CJ had a great night. Pretty much slept right through. I woke up every few minutes for about an hour until the nurses got one of his monitors reset. After that, I was able to have a good night's sleep as well! We've had a lot of information thrown at us today, so I'll try to be thorough.
It was a day of ups and downs.
Infectious Diseases doc came by in the morning & clarified some stuff. Said the "gram test" from yesterday actually showed that there was a bacterial infection, but that they didn't really know for sure it was staph. But it's consistent with staph, so that's why they were treating him with the vancomycin. The cultures will confirm staph & what form it is. The complication is that since CJ has been on antibiotics, the cultures may not grow at all. When the ID doc was there, he said they hadn't started growing yet. He was keeping his fingers crossed that they would. The only other way to confirm staph is by doing a DNA test on the bacteria. He requested that yesterday, but the lab didn't want do it because the sample came from a wound. He's going to call and talk to them to try to get it done. He did confirm that the infection had not entered the blood stream. This is a HUGE praise!
Because vancomycin is so strong, and because it can cause kidney problems, blood is taken ever 4 doses to monitor levels. His fourth dose was a little before 9:00AM, so they had to stick CJ and pull some blood. He was a little concerned to hear he was having some blood drawn, because of the trouble they'd had getting blood on Monday. But he wasn't dehydrated anymore, so it was quick and painless for him. They got it in one stick. They also started giving him Zantac, because the vancomycin can cause heartburn.
They ordered a "PICC line" for CJ. It's like another kind of IV that's higher on the arm and goes straight into a major vein. PICC stands for "Peripherally Inserted Central Venous Catheter." A PICC line is inserted into a vein in one of the arms and extends all the way through to a location near the heart. This is an area of high blood flow and allows better mixing of the IV medications. With a PICC line, we will be able to continue the vancomycin at home. The vancomycin treatment will last 2-6 weeks, so the PICC line is a big deal. We will give him the injections 3 times a day, & a home health care service will come by once a week to draw blood & change the dressings.
The PICC line is inserted by a radiologist using x-ray. About 30 minutes before we went down to Radiology, one of the radiologists came by and put some numbing cream on CJ's arm. We weren't allowed in the room for the procedure, because it's a sterile environment. They use an ultrasound to guide the wire into the vein, then cut the line to the appropriate length (so each person's line is custom.) Once the line is inserted, they confirm the placement with an x-ray. The whole procedure took about 30 minutes.
Most of the afternoon was pretty uneventful. CJ would napped a lot from the Benadryl. He continued his breathing therapy every two hours. Pain levels were consistently 5-6 .
CJ's temperature was up a little bit later in the afternoon, but everything else was fine. Then, at 5:30, his pain level really started to go up. He was complaining about pain in his upper left chest and didn't want to move his left arm at all. We needed to change his shirt, because 1) he was in the same shirt he wore to the hospital, and 2) it had puss that had drained from his incision. Since he was hurting so much, we decided to wait until they switched the IV drip to the PICC.
By 6:08PM, CJ was really agitated. He felt warmer, so I requested temp taken. His primary complaint was still his upper left chest. He complained of difficulty breathing & asked for oxygen, even though his O2 level was 96% & his heart rate was 118 bpm. When they took his temperature, he had a fever of 102.9! His pain level was up to a 9. He was in so much pain, that he actually told the nurse to cut his new shirt (that he loved) to keep from having to raise his arm. When we got his shirt off, I noticed the left incision site was red & swollen. It wasn't open, but it sure looked like it was infected underneath. I can't put into words how miserable he was...this was not my CJ.
Almost an hour later, he was still hurting a lot. The nurse sent a request to the doctor for additional pain medication, and finally, at 7:30, CJ got some morphine. When they took his temperature again around 8:00, it was back to normal.
Seeing him in the state he was in completely wiped me out. He was so miserable, and there wasn't a thing I could do to help. I actually had to leave the room for a few minutes while the nurses worked with him to weigh him and help him to the bathroom. My biggest concern was the fact that he spiked such a high fever when he'd been on IV antibiotics for 3 days. It just didn't make sense to me. It really had me worried.
I was glad that CJ got some relief and was starting to return to his normal self by the end of the evening. He and I both needed a good night's sleep.
Showing posts with label vancomycin. Show all posts
Showing posts with label vancomycin. Show all posts
Wednesday, June 18, 2014
Tuesday, June 17, 2014
Back in the hospital
Well, today is exactly 4 weeks since CJ's surgery, and we're back where we started...in the hospital.
