Episode Transcript
Speaker 1 00:00:07 Hello and welcome to the Wonder Baba podcast. My name is Sheena Mitchell, I'm a pharmacist and mom of three. I'm here to chat all about child and family health Today I'm delighted to be joined by Dr. Moore Finn. Dr. Finn is a GP in Ennis, and we wanted to have a chat because there was a recent survey conducted by Sanofi who are a global biopharmaceutical company who focused on human health. So basically we wanted to chat about it because it found that only 53% of Irish parents had heard of rsv. And this was at the end of the summer. So I know there's been a lot of awareness this year, but the whole survey kind of highlighted the amount of confusion there is about the various viruses and illnesses that we face in the winter season. So myself and Dr. Finn just wanted to highlight some information on that.
Speaker 1 00:01:08 And we also chat a little bit about the difference between a viral and a bacterial infection and how to tell them apart. Obviously with strep, a circulating as well as rsv, it can be really useful to know what happens when you go to the doctor if you need to go to the doctor. And you know what's more likely to be viral and what's more likely to be bacterial. So thank you so much Dr. Finn for joining me today on a Wonder Baba podcast. Um, would you mind just introducing yourself and letting us know what you do on a daily basis?
Speaker 2 00:01:42 Okay. Um, my name is Maura Finn and I have been a GP in EN since 98, which ages me. But you know, there I'm, um, I have, my practice has been, you know, it's, it's a family practices, primarily young kids. I've kind really grown women's practice from the point of view menopause and all that stuff. Cause as I get older, my patients get older too. I have two kids who are teenagers now. And um, I do a lot of media work as well. I, every two or three radio, radio and I, I give interviews and stuff like that. So I kinda give a little bit of my homen GP knowledge to people who anybody wants to listen. And sometimes I hope it's useful. So that's
Speaker 1 00:02:35 What I do and I love that because that is exactly what I do in the pharmaceutical world because I think it
Speaker 2 00:02:41 Sounds like it. Yes,
Speaker 1 00:02:43 <laugh> when you're passionate about a particular area of medicine. And for me, obviously it's, you know, children and family health and for you obviously, you know, kids health and women's health, I think you can deliver, you know, a much more attentive, I suppose, clinical service and you know, you've much more drive to deliver good solid information to women and families that you know who need it. So yeah,
Speaker 2 00:03:10 I hope so. Yeah, experience. There's more to it. And you learn from the people you interact with, don't you, Sheena like, I'm sure you find it in the pharmacy too. Look, I learned from my patients, I learned from my exposure to the illness with the kids, how people react to things, how people deal with issues, emotion, psychological as well know that's how you, and um, hopefully from that you're able to kinda give other people a bit of an insight.
Speaker 1 00:03:43 A hundred percent. Cuz I know I was um, obviously a pharmacist for 10 years before I became a parent. And I, you know, obviously I was giving pharmaceutical advice to parents before that. But I found that once I had children myself, and obviously I have three kids now, I, I just felt that I was able to add so much more to I suppose my suite of advice from, from drawing in,
Speaker 2 00:04:09 You know, you know how hard it's to get an instance <laugh>. Oh gosh.
Speaker 1 00:04:13 Oh, and like there's some battles that are just gonna be tricky no matter what, but there are a lot of tricks. Oh
Speaker 2 00:04:18 Yeah. Yes, exactly. Knowing the tricks is the answer. Yeah. So we're the, the granny in the corner. You, you're the mother in the corner. I'm the granny in the corner. Ok.
Speaker 1 00:04:27 <laugh> I think, I think there's less of an age gap than you seem to think there is. But anyway, <laugh>, we're doing this over the phone, so I'm gonna comfortably hide, perform behind my microphone. Um, okay, so today we are here, obviously I mentioned there, um, that Sanofi have done a study recently just in relation to R S V and I suppose the level of understanding that there is about the disease in the community and it was quite alarming to but understandable, like very believable that only 53% of Irish parents had even heard of RS V. Why do you think that might be?
