Several weeks ago, newFNP stepped in to do a well child exam on an 18-month old well known to her. NewFNP takes care of her grandma (scleroderma), her grandpa (missing frontal skull bone after 2 infected craniostomies following a truck tire exploding and striking him in the head) and her mother (21-year old with uncontrolled hypertension on 5 daily medications including clonidine with a history of methamphetamine use, now abstinent).
Thursday, August 20, 2009
When newFNP saw this child's hemoglobin, her heart sank. It was 4.9. The child's skin had an unhealthy grayish hue.
Repeat it, newFNP instructed her MA. Her blood was pinkish. The repeat hemoglobin was 4.5.
Shit, newFNP muttered.
Is it leukemia?, newFNP asked her colleague. It's leukemia, he responded. 4.9 is fucking low.
NewFNP went with the grandparents into the exam room as the young girl's mom was at work, where she is six days per week.
NewFNP told them that she needed to send the little girl to the hospital and that she was concerned about leukemia.
Never before has newFNP been on the verge of tears in an exam room. But she knows this family and she knows that they have been to hell and back and that they all still suffer and she loves taking care of all of them -- that is one of the joys of family practice.
She called the patient's mom and told her to come immediately to take her daughter to the emergency room. The patient was crying, her mom was crying, her grandma was crying. NewFNP was barely holding it together.
Hours later, newFNP spoke with the patient's mom to see what had transpired.
What had transpired was the this little girl was drinking upwards of 50 ounces of milk daily. She didn't have leukemia -- she was a lactoholic. She was discharged from the ER with iron. No transfusion, no nothing. Follow up and repeat the CBC in 2 weeks. NewFNP couldn't believe it.
4.9. From milk!??!!**
Her repeat CBCs have been greatly improving, her pallor has disappeared and she appears to be not at all suffering withdrawal from her milk dependence.
Pass it on.
**When kids drink too much milk, they don't eat iron-rich foods -- or much of any foods for that matter -- and they may have intestinal irritation that causes asymptomatic blood loss in the stool thus causing anemia.