Yesterday was a long, hard day for CJ. He continued having pain Sunday night. At 3:30 yesterday morning, he woke me up wanting something for pain. When I got near him, I noticed he was even hotter than he'd been. His fever had gone up to 103.5! After ibuprofen & some moisture to cool his skin, it was still 103.3 an hour later. He pain also had gone up, and he was having more trouble breathing.
Because he of the high fever and continued pain, I made an appointment for him at his pediatric clinic. We continued treating his pain & fever by alternating oxycodone & ibuprofen. When I took his temperature at 10:20, it was normal again. Since the fever was down, and he hadn't vomited anymore, I hoped that we turned a corner toward improvement.
Unfortunately, at 11:15, he threw up. At noon, he got some more pain medication, and I happened to notice a small amount of puss oozing from his right incision site. I put some antibiotic ointment that had been prescribed for him on the incision. He was still feeling nauseous, so I gave him the anti-nausea medicine his pediatrician had called in the night before.
His pediatrician appointment was at 2:20PM. He was NOT happy to have to get up and move. Because he was in so much pain and just felt so bad, anything & everything was an annoyance. His pain level was up to a 9, and he was just miserable. He couldn't move without pain, and he was having an especially difficult time moving his right arm. The doctor ordered a chest x-ray and lab work, which was expected. She ordered a CBC, strep test, flu test, and sed rate. Because he'd been throwing up and not able to drink much, CJ was pretty dehydrated. The lab technician couldn't get a vein to pull the blood, and CJ was getting more and more agitated. She went ahead and did the strep & flu tests, and I gave him a Valium to calm him down. While we waited for that to kick in, we went ahead and did his x-ray. The lab tech ended up having to draw blood from CJ's hand, because she just couldn't find a vein that would take the needle. Even that vein didn't pull enough blood to do the sed rate, but it was enough for the CBC. The flu & strep tests were negative (we expected that, but it was good to rule them out.)
The doctor came in and said CJ had pneumonia in both lungs, and the CBC showed that he had a pretty high white cell count of 17,000. When you add that to the dehydration, she said he needed to be in the hospital where he could get IV fluids and antibiotics. So, she sent us back to Children's Hospital.
The ER had been called and was expecting us, so we got right in. They started an IV, and even after the bag had emptied, CJ still looked dehydrated and sickly. His fever had also gone back up to 103. IV antibiotics were started. After 5 hours in the ER, CJ's fever broke, and he was hydrated enough that they felt comfortable moving him to a room. (Part of the delay was determining if he could go to a regular room or if he needed an intermediate care room...a step up from ICU.)
We finally got into a room around 9:30PM and settled in for the normal hospital routine of vitals every hour, etc. I was exhausted from the past two days, so CJ told me I deserved to go home & sleep in my own bed. Such a sweet boy! His grandmother stayed with him.
CJ had a pretty good night. He only needed pain medicine a couple of times, and his temp stayed down most of the night. Between 4:00 & 5:00, it started going up again, but by the time I got back to the hospital around 7:00 it was normal. Our biggest issue was getting him to do his breathing therapy to get those lungs opening back up. It really hurt, so of course, he didn't want to do it. We were continuing with IV antibiotics, fluids, and oxygen. The doctor that made rounds said he wanted to get an ultrasound of CJ's lungs for closer examination.
At 11:00, one of the surgeons came by and examined CJ. He was very concerned about the tenderness over the pectus bar and the redness around the incisions, especially the right one, which was continuing to look worse. He wanted to consult with the doctor that actually performed the surgery, but he thought they may want to perform an ultrasound or CT to determine if there was an infection around the bar.
We went down for an ultrasound a little after noon, but it was only of the lungs.
**Warning: there's some icky descriptions in this paragraph!**
At 1:00PM, our surgeon who worked on CJ came in to check on him. After telling him what led up to our readmission, the doctor took a look at CJ's chest. When he examined the right incision site, I noticed it seemed to be seeping fluid. When the doctor pressed on it, it oozed a thick greenish liquid. The doctor said he wanted to get a culture of the ooze to see what kind of germs we were dealing with. He got some swabs and stuck one into the incision. I was actually surprised how deeply he got the swab in! Of course, CJ didn't like this at all; it hurt him quite a bit. When the doctor pulled the swab out, the fluid (now a thick, brownish liquid) literally poured out. I couldn't believe it; it was at least a good tablespoon if not more. After cleaning the area a bit and putting a bandage on it, the doctor said that while CJ may have some pneumonia, his gut feeling was that we were dealing with a bar infection. This only occurs in about 1% of cases, and he's only had one other patient that had it. (Yay us.) It would take 24 hours for the cultures to grow for us to know exactly what it is. He also said he was going to send an Infectious Diseases doctor to come look at CJ. The reason for this is that, since we're dealing with an infection around medical equipment, the ID doc would be able to determine the best antibiotic for the infection. He also wanted us to move to the surgical wing...I guess because this is a post-surgical complication.
