Wednesday, September 3, 2014

Inpatient - Endocrinology - Day 1

A planned admission is such a different animal, and yet really, it's all the same zoo.

We arrived early enough to have the luxury of taking our time as we schlepped all of our gear through the hospital.  I felt 50% absurd for actually bringing luggage, but also 50% justified, because I know that we're going to be here for a few days, and I'm a human being that needs food, clothing, and the occasional shower.  It makes perfect sense that I might pack those things in a bag and bring them with me when I arrive.  It's just that it adds this air of "vacation" to the whole experience and it feels so inappropriate.

Anyway, I let Aidan pick out a treat from the gift shop - he went with a Doc McStuffins magic ink book - and we went to the Asplundh Center in the Main Atrium for Admissions Registration.  We answered a few questions and I signed some papers - I assume this is the stuff I normally do bleary-eyed and half asleep in the ER at 3am while awaiting a bed on 5 South.  It was downright luxurious to kick this party off 12 hours earlier in the comfort of a quiet room that didn't smell like the previous occupant's vomit.

We had a short wait while they got his room ready - namely, swiped a crib from some other room, because I know, he's a million and should be in a bed by now, but get off my back, okay? - and then we headed up to 5 West, where we settled into Room 9.  We'd been warned that the rooms up on the Endocrine floor were small and not private - so we were prepared for the worst - but actually, no complaints here.  Ours is small by 5 South standards, sure, but rooms up in Gastro are pretty huge (I've always wondered why.  Were they meant to be doubles?) and it's definitely private.

Nobody else is fitting in here.

Aidan had no problem getting right down to business, by which I mean getting his flashcards sorted and his DVD player going.

He quickly decided that one measly show was insufficient.  Any kid worth his salt needs at least two forms of electronic entertainment at all times.

I had to give the backstory to the docs here - which I realize now that I never gave on this blog - so here's the very short version.  A couple of weeks ago, Aidan had a routine scope at CHOP Exton.  The prep included being on Pedialyte for the entire day prior.  He seemed fine at the time, but for some reason, we didn't check his blood sugar that day.  I really wish we had, in retrospect.

The next morning, we woke up early to go down to Exton for the scope.  He seemed lethargic, but it was also 5am, and who isn't lethargic at 5am?  I didn't think much of it.  He fell asleep in the car on the way there, and I had trouble waking him when we got there.  I checked his blood sugar, and it was critically low - 34.  I rechecked twice, and got 31 and 36.  He was rushed back to the PACU and started up on IV dextrose, which brought his blood sugar up to 146.  He was taken off the dextrose for his scope, but within 15 minutes, his blood sugar dropped to 111.  In another 30 minutes, it dropped to 80.  He was given formula boluses, but it fell further to 71.  They put him back on IV dextrose, which got him up to 186, and then he was released to go home.  30 minutes later, he was at 118.  30 more minutes later, he was at 67.

Since then, he's been on 24/7 feeds with no breaks at all, because he's not holding his blood sugar up on his own.  The thought was to admit him today to figure all of this out with a plan in place for what tests would be done to help get to the bottom of things.

I was thinking that it was the smoothest admission we'd ever had, which was obviously the stupidest thing one can ever think in a hospital setting, because you're begging for trouble.  Literally as I was thinking these hazardous thoughts, our nurse brought news that despite the multiple conversations I had with the admissions and endocrine people prior to our arrival, they were unable to find any formula for Aidan.  And we only had this much left of the feed he came in on:

Long story short, I had someone drive some in from home, and like last time, by the time it got here, CHOP was able to rustle some up.  I really wish they could get their act together.  I know it's not a common formula, but it's prescribed by our CHOP doctor and he's gotten it inpatient before - I know it's here.  Why do we have to go through this every time?  Is it too much to ask where they found it, so that next time this happens, I can tell them where to look?  Sigh.

Anyway, the plan for the rest of the evening is to keep him on his continuous feeds and check his blood sugar every 3 hours to establish his baseline (90something at 6pm, 80something at 9pm).  Tomorrow, when the team rounds, we'll discuss the plan for his fast.  That's when the real fun starts.  I'll keep you posted!

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