Thursday, July 26, 2007

Impaired tympanic membranes and a cracked humerus

The long version, as promised. I have to back up a few days from the arm incident, though, to provide some information that will become relevant later in the story.

For those who may or may not recall, Luke had an ENT (that would be ear, nose, and throat doctor) follow-up on July 3. I apologize for not giving the following update at the time. You'll see why in a minute. As I predicted, when she learned that he had had two ear infections in the prior three months, she immediately said he needed to be booked for tubes. She also reiterated that he needs to be tested for allergies when he turns three, since his face is showing signs of allergies (whatever that means; she said she could tell just by looking at him). Guess he's just out of luck if he tests positive for cats!

Anyway, the surprise was she said he also has a sinus infection. Huh? We had no idea! I did comment that I had thought on and off during the previous week that he had a fever, but on the rare occasions that it read higher than normal, it was only like 99 or 99.5; nothing really worth bothering about given that he wasn't acting sick at all (good appetite, good energy, etc). He did have a runny nose, but it wasn't bad, and (forgive the TMI) it was clear, not cloudy or yellow like it was infected. According to the ENT, a recurring low-grade fever accompanied by a runny nose is the most common sign of a sinus infection in children. Great, NOW you tell me! It had been barely two weeks since he had finished the previous antibiotics for his ear infection at the very tail-end of May, so she put him on something different and stronger to try and wipe it out. Hopefully, that will hold until his procedure is scheduled. She gave me the scheduler's name and number to call directly to speed up the process and hopefully get him done in the following two weeks. Ha ha, the cosmic joke was on us.

First off, turned out that the scheduler chick was out of the office that entire week (being a holiday week here in the US for Independence Day). Her voice mail says to expect return calls to take up to two business days, and I figure that is when she is actually in the office. I decide to go on and leave a message on the 3rd, but I'd give her a week (that would be July 10) to call me back before I badgered her again. I also decided not to blog about the issue until I had a firm procedure date in hand, since I knew that would be everyone's first question.

Little did we know! (Anyone who has seen the movie Stranger Than Fiction now laughs every single time they see or hear that phrase! Ahem, sorry, moving on....) The week progresses, Luke is taking his antibiotic, and things seem hunky-dory. July 10th dawns, and on my calendar is a little reminder to call back the ENT scheduler girl that afternoon. Also on my schedule was a 9-10 AM Excel workshop that I was teaching at work (I do them every two weeks). We only get about 2/3 of the way through our example by 10 AM, and everyone agrees they want to stay on and finish it, so we continue. At 10:30, we are *almost* finished with the class, and my cell phone rings. I had given scheduler girl my cell number, since I knew the ENT was in something of a hurry to get his ears done, so I excused myself from the class momentarily, apologizing but explaining that I had been waiting for a very important call (I had told my boss that if she called, I would need take it, and she said that was fine). And I answered my cell without looking at the caller ID.

Imagine my surprise when it is not the scheduler girl, but the director of Luke's daycare center. Great, now what? This is not the first time they have called (as regular readers of this blog know). Most often, it is for a fever, but that seems unlikely given that he is *still* on antibiotics for his sinus infection. Occasionally, it is to tell me that they have had to use his spare outfit and to bring a replacement with me when I come to get him (which I appreciate). And once it was to tell me that they thought he needed stitches. So I had no idea what she was about to say, but it was not the following: "Luke jumped off the top of the slide and landed on his side on top of his elbow. He is holding it like it hurts, he won't move it at all, and he won't let us touch it." They thought he might have pinched the nerve or jammed his elbow. They said they would apply an ice pack and see how he was doing, and they would call me back with status. They just wanted to give me a heads-up that I might need to come get him if he didn't get back to his usual self. Lovely. I go back to my class, took about 15 minutes to finish up, and then called my boss to fill her in on what daycare had said. She is totally family-first, so she told me to just do what I needed to do.

