A+ PulseOx

I got to live my very own episode of Grey’s Anatomy last night.

On Wednesday, Logan woke up with a snorty nose. Jon and I walked into his room to say good morning and he greeted us with a grin and a sneeze. By Friday, the cold had migrated down to my little man’s chest – and the morning greeting had morphed into a grin and a cough.

By the afternoon, my muppet had begun wheezing. We experienced this once before, at the start of Cold and Flu season. So, for my own comfort of mind, I decided to call the advice nurse to perhaps schedule a quick checkup in the peds clinic the following day.

“Does he have a fever?” No.

“Are his lips or any of his other extremities turning blue or gray?” No.

“Has his appetite diminished?” I looked over at Logan; he looked up from the six ounce bottle of milk he was guzzling and smiled brightly. No.

“Is he disoriented? Is he having a hard time recognizing you?” The muppet giggled uproariously at this. “Ai!” said Logan. No.

“Is he lethargic?” As the six ounces was needed due to the non-stop rolling as he canvased the living room throughout the day, no.

“Ok,” the advice nurse seemed pretty unconcerned. “Let me just see if we can find a telephone appointment with a doctor tomorrow, just so you can confirm with him. Now, your child was typically healthy at birth, correct?”

Well, as healthy as a 27-weeker can be, I reassured her. They never needed a ventilator or anything like that…

Suddenly her attitude wasn’t so blase. “He was a preemie?” she asked sternly. Hold on please. I’m going to check with a doctor.

I had said the magic words. NICU grad. Sure enough – less than two minutes later she returned. “We’d like you to come in. How far are you from our Emergency Room?”

This is how I found myself walking into Seattle Grace…er…Kaiser at 8 p.m. with a lone muppet. Thirty minutes later, we reached the front of the line just to check-in. Poor little Logan was stripped down, weighed (20.6 lbs!) and, much to his chagrin, had his temperature taken – rectally. (He responded to this invasion of privacy by pooping on the medical assistant. But he did it with a smile.)

Then we were sent to the chairs.

We waited. Logan observed the bleeding, hacking or otherwise diseased malcontents crowding the waiting room. I did my best to huddle ourselves into a sterile corner, sprinkling Purel around us like an invisible fence. I settled in, expecting a long wait. It was a Friday night in the ER. I didn’t think a kid with the sniffles was going to be a top priority case.

By 10 p.m. Logan was lightly dozing in his carseat, seriously annoyed that I’d pulled the sunshade down over his line of observational sight. But he perked right back up at 11 p.m. when we were finally situated in an exam room. All the while young and beautiful doctors flitted about – gossiping and proclaiming medical terms, with the occasional “Code Blue” broadcast throughout the halls. I could hear the residents conferring with attendings – ordering CBC/chem 20s, chest x-rays and IV fluids STET.

Dr. Alex Karev finally came in to examine my little man. (Ok, I can’t remember his actual name, but he was a young, handsome, pediatric ER doc and his name did start with a K. So Karev fits.) Logan lit right up, bestowing a million watt smile upon his newest admirer. “He is a cutie!” exclaimed Dr. Karev.

I repeated my story, letting the doctor know that I was not simply a petrified paranoid mommy. Ok, I am. But regardless, I was in his ER because the advice nurse said we needed to be there. Karev placed his stethoscope on Logan’s chest and Logan wheezed on command, so the fine doctor attached an oxygen saturation monitor to my muppet’s foot. The monitor (oh, how familiar I am with those blasted monitors) blinked to life before it’s green numbers settled on 100 percent. And remained there. At 100 percent. The. Entire. Time. My little desatter is all grown up!

Obviously pleased with himself, Logan looked up with his wide eyes and batted his eyelashes as if to sweetly say, “See? I’m fine. May I please have the rest of my bottle?” Karev smiled. “Well, he’s experiencing zero respiratory distress. But I’d like to get him started on a breathing treatment.” He left the room mumbling “he is such a cute kid!” as he exited.

The respiratory therapist arrived as promised, along with two more doctors. Because there was not enough drama in our current segment of the medical drama series, these new doctors were there to inform me that the hospital’s computer system would be going down for the night. As the therapist administered albuterol, one of the other doctors diagnosed Logan with bronchiolitis.

Bronchiolitis is a common illness of the respiratory tract caused by an infection that affects the tiny airways, called the bronchioles, that lead to the lungs. As these airways become inflamed, they swell and fill with mucus, making breathing difficult. Hence the wheezing. According to the Kids Health website, baby bronchiolitis sufferers may be more likely to develop asthma later in life, but it’s unclear whether the illness causes asthma, or whether asthmatics were simply more prone to developing bronchiolitis as infants. Both of these conditions are items likely stem from the Chronic Lung Disease diagnosis that resulted from their missing three months of gestation.

