paresis. Status epilepticus as a first seizure does NOT increase the seizure recurrence risk.

http://clinicaldepartments.musc.edu/pediatrics/divisions/emergencymedicine/residentmanual/seizures/

I can pull up hundreds of references showing the etiology of non-febrile seizures. They all state the same thing. They all show that the etiology could be something very deadly and even contagious. NO half-way competent physician would disregard and delay assessment of a child with such symptoms.

I didn't state that this was an emergent (rush him to the ER) problem. It is a problem that could be serious and a competent health care provider would want to evaluate it immediately and not a week or so.

I took the quoted post as an indicator that in your opinion this was a life or death situation. But I do most defintiely agree there is the potential for danger and the child should be seen sooner rather than later.

My son had his first tonic-clonic at under 2 years old. The information you posted is precisely why he was treated in an ER for his first seizure as he was clearly in distress and could have been an energency.

In this case, the description is that of a subtle behavior change that could be indicative of many things, among them potential mini-seizures and imo that is exactly what he told Terri, if the phone call is to be believed.
Sounds like he was gathering data from school and home and was going to evaluate him within that week. I do agree that I might have wanted to get in within a few days as oppsoed to a week, but i don;t think it speaks to the doctor's competence. Perhaps Terri wasn't free til then and she is the one that delayed the appt. We don't know. But it still all comes back to Terri,imo.

 

[BeanE]

Yeah. Mini-seizures. This doesn't take into account what Terri might have used to describe them. still doesn't sound like a diagnosis but sounds like a possibility the doctor believes the symptoms Terri describes MIGHT include.

Still not a diagnosis. Just a reason to make the appointment.

That's what I think too. She talked to the doctor, and used her own words to quickly write a very brief email describing a whole sequence of events.

 

[gwenabob]

And now I still want to know why neither Kaine nor Desiree were aware of this?

 

[BeanE]

And now I still want to know why neither Kaine nor Desiree were aware of this?

I'd like to hear directly from Kaine and Desiree if they were completely unaware of any appointment, or any concerns Terri had about Kyron's seizure-like symptoms.

It's a bit unsettling to me that the info came from a reporter, rather than from the people who were being interviewed, for something so critical to this case.

 

[debs]

Are you are stating that this proves that Ky's pediatrician practices medicine over the telephone?

I can't see how that could be the interpretation of what I stated, no.

 

[Pensfan]

I took the quoted post as an indicator that in your opinion this was a life or death situation. But I do most defintiely agree there is the potential for danger and the child should be seen sooner rather than later.

My son had his first tonic-clonic at under 2 years old. The information you posted is precisely why he was treated in an ER for his first seizure as he was clearly in distress and could have been an energency.

In this case, the description is that of a subtle behavior change that could be indicative of many things, among them potential mini-seizures and imo that is exactly what he told Terri, if the phone call is to be believed.
Sounds like he was gathering data from school and home and was going to evaluate him within that week. I do agree that I might have wanted to get in within a few days as oppsoed to a week, but i don;t think it speaks to the doctor's competence. Perhaps Terri wasn't free til then and she is the one that delayed the appt. We don't know. But it still all comes back to Terri,imo.

BBM and thank you.

Standard of care: A diagnostic and treatment process that a clinician should follow for a certain type of patient, illness, or clinical circumstance.
In legal terms, the level at which the average, prudent provider in a given community would practice. It is how similarly qualified practitioners would have managed the patient's care under the same or similar circumstances. The medical malpractice plaintiff must establish the appropriate standard of care and demonstrate that the standard of care has been breached.
http://www.medterms.com/script/main/art.asp?articlekey=33263


As a verified professional medical professional, I respectfully, but strongly disagree with your statement about "speaks to the doc's competence" because it provides clues to TH's behavior. If the child was having seizure activity, it is the standard of care to evaluate the etiology soon/quickly/without delay/certainly not in a week or so.
This is why in my personal opinion that I feel very certain that Terri lied when she stated that the doc stated that Kyron was having mini seizures (but yet Ky was not scheduled for an immediate appointment). I can't think of a single positive reason why Terri would lie to her friends about a doc diagnosing her stepchild with mini seizures.

We don't have any facts about what problem(s) the doc was gathering info. on. In fact, we don't even know that it was Kyron's pediatrician that was gathering this data. Kyron could have been a patient of other health care providers such as a child psychologist/psychiatrist. Remember that Terri was demanding a behavioral grade for Kyron on a daily basis from his teacher. It is possible that it was a child psychologist gathering info from Kyron's teacher because Terri was unhappy with Ky's daily behavioral evaluations.

 

[Pensfan]

And now I still want to know why neither Kaine nor Desiree were aware of this?

I remember Kaine being asked this in one of the video interviews. He stated that he was unaware of Ky having any "mini seizures". Can anyone remember which video this was on? It was a longer video and Desiree was sitting next to Kaine. They were not inside the church across from the school.

 

[BeanE]

I remember Kaine being asked this in one of the video interviews. He stated that he was unaware of Ky having any "mini seizures". Can anyone remember which video this was on? It was a longer video and Desiree was sitting next to Kaine. They were not inside the church across from the school.

No don't recall that at all, but if you can find it, I'd love to hear what he says.

Thanks.

 

[Pensfan]

No don't recall that at all, but if you can find it, I'd love to hear what he says.

Thanks.

I have to watch the Steelers lose right now but I will look sometime tomorrow. I am 99% certain that this is on one of those earlier videos of Kaine and Desiree after Terri's texts to her gal friends were released.

 

[Billylee]

I fail to see where this diagnosis was made by a doctor over the phone. It sounds to me like Kyron had already been to his primary care doctor, and maybe an appointment had been made to see a specialist. Like some have said, getting any kind of diagnosis over the phone would be extremely unusual, in fact, here in OR, getting to even talk to your own doctor over the phone is weird. But, again, IDK, because I don't have all the facts.


“The past 2 weeks he's been acting really weird. Staring off into space. Can't remember anything. Walks into the room and then back out, stopping to stare and then move on. The doc thinks that he is having mini seizures and I made an appt on Thursday for next Friday to have him checked out."

http://www.examiner.com/amber-alert...e-said-kyron-acted-strange-before-he-vanished

 

[SubtleGrace]

Just thinking aloud...

When do you typically "talk to the doc"? IIRC, it was either during an appointment or an after hours "oh my gosh is this an emergency?" call.

Now, if it was during an appointment, there would be proof, doctors notes, etc. I could see the doc discussing possible dx's, sending the parent home with paperwork for teachers to fill out. I am not sure if I have heard of papers for teachers for epilepsy, seems to me that dx would take medical tests, but perhaps someone who knows will correct me. "Fill out these papers and we will see you back here on *advertiser censored* with the medical test results and your papers, blah, blah, blah."

If it was an after hours call, most likely the convo would have been, "take him to er or call my office for appt." Very doubtfully would he dx something like mini-seizures over the phone and then be so nonchalant about treatment. "I will send you papers and you make an appt.". Dont see that happening. Once mom headed over to WebMD she would be calling him back screaming. I would take my kid immediately to the er if a doc said that to me over the phone.

And I am sure its been mentioned before that Terri's problem with Kyron stemmed more from his boisterousness than his quietly staring off into space. So, papers for a teacher, that makes complete sense for ADHD.

Not sure what point I am trying to make, except that any way you slice it, unless Terri saw the doc who ordered the papers be filled out by teachers, the email mentioning his dx of Kyron pretty much does it for Terri.

I think. Maybe. Thinking outloud here.

MOO and IMO