Friday, July 6, 2012

Our Crazy June, Part One.

When BBZ was 9 months and 16 days old, he underwent surgery for intussusception.  On June 22nd, when LBZ was 9 months and 12 days old, we went to the the same floor of the same hospital so he could be treated for bacteria in his blood.  Nine months appears to be the magic number for my boys.

When LBZ was sick at the beginning of the month, he apparently had Salmonella poisoning.  My last post on June 11th stated that he was doing much better.  That he was exploring and moving and smiling, etc, which he was.  But he was still experiencing diarrhea.  He also had a terrible diaper rash that week and we even had him in disposable diapers to try and treat it.  He was also waking up a lot at night.

By Thursday (6/14), I was concerned about the ongoing diarrhea and decided to pick up a test kit from the doctor so we could do a stool culture.  I also scheduled his well-baby 9-month appointment for the 16th so I could drop off the sample and do the appointment.

The appointment went well.  He appeared to feel ok besides the diaper rash.  The doctor determined that it was yeast and recommended an over-the-counter ointment.  That cleared it up fast.  I gave them the sample and they sent it off to the lab.

He was a bit crabby over the weekend, but nothing too terribly bad.  I woke up on Monday with a low-grade fever.  I had both boys at home with me and felt terrible most of the day.  I also had diarrhea, so I figured I got what everyone else had at the beginning of the month, just a bit later than everyone.

I was so sick.  The worst part was the terrible cramping in my stomach.  Knowing that my sweet little boy experienced this was awful.  I remember him screaming out in agony and me not being able to tell what was wrong.  Now I knew.  His poor little tummy :(

So I sent him to school on Tuesday.  I was incredibly sick.  My fever broke that morning, but I still felt awful.  I tried hard to stay hydrated, but when I pumped milk I hardly got anything.  I went to pick up the boys from school and LBZ's teacher was concerned that he was a little warm and not acting like himself.  She said he still had diarrhea.

He was up a lot Tuesday night and spiked a fever.  I didn't treat it, but I knew I had to keep him home on Wednesday.  I had a really important work meeting at 11am and N had one from 9-11am, so we met at my work parking lot and he took LBZ home so I could go to my meeting.  I had called the doctor's office that morning because I wondered what was taking so long with the results and shared his new symptoms.  They called a few hours later and let me know that he had Salmonella in his stool.

About an hour later, a woman from the health department called and said Salmonella is a reportable disease and she had to get all kinds of information from me.  This is apparently an isolated case so we never did find out where he got it.  It makes me so sad to not know what caused do I know how to prevent it from happening again?  Maybe I just can't.

I was still not feeling well and reported my symptoms to the lady at the health department.  Assuming I had it too, she took my name as another case.  It didn't matter though because it was clear that I probably got it from LBZ.

A little while later LBZ's doctor called back and said she wanted me to take him to a lab to have his blood tested for bacteria, just to be safe.  I knew I couldn't get to the lab before they closed, so I decided to wait until Thursday.  The only time N could stay home was Thursday morning and we were all planning to be on vacation for 10 days, so we both had some loose ends to tie up before being gone for vacation.  I went to work Thursday morning and took that afternoon and Friday off for the first part of my vacation.

I took LBZ for the blood work and couldn't believe how well he did.  He sat still, stuck his little arm out and didn't even cry!  I did though.  When we got back to the car I shed a few tears about having to put my baby through all of this.  I was also still not feeling 100%.  I actually lost 5 pounds during the past 2 weeks.  Having to hold a baby non-stop and being sick myself left very little time to eat.  All of my clothes were falling off.

Thursday afternoon I called his doctor and spoke to a nurse about the blood tests.  I wanted to know what would happen if they came back positive.  She told me that if the test was positive, they would simply put him on a different antibiotic.  I let her know that we had a trip planned next week and wondered if I should plan to go.  She said that we should plan to go and if bacteria is found in his blood then they could even call a prescription in to a pharmacy where we are with no problem.  I felt pretty good about that.

So Friday morning was pretty good.  We went to Target and got some final things for our trip and headed out to my friend's house to pick up a small steamer for LBZ's food.  My friend's husband is going to nursing school and they happened to have a discussion about Salmonella in class the night before.  Laura was much more detailed about the poisoning than any of LBZ's docs had been and I was left feeling a little confused.  No one seemed overly concerned about any of this.  They were just having me do this or do that and all seemed well.

I had been treating LBZ with amoxicillin (which is controversial for treating Salmonella, but after 3+ weeks of diarrhea it seemed like the right thing to do).  LBZ had been exploring the house, pulling up on furniture, happy, laughing and overall seeming like he was getting better.  He did have a pretty bad cough though.

At around 3pm on Friday, a different nurse practitioner called me and said that bacteria was found in LBZ's blood and that I would need to take him to Children's Hospital so they could treat the infection with IV antibiotics.  I was confused and very upset.  Why didn't they tell me this was the treatment plan for bacteria in his blood?  I was so upset.  I called N and my mom and took him to the hospital.  N had to pick up BBZ, so LBZ and I were on our own for the initial admission.

It was a direct admission, so we didn't have to wait at the emergency room.  As I walked onto the floor, the doctor came out and said she wanted to look at him.  She did and said "wow, he looks great.  Especially since he's septic."

