Mother's Instincts - puffiness and transfer

Day 35 - Hospital Stay
Day 30 - Intubated

It just proves that mommy's instincts can sometimes tell us more than what doctors or lab tests can. Remember I've been saying Logan's cheeks look chubbier to me everyday? Now we know the answer. This is what happens during rounds.

Logan weighs 7.2kg today. He had 5 stools yesterday! His sodium level is low, at 128 (I think normal is 135). It either means he doesn't have enough sodium and needs supplements, or he has too much water in his system. It appears his body is holding onto water too much, because he's on the ventilator and can't get rid of excess water by breathing out. Water retention also happens if the patient has active neurological or pulmonary disease, which Logan has both. He has a neurological disorder, and he has pneumonia. The plan is to let his body get rid of the water by holding his feeds for a while. Every 4 hours, the nurse will check his sodium and sugar level. Once the sodium level gets back normal, then they will start feeds again at a slower rate (20ml/hr instead of 50 previously). They might also make his formula more concentrated, thus giving him enough calories but less water intake. Hopefully, by tomorrow his sodium level goes back up without compromising his sugar level. Last time when he got puffy, they turn down his IV, but since he has no extra IV fluid at the moment, the feeds is where they have to change. Aside from that, he's been doing fine. His blood gas shows normal range, and the Director agrees with me that his breathing pattern seems to be more stable. Thus, they will turn down his ventilator rate to 12 instead of 14 from yesterday (down from 16 a few days ago). Director will also talk to neurologist tomorrow regarding another MRI. It's been almost a month since his last MRI on 3/9/09. He is also at Day 4 of his antibiotics for pneumonia.

Logan is still very sleepy today. He opened his eyes earlier when I was giving him a massage and exercising his arms and legs. Now he's going back to sleep. Since his sedation medication hasn't changed, I wonder why he's still always sleeping. Maybe his body is recovering from the fever and pneumonia?

Remember I said before I considered getting Logan transferred to Lucile Packard when I found out about the stroke? After that, I put some more thoughts into the transfer. At this moment, I think we will keep him at Kaiser. Yes, Lucile Packard is a more reputable hospital than Kaiser. However, there are just other factors that I think are important. Logan has been in the care of Kaiser since birth. Kaiser knows him. The doctors and nurses at PICU in Santa Clara know him very well and know how he was, and how he is. If we transfer him to another hospital, new doctors and nurses will have to start to get to know him, and read up on his super long medical history. I think continuing care with the same people will bring stability to him. I know Kaiser doesn't get the greatest reputation sometimes, but I have been fortunate that both the Kaiser NICU in SF and PICU in Santa Clara have been great to us. All the doctors and nurses are fantastic. We have already built a relationship with these people. And if Logan gets admitted again in the future for whatever reason, they will immediately know what's going on with him. Besides, we will be moving down to Sunnyvale at the end of the year (cross our fingers), just 10 minutes away from the hospital. Transferring Logan to another hospital will make things more complicated for the future as well. Well, also our insurance can't be changed until next year. I believe the doctors have tried and done everything they can to make a diagnosis and to provide the best care. Mother's instinct told me, staying with Kaiser is what's best for him. A team of specialists and nurses who already know him, is more important than transferring him to another reputable hospital where no one knows him there. I hope I am right on this.