Approximately 45 minutes had elapsed since the first call, and I had just hung up with my boss, when my cell phone rang again. Caller ID indicated daycare. This can't be good. Sure enough, he was not doing any better. She said that the real key was that he didn't want to play; he just wanted to sit at the table with his head down. That is just NOT like him at all. She said his arm was also just hanging limp by his side, and that he was holding his forearm constantly. I call the pediatrician, who says that if I even think it *might* be broken, I should take him to the ER. I call my husband to fill him in on the plan, I IM my boss saying I was leaving, I filled a cup with juice for Luke, and I ran out the door.

On my way to daycare, I realize that he probably won't get to eat lunch, and the last thing anyone wants to do is to put up with my injured soon-to-be napless child who has not eaten! I also figure lunch for me would be a good idea as well, since ER visits are never short, so I swing through Wendy's to pick up something for us. I even check with DH to see if I need to get him something, but he has arranged lunch for himself on the way to the hospital. When I arrived at daycare, everyone was rather shocked that I was not only calm, but that I had had the forethought to pick up lunch! (They offered to pack a sandwich or something for the two of us to take in the car, which I sincerely appreciated.) Hey, I'm the daughter of a nurse and a man who worked emergency management for decades. I generally know how to handle a medical crisis without losing my head. As long as no one seems to be in desperate pain or anything, I'm good. And Luke, other than holding and not wanting to move or touch his arm, seemed fine. He wasn't crying or acting distressed, just unusually calm and reserved, similar to when he needed stitches in his finger. Got him loaded in the car (that was a trial, since he didn't want to move his arm enough to put on the harness in the car seat), handed him some chicken nuggets, and off we went.

DH actually beat us to the hospital (which is no where near daycare, and added with the painfully slow Wendy's trip, allowed him plenty of time to arrive in Decatur from downtown Atlanta before I arrived from Tucker). We checked in with the ER desk right at 1 PM. They were blissfully empty! Only three people besides us in the waiting area, and they were clicking through them pretty quickly. We only waited 10-15 minutes. Then we had to wade through one of my pet peeves about the system. I understand why it is this way, but I hate reiterating the *same* story about what happened and what we think the problem is four different times to four different people! The check-in desk, the triage nurse, the doctor, and the radiologist. Just read the bloomin' chart, folks! Anyway, triage ordered us to the rapid treatment center, which is actually much more rapid this time than it was during our last visit back in 2003.

Doc comes in and examines him. She is as gentle as she can be, but she has to manipulate the elbow to try and figure out what is wrong. Much screaming and crying ensued, and DH was not handling things well. I can't say that I was either, internally at least, but I had more of a grip on the outside than he did, plus I knew there was absolutely no other way to diagnose the problem (something DH also knows in his head, if not his heart, while my heart told me it was the right thing to do, even if it hurt). And Luke, of course, simply cannot understand why this woman is insisting on hurting him.

She actually thinks that it is not broken, but is instead something referred to as "nursemaid's elbow," which (in layman's terms) is when a ligament gets caught in the elbow joint. The "cure" is to fully extend the elbow, almost to the point of hyper-extension, which will allow the ligament to slide out again. It would be fairly quick, but extremely painful. The upside is that once it slides back out, the pain immediately goes away and all is well. The downside is, obviously, LOTS of screaming from Luke. DH and I have one of those "quick and silent conversations composed of a single look" that married couples often have, in which we both agree that DH will have to leave the room if that is what they are going to do.

But, just to be on the safe side, she decides to send him to radiology to make sure nothing is broken. She leaves to write up the orders, and my cell phone rings. Yes, I had forgotten to turn it off when I came in the ER. Bad me! I figured it was either my father or my brother (I had intentionally NOT told my mother yet, since I wanted to have an answer for her (broken or not?) when I did), so I just answered, knowing I could just say "don't know yet, I'll call you back" and hang up. Nope! It was the ENT lady, wanting to schedule his tubes procedure. You have got to be kidding me! I very briefly explain that I am currently standing in the ER waiting to find out if he has a broken arm and that I will have to call her back (knowing all the while that it will be two more days before she can return my call once I finally am able to get back to her, ARGH!!).