Speaker 2 00:05:07 I, I I think, yeah, it was alarming. Um, I would imagine now that study was published couple months ago, wasn't it? Or earlier November
Speaker 1 00:05:16 I think in
Speaker 2 00:05:17 Research in, I'd imagine the figures actually higher now cause of the, the recent coverage that, um, I think it's, cause it's the name rsv, you know, respiratory virus. It's, it has always been there, we've always been dealing with it. Um, it's, people are not aware of the, the rsv but they are aware of this thing that kids get in the, you know, so maybe, maybe it's that, you know, and it's, maybe it's about kinda naming it as opposed to not being aware the children actually get sick and get seasonal illnesses and that children with kinda wheezy coughing illnesses can actually get quite sick. So it may be that as much as uh, a lack of information, you know,
Speaker 1 00:06:01 And you know, I suppose pre covid, I hate to talk about covid, but in the context of what we're talking about, it is so important because, you know, there's a lot in the media about this immunity gap and whatnot. And we've seen, like we know with R SV that it's the major cause of respiratory illness in kids under two and the leading calls of hospitalization in under fours. And that has not changed as you said there. R S V no has always been there. So those facts remain, I suppose, stable. But what's changed since Covid is that, you know, the, the incidents of first infections are higher because less children have had opportunity, shall we say, to experience a first infection during the two kind of, we'll call them lockdown years. And we know that first infection is the more, most severe, you know, generally presentation of this kind of virus. Yeah. It it
Speaker 2 00:06:58 And you know, that's comfort to parent, but it's very sick child, their first RSV infection, but it's their worst presentation. And if that ave first RSV and then you have a small younger sibling, you know, that's, that's probably one of the problems that, you know, this is this serious infection that you know is, that's really challenging the older child. But also then the younger children have no resources when it comes to RSV. And not that the majority of children with RSV do have minor illness and some have very few symptoms and, and it's not even detectable. Um, and it's only a small promotion that actually really into trouble or develop bronch. But even with that, that's the really important thing. Bronch can make child seriously unwell cause primarily their lungs are under pressure and they can't feed well. So you've got two major reasons why they actually struggle. They're finding it difficult to get oxygen in and they're actually getting really dehydrated and weak cause they're not being able to hydrate and feed themselves as well.
Speaker 1 00:08:10 And that's
Speaker 2 00:08:10 And that's but sorry, go
Speaker 1 00:08:12 On. Yeah, I was just gonna say it's an interesting point there and I'm always conscious when I'm talking about R S V and then suddenly we talk, start talking about bronchitis that there's I suppose opportunity for confusion there. So just explain to people
Speaker 2 00:08:26 Good idea. Ok. Actually, you know what? Be interesting if you don't season. Yes,
Speaker 1 00:08:38 Absolutely. Like
Speaker 2 00:08:40 That would be kinda, that's how every year we always assumed we'd have a really, really heavy winter season with childhood illness. And the winter season tend to be number November until February. Um, and always around Christmas as well. Nora kinda the um, tummy the winter book is a thing as well. But that's, that's kinda quick and easy and they tend to over hours. So the majority of kids you would see and I would see would be presenting suff respiratory always been the case. Yeah. Then um, you, what you would do is you would assess them and see how they were managing. And primarily what you're doing is you're trying to assess the child to see um, you know, you how knowing before I even talked to anybody cause you know, they're the ones who snuggled into mommy, the ones who running around who playing are not sick. Children,
Speaker 1 00:10:03 Children always make fools of parents in this situation though,
Speaker 2 00:10:09 Element of that, but you knows are really sicks are really sick, are are very flat. You know, that's kinda a term we use in medicine and it, it might sound a bit weird, but it's just that really lethargic, you know, they're really not, they're not crying too much and they're not kinda out, they're just actually themselves and they're dehy actually really struggling to breed are both. So they're the things that we really look for. So you look for their baselines, you look at their color, you look at their activity, you look at their temperature, their temperature is above 39. We always say check them, they're younger's. Eight can't as well.
Speaker 2 00:10:55 Every single child that comes into surgery should be examined head to toe. And that means opening the, the vest of a baby, you know, the three buttons underneath an and you look at their belly and you look at their respiratory, they're putting sore throat sore that's classic. They're their ear. And in fact when you look at the belly and you listen to the chest, you realize that they actually have problem in their as well. You have do a full head toe with them, they respiratory their rate and then you examine and ears you how they are generally after that. Then you can really do, you can really give a, an experienced based assessment of whether this is a viral infection, which is when there's usually bit of everything that's probably easiest. Viruses, they're throat, they have a bit of a cough, they're just off, that's a virus.
