Thank you all for your thoughts, prayers, and words of encouragement while we deal with Alyssa's recent infection. As most of you know, I collect mugs from my travels: one mug for each state or country visited. Only rarely do I use a mug from my collection. This week I have decided to invoke the luck of the Irish and have been enjoying my morning coffee out of the Ireland mug I bought while in Lurgen two years ago for my grandmother's burial. Call me superstitious, but it worked for Nana for over 80 years. So here's to the fighting Irish. Let's kick the infection's ass.
Here is a timeline of recent events that have led to Alyssa being admitted to the hospital. I will update as events unfold.
Saturday, September 4th
Alyssa has a mild fever. We figured it was due to teething and watched her, giving her Tylenol to keep the temperature down.
Sunday, September 5th
The fever persists and escalates. Alyssa starts getting fussy.
Monday, September 6th
Labor Day, which means her doctor is closed. The fever is consistent for three days and we're having trouble controlling it with normal doses of Tylenol and Motrin. Suspecting an ear infection, we take Issa to the "Doc in a Box" (MedClinic). The doctor reports clear ears and throat and says it's probably a virus, just keep her hydrated.
Sister visits Issa in the Hospital
Tuesday, September 7th
Alyssa's condition deteriorates after her MedClinic visit. The fever spikes to 103 and her demeanor changes drastically. She becomes subdued and listless and spends most of Tuesday night whimpering. She stops eating.
Wednesday, September 8th
After seeing her regular pediatrician, Alyssa goes to the hospital with suspected "infected lymph nodes". The ER takes blood and does a CT scan. Her white blood cell count is significantly elevated and the CT scan confirms a major infection in her lymph nodes, though the ENT specialist does not see an abscess. Three male ER nurses do a fabulous job starting an IV (twice thanks to Issa). She is admitted and responds almost immediately to the fluids, though the doctors warn us she will likely remain in the hospital for three to five days.
Thursday, September 9th
Alyssa's standard IV cocktail includes fluids, an antibiotic (Rocephin), a steroid (Decadron), and an anti-inflammatory (Toradol).
Friday, September 10th
Issa shows signs of improvement. She sleeps most of Thursday night, starts smiling again, and begins to be a bit of herself again. Her fever is gone. The doctor orders her fluids cut back and the Decadron and Toradol are discontinued. She still receives Tylenol orally for pain as needed. Her white cell counts are down slightly and depending on the counts over the next 48 hours, she may go home as early as Sunday.
Saturday, September 11th
A bit of a setback. Bloodwork shows almost no change in Issa's white cell count. She didn't sleep overnight and the swelling in her neck seems to have gotten worse. The ENT examines her and declares that the nodes are no longer stiff, which is an indication of puss. Surgery may now be necessary to drain the infected lymph nodes. A Sunday discharge is out, Friday is looking more likely. More blood work and another CT scan will tell us more.
Developing...
A second antibiotic was ordered Saturday in an attempt to avoid the "surgical option". Another CT scan and set of blood tests in the morning will determine the next course of action. If surgery is required, it will take place Sunday or Monday.
On a lighter note, Mommy and Daddy grudgingly enjoyed mommy's Mother's Day present tonight: an evening at the theater with "Jersey Boys".
White blood cell count is raised this morning, though the doctor says it is due to the steroids. It is now looking like there will be one surgery for sure, and possibly two (one to drain her neck and one to drain the back of her throat). We're still waiting on a CT scan to determine exactly the extent of what needs to be drained.
At 3:30 this afternoon, we handed our precious princess to an OR nurse and walked out to the waiting room. Almost exactly 60 minutes later, the doctor came out to tell us that everything went great. Here are the details.
- He made a "T" shaped incision at the back of her throat and sucked out a considerable amount of puss.
- Luckily the abscess behind her throat was "communicating" with the infection in front of her spine. As he drained from her throat, the swelling at the back of her neck immediately went down. There was no need for a second incision in her neck or a temporary "drain", as previously thought.
- Due to the nature of the drainage, there is now a pocket at the base of her throat that could potentially be a source for a new infection. Because of this he inserted a feeding tube through her nose that will remain for the next few days.
- Alyssa will remain on IV antibiotics and pain medicine for at least until she can eat on her own again. She will likely remain in the hospital through the end of this week.
