Jackson's Medical History Cheat Sheet
2011
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
2012
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.
2013
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.
2014
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.
2015
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
2016
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.
2017
5/1/17: 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.
10/6: CHOP. US showed a little worse kidneys and ureters, L kidney cyst bigger now. Biofeedback went “well” I forget #s but he did retain. Nothing to do about drips- eventually cath. F/u 3 months Biofeedback.
10/23: Poison Ivy rash x 5d. Treated with Clobestol ointment, now Jason tells me the rx is bad for kidneys. Dr appt.
12/8: CHOP URO Biofeedback. Bladder held 60cc, 20cc post void residual. “Don’t focus on wet pants- him peeing is preserving his kidneys.” Keep strict diary to figure out when he’s leaking. Start Ditropan (to help bladder hold more) 2cc BID- AM and after school. It puts bladder “to sleep” so voiding every other hour is very important. F/u in 3-4 months. Will prob need Cathed in his leftime:(
2018
2/27/18: c/o sore throat and HA, dx strep. Rx Augmentin x 10d.
3/2: 7 yo we’ll visit. 46.5lb 46”. Everything looks good. She wants a CBC done to check Hgb. Dr Cook retiring:( Ditropan working well, no leaks when he takes it.
3/8: 3rd day of generalized intermittent and pain/squeezing. Random N. Some D yest AM, now soft unformed BM. And unremarkable on assess. Pain Kept waking him. Zofran 2mg at 0315 while in bath. Saw Dr at 1pm for bad abd pain with nausea. Zofran 2 mg at 10:30am somewhat effective. Dr said he’s ok, maybe bc of Augmentin that I dc’d on 3/5 (day8) d/t abd pain. Suggested gas meds. V XL amt at 10pm with No fever. Lost 2 lbs since 3/2, 45lbs now. Urine dipped WNL on 3/7.
5/9: chip fracture right middle finger on field trip from being smashed by 2 logs. Very swollen. Tylenol and splint x 3 wks.
9/10: CHOP URO appt, US, change rx to Oxybutinin 5mg extend release QHS.
10/2: left school with fever, painful urination, flank pain & sore throat. Udip WNL and strep neg at Dr with Nan (I’m in Hawaii). Abx started until culture results.
10/5: urine and strep cultures neg, feeling better. Abx d/c’d.
10/11: up x 2 in night c/o shin/ calf pain. Tylenol and hot baths help. Has been intermittent x 3 months atleast.
10/23: flu shot.
10/24: Saw Pediatrician “growing pains”, blood work WNL, no anemia. Creatnine 0.7. Emailed Nephrology re. Fatigue and growing pains x 2, no response.
11/1: Pink eye. Rx oxiflacin gtts.
10/23:dx strepthroat
2019
1/22/19: dx staph impitego infection to finger tip, nostril and left eye area. Rx keflex x 5d, rx abx Bactroban x 7d.
1/28/19: to Ortho Dr for 6 months of intermittent right shin pain that wakes him appx 3 xs a week. Pain is relieved by a 10 minute hot bath. Was dx “growing pains” by Ped in Nov but ortho thought it best to evaluate him. X-ray done, WNL. Bone scan ordered. (2/14 insurance still fighting bone scan)
1/31:19: dx R pink eye. Rx polymicon gtts QID.
2/20: started with Abd pain/N/V at 0900. Zofran a little effective. Around 1545 started to c/o flank pain and burning with voids. Urine WNL. To HOLRMC ER for fluids/UA. UA, CBC, BMP “ok”, no fluids given. Later, D. No fever. Lasted appx 15 hours.
3/1: impitego in R nostril again. Bactroban BID.
3/9: CHOP US and URO. Creatnine 0.8, US “a little worse”. Time to actively preserve his nephrons. Nightly cath vs Mitroffanoff. Can wait until Fall, if Nephro says ok. 5 mg ER Ditropan successful at keeping undies dry during day.
3/14: 8 yo we’ll visit. 53lbs (32%!!) grew over 2” this year. Start Prevavid 15 mg to help reflux, appetite and apnea.
5/19: labs at LGH Cystatin C done (for 1st time?) High 1.34 (over 1.19) shows “kidney damage”
8/22: labs for Nephro appt-
(COVID happened and Dr appts were stopped for months)
2020
9/25: late PM while Jason and I were out he started with UTI s/s- painful urination, fever 101, left flank pain. Urine dip +, to HOLRMC ER for 7 hours while they consulted with CHOP then started on oral Cefdinir. Bloodwork and US done- creat 0.97, BUN 26, WNC 12.3 Dx pyelo (unknown bacteria b/c culture negative)
10/7: CHOP appt Uro: ?Hopefully a fluke? keep peeing Q2', double void, increase water
11/9: CHOP appt Nephro: labs improved- creatnine 0.8, BUN 19, Cystatin-C 1.19, GFR 60. Dr happy. f/u 6 months. *1 week later, saw on portal that his UA that day was + for blood, leuks and protein... ???
11/29: c/o random intermittent x 2 right flank pains, asked me to dip his urine. pain stopped after voiding. Dipped + for large amount of leuks only. Ped sent us to LGH Urgent care since it's Sunday and we caught it early. They sent Urine for culture and rx Cefdinir. (sm amt Staph epidermis, ? Dirty spec?)
