Jackson's Cheat Sheet
3/1/11: Born
3/3: Vesicostomy surgery
3/5: Home
3/14: recheck w/ Sumfest for fussiness, red vesicostomy
3/16: Home nurse - no wt gain
3/18: Dr recheck (fussy, maintained wt)
3/19:Dr recheck (mottled, fussy, urine thick/cloudy)
3/19: ICU at Hershey Na 108, K 9.8 Dx. urosepsis (
Enterobactor UTI, Enterococcus Blood), dehydration, shock treated w/ Gent/Vanco, blood transfusion & dobutamine
3/31: D/C from Geisinger on Salt 4meQ QID
4/20: routine labs (platelets now high (489) creat 0.5)
5/4: 2 month appt - shots with fever x 24'
6/8: Nephro appt (Creat 0.4, platelets 560) F/U in 6 mos
6/22: pink (Right) eye, rx. eye gtts
6/27: fussy x 2 days dx.UTI (
Staph Epidermis) rx. Augmentin
6/28: more tired, CBC/BMP ok, recheck with Dr
7/7: fever and diarrhea, last (10th) day of Augmentin, saw Dr, urine/c-diff stool OK.
7/8: 4 month appt - shots with fever x 48' (no more diarrhea)
7/13: bad pink eye (Right) rx. Amox x 10d
7/18: dx UTI (
E.Coli), fever 101 x 3 days, happy D/C Amoxil, rx Augmentin
7/19: Dr recheck, fever still 101, D/C Augmentin rx Bactrim, Dr NOT concerned w/ platelets
7/29: Admit LGH dx UTI (
Enterobator)/pyelo/dehyd WBC 27k, cr 0.5, BUN 22. IM Rocephin x 3d
7/31: D/C
8/1: f/u ped - rx Cipro x 10d for UTI, decrease intake, Udip neg, fever 100, looks sick, conts D
8/9: sleepy but happy, u dip +WBC, culture sent at Dr appt (cult neg)
8/12: sudden fever 100.2, sort of fussy, u dip +, Dr appt, dx UTI rx Cipro
8/13: admit to GMC dx UTI (
E.Coli) (cr 0.4, BUN 10, Na 140, WBC norm) IM Rocephin x3 then Bactrim BID x 4d then start Bactrim proph. Uro f/u 6 wk; Nephro f/u 4 mos. rx Prevacid
9/7: 100.1, udip +WBC, protein, blood, ER @ HOL d/t weather dx UTI (
Enterococcus Faecalis) (WBC 17.2k, K+ 7.1, cr 0.5) Rocephin IM
9/8: f/u @peds Rocephin shot, rx Augmentin x 8d. (Uro/Nephro N'd GMC closed d/t weather). No fever.
9/12: 6 month appt - shots held for 5 days. Vomitting, weird coloring, no fever, urine dip neg. GHP n'd 2nd opinion.
9/21: admit LGH dx UTI/pyelo (
E.Coli - resistant to Bactrim) IM Rocephin x2, rx Suprax WBC 13.7, cr 0.5, BUN 30, K4.4.
9/25: 6 mos shots and flu shot - fever x24'
9/28: Appt w/Sumfest - surgery 10/13.
10/3: Fussy, no fever, Udip +WBC, protein & blood. Dr appt (DR Curry)- cult sent "Wait and see" "cont Suprax" (Day 12 of 14)
10/4: 101.3, Udip +, Dr Sumfest N'd direct admit to GMC. dx UTI (
Enterococcus species) D/C Suprax, Rocephin IM x2, WBC & Na+ WNL BUN 16 Cr 0.4. US showed debris in B/L ureters. Ucult resist to Rocephin
10/8: D/C from GMC after neg urine cult. Rx Amoxicillan x 14 days
10/13: Urethral Reconstruction Surgery. PUV snipped, Urethral stricture dilated, Vesicostomy reversed. Croup and D.
