Red Man Syndrome……or not? November 25, 2009

When Sam had his open heart surgery he got vancomyocin for his peri-operative antibiotic.  When you have surgery you always get an antibiotic ward off any surgical infection. There are 2 they usually pick from. One is ancef which is in a family that is closely related to penicillins (which Sam is highly allergic to) and can lead to cross reactions. For this reason the surgeon picked to use vancomyocin. No chance of reaction….or so he thought!Sam got the first dose during surgery. The second dose was given 8 hours later in the PICU and about 1/2 way thru he looked like this:

Sam’s vanco reaction

They called it not an allergic reaction but an adverse reaction called Red Man Syndrome (RMS) which can happen with vanco. But I had a patient with that once and Sam looked nothing like that patient. If you look at the pic his eyes and lips are swollen. He got better with benadryl. If it is RMS then they can give it again just with benadryl before the dose and then run it slower. So, they did 8 hours later and he this time just got 6-8 hives on his face.

 

I showed the pic yesterday to Sam’s GI and she agreed with me that it was an allergic reaction! I told her I was considering taking him to a pediatric allergist (appt on Dec 17) and talking it all over with him. She agreed that was a great idea! So, I guess that’s the next step for my little antibiotic allergic one. Uggh! Does it ever end!!!!!

Another cycle, getting bad November 18, 2008

I was called by the daycare this morning and they reported that Sam was complaining of nausea and has a fever.  They say he was fine one minute and it came on suddenly the next.  I went and picked him up and called the pediatrician’s office.  Unfortunately the pediatrician who has been working on this is off today…..uggh….can it get any worse!!

After an hour at least they call back and one of the other docs had called in some zofran for his nausea.  He was his usual pale, limp and inactive self.  But luckily he was back to normal about 30 min after the zofran and he never actually vomited this time.  Whew!! 

Cyclic Vomiting Syndrome November 17, 2008

Today Samuel was seen at the pediatricians office and evaluated for the vomiting.  His neurological exam and the rest of the exam were normal so the pediatrician believes he may have a disorder called cyclic vomiting syndrome (CVS).  He is going to consult with the local pediatric GI group for guidance and call us back within the week.

Frequent vomiting November 14, 2008

Today we got the first indication that Samuel’s vomiting may be more than we thought it was.  He is our little vomiter.  He gets the stomach bug quite often….or so we thought.  It isn’t anything that we can mark a calendar by but it happens quite a bit.  Much more than the other two kids.  We were pretty proud of ourselves as parents because we figured we were doing super great handwashing by keeping it away from the other kids.  Maybe not!

Last month he had an episode that lasted 36 hours and he was on the verge of being hospitalized.  He saw the pediatrician in the evening for the vomiting and a respiratory infection.  They said that if he didn’t stop overnight he would be admitted that next morning for hydration.  Luckily he stopped about 2 hours after seeing them.

Today another episode.  This one prompted a call to the on-call pediatrician as the first episode of vomit had flecks of blood in it.  Among other things we spoke of how often he actually “gets the stomach bug” (my words).   The pediatrician stated that it is much too frequent for this to be the stomach bug and that he wanted to see him on Monday once this episode was over as long as he didn’t get dehydrated with it. 

That I can think of he has had 5 episodes in the last 6 months.  They all just happen to be on dates that I can remember such as Mother’s Day and my birthday along with a few other important dates.  Those are only the ones I can think of.  I know there are more. 

All of his episodes are very similar too.  They involve intense vomiting.  And I mean INTENSE.   Repeated vomiting episodes, several per hour all total lasting from 4-36 hours.  He is pale & lethargic.  Lays on the couch like a limp rag.  Almost like he can do nothing else but lay there.  He always has a fever around 101 (my reasoning for thinking stomach bug).  He sometimes complains of a headache but not always.  And lastly within a day of the episode he always has a mucoid stool. 

This one seems to be over for now.  On to the pediatrician we go on Monday for his evaluation.

Not again October 6, 2008

After having an entire week free of the erythema multiformen(EF)/hives and getting much better from his bronchitis Sam is broken out in the EF again!!  Uggh!!!

This time I noticed it right before putting on his PJ’s when getting him ready for bed last night.  It was not nearly as bad as last time but most definitely there.  Having just given him his claritin I didn’t give him any benadryl.  Also as it makes him so hyper!!

So, I guess a call to the ped’s office is in order for the am today for several things.  First, for a Rx for atarax for the EF since the benadryl makes him so hyper.  Next, to see if they want to see him again (though it is pretty pointless) and lastly, to see what (if anything) the next step is.  Not sure if he needs to go and see an allergist at this point or what. 

I was willing to go with it being viral induced last time but after being a week free of any outbreaks and now feeling much better that seems unlikely.  And the only meds he had gotten before were Vick’s and robitussin and he hasn’t had ANY exposure to them.  I do have food lists for both days but other than yogurt and chicken nuggets there aren’t any other matches for foods for both days. 

I’m at a loss…………………………………………!