12/28: started with R flank pain. Dx pyelo at Pediatrician next day. Fever up to 101.4. UA +RBC,WBC,Blood (and nitrates at Drs). culture sent 12/29. rx Cefdinir. No dysuria or bladder pain.
12/31: Fevers got up to 103.3 last night. Tonight fever and pain gone, UA + sm nonhemol blood only. Culture negative again, per Uro stop abx after 5 days if still fever free atleast 24’.
2021
1/8/2021: Uro appt and U/S: ureters are taking the hit and saving the kidneys. Dr could not explain the past 3 “UTI’s” with neg cultures- he’s baffled too. Surgery scheduled for suprapubic tube x 1 month to rest the whole system, then do VCUG.
4/20: Suprapubic tube inserted at CHOP. No urethral strictures needed to be cleaned up. Diverticulum visualized and confirmed. Nighttime draining, and post void draining x 2 weeks, then full time draining.
4/28: Dx UTI. ? Bacteria- will find out Cx sent. Rx Keflex. No fever. "Stinging/Burning" urethra x 2 days, U-dip ugly, urine now cloudy. Leg Bag hooked up to Suprapuic tube full-time now. Irreg HR- Stat EKG, "Left Atrium enlarged"- see heart Dr.
4/29: "baseline" U/S for compare on 5/17.
5/1: clinically improving- acting better, not worse, urine clear. not voiding. not fever. Udip unchanged.
5/3: Uro N'd Fever 100.3, urine still clear, stinging/burning costs with void during BM. RX changed to Tetracycline 500mg X 7d.
5/5: Urine wise- improving. Legbag draining well. Heart Dr: heart is great! EKG was read as adult.
5/17: CHOP for VCUG and to pull out Suprapubic tube. Went better than expected. Jack could feel when his bladder was getting full. He emptied his bladder and his diverticulum almost totally with one void. No reflux. Keep the course.
10/13: sudden onset UTI s/s, no fever at 0100. Saw Dr 0820. UTI dirty, culture sent. Rx Omnicef. Dx UTI (Staph Epidermis) felt better by 10/15.
11/15: Fell at recess- c/o R wrist pain. Jaylee took him to ortho urgent care. Dx probable Growth plate fx. Feeling better after a splint x 1 week, so we did not follow up.
12/7: Wrestling with Dad, hurt R thumb bad. Ortho urgent care. Dx Thumb Fx. Cast removed 1/3/22.
12/31: COVID +. Jenni had COVID, Jack c/o HA only.
2022
1/22/22: Had cold s/s x 1 week. Today Mom noticed bad wheezing throughout. To urgent Care for X-ray and MDI. Xray showed inflamed lung lymphnodes "from COVID 3 weeks ago, even though there was no resp s/s during COVID"
2/7/:woke with R flank pain, urine cloudy, dipped + leuks, sm ant blood, good amt protein. No fever. Pediatrician saw in AM. Dx UTI. Cx sent. (Staph Epidermis) Rx Omnicef 300mg tab daily x 10 days.
2/9: finally feeling better after running 99.5-100.3 fever with body aches, flank pain and “icky belly” for 2 days. Urine dipping clean now.
2/11: CHOP Uro changed Abx to Levaquin 375mg x 7d since that was the only oral sensitivity that was shown to work and Jack is intermittently 99.5 with intermittent burning.
2/13: no fever, no burning.
2/18: Hurt at recess while playing football. c/o L ankle pain. ortho urgent care. Dx L ankle Growth plate Fx. Put in Boot for 3-4 weeks. (Jack had zero pain 2 weeks later)
3/9: Temp 101 suddenly, wheezing throughout, body aches, albuterol MDI not helping much. Pediatrician rx Flovent 2 puff BID x 14 d, Dx Flu.
4/25: CHOP Appts: U/S- no real changes. Nephro: Creatnine was 0.88 now 1.0, expected with growth. Cystatin-C now 1.46 from 1.35 (below 1.19 norm). GFR down to 50. F/U end of summer either telemed or in person. Bro: Started on prophylactic Bactrim for UTIs every 6 months. "Probably time for overnight drainage, aka cathing". Dr ordered MRI Urogram for June 1, then will discuss Jackson's case with all of his partners and tell us what they advise.
4/26: Saw Pediatrician for 3 days of Hives all over his face and spreading. Unknown exposure, no s/s illness. Rx Prednisone 3-5 days.
6/1: MRI done downtown CHOP, included a catheterization. Dr Shukla will discuss results with his colleagues at their “monthly meeting” then decide or course of action. - Mitrofanoff can hold off for now. No reflux.
9/18: Nephro appt- Creat 1.0 Cystatin 1.54 (a little higher) GFR appx 55 with weight 74 lbs. says Jackson is stable for now to still not intervene. Labs in 6 month with f/u. Ideal BP 102/65- wants it checked at home every once in a while. Was a little high in the office (125/? And 107/?)
11/29: Uro and US appt: US looks unchanged to Dr, though radiologist says hydronephrosis worse. F/U 6 mos.
