Wednesday, May 7, 2014

Q's First (and Second) ER Visit

 So we can't seem to stay healthy here. Derek keeps bringing home the germs from daycare and somehow in the course of 24 hours, he dragged down Mike and Quinn with him.

Saturday morning, Mike woke up with more than the usual allergies and the snot that makes you think, I should go to the doctor. Though his doctor is usually open on Saturdays, his calendar was booked so he headed to urgent care and ended up with antibiotics for a sinus infection. 

Quinn was a bit warm earlier in the day but I checked her and her temp was still in the normal range (around 99). Later that night before bedtime she felt warm, so I checked again. 100.7. Dag. Anything over 100.4 is a fever.

After a quick call to the pediatrician, he made the suggestion we go to the emergency room. Small babies under 2 months old with a fever can be at risk for some serious stuff, especially meningitis.  I remember Derek having a high fever around 2 months, so we'd been through this already but because she was only 4.5 weeks, they would likely want to do a spinal tap (!) as part of their routine care to ensure she didn't have meningitis. Bacterial Meningitis can be very scary for small babies since lead to serious brain damage, hearing loss and or (gulp) death. Though a rarity, the possibility of such a diagnosis meant that the ER would have to do the work-up and admit her if she had the fever and run antibiotics for 24-48 hours until her blood/urine cultures came back.


So to complicate all this, I had to go to the ER alone since Mike was sick and Derek was in bed already. Luckily my parents joined me. They had to leave a wedding early and looked a bit out of place in an ER, but I'm happy they came to help.  I'm also really glad we took her to Fairfax Inova's Pediatric ER.  We've taken Derek several times to Virginia Hospital Center in Arlington and though the care is adequate, Inova Fairfax was a much better experience. For example, when he was 2 months old and we brought him in for a fever at VHC, it was really traumatizing that they couldn't get someone to take his blood and they ended up poking him several times and getting blood more than once before getting it right.  Plus Fairfax has free valet parking, its amaaaaaazing.

Sooooooo... Quinn and I head to the hospital around 10pm. The nurses and doctors were very helpful and thorough. The main frustrating thing is that when we got there she didn't have a fever.  I had not given her Tylenol and its weird that a fever would just disappear. I'm starting to feel like I am imagining things, but I clearly remember taking her temp twice and both times over 100.4. 

We were already there, so they still pinned her down for blood and urine. Of course, its heartbreaking enough to see her so little with an IV getting put into her arm. That little helpless cry and gulping for air makes me feel awful.  The nurse was a 77-year old Filipino man named Leo and he was amazingly efficient at getting the line in though. Though it was hard to watch, I was relieved that they did it very carefully. Nurses swabbed her nose for RSV, flu and even did a strep test. The intern doc mentioned it would be unlikely that we'd have to do a lumbar puncture (spinal tap) or chest xray. The issue was she was in a gray area, since she was 33 days old and their standard procedure for babies under 30 days old with fever is to do a  to test for meningitis. The pediatrician on-called mentioned we could talk about the spinal tap after her results and determine where we go from there.

So I'm feeling better that the work-up will likely not have to go further. Except...

Then things changed, intern doc comes back and brings the kit for the spinal tap. I'm taken by surprise and asked the course of action we discussed just an hour ago. You know the one where we'd wait and see her lab results. I try not to have a complete meltdown but basically want to know what has changed.

I requested to talk with the supervising doctor and stated I would really prefer not to do the spinal tap unless it was medically necessary, especially now that the fever wasn't showing up. Additionally, Q's rapid results for blood and urine all were good - no elevated white blood cell count and everything looking normal. I wasn't trying to be difficult, but I didn't want them to stick her spine given that things were looking pretty good.

So the doc and I reached a compromise that I would bring her back in the morning at 8am to check her temperature again, or earlier if her fever returned.  We agreed to no antibiotics for now.  And if there was any sign of fever, we'd have to do the procedure.  It made me realize how valuable it can be to advocate for a course of action and work with your doctor to reach an outcome that everyone is comfortable with. Its definitely a skill I learned during the birthing process and my squeaky wheel ways has helped me be more assertive. True we could have just gone with the flow, but it would not have been something I was happy with and if the doctor was OK with an alternate and equally effective course of action, then I'm glad I we went that way.

Alright, so we get discharged around 1:30am (again, amazed that they did this whole work-up, diagnosis, and got us out in only a few hours) and we go home. Mike and Dek are sleeping in quarantined spare bedroom. Quinn and I sleep for a few hours. Dek is up at 6am. I get up by 7am. My parents come to watch Dek so Mike and I can bring Q back to the ER.

ER check goes well - no fever, so no spinal tap. YAY. She's acting totally normal now, except for a runny nose so its likely that it is a virus. All that drama and it turns out to be a cold, again. Yup.

Oh, and when we followed up with our pediatrician on Monday, he tells me that he sent me to Fairfax knowing that I always like to negotiate out of anything interventionist. Well, in this case, it worked. Though LPs can save lives and help diagnoses meningitis, I'm glad it wasn't needed in our case.

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