January 18, 2018

CF Clinic

This was basically a follow up appointment after Azer's hospital visit.

So, when Azer started growth hormones, I put him on 5 cans of formula a day instead of 4 to try to keep his nutrition up, since he hadn't gained any weight in quite a while (he also wasn't growing either). He gained two pounds since then, so the GI doctor said we can go back to 4 cans a day, since he's been having reflux and feelings of fullness in the morning from the extra formula.

The GI doctor said that in the event we have to use the antibiotic, Levoquin again, and are forced to stop Erythromycin, she said it might be worth while to temporarily give Azer a G-J tube instead of just a G-tube. This would help assure that he isn't refluxing formula into his lungs. Another alternative would be to temporarily start Reglan which worked wonders for him in the past, but does come with a black box warning. 

His PFT's went up, above where they were in October. The doctor was pleased with those results. She allowed us to look at his X-ray, and explained why the radiologist's report can sound completely devastating because they really don't see the full picture.

The doctor took her time and really explained to Azer the anatomy of his lungs, and what he was actually seeing on the X-ray.



While clinically, he looks great, and he didn't culture anything serious, Azer told the doctor he felt like his lungs still feel sick and congested. She said that even though the antibiotics are really causing a lot of GI problems right now, that we should finish the course. She listened to Azer's lungs, and heard some wheeze and noises. She said it was a good thing that the noises moved around when he coughed or did treatments. She is adding a secondary inhaled steroid to the one he is using already. This is temporary until he starts feeling better.

Regarding, the continued bloody mucus Azer's been coughing up, the doctor said as long as it's mucus with blood in it, and not blood alone, or blood not mixed with mucus, this blood we are seeing is just from irritation, which is likely coming from the Hyper-sal, steriods, and the dry, winter air.

Azer hasn't been able to return to school yet, and the main problem is how many times he's been in the bathroom a day. We counted 8 watery diarrhea BM's yesterday, and the average is 6-8 times a day since he's gotten discharged. He is almost done with Flagyl, and the GI doctor said Flagyl doesn't always work immediately. They took a stool sample to check for any other bacterial overgrowth that might be causing him issues (when Azer came back from "getting the sample", he said, "I am not nurse material"). 

Based on this situation, we will be doing homebound school for the next few weeks, which gives more time for Azer to work on staying hydrated, and more time for extra breathing treatments (which, based on his PFT's, seems to be working!) I contacted this school this week, and the staff worked hard to get me the information needed. I was able to get all the paperwork and brought it today for the doctor's signature. 

I brought up the PEP device we got at the hospital with a nurse and the Respiratory Therapist. They said they don't have them there at clinic, and really hadn't seen them used. While we were all talking, we got on the subject of the Vest. The RT was surprised that we had a SmartVest. She mentioned that most patients use the Hill-rom Vest, and was able to quickly call the company and find out if we could try one out on a trial basis. She said once we get our information settled with Hill-rom, we can be put on a waiting list for a new Vest called the Monarch. This new vest is portable, and is supposed to work more like hand CPT rather than just pressure and vibrations.

January 14, 2018

No Pneumonia

So, the official results of Azer's X-ray came back. He doesn't have pneumonia, but he does have a small area of atelectasis. Basically he has a small area of his right lung that is collapsed. It is blocked from inflating by mucus plugging. Apparently, this is a common thing that happens in CF, and sometimes it may not be accompanied by symptoms.

Twice when he was in the hospital, he coughed up blood streaked mucus. This morning, he initially had coughed on his hand and noticed a drop of bright, red blood on his thumb. He then coughed up some pink, blood streaked mucus. I called the on-call CF doctor who said we should stop doing Hypertonic Saline, and if this doesn't resolve, we have to be readmitted...

January 12, 2018

Still Recovering from Flu

Azer's lung/shoulder pain has been off and on today. CPT this morning was relatively painless. However, the second and third breathing treatments hurt him a lot. He says his lungs are feeling less congested than yesterday.

While the strong antibiotics he's on are helping his lungs out, they are not helping his intestines. He's had strangely colored, constant watery stools. With the fear of possible C-diff, he is now on a third antibiotic, this one to treat bacteria flourish in his intestines.

By the way, if anyone knows where to get a large, 4x a day pill box (I mean large, like it has to hold many, horse pills) please let me know. I bought one off Amazon thinking it was as big as the one we have (which is falling apart to the point we're taping it closed), but it barely holds all his enzymes.