10/15: D/C'd from GMC with decreased input, D & abd cramping. WBC 18.22. Rx Tylenol #3 and "cont with Amox (day 12of14)"
10/15: PM suddenly cath bloody, not draining - to HOLRMC ER for irriagation (sm clot). xfer to GMC ER. Uro Resident irrigated ALOT and did US.Contd with decrease input & D. D/C'd ER at 0500 10/16
10/17: Direct admit to LGH for D/dehydration/? UTI (cult neg). No CBC done. Na/K WNL. Glucose 52, CO2 16, BUN 8, cr 0.6.
10/18: D/C from LGH. Rx Omnicef and Amox.
10/19: Sumfest d/c cath. Rx ONLY Bactrim. Ped Rx Soy formula x 1 month
10/25: Slimy D, decreased input, wt loss, fussy - Dr appt "ok"... Flu shot
10/27: 103 fever - LGH ER. UA, CBC, BMP & CXR WNL. Cr 0.6
10/28: 102.7 fever, whiny, tired. Direct admit LGH for 1 night. Labs/UA WNL cr 0.5. Dx virus
10/30: No fever, blotchy rash. Dx Roseola D/C'd Prevacid
11/7: Urology Appt at John Hopkins
11/15: decreased intake (Jaylee has bad cold) - Dr appt, u cult sent. (NEG) prob teething.
11/28: conts with only trace amt protein in U dips, happy as can be, eats 30 ozs/day + table food, crawling and pulling himself up
12/15: 9 month well visit. Hep B shot. Teething (top 4)
12/19: STINKY urine when he woke (+leuks/trace protein) - rx Augmentin, cult sent (NEG) abx d/c'd
1/5/12: "straining" more to pee x 2 wks. Had 1 episode in AM of no void x 2'. Woke from sleep screaming, then peed intermitt lg amts x 7 mins. Uro N - cysto in OR scheduled 1/11. (*Also 2 weeks of teething - 100' intermitt D, drooling, diaper rash.)
1/6: Pre-op H&P appt at Drs office.
1/11: OR day: Stricture fixed, cystogram shows NO REFLUX, bladder almost a full circle now, hypospadia repair done. Rx Bactrim and Tyelonl #3. (18lb 10oz)
1/12: 7pm spiked 103 fever - to LGH ER. CBC, BMP, CXR OK. D/C'd (cr 0.4, Na+ 138, BUN 7, WBC11)
1/13: NOT eatting, 102.5'. Direct admit to LGH dx. Dehydration. BMP OK(cr 0.5, BUN 11) UA dirty, IV fluids, Rocephin
1/14: NOT eatting, 102' U cult was lost, cont Rocephin, RSV+.
1/15: eats a little, no fever, Rocephin D/C'd, D, D/C'd from LGH @ 1700 after being playful.
1/16: fussy, Ped removed cath, wt 19lb 0oz
1/17: Post-op appt at GMC. f/u 4 mos Wet cough, diarrhea
1/19: in PM: Cold (96.5'), pale, fussy, out of it - LGH ER ?pneumonia?UTI (cult sent); offered admit to "observe" D/C 0200
1/20: 0600 to HOLRMC ER for cold (97.2'), fussy & dry diaper. flu (neg) - D/C. wt 18lb2 oz. then 0950 Ped appt for decreased input, cold, wt loss. CBC, BMP, bld cult (WBC 12.8 - viral, Na+ 141, cr 0.4) ?R otitis media - "just watch for now"
1/25: 6 top teeth coming in -fussy, runny nose, still has wet cough. saw Dr to check ears - A OK!
2/9: Fever x 2d w/ D,pulling at ears, udip WNL - Dr appt, dx. viral GI 20lbs
2/12: Direct adm to LGH for UTI/dehyd (dip + for everything), N,V,D 103 fever. (
UTI E.Coli, ?Strep A Blood) WBC 14.4, cr 0.5, BUN 26, Na 138. IV ceftriaxone. 19lbs2oz
2/14: D/C'd. no fever, pleasant
2/16: pm started with fever 101, some nasal stuffiness
2/17: 0300 spiked 102.6 fever, Dr appt in afternoon for fevers around 102 - CBC, BMP, Bld & urine cult - called with results at 5pm and told to go directly to LGH for direct admit (WBC 22.2, BUN 26, cr 0.5, NA 138, Urine OK. eatting OK, fevers to 103.3 with Tylenol ?virus? 19.4lbs.