Speaker 2 00:11:57 Bacterial infection tends to be focused in one particular area and that's probably the easiest way to differentiate between the two with infection. Might have one ear that's really acutely swollen and painful or a nasty throat where the, there's puss on the tonsils and that's obvious the breath or maybe a bad chest infection without anything else. And they tend to illnesses that are in one area and therefore unfortunately can't give an antibiotic cause it doesn't make any difference. And you treat them supportively with keeping the temperature under control and managing their symptoms and making sure they're not becoming distressed with their symptoms. And I suppose that's kinda the, that's pediatric medicine in a nutshell.
Speaker 1 00:12:49 Well I know a lot of people as well, you know, and there is, there is a real risk of it happening now. It's not as common but maybe important to mention to parents that you know, if a viral illness isn't clearing up, you know, within kind of maybe five to 10 days depending on what's suspected, um, infection, it is like if the symptoms are getting worse and not better in that time period, um, yeah. That there is the potential for a secondary bacterial infection or even things, you know, like a persistent kind of RSV bronchitis cough.
Speaker 2 00:13:23 Absolutely. Yeah. Yeah. No that is one of reasons why, you know, when you're assessing giving people information, if this doesn't improve within this timeframe, then you either need to return or sometimes we'll give what's called a holding antibiotic cause you're covering that possible secondary bacterial infection that happens cause you know, all that mucus in their, their ears and on in their lungs, it's really wet kind muy material that bacteria can get into and really thrive in. Yeah. It's like, you know, that's how they get a secondary infection with that. They get kinda, they've been improving and suddenly they get a lot and they need be treated with an situation. And likewise you've something likes presentation of rsv. Um, and if, if they're struggling and if they're getting tired, they need to be seen and need to be given some very often we try really hard not to send them into hospital because you know, nobody wants the child in hospital and nobody wants tob.
Speaker 2 00:14:31 Sometimes we just need to go in and on a for an hour, you know, a few hours. Yeah. Give them a bit of hydration, little bit of support of oxygen. That's often all they need. And they can often be home within about 12 hours, you know, um, and you know, you're just doing that to just make sure that this child is not at the level they're, that they've become overwhelmed by the endless. And I suppose that's the really important thing for parents to know is like, look for help if you're not sure follow your instincts. But the, you know, most of these things are minor and kids bounce back and they're not always,
Speaker 1 00:15:08 And I think as mothers, you know, even when your child has a cold you, you worry. So I think, uh, it's funny, I've heard a few conversations about this and I've heard some wonderful things from the hospitals comments from the hospitals saying things like, obviously, you know, we don't want to burden the GPS or the hospitals unnecessarily. So o you know, of course as a parent you're going to worry if your child is sick. But looking for maybe warning symptoms and things that are concerning and we can run through them. Do you know, in a sense Yeah. In terms of rsv. But the one thing I heard, um, and I just can't remember who from a hospital say recently was that whilst, you know, no one is ever going to give out to you for being concerned about your child. And if you need to take that trip to a and e, there'll always be room for your baby no matter how, you know, blocked up the system is
Speaker 2 00:15:59 That's so important Yeah. To hear. Yeah. Isn't it? It really is.
Speaker 1 00:16:02 Yeah.
Speaker 2 00:16:03 And likewise and likewise and in general practice, you know, you know, and I know there'll be, oh God, you're full and we can't get, you know, but there's a golden rule if a child is sick, they're seen, that's it. You know. Yeah. Um, and <laugh>, you know, you're never wasting anybody's time as long as child is, you know, okay. At the, that's most important, you know, need actually, I, I was talking there about kind of spotting a sick child in the waiting room, but there is, I like when I say I, I train doctors, um, you teach them to always listen to the parents. Cause you know, you might think this child is okay, particularly if you're young GP and you're not really that experienced or young hospital doctor. The parent is really, really worried. You take them seriously and not second guess them. You actually kinda follow through on that. Cause parents instincts about their children are probably the, the top diagnostic criteria in a lot of things. So it's really well important for parents to know that trust their own instincts and they'll hone their instincts over too. You know, first be more concerned than, you know, your second, you might have seen this and you might actually be able to cope a little bit better with it, but don't be afraid to ask. That's really important Child.
