Friday, November 24, 2017

Daphne's appendectomy

Daphne and Nurse Mary

Every Thanksgiving, we give thanks for all of the good things in our lives. This year, we're especially thankful for doctors and nurses and Daphne's health...

[Before you continue reading, consider yourself warned. There are some graphic details and a gory photo ahead.]

On Saturday, November 18, I drove Daphne to the Melrose Hospital emergency room at 11:50 p.m.

Daphne had been sick all day Saturday, first vomiting several times during the wee hours of the morning and then developing a fever. She slept on the couch all day, uninterested in eating and only wanting ice cold water to drink. By early evening, her temperature was 103°F. When I got her up to take some ibuprofen, she said it hurt her tummy to sit up. Afterward, she went right back to sleep and her fever came down.

All day long, I went through possible diagnoses in my head – and on the phone with my sister, a nurse. Her fever seemed high for just a stomach bug. I knew strep throat was going around and that illness could explain her vomiting, fever, and lethargy, but not necessarily her stomach pain. Perhaps her stomach hurt from dry heaving at the end of her vomiting spell. By suppertime, I was debating taking Daphne to urgent care, but the hospital and clinic in our town don't have urgent care, making the closest urgent care a 45-minute drive away. I didn't think strep throat warranted a visit to the emergency room and I didn't think Daphne could sit long enough for a 45-minute drive.

By bedtime, her temperature was coming back up and she asked to be carried up to bed. I asked Daphne where her tummy hurt and she said, "Where my legs attach to my tummy." I asked her to point to the place and she touched her lower right abdomen. My thoughts turned to appendicitis, mostly because my cousin's 5-year-old son had been hospitalized for an appendectomy just a month ago. But Daphne wasn't crying or complaining – she actually seemed pretty comfortable as long as she was laying down.

During the night, I woke up to the sound of Daphne calling for me. I got up and went to her, but by the time I got there, she was sleeping again. I laid down next to her anyway. As I laid there, I listened to her interrupted breathing and thought, "Something's not right." As she slept, she was taking a breath in, holding it, and then letting it back out. I listened for a couple more minutes before letting my practicality give into my gut instinct. I got up, shook Glen awake, and told him I was taking Daphne to the emergency room. I called the hospital and told them I was bringing my 4-year-old in; she'd been vomiting, had a fever, complaining of abdominal pain, and was now breathing funny.

I started the van to warm it up. I wrapped Daphne up in her blanket and carried her downstairs. She asked about her winter boots, so I decided it wouldn't be the worst idea to at least somewhat dress for the frigid weather. I set her down on a kitchen chair to put her boots on and she promptly vomited clear yellow liquid all over her blanket and boots. I ran upstairs for a new blanket, wrapped her up again, and carried her to the van.

The monitors in the ER showed that her heart rate, blood pressure, and temperature were elevated, but the only number I can remember is that her temp was 104.2°F. The nurses started an IV and swabbed her nose for influenza. A lab tech drew blood. The doctor's exam ruled out strep throat, pneumonia, and ear infections. When the doctor pressed on her tummy, she said it hurt everywhere.

The lab work came back: no influenza, she was quite dehydrated, her WBC (white blood cell) count was below normal, but her CRP (c-reactive protein, a test that measures inflammation) was elevated. The doctor agreed that something was going on and we started talking about imaging to check her appendix. He wanted to rule out a bladder infection first, so we decided to collect a urine sample through a catheter, since it was probably going to be a long time before Daphne had any urge to go.

The urine sample was negative for infection. The doctor then said we had two choices: admit Daphne to the hospital, continue the IV fluids, and recheck her WBC and CRP in six hours – or do a CT scan right away to check her abdomen for the source of pain. Because her WBC count was low and her pain wasn't more intense during the "rebound test", he wasn't certain it was her appendix.

I went with Option B: do the scan right away so that we could either know for sure it was her appendix or rule it out. The scan only took a couple minutes, but since it was now 2-something in the morning, the radiology tech said the images would be sent to a doctor in Australia for interpretation, so it could be an hour before we had results.

I settled in to wait, but ten minutes later Daphne's ER doctor walked in with the CT scan report and said, "It looks like her appendix is the problem and it looks like it's ruptured."

The doctor ordered IV antibiotics and called the on-call surgeon in St. Cloud. At first he thought the surgeon would come to Melrose to do the appendectomy, but after the phone call he said that, because of Daphne's young age and the rupture, the surgery would be done at the St. Cloud Hospital. The next call was to the Melrose Ambulance for transfer to St. Cloud.

