Jackson's Cheat Sheet
3/1/11: Born (37w 2d csection. 8lbs 9ozs)
3/3: Vesicostomy surgery (caudel block did NOT work.)
3/5: Home
3/14: recheck w/ Sumfest for fussiness, red vesicostomy, white D/C from site
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 & tachypneic - 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, dx. 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 16, 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 Ceftriaxone 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)
3/19: ER LGH 0400 for udip +leuk, blood. (N,V,D x 24 hours prior). dx. UTI (
E.Coli) Rocephim IM rx. Omnicef. Cont with V all day, so Dr appt in pm for IM Rocephin repeat. Rx Zofran (effective). CBC WNL, cr 0.5
3/21: acting well. Udip conts with lg blood, sm leuks, + protein. Sumfest N'd - cult results faxed to him, conts to Strian periodically with voids.
3/22: Udip WNL
3/27: Sumfest finally received cult results - wants f/u 4/11. Udip WNL. Still not eatting foods well, prefers milk bottle (32-40 ozs/day) 19lbs 13 ozs. Hershey called re. sleep study - scheduled 5/10.
3/29: Dental appt "gingivitis". Wt 19lb 13 ozs... saw Ped for eatting advice. "Max 16 ozs milk qday, + 8oz Pediasure if not eatting well each day" They are not worried. Udip WNL
4/3: Yeast diaper rash - Lotrimin QID x 3d. Restarted Prevacid 7.5mg since watching his sleeping, and he seems to have reflux a lot while sleeping.
4/6: Teething with 4 teeth - pleasant, some loose stools. Eatting better, tol Pediasure/Milk mixture. 19lb 14 ozs. Says Baa, hi, ball, bird. Tries to jump. Loves outside.
4/9: after a whiny weekend at Liounis', + Udip (lg bact, lg blood, + protein) No fever, to LGH ER - dx. UTI (
E.Coli) IM Rocephin, rx Omnicef. Tylenol for discomfort.
4/10: Ped appt - rx. Miraalax, Pediasure BID, stop Bactrim, see Speech therapy, Early Intervention, & OT for refual to eat. 19 lbs 14 ozs. dx. Failure to Thrive. WIC notified.
4/11: GMC Uro appt - US no changes in kidney/ureter size, bladder empty, Xray "No constipation" that could be causing UTIs, D/C Bactrim and Miraalax. Unknown reason WHY UTIs now since hypospadia repair. Will do Cysto in OR and repair any strictuers, possibly make urthra opening bigger, but he doubts it is the cause, since bladder is empty. Suspects Ureters are the issue - Ureter surgery is TOO risky at this point and unwarranted since kidneys show no damage from UTIs. Jackson in good spirits - ate chips and pizza!
4/12: Udip WNL, snacking more!
4/13: Speech therapy eval - "prob bad reflux" will see weekly x 2 to be sure. Ate more than usual today, Udip WNL.
4/14: eatting food better x 2.5 days (cheese, chips, baby jars, pickles.) Also 16 oz Pediasure and 24 oz whole milk. Bad diaper rash - ? yeast, Lotrimin applied.
4/20: 20lbs 5ozs. Done abx - no daily abx now, eatting more - variety, textures. Conts with acidic D. Teething bottom I teeth. Talking a lot. Pediasure - 2 cans/day + 20 ozs milk. U dip WNL. Peeing without straining. Speech therapy "focus on pureed".
4/27: 20lb 1 oz... not eatting or drinking as much. Teething bad. Tylenol Q4-6. Increased reflux s/s. Speech therapy was a big fight - she states it's common with teething kids. low grade fever. Udip x 2 WNL. Straining some to pee, but pees into cup on demand.
4/28: increased Prevacid to whole tab (15mg) Qday.
4/30: Woke w/ vomitting... Udip +lg everything. Dr appt. dx UTI (
E.Coli) Roephin IM and rx. Omnicef x 10d. rx. Zofran Sumfest N'd- OK with June surgery.
5/2: WIC - Pediasure approved 2/day.
5/3: Nutritionist - needs 900cc fluid, 1200 calories/day. Plan: 3 can Pediasure, 6-8 ozs H20, 2-4 ozs Cranberry Juice. Eat as wanted... push calories, not food.
5/4: Speech - ate better, dipping foods.
5/6: Possible antifreeze ingest. - LGH ER, labs OK (cr 0.4). Muchant notified.
5/8: 3' Early Intervention Appt - OT with S June Center on June 17th
5/9: Dr f/u appt: Labs OK, GI referral given (May 25th)
5/10: Sleep study- had episodes of resps down to 9 or 12 (normal 24-30), results in 1-3 weeks. BP 98/54.
