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Thursday, March 5, 2009

Semi-real time blog while at the hospital

8:45 a.m.- arrived at hospital and the technician was putting EEG probes and video on Logan. So I went outside while that was being done.

9:15 a.m.- came back inside and the nurse and technician said the EEG will be on for 24-hour monitoring, instead of just 20 mins. When an episode happened, I can inform the nurse immediately and she can note down the time and look at the EEG monitor.

9:30 a.m. - met with the Pediatric GI doctor. I told him again about his acid reflux history and what the episodes look like. He said acid reflux could cause the breathing problems, but usually not the stiffening of the body. For now, we will do the EEG and if we can't detect anything, they will put a pH probe in him (after stopping drugs). He said from what I have described, it didn't seem like it's acid reflux, but we want to be able to rule out everything.

10:00 a.m. - doctors came in for rounds. He had one episode at around 5 a.m. Will continue to monitor with EEG, and will decrease the high flow to see how he can tolerate it. Will talk to ped neurologist about it. I have also requested to get a second opinion from the ped neurologist since we are down here anyway.

10:10 a.m. - called Hank and updated him. Ped neurologist came in to look at EEG monitor and to check on him. Asked if a MRI is better but he said to look for seizures, EEG is the one to go.

10:15 a.m.- Nurse turned down flow to 2 L and Logan finally went to sleep. The high flow really bothered him as air was pushing into his lungs.

10:20 a.m. - He had an episode!!. They were figuring out the technical difficulties of the EEG machine to see if the episode was recorded. Freaked me out because I didn't get to him early enough and he turned pretty dusty. Usually I was able to get to him sooner once I heard the ding ding of the machine when his respiration goes down. As I was typing this blog, I didn't get to him fast enough. He's ok now.

10:40 a.m.- Ped neurologist and tech are looking at the EEG monitor to figure things out and to see if anything is being captured.

10:50 a.m.- Both the tech and the neurologist said it's not a seizure. I asked if we should wait for another episode. They are pretty sure it's not and it's clear cut. Grr... he said it might be respiratory. Neuro would like his probes off so that he could examine him a little better. He's going to talk to the other doctors and then come back and talk to me.

11:42 a.m.- just finished talking to the Ped Neuro. He did an exam on Logan, asked some questions and is off looking at his huge medical record. Logan is awake now after the examination, moving his arm and legs, thus making it difficult to monitor his oxygen saturation.

12:15 p.m.- Pulmonologist stopped by to see him. Suggested trying the C-pap for Logan to see if it is going to help with his breathing when he sleeps. Might do bloodwork that neurologist has mentioned. Asked pulmonologist if caffeine that's being used for preemie might help with his apnea. She said it might, but caffeine also worsens acid reflux.

1:30 p.m. - Came back from lunch and nurse said Logan had another episode. He is currently at 0.85L of oxygen and changed back to regular nasal cannula. The cannula doesn't bug him as much now. Gave him a nice wipe of the stinky sour neck and changed bedding.

2:00 p.m. - He's getting a little sleepy but this is always when we have to worry about him since his episodes seemed to happen when he's asleep.

2:15 p.m.- another one. I was looking at the monitor and saw that his RR was 17 but the wavelengths show that he was breathing VERY shallowly. Then his face changed color again, eyes opened briefly, needed us to prop him up and open his mouth. He just won't breathe for whatever reason. And, he went right back to sleep as if nothing happened.

4:08 p.m. - just finished talking to pediatrician about Logan. The urinalysis came back from the sample taken on the 3rd and it seems like he has a bladder infection. Still have to wait for the culture to see what type of bacteria. For the time being, Logan will be receiving antibiotics. It seems like his kidneys are ok but he will get an ultrasound just to be sure. He will also get a VCUG (shoot dye up in his bladder through a catheter into his little pee pee and then do an x-ray). For the time being, all medications will be stopped to prepare for the pH probe on Monday. He will resume feeding. If his acid reflux gets worse, then it shows that his reflux is present and we probably don't have to do the pH probe. The probe is supposed to be left in him for 24 hours, and if he has any episodes while the probe is in there, they will match the time to the activity that the probe shows. Logan will also get the Bi-pap tonight with(without) oxygen to see if it is going to help with the episodes. The bi-pap works similarly to the high flow oxygen that he was getting last night. The ped neurologist will come see him again tomorrow to do a more detailed exam and might do a MRI, if necessary. Of course the concern is still his apnea while sedated for the MRI. I mentioned the hearing test that he's scheduled to do on the 19th, and if he's going to be sedated for the MRI, might as well do the hearing test as well to kill two birds with a stone. Pediatrician will double-check on the type of hearing test. I also asked about the radiation from all the x-rays and scans that he has received and if it's going to be bad for him. Ped said that the CT scan and x-rays are worst, but the radiation is just as bad if you're out in the sun at the beach. Since he didn't have many CT scans in a short period of time, I shouldn't worry about it. We also talked about the different symptoms and his laryngomalacia and hypotonia.

4:30 p.m.- had another one but I was right there to catch it. Staring at the monitor and his face at the right time.

4:55 p.m. - Mommy's leaving to pick up big brother from school.

1 comment:

GRASSHOPPER said...

Hi Virginia, I've following your blog about Logan's progress. At this point, it's MOST important to support his breathing and minimize the number of desaturation episodes while you're still looking for the root cause. I know you do not want Logan to be intubated but that may be the kind of support he needs at this point. Trust me, the doctor will try to wean him off the respirator as soon as they possibily can. Logan may likely be sedated if he were put on a respirator. The positive side is he will receive not only oxygen but numbers of breath regulated by the respirator. He will als0 receive moisture for his airway. As you know the nasal cannula oxygen flow makes his airway quite dry. If he continue to have frequent episodes, he will continue to waste his calories intake to recuperate. While he should be using the calories to grow. Ultimately, he has to grow bigger and stronger to overcome whatever this root cause may be. I hope you see my point.Focus on the immediate support now and look for the reason later. Please trust me on this; I have been there and I know how you feel as a mom. This is not going to be an overnight cure. I know this is not easy and it will never be easy to care for a really sick baby. Stablize his breathing before he wear himself off and became too weak to fight. And worry about the cause later. You can't do too much all at once. Please make one step at a time and celebrate small progress.

My son is 12 y.o. now. I recall a lot about the days I spend at the NICU and PICU. He is a miracle baby and I believe Logan will be also. We love you! Peggy from Seattle