Dr. Becks
Appearances
Nobody Should Believe Me
S05 Ep06: Human Timebomb
So hospice care specifically are those ones that you know have less than six months to live. Palliative care is kind of that expansion on that. For instance, they have a cancer or a life-threatening condition that there is a potential that the child could die. You're not saying that the cure may not still work, but you're kind of trying to help the family survive.
Nobody Should Believe Me
S05 Ep06: Human Timebomb
through that time, knowing that the outcome may not be the one everyone is hoping for, but you are concurrently doing the palliative care, knowing that the prognosis is poor, but you are continuing to do the treatment and continuing to be hopeful and to think my child is going to be that one, you know, that gets through this.
Nobody Should Believe Me
S05 Ep06: Human Timebomb
I can start with the ones that were actually prescribed to her. Here again is Dr. Becks. So she, it looks like was on atropine sulfate drops, which are eye drops. And they're usually used in children most commonly if you have one eye that's much stronger than the other.
Nobody Should Believe Me
S05 Ep06: Human Timebomb
The thing is, this does have side effects of things like dilating the pupils, you know, just putting drops in a child's eyes before the exam could change. And it may change your diagnosis if you come in and see a child with dilated pupils and you don't have an explanation for it. And then it's in the class of benzodiazepines.
Nobody Should Believe Me
S05 Ep06: Human Timebomb
So things like Ativan and things that we use in pediatrics, both to break seizure episodes is probably the most common reason that I prescribe it. And then also for things like increased tone. So children who have cerebral palsy or brain injuries and therefore are very tense or very increased in tone, This medicine helps them to be a little more relaxed.
Nobody Should Believe Me
S05 Ep06: Human Timebomb
Now, diazepam in and of itself is extremely sedating. One of the reasons that we only give it in specific situations like when a seizure happens or to kids at appropriate doses that are often... what we say titrated up, meaning you start at the lowest dose and then you work up so you're sure that they don't have all of those side effects, is it is extremely sedating.
Nobody Should Believe Me
S05 Ep06: Human Timebomb
And then the extra medicines for C that I saw were flugercortisone and oxcarbazepine And then the last one actually does worry me just because of what I know about it. So oxcarbazepine is trileptal. Again, it's another seizure medication. With any medicine, we sometimes use it off-label for other things, but this one is definitely a medication used by neurologists in seizures in children.
Nobody Should Believe Me
S05 Ep06: Human Timebomb
The thing with trileptal is if you are taking too little, you may have seizure episodes that break through. If you are taking too much, you can have... side effects from taking too much. So, and one of the biggest ones, again, being somnolence or sleepiness. And I have actually had a child come in with toxic levels of trileptal in my career.
Nobody Should Believe Me
S05 Ep06: Human Timebomb
And I mean, it really looks like a child who is completely out of it. Like you can't, you can wake them up, but they don't seem very coherent. They can't, they aren't aware of their environment.
Nobody Should Believe Me
S05 Ep06: Human Timebomb
Okay, so baclofen is a medicine also similar to diazepam in the sense that we use it in children with cerebral palsy or increased tone to also help them with relaxation. Posturing is just very tight. And so what that does is it helps to release all of the connections so that they can move a little more freely.
Nobody Should Believe Me
S05 Ep06: Human Timebomb
Right, so baclofen being for tone is kind of what I was saying. So tone is that you either have low tone and you're extremely floppy or you have high tone and you're extremely like stiff and tense. As far as baclofen being like a rescue medicine for something, I mean, that I don't, diazepam, yes, I could argue we do,
Nobody Should Believe Me
S05 Ep06: Human Timebomb
But typically it's given either like rectally or through the nose or something, something that if a child was truly in a seizure that you could still give it. So again, it's odd that you would give it during an episode because during episodes, usually you don't want to put things necessarily in the child's mouth.
Nobody Should Believe Me
S05 Ep06: Human Timebomb
And that's just baclofen is more of an every day you take it three times a day or, you know, however many times a day to maintain normal tone, not that you would give it in kind of a bolus dose like that.
Nobody Should Believe Me
S05 Ep06: Human Timebomb
So diazepam, we do give during episodes, but like I said, you're usually, you give it in a safe way because during an episode of any kind, children are at risk of aspirating. So you don't really wanna put anything in the mouth. So you wanna put it somewhere that it can absorb where they don't have to actually swallow. But typically we don't do like an oral liquid medicine in those cases.
Nobody Should Believe Me
S05 Ep06: Human Timebomb
because you would worry they're not going to protect their airway during an episode and that they could choke. Or like she said, she gets it with food. To me, that would imply you're also maybe eating during that episode. Just something about that timing, that wouldn't be how we would do it.
Nobody Should Believe Me
S05 Ep06: Human Timebomb
Just kind of explain the paralysis and stuff like that. I've never seen it.