12/24: sudden dysuria and frequency. To ER. Dx UTI. Rx Levaquin 350mg P.O. Qday x 7d. C/o right kidney pain that night. No fever. Feeling better the next day. BP 124/82. (Staph Epidermis 40-50k)
12/29: still stings with voids. Udip WNL. Uro “increase water”
2023
2/6: Dx Strep a weekend of 101+ fever, big tonsils, nausea. Rx Keflex x 10d. Then 10 days of Strep-induced arthritis. Labs WNL after missing 1 week of school.
3/7: Routine Nephro Appt. GFR 55. “Kidneys not responsible for Jackson being sick constantly since November, see Ped to r/o autoimmune issues.”
3/15: Saw Ped for constantly feeling sick with random illnesses since November. Often c/o belly aches, sore throat and/or headaches. Blood work all WNL. Rx Prozac 10mg. Dx General Anxiety.
3/22: official Psych Evaluation by Ped… “cont with Prozac” and Counselling.
3/31: Sick visit with CHOP Uro due to 6-8 weeks of straining to start voiding, urethral “burning” at most times, and b/l constant flank discomfort. U/S showed no further kidney damage. Plan is cystoscope to look for/fix stricture, leave in SP tube for 2 weeks to monitor residual urine and do Video Urodynamocs Study 2 weeks later to r/o reflux. OR scheduling out 3-4 months:(
4/3: started Counselling with Elaine Campbell at Providence Behavioral Health- went very well.
4/7: started feeling “icky” with body aches and 100.5 fever.
4/8: obvious kidney infection… fever, nausea, increased flank pain, cloudy urine, dirty Udip, sone RLQ discomfort. 2pm: To LGH Urgent Care. Dr listened to story, did not assess him, Dx Pyelonephritis Rx Levaquin since that is what he was on the last 2 times. First dose 5pm. To Hershey Med ER at 10pm to rule out appendicitis. Hunched over, crying in pain in RLQ, worse with rebound tenderness. Morphine helped. Creatinine 1.09 WBC WNL, CRP and PCT high. IV Levaquin adm x 3 days. urine culture grew NOTHING. MRI showed appendix WNL. Pain 8/10 due to “very distended bladder” and possible heavy fecal load- not constipated though. Miralaax adm multiple doses. D/C home on 4/10.
4/12: Dr Shukla at CHOP Uro reviewed in patient notes…. “No need to move up any interventions, June/July is fine.”
4/24: 2nd opinion at Hershey Med Uro… VCUG this week with cysto in one week.
4/27: VCUG: Post urethra dilation from PUVs, no stricture, big diverticulum, emptied completely.
5/5: Cysto at Hershey: no urethra strictures. “His bladder his huge”. Left a catheter in for 4 days to rest his bladder. Will discuss best plan with his urologic team and call us. “He needs a Mitrofinoff”. Will meet on 6/12 to go over details.
5/8: Mom removed Foley… no longer has urethra, bladder or kidney pain.
5/11: started to c/o kidney pressure and bladder pain again :(
5:29: spent day at beach. Voided WNL 1130. At 1600 he tried very very hard for a long time to void. Suddenly, he heard a “pop” or “crack” cone from his penis. The distal 1/2 of his penis contracted then slowly released and a forceful stream of bloody urine came out painfully, but only a small amt. he was then unable to get his stream going again after many attempts he was in a lot of pain… especially where his urethra met his bladder and 1/2 way down his penis. Eventually, he said his penis looked bruised. Tylenol and purifying had no effect. We drive 4 hours to Hershey ER. Catheter drained only 250cc. Bloodwork WNL, creat 0.99. CT and/pelvis ok- Drs said it ruled out penis injuries. (?) went home after seeing Dr Ziada in the AM- “leave cath in for 4-5 days”
6/2: cath d/c’d. Cloudy, bloody urine. Udip sm leuks, lg blood. Uro notified “push fluids.” I also started treating with Bactrim, in case. Jenni graduates HS tonight, I can’t miss it.
6/4: no UTI s/s but Udip sm leuks still and less blood. Cont daily Bactrim.
6/6: 5pm sudden UTI s/s - dysuria, cloudy urine, flank pain, shivering 99.5. Udip + leuks, protein, blood. Appt 7:30 at Urgent Care. Arrive at 7, Jack going down hill quick. Shivering a lot, crying in flank pain, says “I feel so sick”. Udip done at Dr. I gave him pyridium and 500mg Tylenol. Dr encouraged us to go to hospital. Agreed to Rocephin IM shots and Rx Omnicef to see if Jack can get over the hump. Temp up to 101 in the 45 mins we were there. There from 7-8pm. To Hershey ER at 11pm admitted for pyelonephritis Staph Epidermis 100k. Creatnine up to 1.21. IV Vanco and Ceftriaxone Q 12’. Foley.
6/9: D/C’d at 2000 b/c fever finally less than 101 x 10 hours. Creat 0.92 No longer squinting in pain with and and flank palpation. Sent home with foley and Rx Levaquin.
6/10: gave Levaquin in AM. Got call at noon that sensitivities show susceptibility only to Vanco, Rifampin and (one more). First dose Rifampin 1330. At 1700, suddenly began feeling achy, light headed, dizzy, nauseated, feverish (100.5) and full body aches.
6/11: Cont with same s/s - assuming it’s the Rifampin.