5/11: teething/drooling, eatting down to 14 ozs Pediasure/milk mix, udip WNL
5/18: croupy with runny nose. Udip WNL. No fever. eatting less. 20lb 12 ozs.
5/20: No sympotms. Udip + lg leuk, trace blood - HOL ER. dx
UTI (
Enterococcus Faecalis). Rocephin IM, rx Omnicef. 20lb 3ozs. Eats only Pediasure. sleeping through night. Talking a lot, running, climbing, horse/ATV riding.
5/21: ENT apt - had nasal scope!! Everything WNL. Sleep study - mild sleep apnea not needing intervention. No f/u. Suggests have GI reflux study done. Teething - bottom four eye & molars.
5/22: Udip still +lg leuk, trace blood. Cult shows resistance to Omnicef - rx. Amox x 10d. Sumfest N'd. + D. Speech: ate a whole yogurt and a pepperoni!! He cries and fights eatting so bad.
5/25: Udip trace leuks, 20lb 7ozs. GI appt: Cont Prevacid 15mg, start Carafate QID x 14d then call with improvement or no change status. Will prob scope/biopsy Jackson with Uro surgery - now moved to July 17th. Awaiting Carafate pre-Auth.
5/26: Carafate d/c'd 2' gagging (smells aweful) started Maalox 10cc QID x 10d.
6/5: 15 mos appt. WIC rx for 3 Pediasure/day. 2 shots - no fever. (-)PPD
6/7: Nephro appt. Stop NaCl x 7 day then blood work. f/u 6 mos. BP 94/? "hopefully surgery will stop the infections" eatting more the past few days. D x 2 days w/ diaper rash.
top canine teeth, interested in eatting. Hugs, kisses, tries to jump, runs, shakse "no".
6/14: +D, low grade fever, +MMR rash. Udip WNL. BMP done. Speech Therapy cancelled.
6/15: OT visit - Food Play. cr. 0.5 BUN 26 Na 141 (?dehyd?). GI Dr "Maalox x 2 more days, may stop Prevacid in 2 wks if you want, f/u in August, NO scope!"
6/17: a lil fussy - Udip +lg leuks/bld - to HOLRMC ER dx
UTI (Strep) rx. Amox x10d.
6/18: Dr f/u appt. Wt 21 lb. Udip still +lg blood,leuks. WIC appt - 3 Ped/day.
6/19: Dr Sumefst and Muchant n'd UTI. Conts with decreased PO intake. Udip +Mod leuks.
6/26: Udip WNL, "bratty" x 5 days. Dr Muchant not worried until BUN is 60+
7/2: Pre-op appt. 21lbs 7oz. Asks to eat a variety of foods. 2-3bottles Pediasure/day.
7/16: OR Cysto: 22lb3oz, BP 90s/50s, No strictures/valves, No reflux, Tiny stricture scar sliced, No catheter, Udip barely + leuk/blood, No pain meds needed
7/18: 102 fever. Udip WNL. Dr appt dx. Hand-Foot-Mouth Dz
7/24: OT appt - taste buds dull, decrease Pediasure amt. 22lbs
7/30: Udip conts with spec grav 1.030, yellow urine.
8/14: Nurtition appt - 21lb 13 ozs. (gaining lower end of appropriately). Decrease Pediasure to 20 ozs/day. Stimulate taste buds. Requests GFR w/ next labs. Appeal mailed to GHP.
8/17: Intermit coughing spells 2-3 x's a night (10 mins each) - sounds like whooping cough. No cold s/s. Started 8/3 in Seattle. Ped notified. OT visit... play "mouth games" more. Restarted Maalox until GI visit - ? reflux at night??
8/28: repeat BMP: BUN 19, cr 0.5, Na 140. GFR est online of 64. Udip WNL. Appt 9/4 for night cough.
9/4: Ped appt for night cough x 5 weeks LCTA. CXR: asthma vs viral. Per Dr, not whoop cough
9/5: CHOP - Dr Shukla "needs Urodynamics and Mag 3 to see how the urine is flowing thru kidneys and how the bladder is actually working." Dr Meyers "Kidneys ok right now, just sit and wait"
9/12: Fever and cough all night 101.4-102.4, mottled, c/o right eye and belly pain. Drooling, red spot on tongue x weeks, increased apnea, cough during naps now. Udip WNL, eatting bottles, Dr appt and WIC appt.
9/13: 102.5 fevers, front top gum RED and swollen. Peds sent us to HOLRMC ER. CXR "viral bronchiolitis" RSV (-) Pox not done. Taking bottles only, vomits with meds.
9/14: did not seelp at all, in ovious pain ?abd pain, tooting, Zofran adm. 1400 F/U appt - dx Hand Foot Mouth dz and viral URI. Benadryl QHS for cough.
9/21: OT appt - cont to play with food.
