So I'd been hoping to start veering away from the sickness posts. They haven't really been all that fun to write, and honestly, they have all started to sound the same to me. Can't be much fun to read either. But I guess when there's nothing else going on in our lives, it's all I got.
So yet again, Tues, the little D got sick. She spiked a fever in daycare, and they called me that evening. Gregg was actually around the corner to pick her up when they called. He took her home and checked her temperature -- 102.6! He took the day off on Wed (it's crazy, we kind of argue now about "whose turn" it is to take the sick day because we're both just running low on time off and SO busy at work). I called our ped, and we scheduled an appointment for that afternoon. And it was the same old, same old. Shivering, then a spike in fever, feeling fine when the meds kicked in and she was fever-free. And of course, a trip to the doc wouldn't be complete without blood work showing super high white blood cell count, indicative of either a bacterial infection or a pretty serious viral one.
We discussed our options with the doc. She had said after the last bout that she was considering checking for malaria, due to our recent travel. Malaria has sort of a cyclical pattern with fevers going off and on every few days. The length of the fever and frequency depends on the strain of malaria. Also, she considered running some immune tests to determine if our kid just had a poor immune system. Neither theory really fit, but it was the best she could come up. She's also mentioned it being somehow related to her kidneys but the tests just kept coming back negative. She first suggested just having us go across the street to the hospital she's linked with and running these two tests to start. Or she suggested getting admitted there or at Good Sam, where we've been before. But I started thinking that if our kid had some obscure travel-related disease (and believe me, now, I'd read up on a bunch of them and have managed to sufficiently scare myself shitless), I'd rather she be at Stanford.
Doc agreed that this was a good plan, but that we couldn't just get admitted there. We'd have to go through the ER, and of course, there were no guarantees that they would admit. But we decided we'd give it a shot and showed up at the ER at 5:30 in the evening. And were still there at 11 that evening, being told again and again that it would just be a few more minutes before they could go over our lab results and probably send us home. I was getting more and more livid. They did do more tests than we had done previously, but also the same urine and blood work. They ruled out malaria but said that it was actually hard to pick up in infants. Usually they needed to do it three times to rule it out for sure. They tested for things that I know she didn't have (cuz come on now, I google with the best of them) -- TB, various flu strains, pneumonia, mono, Eppstein-Barr. At the end of the night, I was feeling like we could have done this much closer to home and probably been home already. I think they probably would have liked to do a spinal tap to check for meningitis, but they backed off that one when I sounded less than thrilled about it.
At 11, they said they wanted to consult with infectious diseases. Everything took 3x longer because it's a teaching hospital. The resident had to check with the attending, same with the ID department - they needed to call back after consulting with the ID attending. And finally, they decided at 1:30 that they couldn't send us home after all. To be honest, it was crazy that they ever thought they could although by that point, we were ready to be out of there. D's white blood cell count had actually INCREASED from the time we took her blood at our doctor's office. And her blood markers for infection were super high. As in, apparently, usually the value is like 1 and hers was in the 100s. But the markers didn't shed any light into what kind of infection, just that she had something. But given that, it was crazy they wanted to send us home and crazy that we wanted that too. But I think we were all thinking that not much had changed from the previous times. Her fever was actually a bit lower than it has been on other hospital visits, and when she didn't have a temperature, she was happy and cheerful.