6/12: Endocrinology for Growth Hormone evaluation- will put through prior auth paperwork but he probably won’t qualify. Then Urology appt: 1. Foley removed 2. Discussed sick s/s with resident and he was going to see if we should blame Rifampin but when surgeon came in we talked about Mitrofanoff and forgot to circle back to how bad he was feeling. 3 Mitrofanoff in October is the plan after soccer done and VUDS in August. “He’s not emptying his bladder. This will help him empty all the way”
6/13:Woke feeling worse but vitals the same. Nephro notified at 1100. Now c/o sore throat with wet cough too. Nephro- “probably Rifampin, let’s D/C it. He’s had 6.5 days of abx, that should be enough.” Told to be evaluated for fever or worsening. Ate some dinner at 2030, after not really eating x 3 days. 2200 V and fever 101.2.
6/14: Woke 0400 nausested 101 Zofran 4mg PO. 070 found him literally passed out in the bathroom on the floor. To pediatrician at 0950. She sent us to ER. Though he was trying to force himself to drink enough, he was dehydrated and lethargic. IV bolus, Zofran and Tylenol perked him up. Creat 1.07. UA WNL. EKG/CXR WNL. + Adenovirus. Home 1900. Fever 101.3 at D/C.
6/16: still 102 fevers. C/o increase throat pain. Tonsils more swollen with white patches. To Hershey walk in clinic at 6pm. Neg rapid strep but clinically appears positive, so Dx Strep and Rx Omnicef x 10d since we already had a filled Rx of Omnicef. Not eating, but drinking the H20 we’re pushing. RLQ wheezing.
?
8/7: VUDS at Hershey: he CAN empty bladder. Mitro still needed but not necessarily now. We decide when. Catheter used for test.
8/11: At peds with kidney infection s/s. Udip Lg leuks, Lg blood, 30+ protein. Rx Levaquin. Culture: Staph Epi
9/6: At peds with Jason for UTI s/s. Udip cloudy at home +leuks and blood. Udip in office WNL. Dx virus. Fever, urgency, dysuria, cloudy, kidney pain. Appears.pretty I’ll. Culture sent anyway: “mixed growth below clinical significance”. Started and stopped Levaquin.
9/29: woke with sudden s/s UTI and fever. Cloudy, +leuks, blood, protein at home. At pediatrician less cloudy, +blood, + protein. Dx virus. Culture sent anyway. Feeling much better before leaving Dr. Culture: no growth. Told to start Levaquin if he got sicker before culture results were back, didn't need them.
10/30: woke suddenly with R kidney pain, burning, cloudy urine. +Lg leuks, +blood, 30+protein at home. Specimen collected, started a Levaquin. Dr appt later in day. Still very sick at Dr. Udip +blood, +protein, +leuks. Dx kidney infection. Culture sent, “mixed growth below clinical significance”. Dr said stop Levaquin. But, Jack conts with right kidney pain and dysuria though he doesn’t appear ill anymore. Uro asked if we should D/C Levaquin or not- did not answer but scheduled an appt for 11/8. We decided to cont Rx x 10d.
11/7: Nephro 6 mod appt. Jack on day 9 of 10 levaquin. Conts with mild burning only. Udip WNL. (Trace protein). Dr says lower BP number conts to be “a little high” “just watch still for now”. She will push for growth hormones. Ordered blood work that was drawn after appt. Next time wants CKD labs done prior to appt. ***EXPLAINED That the last three UTIs in six weeks that were then called not UTIs were probably irritation to the bladder caused by caffeine or chocolate, or not emptying his bladder enough or constipation. She said, then urine will become cloudy as a bladder is irritated and creating white blood cells, and then it will bleed a little bit.*** Will cont to f/u with peds for urine cultures if he conts with symptoms 24 hours or with fever. Labs WNL. Cr 0.96 GFR 63
11/8: Uro UTI (?) F/u appt and appt to regroup about Mitro… “think about doing Mitro this summer”. F/u in 3 months with U/S. Can’t explain why bladder is irritable lately.
11/9: started treatment for topical yeast infection. Lottimin BID.
11/12: 8pm started with UTI s/s… dysuria, cloudy urine, “right high bladder pain”, B/L flank pain. No fever. Udip +Lg leuks, - nitrates, +Lg blood, Lg protein. Levaquin HELD until fever for now.
11/13: s/s worse. Dr appt 1100. Udip sane. Culture sent. “I guess he should start Levaquin for now.” If culture neg, KUB will be done. Start 1/2 cap Miralaax Qday anyway. Increase salt for nightly leg cramps. Dx UTI (Culture neg)
11/14: Appears to be more uncomfortable. Says urethra stings at all times. Pyridium only helps a little bit. Levaquin dose 1 given. Urine less cloudy but dips the same (+lg leuks, lg blood, lg protein) no fever (99.0). Not eating much. Drinking at least 100ox water.
11/15: home again. Flank pain a little better. R bladder pain the same. Urethra burning. Increased frequency. Culture neg. KUB at LGH “no stool burden” “no gas”. Pediatrician wants me to contact nephrology for further instructions. eating better this afternoon.
