Her nurses and doctors were amazing. Each one of them took her extensive health history seriously, researched what they needed to, approached her care in an all encompassing "covering every base possible" way, and even yielded to her primary doctors for all final decisions.
True to Phoebe form, her labs showed an array of levels that ranged from normal to very concerning. Not surprising to us, as we are used to these multiple variations of levels making it difficult to connect them all to one thing, leaving doctors scratching their heads saying "I don't know". In an effort to not leave us with an "I don't know", these doctors ran more specific detailed tests to see if we can pinpoint any reason for even one of her levels being too high or too low. (We are still waiting on these results and hoping to have them by the end of the week at the earliest.) While there is a very good chance of these tests not giving us any new information, because they never do with Phoebe, we still hold out a little hope that one day they will.
There was one lab level that was most concerning to the ER staff and had them contemplating admitting her to the pediatric floor. But, again like we are used to with Phoebe, the decision to admit is not always an easy one. With her compromised immune system and already being sick, admitting her could become very dangerous for her. To make the decision the doctors yielded to her immunologist, who said no. He did not want to risk admitting her when tests, images and symptom management could be done at home and through her doctors offices.
Symptom management. Something we are all too familiar with when it comes to Phoebe's care. Being undiagnosed and rare leaves very little treatment options available. In the ER symptom management includes IV fluids and fever reducing medication, with the hope the combination can break her high temperature and get us a few steps ahead of this thing. So when the IV finished, the fever came down, and the results of the routine tests, respiratory panel and urinalysis came back, the call to the immunologist was made. And with her immunologist declining admission, we began the process of discharge from the ER.
Our time home has been filled with trying to maintain Phoebe's hydration level while battling her temperature that continues to spike to over 103. It is not the easiest of tasks, and means little to no sleep for either of us. We have spoken to and seen a few of Phoebe's doctors, with more scheduled for tomorrow. (it is not as easy to get same day "hey my daughter was just in the ER" appointments as it should be). While we don't have a definitive answer, we do know some information.
What we know...
-What Phoebe is experiencing, her doctors call "her body shutting down". When she gets sick, her body doesn't do what it is always supposed to do. While she will exhibit some "normal" immune responses, they are not always for the reasons she should be experiencing them. And they are not always doing what they should be doing. Her body begins to attack itself instead of fighting off whatever is going on, which results in her entire systems becoming overwhelmed and her body just starts to cave into whatever illness(es) have taken ahold of her.
-She does have a virus, they just don't know which one. Her respiratory panel came back negative for all the test encompasses, but that just rules out the most commonly tested for ones.
-She is beginning to do her grunting and head bobbing breathing. This is an indication that her lungs are being affected and something we have to watch very closely since her right middle lobe collapses.
-Her lymph nodes are still enlarged (her normal), but they are beginning to grow into one another and there are more of them. We would need more imaging to check the size of the enlarged lymph node on her trachea and to check the rest of her body.
-Her liver and spleen, which they thought she had "grown into", (they were enlarged for many years) are in fact still enlarged.
-Her CRP is very high, showing there is inflammation in her body, but further testing needs to done to identify what, where and why.
-We need to add a 17th specialist to our list of doctors, to give not only her history a new pair of eyes, but to also see if they can make sense of her all of the place lab levels.
-She is still receiving all her regular daily medications, they are now more strictly regimented while we support her through this.
So round the clock temperature checks, alternating tylenol and motrin, and waking her up every thirty minutes to drink fluids, we hope to avoid another trip to the ER. Which, unfortunately, if we cannot keep the temperature "controlled" (keeping it from going to high or staying too high) and we cannot keep her hydrated enough, another trip to the ER will be inevitable.
So while she is curled up next to me in "that" blanket, I'm waiting for the alarm to sound to signal our 2:30 checks and medication administrations. Maybe after that I'll be able to get a couple hours of sleep before the alarm sounds again.