In and out of CHOP again

We had another unexpected admission to CHOP last week. Peter was fussy, temp on/off, and then began vomiting. If you get a fever with a central line, it pretty much automatically means that you need to obtain blood cultures and begin antibiotics for at least 48 hours. If nothing grows out of the culture, antibiotics can be stopped. Last time Peter continued antibiotics without anything growing because it was possible he had a pocket of infected fluid. This time though, he had been exposed to a cold, strep throat, and a GI bug with vomiting. After nothing grew out of the cultures, he was taken off antibiotics and sent home, looking pretty good for a kid who three days before was vomiting and two days before slept almost the whole day and had started retaining fluid. Peter almost always retains fluid when he gets hit with a virus or bacterial infection.

The good that came out of the admission was that we had a very astute GI attending (the director of the GI dept) who saw beyond the current illness and began discussions with our Boston team about Peter's overall illness and progress. This has helped us in the reevaluation of his TPN nutrition, which always seems to be such a delicate balancing act. Peter's liver numbers are good enough that there has been some question if he is actually getting enough protein, even though by the books he is receiving a huge amount. We are going to go ahead and try making some big changes, increasing his protein and increasing his calories by quite a bit, which hopefully will boost his energy and reduce the ascities. We have our fingers crossed. It seems worth a try, and if Peter can't handle it, then we can always go back down on the protein. Dr. Kamin is in complete agreement, and I think is glad to have another GI who also feels that Peter may need more protein, whether "the books" say he is getting enough or not.

We also met with Peter's CHOP surgeon, Dr. Flake, and discussed Peter's surgical issues with him. That is for another post, but the meeting was sincere and was actually suggested by Dr. Kim the last time we were in Boston. So, I must say, that as much as we always dislike an unexpected hospitalization, especially if Peter is acting ill, the admission gave us the opportunity to discover and address some needed tweaking in Peter's care.