We were then left to wait some more – to see how Logan reacted to the treatment. They warned me it might make him agitated. But, just like our previous adventures with albuterol, he just curled up in my arms and grinned as he inhaled the stimulant. As we hung out, I held him, I curled up with on the gurney, I rocked him, I stood and swayed with him, I tucked him into his carseat. He was calm, absolutely exhausted, and completely wide awake. “I can’t go to sleep Mom, these are my people!” Despite my cajoling, the muppet could not be persuaded to miss out on any potential excitement.

Karev arrived about an hour later with a handwritten prescription slip. “Have the pharmacy call me if they can’t figure that out. We don’t really write prescriptions anymore because we have the computer.” Which was down.

At 2 a.m. the two of us finally stumbled out of the hospital. Logan was still smiling. I thought about asking him to drive me home, but his infant inhaler instructions explicitly stated “Do not drive or drink alcoholic beverages for 8 hours or until you are sure the effects of the drugs have worn off.”

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Cold and Flu Season

It’s the 2010 cold/flu season. And the muppets are now the recipients of a 2010 cold.

This is their first illness (other than “tiny”). So naturally, I panicked. Jon called the advice nurse to ask if we should bring them in to see the doctor.

“Do they have a fever?” No.
“Have they stopped eating?” No.
“Is there green goo coming out of any orifice?” No.
“Is he vomiting?” Other than the standard projectile spit-up, no.

I think I could hear the advice nurse rolling her eyes at us. She told us that the muppets have a cold; watch them. Surprisingly, this made sense to me. For some reason, I always assumed that very sick children come with a fever. Instead, Logan got wheezy.

Grandma Nancy came to visit on Friday. Logan grinned, coughed and wheezed hello. “Oooh, I don’t like the sound of that,” she commented. That was all it took – Jon immediately made an appointment for that afternoon. He called me at work to let me know of the change of plans.

In a previous life, I likely would have quietly approached my boss and inquire if it would be okay if I left a little early so I could go to the doctor. But now it was about my boys. Mommyhood engulfed me. “I’m leaving to take my muppets to the doctor,” I informed my boss. Sick muppets do not qualify for a debate. (Although, to be fair, this was already a Friday afternoon and I have 24/7 access to work from any location.)

The doctor looked at Logan’s breathing and said “I can’t let him leave here looking like that.” My eyes widened and my stomach began to sink. I wanted no part of staying in the hospital and there was no way I was going to be able to leave my little man there again. His pulse ox (oxygen saturation level) was 94 and he was experiencing heavy retractions – where the skin pulls tight around each rib on the chest as the child works to breathe.

The day the muppets graduated from the NICU, their pulse ox was 94 – and we were doing a happy dance it was finally so high. But 94 is apparently a bad low number now that they’re big boys.

The doctor decided to try treating him with albuterol, a bronchodilator that helps open up the airways in your lungs to make it easier to breathe. It’s normally used as an asthma treatment, but also works for tiny developing lungs. The medication works by creating a steam that is inhaled through an oxygen face mask.

Logan wasn’t thrilled with the concept, but he didn’t fight it too hard. And amazingly, he responded phenomenally to the treatment. The doctor even later admitted that she didn’t think we’d be going home that night…

So we were given a crash course on how to work a nebulizer and sent home. Yay! Turns out the biggest complication was when Jon got locked in the pharmacy. (They shut all the large fire doors at closing. I was beginning to wonder if we’d end up spending the night for a completely unforeseen issue.)

This morning, after a wake-up nebulizing albuterol experience, we went trooping back to the doctor for a follow up. Both muppets were getting checked since, even with my limited medical training, I’m pretty sure they have the same virus.

Logan’s pulse ox was 100. Caden’s read low, 96. But the medical assistant looked at him and decided he looked far too healthy to have only a 96 percent saturation level. After a repeat measurement, Caden was 99 percent saturated. I then came to the conclusion that yesterday’s technician got the wrong result.

Today’s doctor confirmed – they have a cold. She also thought Logan responded really well to the albuterol and said, in the grand scheme of sick babies, this is relatively mild. (They still have not experienced a fever and continue to eat like gangbusters.) We can expect the wheezing and coughing to last about one to two weeks – similar to when you or I get a cold and then can’t shake the blasted cough for 7-14 days after we feel better.

In addition to albuterol, this weekend’s prescription involves a significant amount of snuggling. Despite feeling icky, both muppets have maintained their awesomely adorable happy baby demeanor. They just require a lot more holding. They’ve slept a tremendous amount for the past couple days; I am encouraging this because I know that’s what I enjoy doing when I’m sick. But the second I try to put them down, their little snuggle meter blares to life.

“HOLD ME! I NEED TO BE HELD. I DO NOT FEEL GOOD!!!” As soon as I pick them up, I am rewarded with a coo.

Apologies if I appear a bit skittish for the next one to two weeks. Babies get sick. Colds are to be expected (especially during the cold and flu season). But that doesn’t mean I have to like it. I plan to remain on high alert in Mama Bear mode until the muppets are all better.

One final Public Service Announcement: If you are sick, stay home. Keep your cooties to yourself. The muppets don’t want them.