If I've ever learned anything about life over the past few years, one thing is certain--never assume a thing. Mrs. X brought her four year old into the office because of a recurrent problem with pinworms. The first episode occurred while on vacation. It seems that her son woke up out of a sound sleep crying hysterically. As it was late at night, and they were away from home, they decided to take him to a local emergency room thinking he might have an ear infection. The astute E.R. doctor noticed the sleepy-eyed four year old scratching his bottom. With this, he examined the tykes bottom and saw the tiny parasites which confirmed his suspicions that this was pinworms.
He explained to mom, in great detail, how the child ingests the eggs which pass into the intestines where they hatch and become mature adult worms that live in the large intestines. At nighttime, usually after the host has fallen asleep, the adult female worm crawls out onto the peri-anal area to deposit her eggs. They then crawl back into the rectum to co-habitate symbiotically with the unsuspecting host. He went on to explain how the worms crawling onto the anal area can cause a strange sensation to the sleeping child, sometimes enough to awaken them out of a sound sleep. It can appear like a night terror. He assured mom that it wasn't really as bad as it sounded, and it was certainly easy enough to treat.
Since it was late at night and there wasn't a pharmacy that was open for miles, he gave her two tablets of Vermox tablets which is the treatment of choice for pinworms. "Give your son one tonight, and one in 10 days," he told her. "This will kill both life cycles of the worm--the adult with the first dose, and then the worms that have yet to hatch. The second dose will pick them up," he explained further. This made perfect sense to both mom and dad, and soon they were on their way.
It had been two weeks since he had finished his treatment and now it was back, worse than before. She told me that the past three nights were "the worst!" Her son was up every night exactly one and a half hours after he fell to sleep. What prompted this visit however, was the fact that last night she actually saw the worms herself!
I had her recount verbatim what had transpired in the emergency room that night. She gave me a word for word description of the conversation with the E.R. doctor, complete with a detailed description of the life-cycle of the pinworm (as good as any that I've heard from an intern or a medical student). She then told me about the Vermox, and how nice he was to give her the medicine since there wasn't anything open for miles etc..
It sure sounded as if everything was done appropriately. She washed the bed sheets, towels and underwear as she was told to do. I was at a real loss as to why it might have recurred. As I was scratching my forehead, the little boy looked at me and said in a very guarded and apprehensive voice, "Do I have to take that medicine again?"
I explained to him that it sure sounded as if the infestation had come back, and I thought the medication was important to get rid of it. "Besides," I tried to rationalize with him, "It really isn't bad tasting stuff."
As the last sentence was rolling off my tongue, he looked me in the eyes and said in a very serious voice, "But they hurt my bottom!"
With that exchange, mom paled. "Oh my gosh!" she blurted out. "You mean to tell me....I, 'er just assumed that...I figured that since most medications are taken for ten days, and since this was for those horrible little worms...and since there were just two of the tablets...I thought they were to be used like suppositories."
Assumption is a funny thing. The E.R. doctor did a magnificent job in explaining to mom in great detail all there was to know about pinworms...Parasitology 101. Yet he assumed that mom would know that the Vermox was a chewable tablet (for her son, and NOT the worms). And mom assumed that since there were just two tablets, and they were for the dastardly little parasites, that they HAD to be used as suppositories.
I am happy to report that the pinworm problem has been solved once and for all. Sure enough, two tablets of Vermox, taken ten days apart, and taken ORALLY, did the trick.