About an hour later, the ID doctor came in. The initial results from the cultures came back as staph. As a result, they would be starting us on a very aggressive antibiotic called Vancomycin. There are two forms of staph infection: MSSA and MRSA. While no one wants staph, MSSA is the preferable strain, because it is more easily treated. The "R" in MRSA stands for "resistant," and as the name implies, is harder to treat. If that's what it is, we will also have to be in isolation. Since staph is taken pretty seriously, and because we won't know what exactly we're dealing with until late Wednesday or Thursday, we were told we'll be in the hospital at least until Friday. :(
As I mentioned, Vancomycin is a very aggressive antibiotic, so there are several precautions taken when it's being given. In many patients, it causes a reaction called "Red Man Syndrome" or RMS. The biggest symptom of RMS is (as the name implies) the patient turning red. It can also involve fever, rapid heartbeat, and nausea, among some other things. To prevent this redness and fever, Benadryl and Tylenol are given before the Vancomycin. Since it's so strong, it can also cause kidney problems, so after the 3rd dose of Vancomycin, blood is drawn and tested. They keep a close eye on kidney functions as long as your on it. (More on Vancomycin here: http://en.wikipedia.org/wiki/Vancomycin)
At 3:45PM, CJ was given the Benadryl & Tylenol in preparation for the Vancomycin. He received his first dose of Vancomycin at 4:10PM. About 45 minutes later, we moved to the surgical wing.
CJ's second Vancomycin dose was given around 9:45. Shortly after that, we were moved to another room on a different floor. This was for CJ's protection as well as any other patients, since we don't yet know what form of staph we are dealing with.
CJ is doing better with his pain, and his fever seems to be staying down. I will update again tomorrow. Thanks again for all your prayers.
Yesterday was a long, hard day for CJ. He continued having pain Sunday night. At 3:30 yesterday morning, he woke me up wanting something for pain. When I got near him, I noticed he was even hotter than he'd been. His fever had gone up to 103.5! After ibuprofen & some moisture to cool his skin, it was still 103.3 an hour later. He pain also had gone up, and he was having more trouble breathing.
Because he of the high fever and continued pain, I made an appointment for him at his pediatric clinic. We continued treating his pain & fever by alternating oxycodone & ibuprofen. When I took his temperature at 10:20, it was normal again. Since the fever was down, and he hadn't vomited anymore, I hoped that we turned a corner toward improvement.
Unfortunately, at 11:15, he threw up. At noon, he got some more pain medication, and I happened to notice a small amount of puss oozing from his right incision site. I put some antibiotic ointment that had been prescribed for him on the incision. He was still feeling nauseous, so I gave him the anti-nausea medicine his pediatrician had called in the night before.
His pediatrician appointment was at 2:20PM. He was NOT happy to have to get up and move. Because he was in so much pain and just felt so bad, anything & everything was an annoyance. His pain level was up to a 9, and he was just miserable. He couldn't move without pain, and he was having an especially difficult time moving his right arm. The doctor ordered a chest x-ray and lab work, which was expected. She ordered a CBC, strep test, flu test, and sed rate. Because he'd been throwing up and not able to drink much, CJ was pretty dehydrated. The lab technician couldn't get a vein to pull the blood, and CJ was getting more and more agitated. She went ahead and did the strep & flu tests, and I gave him a Valium to calm him down. While we waited for that to kick in, we went ahead and did his x-ray. The lab tech ended up having to draw blood from CJ's hand, because she just couldn't find a vein that would take the needle. Even that vein didn't pull enough blood to do the sed rate, but it was enough for the CBC. The flu & strep tests were negative (we expected that, but it was good to rule them out.)
The doctor came in and said CJ had pneumonia in both lungs, and the CBC showed that he had a pretty high white cell count of 17,000. When you add that to the dehydration, she said he needed to be in the hospital where he could get IV fluids and antibiotics. So, she sent us back to Children's Hospital.