Radiology was not fun, at all. Once Luke saw DH in the parking deck, he didn't want to be put down for any reason (he is definitely daddy's little boy). All exams to this point had taken place in DH's lap. Obviously, we couldn't do it that way in radiology; he had to lay on the table. And he screamed and he cried the entire time, bordering on hysterical. In order to try and keep him still for the x-rays, DH was up by his head, talking to him and holding the non-injured arm, while I was laying across his legs and holding the hand of his injured arm both for stillness and positioning (had to take off my wedding ring, but I did manage to keep my fingers out of the x-rays). And this x-ray tech (not the actual radiologist, who we actually never saw) was obviously not used to young children, so that didn't help any. He seemed to think that since it wasn't hurting him, Luke should be fine and not scared. Um, yeah, not-quite-3-year-olds don't think like that!

So anyway, x-rays were an ordeal, and the radiologist decided he wanted an ultra close-up of the elbow itself, so we had to go through it all twice. By now, Luke is just a zombie. They give him some children's ibuprofen (finally! why did that take so long?) and some juice while we wait, and I supply marshmallows from the diaper bag. The x-ray tech said everything looked fine to him, our doctor said everything looked fine to her, but she was waiting on official word from radiology. And to everyone's great surprise, the radiologist said he thought that the radius (that would be the larger of the two bones in your lower arm, for those who have forgotten your biology) might be cracked right at the knob of the bone where it meets the elbow joint. He wasn't positive, but he still advised that we see an orthopedist. Great.

They rig him up in a soft cast, which is basically a glorified splint. A hard bent core to support the elbow, wrapped in ace bandages. Add in a prescription for Tylenol with Codeine for pain, follow-up orders for the Ortho, and a CD of his x-rays (which I did download before giving to the Ortho, geek that I am), and we're all set to leave at 3:15 PM. Knowing that Luke would pitch a fit if we tried to get in separate cars (and knowing that we had already hit the daily max charge for the parking deck after two hours), we decide to leave DH's car and all leave in mine. I'd just get my brother to come get me and drop me off at the car later in the evening (have I mentioned how much I LOVE my brother now living locally?).

I don't even think we had left the parking deck before Luke was asleep. Poor baby! We decide to just have me go on and take the other car, since Luke now won't miss me. I actually had to call my husband after I got to the car to meet me at the back door to the deck since I had no cash for parking, but other than that, it was a good plan. I drove to the pediatrician's office, since it is right by the hospital, to see what we need to do about an ortho referral. We then went to Target to fill the prescription; I ran in and DH stayed in the other car with Luke. He did wake up while I was waiting, so they came in and wandered around, and I called the ortho's office for an appointment, which was scheduled for two days later. As we were leaving Target, Luke requested pancakes (IHOP is just up the road), and who were we to refuse at this point. It had been a long and trying Tuesday!

I did go on and send him to daycare on Wednesday. No point in missing a day of work for him to just sit around the house bored. I knew if he was acting like he was in real pain, they would call me. Otherwise, being distracted at school was probably the best thing for him. He did just great.

8:10 AM on Thursday was our appointment with the Orthopedic arm and wrist specialist at Emory. First off, this is the hugest doctor's office I have ever been in. They have *five* windows to help patients: three for check-in, one for x-ray only patients, and one for all other inquiries. The waiting room is half again the size of the bottom floor of my 1800 square foot house! And it has a fish tank bigger than my television (a 53" widescreen HD projection), which Luke adored. I actually didn't even have time to finish filling out the H&P (history and physical) before we were called back. The girl who saw us first (no idea of her "rank" (nurse, PA, NP, doctor, etc; her name badge didn't specify) was very nice, and she checked his arm very gently, merely making him whimper.

I gave her the x-ray disc, and she went to show them to the doctor. He came in and said that he couldn't actually see anything on the x-rays, but that hairline fractures on the knobs of the bones in children are virtually impossible to see on x-ray if they are not displaced (Luke's was not), so he would have to use what he termed "the caveman method" to check, which basically amounts to squeezing the bones at the joint to see what hurts. Joy. He squeezed all up and down Luke's arm, except the elbow, with no reaction from Luke. (He is very good with children, BTW. Not his first time, I expect! LOL) But when he got to the elbow, Luke whimpered and cried. He even pushed the doctor's hand away and said "NO!"