9/25: Nutrition appt: only gained 3kg/day (should be 6-10). Only give full strength Peidasure - atleast 3 bottles daily. Push proteins, follow meals with 4 oz Pediasure. No longer coughing at night.
10/22: Dx croup, rx. Prednisone x2d. Udip WNL, 24lb4oz, 18 ozs Pedia/day plus 10 bites food
11/20: Interested in eatting, 24+ lbs, decreasing Pediasure - now in sippy cups except for bed. Udips WNL.
11/27: Conts with dry hacking cough every day, worse at night and after exercise. No wheezing. Dr Knox-Lee ordered STAT xrays to r/o foreign body. Xrays repeated next day due to not being done right. Xrays OK, f/u with her- Probable Pulmon. referral or MDI trial.
11/30: Nutrition appt - Max 16 ozs Pediasure, try to get bottles out of bed. try down to 1 bottle by Feb.
12/5: croupy all night (not bad though)
12/7: worse cold s/s.- constant hacking wet nonprod cough with coarse lung sounds. Benadryl and Maalox not effective.
12/10: Dr appt, only runny nose now. prob reflux - f/u with GI. GI emailed... "if cough conts try Prevacid x 2 weeks, see me if no improvement," Not coughing.
12/18: 23lbs 9ozs - eatting more, down to 8ozs Pediasure and 8 ozs Milk - Nutritionist emailed.
12/19: Dr appt for Terrible croup all night. states throat very irritated - prob refluxing badly which can cause the croup. Rx: Prevacid, Flovent 2 puffs BID (when not sick Qday), Steroids x 2 days. Will also do 10d Maalox QID for throat healing. 23lbs 15ozs.
12/31: No longer coughing, taking 2+ full bottles of Pediasure at night time plus one for naps. WIC paperowrk filled out. MDI Qday and Prevacid only now. Talking in 2 word sentences. Straining to pee sometimes. Udips WNL.
1/22/13: Hardly eatting food. 3-4 btls Pediasure. Dx3d, pleasant
1/23: GMC for labs/US/appts... CKD stage ONE now, labs WNL - cr 0.4 BUN17. US showed inprovement in hydro. Down to 1/3 chance he'll need transplant. Bladder still thick... ? try Ditropan IF probs with potty training next year. Nephro doesn't care about eatting - not kidney related -as long as he's growing, she's happy. BP 96/?. F/U 1 year.
1/25: Dx6d now, cont to be happy, not sick. 24lb 13 ozs. Dr N - + culturelle daily.
1/28: OT: "reflux kids have a hard time getting back to eatting" Cont with food play.
2/5: Up all night screaming in pain with vomitting... lasted 8 hours only
2/8: Nutrition: needs 1200 cal/day. 25lb 1 oz, 33.6". Happy with growth. Cont to get in 3 bottles Pediasure for cals, since he'll only eat junk. + Daily vit. for ice cravings. F/U with GI re. ?celiac dz and need for scope.
2/21: 4 BMs No D, woke Q1' all night screaming in pain. Gas med - no relief. No V,D. c/o Booboo, points to belly. Conts to hardly eat food.
2/22: c/o bellypain in early am with 3 BMS no D, drank Pediasure ok. GI Dr appt made - 3/29.
2/23: c/o intermitt belly pain - Dx2. Dx over phone OU Pink Eye, rx Cipro gtts x 7d. Right worse than left. Right top molar thru.
2/24: Dx3. less c/o's belly pain. Ate some food today! Eyes less red, goopy.
2/25: 1 BM then Dx1. up until 0230 c/o throat pain. +wet cough. Vx2 with cough.
2/26: Dr appt: dx GI bug - talked with GI - appt now 3/1. Cont 3-4 bottles Pediasure/day.
3/1: GI appt: prob. medical, needs scope with biopsy to check reflux, eosinophiliac esophagitis and celiacs. Liquid Prevacid NOT covered by insurance ($200/month). Scope 3/27.
3/13: noon sudden screaming & rolling in pain. c/o leg pain then abd pain. 8pm spike 103.3 fever... Ped said to go to ER at LGH. Abd US ok, no intususseption and less hydro. Abd xray shows gas. No other tests or exam done. Vicodin x1 effective. Suggests Barium swallow to r/o Dyspgia w/
Aberrant subclavian artery.
3/14: home from ER at 0330. Woke 0630 screaming in pain, 103.8 fever. Glycerin suppos and Tylenol given. Dr appt 1045. Dx. Flu B. (Strep neg)
3/15: Much improvement, no fevers
3/22: Woke 0600 screaming in pain - Vx2. 0900 Tylenol for leg and abd pain. Lg BM, No D. No fever. Conts with MDI BID. Still has dry cough without wheezing with exercise. 6 oz Pediasure at 2030, vomitted it all at 0130.
