For over a week now, Namine has had a cough that simply won’t go away. Her doctors believe it to be a viral infection, so we just have to let it run its course. It got so bad, however, that she was admitted to the hospital overnight. But before I get into the hospital stay, let me back up a bit.
Namine is no stranger to the croup. Many a winter’s morning, she’s woken up with its signature barky cough. What’s strange, this time around, is that she was fine all winter. Now that the weather has warmed up — relatively speaking, I suppose, having fluctuated as Wisconsin weather is wont to do — she’s come down with a particularly nasty cough.
Before ending up in the ER, we took Namine to see the pediatrician twice. She was given a steroid to help with the inflammation that often accompanies croup. Unlike previous times, it didn’t help with Namine’s cough at all.
The first time Namine saw the pediatrician, she didn’t have a fever or an ear infection. By the second time, she had both. She had a temperature of 102, despite being on a rotation of alternating Motrin and Tylenol — both of which normally help a fever, but this time neither did.
With a cough that wouldn’t quit and a fever that didn’t go down, we took Namine in to the ER. Her medical history complicated things, too: since she has a heart defect, she never has a blood-oxygen saturation level of 100%. Being post-Fontan, she typically has an O2 of about 94-96%. When she’s sick, we can expect that to be lower, but her O2 was dangerously low at 85%. Because of this, they put an oxygen mask on her.
Namine isn’t just a heart patient. She is described as having “lung disease,” which unfortunately isn’t a very helpful descriptor. In her case, it means that her airway and lungs suffered atrophy during the first two and a half years of life when she had a tracheostomy tube. Because she is susceptible to lung infections and other airway-related complications, they did a series of chest X-rays looking for signs of pneumonia or bronchitis. The X-rays indicated neither, but that still didn’t explain her persistent cough or low O2 saturations. Since she still needed the extra oxygen — and we haven’t had home oxygen since shortly after Namine was decannulated — they decided to admit her and keep her overnight.
I should mention that at this point it was about 4:00 in the morning. Namine was tired, but she was far more cheerful than I had any right to expect a sick and coughing ten year old to be. She was disappointed to not be going home, but since we had already discussed the possibility, it wasn’t completely unexpected. Namine slept for a few hours with the oxygen mask on, keeping her sats in the low nineties.
The following day (although it was actually the same day because we were admitted after midnight), the doctors decided to try taking Namine off her oxygen. If she could maintain her saturations in the low nineties, then they were okay with sending her home that evening. In the meantime, they gave her an incentive spirometer ↗ which exercised her lungs, helping the bronchioles to expand. A pulmonologist came by a little later and had her do a breathing treatment. When he left, he left Namine an Aerobika ↗, which would help to break up any gunk in her lungs, making it easier to cough up.
Namine spent the remainder of the day doing her breathing exercises every hour. She kept her saturations up in the low nineties, and by evening her doctors agreed that she could go home. She’s been home since. She’s still coughing, but not quite as often. Since she’s been doing her breathing exercises, she hasn’t suffered any further drops in O2.
Namine has since finished up the round of antibiotics for her ear infection, and her fever has dissipated. As far as anyone could tell, the cough was viral, not bacterial. Since there was nothing anyone could give her for it, she had to wait it out.
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