Saturday, September 21, 2013

Fever Protocol

I knew it was going to happen sooner or later, but I was hoping for much later.  We experienced our first fever emergency protocol.  While at a friend's house for a group playdate/dinner, Logan was acting particularly cranky and began to feel warm.  I took his temperature (101.2) and called the on-call oncologist as we have been instructed to do.  She told us that we would have to come in for antibiotics and a check of his blood count.  If the counts indicated so, he would have to be admitted to the hospital.  The dilemma we face living in approximately an hour away from our children's hospital: do we drive the hour to their ER, or go to our local ER about a mile away.  The doctor let me know that their protocol states, if we can get there within the hour, go there, if not, go local. Without spending too much time debating this, even though we are right on the edge and you never know with DC traffic, we opted for going there.  We suppose it would just be easier to deal with this where they already know us, especially for our first time.  Maybe next time we'll stay local. I left Ryan and Parker at the playdate, and headed off to the ER.

On the plus side, they take fever in chemo kids very seriously.  They knew we were coming so when we got there, we got vitals (Temp 100.5) and we got right back into a room.  No waiting.  I could get used to that! What I will never get used to, them making Logan wear a mask.  He DOES NOT LIKE wearing masks (and that's a significant understatement.) As soon as we were back in the room, it was time to get his port accessed for blood draws and to administer fluids and antibiotics.  For those of you that watched the port access video, that was a day at Willy Wonka's chocolate factory compared to this access. Even our first port access was not this bad.  While I didn't get video of this one, for obvious reasons, let me set the stage for you.  Two nurses, mommy and a child-life specialist armed with her bag of tricks.  Kicking, screaming, crying, flailing and a port that did not want to be accessed.  While the nurse was able to get through the skin with no problem, he could not get into the port.  After what felt like forever, he was in, but now he could get not the blood to flow.  A little more adjusting of the line and a lot more screaming and we were finally situated.  Blood was sent for counts and fluids started.

Thermometer and "tubie"
Once the access from hell was over, Logan was quite easy going.  Watched some TV, colored some pictures brought by one of the great family concierges, and even took some good naps (remember, this is all taking place 8PM-Midnight).  He was getting more lethargic and hotter as the night went on (102.5) so it was time for the Tylenol.  Three hours after arriving, we were cleared to go home.  Blood counts were not low enough to indicate infection so we did not have to be admitted.  What we will have to do is return the same time the next day for the same treatment.  He will get his blood counts checked again and a second dose of antibiotics.  Thankfully, they opted to leave his port access in so we do not have to go through another access. 

Why such a reaction for such a low fever?  We have always been very easy going about fevers and illness.  We rarely take our kids to the doctors (aside from Logan's NF related appointments).  We have seen fevers as high as 104 and managed them at home without a second thought of going to the doctor.  For Logan, that lax approach is no longer an option.  We have been instructed time after time, if he get a temperature that hits 100, we have to go the ER immediately.  When the doctor tells you to go to the ER, you don't argue.  Being on chemotherapy means Logan's blood is not able to fight off an infection that may have been introduced and even the mildest infection can become life threatening rather quickly. 

At least our return visit tonight will be easier, as we will not have to struggle through another access and we will be prepared this time with entertainment. Even better news, this silly fever seems to be gone.  Not looking forward to doing this EVERY TIME he gets a fever, especially with cold and flu season rapidly approaching.

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