3/23:c/o leg/belly pain thru day - obvious discomfort. Tylenol Q4' helpful. norm BM. No fever. Ate little. 8 oz Pediasure at 2000- then vomitted it all at 0100. Udip WNL.
3/24: less c/o's slept thru night.
3/27: GI scope by Dr Peters @West Shore Surgery Center. Everything looked good except for possible delayed stomach emptying. Biopsy results 5 days or so. 24lb 12oz. 107/71, HR 108, 99%. I D/C'd Prevacid and Flovent.
4/2:Nutrition: needs min 1200 cal. Conts with good growth. Try meal at midnight feeds. Per GI Dr Kuhn: Biopsy shows reflux - cont Prevacid. Duodenum biopsy "some intraepithelial lymphocytes" suggests possible Celiacs but doesn't reach enough criteria to diagnose... need blood work. No eosinophelic esophagitis. Did not mention GI delayed emptying.
4/3: blood work at LGH (CBC, BMP, Thryoid, Celiac markers,Lipase) (cr 0.5, BUN 21, wbc 13.6) AST 51, ALT 48- liver results not mentioned.
4/16: Tried Omeprazole for reflux but he picked the medicine balls out of his ice cream
4/30: 1 week of 1/2 strength Pediasure/whole milk just caused D, no increase in eatting. Per Dr Kuhn... "try with Lactaid, he may have milk intolerance" 25lb 15 ozs
5/5: Cold s/s x 5d +runny nose, wet cough, D, pleasant. No fever. Tried 1/2 Pediasure/Lactaid.
9/3: Still picky eater but we can force him to take a bite now. Still no real interest in eating. 2 bottles of Pediasure a day ave. (usually 1/2 Lactaid.) Tells us before he has to pee if he is naked. Pees outside if not in a diaper. Randomly tells us that it hurts to pee. No meds for months now. At beach last week, had minor issues with sand and cold. Also c/o tummy pain with foot pain x 2 days at beach, but then acted fine 10 mins later - ?.
9/26: 30 month checkup... 28 lbs. "Don't worry about his eating!" start teeth brushing and potty training.
10/27: 4 days of fevers 104. c/o mouth pain and foot pain. Strep neg, UA WNL (sm ketones). Tylenol brings fever down to 101/102 only. Prob hand/foot/mouth dz. Then this am started with obvious croup... LGH ER - Rocemic Epi Neb and Orapred 30mg and rx x 5d. Given Tyenol w/ Codeine at home b/c screaming about mouth pain.
10/28: F/U with Ped (Take Orapred 15mg x 2d only) restart Flovent Qd (BID when sick)
10/31: 101 again... to Ped. "Throat so red" Strep neg, CXR neg, CBC OK (Metamyelocyte high 1%), CMP: BUN 28, cr 0.5, ratio 56. K+ 5.6 (tough draw), AST 56, ALT 42. Rocephin 2 shots. 27lb 12oz.
11/1: Cont with 101 fever. Dx Flu B.
1/9/2014: 28lb 4 oz. 4-5 bottles Pediasure daily. Per nutrition phone consult "Do not push milk b/c high renal load" suggests seeing Sandra, Speach therapist again. Labs drawn for GMC appts (Renal panel, CBC) Still PICKY eater. Potty training... with no diaper on will potty almost every time. Must double/triple void. Pees every 20 minutes or so. Hides when he poops his diaper. Randomly stopped using his paci!!! Conts to randomly c/o foot/leg pain. Has short hair cut... looks "sick" to me over past few weeks. Has dry skin around mouth- hydrocortisone improving it.
1/10: AST/ALT high, per Dr Muchant (Labs ran by mistake at LGH). Ped appt on 1/14 for f/u- will need to see GI again. WBC "slightly high" cr. 0.5 BUN 23.
1/14: Dr Cook thinks viral hepatitis from Flu in Oct/Nov. ordered labs, not overly concerned.
1/15: Uro appt at GMC... "dramatic improvement of US" - less hydro b/l, megaureters hardly seen on US, bladder wall still thick "cont trying with potty training". F/U 1 yr.
1/16: Nephro appt - Dr. very pleased. No diet restrictions, BUN in 20s is fine (worry when in 60s). BP 100/64 ("ok, but watch"). F/U 1 yr. GI appt - norm kids AST/ALT is 50s. Not overly concerned b/c not all liver enzymes hi "prob related to a virus". Large amt blood work ordered for 3 weeks or so "Just to be sure, since you are having metemyelocytes rechecked anyway" Referred to GMC feeding clinic though (April 28th) "He will prob just grow out of it".
1/29: Labs at LGH (Metamyelocytes ZERO, AST/ALT down to almost normal, BUN 23 and cr 0.5, Hepatitis neg. Jason forcing him to take bites of dinner, sometimes gags himself.