Speaker 1 00:17:22 Then you're ignoring everything and going, unless I don't wanna hear
Speaker 2 00:17:26 Is that're mother, you just, you know, they used to say, say to me, it was like I treated a viral illness, illnesses like a computer. Turn it on and off again and you'd be, you know, so I do have a year upstairs bed in my all night never ends. Tina <laugh>.
Speaker 1 00:17:50 Oh, don't say that. Don't say that you're not filming me
Speaker 2 00:17:53 With, but it's the only time, that's the only time they wanna snuggle in with you actually when they're 16. So <laugh>,
Speaker 1 00:17:58 I suppose you take it, you take it where it's coming. Yeah,
Speaker 2 00:18:01 Absolutely.
Speaker 1 00:18:02 <laugh> on that note. Right, it's an interesting point. The gut instinct and the, I suppose the, the mother's instinct because sometimes things like lethargy, you know, sort tiredness and lack of energy can be identifiable to a mom who knows the child but not to a doctor who maybe thinks that child's fine if the mother knows that that child's normally bouncing off the walls and this is not normal for them. You know?
Speaker 2 00:18:27 Absolutely. Yes. That's where you have to follow that, you know, you, you know, you know, if that child has been pancake all day and then cause they've come outside and they've actually, they're environment you knowing parents always be, um, always be confident enough to say exactly what you wanna say, you know? Yeah. Don't be afraid to kinda give your opinion on a child because that's all information and diagnosis of anything is based the information we can from examining history, which, so if you don't tell us the story and if you're not not confident enough to kinda give your uh, interpretation of what's going on, then something might be missed. So have confidence in your own instincts.
Speaker 1 00:19:18 So important. And in terms of warning symptoms, I always refer, so apologies cause I'm always like, hmm, any, you know, signs of dehydration. So you've got a child who's got a dry, dry nappy for more than 12 hours or taking less than 50% of their fluids, A bit of blue coloring, um, around the mouth and lips. And even, I don't know if you found, um, red a lot. So for me it's theoretical for you <laugh> you'll have experience but kind of the area behind the ears, um, and neck apparently can, can go a little bit blue as well as just around the mouth and lips.
Speaker 2 00:19:53 Um, yeah. Now mind you, if you have a child that's going a little bit blue color, it's, it's a dangerous sign that is an sign. Yeah. You know, we're they're pale off, they're, you know, that's not something you, you mess around with. You go call an ambulance in that situation cause that dusky kinda slightly gray blue coloration is a sign that they're not getting enough oxygen. Yeah. And I don't people think that that means that they're imminent danger, but it does mean that they need strong supportive therapy straight away.
Speaker 1 00:20:29 And in terms of scales of difficulty breathing, like we know that babies and kids can be coughing and especially the bronchiolitis cough can be quite persistent and tricky. But we always, I suppose an increase in speed of breathing or drawing in the chest or long pauses and breathing, you
Speaker 2 00:20:51 Know? Yes, exactly. And it's, it's kinda, when you say an increase in rate of breathing, that's really tough for a parent to assess. Cause you know, a big gentle their up and down their, so what if you notice, notice them breathing or if you, you don't have count it, but if you look at their belly and you look, you see the ribs actually sucked in bit. Their belly is moving up very quickly when they're trying to take a, or if there's any underneath theri the bottom of the rib. Cause there's that suck. That's a sign baby is distress. The other sign is that they, their noil now that it's a, you know, they're actually really making that big effort to get air in so their nostrils actually flare out and that's a sign again that they're a little bit distress. So, you know, counting the number of breaths is difficult to do, but if they're obvious and you know, it seems to be faster than you'd normally notice baby check. That's really important. And that's particularly important in babies under a year. Ok. Particularly under six months and absolutely under three months.
Speaker 1 00:22:14 Okay. And people can kind of expect, um, a mild case to resolve within two weeks. And the one problem I find, um, in the pharmacy is that parents come in initially, you know, maybe day one or two with a child with a runny nose and a bit of a cough, but not too bad. Um, but then they come in maybe a week later and say, whew, on day three or five Yeah. We ended up in hospital because the, the peak of the cough and the difficulty breathing in young babies happens at that kind of day three to five stage.