At this point, it was around 4 a.m. We usually get up for morning chores at 4:30 a.m., so I waited until 4:25 to call Glen and let him know what was going on and make a plan. Glen would do morning chores with our employee and I would go with Daphne. Glen then called his parents; his dad would come out to the farm to help with chores and his mom would pick up a few things for me from home and then meet us at the hospital.

Daphne heading to the ambulance

Sometime after 5 a.m., Daphne and I left in the ambulance for St. Cloud. Daphne continued to be quiet and sleepy.

The ambulance crew brought us to Daphne's room in the pediatric unit. We waited there until it was time to go to pre-op. We got to pre-op and found out that the surgery ahead of us had become complicated, so our wait in pre-op ended up being an hour and a half. Daphne continued to sleep and ask for water; she couldn't have water, so that made her pretty ornery.

Finally, the surgical team came to take Daphne to the OR. I walked with her up to the OR unit doors and gave her a kiss and a hug. She asked me, "Why aren't you coming with, Mom?" Using every ounce of composure I had, I told her that moms can't go into the surgery room. They rolled Daphne's bed through the big double doors and I let all of the worry I had held back for the past 12 hours spill out.

The surgeon had told us he expected the procedure to take 30 minutes. He would remove her appendix and, depending upon what he found inside, probably flush her abdominal cavity. I went with Glen's mom to the family waiting room. A little later, the waiting room hostess came to tell us that surgery had started. I closed my eyes, figuring sleep would be the best way to wait. I'm not accustomed to pulling all-nighters anymore, so my foggy brain dozed right off. I woke with a start 40 minutes later and realized nobody had come to tell us the procedure was over.

Another 20 minutes passed – the slowest of my life – before the call came from the OR that Daphne's surgery was over. The surgeon would come talk to us shortly and then we could go see Daphne in recovery.

The surgeon came and reported that the diagnosis of ruptured appendix was 100% accurate. (There had been some questions before surgery about what exactly was going on. Daphne's lack of intraperitoneal fat made it hard to see her appendix on the CT scan.) He gave us a picture from the laporscopic camera he used during the procedure and the picture below of Daphne's ruptured appendix after it was removed.

Daphne's ruptured appendix

He said that there was so much purulence (aka pus) inside her abdominal cavity that he used 4 liters of saline solution to clean out her insides, which made the surgery take longer than expected. A JP drain was inserted into one of Daphne's incisions to continue draining the fluid after surgery.

He also explained that the reason why Daphne's WBC count was so low in the ER was that her WBC had already peaked and fell, likely because she was in early sepsis.

Daphne in recovery

An hour later, Daphne finally started to wake up in recovery. Just as we rolled back into the pediatric unit, Glen, Dan, and Monika arrived to see Daphne.

Glen and Dan were pretty quiet, but Monika kept saying, "I can't believe my little sister went from being OK to needing surgery in less than a day!" I guess our kids are more familiar with the need for scheduled surgeries and less familiar with the need for emergency and urgent surgeries.

Daphne slept through the rest of Sunday.

Daphne sleeping in hospital

She slept a lot on Monday, too, and was downright ornery when she was awake – and rightly so. Her tummy hurt a lot. She didn't want to talk or eat or walk. I made her walk back from the bathroom during the middle of the night and she vomited again as soon as she got back in bed.

Tuesday started out with Daphne in a better mood. She ate a little and went for a walk to the playroom. Her good mood dissolved into ornery and tired by the afternoon.

My mood went from good to worse, too. The results from Daphne's Tuesday morning lab work showed that her CRP and WBC had gone up instead of going down. Our nurses said we would likely be spending Thanksgiving in the hospital. Daphne's surgery PA (physician's assistant) said they'd do more blood tests on Wednesday and make a decision regarding discharge then.

It looked like Wednesday would be more of the same. The morning started with another blood draw that made Daphne hysterical. Daphne cried every time we made her walk and pouted when I asked her to eat and drink. She refused to take her oral meds, insisting they just give her medicine through her IV. She told me she didn't want to go home.

Then, Nurse Kelsey said the magic words that turned everything around. "If you eat and drink enough, we can take the IV out of your arm, Daphne," Kelsey told her. Daphne literally started gulping down milk and Gatorade.

The next time we asked her to walk back from the bathroom, Daphne said she only wanted to walk in the hallway. Nurse Kelsey told Daphne, "I need to see if you can walk back from the bathroom before I can let you walk in the hallway." With that, Daphne almost trotted back to her bed and climbed up into it herself. (Prior this, I had been carrying her to and from the bathroom.)

