bleh.......

Today we explored the Infectious Disease department at Children's Mercy.  


The evil staphylococcusaureus is attempting to rear its ugly head!!

staphylococcusaureus

So we are fighting it by doubling our dose of clindamycin, and adding another weapon: rifampin.  Together, these two drugs/weapons are predicted to slay the evil staphylococcusaureus!!!

The side effects of the new drug are similar to the clindamycin, with one important distinction:  rifampin is known for turning your urine orange.

It can also turn your tears or sweat orange.  This should be interesting....

We go back to the orthopedic clinic on Wednesday of this week to see what they have to say.  We need to keep the staphylococcusaureus  at bay for at least a month before we can take out the plate, so keep your fingers/toes/arms/legs etc crossed for us!

(did you guess-- I love the guy's pronunciation of staphylococcusaureus )

finally!

We are home!
Mason will be taking clindamycin (antibiotic) for awhile, and he will be followed closely by both the orthopedic department and the infectious disease department.  They want him to stay out of school until Thursday or Friday, or later if he still is feeling bad.
The plan now is to keep him healthy and let that bone grow and consolidate.  That should take a couple of months, then another surgery to take out the plate.
We are all exhausted, but Mason is really still very tired.  


During one of the times Mason was very "animated" during his hospital stay, he decided his bacteria, staphylococcus aureus, sounds like a dinosaur name.  Click here to see what he means--he is right.  :)

sunday afternoon

Mason is back in his room, pain medicines are in and football is on.


Surgery went well!  The doc said it looked very clean, so she was able to close it up.  She said there was no more bone loss and no more infection apparent.  She irrigated it an extra time for good measure, put in some antibiotic-laced orthopedic cement beads and sewed him up. 


More good news is that the staph strain is not a Methicillin-resistant strain.  We are now going to cut out all the antibiotics except clindamycin, which he will begin taking orally this afternoon or tomorrow.  If he is able to tolerate that well he will probably go home tomorrow!  Wooohooo!


The plan at this time is to try to keep the staph at bay for a few months, until the bone consolidates in the distraction area.  Once the dr. feels that is at an acceptable level she will go back in and take out the plate and the cement beads.  Once the plate is infected there is no chance of leaving it in place, but we really need to keep it in there as long as possible, otherwise we would have to go back to an external fixator to keep it in place (no stretching, tho) because a cast can't keep it absolutely immobile.


After the plate is out, then he will continue to antibiotic therapy for a few more weeks or a month to make sure the staff is out of his system.  They have tests that we will be doing to monitor the bacterial load and inflammation in his system, so we will be able to react quickly if things don't go as planned.


Mason is ready to be out of here!!  Actually, he said if he didn't have to have surgery it wouldn't be a bad place to be.  Everyone here is soooo nice. I don't know why all hospitals can't do it the same way.  But we are looking forward to being home!  

Mason is in the surgery, we are in Ronald McDonald family room. Olivia and I worked at the Ronald McDonald house before but never imagined we would be on the receiving side.
Surgery should be about an hour or less.

10 is the new 8

Yep.  We are delayed.  Seems a couple of emergency appendectomies took our OR.  So instead of starving Mason for 8 hours, they are starving him for 10.  (his words)

Last night was pretty good.  Mason spiked a high fever around 11:30 but by 1:00 was pretty comfortable, and has remained fever free.  That's kind of how bugs do it, I guess.  The surgeon came by this morning and said the latest word is that the germ in Mason's arm is staph, although so far it does not show MRSA characteristics. (Yay!!) The culture is still growing, but this seems promising, and she *may* close his arm today if it looks good when she is in there.

Will keep you posted.

up and down...and up

Mason seemed to be doing well this morning until around 9:30.  Scott & Olivia arrived, and I headed off to grab a cup of coffee down the hall.  When I got back, Scott was holding the vomit bucket for Mason, who was complaining of an extreme headache.  His heart monitor alarm was blaring because of the pain and the vomiting elevated his heart rate, Olivia was in the corner trying to avoid eye contact with the vomit bucket, and Scott was left holding the bucket.

The infectious disease doctor happened upon all this, and asked if Mason had ever suffered migraines - he did when he was in elementary school, but hasn't had one in several years.  She said it could have been triggered from the stress of the situation. Mason didn't think it felt like a migraine, he thought he had a reaction to some medication.  He had just taken doses of 2 different antibiotics, cefazolin and clindamycin.  Since then he has had more of those same medications, and was fine.

At any rate, they took him off the morphine drip (goodbye for now) because that is known for headaches as a side effect.  After making sure he could keep it down, they gave him an oral vicodin (hello, old friend) and that seemed to do the trick - eventually.  He spent a good part of the day with an ice pack on his head or asleep.

However, he is now perked up considerably.  Could be because he got some afternoon visitors today, who came bearing gifts:

home made cookies

+ candy

= good living. Yay!!