The ER had been called and was expecting us, so we got right in. They started an IV, and even after the bag had emptied, CJ still looked dehydrated and sickly. His fever had also gone back up to 103. IV antibiotics were started. After 5 hours in the ER, CJ's fever broke, and he was hydrated enough that they felt comfortable moving him to a room. (Part of the delay was determining if he could go to a regular room or if he needed an intermediate care room...a step up from ICU.)
We finally got into a room around 9:30PM and settled in for the normal hospital routine of vitals every hour, etc. I was exhausted from the past two days, so CJ told me I deserved to go home & sleep in my own bed. Such a sweet boy! His grandmother stayed with him.
CJ had a pretty good night. He only needed pain medicine a couple of times, and his temp stayed down most of the night. Between 4:00 & 5:00, it started going up again, but by the time I got back to the hospital around 7:00 it was normal. Our biggest issue was getting him to do his breathing therapy to get those lungs opening back up. It really hurt, so of course, he didn't want to do it. We were continuing with IV antibiotics, fluids, and oxygen. The doctor that made rounds said he wanted to get an ultrasound of CJ's lungs for closer examination.
At 11:00, one of the surgeons came by and examined CJ. He was very concerned about the tenderness over the pectus bar and the redness around the incisions, especially the right one, which was continuing to look worse. He wanted to consult with the doctor that actually performed the surgery, but he thought they may want to perform an ultrasound or CT to determine if there was an infection around the bar.
We went down for an ultrasound a little after noon, but it was only of the lungs.
**Warning: there's some icky descriptions in this paragraph!**
At 1:00PM, our surgeon who worked on CJ came in to check on him. After telling him what led up to our readmission, the doctor took a look at CJ's chest. When he examined the right incision site, I noticed it seemed to be seeping fluid. When the doctor pressed on it, it oozed a thick greenish liquid. The doctor said he wanted to get a culture of the ooze to see what kind of germs we were dealing with. He got some swabs and stuck one into the incision. I was actually surprised how deeply he got the swab in! Of course, CJ didn't like this at all; it hurt him quite a bit. When the doctor pulled the swab out, the fluid (now a thick, brownish liquid) literally poured out. I couldn't believe it; it was at least a good tablespoon if not more. After cleaning the area a bit and putting a bandage on it, the doctor said that while CJ may have some pneumonia, his gut feeling was that we were dealing with a bar infection. This only occurs in about 1% of cases, and he's only had one other patient that had it. (Yay us.) It would take 24 hours for the cultures to grow for us to know exactly what it is. He also said he was going to send an Infectious Diseases doctor to come look at CJ. The reason for this is that, since we're dealing with an infection around medical equipment, the ID doc would be able to determine the best antibiotic for the infection. He also wanted us to move to the surgical wing...I guess because this is a post-surgical complication.
About an hour later, the ID doctor came in. The initial results from the cultures came back as staph. As a result, they would be starting us on a very aggressive antibiotic called Vancomycin. There are two forms of staph infection: MSSA and MRSA. While no one wants staph, MSSA is the preferable strain, because it is more easily treated. The "R" in MRSA stands for "resistant," and as the name implies, is harder to treat. If that's what it is, we will also have to be in isolation. Since staph is taken pretty seriously, and because we won't know what exactly we're dealing with until late Wednesday or Thursday, we were told we'll be in the hospital at least until Friday. :(
As I mentioned, Vancomycin is a very aggressive antibiotic, so there are several precautions taken when it's being given. In many patients, it causes a reaction called "Red Man Syndrome" or RMS. The biggest symptom of RMS is (as the name implies) the patient turning red. It can also involve fever, rapid heartbeat, and nausea, among some other things. To prevent this redness and fever, Benadryl and Tylenol are given before the Vancomycin. Since it's so strong, it can also cause kidney problems, so after the 3rd dose of Vancomycin, blood is drawn and tested. They keep a close eye on kidney functions as long as your on it. (More on Vancomycin here: http://en.wikipedia.org/wiki/Vancomycin)
At 3:45PM, CJ was given the Benadryl & Tylenol in preparation for the Vancomycin. He received his first dose of Vancomycin at 4:10PM. About 45 minutes later, we moved to the surgical wing.
CJ's second Vancomycin dose was given around 9:45. Shortly after that, we were moved to another room on a different floor. This was for CJ's protection as well as any other patients, since we don't yet know what form of staph we are dealing with.
CJ is doing better with his pain, and his fever seems to be staying down. I will update again tomorrow. Thanks again for all your prayers.
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