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Wednesday, February 02, 2011

In which Yonah gets to ride in a 'weeyoo'


In Yonah slang, a 'weeyoo' is an ambulance. Don't worry, things are okay... now.

Zahava and I spent a long evening/night/morning escorting Yonah through the Israeli medical system.

A spiked late afternoon fever, purple cheeks and difficulty breathing prompted Zahava to take Yonah to our pediatrician who listened to Yonah's chest, and told us he was 99.99% sure he had full blown pneumonia.

The next step was to take Yonah to 'Terem' for a chest X-ray to confirm the doc's diagnosis.

At 'Terem', a doctor listened and nodded his head... it sounded like pneumonia to him too, but the fever had dropped to almost normal (99F) a couple of hours after giving him some children's fever reducer.

However the chest X-ray came up clean. The doctor was completely puzzled by the chest film since he'd clearly heard something entirely different from his stethoscope. However, when he checked Yonah's pulse oxygen saturation, he found evidence that something was wrong. He was getting 'pulse ox' numbers between 83 and 90, rather than the normal 95+.

After several nebulizer treatments with Ventolin (administered over the course of several hours), and a dose of oral steroids, Yonah's blood oxygen level still hadn't improved, so the doctor said he wanted us to go to the hospital. But since he wanted to have Yonah using an oxygen mask during the trip to the hospital, he decided to send him in an ambulance.

Yonah was delighted. Us... not so much.

I told Zahava to go with Yonah in the ambulance, and I drove our car over to meet them at the hospital.

When they arrived, Yonah was still coughing and struggling for breath. However he was grinning from ear to ear from the ambulance ride. Apparently, even though it wasn't really necessary, the nice ambulance driver had run the lights and siren for Yonah's benefit.

By this time it was the middle of the night. They checked his 'pulse ox' after taking off the oxygen mask and it hovered around 89 or 90. Yonah was put in an observation room and he and Zahava slept fitfully together in the room's only bed. I used my iPad to watch 'Goodfella's', surf the web and check my email for the rest of the night from the bedside chair.

By 9Am an ER doctor had had another look at Yonah's chart, listened to his lungs and poked and prodded him... and was stumped as to what was going on. The 'pulse ox' remained stubbornly at or below 90, and there was nothing else besides a low-grade fever to suggest anything else wrong.

They decided to send us home with a prescription for Ventolin and more steroids (despite the fact that neither had done a thing to improve the situation), and told us to see our pediatrician.

Yonah is still coughing, but he seems to be slightly improved in terms of his color and comfort. However, since we don't have a pulse-ox meter at home, we have no idea what is really going on. This morning Zahava will be taking him to the doctor again to see where things stand.

If I seem a little detached or hard to get a hold of... now you know why.

Posted by David Bogner on February 2, 2011 | Permalink

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oy...kids...
its a wonder we survive their childhood ;)

hope all goes well today and Yonah finds his oxygen.

Posted by: weese | Feb 2, 2011 3:19:23 PM

Refua Sheleima, Yonah! And good luck, parents :)

Posted by: SaraK | Feb 2, 2011 4:59:28 PM

Refua Sheleima, Yonah! And good luck, parents :)

Posted by: SaraK | Feb 2, 2011 4:59:31 PM

Refuah sheleimah to Yonah! And our love to the rest of you. Ain't parenting fun? (We're busy nursing the Mistress of Sarcasm, who has type-B influenza... 28 years old, but they never really leave the nest when they're sick!)

Posted by: Elisson | Feb 2, 2011 5:04:12 PM

Ohhhh - poor little Yonah. Sending hugs from my little one to yours. Hope he is feeling better soon.

Posted by: orieyenta | Feb 2, 2011 5:24:17 PM

Oh poor boy! Not getting enough oxygen is horrible! Sounds like the ambulance event will be one he talks about for a while. Health and strength to mum and dad, and recovery for Yonah.