11/17: Nephro says to talk to Uro. I will wait until next episode since Jack is coming out of it now. C/o minimal R bladder pain, “sone” burning with void. Udip trace leuks, mid protein, no blood.
12/1: big tonsils and cold s/s. No fever.
12/2: also now c/o burning with void. U dip + lg blood, mod leuks, lg protein NEG nitrates, slightly cloudy. Pushing fluids since he wasn’t drinking as much.
12/3: 1800: suddenly c/o fever with left flank pain, RLQ pain, “lots” of burning. Udip now also + for small nitrates. Spec in fridge. Levaquin started.
12/4: Ped: culture sent. Talk to Uro re. Switching back to Oxybutinin instead of Flonax? Uro emailed.
12/5: feeling much better. Back to school.
12/8: Uro emailed again 12/6, no response, so called and left message…. Home culture dx Staph Epi >100k. Ped culture after abx started neg.
12/11: Uro nurse called “just cont abx” can see sooner than Feb if you want “ did not address meds- I switched him from Flomax to Oxybutinin last week already.
12/12: woke 0300 c/o body HURTING and N. Zofran and Tylenol. Redosed at 1000 for same c/o’s. Slept until I woke him at 1600 to make him pee and drink. C/o some burning with pee. Tonsils huge. Went to bed again at 1930.
12/13: woke 0200 c/o N- Zofran. Woke at 1000 c/o N, less body aches, less sore throat. Still no fever. Tonsils still huge. Still on Levaquin (Day 10). Zofran adm. Udip.
12/31: started with cold s/s, stated in AM his urine was cloudy but didn’t really burn- passing fluids.
2024
1/1: cont with cloudy urine, burning, bladder pain and cold s/s. Temp 99.6. Udip + Lg leuks, Lg blood, Lg protein but NEG Nitrates so not going to Dr. pushing fluids. Udip in PM a little improved… moderate leuks, blood, protein.
1/2: cont with same s/s. Cough worse. Urine s/s the same. U dip +mod leuks, blood and protein, neg nitrates. Cont pushing fluids and no dr appt or abx. 1800: spiked fever 100.7 c/o l flank pain and LLQ pain, Udip + lg leuks, protein and blood, still neg nitrates. Spec in fridge. Levaquin started. PM cold med adm.
1/3: 0330 came to my bed “feeling worse”, 100.3 PM cold med adm. 1000 woke no fever, cont R flank and LLQ pain, frequency, burning. Started jock itch cream. To Ped: 2 cultures sent, talk to Uro about maybe switching to tetracycline since last UTI was susceptible to it, but he will be photosensitive in the D.R. I emailed Uro. Dx. UTI (Staph Epi >100k and 2 other nonpathogens)
1/13: Stayed on Levaquin entire trip to the D.R. improved quickly on meds.
1/19: Emailed Uro b/c Ped wants Jack on Tetracycline moving forward and she wants him to decide dose.
1/28: Evening started with muscle aches, feeling ill, 100.5', some stinging with void- Dip WNL.
1/30: Still pretty sick- Dx FLU A. 100.5, body aches, HUGE tonsils, sire throat, tired.
2/2: Finally feeling a little better, fever gone.
2/7: Ped ordered labs at LGH for CHOP 2nd opinion appt next week with Dr Kolon re. Mitrofanoff. (creatnine 1.21, BUN 31, ratio 26.)
2/8: Woke with big sore tonsils fever 100.8, nausea, body aches. no urine s/s.
2/9: improving. saw Dr. strep NEG.
2/15: Uro appt at CHOP with Dr Kolon. Plan: Cysto with SPT x 5 weeks then repeat labs, US, and urodynanics. He thinks his diverticulum may be bigger. He thinks he will eventually need a Mitro. He put down idea of ureter surgery “but let’s see what the testing shows”.
2/25: c/o R kidney pain on a Sunday AM (suddenly). Quickly went down the tubes. Fever up to 101. Urine clear, burns a little but appears ill. Udip +nitrites, med blood, SMALL leuks and med protein. Started Abx Tetracycline and spec obtained. As day went on, burning got worse and urine turned cloudy. Vommitted twice during day too- not abx related.
2/26: At Peds. Dx. Pyelo (cx. NEG) Urine cloudy. Udip + nitrites, Lg leuks, Lg blood, Lg protein. Both specs sent for culture.
2/29: Still appears ill. Urine clear, dips clean. Increasing R kidney pain and now left kidney and bladder pain. Sent to CHOP ER by Ped for imaging. Creatnine down to 1.08. US and CT “no acute change, no kidney stone”. Feeling better that PM. Told to stop Abx after 5 days since Udip and culture and urine s/s are improved.
3/8: nephro labs at CHOP. Udip WNL. Creatnine 0.99 Cystatin-C 1.68.
3/13: Nephro Appt: Dr impressed kidney labs stable despite UTIS. Thinks creatinine 1.2 in Feb may have been “a blip”. PTH a little high (95.9). Wants to recheck in 5-8 weeks before starting to treat it with medicine. Suggests getting Infectious Dz involved for UTI Neg Cultures. Wants 3 month f/u. Happy with Jack BP and growth.
3/13-3/20: cold s/s with occasional wheezing.
3:20: Cysto and SPT at CHOP.