In a matter of minutes, Daphne returned to being the silly, spunky girl we know. She had her nurses nearly rolling with laughter.

Daphne and Takoda, the therapy dog

Shortly after, the surgery PA came and said that since her CRP and WBC count were down, Daphne could go home.

Daphne's brave nurses – Cass and Kelsey – came to remove her JP drain and IV. Neither process was anything close to comfortable – mostly because the tape they used to hold those things in was the strongest ever. It was the first time we had to hold Daphne down. Daphne got so worked up that she got a bloody nose. Thank goodness Glen was there by then, because he's the bloody nose expert in our family. Daphne eventually settled down and we got her cleaned up.

Daphne with Nurse Cass and Nurse Kelsey

Daphne gave her nurses each a big hug and we headed for home.

Looking back on the past couple days, I am so incredibly thankful for many people: family and friends, who helped us out at home, came to visit Daphne, and lent long-distance support over the phone; our employees, whose help with farm chores made the week a lot more manageable; and all of the doctors, nurses, and hospital staff, who gave Daphne the very best medical care.

To all of the folks from the Melrose and St. Cloud Hospitals – most of whom are listed below – thank you from the bottom of my heart!

• Melrose ER Team: Dr. Wendlandt, Jolene, and Amanda
• Melrose Lab Tech: Nikki
• Melrose Radiology Tech: Hannah
• Ambulance Crew: April and Clay
• Surgical and Pre-Op Team: Dr. Schmidt, Dr. Lang (anesthesia), Yen (post-surgery PA), Eileen, a few whose names I can't remember and more we never met
• Recovery: her wonderful nurse whose name I can't remember Marie
• Pediatric Unit Nurses, PCAs, and Staff: Mary, Cass, Kelsey, Deb, Kristy, Janet, Kenzie, Marcella, Toshie, Jeannie, Jess, Michelle, Anna, Jon, Natasha and Emily (nursing students), Brittany (the lady with all the toys), and a few more whose names escape me
• St. Cloud Lab Techs: Erik and Judy

And, lastly, a huge thank you to Nurse Mary, pictured in the first photo above, for going above and beyond. Mary is an old dairy friend of mine, who I hadn't seen in a long time. (For you dairy readers, you might recognize her as a former Princess Kay of the Milky Way.) When Mary walked in for her shift as our night nurse on Sunday night, we were equally shocked to see each other. Her instant hug meant so much at that moment. Mary came back throughout our stay to visit, to sit with Daphne so I could shower, and to bring me lunch. She stopped in one last time as we were leaving for one last hug.

Seeing Mary this week reminded me that friends are friends forever, regardless of the interval between visits.

UPDATE: Unfortunately, there's more to this story... Read the rest here.

Saturday, November 11, 2017

A new lease on life

sunrise over dairy farm

Like the sun rising on a new day, a big change here on our farm has given us a new lease on life.

A couple weeks ago, we hired our first full-time employee.

This might not seem like a big deal to some, but it's a big change for us. For the past 12 years, Glen and I have done most of the work here. We get extra help as needed from family and friends, including a good friend who has done relief milking for us for over 10 years now.

But that was no longer enough.

To put it simply, our herd size has grown considerably over the past year. We’re now milking 100 cows. The reasons for this growth could fill another post with a complicated explanation of dairy markets and economics. What’s not complicated to understand, though, is that milking more cows means more work for us – more work than we could handle ourselves.

We trudged through the spring and summer with a workload that left us completely exhausted. Most days, it felt like we were barely getting through the day, or worse, falling behind.

I can’t even remember when we started talking about hiring full-time help. It came up during milking one morning. We’ve talked about hiring in the past, but never gave it serious consideration. This time, it was clear: We really need another person here.

We found that person a couple weeks ago. The young man we hired is a quick-learner, has a great sense of humor, and is fun to work with. In the short time we’ve been working with him, we already feel like he’s part of the family.

We also feel like we can breathe again. Instead of feeling constantly behind, it now feels like we’re moving forward. The exhaustion and frustration we felt before have been replaced with energy and satisfaction. Dairy farming is fun again.

I am so incredibly thankful we made this decision when we did. I'm thankful, too, for this young man's interest in working with us.

What's more, and just as important, is that we're once again finding time for the other things we enjoy. We took the kids out to eat. Glen got to go deer hunting. I've actually been cooking supper. Glen and I went to an auction – together! That counts as a date in my book.

Thank goodness for changes for the better and for more good things to come.