>Super nice Clinical Instructor

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It’s Thursday, which means I had clinical today n the school system. It was a VERY slow day; a lot of filing, twiddling of thumbs and inconspicious clock checks.
An hour before the end of the day I got a call from C’s school nurse. She said his inhaler wasn’t working well and she couldn’t give him any more. I asked if she had given him the nebulizer and she said no because she didn’t think the wheezing was all that bad. Funny thing about wheezing…. if you don’t stay on top of it… IT GETS WORSE! So, by the time I got there he was struggling pretty badly. The inhaler works BEFORE the attack, by the time he starts wheezing the nebulizer is the only thing that can help him. He has moderate to severe asthma, and has had it all his life so he knows what he needs. If only she had asked him rather than assuming she knew what would work. Obviously he needs it or the doctor wouldn’t have sent orders for the breathing machine.
My instructor was very cool about it though, she excused me from Post Conference. I sent her my Care Plan and Clinical Packet (nursing school homework) and decided to spend tonight organizing my thoughts for my term paper.
The paper has to be on a topic related to OB or Peds. It can be controversial (I like that) and needs to be 15 pages long. A lot of people are doing Breast Feeding/Formula, vaccinations, and new father support. I don’t want to do something everyone else is doing but I’m having trouble deciding on something that interests me. Maybe I’ll just google “controversial pediatric/OB topics” and see what comes up.
It’s almost dinnertime and I still haven’t started anything. In fact, our kitchen is looking a little light. I haven’t been grocery shopping in too long. We have no meat in the freezer, I think all I CAN make is pasta. Yuck.
I need a maid and a butler.

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>Paging Dr. House

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Symptoms
right side chest pain between 2-8, constant: “feels like I’m being stabbed with a fork”
left side tightness, intermittent 1-3 times/day lasting 30 minutes each
Tylenol and Ibuprofen do not relieve pain
decreased appetite
possible positive Murphy’s sign
mild epigastric tenderness on palpation
no rebound tenderness
Diagnostic Tests
Ultrasound : normal 
Chest x-ray: normal
Blood tests: normal
EKG: normal (pending verification by pediatric cardiologist)

Possible Diagnosis
Chest wall pain: ruled out – no pain on inhalation, coughing, movement, etc
Cholecystitis (gallbladder): ruled out by ultrasound
Pneumonia: ruled out – no fever, normal white blood cell count, chest xray

The pediatrician calls me last night to check on C. I tell him that there is no change.
Dr: “Lindsey, why are your kids always such a puzzle”?
Me: “We like to keep you on your toes”.
Dr: “no, I think you keep all the easy diagnoses to yourself and solve them at home, then you come to me with the tough ones”.
Me: “OK, then next time one of my kids have the sniffles I will rush right in so you can have an easy one”.
Dr: “Oh, nevermind, I get that all day long from the other mothers”.

So, where does that leave us you might ask?
It leaves me sitting here watching my son suffer with no way to make the pain go away.
It leaves my son with a 3+ day extended absence from school.
It leaves me sitting here using Google to try to come up with ideas to give the doctor.
My Mom is coming down tonight and we are going to put our heads together. She will be able to assess him in person rather than me telling her over the phone and sending pic messages with stickers on his chest to show locations of pain.
At least I’m giving my nursing assessment skills a good review; I even brainstormed with some of my nursing school peers before our exam this morning. C came with me because I wasn’t comfortable leaving him home by himself with chest pain. We came up with nothing.
I will update when I know something more.

>I’m not overreacting!

