Saturday night I went back to visit my least favorite place. The ER. If you refer to my previous post, you’ll see Faith was sick a week ago (on her birthday, no less!), and we suspected Zoe had came down with the same. But with her, there are a few additives that make it hard to determine sometimes what’s really going on. For one thing, Faith never had nausea/vomiting with her illness. Fever, clinginess, yes. But no puke. Zoe, however, threw up five times on Saturday evening. That’s a record for her. With her, there is always the possibility of an underlying shunt issue causing the vomiting, and the possibility of a kidney infection causing the high fever. The final straw came when John & I were out at dinner Saturday evening & my mom called to say Zoe was very feverish despite Tylenol, and very sleepy.
So off we went.
Thankfully, the worst part of that night was the sleep deprivation from being up so late. This time, there were no multiple IVs, multiple sticks for labs, or confusion like at our last ER visit. Of course, this time around, I made no bones about the fact that I was a nurse practitioner, that we do not routinely visit the ER for minor illnesses, and I was concerned. I also knew now from previous experience, to ask for labs to be obtained when starting the IV to eliminate multiple needle sticks, to request cultures because yes, her urine dipstick will look gunky because we do intermittent cathing. The ER doc could not understand why her dipstick would look positive for a UTI if she didn’t really have a UTI, but I just let it go & waited for the culture results. Whatever. I think the pediatric urology department needs to do some educating for the ER docs on treatment of kids who are intermittently cathed.
We got in quick (the words shunt, vomiting & lethargic really speed things up), and before too long we were back with Zoe getting a CT scan of her shunt, and a shunt series. The CT scan allows the physician to see the size of her ventricles; if they are swollen or increased in size when compared to previous scans, the suspician is raised for a shunt malfunction. A shunt series is basically a series of x-rays (head/neck, trunk & abdomen) to evaluate the position of the shunt. Is it in the proper place? Is it broken? Yes, these things as lifesaving as they are for kids with hydrocephalus are mechanical and can break & move out of position. It also helps to show if there is a blockage. Even excessive constipation can cause a shunt malfunction. I think shunt placement is more of an art than a science 😉
Thankfully, all of Zoe’s images looked great and her ventricles were actually better than they’ve ever been. So no shunt concerns. I truly did not feel it was a shunt issue–not with the fever. Shunt infections are common within the first few months after their placement, but since her incisions have long healed up, there was no open entry route for infection to the shunt.
After labs, cultures, urine samples, & Zofran, we were sent home with antibiotics. Her WBC count was just barely elevated, indicating a bacterial infection. We ruled out ears, throat & chest as sources for infection as well. I still have no clue what she had. Her cultures–blood & urine, both were negative. She is doing much better now, and last night seemed back to her old self–with a lot more talking & interest in going places. The fever is gone, the vomiting has ceased, so hopefully this bug, whatever it was, has run its course in our home and both the girls are on the mend.
Working in healthcare, I often see the ER get misused. People going in to ER for colds, allergies, flu, sinusitis. So part of me hesitated to make the drive to Vanderbilt when deep down I truly felt she had caught a bug from Faith. But ultimately, I decided, I didn’t really care because I would not live in regret if I just kept her home & chalked this up to a routine illness & missed a shunt malfunction or pyelonephritis. All I knew was my baby was NOT herself, had never been this ill, & I was going to throw my common sense healthcare knowledge out the window because I was first & foremost her momma, and sometimes mommas get a little irrational when their babies are sick.
I am very thankful today my girls are healthy. And very tired.
On a good note, we have started several new things with Zoe’s therapy that I am excited about. She is progressing, slowly. So are we, I suppose. We have also started working on some new things with Faith too…more to come on all of this later. 🙂
For now, I am savoring the reprieve from doctor’s visits, clinic appts, & the dreaded ER.