Also, he has been given a reprieve from the land of IV!  He is currently, temporarily FREE of the IV and the heart monitor.  All he has tethering him is the wound vacuum, which continues to suck goo out of his arm. His pain level is good, his head quit hurting, all is well.

Mason can have nothing to eat or drink after midnight, in anticipation of an 8am surgery tomorrow.  We will know a lot more after the surgery.  Hopefully the last one for a while.  

in between

Mason had a pretty good night - as good as you can expect in the hospital with someone waking you up every couple of hours!!  And the word on the street is that Lamar's donuts are comin' his way. Sweet!!

Mason's surgeon came by this morning - his next cleaning is scheduled for 8am tomorrow morning.  After she goes in she will know what the next step is.  We are still waiting on the lab culture report. Preliminary reports showed strep, and it would be good news if that is all there is.  The doc said it is likely to show staph as well, so we will wait and see.  She has a plan for whatever the results are, we just have to wait on that to see how to attack.  She would not give me a go-home scenario/time frame yet. She said we would discuss after tomorrow.

We have seen some familiar faces since we've been here.  Mason's favorite care assistant has been in, and a couple of the same nurses he's had before.  Sadly, the receptionist in the surgery waiting area recognized us!  I could have gone all my life without being in a children's hospital.....but if we have to be in one, I will say this is a good place to be.  We are fortunate to have this available so close to home.

the low down

Mason has eaten dinner and is sleeping intermittently...a slave to the morphine drip, which is ok in this instance. When we got to bring him up to his room he was much more alert than he has been after the other surgeries. I think that can be attributed to the absence of toradol in his pain killer regimen.  They did have a little trouble getting the pain under control, but now he is using a pca pump - which is the magic button for the morphine.  

He is also getting IV naloxone to control the side effects of the morphine, and IV clindamycin, which is an antibiotic.  


The surgeon irrigated and debrided Mason's arm where the infection had set in - around the pin hole closest to his elbow, and near the plate.  We are speculating the infection started at the pin site, which is not uncommon for people who have external fixators. At any rate, she got it cleaned out pretty well, but there was a "defect" on his bone, meaning a hole in his bone, either from the infection itself, or from the body killing cells to fight the infection.  She assures us it is not a dire circumstance, that the bone will regenerate and be fine once we get rid of the infection. She also removed the screw closest to the defect, as it didn't have a good hold in the bone anymore.  


Mason now has a wound vacuum that is continually removing the fluid build-up in his arm - the pressure from the infection is super painful.  

The bone scrapings, nasty puss, etc. was sent out for culture to find out what the culprit is.   Looks like staph, we are HOPING it is not MRSA.  We should know sometime tomorrow what kind of bug we are up against.   We have another debridement surgery scheduled for Sunday morning.  If it looks really good when she does that one she may close up the wound and we can manage the antibiotics from home.  If not, he may stay for more IV antibiotics.  It all kind of depends on how the cultures come back, and how things look Sunday morning.  We are just going day by day.


I am hoping he gets a good night's sleep tonight....they are taking vitals every hour right now, but should be moving to every 4 hours soon, which will be nice.  He is having bad dreams every time he sleeps - from one of the medicines I suppose.  And the antibiotic put a horrible taste in his mouth that we are trying to get rid of.


Thanks for checking on Mason, and for all the texts, emails and such.  I'm hoping he doesn't go too stir crazy having to stay in the hospital for awhile.  Actually, I guess I hope he feels good enough to be stir crazy!!

Mason is now in room#10 in 5 Henson. He looks good and has already requested food. I will update about surgery info after I get my laptop out of the car, and after mason eats.

Mason just went back to surgery. Shouldn't take more than an hour or so, then another hour in recovery before he gets a room for the night. I will update after he is in a room.

another friday

Mason is scheduled for surgery tomorrow at noon at Children's Mercy (downtown).  He will check in about 10:30, and will be staying at least Friday night....we shall see how things go and how long his visit will be.  I will update after the surgery when we know more.  
Below is a random cute puppy to cheer me up. :)

another setback...

I was thinking something was not right because of the high pain level Mason has had this week, and then yesterday his incision/pin sites started looking menacing.  Today I took him into the doctor.

Mason has an infection in his bone where the plate is.  He will have surgery this Friday 1/21 to have it cleaned out, and will spend the night.  The doctor mentioned the possibility of another surgery on Sunday, depending on how things look inside, so we may be in for a weekend of hospital "fun".

This is a complication that was mentioned before each of his surgeries, but somehow you never think it will really happen.  Mason is overwhelmed.  I am overwhelmed.

aaaahhhhhh....

It must feel good to  have that wrapping off his arm!  Mason's "new arm" was unveiled at his appointment today, and he was pretty happy about that.  No cast, just a splint to wear when he leaves home. His arm looks straight and pretty darn good! His incision is longer than I was expecting, but it looks good.  The holes left from the pins were not closed up (to prevent infection), but they don't look too bad.  They will heal quickly.  Inside his arm, under the muscle, Mason now sports an "8 hole mini-fragger" plate with 6 screws holding his new bone together.  That will stay there indefinitely, even after the bone is fully grown in.  Sounds like name for a half brick game.