But the infectious disease folks finally called bullshit and told them to admit us. It then took a few more hours for them to find us a bed. We finally "settled in" at 3am, and then handled more than an hour of questioning by the docs. Incredibly detailed questions about when the fevers started, how frequently did she have them, how long exactly between symptoms, what was she like between symptoms. Did she have these symptoms . . . etc etc. You know, I have to say, I bet there are studies that correlate the comfort patients feel when they sense they are being adequately listened to. Because after that, I decided we were probably in good hands. And it's silly because they didn't tell us anything. And as it turns out, the things they considered were all completely wrong. So it's kind of crazy that THIS was all it took to reassure me a bit. And god, I had no idea, but apparently specific questions are up my alley. Even while we were in the ER, I had come up with this long timeline of when D had gotten sick, what day she got better, when she spiked again, etc. It was totally legit too, all spread out on a napkin and everything. The peds team we talked to that night (everyone here is a "team" -- I'm not sure we've had many conversations with solo docs, usually only while they were waiting for their team to show up) decided that our trip to India was probably the source of our troubles. They seemed to think that the most likely prospect was this bacterial infection that's caused by drinking unpasteurized milk (which we did in India, but always boiled first which is supposed to remove the bacteria).
The next "morning" (because you know, 4am is totally the middle of the night), it was a slew of people one after another. A med student coming in to get more history so she could prepare to "present" us while on rounds, the entire pediatric group, infectious diseases folks, nurses in all shapes and forms, lab guys sucking more and more blood out of our kid's veins, some one from the peds team again to clarify a few things because they had been discussing us and had more questions. Somewhere in the middle of it all, I called to update our pediatrician and she brought up again that she was highly suspicious of it being kidney related. This is something she's said to us often, during our multiple visits. And yesterday morning, she said again that I should be pushy about that, ask them to try to do some type of kidney related test to rule that out. Look, she said, we know she has this probably already. If she were a kid with asthma, I wouldn't be questioning the lab results. But if you have a likelihood for one thing that causes fevers, why go reaching for more exotic options. I brought that up to the peds group, and they said it was highly unlikely that she'd have a kidney infection (or as our ped wondered an abscess -- which is basically a little pocket of infection that may not show up on urine tests). But they are keeping all options open. And in fact, her abdominal ultrasound which they had also run in the ER did show swelling in her ureters, a difference from our last urology ultrasound. So they weren't ruling it out, but the urine tests should have picked up something if that were the case.
The ID folks came in the afternoon, and if I thoughts peds had a lot of specific questions, they had even more. At the end of our talk, they told us that the unpasteurized milk was pretty unlikely but we'd wait for the tests before ruling it out. I guess usually that's linked with lower white blood cell counts. They also said they'd continue with the malaria testing but didn't see her fitting that pattern either. Yes, it's a cyclical fever, but more like every 2 days. There wouldn't be such long gaps between sickness. They said according to the literature, it could be every 48-72 hours max. But honestly, they'd rarely seen a fever break for more than a day. So . . . what did they think? Well, what do you know, they also wondered about an abscess of some sort, either in the kidneys or somewhere near by. I think basically what that means is that bacteria aren't all flowing around in there but have kind of congregated into little pockets of infection. So easily missed on a test. Not easy to treat, but it would explain the symptoms and why her urine tests have always come back negative. They ordered a CT-scan. The message from ID seemed to be, yes, we'd consider all options, but it was looking like our India trip may not be the culprit after all.
They did the CT at midnight last night, and had us stop all food by 6:30. Actually, at some point they asked us when she'd last eaten and said they needed to wait 6 hours from that time. Except the problem was that by eating, we really just meant she'd taken a sip of milk and a few bites of cereal, not what you'd really call a meal. Her appetite was crap all day, and if we'd known of the cutoff ahead of time, we may have tried a little harder to convince her to eat. Or stuffed her full of cookies at least. So it was a fun time because around 9, D decided she wanted nana and mi (banana and milk) and there was no distracting her from the thought. Rather than sleeping, she spent a chunk of the time asking for food and drink. And it was so sad/cute. She'd start crying at times, calm down and let herself be distracted but then smile and ask us cheerfully "mi?" like she was JUST realizing she may be thirsty. G was able to finally calm her down a bit (he actually had her sleeping even until housekeeping came in and threw garbage cans around all over the room for five minutes). He then left for the night-- oh yah, we've also been driving the 45-minutes back and forth to the house during all this to deal with the dogs. We figured the CT would be relatively painless, so no need for both of us to hang out. How wrong that was!