Posted by: Kiwi Noa | Feb 2, 2011 5:36:39 PM

OK, let's pretend I'm still your pediatrician for a moment (It's only been about 12 years):

You can have an interstitial pneumonia, even with a normal chest x-ray.

Did the doctor hear wheezing with his stethoscope, or crackles?

Was the chest x-ray completely normal, or were there increased interstitial markings?

How high was the fever?

Did they do a blood count on Yonah? If so, was his white blood cell count elevated?

Is he breathing fast?

Did they swab him to test for the flu?

Does he have a history of wheezing, ever before in his life?

If he's never wheezed before, he has an elevated white blood cell count, there were increased markings on the CXR, he has crackles instead of wheezing, or his fever was relatively high (any of the above), he should probably be on azithromycin (Zithromax) to cover him for mycoplasma, the most common source of "walking pneumonia" or a bronchitis.

A chest x-ray is a poor indicator of pneumonia or not if the clinical signs are there, especially if he might be dehydrated.

I hope that's helpful.

Please let me know how Yonah's doing.

Larry

Posted by: Larry | Feb 2, 2011 5:40:33 PM

Oh, Larry!!!! How we LOVE & MISS you so!!!!! David's version of events was somewhat sanitized.

When we left the hospital Yonah had NO fever, which was the number one compelling reason that even though the symptoms hadn't improved that the attending pediatrician refused to give antibiotics...his white count was elevated but the docs attributed THAT to the oral steroids. Upon release, we were advised that 1) if the fever returned, or 2) if his breathing became more labored we were to return to the ER.

Per discharge advise, we immediately scheduled a follow up for Wednesday a.m. All seemed to be stable until about three in the afternoon when Yonah's flushed cheeks and glassy eyes returned, and he began complaining that it hurt MORE to breathe than before... A quick call to our family pediatrician confirmed that he needed to be reevaluated.

Our doctor said the sound was absolutely consistent with pneumonia and felt that the recurrence of fever rather supported atypical pneumonia rather than an odd presentation of asthma, especially considering that Yonah had no history of wheezing. He prescribed zythromyacin and asked us to keep our appointment this morning.

Thanks to the antibiotic,Yonah awoke a completely different child today. He had low grade fever, but his color was back to normal, and he was up to his usual mischief.

While his pulse ox is still hovering between 93 & 94, his heart rate had dropped from 165 to 97. Our doctor also felt that there was improvement in what he was hearing.

And, YES!, poor kid was breathing very rapidly. Just before and after each coughing fit, he was panting from the effort to breathe.

Thankfully our doctor shares your wisdom, and we seem to be on the path to recovery.

Posted by: Zahava | Feb 2, 2011 7:21:15 PM

Refuah Shlemah whatever it is!

Posted by: Mark | Feb 2, 2011 7:30:45 PM

You'll find reading about pulse oximeters interesting, see
http://en.wikipedia.org/wiki/Pulse_oximeter.

You can buy a pediatric home pulse-ox if this sort of problem persists.

Posted by: Freddy | Feb 2, 2011 7:42:21 PM

Glad that Yonah is better and glad to see that your pediatrician is a real clinician. Like I told David on the phone I hate to second guess another doc especially when I hadn't actually examined Yonah meself. But I was concerned. It seems to me that the docs in ED dropped the ball this time. They were fooled by the normal x-ray (a red herring) and explained away the high white cell count because of the oral 'roids.

Posted by: QuietusLeo | Feb 2, 2011 9:45:40 PM

I'm glad you got to the bottom of this. Four years ago we also had an ambulance trip with a kid with pnemonia which was disastrous (Thank G-d child is well now). I'm sure you're keeping a careful eye on Yonah--wishing him a speedy recovery.

Posted by: Baila | Feb 3, 2011 2:53:39 PM

Anyone that has a child with respiratory issues knows all to well the anxiety in wondering what their spo2 is.The finger oximeter is a great home healthcare tool that will ease a parents anxiety.

Posted by: buypulseoximeter | Aug 5, 2011 1:56:10 AM

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