The pain after this last surgery has been harder to get away from.  The doctor thinks its because of having 2 surgeries so close together, that his body is just worn down a little. Today was a little better, especially since he got some freedom from that cast!  Mason was very thankful for the 2 snow days this week, because that gave him more time to try to recuperate.  We're just taking it day by day now.  He goes back in 3 weeks for another look.  He is still on restriction from everything except music (drums, piano) but he has to do those in moderation.


Thanks for reading along.  This has been a crummy way for Mason to spend his winter, but hopefully it will give way to a fabulous summer and sports-filled future!  I will continue to update progress as it happens!

rough night....

Last night about 8:30 Mason could wiggle his fingers, but he still had no pain.  Around 9pm (still no pain) I gave him the narcotic med prescribed, hoping to manage the pain before the nerve block wore off completely and it got bad.  Around 12:30 he woke up screaming from pain.  I gave him another pill, waited about 30 minutes, gave him 2 ibuprofen, waited 30 minutes, then called the hospital.  The nurse said she would page the on-call doctor, but after waiting another 30 minutes I gave him another narcotic pill, even though it had only been 1 1/2 hours rather than 4.  Around 2:30 he finally fell asleep, after horrible pain for 2 hours.  It was heartbreaking.

I woke him up about 6am to take another pill even though he was not in pain, and am going to keep him medicated every 4 hours, all day today so we don't have this problem again.  I guess that the down-side to not being inpatient is that you can't manage the sudden-onset post-surgical pain like a morphine drip does.  Things should start getting better from here.   I can tell you that when we have our visit on Wednesday, our surgeon is going to get an ear full regarding that on-call doctor who blew us off.  

home sweet home

We got home about 3:15.....yay to no hospital overnight!!


About 45 minutes into the surgery we got a call from the anesthesiologist that we needed to come upstairs to talk to him "real quick".  After I picked my stomach up from the floor we hurried up there, to find out he only wanted to talk to us about a nerve block, which wasn't brought up before this surgery.  Mason had one for his last surgery, and it was very successful at keeping the pain levels manageable.  So of course we were in favor, but geez....the guy didn't have to scare us to death.  English was not his first language, so I think he meant "real quick" in the sense that he just needed a minute of our time, not that it was an emergency.


Right now Mason has a post-surgery splint w/dressing, and has no feeling in his arm.  He has to be kinda careful not to smack himself in the face with it.  He should regain sensation tomorrow sometime.  Then we will have to be diligent with the pain meds. He goes back Wednesday to take off the dressings and get a splint, which he will wear for awhile....probably for a couple of months.  But, at least it is removable, so he can shower normally etc.


So we will focus on healing for a few weeks, then start therapy to see if this all worked like the doctor envisioned, and if Mason will be pain free. 


Edit--Here are a couple of pictures from today.  Before surgery:

And after surgery:  

You can't believe how heavy that thing is off the arm!!  Wow!

      

Surgery is done! Dr is very pleased with how it went. Mason is getting a nerve block, then off to recovery. Should be going home in a couple of hours!!

Mason went to surgery just a few minutes ago. The procedure is expected to take about 2 hours.

Déjà vu

We have to check in at the hospital at 8:00 am for a 10:00 surgery slot.  The doctor thinks it will be about a 2 hour surgery, and then he will be in recovery for awhile, then he will go home.  She doesn't think he will need to stay all night this time since no bones are being cut. (yay!)


Hopefully this time the early appointment will go smoothly so we can start on time! 

surprise!

Mason's next surgery is scheduled for day after tomorrow, (!!!) Friday, January 7 at 10:00am.


We were surprised to find that the ulna has "grown" as far as it can go toward the wrist, and Mason can stop wrenching!  On the x-ray the gap looks pretty wide - the doc says there is good bone growth in there.  I'm going to have to take her word for it, because I can't see that.  Looks empty to me.  She was very pleased with how things progressed (I can't help but add here, "especially since she wasted a week telling Mason to turn it the wrong way". Not nice of me, but....).

Anyway....they will take out the fixator and the pins, and put a new stainless steel plate over the new bone growth (both sides of the bone) to stabilize it, then release him with JUST A SPLINT!!  No cast! I thought Mason would be thrilled with that, but he is actually a little nervous.  I'm thinking the plate probably will hold everything together and the splint is insurance.  She did say no to contact sports for a while, and NO to collision sports (ie lacrosse).....not sure how long awhile is.


He will get a 2 week healing period before he starts back into occupational therapy.  That's when we will see if this all worked like we  hope.  Ugh.


So only one more day of the external fixator (yay) and no more painful bone wrenching (YAY)!!!