Saturday, April 26, 2008

We hope Daniel is on the mend now, but it's been a rocky week. The ER instructions were to follow up with his doctor if he didn't seem to be getting better. He was still coughing a lot and it was definitely interrupting his sleep so Wednesday I called and got an afternoon appointment. It was a gorgeous day and I had expected that we'd spend the afternoon at the park since we had another house showing. Instead, I had to wake Ed from his nap (actually, I let Daniel's squawking do that) and then entice him out to the car by saying we could have a snack at the doctor's office. We were there for more than two hours, killing the whole afternoon.

The upshot was that the pediatrics doctors said the ER doctors were wrong. Infants don't get bronchitis, they get bronchiolitis, and it doesn't usually just go away on its own. They were concerned enough to swab for pertussis, but that had to be sent to the State Hygienic Lab for testing so we wouldn't know the results for up to a week. They also managed to remove enough wax from his ear to actually determine that he had an ear infection. So for that and the possible pertussis, they put him on a strong antibiotic (azithromycin). They gave us an albuterol inhaler with a mask and said he could use it up to four times per day. We were told to call if he needed it more than that or if he needed two treatments in quick succession. Basically, they were worried about him being able to get enough oxygen so he could eat and sleep as much as possible. Eating has not been a problem, except for the few vomiting episodes. As it turned out, his weight had actually gone up almost half a pound since just last week when we were there for the conjunctivitis.

He did OK on Thursday, but needed more than four albuterol treatments. Then he needed two in a row at about 4 a.m. Friday, so I called the 24-hour nurse again. He was able to pull up the doctor's notes from our Wednesday appointment and said that the instructions were to call the office in the morning. If we'd had trouble before midnight the instructions would have been to go back to the ER, but since it was only four hours until the office opened we were safe to wait. I called right at 8 and we got in a little after 9. The same resident was able to see him again. She'd already called the state lab to check on the pertussis question and had been told the results would be ready by the afternoon. She ordered another chest x-ray and also a nasal wash, which involved a nurse squirting saline up one nostril and suctioning it out the other, then repeating on the other side. He did not enjoy this. He wasn't too happy about the x-ray either, which hadn't bothered him during our ER visit. The nasal wash was for labs to check for RSV, influenza and a host of other possibilities.

These all came back negative along with a negative for pertussis, which on the one hand is good, since those are nasty things for a little guy to have to fight. But on the other hand, it just means we're still dealing with a plain ol' virus and can only offer "supportive" treatment. In addition to continuing the antibiotic and albuterol, they put him on a seven-day course of steroids and said to bring him back if he wasn't much better in five days and totally free of cough in seven. And, by the way, the steroid will make him hungrier than usual and crabbier than usual. Hooray--nothing like a three-month-old with 'roid rage! But if it makes him better, we'll deal with the crying.

So far things seem to be improving. He only needed one daytime albuterol treatment yesterday and one first thing this morning. He's definitely eating a lot. I can't say whether his fussiness is normal or steroid-enhanced.

Wednesday was Edward's first time to the doctor when he wasn't the patient. He did pretty well, but was getting antsy as we approached the two-hour mark. Luckily, John arrived after work, which made things a lot easier. Edward always plays with the stirrups on the examining table, pulling them out and pushing them back in. This time he realized they were hinged so he could not only pull them out from the table, but also open them up to reveal the heel support (though of course he doesn't know that's what it's for.) After doing this on both sides he looked up at me with glee and said, "Two cranes!" He also was very interested in people's names, especially the doctor, Dr. Lyon. "Where Dr. Lyon go," repeated endlessly as we waited for her to return with the prescription. Later, reading Richard Scarry's "Busy Busy Town" I noticed that the doctor in the "Lowly Worm Visits the Medical Center" section is, in fact, a lion.