2/18: Dr Kuhn agreed to 2-4 week trial of Periactin (appetite stimulant).
3/17:Dr Kuhn notified of Periactin success "cont! if it stops working, we'll stop and restart. Cancel feeding clinic". Down to 2 bottles Pediasure daily. Eating more, feels hunger. still picky. Well visit w/ Dr Cooke... 31 lbs, 94/58... only give 1 bottle Pediasure daily, see ENT asap for restless sleep at night with snoring/apnea (appt 3/24). POTTY TRAINED!!!
3/24: ENT Kevin, PA appt... "nasal swelling"... try Nasonex x 1 month and see if improvement. in 3 weeks, get Adenoid xray. Tonsils are tiny.
3/30: He HATES Nasonex but he is not tossing and turning nearly as bad. Also is not picking nose anymore. Weight down to 28 lbs(down 3 lbs) with 1 bottle Pediasure daily... will increase to 2 bottles.
4/23/: Dx sinusitis w/ wheezing (fever 103 x 2d, wet/croupy/whoopy cough). abx x 10d/steroid/nebs.
?/?/: ENT f/u D/C spray since he hates it, could do sleep study, but he'd end up with a mask probably - I declined. Xray WNL.
6/15: Admit at HOLRMC dx: pyelo (
morganella morgani). IV Rocephin x2, fluids, tylenol, zofran (fever, c/o "tough guy scar hurts", scream with void, nausea, bloody urine) WBC 18.1, cr 0.5, BUN 18, NA 135
6/16: D/C'd
6/17: Ped f/u. rx Bactrim x 10d. f/u Sumfest for prohylact abx? VCUG? US? cystoscope for stricture?nothing? Muchant wants cr repeat next week, Sumfest emailed - on vaca until next week.
6/26: Creatnine 0.8 BUN 23 BMP WNL US shows obvious mega ureters. No s/s. Muchant will see us tomorrow. Sumfest N'd.
6/27: Muchant "?" Repeat labs in 2 weeks. Had US done at GMC for better imaging: R kidney down to 5.5cm from 6.5 cm plus there is a 0.5cm mass on it (?lymphnode) Left 7cm. Sumfest NOT worried about mass. "Maybe he's not voiding all the way." We put Jack back in diaper so he can void freely, he had started to laek a little before getting to potty, thought he was too busy to go to potty.
7/2: Uroflowmetry Test WNL with no residual at GMC. "? what's going on... will go to OR to check it out." Spoke with Kerry NP @ CHOP... will transfer care there and start Bactrim 2.5cc/day awhile.
7/5: LGH labs: cr 0.7, BUN 20
7/9: Diapers ordered with rx. GMC med records done to CHOP. CHOP apt 7/14. GMC OR 7/24. UA WNL.
7/14: CHOP Shukla "OR for cysto/check VUR/suprapubic cath. 7-10d later, MAG3 & urodyn." "I think the issue is the bladder." Kaplan "US dx Duplicated Kidney. Pediasure is just fine. No mass on right kidney. Kidneys small, echogenicity says there is damage. Kidneys function 56%. Dx. Pseudo prune belly. F/u 1 mos w/ labs."
9/4: Anesthesia phone call pre-surgery. Wt 33lb 1oz. decreased po and pediasure input. X 4 weeks. D/c'd Periacton. c/o headache intermitt. trying to push fluids.
9/6: croupy through night. No fever, LCTA. Albuterol Neb BID Prednisone 15mg x 2d (home treatment). Drs N
9/9: CHOP cysto (no urethral obstruction, lg badder) and suprapubic cath placed (clamped, in a dsg) inserted. Creatinine 0.4 BUN 17 despite no po x 17'.
9/10: requires Tylenol #3 and Ditropan for bad bladder spasms. Urine more bloody, CHOP N'd "prob bladder spasms, not UTI. Drain cath PRN"
9/11: Keflex for possible UTI. cult sent from Dr Cook. SP Tube to be left open to drain. Ditropan causes him to be very flushed. He is terrirified of the tube.
9/15: mag 3 (right 30%, left 70%). VUDS (bladder divereticulum; held 130 cc, emptied tic completely; no reflux) Suprapubic cath d/c'd; urine cult neg d/c keflex cont Bactrim x 1 year
10/29: Neph appt. PTh down to 72, no treatment at this time. BUN 21, cr 0.5, Na 137. Spoke with nutritionist "offer Pediasure only after solids"
12/22: U/S and Uro appt: No change. better at potty training, and eatting more! 33lb 15 oz. f/u 6 mos.
12/26: croupy, vomit x4 in 2 hours. No fever. Urine WNL. flu neg. Dx croup, rx predisolone.