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 I have a sick kid home today, well, not really sick, but not well enough to go to school. He’s been having chest pain which the pediatrician attributed to the amount of asthma medication he is on. It has gotten progressively worse over the weeks, and this weekend I decided that I was going to INSIST that he investigate this further. When he told me in September that C was healthy and the chest pain was nothing to worry about; I listened. I didn’t panic, but I didn’t dismiss it either. I watched, I assessed his pulse when he said it was bad, I checked his pulse when he was feeling fine. I monitored his bp also. No difference. At first I thought it was only on exertion, and while it may have started out that way it certainly isn’t anymore. It happens at rest now. So, overprotective mother that I am I called the Pediatrician the minute they opened this morning and insisted on being seen this morning. With it being a right sided pain I’m thinking of other possibilities besides cardiac but I’m not completely ruling it out, I’m possibly going to ask him to check his gallbladder (yes, I know, 14 is young to have that issue but it’s not unheard of). I just want an answer. I have a little experience with being dismissed as a Panicky Mom. I wasn’t blogging at the time but I think I have mentioned it a couple times before.
The summer of 2009 my (then) 8 y/o developed a circular rash at the base of his hairline on June 25th, I remember the date because I took a picture of it to note any changes (yeah, that’s the kind of mother I am, I go overboard). It was a Friday around 6pm. The more I looked at the rash the more I thought I could almost make out a Bulls-Eye. That’s when I decided that I didn’t want to take any chances with Lyme Disease. I didn’t want to wait through the weekend to get antibiotics so I decided to take him to the ER. In addition to the rash he had a VERY mild cough and sick eyes (all Moms know what sick eyes are; that look in a kid’s face that tells us before even the first symptom, that they are sick).
So, anyway, off to the ER we go. They put a mask on him and said that he most likely had Swine Flu. They said the rash was not a classic Lyme Disease Bulls Eye. I insisted on a Lyme Titer, which they did, but refused to prescribe antibiotics until the titer came back in a week in which case they’d call if there was a problem.
OK, so, I went home. TRUSTING these doctors.
Over the next couple weeks, the rash went away and a headache took it’s place. I brought him to the pediatrician. He diagnosed him with migraines; said to give him Tylenol.
I brought him back two days later when he developed photophobia (light hurt his eyes and head) and a worsening headache. Again, migraine diagnosis with a prescription for migraine meds.
Three days later back at the office. Severe headache, sensitive to light and now sound too. At this point, our doc sent us to the Children’s Hospital. We sat there for 5 hours and were sent home with a diagnosis of Cluster Headaches.
Two days later he developed double vision (not blurred; double). Back to the Hospital with an order for a CT scan from our pediatrician. Results: normal.
The next day back to the Hospital with an order for CT with contrast. ER doc sent us home without doing the procedure. Said it wasn’t necessary. B and I walked out of the hospital both crying. Him because of the pain and me because I was helpless to fix him.
Now at this point, my son is almost unable to function. His headache is so severe he can’t move. Light and sound, no matter how minimal, hurt him immensely. He wasn’t talking much because that hurt. I would sit with him all day and all night holding him; not knowing what I could do. I knew something was wrong, but the doctors weren’t listening. I cried because I had never felt so helpless. As a mother we always have the right fix; whether it be a band-aid, a bowl of ice cream or a hug. We can always fix our kids problems, but this time I could not.
At this point I had had enough. I called my pediatrician and said that someone somewhere had to do something. If he or the Children’s Hospital was not going to investigate further than I was going to go out of state to the Children’s Hospital in Massachusetts. This is when my pediatrician finally took me seriously. He said he didn’t want me traveling with him in his condition. He asked me to try the local Children’s Hospital one more time. He said that if they tried to discharge us from the ER to call his personal phone number and he would admit him under his care until we figured it out.
So I went in. I begged them to do another test, any test, I didn’t know what to ask them to look for but I wanted them to at least try! I had asked about Meningitis or Encephalitis on one of my previous ER visits and they said that without a stiff neck Meningitis was highly unlikely. After 6 hours they finally came in to do a spinal tap. He was in so much pain that my 8 y/o son saw the size of the needle and didn’t even flinch. He didn’t care. At this point all he could focus on was the pain.
So they did the procedure, now they explained to me that they were looking for Intracranial Pressure (ICP) of between 10-20. When they put that needle in and began aspirating his spinal fluid they determined that his ICP was 36!!!!!!! HE HAD MENINGITIS!
They immediately placed IV’s and began the medication to decrease spinal fluid to take the pressure off his brain. They admitted him and brought him upstairs where they proceeded to do more tests to determine the cause. You know what it was? LYME DISEASE. Months before when I had taken him in to the ER and they sent me home with NOTHING they had been wrong. It was Lyme Disease and because it was untreated it had passed into his spinal fluid and developed into Meningitis. The double vision was because the pressure was pressing on a nerve in his brain; he had 6th Cranial Nerve Palsy.

A week in the hospital, a PICC line insertion and 30 days worth of IV antibiotics later; he is better. All better. No residual symptoms except for a sensitivity to loud or high pitched sounds. We are VERY lucky.

After all was said and done, my pediatrician actually apologized to me for not insisting that the hospital admit him sooner. He told me that I’m not like most moms in that I don’t tend to overreact over the small things and even though he knew that I wasn’t typical, it still took my threatening to go out of state to get him to realize how serious it was. I think I have proved to him that if I’m saying there is something wrong it probably deserves further investigation. So hopefully today will go well.

>Sick kids and sick me.

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 Well, I am having on of those weeks. You know the ones in which nothing goes right, but nothing goes completely wrong either. It’s just been a week requiring patience. I’ve been working some more on the yard. I’ve gotten quite a bit done,although, if the brush trimmer could make my life any easier I’d be so appreciative. I’ve replaced all the parts on it at least once since I started my Brush Crusade. It’s not working right now, I have to go back to Home Depot AGAIN, but I won’t get into all that.
Last Tuesday night I tossed and turned all night with a fever.
Wednesday I suffered through my clinical day with a nagging tickle cough.
Thursday I was diagnosed with Bronchitis. The doctor told me to call if it hadn’t gone away in 2-3 days. I was not getting better but I figured I would finish my antibiotic course before calling. I finished yesterday and today I was not feeling good at all.
In fact, I went to lecture and after 30 minutes I felt achy, hot/cold and overall crappy. So, I left. Called the doctor. He put me on an inhaler and gave me more cough medicine.
OK, now that’s what’s going on with me. Now I’ll tell you about Z. For the past week and a half he’s been lethargic. Doesn’t play outside like he normally does, decreased appetite, no fever, but he has the “sick eyes” Moms know and love (insert sarcasm). Yesterday he started complaining of a sharp pain in his tummy. This morning he has had no appetite. So, I called the doctor, we will go in today at 1530, I’ll update you then. I’m going to push for a Lyme Titer. And hopefully he’ll put him on antibiotics while we wait for the results. Although, I don’t put a lot of faith in those tests. After all, last summer B had one done, it came back negative and 3 weeks later he was in the hospital with Lyme Meningitis. So, anyway, here’s hoping the doc is generous with the antibiotics.
And last but not least. There’s B. Now, remember all the yard work I told you I’ve been doing? Well, of course, I’ve recruited the boys to help haul off the brush as I trim it all down. Well, I didn’t think there was anything yucky in the brush, but apparently, B found something.
He will be going to the doctor with Z. I’m thinking poison ivy although, there are no blisters. He developed this rash yesterday. It started off as flat red blotches, not itchy. This morning the rash is raised, but it’s still not itchy. I didn’t think it was poison ivy at first but the more time goes on the more I wonder.
So, nobody is feeling all that great here, well, except for C. He’s doing great. Let’s hope he stays healthy.