Alyssa and her "accessories"
It's quite a tangle of tubes and wires in little Issa's hospital crib now. She has a feeding tube coming out of her nose and rolled up behind her, an IV in her left foot, EKG leads on her chest leading to a portable transmitter, a pulse-ox sensor on her right arm, and splints on both arms to prevent her from pulling out the feeding tube. Because of the anesthesia and the risk of infection should she vomit, even with the feeding tube she can't have any food until tomorrow. When I left the hospital about two hours ago, she was awake but sedate. In addition to the two antibiotics she is also on steroids, Tylenol (administered in places you don't want to think about), and Morphine. I never thought I would be writing about my eight month old daughter receiving Morphine.
Again, thank you all for your prayers, thoughts, Internet comments and phone calls. We may not be able to respond right away, but it is appreciated. Please keep it all coming, she's not out of the woods yet. The next few days will be important to make sure the infection doesn't spread and the healing process begins.
After nearly 40 hours of not eating, Alyssa finally got some food this afternoon via her feeding tube. Though not yet herself, she seems to be doing much better. She's alert and now cries rather than whimpers. No big toothless grins yet.
This morning just before noon she had a PICC line inserted into her left arm. This will be more resilient than a standard IV and will prevent the nurses from having to continually stick her when an IV needs to be changed for hygienic reasons. That was by far the high trauma of the day. The doctors are pleased so far with Issa's progress. We are now waiting on the results of the cultures taken during the surgery; this will allow the doctors to pick the best antibiotic to finish off the infection.
Alyssa is also being monitored to be sure that, as her abscess continues to drain, she doesn't develop a secondary infection in her chest. With the abscess "opened", the preference is for any additional drainage to go into her stomach where it will be neutralized by acids and passed harmlessly. Meanwhile the antibiotics will continue to knock down the infection. Blood will be drawn again tomorrow for a white cell count. If the numbers are down, we're on the road to recovery, and hopefully we'll all be home by week's end.
I found an interesting case study on her condition that describes almost verbatim what we've experienced in the past six days. If you're interested, you can read everything you never wanted to know about retropharyngeal abscesses in the study here and in a shorter explanation here. It's always nice to know that you're statistically significant.
Just a Hint of a SmileIf you look closely, you can see a Mona Lisa type smile on Ms. Issa tonight. The EKG leads have been removed, providing a little more mobility and a lot more room in the crib.
The cultures came back and the bacterial infection is MRSA, which is a resistant form of staph. The good news is that it's still treatable. Alyssa's antibiotics (she's still on two) have been adjusted accordingly. She's taking formula regularly now via her feeding tube. Both of her doctors are pleased with her progress though they still want to keep an eye on her to make sure she continues to recover. One of the biggest issues is preventing infection to the pocket in her throat. If she's allowed to eat before it has a chance to heal sufficiently, she risks another infection. She'll likely remain in the hospital until Friday. There will be at least one more radiological study (either ultrasound or CT) later this week to confirm the infection is subsided.
All that aside, she's almost back to her old self. Normally when I come home from work, she greets me with a big smile and little fit of excitement. Tonight when I got to the hospital, she popped her head up and stared at me. With a little coaxing I was able to elicit the Mona Lisa smile in the picture. As I held her for a bit, she tried to jump out of my arms and go exploring, which is quite normal for her. So I'd say we're about halfway back to normal.
After a pretty good night (really a great night with the exception of all the hospital interruptions), Alyssa had another CT scan first thing this morning. Unlike the previous two scans, we had a hard time subduing her, even with a dose of Atavan. She repeatedly lifted her head to look around, touch the machine, and break loose. It was great to see!
Her doctor just reviewed the images and said she's in the clear. Her blood work came back this morning as well. The white cell count is down to 14--from 18 two days ago and a peak of 28 prior to surgery. Her isolation decree has been lifted and she's once again free to roam the halls. Hopefully her feeding tube will be removed tomorrow and, depending on how well she eats and when the doctors actually visit her, she may be able to go home. We should certainly have the whole team back home by Saturday.
All your thoughts, prayers, and well wishes have worked! It's definitely feeling like the home stretch, especially seeing Issa's usual personality and feisty curiosity return.
I stepped into the bathroom for a quick biological break. When I came out Alyssa's admitting physician was removing the tape from the side of her face. In another instant her feeding tube was out and she was enjoying what I can only imagine tasted to her like a cold beer tastes to me after a hot day in the sun.
On Friday, September 17th at 2:38 PM, the last of our stuff was loaded into the car--including Alyssa--and we were on our way home. Driving her home yesterday was a more emotional experience than bringing her home from the hospital after she was born. After two weeks of being sick and ten days in the hospital, Alyssa is home at last.