Thursday, November 14, 2013

Well, This has been an Interesting Week

I am exhausted.  And by "exhausted", I mean that the bags under my eyes have exceeded their two carry-on limit and my head is about to collapse forward on the keyboard so I can take a quick nap.


So what the heck happened?!?!?!?

Bridget started her cough on Saturday morning and we started the hypertonic saline treatment and everything (i.e., her oxygen saturation levels) were fine and dandy.

Then Monday night, while she was going to sleep we had enough funky readings to start her shaky vest Tuesday morning.  But all was fine at school and before bed Tuesday morning.

Then Wednesday morning at 4 am, she woke up coughing.  Dave and I felt around the dark in the bed trying to find the pulse oximeter (I had put them in my pajama bottoms thinking--in my sleep--that was a good idea), we checked her O2 levels, which were stable but around hanging around 90-92.  These are not good levels.  We asked her and she agreed to do a shaky vest at 4:15 am.  Her O2 got back up to 97.


We went back to bed.  And while they started to nod off, I noticed the numbers started slowly slipping back down to about 91 but stable.  That isn't a great number, but it's a number I can wait to see the doctor in the morning.  I got up to do some work.  I came back in to check on her and she was steady at 88.

88 is bad.  Not brain damage bad.  But 88 is the level my RTs (respiratory therapists) say you really need to start oxygen.  Of course, I have mom/RT mentors (cough, cough, Liz, thank you) who have taught me there is a difference between hanging at a bad number (bad) and dipping to a bad number (OK and probably normal).  I watched Bridget.  I sat down beside Bridget.  She slept soundly for at least a few minutes ad her numbers held steady at 88.  I went to tell Dave downstairs that she was 88.  I came back to the room and she was 86.


I threw on my clothes, came back to her, and she was back up to 88.  I grabbed her and told her we were going to the hospital.  When she was getting her coat on, Dave said she was back up to 94.  I didn't really care because that 88 scenario was playing in my head.

We got to the hospital. I told them the story.  And they hooked her up to the pulse ox in ER.  She was 100% O2 saturation.  What the fuckity fuck?  I told the nurse everything, she was supportive.  I told the doctor everything and he thought I was an idiot.  (I'm not)  He also said "Well, it looks like she might have an ear infection."  (She doesn't).  I asked the nurse if we could just let her calm down for a few minutes and see if we can get her O2 to do what it had just done 20 minutes ago.  She said Yes, and turned off the lights.  One minute, the doctor walked in, turned ON the lights, had the nurse give us a ginormous dose of oral prednisone, and told us it was time to go.  Neither the nurse nor I were amused.  REALLY!?  REALLLLLLLLY!?  I just told you she was at 86-88 O2 and you think I am so stupid that I'm in an out of  ER in 45 minutes?!?!?!

We get back home and within, I don't know, 30 minutes, Bridget was back to 92-94 O2.

I talked to our various pediatricians, pulminologists, and w(h)ine partakers and thought we'd give it a bit of time to see if the prednisone worked before we did anything.  I also told our ped there was no way in H-E-Double-Hockey sticks I was going back to ER.  If there was a problem, I wanted a direct admit from the pediatrician's office.

I *KNOW* ER docs see a lot of stupid people.  I know that.  I also know that at 6 a.m. in my comfy and old pants and sweater with no makeup and graying temples, you would be surprised to learn that I am not as dumb as I look.  (Or as old:  Thank you ER doc for asking if I was mom and then joking about me looking like the Grandma.  Actually, suck it, you old poop*).

ANYHOO, we/I/someone decided to see what would happen during Bridget's nap with her O2 levels and we'd decide then if anything needed to be done.

Her nap was fine.  She had one dip down to 93, but for the most part, she was hanging between 94 and 96.  Not bad numbers and certainly not worth going to the hospital.  So when she woke up, I called the pediatrician to give an update and ask about the antibiotics for the ear infection I knew didn't exist**.

While I was on hold, in my (mother) mind, all hell broke loose.  Bridget started coughing crazily, and her number dove to about 90-92 with no upticks.  I was on hold for 6 minutes and it stayed at that level the whole time.  I say "mother mind" because I've also developed a "nurse mind" on oxygen sats and may not have been so worried about that.  But Mama mind freaked.  I got in to see the doctor right away, carrying BOTH our home pulse oximeters with us to see how they compared with the doctor's office.  Bridget stayed at that level the whole time over.

We got in quickly and they immediately hooked her up--92 O2, consistent and stable.  My pulse ox was actually registering a little higher than theirs, which freaked me out even more.  Nonetheless, this whole experience was starting to seem an awful lot like what we had seen before.  So our pediatrician called in a direct admission.

I call Dave.  I get to the hospital.  They check us in.  And WOULDN'T YOU KNOW:  she immediately registered a 100% ox saturation and pretty much stayed between 97 and 99 for the next 16 hours--until we were discharged. And WOULDN'T YOU KNOW, both of our pulse ox's registered either the same number or 1 off the hospital's pulse oximeter the whole time, too.  In fact, we had one de-sat on the hospital pulse ox, but I told the nurse that OUR pulse ox stayed at 98 the whole time so I didn't believe it.  She agreed.

What the fuckity fuck, part II?

So I felt very over-reactive to have gone to the pediatrician and freaked out, although she absolved me by saying this was a team decision.  Dave gave me the best absolution for spending the night in the hospital unnecessarily by saying the alternative--her desatting in her sleep overnight at home--would have been much, much worse.

Still.  I have decided that I'm going to write a post on what I've learned about how to use a home pulse oximeter that will hopefully be helpful to others.  I'll link to it once it's done and I'll update it when I hopefully hear from others.  These devices are getting more common but there is precious little info on how the lay person should effectively use them and when to freak out and when to wait another hour.

Meanwhile, I'm trying to figure out what day it is, where we are, and if Bridget's current cough scare is at the beginning, the middle, or the end.  I am pooped.

*I get saltier when I am this tired.
**I didn't tell any of the doctors about his diagnosis, and everyone else commented how nice BOTH of her ears looked.


James Hathaway said...

My theory -- if you're freaked out, you're right. Period. Screw the doctors if they think you are overreacting. It's YOUR child and you probably know as much or more than they do. And it's YOUR child. Period. Don't ever feel bad for worrying or freaking out.

Carroll said...

Exactly what James said! My wise first pediatrician for our kids told me in the pre-natal interview that the only request he makes of mothers is to tell him when they don't agree with something he's saying, or if they have a "gut feeling" that something might be wrong. In his years of practice he had learned that (barring the mothers who think every cold warrants antibiotics) for the big stuff, those maternal gut feelings were right far more often than his objective clinical observations/diagnosis.