Rhinovirus and The Bear

Well. Our family has a love affair with the Emergency room. Jonah was the only child who had not toured the closest ER (Jarvis went for a frenulum caught between his front two teeth- don’t ask, Joelle went for fluids after food poisoning), so he decided to take his turn. I am going to *briefly* write up everything that happened for my own memory, and for the family and friends who are wondering just what exactly happened to land Jonah in intensive care.

Thursday, May 9th was when it all started. I started off the morning with an OB appt and a diabetes appt, then a little grocery shopping. Daddy was home with the kiddos because he was heading into work that evening for a 72 hr alert (until Sunday evening). Jonah woke up much earlier than usual from his nap and I let him fuss for a bit hoping he would go back to sleep, however he was not having that. I immediately noticed him wheezing loudly and breathing hard when I picked him up. He hadn’t shown any signs earlier in the day, but after a half hour, I decided to give him his albuterol inhaler (from this ER trip). It helped for a while, and Daddy left for work. At 6 I ave him another treatment, but by 730pm that evening it was clear that the inhaler was not cutting it. I put Joelle to bed and left Jarvis and the monitor with Jace’s brother and his wife, who live in the apartment attached to our house.

From here, it’s easiest to just shorten the next couple of days, or it would take pages!

Calvert ER, 5/9: 8pm-130am– respirations >60 per min, oxygen saturation 90%, heartrate >150bpm, retraction on belly and ribs, mild tucking of the throat. 4 nebulizer treatments and two oral steroids.  Basically, they considered this to be an “asthmatic type” of attack and were treating it as such. The nebulizer treatments were only working for about an hour at a time, which was more than this hospital could handle on their pediatric floor so they requested a transfer for us to Children’s National Medical Center.

Children’s ER, 5/10: 130am-330am– (at this point in time, Jace started working on getting off alert so that someone would be able to pick us up when we were released from Children’s) We were transported an hour by ambulance during which Jonah stabilized  Whether it was finally getting some sleep on the drive, or the second dose of oral steroids, we aren’t sure. But by the time we reached Children’s ER, he was given one more nebulizer treatment, another oral steroid and we were discharged because he was going 4 hours between nebulizer treatments. We were told to continue with the albuterol inhaler every 4 hours and given a second dose of the oral steriods to be given at 3am the following morning. We then had to wait in the waiting room for an hour for Jace to drive to come pick us up. We arrived home at 630am, just about as the other two woke up from the morning.

5/10: He was fairly normal all day. Slept quite a bit to make up for not sleeping at night, but he was happy and not having much trouble breathing all day. Everytime the 4 hours hit for another albuterol treatment, he would be wheezing slightly and have a bit of trouble, but not too much. I finally put him to bed for the night around 630pm. He woke up at 8pm and was due for another albuterol treatment but this time it made very little difference. He was inconsolable for an hour and continued to struggle more and more to breathe. I laid him in his crib to get ready to take him back into the ER and by the time I was ready and packed he had fallen asleep. He slept fitfully until about 11pm, he woke up struggling significantly to breathe but when I gave him another albuterol treatment, he immediately started breathing easy and passed out. He woke again just an hour later and was right back to severely struggling to breathe so we headed into the hospital again.

Calvert ER, 5/11: 12am-630am– respirations >80 per min, oxygen saturation 90%, heartrate >150bpm, severe retraction on belly and ribs, severe tucking of the throat. He received 4 nebulizer treatments, 2 oral steriods, CPAP machine for 3 hours. Basically, everything they tried did not work. He was in severe respiratory distress. He was not wheezing badly, but he was simply working SO HARD for every breath. He was very rapidly getting physically worn out. They put him on the CPAP in the hopes of giving his lungs a break but it simply wasn’t working. At this point they ordered a flight transfer to Children’s with a critical care nurse on board. However we had a severe storm and the helicopters were ground. The critical care team from children’s arrived around 630am.