4/7: 0100 Suddenly started with R kidney pain at bedtime at sleepover. Body aching some too. Didn't think it was bad enough to come home. 1000 home, much sicker. 101', R flank pain, bloody urine, body aches, N. SPT D/C'd and sterile syringe Hooked up to SPT. 1100 Unable to void still- spec pulled from SPT with syringe. Dip +Lg Leuks, + Lg Blood, +Lg Protein, NEG Nitrites, cloudy.
4/8: To Ped: 100.5' Conts with R Flank pain, body aches, fatigue. Dx Pyelo Cx sent to b grown for FIVE days.
4/9: Appears better. Less R flank pain. RLQ pain too now. 99.5. Clear urine.
4/10: LGH only grew cx for 48' and then threw it out. Cx "Mixed Pathogens below clinical significance." CHOP notified. Back to school. Minimal R flank and RLQ pain.
4/16: huge tonsils, no white patches, sore throat since last night, bad HA, 99.5, no appetite. Missed school. Pre-op urine culture at LGH with syringe. Joint pain too.
4/18: “organs are spinning around each other” pain since last night. Tums and Zofran no help. Whiny. Still sore throat but improving. HA. To Ped. Abd US bc spleen and liver feel enlarged. Blood test for mono. US results: nothing acute. Spleen max size of normal. “Ureters not dilated” (?!?). Mono spot:neg Epstein Barr: Positive for recent mono Pre-op Urine “dirty but no infection “
4/24: only made it to school 1/2 day this week… c/o LUQ and L flank pain. Neck/throat swollen. Tired. Generally not feeling well. Today has pre-VUDS bloodwork and US. Creatnine back up to 1.18 and Cyststin-C is 1.73 (was 1.68 in March). GFR around 50. PTH still high, 94.3. US did not mention spleen unfortunately.
4/25: CHOP for VUDS. We realized that when he wakes and empties his leg bag ASAP, his ureters seem to THEN dump 100-200 cc urine into his bladder right as he gets up and moving around. VUDS: fully emptied bladder. Normal capacity 300. He held 350 and barely felt the urge. No cathing needed. Imperative to void Q2. Stay on prophylactic abx x 3 mos and reconvene.
5/5: Dx UTI. Rx Tetracycline. C/o frequency, urgency, stinging. Says urine cloudy x a few days. Udip +mod leuk + sm Nitrite + sm blood + Lg blood. No flank pain. (Sunday)
5/6: saw Ped. Urine cx sent “for 7d” “and for fungus” +R flank and LLQ pain. No fever.
5/8: feeling worse but Udip almost normal. Saw Infectious Dz Dr: ignore “neg cultures”. Could be bacteria in number below reporting guidelines but making him sick. It’s not fungal or there would be yeast balls in his kidneys on US. Bactrim prophylactic should be ok. He wants blood cult. With next infection to r/o systemic infection that presents through urinary system. Will discuss with Uro then contact us. He needs to understand Jack’s anatomy better.
5/9: Cx results STAPH EPI >100k Resistant to Tetrac. Changed to Cipro. Jack dicker everyday but stable. C/o bladder pain a lot. 99.5 + mild nausea.
5/10: abx changed to Levaquin, per Infectious Dz. By bed, Jack finally improving. Udip normal. No more mono issues.
5/13: Day #4 Levaquin. C/o ankle and finger pain.
5/16: 99.9' c/o uncreased joint pain. Obviously hurting. a little N. Watched soccer practice b/c R ankle so swollen.
5/17: Dx. Serum Sickness. Dx allergy to Levaquin. He's in pain. Dip WNL. Rx Prednisone.
5/21: AM: "last night my R kidney felt big- now R flank pain and urethra stinging." Dip +sm leuks only. AFTERNOON: pushing H20, no fever, no increase in discomfort. Urine frequency now. Udip same PM: Now bladder pain w/ frequency. increased burning an stinging. Dip WNL Pyridium per his request- did not help.
5/24: Dr N R kidney pain and now "large bladder that feels hollow" Urethra stings only with void. Pyridium x 2 *did not turn pee orange. UDip +Sm leuks. 99.3 c/o ankle, jaw and thumb pain.
5/29: c/o R flank pain 6/10, stinging with void. c/o R ankle, B/L thumbs, and HA x 2d.
6/10: to Dr for joint pain f/u. No urine s/s. C/o R flank, L knee, R ankle, B/L thumb pain. R/O autoimmune reactive arthritis. To Rheumatologist and blood work done at LGH. Creatnine 1.25 Autoimmune tests NEG.
6/19: at Dr for asthma test and re. anxiety. stopped Prozac for now. (? will help with joint pain?) "I don't have anxiety". Will restart for HA or belly aches.
6/26: Renal labs and CHOP and Limes test from Pediatrician.
7/1: Nephrology Appt. Creatnine ___
7/10: Physical- stable. Dx poison ivy on privates and face Rx Prednisone x 10d
7/12: Tonsils/Adenoids out
7/23: Rheumatology at CHOP.