I found that only somewhat comforting.  I noticed that we were on the same floor at the same hospital where BBZ was almost exactly 3 years ago.  All of those memories came rushing back.

We got to the room and they explained the treatment, IV, blood work, etc.  I had to hold him down so they could put the IV in his foot.  That was so sad.  He cried in pain and looked at me for comfort, which I couldn't give him.  My poor, sweet baby boy.

They placed the IV, took some blood and let me take him and nurse him.  That helped him calm down.  N and BBZ came by a bit later and so did the attending physician, who was apparently the world's expert in bloody diarrhea.  He explained some stuff to us and started talking about meningitis.  He said that the only way to rule it out is to do a spinal tap.  N and I were floored.  We weren't sure what to do.  He said it was the only way to get a really early diagnosis (if it was meningitis) and an early treatment plan.

It was about 8pm by now, and BBZ was needing to go home to go to bed.  N didn't want to leave me there to deal with the spinal tap procedure alone, but we didn't really have a choice at that point.  He left to take him home and the nurse came back to explain the procedure.  They said I could be there, but that I couldn't touch him during the procedure.  She kind of encouraged me not to go, saying that it can feel very distressing to watch and not be able to rescue him.

I called N and asked him what I should do.  He suggested that I not go.  It was a really hard decision to make, but I decided not to go with him.  The whole thing took about 25 minutes and when he came back he was tired and sweaty.  The nurse said that he cried for about 10 minutes and then fell asleep.  I guess his little body just gave up.

They initially said that we should know the results in an hour or so.  I tried to get some sleep and kept waking up and wondering when I would hear something.  The nurse came in to take his vitals at one point and said I probably wouldn't know anything until morning since they wouldn't wake me up to tell me.  They had started IV antibiotics by then.  LBZ was up about every hour.  I held him on me most of the night.  He seemed really bothered by the IV in his foot.  I couldn't take him out of the room and didn't have anyone there to give me a break.  He would cry hard if I put him down in the crib to go to the bathroom.  It was a rough night.

N and BBZ came to the hospital the next morning and I was able to take a shower.  It's funny, since I spent so many days with BBZ at this same hospital, I knew exactly what to bring.  Changes of clothes, hygiene stuff, I seemed like an old pro.

The doctors still didn't give us a clear explanation of what was happening.  They kept talking about 48 hours and bacteria growing, etc.  Finally, a really nice nurse spent some time with us and explained that the blood and the spinal fluid was put into separate cultures and placed into a machine.  The cultures sit in that machine and we wait.  We wait to see if any bacteria grows.  If something grows, an alarm goes off and the doctors are notified.  If nothing grows, nothing happens and we just wait.  So apparently, nothing was growing, so nothing was happening.

We waited all day.  My mom ended up coming in town around lunch time and helped, but LBZ just wanted me to hold him.  He had a terrible cough, so they did a nose swab and diagnosed croup.  Looking back, that is probably what caused the fever on Wednesday.  They also did another stool culture.

By Saturday night I was starting to go stir crazy.  I walked around with BBZ a while and was able to get some snacks.  One of the best things about this hospital is that breastfeeding moms get free meals while there with their babies.  So I ate better in those 2 days than I had in weeks.  I gained those 5 pounds right back :)

He slept terribly Saturday and I ended up holding him in the couch/bed with me all night again.  Sunday morning at around 6am, a lady came in and said she was there to take blood.  I told her that I didn't think they were going to take any more blood.  She asked if I wanted to speak to the nurse and I said yes.

The nurse came in and I asked what the purpose of the blood work was.  She said he was on daily blood draws.  I didn't understand why I would need to hold him down and traumatize him yet again if the blood they took upon his admission had not yet grown any bacteria.  At this point, we were at about 33 hours of incubation of the cultures.  I explained that I understood the risk of if the blood grew bacteria at 47 hours, we would have to wait again for another 48 hours to leave, but I was willing to take that risk (since I really believed that the bacteria was gone).

The nurse agreed.  The doctor came in and he agreed and wanted to start the discharge right away.  I thought that they would keep us there for the full 48 hours, but they didn't.  They all said we could leave as soon as all of the paperwork was done.

They took out the IV, which made LBZ one happy little boy.  He had all of the necessary IV antibiotics and they prescribed oral antibiotics for 12 days.  I was so happy we were heading home!

The frustrating thing about this is hind-sight.  The blood that was drawn upon admission was clear of bacteria.  That means that the oral antibiotics he took Wednesday evening, twice Thursday, and Friday morning killed the bacteria sometime between when his blood was drawn on Thursday afternoon at the lab and Friday evening at the hospital.  That is wonderful news, but I wish we didn't have to put him through the whole hospitalization for what now seems like no reason.

I do know that there was a reason though.  Had they been right about any of it, the meningitis, the sepsis, any of that could have turned very bad very fast.  So I understand the urgency and the precaution, I just wish he didn't have to go through all of it.  Thankfully, he is no worse for the wear.  He is back to his old self.

Did I mention through any of this that we were scheduled to leave for a week vacation on this very same Sunday?  Well we were, and we decided to go after all.  We left Monday around 10am, just one day late. 

That story will be Part 2 of our crazy June, so stay tuned!

To jump to part 2, click here.