Little Man's visit to the ER

Disclaimer: A small part of this post explaining the reason Owen had to the ER may be a bit graphic for some people. I will try to keep it to a minimum, and only explain what is necessary.

Reminder: Owen has a bilateral ureterostomy. His ureters are disconnected from his bladder (since December 4, 2009) so his bladder is just hanging out in his body, never filling with urine. His urine drains through these holes in his abdomen. Nothing should ever be in his bladder. If something comes out of his bladder that is a big concern.

Reminder 2: Wes is in Chicago on a business trip. He left early Thursday morning and will not be back until late Wednesday night.

I meant to get this post up yesterday, but life got in the way. I just haven't had time.

Owen had his VCUG on August 25, where dye was injected into his bladder. As you may remember from that post he was cathed three times before it was successful. He spiked a fever on August 31 and I took him to the doctor. There he was cathed again to make sure nothing was in his bladder, ruling out a bladder infection, which is a risk for him after the VCUG. Nothing came out and the pediatrician decided that he either had something viral or the fever was being caused by a blood blister that developed as one of his incisors was trying to break through. September 4 he had his one year well visit. All was A-OK. A few days later he became feverish again and very fussy. This continued to escalate to the point where I really wondered if it was just teething related. I kept telling myself that the doctor found no infection, he is fine.

Fast forward to Saturday. In the 24 hour period from Friday night to afternoon nap time on Saturday Little Man slept only 7.5 hours. This is not enough sleep, and not like him. He was fussy, clingy, and inconsolable at times. I had begun to worry. He woke up from his afternoon nap after only 45 minutes (way shorter than normal, especially considering his poor nighttime sleep and lack of morning nap). Even worse, instead of chatting or fussing to let me know he was awake, he was screaming as though in excruciating pain. I tried to comfort him and went to change his diaper.

Here comes the slightly graphic bit...

In his diaper near where his penis is there was a brownish sort of rust colored spot that looked exactly like dried blood. I freaked. As far as I could deduce, blood had discharged from his penis. This is a big deal, a big no no. Something to be worried about.

I called the urologist's office and waited the agonizing 20 minutes that it took him to call me back. After some discussion he thought that it was unlikely that there was a bladder infection resulting from the VCUG because of how long it had been. He thought the repeated catherizations could have caused irritation resulting in the bloody discharge. After discussing the fact that I had taken him to the pediatrician twice and he had undergone a general checkup resulting in nothing but normal findings, and hearing that the symptoms (fever mostly) had been persistent for so long, he recommended that I take Owen to the ER.

My mom came over to watch Carter and Ashley went with us to the ER. We waited for an hour just to be seen in triage and a total of 2.5 hours to go back to our room.

Long story short: He was examined. He was held down while the nurses looked for a vein and took blood. We both cried. They were going to place an IV since they had to stick him anyway but it infiltrated, just like I told them often happens. The nurse said "You were right mom." Do you know why I was right? Because I have seen it too many times, Owen has been through it too many times. Going through things like this never gets easier for either of us.

Diagnosis: Owen's left ear was "a little red, but probably not enough to cause the fever and elevated white blood cell count" The ER doctor talked to Dr. Gazak, who told him not to collect a urine sample (the only way to do that is to cath his ostomies, which would not provide a valid sample since they are open to the skin and the skin always caries bacteria) and to put him on a vigorous course of a stronger antibiotic than the one that he as a proflyactic.

Translation: Owen might have a slight ear infection and probably has a UTI. We have made it almost 11 months without Owen getting a UTI or a more serious kidney infection, which is a major concern with bladder reflux kids. Especially those with reflux as severe as Owen's and those children with ostomies. Now here we are less than a month away from Owen's reimplantation surgery and he gets an infection.

What now?: They send more specific blood cultures off to check for a more serious (kidney) infection. We hope they don't find one. I watch him. I make sure his fever doesn't spike and that he doesn't act out of sorts. Mostly, I worry and hope I will be able to tell if something more serious is wrong. Also, we pray.