7/27: 9pm sudden pyelo symptoms R flank pain, urgency, frequency, dysuria, cloudy. Udip +sm leuks, +++ protein, nonhemo blood. Cipro started. 101.8
7/28: AM Cipro but no real improvement. Pre sent us to Urgent Care to turn in UA for culture within 24 hours. Urgent care dx pyelo/Sepsis… sent us to ER for admit. Fever up to 103.8 pain 8/10 R flank. +N shivering so bad. Scaring me. HR 130 BP 110/60. Rocephin IV at 7pm.
7/29: around noon he starting improving some. 24’ culture results- Enterococcus Faecalis >100k. Ampicillin IV added at noon.
7/30: D/C’d Rx Amoxicillin x 9d. R kidney pain 5/10
8/12: CHOP enrolled in KIT4KID study. Labs/urine done. DM labs done too. DM labs neg.
8/17: cold s/s with SORE throat, joint pain. Exhaustion, 101, body aches. Dx COVID bc sister is +.
8/24: 1 week of soccer tryouts and dancing at wedding- acutely started with swollen R hell and could not put any weight on it. Ortho Urgebt Care. Dx Sever’s Dz. (Ligament is too tight, pulling heel growth plates together). Boot and crutches… obvious pain.
8/26: US done for f/u appt in 1 week.
9/4: CHOP Appts. Research: Start on 9/6. 3 mons of meds in hand. Urology: Unsure why R kidney hurts all of the time. States there is no possible ureter surgery (?). Ordered Bio Feedback to make sure he is emptying as much as possible. Ordered MRU to see everything and come up with plan. Rheumatology: low dose steroids for 17 days to try to "kick" the rest of his R ankle pain. He also has minimal pain when he presses on his thumbs. Nephro contacted us that his creatine is up to 1.2 with the research labs... will repeat in 1 month.
9/18: to Ped for increased R kidney pain. ? Virus starting? Nothing ordered.
9/20: to CHOP ER for increased R kidney pain and now bladder pain too. Constant urethral burning too. Ruled out anything acute. Nephro concerned divertic is pinching off bladder or ureter causing back ups.
9/22: Increased bladder & R kidney pain, increased stinging, cloudy urine. Dip +sm leaks, Sm blood. spec collected, Cipro started.
9/23: To Ped. cult sent. feeling worse. Dx UTI
9/24: PM started feelin better. Dip WNL.
9/25:Culture "# too low to count"
9/26: Per URO, stop Cipro since 3.5 days and now urine better. Conts with R flank, bladder pain and stinging always.
9/27: Nephro labs... creatinine down to 1/06. PTH 54.
10/1: GI bug +ND Zofran and Imodium. NO fever. No eating.
10/4: CHOP BioFeedback Jack was able to pee with a bell curve! After practicing relaxing.
MRU: IV&PO Versed not enough. Ativan next time. IV and catheter needed and laying on his belly x 1 hour.
10/16: sent home from school for R kidney pain and Nausea. Zofran and Tylenol effective. To Ped for asthma appt. Flu shot.
10/23: Video visit for MRI results: plan is to place stent in R Ureter on 10/31. It will stay in x 1 month. If it relieves kidney pain, reimplantation surgery.
10/31: 13th Surgery for him: Cysto at CHOP with R ureter stent… but… stents were too short for his LONG ureter. So… ??? He left in a SPTube to see if it would help alleviate the R kidney pain. He now appears to almost have 3 bladders, rather than just 2. If this does NOT helps the pain, then we discuss urostomy, nephrostomy and ureteral reimplantation. If this does help, then the terrible looking bladder needs intervention too.
11/11: Sent home from school. c/o Increased R Flank pain, increased urethra burning, body aches, fatigue. no fever. urine clear. Dip +Lg blood only. (*R flank has not gotten better since SPTube and he has contd to c/o "bad" urethra burning ever since surgery). Pediatrician sent culture and started Cipro x 10d. Dx UTI
11/12: Feeling worse but urine clear, not fever. Culture "<10k nonpathogens..."
11/13: Per URO not a UTI. D/C Cipro. See Dr Shukla on 11/18 to D/C SPTube and plan ureter surgery since SPTube did NOT help R flank pain. Jack’s urethra is still STINGING from OR.
11/18: CHOP appt Dr Shukla: SP Tube pulle. R Ureter Reimplantation surgery to be done with robot and both Drs on 1/7. Research labs done while there- urine a little cloudy.
11/19: c/o R Pyelo. cloudy. Dip +Lg Leuks +Lg Bad, +body aches (esp neck) "I feel ill", dysuria, R flank pain. Saw Ped. Dx Pyelo. Rx Cipro. U Cx: Staph Hominis
11/22: Cx results. "A weak skin bacteria that wouldn't make most people sick" but ONLY IV abx will work. He seems to be improving sine the 19th though... Per CHOP, let him fight this UTI at home. at first fever- straight to ER.
11/25: Admit 0300 to LGH for Pyelo. R/O sepsis. Sudden increased symptoms and fever. CHOP wanted us there but its the holiday and we needed to be local. IV Vancomycin.
11/26: 104.5' IV Daptomycin and IV Tetrayclin
11/27: 101.5' all day so no longer transferring to CHOP via ambulance.
11/29: Home with Midline in place for IV Daptomycin daily x 14 days total.
12/3: Home Health Nurse dressing change but now Midline leaking. She D/C'd it inserted 24g into L AC.