Children’s Hospital ER 5/11: 730am- ???? Jonah’s stats were basically the same as when we reached Calvert ER. They noted his wheezing was minimal but he had severe Tachypnea. They administered magnesium sulfate, did blood testing, and transferred him by another hour long ambulance ride to Children’s where we were taken to the ER. They put him on continuous flow albuterol and around 9am they put him on high flow oxygen at 8 liters per minute. After about an hour on the high flow oxygen we FINALLY began to see a difference in his respiration rate. We were moved up to the Pediatric Intensive Care Unit (PICU).

Children’s PICU 5/11: 1030am- 5/13 300pm: Once in the PICU, they opted to stop the continuous flow albuterol and take him off the high flow oxygen. We immediately saw regression without the oxygen and they started it back up. That afternoon they moved the flow from an 8 to a 7 which he tolerated, so that evening they moved him down to a 5. He was taken off IV fluids and allowed to begin to drink pedialyte and milk. During the night he started struggling again significantly, so they bumped him back up to a flow of 8 and started on albuterol nebulizer treatments every 4 hours. At rounds at 830am, 5/12, they decided that it was all bronchial related and not asthmatic at this point and stopped all steroids and nebulizer treatments. They decided to continue to lower his high flow oxygen slowly until he could tolerate being without it. Throughout the day they slowly lowered him from an 8 to a 4, which he tolerated well. He drank quite a bit of milk and ate some table food. At this point in time I finally felt like I started to see the real bear come back. He had more trouble falling asleep because he felt much better. They left him at a 4 overnight and he tolerated it very well. 5/13: We continued to lower his oxygen level slowly and were approved to transfer out of the PICU to the normal pediatric floor. He transferred rooms at a level 2 on the high flow oxygen.

Children’s Peds 5/13 300pm: Dropped him to a level 1 right after we transferred and took him off oxygen completely at around 6pm. He tolerated both really well. As I write this, it is nearly 10pm and we are still working to get him to sleep, ha! His eating and drinking and wet diapers are good, so as long as his oxygen saturation and respiration hold up well overnight, we will likely be discharged tomorrow, horray!

Now as far as the WHY this happened goes, it’s kind of complicated. Obviously Jonah has had one other occurrence of wheezing that accompanied a croup virus shortly after we moved to Maryland. The cultures this time came back as Rhinovirus, which is basically just one of the common cold viruses. On it’s own, in a normal person, it’s simply a cold. Children have smaller airways than adults, so it doesn’t take much for them to react strongly to a cold virus. But Jonah has obviously had other colds before and it’s never gotten this bad. Honestly, there’s no explanation as to why it got this bad this time. And there’s really no prevention to keep it from happening again. They have classified his reaction to the Rhinovirus as bronchiolitis (NOT bronchitis). Usually kids outgrow this severe reaction to colds with age, unless they have other complicating factors (allergies, asthma, or eczema). Jonah has shown signs of eczema before and definitely has the most sensitive skin of our three, but he is too young to determine seasonal allergies or asthma. If he does not seem to be growing out of the bronchiolitis later on then we will be able to explore other options. For now, we simply have to be aware of the signs and symptoms and know when it’s time to head to the hospital for extra help. If we are lucky, this won’t ever happen again, but realistically, it could happen again fairly easily.

But yes, Bear is on the mend and doing much better, although he, Jace, and I are all exhausted. My dad, who is retired, flew in Saturday night in order to help watch Jarvis and Joelle, since the in-laws had to work Monday. Jace went back on alert on Friday evening, but came back off Saturday morning when we transferred to children’s. He joined me at the hospital mid-day on Friday and our awesome in-laws watched the kiddos Saturday and put them to bed. Since then Jace has gone home for a while to get us supplies, but I have not left the hospital. We will be excited to all get back to normal as a family tomorrow!

Thank you to everyone for the well wishes and prayers, we are very thankful to have our destroyer Bear back! And of course, some pictures of the sweet bear—

IMG_6948 IMG_6949 IMG_6954 IMG_6970 IMG_6973 IMG_6976 IMG_6991 IMG_7002 IMG_7003 IMG_7014

 

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s