Good riddance to you, October!

I know I have not posted in a while and I apologize for that.  I tire of writing bad news about Joshua.  We had a few good days at the beginning of last week... then we started from scratch with the MRSA infection in the wound.  Last Wednesday evening when I arrived back from a one day trip home, I learned Josh had pus squeezed out of his wound that afternoon.  I was immediately concerned because there had not been pus in the wound for a week since the antibiotics should have cleared up the infection already.  Josh's heart rate was higher than usual which is a dead giveaway something is not right and he felt warm to me.  Turns out he had a fever of 37.9 C.  Here we go again.  Since it was night shift, I had to go through a nurse practitioner to get an order for vancomycin.  She initially resisted and wanted to wait until the morning for the doctor to order the antibiotic.  Um, no thank you, I am not interested in watching my son's vitals get progressively worse over the next 12 hours until the doctor orders the same medicine I know he needs right now.  Get the kid some antibiotics now, please.  I cannot stress how important it is for the parents to be aware of what is happening and to speak up when they disagree with a nurse/nurse practitioner/doctor/surgeon's opinion.  Only you have the unique overall knowledge of your child's baseline and tendencies.  Josh was given the vancomycin that night and had two doses in him before the doctor ordered the same course of antibiotics for him the next morning.  By then his fever had come down and his heart rate was closer to normal.  Getting the antibiotics in him quickly was crucial in preventing an episode like the first time when he was so ill for 48 hours.

Unfortunately, this time around the wound continues to have pus that needs to be squeezed out almost every day.  Our surgeon started making daily visits to open up the wound more, cauterize parts of the granulating tissue with silver nitrate, squeeze pus out of the wound, and redress it.  These visits are terribly painful and upsetting to Josh and, therefore, to me.  Since he is still not allowed any kind of sweet pain reliever because they can cause diarrhea, I requested he get a half dose of morphine before the wound care.  Our doctor agreed, but most of the time they only get it in him 5 minutes before the surgeon shows up and it hasn't taken effect yet.  Our surgeon is concerned about why the wound is not healing and the antibiotics have still not cleared up the pus after 5 days.  Her plan is to continue the bedside wound care through the end of the week and if that does not clear it up, Josh will have to go back to the operating room to find the source of the pus. The surgeon suspects it could be an internal stitch that is causing an inflammatory response, although she hasn't seen any evidence of that during her recent squeezing, cutting, and poking sessions.  I just really want the bedside care and antibiotics to work so he doesn't have to be opened up in the operating room again.  Then we literally do start over with the wound healing process and that would be a major setback.  But, setbacks are commonplace around these parts and never more so than in the month of October.  I enthusiastically welcome November's arrival.

This latest round of infection has necessitated countless needle sticks and blood draws.  These are always a source of stress and pain for Josh.  He required a venous blood draw for the blood culture, another blood culture from his PICC line, a wound culture, and multiple rounds of heel sticks for testing samples.  His hematocrit level has continued to fall so he needed two blood transfusions on Saturday which of course required a new IV and, thus, another needle stick.  My poor pincushion baby.

Despite all of the negative side of the wound and infection, Josh's feeding has continued progressing well and he is now up to 20 cc's of milk every 3 hours.  The doctors are very pleased with his progress even through the multiple infection episodes.  This is the incredibly important aspect of Joshua's overall healing process so we are very thankful the feeding is going well so far.  I never had any doubt Josh would excel at eating, he is always hungry like his Mama!  Now we have to get the infection under control and the wound healed this week.

Throughout all of this, Joshua has continued to exhibit the strong and sweet spirit so many people have come to admire and love him for.  Josh is such a tough kid and I am so very proud of him.  I feel very blessed to be his Mom.