Based on said squeezing, the doctor said that it is actually the humerus (that is the bone in your upper arm) that is almost definitely cracked right at the knob of the elbow, but that the radius is also probably cracked (at the mirrored knob on the other side of the elbow). The injury itself didn't require a cast to heal properly, but given that Luke is only 2 and unlikely to "take it easy," he wanted to cast it to prevent any further injury and/or displacement should he take another tumble (and, being already cracked, it would take significantly less force to displace it than it did to break it in the first place). Displaced "knobs" like that require pinning (that would be surgically inserting rods to stabilize the pieces until they heal), which no one wants, so casting it is definitely the way to go. The rule of thumb used for children is that it takes one week per year of age for a break to heal, so we would be seen back in about three weeks for cast removal (that is this coming Monday, July 30). We picked blue for our cast color, got that applied, dosed him with some ibuprofen, and he went off to daycare (it wasn't even 9:30 AM yet).

ENT chick called back the next day, Friday, July 13. I decided that I had had enough medical trauma in my life for the month of July, so I booked his procedure for August 10. That is almost two weeks after he gets his cast off. Hopefully, we will all be recovered from the arm ordeal by then. The good news is that they do the tubes at an outpatient facility dedicated to children. They are done in order of age (the idea being that older kids can understand the idea of waiting and that they can't eat better than younger ones, which I definitely appreciate!), so until closer to time, we won't know exactly what time. They'll call the week before to let us know. Also, being run by people who understand children, they let parents go back with their child until the child is asleep with the anesthesia. Hospitals generally WILL NOT allow this (I've heard multitudes of mothers complain about this), so that made me feel significantly better.

The procedure and the tubes don't scare me. I had two sets myself, at ages 2 and 6. I actually distinctly remember breathing the general anesthesia before (what I assume is) the second time. I know it is routine, I know it is what he needs. But for some reason, being that this is MY child, that doesn't help a lot. I'm sure, as usual, I will be doing heaps better than most parents. I am familiar with the procedure, and medicine, doctors, hospitals, surgery, etc do not scare me in general. But that doesn't mean I have to like it when it is happening to MY son! LOL

And can we PLEASE go more than three months before the next medical emergency? I would greatly appreciate it.

Currently feeling: doctored out!


  1. Oh my goodness, what an ordeal!!! I'm so glad that the orthopedist appointment went so smoothly, comparatively! And glad that there won't be any pinning in Luke's future!! Sounds like you were way more a trooper than I would have been. =)

  2. Wow... poor little guy and poor you too. So hard when kids are in pain... almost worse than when we are, I think. (Says she who fell down the stairs today and is doped up on ibuprofen and SITTING on an ice pack...) You handled it all so well. High five, my friend.

  3. You certainly handle things better than I do! Poor Luke. I hope his hand is better now. {{Hugs}}

  4. You poor, poor things. What an ordeal for you all. My DH is the same and can't hang around if Marcus is really upset. I can tough it out because I know it has to be done to start fixing the problem, but I don't like it.

    I hope everything is beautifully healed when you go back. And I'm sure the tubes will go well. Marcus has had them twice, plus been under anaesthetic for the tonsils, so I'm getting better and watching him get knocked unconscious. Still don't like that either though.

    Hugs to you all.

  5. I have heard/read that dark circles under people's eyes can be an indication of allergies which could be what the ENT was referring too. I've also heard Eczema in smaller kids can be an indicator but I'm not sure how true that is.

    As for cat allergies, I have them, and have now two cats, but at the time of diagnosis, I had 3. I now have short haired cats which is better and I also bathe them(well one is realitively new so I haven't gone there yet but Isis who we adopted as a kitten has hadregular baths). I find it does help some. I also find it good to wash my hands/face after petting. Thankfully my cat allergy is not that bad, I'm thinking it's because I've been around them my whole life. Now the dust allergy and the allergies to basicaly everything green are harder to deal with. DS #1 seems to have inherited some of the summer allergies but he does really well with a benedryl before bed.

    I also wonder once you get the tubes in, if maybe his speech might not improve too so maybe speech therapy might not be required.

    Big hugs to you all though!! It sound traumatic!



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