Speaker 2 00:22:48 It does. Yeah. And, and that's, and even if it doesn't peak or get really bad, it's very hard to have a child that's actually just off form and snuff even without that bad peak for two weeks. Yeah. You know, you think it's never, and then if you've got than one child home, you know, might be getting, have a month or two months of the year where you feel that you've never been outta the doctor's surgery or outta the pharmacy and you, you know, you frequently have people that say, my children have been sick all winter. And it feels to them that they have, and it's cause they've been beginning in a viral infection that's lingered just over something. And a cough can go on for up to a month after a viral infection has settled. Um, and that, that's hard. And that leads to another question, Gina, which I'd be interested in your opinion on about what happens in c when children are unwell with something like this. Because, you know, parents have um, practical responsibilities as well and you know, if there, there's that lingering cough that can go on for that length of time, but the child is very well.
Speaker 1 00:23:58 Yeah. So this, what
Speaker 2 00:23:59 Do they do? Do they go
Speaker 1 00:24:00 Back to Yeah, so this has come up a lot during covid because obviously covid, like any viral infection can cause that kind of persistent lingering cough. So what I say to parents is, if your child is well and they have no symptom other than the cough and it's been 48 hours, you know, since they've had any other symptom, whether it be, you know, kind of a fever or sore throat or ears, anything like that, if they, after a viral infection, if the child has recovered to full health other than the cough that they can return to school or crash, you're watching then for any change in cough. So if it's a new cough or a worsening of a cough or an additional symptom returning or coming back, then you're pulling them straight out again. But I think it's impractical, like even asthmatics. So there are some asthmatic children Yeah. Who unfortunately don't,
Speaker 2 00:24:53 That's what
Speaker 1 00:24:54 They do. Yeah. They don't have asthmatic control and that can take years to kind of perfect as the child ages, you know, um, they, they mightn't even have an asthma diagnosis. They might be, you know, being obviously treated for charismatic type symptoms from kind of Yeah. You know, young age and a particular four, five or six to get proper control. And I suppose assessment on the situation, I suppose kids can be coughing every time it's cold, you know what
Speaker 2 00:25:19 I mean? And actually there's a, there's a whole other kinda diagnostic criteria now and asthma that they're actually that recurring wheezy cough that isn't actually ever gonna be diagnosed as asthma. So, you know, so they they're the kids you're talking about, you know, and they cough and every time they get a, they get a bad cough as well. Yeah. So understand concerns and that they don't wanna be a breathing for new infection. But on the other hand, you can't be sending every parent who's managing a child at home very well and knows that the child is fine into a pharmacist or doctor to say holy. And that's what overwhelmed the, the services and also damages the parents' credibility and confidence Yeah. In that situation, you
Speaker 1 00:26:13 Know. And most importantly it's damaging for kids to be missing out on more, you know, education or socialization at that age. So I think a cough plus any other symptom is stay home a cough after recovery that is the same cough and isn't a new cough is go to school, do you know? So
Speaker 2 00:26:33 Yeah, that's a, that's a good kinda boss line actually to use. Yeah. Um, I wish, I wish you tell all the questions.
Speaker 1 00:26:41 Do you know what I, you can find information which kind of says that on the HC website in relation to covid information that, you know, a cough alone is not, you know, a new cough is a, a potential infection, but a lingering cough in a postviral situation, you know, is expected.
Speaker 2 00:27:05 I I I suppose my concern is that very often parents are in the position that they've been, you know, they would, we would say that to, you know, consultation that's an interaction may need have, which is completely unnecessary because um, some other entity has decided that the, there had to be a professional who's given this opinion as opposed to the parent trusting their instinct. I, I get it, I understand it's a dilemma for everybody, but it, it's, it's a problem. You know, it's um,
Speaker 1 00:27:37 It's difficult uh, and it's difficult because there are unfortunately situations where people are under a lot of pressure and mm-hmm <affirmative>, they maybe have feel like they've no choice but to send their child crash and maybe it's not appropriate. Yeah. And this is where this conflict arrives where you've got very rightly sensitive parents not wanting a sick child in the crash, which is correct and absolutely valid. Yeah. And I would be one of them, but you've got that balance with trust because if it's, you know, it's a bit subjective isn't it? Like it's,
Speaker 2 00:28:13 It's, it's really subjective know, have to trust parent is trying to do the right thing by their child and that we all have responsibility. Well responsibility.
