A Scary Morning

Let's see... where did I leave off in my earlier post?  Ah, yes, Annie had her grand mal seizure and got ativan.  Then she slowly started to struggle with her breathing.  We suspect that she might have aspirated last night with all the vomiting and coughing.  This morning she still sounded really junky, but I didn't realize really how bad her breathing had gotten until the infectious diseases doctor stopped in and said she wasn't concerned that the c-diff hasn't responded to treatment yet, but she was rather concerned about Annie's high temp (101.7) and her labored and fast breathing.  At that point I realized, oh ya, it's gradually gotten a little worse.

We repositioned her to try to open her airway, but her breathing continued to worsen.  I even put her CPAP on her to help open her airway, but the stinker wouldn't keep her mouth closed.  Her breathing eventually got to where Annie's chest and stomach were heaving with each breath, and we could tell she wasn't moving much air even with her CPAP on.  By this time I was even sensing the nervousness in the nurses.  We repositioned Annie yet again, elevating the head of her bed even higher with even more rolls behind her neck to tip her head back.  The fact that she was completely passed out and totally unaware of us even moving her didn't help settle my nerves either.  We continued like this for a little over 2 hours, during which they did another chest x-ray to check for pneumonia, drew blood for another blood culture, and did a separate finger poke to check her blood gases.  All the while her oxygen sats were hanging out in the 90s with only an occasional dip into the low 80s, which isn't terrible, but not great, especially considering that she had CPAP on.

Annie eventually started to become a little more alert, at which point she started crying.  Nothing seemed to help, so I got her in her wheelchair to sit up for a while.  She continued to cry until a little while after her friend came to visit.  I'm not sure if it was a little extra motrin or the kindess of a good friend (probably a little of both) but she soon was all smiles.  This little girl loves sending her momma on an emotional roller coaster ride!  We still don't know for sure if she has pneumonia, but they'll repeat the chest x-ray tomorrow to take another look. 

So, back to the ID consult... I guess they're not concerned that Annie's diarrhea and vomiting haven't improved because they said c-diff is usually very slow to respond to treatment.  They said vomiting is fairly normal at this point with c-diff because there is so much inflammation that it's normal to not be able to tolerate feeds.  So I guess that's encouraging--I just need to have more patience.

We also consulted with GI today.  Since Annie isn't tolerating her feeds, and since she's now been in the hospital 6 days, they know Annie needs to start receiving more nutrition, especially to help the swelling go down.  So tonight they plan to start her on TPN through her regular IV line--she got a new one today.  Ideally TPN would go through a PICC line, but because Annie has an unexplained fever, they can't start a PICC line since it would potentially increase her risk for even more infection.  So they can only give Annie a diluted form of TPN through her regular IV line, which isn't ideal, but it's the only option right now until they can figure out what is causing her fever.  She started neocate jr. at 10cc/hr (about 1/3 oz every hour) and has tolerated that just fine so far.  If she tolerates it well through the night they might increase that to 20cc/hr tomorrow.  If she can't start tolerating more formula, they will consider inserting a G/J-button in place of her G-button.  A G/J-button would go in the same stoma (hole) in her stomach, but it has a small tube that would snake down through her stomach into her intestines so the formula would bypass her stomach and go directly into her intestines for absorption.  But they probably won't consider that until Monday when the interventional radiologist is available.

Annie was rather pleasant this afternoon while she was sitting in her chair, so we ended up leaving her there several hours.  It was a few hours too many though, because her feet and ankles got incredibly swollen--worse than they ever have been.  So we had to lay her down and elevate her feet.  She also never had a wet diaper during all that time, but they think that might have to do with all the fluid retention.

So, test results from today so far... her urine culture is still negative, her blood culture is still negative, and her chest x-ray looked the same as it did on Wednesday.  Her temperature is still high, so they decided to start IV antibiotics vancomycin and cefepime to treat any infection that might be brewing somewhere.  They plan to keep her on those antibiotics for 24-48 hours or until her fever goes away.  This afternoon her temp was 100.1 even with her on motrin, so hopefully that will improve soon.

I'm grateful that Annie gave us a chance to relax a little bit more this afternoon and evening after scaring us so badly this morning with her breathing issues.  If all of that WAS due to the ativan, I would MUCH rather watch her have seizures than struggle with those breathing issues!  Neither are great options, but I'm used to seeing seizures.  So hopefully we'll have a better night tonight than last night and an uneventful day tomorrow.  I've never been in the hospital with Annie before when I've been so busy!  I can't believe how fast the days are passing when we're almost constantly consulting with so many doctors and dealing with new issues.  Hopefully things will calm down soon and Annie can start feeling better with no new complications!