2/19: D/C'd dx bacterial infection with unknown source. IV Rocephin effective Rx. Augmentin x 5d. + diarrhea, started soy formula. Urine and blood cult neg.
2/23: F/U appt with Dr. Give saline drops for snoring, 18lbs 12 ozs (not worried) I mailed paperwork to LGH to access health records. Udip WNL at home, feels cool, clammy often. Walking, 2 molars coming in on top.
3/1: 1 year old birthday!! Weight over past few days at home 19lb 7 oz to 19 lb 3.5oz to today 19lb 1oz. Udip WNL yest b/c waking everyother night x 2 nights.
3/7: Well check up. 19lb 9oz, got 3 shots, Sleep study scheduled for snoring/apnea, started on Soy milk, has molars popping through, great spirits, Sumfest N'd straining and drippy then hard urine stream- not concerned.
3/16: Fever 100.3 x 3d. Teething, NOT sleeping well x 10d, clingy. On Whole milk - 40-48oz/day- pale pasty poo .20 lbs. Walking well, says Milk, Dada, Mama, Bird. Dx pharyngitis (viral). Pee-sized lump L throat. Udip WNL. good urine stream x 1 today (dripping only alot x 10d)
Summary from his admission 7/29/11:
"The patient was born at 37 weeks and 2 days to a G5 P3 mother by low-transverse c-section. Prenatal course was complicated by suspected pseudo-prune belly syndrome. At 19 weeks the bladder was very massively enlarged, and there was oligohydramnios, and, therefore, bladder decompression in utero had to be performed. The patient was born with apgar scores of 8 and 9 and with birthweight of 3.917 kg and was large for gestational age. He underwent unsuccessful urethral catheterization while in Geisinger NICU and, therefore, urethral stricture was eventually diagnosed. He had to undergo a vesicostomy at Geisinger on day of life #3. He was discharged then to home but was admitted at 2 weeks of life to hershey med and had a diagnosis of urosepsis with Enterobactor cloacae sensitive only to Gent growing out of his urine. He also had septic shock and required dobutamine drip, and his blood culture grew out Enterococcus faecalis that was sensitive to Ampicillin. He required intubation temporarily for a central line at that point and was severely hyponatremic and hyperkalemic, which had to be corrected. He had been seen by Ped Infectious Disease and nephrology while at hershey Med and was subsequently transferred to Geisinger for further care. The pt has continued to be followed as an outpatient by Geisinger ped Uro and Nephro. His formal diagnosis are bilateral hydronephrosis, hydroureters urethral stricture/bladder outlet obstruction, bladder wall thinkening, hypospadias, chronic kidney disease stage 2, and the appendicovesicostomy. The urinary system abnormalities do give him a diagnosis of pseudo-prune belly sysndrome."
Meds
NaCl 4mEq PO QID
Bactrim Susp 2cc PO Qday
Acidophilus 1 pack PO BID PRN D
Flouride 1/2 dropper PO Qday
ON HOLD Prevacid 7.5mg (1/2 solutab) PO Qday
Diagnosis
Hypospadia - repaired 1/11/12
Chordee - repaired 1/11/12
Urethral stricture - repaired 10/13/11 and 1/11/13
Vesicostomy - reversed 10/13
Bladder Wall thickening
B/L Megaureter
B/L Hydronephrosis
Chronic Kidney Dz Stage 2
Hyponatremia
Nephrogenic Diabetes insipidus - Kidney concentration deficit
Roseola 10/2011
RSV 1/2013
*As of Feb 14, 2012: 3 surgeries, 9 UTIs, 50 Hosp days*
Doctors
Pediatrician: Eden Park Peds - Dr Colleen Cooke-Moine
1725 Oregon Pike, Ste. Lancaster, PA 17601-4206
717-569-8518
Urologist: Dr Joel Sumfest
Urology, Geisinger Medical Center 100 N Academy Ave Danville, PA 17822
570-271-6211
Nephrologist: Dr Dianne Muchant
Pediatric Nephrology F6, GMC 100 N Academy Ave Danville, PA 17822
570-271-8055 :
