Croup

Well, one of our biggest concerns finally came to pass.  Cayden got sick and ended up in the hospital. 

This all started about ten days ago with what I thought was a stomach bug.  Jamison had it first, then Cayden.  He had diarrhea for five or six days, and by about the fourth day, he started sneezing.  The next day, his nose started running and then came a dry cough.  By Tuesday of this week, the cough was frequent and starting to sound like that dreaded "barking seal", the hallmark sign of croup.  I had to take Cayden with me to Jamison's 2-year check-up on Tuesday, and although Dr. Stanford is no longer Cayden's primary care physician, she knows him and his history.  She confirmed that his cough sounded very 'croupy' and said I should take him to his doctor ASAP.  So when we finished up with Jamison's appointment (found out he has another ear infection), I called and made and appointment for Cayden that afternoon with a nurse practitioner at the Special Care Clinic.

The nurse, Mary Gabriel, listened to his lungs, examined him, took a pulse-ox reading (his oxygen saturation was fine) and prescribed albuterol inhaler treatments every 4-6 hours.  She didn't think it was quite croup at that point, more of a bronchiolitis or inflammation and irritation of the airway.  Since he didn't exhibit any of the most concerning symptoms like running a fever, struggling to breathe by having retractions or rapid breathing, poor color, or loss of appetite, she was hopeful that he would recover with just the albuterol, but she wanted us to come back on Friday to be checked again.  She reminded me that if he started to exhibit any of the concerning symptoms, we should come back sooner or head to the ER.

I gave him the albuterol as prescribed, but he still didn't sleep well Tuesday night.  By Wednesday morning, he sounded even worse, but still didn't exhibit any of those symptoms to be concerned about.  Wednesday was another rough night with lots of coughing.  Thursday was about the same, although his cough had changed in tone.  He went from sounding like a barking baby seal to sounding like a goose honking, then finally, he sounded like a baby elephant trumpeting.  I felt like I had my own little zoo!  When Nurse Gabriel saw him on Friday, she immediately said she didn't like how it was sounding, but again, his oxygen saturation was o.k. and he still didn't show other concerning symptoms.  At that point, she said it sounded like it was more 'croupy' and prescribed a three-day course of oral steroids.  She said he should start to show significant improvement within hours of a dose, but again, if anything changed, we should take him to the ER.  She asked if I'd feel more comfortable if they set us up with home oxygen again but I declined, saying I was reassured that he was satting well and didn't think he'd keep the cannula on anyway!

So off we went on our merry way - picked up the prescription, gave him a dose as soon as we got home, and sure enough, he seemed to be breathing better and coughing less within a few hours.  Jason came home late that night - he had been gone all week and missed hearing the progression of different sounds of wheezing, coughing, rattling, etc. - and as far as he could tell, Cayden sounded just great.  He slept quietly and didn't cough all night.  I thought the worst was over and that he was finally getting better.  I was wrong.

Since I hadn't slept much all week, Jason let me sleep in on Saturday morning.  By the time I got up and moving around 11, Jason burst through the bedroom door and said, "I need some help."  I thought maybe he was having trouble dealing with both boys at once, but as I came out of the bedroom, I realized Jamison was already down for his nap and he was just with Cayden. 

Jason was concerned that Cayden was having retractions and struggling to breathe.  My first thought was that he hadn't seen him all week and didn't know how bad he could sound, so despite the fact that Jason has paramedic and pediatric experience, I thought maybe he was over-reacting.  But as I shook off the fog of a decent night's sleep, I realized maybe he was right and that Cayden did look like he was struggling.  We gave him a dose of albuterol, but it didn't seem to help at all.  Jason wanted to take him to the ER right away.  I suggested we give him his second dose of oral steroid before he left to see if that helped.  We didn't want to wake Jamison up, so Jason wound up driving to the hospital with Cayden by himself.  I was scared that he wouldn't be able to keep an eye on him in the back seat while he was driving, but we didn't have much of a choice.

So they headed off to the ER around noon and I sat at home, anxiously awaiting any news.

Cayden was seen right away and given a dose of epi-something (epinephrine and some other drug), and it immediately helped dilate his breathing vessels.  The retractions went away and he seemed to be doing well, but they wanted to keep him there for several hours to observe how he did after the drug wore off.  He ate and slept for a bit and seemed to be doing well.  Once Jamison woke up from his nap, the two of us went to the hospital too.  By then, the medicine had worn off and his breathing starting going downhill again.  The docs recommended he be admitted and kept at least overnight so they could watch him and administer the medication again as soon as he needed it.

By the time he got admitted, transferred to and settled into his new room, it was after 8 p.m.  His new nurses and resident doctors came in and examined him.  We decided that Jason would stay there with him that night and I would go home with Jamison, so once I was sure everything was going to be o.k., I left.

He got another dose of the epi-stuff before bed last night.  Jason said he slept well and at rounds this morning, the docs thought he sounded much better.  They want to observe him some more today, but they're hopeful he'll be discharged this afternoon.  We were told that a bout of croup typically has three days that are the worst, so hopefully he is over the hump.  I'm going to get off the computer so I can call and check in to see how things are going, and will try to post an update when possible.