Speaker 1 00:28:24 Like there's no doubt that every parent is doing their best in their life, but whether they're doing their best in terms of these guidelines is sometimes a conflict, you know, and yeah. Just through life.
Speaker 2 00:28:35 Yeah.
Speaker 1 00:28:35 One thing just before we kind of finish up, it's very topical at the moment and I just would love to hear a little bit of information and maybe reassurance for you for parents in relation to the, I suppose assumed increased circulation of scarlet fever based on what's going on in the UK and how that can sometimes then, you know, increase levels of scarlet fever may increase the levels of invasive strapa infections because they're both streptococci based. Yeah. Infections. Uh, and actually just just to add to that, cuz there, I know a really important question that people will want to know is how do we know the difference and just to highlight the importance of the, the potential role of antibiotics for strep A versus absolutely no use in bronchitis.
Speaker 2 00:29:26 Okay. Yeah. And I suppose that's what's you flu your snotty nose and your toes are sore, you know, every bit of you is affected by it. Um, so you may have snotty nose, might conjunct cough, have might bit vomiting, diarrhea, infection tend to affect every part of you. Bacterial infections are focused on one particular organ that is the basic difference between them. So bacterial infection will give you, um, a bad for instance or a bad infection or bad lower respiratory tract infection, pneumonia. The fundamental difference between them, um, and a bacterial infection requires an to clear it, a viral infection does not and an makes no difference to it. However, a lot of bacterial infections start in similar ways. Um, one other thing is bacterial infection tend start a lot quicker actually, you know, virus there's gonna gets worse and worse and worse like you talked about with the RSVs.
Speaker 2 00:30:44 And then day three they get worse with a bacterial infection. They were fine yesterday and they're really sick today that again, this is not an but these are can go by very, very high temperature from day one with bacterial infection, hard to manage and, and, and the bacterial infection will not clear without a cover. That is the essential difference between them. Um, infection has always been around and it's really important. Parents, this is not ISN scary thing that's come out there every wintertime, summertime as well. Um, and of us actually store as a, what's called a, so it's a normal bacteria. We, our, our systems then are much vulnerable present a are ingo, which people know a lot about, you know, that horrible crusty that children get in their hands in particular, it's very contagious needs sore kind of. Um, the classic scarlet fever presentation is a sore throat, really red tongue.
Speaker 2 00:32:08 They tend to be look kinda white around the mouth, but the rest really flushed. That's kinda the classic scarlet fever look. And that's just a particular presentation of a infection. Very common. We see it all the time. And when we finished we treated this and the children tend to do very well, but as always with anything, some children are a bit more vulnerable and some children don't respond as quickly to antibiotics can get worse illness. And that has always been the case. Um, there isn't anything new and different that is actually out there to frighten people right now. It's just what's really important is that, you know, that um, if child is presenting these sort, get the child checked in case bacterial infection, they're not responding quickly or if they seem to be deteriorating, go into the hospital or do, you know, get the follow up appointment. Don't be afraid to check again if you're not careful. I'm not, not sure. And we do that in, we see child one day and say, bring them back in morning again. Have a little look at again to see if they're improving or deteriorating. And that call needs to be admitted. Yeah. But the majority ofa infections are minor and they respond really, really well and quickly to antibiotic
Speaker 1 00:33:25 In the pharmacy. I always say to parents like, just like that, come back to me tomorrow we're gonna do a period of what I call watchful waiting <laugh>.
Speaker 2 00:33:35 Yeah. And it, it's a great phrase now. And, and I think parents like that cause it's that little backup that they needed as well. You know, um, and we need it. I like, I need it as a clinician as well. I'm sure you feel the same Tina that, you know, you see a child the next day and you can kinda, he's so much better. That's great. You know, and you know, when you're looking at your own, it's, that's about, you know, know. Um, so I, yeah, we do that frequently and it's, it's, it's a really good thing to do, but just trust your instincts again, you know, if you're not sure, check the child out. But invasive strep disease is an unusual, um, complication of a strep illness. Doesn't happen very often, thankfully. It's serious and it needs to be treated really aggressively. But most of these infections respond very quickly to ans problem is actually deciding which ones need which as well.
