Friday, September 16, 2011

In the Hospital

Naomi before her spinal tap last Tuesday

In the ER Wednesday, unable to straighten her back

Yesterday Naomi's backache had lessened, but her headache had become very severe. The back pain that had had her screaming in pain in the ER she had described as an 8 out of 10. The headache she described as a 9! I didn't immediately recognize it as a spinal headache because it was so long after the spinal tap and because laying down didn't immediately relieve her pain. I rushed to get Emma dressed and out to her bus for preschool on time. Then I rushed to frost and pack the cupcakes I was supposed to bring to the preschool for Emma's birthday celebration. Naomi vomited twice, but seemed to feel better.

I asked Naomi if she thought she could tolerate the ride to drop off the cupcakes since Matt was at work and I couldn't leave her home alone. The ride is about five minutes either way so Naomi agreed to try it, but once she was in the car and on the way she was in agony. I was so flustered that I made four wrong turns and managed to change the five minute drive into a ten minute drive. Then I ran the cupcakes into the classroom and explained that I couldn't attend the party and rushed back out to the van. Naomi cried all the way home and vomited again once we were home. I called the neurosurgery office and had them phone a prescription for an anti-nausea med to our pharmacy. A neighbor agreed to sit with the kids while I ran to pick the prescription up, and I almost left before I realized that I had forgotten I needed to pick Emma up from the bus. My mind was in so many places at once it was in danger of making a major mistake. Deep breaths followed while Naomi laid on the couch and watched PBS and I retrieved Emma from her bus.

When I finally did get home with the anti-nausea med I felt a sigh of relief as she swallowed it with just a sip of water. Now, I thought, she'll be able to settle her stomach and then take some pain meds and we'll be comfortable again. Unfortunately, she only vomited up the anti-nausea medicine fifteen minutes later. As the hours of vomiting and pain passed it was very clear that Naomi had a spinal headache from the spinal fluid continuing to leak out the sight of the spinal tap, and only the hospital could really help her out. Naomi, who by now realized that lying down did help the headache, reluctantly agreed that she needed to go back to the hospital, "but, Mommy," she cried, "how will I get there?" When I offered to let her lay down in the van she objected further, "but how will I get into the ER?"

The neurosurgery office agreed to call ahead to the ER to try to expedite the check-in process. My mother-in-law came over after work and helped me load Naomi in my mini-van lying down, then she stayed with the others while I drove carefully to the hospital. I pulled the van up to the ER doors and informed the registration desk that unless someone brought a gurney out to my minivan Naomi would vomit all over their floor. A technician with a gurney promptly met me at my van and lifted Naomi onto the bed. She was wheeled back to a room where a doctor met us within minutes.

Resting comfortably last night in her own room
He confirmed what two other people had told me, that the normal treatment for a spinal headache from a spinal fluid leak was a "blood patch" where some blood is injected over the hole to form a clot and seal the hole shut until it can heal. However, after some phone calls he told me that our local hospitals are not equipped to perform this on a seven year old. Naomi would have to be transferred by ambulance 3 1/2 hours away to the children's hospital if we wanted that procedure done. Add to that that the procedure is not always effective and could start her back muscles spasming again. Some blood work showed that Naomi's kidney function was declining from dehydration, so the decision was made to admit her to the hospital for IV fluids, anti-nausea meds, and pain meds while we decided whether or not to transfer her to the children's hospital to do the blood patch.

One of the medications that Naomi was given through IV was a bag of caffeine, which is apparently effective at lessening the pain of spinal headaches. It did lessen her pain, but it also effectively wired her until five in the morning! Multiple doctors also tried to give Naomi NSAIDs like Motrin, Ibuprofen, and Excedrin, and I had to keep informing them that she's not allowed to take these medications because of her kidney disease. Instead we ended up with a little more morphine as needed. We were settled into our room around 8:00pm, had a visit from our pastor and his wife, and then Matt came to join Naomi for the night while I went home to rest.

It was hard to get too much rest while caring for my other children, who were obviously feeling the stress of this week themselves. Hannah, who has never once wet her bed, woke up soaking wet and crying in the middle of the night. Not long after that was cleaned up Toby came screaming into my room and was so happy to find me there he insisted on sleeping beside me for the rest of the night. This morning, when I needed to return to the hospital he told me, "That makes me sad," but he seemed to understand that Naomi needed me to be with her and he didn't fuss when I left.

Watching "Black Beauty" this morning...and waiting
Naomi's pediatrician visited our room and agreed to call every anesthesiologist in the area to see if anyone would perform the blood patch on Naomi, but after two hours of phone calls no one was willing because of Naomi's age. We then decided to transfer Naomi to the children's hospital, but after another few hours of waiting those plans were changed. The neurosurgeon who had done Naomi's spinal tap was out of town and his partner relied on the procedure notes that said the tap had gone easily. She insisted that Naomi shouldn't be suffering from a spinal headache since the tap was uncomplicated. She convinced the pediatrician that Naomi should continue to be treated conservatively in the local hospital for a few more days. So now we are stuck in the hospital relying on IV medications to keep Naomi comfortable while we hope that hole in the spinal column heals on its own. If by Sunday no significant improvement is seen, then Naomi will be transferred that night and the blood patch will be performed Monday morning.

My mom is driving out today to help out, but it could be a long haul until we are comfortable at home again. Naomi was just infused with another 500mg of caffeine, so there's not much rest for anyone in the next day's forecast. I'll keep you updated.

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