1/7/2015: woke mid night w/ 103 fever. Vomit X1. C/o and pain, later c/o right ear pain. Dx OM R ear with large hard wax pellet removed by Dr. Rx augmentin.
2/28: Abd pain with pale BMs and D on/off for a few weeks. Today c/o abd pain x 10 hrs then V. No fever. Udip WNL.
3/3: well visit. 35 lb. stool tests for ongoing and pain. PPD.
3/4: stool spec to LGH
3/5: cont with random hrs c/o umbilical and lower abd pain w/ V. Then fine thru day. Cries in sleep. Ped and GI Nd - warm compresses, 5cc maalox. Tried Ditropan, no effect. Udip WNL.
4/22: GI issues slowly went away. Periactin effective. Has "good" eating days. + 4 bottles Pediasure. Trying Nasonex again for restlessness. Has good potty training days, other days dribbles constantly.
5/11: CHOP Nephro Dr Baluarte. F/u 1 year- labs after GI appt.
5/21: CHOP GI Dr Flick. Change Periactin to 3 wks on/1off. Blood work done (CBC, CMP, PTH, Celiacs). If blood ok, go to Hershey feeding clinic. "Prob was a health prob younger and now is behavioral results." Cont 4 pediasure daily (gives 960 cal). Needs 1300 cal.
Results: celiac neg, CBC OK
5/27: results from Nephro. cr 0.6 (up from growth spurt?) BUN 20, PTH WNL 52. Labs in 6 mos, f/u 1 year.
6/22: Uro at CHOP. D/C bactrim is ok! F/u 6 mos
7/2: c/o r ear pain x 2d. Dx ROM rx Augmenting
7/9: 104.4 fever x 24'. Patchy sore throat. HOLRMC ER. Dx virus
7/10: 3rd day of fever 104+
7/23: Open Fx right thumb; rx Keflex. Eating better on his own still 4 pediasure. "Good" at potty training when his pants are off
7/25: thumb still oozing. Saw Ped for wound check-see Ortho on Monday
7/27: Saw Ortho Dr Battista - f/u 2 weeks for X-ray. OK to swim, etc.
9/26: flu shot
12/11: CHOP Uro: potty training going well but also dribbles some. eating well + 2 Pediasures. Counts Periactin cycles. 35.5 lb. US "unchanged". "Worry about potty training in 2 years." Creatinine 0.5. BUN 17. Glucose 60. Signed up for PreK
3/4: we'll visit. Stopped Pediasure on 3/1. 38 lbs. ER check in 2 months. Day time potty trained.
3/8: croup. Prednisone x 2d
3/21: still little, picky eating. Wants milk all day. Solids pushed. Prefers ice cream, pudding, yogurt, cheese, Cheezits. 34lb. Pediasure restarted 1 daily. Udip TRACE PROTEIN x 2 wks.
4/25: CHOP US URO 37lbs 41" 96/64. Eating!! 1 Pediasure daily. Pee accidents when playing-behavioral? "Drops just come out" sleeps with PM diaper and pad to keep bed dry. Dr wants suprapubic/Urodynamics in Sept - Jason said no. F/u 6 mos for spot, US, uroflow and re eval need for Urodynamics. US showed a little more pee in kidneys/ureters but bladder was full too. Start potty chart
5/3: ENT says adenoids and tonsils must come out "tonsils large" "+3" and no need for sleep study. Uro notified- will do procedures at same time in Fall.
5/23: Ped, Nephro and Dentist say tonsils NOT large. ped ordered Sleep Study at CHOP, before surgery. Cont 1 Pediasure daily- wt 39 lbs. eating OK. Cr up to 0.6 - recheck at Urondynamic appt. "cont to sit and watch and wait".
7/23: sleep study went well. "Mild apnea" apnea 3.1 times/hr, pox >90.
8/11: ped ordered adenoid X-ray b/c tonsils only +1. ? Only adenoids out? X-ray: "13mm" "large/normal" "nasal passage open" "same size as 2014". ENT NP N: surgery cancelled f/u different ENT 8/31. Uro N to schedule surgery in Oct. no Pediasure x 1 month... Eating more foods!!
8/31: New ENT DR... no ENT surgery needed! mild sleep apnea... no intervention.
9/27: flu shot. Surgery 11/9. Tests 11/23. 1 Pediasure/day to increase at. Wants to stay full day at kindergarten
9/29: Full day kindergarten! Eats1 Pediasure after lunch. still damp undies most times.
11/9: CHOP: cysto with Suprapubic cath. No valves or structures. Creat 0.6
11/23: CHOP urodynamics, tube removal. No changes, diverticulum still big. Empties pretty well. "Pee twice each time!" Creat 0.7- he has not eaten or drank x 2 was since suprapubic hurts him a lot. He didn't dribble at all bc the cath made it hurt, he peed small ants frequently and we drained his cath mostly d/t pain.
