Septic Peanut

Earlier this month, on June 1, Lilly began complaining about her leg hurting.  She said that it hurt and then played at Grandma's in the morning, did some gymnastics with the neighbor girl in the afternoon and tormented Jack that evening so we didn't give her complaint a whole lot of weight, especially since there wasn't anything visibly wrong.  Then, the next morning she didn't get out of bed, again complaining of pain, and I noticed that her leg seemed a little warmer than the left, but she had been warm in her bed so we decided to go about our morning and take a look in a few minutes.  Lilly played a little while Bryan made breakfast for the kids and I opened our garage sale.  I came back in to examine the knee and we noticed that it was in fact warm, and was already kind of swollen.  We decided that I'd run Lilly over to the immediate care center after she ate.  I checked on the garage sale, got dressed and made a cup of coffee.  In that time Lilly's knee had gotten bigger and was now hot, and that heat was spreading.  She was already starting to show signs of fever.  Away we went to the immediate care center, fully expecting to be home in an hour or two with an antibiotic or a knee brace.

I explained to the nurse and then the doctor what was going on and obviously they asked me about injuries, falls, or bumps.  There were none.  The doctor did a brief exam and casually told me that he thought it might be an infection and that Lilly's temperature was just over 99.  He sent us to X-ray to rule out a break.  They X-ray showed nothing except a lot of fluid around a little knee.  When Dr.Romero came back in to talk to us he casually mentioned septic arthritis and suggested (very casually) that I should take Lilly to Peyton Manning Children's Hosptial at St.Vincent's.  He explained that to be sure that his diagnosis was correct some blood work and labs would need to be done.  He assured us that he could run the labs there at his office, but that we would probably have to go to a hosptial anyway for treatment and that they could do the lab work quicker and it wouldn't have to be sent over from his office.  At this time I still thought that I would take Lilly home in about an hour with an oral antibiotic.  When Dr. Romero asked me if Peyton Manning was the children's hosptial that I planned to take Lilly to and I said yes I was a little surprised when he nodded his head and said, "Great, I already sent Lilly's X-rays over and spoke with them, they know that you're on your way."  That seemed really efficient.

As it was now nearing lunch time and Lilly was saying that she was hungry I asked Dr. Romero if I had time to stop and get Lilly something to eat.  He assured me that lunch was OK and there was nothing so emergent that she couldn't eat, and that eating wouldn't effect any possible treatments.  Lilly and I swung through the drive thru at Steak N' Shake and headed to the hosptial ER.  Already, I could tell that Lilly was feeling worse, but she managed to drink about half of her milkshake before we got to the hosptial.  I carried her in because it hurt too bad to walk at this point and sure enough, the triage nurse knew that we were coming.  We had to wait about 15 minutes, which is an ER record.  Lilly's temp was now 101.5.

We were put into a room and a nurse came in to do an initial exam.  The nurse explained that the doctor, who hadn't even seen Lilly yet, had ordered some blood work and I was a little surprised that she put in an IV to take the blood.  Then, the doctor came in and explained that Lilly's symptoms were such that she wasn't planning to wait for the labs to come back before calling the pediatric orthopedic surgeon to get his opinion on a course of action.  The options were this: Either they were going to pull fluid from Lilly's knee to test it and then make a decision, or they would prep her for surgery and test the fluid while she was under.  Most of this was not what I expected.  That's about the time that the blood labs came back.  Lilly's white blood cells were very high, indicating quite a bit of infection in her little body.  I was shocked at this point to learn that the doctor planned to admit her to administer an IV antibiotic.  We were now just waiting to see what Dr. Bellflower, the orthpedic surgeon, wanted to do.  It was clear that the knee was infected, but if the infection hadn't gotten inside the actual joint then surgery wouldn't be neccessary.  This is the point in time when Lilly's 1/2 of a junior milkshake came back to haunt us:  they would not put Lilly under until 5:30pm since she had "eaten" at 11:30am.

So, the next step was to test the fluid inside Lilly's knee joint.  I will spare you the details, but after the doctor pulled the fluid from Lilly's knee she wasn't shy about telling me that it was some of the most infected fluid she had seen in a while.  She sent it to the lab, but assured me that she didn't need the labs to know that Lilly was going to have to have the surgery to drain and rinse her knee.

It was about 2 or 2:30pm at this point and a lot had happened since Lilly and I had left the house.  My mom, who had been about and hour and a half away at a music festival with my dad, gathered up her things and headed home.  She came to the house and picked Jack up (because I had his carseat) so that Bryan could come to the hosptial.  Bryan and blankie arrived shortly after the procedure to pull the fluid from Lilly's knee...she was still loopy when Bryan walked in and pretty much thought that he was there to join the party.  At this point we were just waiting until the labs came back and until Lilly could be put under for surgery.  We watched movies, played princesses and sent texts to nervous grandparents.

I have to take this oportunity to mention the child life specialists at the hospital, especially Miss April.  She came shortly after we got there with a little doll with an IV and explained an IV to Lilly.  Miss April had pictures, medical equipment and toys.  Lilly was able to see and touch and ask questions about almost everything, the IV, the tubing, syringes, masks, rubber gloves, and anything else that was going to be used on or near her.  Miss April even had toys to leave in the room, a little tub filled with Disney princesses and dresses.  This was especially appreciated since I left the house that morning with almost nothing.  I also need to point out that upon realizing that Lilly would be awake in the hallway when we would say our good byes, April not only volunteered to dress for sugery in front of Lilly so that she would know that it was still her new friend under the mask, hair net and scrubs, but also walk to the OR with her and stay until she was asleep so that she wouldn't be afraid.  Lilly in her hospital gown, preparing for her IV. 

