The past 24 hours have been quite a ride for Caden. He had a rough night last night. He ran a fever of about 103.5 and required an above normal amount of suctioning. Caden has had an increasing amount of greenish secretions this week and the full fever (above 101.5) justified Sherry taking Caden in for a visit with the pediatrician today. The pediatrician listened to Caden’s lungs to see if there were any signs of pneumonia. She also had the nurse check Caden’s oxygen saturation levels (SATS). The pediatrician did hear something in his left lung that she thought justified a chest xray. The O2 SATS also were 93-94% which is low even for Caden the recipient of numerous open heart surgeries. Sherry sent me a text message giving me the news. I left work to meet her at the MUSC emergency department.
By the time I arrived they had already processed Caden in and moved him to an ER bed. The doctors came in to listen to Caden’s lungs, take his temp, etc, etc. They said they had talked to Caden’s pediatrician and based on what they saw they agreed that he needed a chest xray because they heard the same noise int he left lung. Caden still had SATs in the low 90s.  We asked that they run a flu test just to humor us. I told them that I knew folks were not supposed to get flu twice in a season, but they are also not supposed to get RSV twice in a season and Caden has already broken that rule. The flu test came back negative. It was sent off for a second verification since false negatives on a flu test are supposedly not uncommon.
The chest xray results came back and the ER doctors said, “this chest xray looks better than the one Caden had at the end of August.” They said that if they did not have a chest xray to compare to then they would consider this xray to be pneumonia and would treat him for it. They leaned more toward an assumption that the “better looking” chest xray today could be explained by saying that Caden is still recovering from the pneumonia from mid August. Their follow on to this assumption was to turn their focus to Caden’s secretions. They said they needed to get a CT scan of Caden’s sinuses. My initial conversation with the resident delivering this news of the CT scan centered around us trying to avoid getting an IV until there was a diagnosis that required treatment via an IV. Sherry had stepped out with Riley to get a sandwich and she came in immediately after the resident departed. Within a minute later the nurse came in to announce that they were prepping for an IV. WHAT? I just finished a conversation with the resident on avoiding an IV. Turns out the resident did not know the CT would need contrast and come to ind out they actually wanted to get some blood tests anyway. Sherry raised some great questions that led to having the doctor come back and explain in more detail how their treatment would change based on the results of a CT scan of Caden’s sinuses. They convinced us to go forward with the IV to prep for a CT scan. Ultimately after two nurses attempts in each of Caden’s hands the IV would not thread. I had given them our standard “Caden is a VERY difficult stick” speech with no real response. I am not sure I have met enough nurses in five years to count on one hand who are humble enough to say, “I am not the most experienced with kids who are tough to stick.” Most nurses get a little offended when you suggest that there might be a difference in the level of experience and skill involved in placing an IV in your child. While they did not get the IV in they were able to make Caden bleed enough to draw some labs that ended up clotting before the tests could be run.
After this episode with the IV we had a little heart to heart with the 1st attempt nurse and a resident. I told the resident that I can get past the screaming and crying and can restrain Caden all night to assist in getting an IV if I know that a procedure is really needed. But the more I thought about it the more convinced I was that Caden did not need a CT scan. Sherry had drawn attention to the fact that we have been dealing with sinus infections since Caden’s birth and all of a sudden a CT scan of his sinuses is needed to determine a treatment. I piggy backed off of that by saying that if the pediatrician had not heard some noise in Caden’s lungs and seen his SATs low, we would not have even been sent to the ER. We would have been given an antibiotic to treat sinus infections and Caden would be home playing by now. They were pretty amendment about the sinus CT and even had the “educator” nurse come in to discuss the next attempt for an IV. I told her that we needed to wait a few minutes to see how the doctors responded to our questions concerning the real need for the CT in the first place. After all, Caden had sounds in his lungs, his chest xray did show some some signs of concern on the side of the noise, and his SATs were below normal. All of these things pointed back to the lungs as a target treatment area and as Sherry reminded them (based on our own knowledge of antibiotics) the antibiotics used to treat pneumonia and sinus infections are very often the same so why not prescribe an antibiotic with a broad enough spectrum to cover both and let us go home.
After a little doctor pow-wow and a call to Caden pediatrician’s office they agreed to forgo the CT scan and the IV. They came back and had a discussion with us on the best course of antibiotics to choose based on our experinces and told us that if we were comfortable going home then they felt like that would be okay. We all agreed that Rochepine injections would be a good boost for the night until we could start an oral (g-tube) delivered antibiotic.
Scoliosis
While I was out getting be a sandwich I stopped by to retrieve a copy of the doctor notes from Caden’s recent trip to the Orthopridic surgeon. They told us that the scoliosis had not really changed since the last six-month check up even though Caden had grown significantly. Normally they see the curve increase with growth spurts, but that was not the case for Caden. The composite curve was recorded on the notes at 63 degrees during this recent visit which is a very small increase of less than 10 degrees over the past 18 months as compared to the 20 degree increase in jsut five months between late 2007 and early 2008. The orthopedic surgeon did not even try to expain it and I did not need an explaination becasue I know that God is way bigger than this diagnosis.
BONUS
Many of you know that I am the technical adminsitrator behind the scenes of the GroingKdis.org web site. I have been working with Gary and Anne Marie Ezzo over the past coupel of weeks to post a new page on GrowingKids.org dedicated to delivering a preview to the new Toddlerhood Trainsitions video series. Sherry and I have the priviledge of leading one of the very first classes in the world using this new material on Monday nights are Seacoast Summerville. Your bonus is to get a peek at this series before anyone else even knows the clips are available on the Internet. Enjoy the Growing Families International Toddlerhood Trainsitions Series Preview!