Sunday and Monday were relatively uneventful days. Henry's Grandparents came over on Sunday. On Sunday night, Jeff and I gave Henry a bath, much to Henry's discontent. On Monday, Grandpa Kenski did the morning shift, and Grandma Kenski did the afternoon shift, so that I could prepare for class. Jeff returned back to work. Michael, the home nurse, came around 10AM. Henry weighed 5 lbs 6.5 ozs. I left for class around 4:30PM (class starts at 6PM). Jeff said that Henry had two stools that contained a bit more blood than Henry's previous bloody stools. I was surprised because Henry's stools had been blood-free earlier in the day. The blood specimens had moved in size from flecks to spots.
On Tuesday morning, I called Dr. Bianchi's office. He returned my call a few hours later. I told him about the increased spots. He said, "Oh darn. You are going to have to call the GI doctor." Called the GI doctor in the morning. Left a detailed message. Grandma Kenski came by in the afternoon. Grandpa Kenski came around 6:30PM to trade off with my mom. I changed Henry's diaper before my dad gave Henry a bottle. The stool in the diaper had a significantly larger amount of blood than I had seen previously. I woke Jeff up (he had just settled down to get some sleep) and said that we needed to take Henry to the ER. Jeff looked at the diaper contents and agreed. As Jeff and I packed up the diaper bag for our trip to the ER, Dr. Hassan (the GI doctor) called. I told him the situation. He said he thought it was most likely the Isomil; he said to give him a report about what the ER doctors concluded.
We headed out to the ER, arriving around 7:40PM. Jeff dropped us off and then went to park the car. As I entered the ER, I was not prepared for the chaos inside. I had been to less than ideal ERs before. For example, the HUP ER in West Philly isn't a good place to be; it's gunshot central. There were about 60 people packed into the waiting room at UMC, many of whom were coughing and hacking. Frankly, I'd take the gunshot people over the people with communicable diseases any day. People were laying on the floor, hunched over. I was upset. After all, the NICU staff told us that Henry should not be exposed to the germs of other people quite yet. This presented us with a bit of a dilemma. On the one hand, I didn't want Henry exposed to these germy people. On the other hand, the kid is anemic, and I couldn't have him bleeding through the night. I filled out one of the forms. Tried to find a place against a wall, away from the seats. A nice man offered his seat to us. I thanked him but explained that Henry wasn't supposed to be near people. While waiting for Jeff to return from the parking lot, some teenage girl curled up on the floor about three feet from where I was standing with Henry. As soon as Jeff arrived, he ushered Henry outside, while I waited for Henry's name to be called. I called the NICU, asking them if the ER was where we were supposed to go, considering Henry wasn't supposed to be around people. They said yes. That's where we had to go.
Several minutes later, a nurse named Chris called out Henry's name. I waved to Jeff to bring Henry inside. Chris was the registration RN. He took Henry's temp (37.1 degrees Celcius), weight (5 lbs 8 oz with clothes on), and head circumference (34 cm). We gave Chris the details. Rather than having us wait in the waiting room, he put us in a small room, not far from the check in desk and screening exam areas. As we were waiting, we could hear people coughing up a storm. One nurse walked by and said to someone, "I'm trying to stay away from the kid with chicken pox because I haven't had it yet." Great. Super. We closed the door to the small room. I guess you'd have to have been there to appreciate how horrifying the scene was.
Unfortunately, I forgot to pack the nipples to Henry's bottles, so I ended up breast feeding. Very thankful that we were in the small room by ourselves rather than the waiting room. Several ER personnel burst into the room without knocking. Jeff stood near the door, so that I wasn't completely exposed to the world. Henry didn't seem phased by the noise level of the ER. Jeff said that it probably reminded him of the noises of his first home.
A doctor named Rebecca Fung (who I assume was a resident) saw us first. She had been called from pediatrics by the ER staff because the ER was so overrun with patients. We went over Henry's list of issues. It is always a chore to answer the question, "What problems did he have while he was in the NICU?" Glad that Jeff was there, because listing out Henry's history is a two person job. A second doctor named Stephanie Castrillo (who I assume was also a resident) came into the room. Then, a few minutes later, a Dr. Cleo Hardin came in and was briefed by Dr. Fung.
We showed the doctors one of Henry's bloody diapers. It didn't look as bloody as it initially was, because a good deal of the blood had been absorbed into the diaper by this point. Dr. Hardin thought it was unlikely that the blood signified a return of NEC. She said that Henry was took "vigorous" and didn't look particularly sick, other than the blood in the stool. Plus, considering that the blood had been happening for a week now, she said that was uncharacteristic of NEC, which would be more aggressive in time span. She felt his belly. He is a bit guarded about his belly (preemies have had such negative experiences with touch from being poked in the NICU that they are often guarded). Eventually, he relaxed, and she said that his belly was nice and soft (a good thing). She didn't think that the amount of blood in the stool was particularly large. The stool had a bit of mucous in it, which suggested inflammation to her. She thinks that a food allergy is the most likely culprit.
I told her that I'd cut dairy from my diet a week ago. We were concerned about the blood because it was getting worse, not better. She thought that maybe Henry was having a reaction to the increased amount of soy in his diet. So now we have a possible soy allergy in addition to the dairy allergy. I told her that Dr. Wispe had said that Henry had to have fortification to the breast milk because of his metabolic bone disease. A problem, since most fortifications are made with either milk or soy. She ended up prescribing a formula called Neocate for his fortification. Neocate is much like Simulac's Alimentum. Essentially, this formula has all of the amino acids that the babies need, but the amino acids are already broken down, so they are easily absorbed into the intestines. No breaking down of the soy or milk proteins is needed. I believe that they often give this type of formula to short gut babies, because such babies don't have the intestinal space to break down regular foods.
I told Dr. Hardin the same thing that I've told several doctors and nurses in the NICU. If I have to eat meat, I'm willing to do so, even though I haven't eaten it in 26 years. She didn't think that it was necessary. It would put a stress on my system, considering that I don't have many of the enzymes to breakdown meat proteins at this point. She said to avoid soy milk, but that tofu had less soy in it and should be OK to consume on occasion. She also suggested almonds, which are high in protein and calcium.
Dr. Hardin took a look a Henry's tongue. He does indeed have thrush. A bit disturbing because I know that he had a white tongue in the NICU, but no one in the NICU ever said anything about it. She prescribed some medication for it.
All in all, although the ER was indeed horrifying, we really liked Dr. Hardin a lot and just wished we could find a primary care physician with the same level of expertise in infant care as she has.
Nurse Chris came back to help us with our discharge papers. He explained that it was unusual for us to have seen someone from pediatrics (he initially tried NICU, but there was only one attending doctor who couldn't leave the area); it was just because of their backlog of ER admits that things worked out for us on that front. Dr. Hans Bradshaw (Henry's resident from July in NICU) stopped by to say hello. He's working in the ER this month for his residency duties.
That's about it on the Henry front. Jeff gave Henry a bottle when we got home around midnight or so. I pumped and cleaned up the kitchen. Crashed on the couch for a little over two hours. Around 4:15AM, I went on Henry duty while Jeff went to the guest bedroom to get a little shuteye that is hopefully alarm-free.
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