At about 5pm the labs came back, suspicians were confirmed and our ER room was flooded with doctors and nurses as we met the anestesiologist, surgeon, surgical nurse practisioner and a slew of other specialists.  By 5:30 we were heading down the hallway to the OR.  We gave Lilly kisses, told her that we'd see her in a few and parted ways.  As Bryan and I made our way to the waiting room we heard Lilly say something and everyone with her crack up laughing.  Clearly, if she was cracking jokes she wasn't afraid at all.  After surgery, which only took about an hour, we met Lilly in the 'wake up' room, where she slept off her anesthesia and was in no hurry to actually wake up.  Finally, when I mentioned to her the her Uncle Wes had had knee surgery, she sat straight up, looked around and asked, "Is he behind one of these curtains?"  Well, no he wasn't, but then Lilly asked for a drink and declared that she didn't want to hang out there any more.  So, we made our way to a room, where we would stay for a minimum of 48 hours while Lilly recovered, stayed on IV antibiotics and waited to see what bacteria might grow in a petri dish.

The petri dish experiment was a double edged sword:  If something grew in the perti dish then doctors could identify the bacteria and type of infection in Lilly's body, which meant that they could tailor the antibiotic treatment to target that specific bacteria.  But, that might mean that we could potentially have a longer hosptial stay.  If nothing grew in the dish AND Lilly was responding well to the broad spectrum antibiotic that she was already on then she could switch to an oral version and go home after 48 hours.  The problem with this is that obviously we would be curious about the infection, but also Lilly would have to go home and take, three times a day for three weeks, the worst tasting antibiotic in history.  The nurse explained to us that it tastes quite similar to raw sewage.  When I repeated that description to the doctor he chuckled and assured me that is was actually more like kerosene.

Lilly finally settled into her room after a long day.

By the time we got to our room and got settled it was close to 9pm and the cafeteria was closed so, Bryan went and got dinner for us (and grabbed my overnight bag from a good friend who dropped it off for me) while Lilly and I watched a movie.  When we found out that Lilly would be spending the night in the hosptial the staff was really good about making it seem like it was a big, fun adventure.  They told Lilly all about the fun things to do in the children's wing.  Lilly focused in on the playroom and wanted to see it that night.  After a few bites of dinner she asked again and we debated for about 30 seconds before deciding that 10pm was not at all too late for a four year old to visit the hosptial play room.  Lilly deserved something good so we loaded her into a wagon, trailed her IV and wheeled her to the playroom where she examined the toys, listed what she would play with the next day, and picked out a couple of books for her room.  Pictured below are the first smiles we had seen for several hours.

After the playroom, Bryan read stories and headed home.  Lilly and I didn't take any time to fall asleep and had a pretty uneventful night.  The next morning, Sunday, we ordered breakfast, saw most of the doctors and then Bryan came and took Lilly back to the playroom while I ran home for a shower and a deep breath.  I got this picture via text message while I was at home.  So happy to see her up on her feet!

The surgeon assured us that Lilly's only limitations were the ones she placed on herself.  Basically, if she felt like standing she could stand, if she felt like walking she could walk.  He explained that kids are a lot like dogs in that they won't do anything that hurts and if it doesn't hurt it is probably OK. 

That day we had visitors, deliveries, movies, and trips to the playroom and Lilly continued to improve with her antibiotics.  Monday showed even more improvement with Lilly devouring a huge lunch, walking to the playroom and having her drain removed and dressing changed.  Nothing was growing in the petri dish, but the antibiotics were clearly doing their job.  We found out that afternoon that if Lilly was able to keep down two oral doses of the antibiotic that they would release us.  This was much harder than it seemed and the medicine was much worse than we had imagined.  But, like a trooper, Lilly kept it down and as good as their word...the three seperate doctors that needed to sign off on us did as they promised.
We were so excited to get head home and then, just like when she was a new born, so nervous when we got her there.  In the two hours after we got home Lilly fell, spiked a fever, spit her medicine all over the kitchen floor and passed out cold on the couch.

We carried her to bed and counted ourselves lucky to be home.

Within the next couple of days Lilly was back to her old self again and has shown nothing but improvement since. 

At the follow up with her surgeon we were given a script for physical therapy and were released, and encouraged to swim. "The more she swims, the less physical therapy she'll have to do." is what the Physician's assistant told me. So, swim we did.  Lilly has been in the pool almost everyday since then and we were released from physical therapy before we really even got started. 

During this whole event Bryan and I realized a couple of things, but the main thing is this:  We are fortunate, so very fortunate.  We are lucky that we have an immediate care center that is right down the road.  We are lucky that we have a first class pediatric hospital less than ten miles from our house.  And, we are so, so lucky that we were in that hospital for only two nights for something that was easily treated with surgery and medicine. 

Thank you to everyone who thought about or asked about Lilly, helped out with babysitting and errands and made Lilly's recovery easier on all of us.  I can't begin to express how grateful we are to have so many people in our lives that love our kids.