Pneumonia

Sam has had 2 sinus infections this winter already.  Did a course of amoxicillin from the pediatrician’s office and then went to the ENT as we had the same problem last winter.  He put him on a 2 week course of omnicef.  Well, his nose is much better but he continued with a nasty congested cough the whole time.  Really?  While on an antibiotic for respiratory issues?  So, off to the pediatrician we go…………

And he has pneumonia.  Uggh!  Now on his 3rd antibiotic in about 5 weeks.  Not my favorite thing.  But hopefully this one will finally get him better.  If not, we go back for inhaled steroids for the rest of the winter and possibly singulair for a diagnosis of cough-variant asthma.  I have it so we’ll see where we end up in a week………..


Back on Periactin

The wean went successful for Sam coming off the periactin.  He takes it for the cyclic vomiting syndrome.  He came off it fine and then had only one cycle while he was off.  It was the day after Christmas, so could have been caused by the excitement of Santa & the presents, etc.  It was a fairly easy cycle with us being able to break it with just zofran.  Some cycles are soooo much worse!!

As for his behavior and sleep…..I didn’t think there was really much change.  :-(  He still continued to be crazy and hyper etc.   Much like he was when he had the paradoxyl reaction to the Benadryl.  The sleeping is so much better now but it is because once I knew it wasn’t the periactin I enacted a reward system that is working wonders!! 

On Monday of this week he again complained of some mild nausea, not really a cycle, just mild nausea so I decided it was time to restart the periactin.  Three days into it I wondered if there really was a difference in his moods off it vs. on it.  Sure, he’s a hyper rambunctious boy but in the 4-6 weeks he was off I don’t remember seeing any episodes where he got VERY angry when he didn’t get his way.  Three days into being back on it I did.  I remember these episodes well too!!  When Sam doesn’t get his way he gets quite angry.  He yells in a totally different voice and if angry enough he hits.  I really don’t remember ANY of these episodes when he was off the periactin.  Now though, I really wish I had known to closely watch for these along with the sleep issues and craziness. 

I don’t really want to take him off again so soon and really confuse his little body.  So, I guess my plan now is to keep him back on it for long enough to see if these anger reactions are happening often.  If they are then I’ll take him back off and see if they really do stop.  And if they do then no more periactin for Sam!  It’s not really worth it to be so angry at 4 years old.  Not when there are other meds out there.


ENT appt — Ben

Another 6 months and some great ear tubes.  The ENT must really use glue on that boy when he puts his tubes in.  He had to have the last set surgically removed and this set is staying just as well.  But that’s fine with me since it’s his second set.  Maybe once this set is out we’ll finally be done!!!

The Wean

Remember this post where I wasn’t real happy with the decision by the GI doctor & APRN not to go along with my trial off the periactin for Sam?  Well, I talked with a friend of mine, who also happens to have a kiddo with CVS on periactin, and she agreed with me on several things:
  1. the docs in that group don’t really listen
  2. the periactin definitely could be causing Sam’s behavior & sleep issues
  3. trialing him off is a great idea
So, today starts the wean.  He currently takes x mg.  Today we will go to 1/2x mg for a week and then off for 6 weeks and see how he does.  Hopefully he will have no vomiting episodes.  But really, I’m not sure how much the periactin has been helping anyway.  He goes for 4-6 months cycle free and then will have 3-5 cycles all in a row.  That is when they up the dose.  Then wha-laa no more cycles for the 4-6 months.  But is that the periactin helping or is that just the way his cycles naturally go?
 
I think I forgot to mention in that post that he had an opposite reaction to Benadryl when he took it for a drug reaction around age 3.  He was quite hyper and didn’t sleep for days.  That is why I wonder if the periactin is affecting him negatively.  I guess only time will tell.

Red Man Syndrome……or not?

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!!!!!

GI appt — Sam

Sam had his latest GI appt today for his cyclic vomiting syndrome (CVS).  He has been episode free since before his surgery so there will be no dosage changes.  This is fine with me as I don’t really want to go up on his periactin at all.  In fact, I wanted to and asked to have a trial off of it.

Sam is a very wild child.  Some would describe him as a “typical boy” but I’m not sure it isn’t more than that.  He is just downright crazy!!!  And more than anything he doesn’t sleep well.  They really grilled me as to if this started when he started the periactin and if so why I hadn’t said anything before now.  Well, first of all, he has been on the periactin so long that I really cannot remember what he was like before it and second of all I didn’t realize this was possibly one of the side effects. 

But they didn’t agree with me and say that periactin is the #1 best med for CVS so we should continue on it.  To pacify me it was agreed that we would give 1/2 the dose in the morning and 1/2 the dose in the evening and see if that had any change in his behavior  or sleep habits.  I’m not convinced……

Oh and he gained a pound and grew 1/4 inch in the month since he was seen last!  Quite amazing since he was recovering from open heart surgery during that time!!!


Bronchitis Now….uggh!

Poor poor Ben!

First the cold, then the asthma diagnosis, then the seasonal flu and now bronchitis.  Can it just stop already????

He had a dry hacking cough when he had the flu but it changed to this wet productive yucky cough.  He then started complaining that when he coughed stuff was coming up from his lungs.  Off to the pediatrician we went.  Sure enough….wheezing and junky lungs.  Pedi said he had a secondary bronchitis from having the flu.  Breathing treatments and z-pack, recheck in 2 weeks.

G I V E      H I M    A    B R E A K!!!!!!!