Secure Message Visit
Narrative: SPRUCE MESSAGE VISIT Date: 2023-09-30 Encounter: Spruce text message CC: Post-tonsillectomy pain management and GI symptoms including diarrhea and vomiting. HPI: Henry underwent tonsillectomy and adenoidectomy on 9/29 and was discharged with oxycodone 5mg/5ml at 1.5ml per dose. On 10/1, he woke at 2am in serious pain having missed a dose, and developed nausea/upset stomach attributed to oxycodone on an empty stomach. By 10/3, he had significant diarrhea, inability to control it, and one episode of vomiting overnight. No blood in stool. Stomach pain present. Miralax had been started on 10/1. No discharge papers were provided at the hospital. Assessment: Dr. Hobbs assessed the post-operative GI symptoms as not related to anesthesia. Possible causes included antibiotics given during surgery (unknown to parent as discharge papers were missing) or post-surgical gut disruption. On 10/4 parent reported worsening; on 10/5 improvement was noted. Plan: Continue oxycodone for pain, stay ahead of dosing schedule. Monitor bowel movements (narcotics can slow gut). Continue Miralax. Start probiotic. Reduce dairy and fruit (especially berries). Prioritize fluids over food. Dr. Hobbs followed closely through 10/5. Medications: - Oxycodone 5mg/5ml, 1.5ml per dose - Miralax Not specified Key clinical quotes: "Keep an eye on his pooping. The narcotics can slow things down." "Check what he's eating for what I mentioned. Get the probiotic going. Let's stay in touch to make sure it's slowing down" "It's ok to do the mirialax. People tummies and brains don't all love anesthesia." Source: Spruce conversation t_226ST10QO3800