January 11, 2018

First Day Home

We've been trying to do breathing treatments every 2-3 hours. Azer can only tolerate 2 minutes at a time on his chest. CPT is causing shooting pains going to his shoulders. Today, he says that it is getting harder to breathe that yesterday, and feels like his lungs are getting worse. His lungs definitely sound much noisier than yesterday, and he is producing more. I really feel like the largish spot on his X-ray may have been pneumonia instead of just simply mucus plugging.

After sending a semi-panic stricken email to the CF clinic, he will be starting steroids for the next week. Hopefully by the end of the course of steroids, the antibiotics will really start to kick in! 

January 10, 2018

Discharged

Azer had a very hard time doing a PFT test. He was refluxing and nearly vomited several times. Thankfully, the technician was very patient with him and let Azer blow when he was ready. He is, not surprisingly, about 10% lower than normal.

They switched him to a different antibiotic so that he can go back on the erythromycin. He was practically begging for it earlier.

His cough sounds pretty wet, and his x-ray showed some mucus plugging, which is probably why CPT hurts so much right now. Hopefully it will clear up soon, but we are very happy to be discharged!!



Day 3

Yesterday evening, Azer's IV really started to bother him. It flushed fine, but just running fluids through was causing pain. The doctor said as long as he drinks plenty of fluids, they could take it out and not replace it.

The most painful part of the removal is the tape. The nurse was very patient and let Azer remove it slowly himself a little at a time.



He hadn't drank much all day, so a resident doctor came in and essentially threatened Azer that if he didn't drink enough Gatorade, he wouldn't be discharged. It worked, and Azer managed to drink and hold it down.



He's had reflux issues since we've been here. It's difficult to keep track of what medications he's taking when they're given on a different schedule than we do at home. This morning I realized he hasn't been taking Erythromycin, which he takes for GI motility. Apparently, it reacts badly with the antibiotic he's taking right now. There is another antibiotic he could take, but he has experienced chronic vomiting with it. So, they are trying to figure out what antibiotic would work for the bacteria he cultures without causing an interaction with his other medications.

CPT has been painful for him, especially the upper loves, and we've only been able to do a few minutes at a time. He's been trying out a different device called PEP which is different than the Aerobika in that instead of using positive and negative airway vibrations, it only uses positive pressure to open the airways. It has been helping bring up a lot of mucus. Unfortunately, last night, his mucus had some bloody streaking in it, so we are keeping an eye on that.

The doctor ordered an X-ray to see how his lungs look. She said if we did a PFT, it would be kind of pointless because we know it would be abnormal between his refluxing and congestion. After she looks at the X-ray and figures out his medications, we might be able to be discharged today!


January 9, 2018

Admission Day 2

Yesterday, they were able to start Azer's IV easily. His electrolyte panel turned out to be normal when he was admitted, despite how little he has been drinking. He has had hydration fluids running all night long. He was able to eat some dinner before his night feed was started. They also started an IV antibiotic to help his lungs out.

Azer's night was rough. Around 7pm, his fever and headache came back. His head hurt so bad it was difficult for him to cough all the mucus out during his breathing treatment. They had to get in another breathing treatment for the day, which unfortunately ended up being around 1:30am. His fever spiked again around 4am, and had to stop his night feed just a little early due to nausea. He has been holding down his formula despite having reflux this morning.



The doctor is happy with how Azer presents this morning. The decision of when to go home has been left up to us. The doctor agreed it can be scary to deal with these fever spikes at home while worrying whether he's hydrated enough or not. We have opted to stay a few days to make sure he's getting better before going home on oral antibiotics.


Watching Dude Perfect to pass the time

January 8, 2018

Admission


This morning, I emailed the CF clinic out of concern. Azer still had a fever, and it wasn't going down with ibuprofen or Tylenol. His headache was very painful, and he was also experiencing vomiting and diarrhea. He was having a hard time keeping hydrated. Our CF doctor recommended admitting him.

A few hours later, around the time when the bed was ready, his fever finally broke and he was feeling a lot better. He still wasn't drinking much, but was holding down his formula and his headache was gone. I asked the CF clinic if it was still necessary to admit him. The CF doctor still wanted him admitted, especially since he's had the flu back to back now. His cough is also sounding pretty wet.

They are starting IV fluids to get him well hydrayed. Hopefully this will be a quick hospital stay!

January 7, 2018

Influenza Type B

Yesterday, Azer started to feel exhausted and his cough started to turn wet again. Today, we can barely keep his fever down and he says he feels worse than two weeks ago when he first got the flu. So, we had him tested... again. He now has Type B Influenza. The doctor said there are a few different strains of each type, so even though he has now had Type A and Type B, we still have to remain cautious. He is starting Tamiflu... again, but will not be going to school for at least a few days. He is very congested as well, so we are again working hard on keeping his lungs clear.