5/1: CHOP. U/S unchanged. Creatinine 0.6 (0.5 normal now). Biofeedback went "well". Void 130cc, retained 30cc. Bought WOBL Watch.
5/17: vomitted X1. UA WNL. C/o butt itch. Dx anal strep. Rx keflex x 10d, Zofran 2 mg prn
5/30: rx Bactroban TID X 7d to get ride of remaining anal strep.
6/13: Dx anal fungal infection. Lotrimin x 10d
7/11: cont c/o a lot of pain with BMs. Saw Dr. 42lb. Exam WNL. Referral to LGH nutrition. Prob anal fissure. Stated Fiber gummy and 1 tsp miraalax.
8/15: Nutritionist @LGH : needs 1800 cal/day to grow/gain wt. pediasure each appx 200 calls- good to give. No daily vit if 2 pediasure/day. Needs 50 ozs liquid every day. Increase protein rich foods. "No Thankyou bite". F/u 2-3 months. Email 2 wk food log.
*********
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
D/C'd:
Periactin 2mg/5ml. Take 5ml PO BID (start 2/18/14, held 5/1/14, start , held 9/5/14, start for two week cycles 3/1/15, change to 3weeks on/1 off 5/22/15) D/C'd 3/2016
Nasonex 1 puff Q nostril Qday (start 3/18/14, stop 4/23/14, start 4/15/15, stop 3/2/16)
Culturelle PRN
Bactrim 2.5cc Qday (start 7/2/14 end 6/22/15)
Flovent 44mcg 2 puffs Qday or BID (start 12/19/12, stop 3/27/13, restart 10/28/13, stop 3/15/14)
Albuterol 1 men PRN
Flouride 1/2 dropper PO Qday start
Prevacid 15mg (1 solutab) PO Qday (start 8/11, held 7/12, start 12/19/12, held 3/27/13)
NaCl 4mEq PO QID (start 4/11 stop 6/7/12)
Bactrim Susp 2cc PO Qday (start 7/11 stop 4/12)
Acidophilus (Flourogen) 1 caps PO BID
Maalox 10cc PO QID x 10day (PRN for reflux bad s/s)
*********
Diagnosis
Hypospadia 3/1/11- repaired with circumcision 1/11/12
Chordee 3/1/11 - repaired 1/11/12
Urethral atresia/stricture 3/3/11 - repaired 10/13/11 and 1/11/12 and 7/16/12
Cysto 3/3/11, 10/13/11, 1/11/12, 7/16/12, 9/9/14
Vesicostomy 3/3/11- reversed 10/13/11
Lg Bladder with Lg Bladder Diverticulum 9/15/14
Bladder Wall thickening 3/1/11
B/L Megaureter 3/1/11
B/L Hydronephrosis 3/1/11
Chronic Kidney Dz Stage 2 3/1/11 - Changed to Stage 1 1/23/13 - changed to Stage 3 7/14/14
Hyponatremia d/t salt spilling 3/20/11- resolved 6/7/12
Nephrogenic Diabetes insipidus - Kidney concentration deficit 3/20/11 - D/C'd 1/23/13
UroSepsis 3/19/11
Seizures at home while septic 3/19/11
RSV 1/14/12
UTIs/pyelo 3/19/11, 6/27, 7/18, 7/29, 8/13, 9/7, 9/21, 10/4, 2/12/12, 3/19, 4/30, 5/20, 6/17/12, 6/15/14
Mild Sleep Apnea 5/21/12, 7/23/16
Failure to Thrive 4/10/12 D/C'd ____
Roseola 10/30/11
Hand-Foot-Mouth Dz 7/18/12, 9/14/12
Croup 10/13/11, 5/18/12, 10/22/12, 12/5/12, 12/19/12, 10/27/13, 9/6/14, 12/26/14, 3/8/16
Pink Eye 6/22/11, 7/13/11, 2/23/12
Flu B 3/14/13, 11/1/13
Viral Hepatitis 1/14/14
Acute Asthma 4/23/14
Sinusitis 4/23/14
Pseudo Prune Belly Syndrome 7/14/14
Duplicated left kidney 7/14/14
Suprapubic Cath 9/9/14-9/15/14
Ear infection 1/7/15(R), 7/2/15(R)
Fracture 7/23/15 Distal right thumb
Perianal strep 5/18/17
Anal Fissure 7/11/17
*As of September 10, 2014: 6 surgeries, 15 UTIs, 57 Hosp admit days*
*********
Doctors
Pediatrician: Eden Park Peds - Dr Colleen Cooke-Moine
1725 Oregon Pike, Ste. Lancaster, PA 17601-4206
Urologist: Dr Akeem Shukla
KOP LOCATION: 210 Mall Blvd KOP, PA
CHOP 34th St. and Civic Center Blvd. Philadelphia PA, 19104-4399
http://www.chop.edu/service/urology/home.html
Nephrologist: Dr Baluarte
Prior Dr Bernard Kaplan
CHOP 34th St. and Civic Center Blvd. Philadelphia PA, 19104-4399
Gastroenterologist: Dr. Flick
CHOP 34th St. And Civic Center Blvd.