Colds, allergies and asthma….part 2 September 29, 2008

We are back from the pediatrician with Samuel.  We ended up having to go early and somewhat urgently.  I gave him a breathing treatment at 12:45 that he asked for.  He had asked for the one 4 hours previously too.  That one had worked well though.  At the end of the lunchtime one he said “I don’t feel better” and when I asked if he needed to go to the doctor early he said “No, I feel a little better.”  So I put him down for a little rest time.

Not even 5 min later he was up calling for me.  I went up there and he couldn’t finish a sentence but managed to get out that he needed “another treatment”.  At this point I noticed that he was breathing pretty fast too.  Called the pediatrician’s office and they said to bring him right down.

His O2 sat was good there and he was improved enough to speak in full sentences but he was still breathing pretty fast.  The doc (luckily same one as saw him on Sat) said his lungs went from slightly wheezy to VERY wheezy and quite junky.  Now my poor little guy has bronchitis along with this episode of viral induced asthma  We are to continue his breathing treatments and have added an antibiotic and steroid.  He expects in about 24 hours we should notice a huge difference.  And he wants to recheck him on Friday.

Guess I should restart Jennifer on her singulair tonight before she heads down this road too!!

Colds, allergies and asthma…part 1 September 29, 2008

The title pretty much sums up our weekend with Sam.  He has had a cold for over a week now and this weekend took a turn for the worse.  He’s my one that gets every bug that comes through the poor little guy.

It started out innocently enough as just a cold with a cough.  But his claritin and some Vick’s on his chest was managing it pretty well.  Then Friday he came home from daycare feeling a bit warm.  We were getting ready to go out to dinner as a family so I was going to change him out of his daycare clothes and I find this:

It was basically covering his whole trunk.  My initial thought was Scarlet Fever but then a certain familiarity came to me with this rash.  It is erythema multiforman.  Or in English a severe form of hives that signals an allergic reaction.  He had this once before at about 8 months when on an antibiotic.  It lasted almost 3 days and was awful for him.  

After speaking with the nurse at the pediatrician’s office he got a dose of benadryl and some tylenol.  Looked much better after about 30 mins.  But still had a temp of about 100.4.  Nothing too major.  They wanted to see him Sat am if he still had the fever.

Sat am he wakes covered in spots again and with a temp of 101.  Off to the doctor we go.  He looks him over and cannot find a reason for the fever.  Then asks if he was one of my wheezy kids.  I say yes, he had infantile asthma but has outgrown it as of last winter.  Then he says that he feels bad telling me this but he is wheezing.  Ahhhhhhhh!  Back to breathing treatments we go:

 

Now, about the rash, before we knew what the source of the allergy was so we can avoid that antibiotic in the future.  This time…….not so easy.  The doc isn’t sure if it’s the cough medicine we gave him a dose of, the Vick’s we were putting on him or the cold virus itself.  Only time will tell I guess.

The rash lasted 1 1/2 days this time, was gone by Sunday morning and was incredibly itchy for him.  He got lots of benadryl and unfortunately turns out to be one of those kids that benadryl makes hyper….uggh!  Then I thought we were done but Sunday afternoon he spikes a fever of 102 this time and is covered in regular hives.  Not nearly as bad a reaction but still reacting again.  

So we are off to the doctor again today to see why still a fever……….

I have a couple of 3 yo seals!! September 15, 2008

Croup has invaded our house!  Jen awoke with it last night around 1:25.  It always sounds so scary.  I cannot imagine what people thought before the age of modern medicine when croup’s description really got out there.  My first thought each time my kids awaken with it is:  oh gosh they cannot breath!!  Then I really wake and remember it’s only croup.  Outside we go and things improve dramatically.

Jen’s breathing sounds fine this morning but she is still doing the barking cough.  Sam, who slept fine, awoke with the barking cough this morning too.  Probably means we’ll be in for a rough night tonight.

So far Ben is spared.  Shouldn’t be much longer though!!!!

My babies are 3 today!!! August 23, 2008

My twins are 3 today!!  I still call them my babies though it’s probably time to start dropping that line huh!!

I can hardly believe they are 3.  It seems like yesterday that I was being wheeled into my room after my c-section and seeing my hubby holding them and reality that I actually had TWO babies to take home setting in.  And then it seems like the day before that I was getting my older one out of bed and some voice inside my head told me to do a pregnancy test that morning even though we had been unsuccessfully trying for about 9 months at that point and I had all but given up on getting pregnant on my own again.

My life is so blessed.  I have a wonderful hubby and 3 wonderful children.  I only wanted 2 children.  You know, the whole I have 2 hands for 2 kids etc line…….  But then God blessed me with an extra and though it gets hectic at times (well most of the time!!!) I wouldn’t change it for the world. 

We are having a big BBQ for the 3 of them today as Benjamin’s b-day is this coming Wednesday.  Quite the busy week for us!

Here are some pics down memory lane………..

Now:

Jen at birth:

Sam at birth:

Another year down for Sam and his heart August 22, 2008

Samuel saw the pediatric cardiologist on 8/21 and he was cleared for another year!  He said that his aortic valve is slightly leaky but that it is nice and stable.  He also said that the pressures across the membrane (his defect is a subaortic membrane or subaortic stenosis) are also stable when compared to last year.  What wonderful news!!