Oops, to be continued . . . probably later today once the docs are out of the room. . .
So yet again, Tues, the little D got sick. She spiked a fever in daycare, and they called me that evening. Gregg was actually around the corner to pick her up when they called. He took her home and checked her temperature -- 102.6! He took the day off on Wed (it's crazy, we kind of argue now about "whose turn" it is to take the sick day because we're both just running low on time off and SO busy at work). I called our ped, and we scheduled an appointment for that afternoon. And it was the same old, same old. Shivering, then a spike in fever, feeling fine when the meds kicked in and she was fever-free. And of course, a trip to the doc wouldn't be complete without blood work showing super high white blood cell count, indicative of either a bacterial infection or a pretty serious viral one.
We discussed our options with the doc. She had said after the last bout that she was considering checking for malaria, due to our recent travel. Malaria has sort of a cyclical pattern with fevers going off and on every few days. The length of the fever and frequency depends on the strain of malaria. Also, she considered running some immune tests to determine if our kid just had a poor immune system. Neither theory really fit, but it was the best she could come up. She's also mentioned it being somehow related to her kidneys but the tests just kept coming back negative. She first suggested just having us go across the street to the hospital she's linked with and running these two tests to start. Or she suggested getting admitted there or at Good Sam, where we've been before. But I started thinking that if our kid had some obscure travel-related disease (and believe me, now, I'd read up on a bunch of them and have managed to sufficiently scare myself shitless), I'd rather she be at Stanford.
Doc agreed that this was a good plan, but that we couldn't just get admitted there. We'd have to go through the ER, and of course, there were no guarantees that they would admit. But we decided we'd give it a shot and showed up at the ER at 5:30 in the evening. And were still there at 11 that evening, being told again and again that it would just be a few more minutes before they could go over our lab results and probably send us home. I was getting more and more livid. They did do more tests than we had done previously, but also the same urine and blood work. They ruled out malaria but said that it was actually hard to pick up in infants. Usually they needed to do it three times to rule it out for sure. They tested for things that I know she didn't have (cuz come on now, I google with the best of them) -- TB, various flu strains, pneumonia, mono, Eppstein-Barr. At the end of the night, I was feeling like we could have done this much closer to home and probably been home already. I think they probably would have liked to do a spinal tap to check for meningitis, but they backed off that one when I sounded less than thrilled about it.
At 11, they said they wanted to consult with infectious diseases. Everything took 3x longer because it's a teaching hospital. The resident had to check with the attending, same with the ID department - they needed to call back after consulting with the ID attending. And finally, they decided at 1:30 that they couldn't send us home after all. To be honest, it was crazy that they ever thought they could although by that point, we were ready to be out of there. D's white blood cell count had actually INCREASED from the time we took her blood at our doctor's office. And her blood markers for infection were super high. As in, apparently, usually the value is like 1 and hers was in the 100s. But the markers didn't shed any light into what kind of infection, just that she had something. But given that, it was crazy they wanted to send us home and crazy that we wanted that too. But I think we were all thinking that not much had changed from the previous times. Her fever was actually a bit lower than it has been on other hospital visits, and when she didn't have a temperature, she was happy and cheerful.
But the infectious disease folks finally called bullshit and told them to admit us. It then took a few more hours for them to find us a bed. We finally "settled in" at 3am, and then handled more than an hour of questioning by the docs. Incredibly detailed questions about when the fevers started, how frequently did she have them, how long exactly between symptoms, what was she like between symptoms. Did she have these symptoms . . . etc etc. You know, I have to say, I bet there are studies that correlate the comfort patients feel when they sense they are being adequately listened to. Because after that, I decided we were probably in good hands. And it's silly because they didn't tell us anything. And as it turns out, the things they considered were all completely wrong. So it's kind of crazy that THIS was all it took to reassure me a bit. And god, I had no idea, but apparently specific questions are up my alley. Even while we were in the ER, I had come up with this long timeline of when D had gotten sick, what day she got better, when she spiked again, etc. It was totally legit too, all spread out on a napkin and everything. The peds team we talked to that night (everyone here is a "team" -- I'm not sure we've had many conversations with solo docs, usually only while they were waiting for their team to show up) decided that our trip to India was probably the source of our troubles. They seemed to think that the most likely prospect was this bacterial infection that's caused by drinking unpasteurized milk (which we did in India, but always boiled first which is supposed to remove the bacteria).
