We were about to prep it, but hadn't explicitly told her she was about to get it, though she's a smart girl, she maybe could guess what's up. Cordelia (helpful big sister 
) had also just mentioned at the dinner table that Phoebe was going to the doctor's tomorrow and needed a shot. Anyway, Phoebe went into the play area, over to the reading chair (where we normally give her her shot), and immediately barfed all over the chair and her blankie (how traumatic).
) had also just mentioned at the dinner table that Phoebe was going to the doctor's tomorrow and needed a shot. Anyway, Phoebe went into the play area, over to the reading chair (where we normally give her her shot), and immediately barfed all over the chair and her blankie (how traumatic).
Phoebe has never thrown up before, so she was quite startled. Poor baby.
So. Was it a fluke? Did she drink too much milk at dinner (though I've seen this girl down gallons of milk away with no trouble before)? Was she about to come down with a stomach bug (like a kid in my class this week)? Or was she having a reaction to the methotrexate Yes, one of the most common side effects of methotrexate is vomiting, either before or after.
She didn't have a fever, but I didn't really want to give her the shot if she was about to come down with a stomach bug and potentially make it worse. :( So we decided to wait until morning to see if she stayed settled or was up barfing all night. It turned out to be the former. She was acting normal by bedtime and slept all night. We can rule out germ related vomiting.
We did the shot in the morning, but then I started wondering if there was any conflict with her getting her shots at the pediatricians.... We were planning to catch her up on the vaccines we'd postposed at her 18 month appointment, and I didn't really want to have to reschedule another appointment. I left a message with her rheumatologist and didn't end up hearing back until the end of the day, and the appointment was at 1:30, so we just went ahead and did the shots. Dr. Jen checked and the only thing in the notes was No Live Virus vaccines, which we already knew to avoid. We did Hep A and the 2018 flu shot. 3 shots today!! Poor thing! Sorry, Phoebe!
Dr. B said that there is some concern that vaccines while on immunosuppressants could be less effective, but in general it does not really happen and it shouldn't matter if she had the shot the same day or 3 days later because with the regular dosing, the medicines are already in her system anyway. I hadn't thought of it in quite such explicit terms, but makes sense. Ultimately, right call, it was ok to get the shots done, which is good cuz we already did them ha ha.
Dr. B was pretty interested in Phoebe throwing up on the chair where she normally gets her shot. Yeah, how does that not seem symbolic? She said that people tend to vomit from mtx for two reasons. One is that it causes nausea. Second, is that they then start having associative nausea and shot anxiety--- seeing a needle, smelling an alcohol wipe, seeing that particular shade of yellow, even hearing the word methotrexate can make people nauseous or vomit.
I said that in general Phoebe seems really well adjusted to her medications (though she is starting to protest more as she knows what's up). She has a really fast recovery time and we don't notice any side effects the next days. But I suppose it's possible Phoebe could experience some nausea and not be able to to verbalize it? She's such a tough kid, I think she'd just power through. We usually do the shot at bedtime so she can sleep through any reactions anyway.
Anyway, I'm really hopeful it was just a fluke. If not, Dr. B said we can discuss some meds to help settle her stomach. Stay tuned.
Phoebe did great at her check up. We love Dr. Jen! She's the nicest!
She is 35.5", so almost 3 ft tall. (87%)
She weighs 28 lb 9.6 oz (69%)
Head circumference 19.65" (95%.... she has consistently had a huge head)
I brought two Phoebe Steps magnets to give to Dr Jen, but left them in the car and had to go back to get them. I dropped them off with the receptionist, but when Dr Jen's nurse Nancy (who we always see) came by, she asked her to give them to Dr. Jen. Literally, Nancy's jaw dropped and she said "OH. MY. GOD. I love this!" I told her she could have the other one! 😊
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