Speaker 1 00:34:40 Just, I'm just going to ask you a little, um, favor on behalf of pharmacists all over Ireland right now, <laugh>. Okay. Put all GPS and prescribing clinicians, please write a first line and then a second line antibiotic for this because we are suffering from shortages of some and not all antibiotics. So for example,
Speaker 2 00:35:05 Interesting.
Speaker 1 00:35:05 Okay. The likes of some of the, um, you know, amoxicillin kind, ethyl penicillins, some of them are in short supply, some pharmacies have them, and a second line treatment for Astra infection would be, for example, ch clarithromycin suspension. Yeah. Um, and that is currently available. So <laugh>, I'm ju I'm just solving, solving solutions here.
Speaker 2 00:35:29 Thank you Alex. You'd be solving a lot of problems. Me too. With phone call back.
Speaker 1 00:35:37 Antibiotic choices, two antibiotic choices. We'll have a first and a second line please. Thank you, <laugh>.
Speaker 2 00:35:42 Absolutely. Well that's good to know. I I'll certainly say that in my, anyway. Yeah, that's a really clever idea. God's a whole layer of work for you. It's a whole layer of worry for the, and a whole layer of work from my admin staff, from them
Speaker 1 00:35:56 <laugh>. And when people go out in here, okay, I can't get first line. They think, well, second line isn't gonna be as good. And really it's the, the lucky thing is that they is actually sensitive to quite a few antibiotics and yes, we
Speaker 2 00:36:08 Can work. Yeah,
Speaker 1 00:36:09 Okay. We can work around it. So we just need That's yeah,
Speaker 2 00:36:13 That's a very good lesson. Okay. Thank you. I'm, I'm, I'm, I've learned from you as well. I knew I would <laugh> actually there was one other thing I wanted to say just about the kinda decisions and should collaborative, you know, patriarchal over be over. Um, so, you know, if you're in a situation and you're, you know, you're adamant that your child is very sick and the doctor has given you their opinion and they're saying no, it's a virus and, you know, shouldn't be a shouldn't, you know, you should be able to come to a conclusion and we very frequently give these holding prescriptions, hang onto this script. The child is getting sick. Um, sicker you can give it, but the worry with that is that the child is getting so sick and that, you know, they're just getting an need more. So this role as clinicians and yours as well to give that to, you know, you can do this and you can do this, but come back if things are deteriorating. Yeah. That's the thing that we need to get out there, you know?
Speaker 1 00:37:25 Yeah. One GP visit or one, you know, I suppose visit to a and e only defines a picture in time and tomorrow the picture may look different. Yeah,
Speaker 2 00:37:35 Exactly. Yeah. And that frequently happens and we, you know, and we sometimes send children into the hospital and do it very reluctantly, in infrequently, but when you do, they might see this junior in a hospital who says home again, you're furious, you know, happens. So don't afraid of that. Have the, in the surgery too that, you know, three strikes and you're out, which means that a child has been seen three times in surgery and you're really not, they're not improving. They need to be getting another opinion on this in the hospital scenario. You know? So we don't always know everything either and just, just be aware of that we're all fallible and we, we need to kind, you know, parents give the information as they see it. We give our information as we see it and we come up with a plan together.
Speaker 1 00:38:24 Okay. Thank you so, so much for talking to me today. It's been Absolutely.
Speaker 2 00:38:29 It's been a pleasure. Thank you.
Speaker 1 00:38:31 No, it's been so great and I know like you've given me an enough, a lot of clarity, so I'm sure you've given enough, a lot of my listeners, a lot of clarity and sometimes I think it's just nice for parents to hear that, you know, GPS, pharmacists, we all care. We're on the same boat and we're all navigating this together and yes, it, you know, it's not a great winter boat. We'll get through it and by being aware of the symptoms of everything that's going on. And I'll certainly keep, you know, popping up as much information as I can on my Facebook and Instagram and on the podcast. And I think knowledge is power and Yeah, absolutely. Yeah. That's all we can do is know when to act.
Speaker 2 00:39:11 Yes. Perfect. Great lesson, sir, to end with <laugh>. Yeah, Tina, thank you. It's been a real
Speaker 1 00:39:16 Pleasure. Thanks a million.
