Haha Pilgrim!
What I Did On My Summer Vacation
Went to school with O. Status quo (15-20 BM's day, 1-4 throughout the night, bleeding, no appetite and losing almost a pound a day).
The day before I was supposed to leave she comes down with mouth ulcers. I was just going to take her doc and then fly out.
Last day she wakes up. Shaking, cold, vomits a lot of green/yellow bile fluid and then high fever. Email GI and told to hold Tacro, wait and watch. Rest of the day is fine. Fine through the night.
Wednesday give GI update. Told O.K, to restart Tacro. Eating breakfast, take Tacro and immediately shaking and freezing. Go home. She vomits same as day before and temp of 104.7. GI instructs us to hold taco (drug reaction?), stay home wait and watch. Fevers throughout the day. Still told not to go to ER unless certain conditions are met. Dose with Tylenol, fever breaks. Up 6 times through the night to go to bathroom.
Thursday 5 a.m. Shaking, freezing, vomits (same as before), fever 103. 6 a.m. Shaking, freezing vomits (same as before) fever 104+. Call the on call and instructed to go to local ER we can transport if necessary. Remember she is in rural area. No GI in town or at this hospital.
ER gives iv fluids and zofran. Tests for everything known to man. CRP 198. They work with home GI and home on call GI. All cultures coming up negative. They figure bacterial translocation (basically colon so inflamed that bacteria gets through the walls and into blood stream and other organs). Started on round the clock IV broad spectrum antibiotics. There for 15 hours with lots of back and forth on whether to transfer to major university hospital 2 hours away. Decision is made to admit at local hospital.
Friday a.m., shaking, freezing, vomit, high fever. Lousy day. Home GI wants CT scan to rule out perforation, abscess, or fistula. On IV antibiotics she should be getting better. CT done last night. Terrible night...high fevers, vomiting, regular Crohn's stuff etc. Home GI wants her transferred next day.
This a.m. hospitalist reports CT is clear. Wants more testing. Wants general surgeon who treats IBD (remember I told you RURAL) to see O and maybe do scopes. Decision made not to scope since we just did them and have CT. He says "Just a REALLY bad Crohn's flare" and orders iv steroids for a few days. Get her to a point where she can take oral steroids. They consult with home GI. Home GI says clear CT is encouraging and he thinks we could keep her local and approves iv steroids for a few days. Waiting for some cultures and more labs to come back. Can you believe they send out labs?!
So she will remain inpatient locally (locally to school that is) for 2-3 more days.
Withdrawing from her semester. Coming home when discharged.
My Lesson learned: when going to E.R. if you can (i.e.: not anaphylactic shock or life or death) drive the extra distance to a major/university hospital. They are nice people here and most are trying but.......
Also, pay attention to inflammation y'all. This is what happens when it goes unchecked. She honestly is a very sick girl. I have confidence that the steroids will turn this around but they are steroids. Need an exit strategy.
GI's lesson learned: O always looks better than how she presents. Should not have let her be discharged last week. Should not have let her go to school. Bet he will never say IBS to me again.
I AM NOT BUYING A PUPPY OR A LEASH TRAINED CAT!