12/5: No more UTI s/s. F/U with Infectious Dz: Stop Dapto after today's dose and pull IV. F/U with them PRN.
2025
1/3: Sudden R Pyelo s/s. No fever. Cipro started. To Peds. CHOP Notified. UCx Enterococcus Faecalis >100k
1/6: Improved. Last Dose Cipro Tonight before AM surgery. Per CHOP, sent UCx to verify infection gone.
1/7: Surgery!!! R Ureter Reimplantation at CHOP. Removed 12" that were in a knot, left 10". A stent from the kidney to the bladder x 16 weeks. Stayed in hospital until1/10. Creating 0.88 and Cystatin C 1.6
1/24: Urethra stinging. Dip +blood and +protein. To CHOP ER r/o UTI. Cipro x 1 at home. Ucx sent (neg) Amoxicillin BID started in meantime. Creating 1.03. U/S and And Xray show stent slipped down out of kidney. F/U with surgeon in 2 weeks to decided if we remove the stent early or replace the stent for the rest of 16 weeks.
!!!!!!!!!!NO MORE CHONIC KIDNEY PAIN LIKE IN THE PAST 2 YEARS!!!!!!!!!!
2/4: saw Ped for old s/s x 5 days. Neg COVID, Flu, Strep
2/8: Telehealth Appt with Dr Shukla re. stent mint. creating 1.08.
2/24: Research Appt with labs. Nephro Appt: reatnie 1.08. Cystatin C 1.76 PTh 90.9 (high) Vit D 30.80n (low) Phos 5.5(high)
*********
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:
Flomax 1 tab QHS
Ditropan ER 5mg PRN
Bactrim DSDS 1 tab PO Day
Calcitrol 1 tab 4xs weekly
Iron 1 tab 3xs weekly
MVI 1 tab QHS
Flovent 2 puffs BID PRN
Albuterol MDI PRN
Probiotic daily
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 puff 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, start 3/14/19
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, 9/11/14, 10/13/16, 9/25/20, 11/29/20, 12/29/20, 4/28/2021, 10/13/21, 2/7/22, 12/24/22, 4/8/23, 6/6/23, 8/11/23, 9/6/23, 9/29/23, 10/30/23, 11/13/23, 12/3/23, 1/2/24, 2/25/24, 4/7/24, 5/5/24, 7/27/24, 9/22/24, 11/11/24, 1/5/25, 10/12/25, 10/29/25, 12/29/25, 2/11/26
UTI s/s with neg culture: 4/8/23 (admitted), 9/6/23, 9/29/23, 10/30/23, 11/13/23, 2/25/24, 10/12/25, 10/29/25, 12/29/25
Mild Sleep Apnea 5/21/12, 7/23/16
Failure to Thrive 4/10/12 D/C'd ____
Roseola 10/30/11
GERD
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, 9/17/14, 12/26/14, 3/8/16, 1/17/21
Pink Eye 6/22/11, 7/13/11, 2/23/12, 11/1/18, 1/31/19
Flu B 3/14/13, 11/1/13, "Flu" 3/9/22
Viral Hepatitis A 1/14/14
Acute Asthma 4/23/14, 3/8/16, 1/29/22
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, 11/9/16-11/23/16, 3/20/24-4/25/24
Ear infection 1/7/15(R), 7/2/15(R)
Fracture 7/23/15 Distal right thumb, 5/19/18 R middle finger tip, R thumb 12/2/20
Perianal strep 5/18/17, 6/13/17
Anal Fissure 7/11/17
Strep throat 5/18/17, 2/27/18, 7/28/18, 11/23/18, 2/23/21, 2/6/23, 6/16/23
R Shin pain x 7 months 1/28/19
Impitego 5/18/17, 1/22/19 left nostril and cheek and left index finger
Ring worm 7/21/21, 2/1/23
Adenovirus 6/14/23
Poison Ivy EVERYWHERE 7/10/24
Tonsillectomy/Adenoidectomy 7/12/24
Server’s Dz 8/24/24
R Ureter Stent 10/31/24-
EBV mono 3/?/26, 6/?/26, 2/11/26
*As of September 10, 2014: 6 surgeries, 15 UTIs, 57 Hosp admit days*
Doctors
Pediatrician: Eden Park Peds - Jessica Quirnin CRNP
1725 Oregon Pike, Ste. Lancaster, PA 17601-4206
Urologist: Dr Akeem Shukla
KOP LOCATION
CHOP 34th St. and Civic Center Blvd. Philadelphia PA, 19104-4399
http://www.chop.edu/service/urology/home.html
Nephrologist: Dr LaRosa
Prior Dr Bernard Kaplan and Dr Baluarte
CHOP KOP LOCATION
CHOP 34th St. and Civic Center Blvd. Philadelphia PA, 19104-4399
Orthopedic: Dr Vincent Battista
Orthopedic Associates of Lancaster
170 N Pointe Blvd, Lancaster, PA 17601
http://www.fixbones.com/
OLD Feeding Clinic/Anxiety Therapist: Chloe Tarson
Philhaven Ephrata Office
OLD Gastroenterologist: Dr. Flick
CHOP 34th St. And Civic Center Blvd.
Philadelphia, PA 19104-4399
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
OLD 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
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