Philadelphia, PA 19104-4399
215-______
https:/________
Orthopedic: Dr Vincent Battista
Orthopedic Associates of Lancaster
170 N Pointe Blvd, Lancaster, PA 17601
(717) 299-4871
http://www.fixbones.com/
OLD Urologist: Dr Joel Sumfest
Urology, Geisinger Medical Center 100 N Academy Ave Danville, PA 17822
OLD Nephrologist: Dr Dianne Muchant
Pediatric Nephrology F6, GMC 100 N Academy Ave Danville, PA 17822
570-271-8055 fax
570-271-6002
http://www.geisinger.org/
OLD Gastroenterologist: Dr Benjamin Kuhn
Geisinger Pediatric Specialties, 6085 Linglestown Rd Harrisburg, PA 17112
717-920-8630 fax
717-920-8636
http://webapps.geisinger.org/findaclinic/clinicdetails.cfm?ClinicNum=O125
Hershey Sleep Research and Treament
1214 Research Blvd Suite 1159 Hummelstown, PA 17036
*IF he spikes a fever or gets irritable, have him pee on stick if top (white) box turns purple at all, or 3rd (orange) box turns green, he has in infection
* Tylenol 5 ml every four hours if he needs – HE MAY NOT HAVE MOTRIN/ADVIL/ IBUPROFEN
Summary of the summary...
2011
3/1 Born GMC c-section
3/3 OR vesi @ GMC
3/5 home
3/19 Urosepsis @ Hershey (Enterobactor UTI, Enterococcus Blood) - 3/31 D/C'd GMC rx NaCl cr 0.5
6/22 Right pink eye
6/27 UTI (Staph Epidermis)
7/13 Right pink eye
7/18 UTI (E.Coli)
7/29 @LGH UTI (Enterobact.) - 7/31
8/13 @GMC UTI (E.coli) - 8/14 rx Bactrim Qday, Prevacid
9/7 UTI (Enterococcus Faecalis)
9/21 @LGH UTI (E.coli) - 9/22
10/4 @GMC UTI (Enterococcus) - 10/8
10/13 OR cysto/ureth dilation/ureth reconstruct @ GMC - 10/15
10/15 pm ER @ HOLRMC cath irrigation
10/17 @LGH dehydration - 10/18
10/28 @LGH viral fever (Roseola) - 10/29
11/7 Hopkins visit
2012
1/11 OR cysto/hypospadia repair/stricture fix @ GMC
1/13 LGH RSV/dehydration - 1/15
2/12 LGH ? Sepsis/UTI (E coli urine, Strep A blood) - 2/14
2/17 LGH unknown bacterial infection/fevers - 2/19
3/9 UTI (E.coli)
4/9 UTI (E.coli)
4/13 started speech therapy
4/30 UTI (E.coli)
5/3 started Nutritionist
5/10 Sleep study at Hershey
5/20 UTI (Entero. Faecalis)
5/21 ENT nasal scope WNL, dx mild sleep apnea, GERD
5/25 GI appt at GMC
6/7 Nephro D/C'd NaCl
6/15 start OT at home, stop speech
6/17 UTI (strep)
7/16 OR cysto @ GMC "timy stricture snipped"
7/18 Hand/Foot/Mouth dz
9/4 Asthma
9/5 croup
9/13 viral bronchiolitis
9/14 Hand/Foot/Mouth dz/ viral URI
10/22 Croup
12/5 Croup
12/19 Croup rx. Prevacid/Flovent
2013
1/23 GMC appts "improved"
2/23 B/L pink eye
3/14 Flu
3/27 GI scope mild reflux, possible delayed stomach emptying
10/22 Croup/Hand/Foot/Mouth dz
11/1 Flu
2014
1/14 Viral Hep
1/15 GMC appts "dramatic improvement" cr. 0.5
2/18 rx. Periactin
3/24 ENT "nasal swelling" rx Nasonex
4/23 Sinusitis/Croup/Wheezing
6/15 @HOLRMC UTI (morganella morgani) cr 0.5
6/26 cr 0.8 BUN 23 US hyrdro/megaureters
7/2 Uroflowmetry WNL
7/5 cr 0.7 BUN 20
7/14 CHOP dx Duplicated Left Kidney, Pseudo PBS
9/6 Croup
9/9 Cysto/ suprapubic cath placement @CHOP
9/15 Mag 3/ VUDS @ CHOP