The next "morning" (because you know, 4am is totally the middle of the night), it was a slew of people one after another. A med student coming in to get more history so she could prepare to "present" us while on rounds, the entire pediatric group, infectious diseases folks, nurses in all shapes and forms, lab guys sucking more and more blood out of our kid's veins, some one from the peds team again to clarify a few things because they had been discussing us and had more questions. Somewhere in the middle of it all, I called to update our pediatrician and she brought up again that she was highly suspicious of it being kidney related. This is something she's said to us often, during our multiple visits. And yesterday morning, she said again that I should be pushy about that, ask them to try to do some type of kidney related test to rule that out. Look, she said, we know she has this probably already. If she were a kid with asthma, I wouldn't be questioning the lab results. But if you have a likelihood for one thing that causes fevers, why go reaching for more exotic options. I brought that up to the peds group, and they said it was highly unlikely that she'd have a kidney infection (or as our ped wondered an abscess -- which is basically a little pocket of infection that may not show up on urine tests). But they are keeping all options open. And in fact, her abdominal ultrasound which they had also run in the ER did show swelling in her ureters, a difference from our last urology ultrasound. So they weren't ruling it out, but the urine tests should have picked up something if that were the case.
The ID folks came in the afternoon, and if I thoughts peds had a lot of specific questions, they had even more. At the end of our talk, they told us that the unpasteurized milk was pretty unlikely but we'd wait for the tests before ruling it out. I guess usually that's linked with lower white blood cell counts. They also said they'd continue with the malaria testing but didn't see her fitting that pattern either. Yes, it's a cyclical fever, but more like every 2 days. There wouldn't be such long gaps between sickness. They said according to the literature, it could be every 48-72 hours max. But honestly, they'd rarely seen a fever break for more than a day. So . . . what did they think? Well, what do you know, they also wondered about an abscess of some sort, either in the kidneys or somewhere near by. I think basically what that means is that bacteria aren't all flowing around in there but have kind of congregated into little pockets of infection. So easily missed on a test. Not easy to treat, but it would explain the symptoms and why her urine tests have always come back negative. They ordered a CT-scan. The message from ID seemed to be, yes, we'd consider all options, but it was looking like our India trip may not be the culprit after all.
They did the CT at midnight last night, and had us stop all food by 6:30. Actually, at some point they asked us when she'd last eaten and said they needed to wait 6 hours from that time. Except the problem was that by eating, we really just meant she'd taken a sip of milk and a few bites of cereal, not what you'd really call a meal. Her appetite was crap all day, and if we'd known of the cutoff ahead of time, we may have tried a little harder to convince her to eat. Or stuffed her full of cookies at least. So it was a fun time because around 9, D decided she wanted nana and mi (banana and milk) and there was no distracting her from the thought. Rather than sleeping, she spent a chunk of the time asking for food and drink. And it was so sad/cute. She'd start crying at times, calm down and let herself be distracted but then smile and ask us cheerfully "mi?" like she was JUST realizing she may be thirsty. G was able to finally calm her down a bit (he actually had her sleeping even until housekeeping came in and threw garbage cans around all over the room for five minutes). He then left for the night-- oh yah, we've also been driving the 45-minutes back and forth to the house during all this to deal with the dogs. We figured the CT would be relatively painless, so no need for both of us to hang out. How wrong that was!
Oops, to be continued . . . probably later today once the docs are out of the room. . .
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