Trip to the ER avoided...for now (Part one)

Something's been up with Cayden since Sunday afternoon.  He took his biggest bottle ever and then while he was supposed to be being held upright for 30 minutes, he spit up quite a bit.  Granted, he wasn't quite being held upright - he was more reclined on his back, so that may have exacerbated the problem.  Throughout the afternoon and evening, he had a bit of a wheeze/rattle, but I attributed it to reflux.  Sometimes that happens.  But later that night, he started sounding worse, and my concern was raised because . . .

Jamison is sick yet again (I know I just posted that he got sick a little over a week ago, but I swear to God, he is sick AGAIN, with ANOTHER round of sneezing, runny nose, and 102+ fever as of Saturday.) 

Cayden's wheezing got to the point where I called the doctor's office at 10:30 Sunday night to see what I should do.  He didn't have a fever or runny nose, both which would be signs of a cold rather than just a reaction to his reflux, so that was slightly reassuring.  Plus, his appetite was still normal and he was sleeping OK despite the wheezing.  The answering service paged the Children's Hospital triage nurse, and after giving her all the details of Cayden's situation, she said the case was out of her range of dealing with, and she had our pediatrician, Dr. Stanford, call me directly.

Dr. Stanford gathered the information and said I did the right thing by calling, but in the end, she didn't think he needed to be rushed to the ER.  Her gut feeling was that the wheezing was related to his reflux.  She said to keep an eye on him throughout the night and that if anything got worse - if his color changed, if he looked like he was struggling to breathe, if he wouldn't eat - I should take him to the ER.  She also said if he was the same by morning, I should bring him into her office first thing.

Keep in mind the rest of our scenario:  Jason is out of town.  My grandma is staying with us, but Jamison is moaning, running a fever, and not sleeping very well, and I didn't want to leave him with her if I had to go to the ER.  What a dilemma!

Amazingly, we made it through the night without Cayden getting worse.  He actually slept and ate on a regular schedule, but I was awake most of the time, listening, checking on him, terrified he would turn blue.

After a month of waiting, we finally had our first visit weekly home visit from an occupational therapist at 8 a.m. Monday morning.  Cayden ate around 7:15 and seemed to be breathing alright, so I didn't feel the need to cancel the therapy appointment to rush to the doctor's office first thing that morning.  But as Murphy's law would have it, as soon as the therapist showed up, his breathing started sounding worse and worse.  She was concerned that he was coming down with something and kept mentioning pneumonia, and that he didn't sound good.  She gathered her initial information and briefly discussed some exercises I should be starting with to reach our goal of getting him to breast feed more, but we didn't actually do any of the exercises for fear of exacerbating the problem.  She cut the session short and suggested I take him to the doctor right away.

So after getting Jamison (somewhat) settled with Grandma, I rushed out the door to Dr. Stanford's office.  We spent over two hours there and left without any definite answers, but the doc was leaning more toward his symptoms being related to a bad episode of reflux rather than coming down with a cold.  They monitored his oxygen saturation and heart rate the whole time we were there and it looked great.  She listened to his breathing but couldn't make a clear determination of the source (upper airway vs. lower).  Frustratingly, the wheezing and rattling noises came and went, and it seemed as soon as someone put a stethoscope on him, he would breathe normally.  There was discussion of needing a chest x-ray.  The nurses did a deep suctioning of his nasal passages to clear out any aspirate that was there.  The doc consulted with a pulmonologist from Children's Hospital to get his advice.  The pulmonologist said there is no consensus on how to treat or proceed with a case like Cayden's, but gave a couple options:  a conservative route of prophalactically treating with a short course of steroids or a more aggressive route of hospital admission, chest x-ray, and observation for 24 hours or more.  Given my situation at home, we decided to go with the less invasive choice.  He got his first dose of steroids in the office, then the doc sent us home but told us to come back at the end of the day unless he made some sort of stellar improvement by then.  She said she wanted to examine him again and then make the next decision about whether or not to send him on to the hospital. 

In the hours we were at the doctor's, I tried getting a hold of Jason to let him know what was happening, but he had limited phone signal, so we were left trying to communicate by text.  I asked if there was any way he could come home early (he wasn't scheduled to be home until Tuesday night).  He said he'd see what he could do, but in the meantime, we were both scrambling to reach out to friends we thought might be able to help Gramma take care of Jamison in case he couldn't make it back and I had to take Cayden to the hospital.  There were so many loose ends, so many unknowns, so much anxiety and worry and stress!

Around noon, we headed home.  Thankfully, Gramma had managed o.k. with Jamison, so that was a relief.  I was deliriously exhausted, but there was no time for sleep.  The few hours we were home flew by, and before I knew it, it was time to go back to the doctor.  (There was no 'stellar' improvement on Cayden's part in that short time, and I was concerned because he seemed to be coughing more.  Not just his typical 'reflux' cough, but a more drawn out, whistling/wheezing, sort of croupy sounding cough.)

So I left Jamison with Gramma again and loaded Cayden back into the car.  At the doctor's office, there was more pulse-ox monitoring, more listening with a stethoscope, but still no clear cut answer on what to do.  Dr. Stanford didn't think he was struggling as much to breathe, but was still concerned about the sound of things.  She said her gut feeling was that the wheezing, rattling, and coughing were all related to the one bad episode of reflux.  Her thinking was that he was suffering from a sort of chemical burn that had irritated his esophagus all the way up to his vocal chords.  She said I had been doing a great job of assessing his symptoms and taking care of him, and that if I was comfortable with it, she thought we could just keep him at home and observe him again overnight. 

By this time, it was looking like Jason was going to be able to come home, and I felt a little more comfortable bringing Cayden home for the night.  If I had to do it again on my own, without Jason and his pediatric/paramedic eye there to evaluate how he was doing, without his level headedness and help, I don't know if I would have been willing to do it.  I was so sleep deprived and emotionally exhausted, and I felt I couldn't objectively assess how Cayden was doing anymore.  He either seemed perfectly normal or sounded absolutely, terrifyingly sick, and I was swinging back and forth between hope and despair.  She decided to increase his oxygen a bit to give him a little extra edge and said she'd call us to check in around 9 that night.  We left the doctor's office around 5:30, ran by the drive-through pharmacy to pick up his steroid prescription, and soon after we got home, Jason had texted to say he was on the plane.  I hadn't had a chance to update him on the latest happenings at the doctor, but he'd be home soon enough and I could tell him in person.

By the time Jason walked in the door around 9 p.m., Cayden was sounding really rattley and I couldn't wait for him to don his stethoscope and tell me what to do.  I was sure a trip to the ER was in our immediate future.  He listened and calmly, without hesitation, said, "It sounds like it's in his vocal chords.  His lungs sound o.k."  I just burst into tears!  All of the anxiety, worry, fear just poured out and melted away.  Without knowing what the doctor had said, he confirmed exactly what she was thinking.  Although I thought Cayden sounded awful, Jason reassured me that he was o.k.  A few minutes later, the phone rang:  it was Dr. Stanford calling to check in.  She was pleased that he didn't seem to be any worse and said to check in again in the morning.  Jason got some dinner while I fed Cayden, then we switched and he held him upright while I got a bowl of chocolate ice cream.  We sat and watched the latest episode of the TV show Parenthood before laying Cayden down in his crib and crawling into bed ourselves.  Comforted by the presence and reassurance of my husband, I slept harder than I've slept for a long time and it felt so good!