February 14, 2008
Advantages of a Children’s Hospital
For a child who is seriously sick, a children’s hospital is better than a community hospital for care. A number of reasons account for this difference, including the following:
First, an emergency room at a children’s hospital is generally not as busy as an emergency room at a community hospital because the former just treats children whereas the latter treats adults and children. In addition, the attitude of the emergency room staff is different between those facilities. In a children’s hospital, the very act of treating sick little ones tends to soften the hearts of the health care providers. On the other hand, in a community hospital setting, the attitude of the staff is generally more hardened towards patients because they regularly experience unpleasant encounters with some of their adult patients, such as criminals, narcotic drug seekers, rude patients, and violent patients.
Second, because the health care staff at a children’s hospital specialize in pediatrics and do not deal with adult problems, the staff are not only knowledgeable and experienced with respect to children’s health issues but are also much more sensitive to the needs of the children’s parent(s). In a community hospital where the overwhelming majority of the inpatients are adults, the staff are less knowledgeable and less experienced with respect to children’s health needs, and they are also less attuned to the concerns of parents. In addition, because the patients are exclusively children, the atmosphere of a children’s hospital tends to be much warmer and friendlier in comparison to that found in a typical community hospital. Workload also makes a significant difference in staff’s attitudes. On the general pediatrics ward where Lydia stayed, the nurse to patient ratio was 1 to 4. In a community hospital on a similar medical ward, the nurse to patient ratio is higher than that.
Third, as a specialized hospital, a children’s hospital is designed with children in mind. The chest x-ray apparatus that included a seat for a child was just one important example. Others include the colors and animal designs found on corridors, elevators, and children’s rooms. Children’s hospitals also provide some extra amenities to families. One is high-speed Internet to connect families with loved ones. Another is a family resource center that has staff who provide assistance to families with respect to finding information about their child’s disease(s), to researching reliable medical websites, and to locating support groups, classes, and community resources.
Saturday, February 23, 2008
Photos: Rainforest Cafe, Love My Sippy Cup
DSC_0014The colors of the sippy cup and the straw appeal to Lydia, who is drinking water from the cup.
DSC_0017She's using two hands to drink comfortably from the sippy cup.
Although Lydia still drinks often from a bottle at home and in the car, she enjoys using a sippy cup on the days that she attends day care, and she relishes those opportunities when her mother allows her to use a standard plastic cup.
Note: SiowFong took these pictures on January 5, 2008 at the Rainforest Cafe in Tukwila, WA.
Day 10 of Illness
February 12, 2008 (Tuesday at 7:00 PM)
Day 10 of Illness
Lydia is continuing her remarkable recovery of the last 48 hours. She awoke this morning at 9:00, and she had enough stamina to make it through the day without taking one nap. Right now she is saying a lot of “no. . .no. . .no”, an indicator that she is tired, so she’ll have an earlier bedtime tonight than usual because of the lack of an afternoon nap today.
At her follow up visit with Dr. Julia Bledsoe, she was crying a good bit because the surroundings reminded her of her recent visit there last Friday. Dr. Bledsoe was pleased by her progress, and the only change she recommended was for us to give Lydia her albuterol, a medicine that opens the airways, three times a day for seven days to help Lydia clear her respiratory secretions better. To try to ease Lydia's discomfort, Dr. Bledsoe graciously gave Lydia a white Valentine's Day bear near the end of the visit.
Lydia’s appetite is stable. She drank 11 ounces of milk so far today (with one more bottle coming soon before bedtime), drank some of her mom’s homemade chicken noodle soup for dinner, ate two Skyflakes crackers, and consumed a number of raisins and grapes. She also took in 3 ounces of water.
Her activity level continues to increase. For the first time in a week, she asked her mom and I to read some books to her. For most of the day, she kept herself busy by playing with her toys. In addition, she is speaking more today than she did yesterday (asking a lot of questions, answering a number of them also, and speaking to herself when she is playing with her toys, particularly the Swirl and Whirl baking set that her mom opened for her last night).
Her cough is still present, but her breathing continues to remain at a normal pace (25 to 30 breaths per minute) without the use of any accessory muscles for respiration. Her mom and I are periodically doing a little chest physical therapy on her to try to help her evacuate her secretions in her lungs.
With respect to taking medications, she is not resisting taking the not-so-nice tasting cefuroxime (antibiotic), and she does not fuss much either with the albuterol, spacer, and mask apparatus. SiowFong and I think that she is getting accustomed to both of these things.
Day 10 of Illness
Lydia is continuing her remarkable recovery of the last 48 hours. She awoke this morning at 9:00, and she had enough stamina to make it through the day without taking one nap. Right now she is saying a lot of “no. . .no. . .no”, an indicator that she is tired, so she’ll have an earlier bedtime tonight than usual because of the lack of an afternoon nap today.
At her follow up visit with Dr. Julia Bledsoe, she was crying a good bit because the surroundings reminded her of her recent visit there last Friday. Dr. Bledsoe was pleased by her progress, and the only change she recommended was for us to give Lydia her albuterol, a medicine that opens the airways, three times a day for seven days to help Lydia clear her respiratory secretions better. To try to ease Lydia's discomfort, Dr. Bledsoe graciously gave Lydia a white Valentine's Day bear near the end of the visit.
Lydia’s appetite is stable. She drank 11 ounces of milk so far today (with one more bottle coming soon before bedtime), drank some of her mom’s homemade chicken noodle soup for dinner, ate two Skyflakes crackers, and consumed a number of raisins and grapes. She also took in 3 ounces of water.
Her activity level continues to increase. For the first time in a week, she asked her mom and I to read some books to her. For most of the day, she kept herself busy by playing with her toys. In addition, she is speaking more today than she did yesterday (asking a lot of questions, answering a number of them also, and speaking to herself when she is playing with her toys, particularly the Swirl and Whirl baking set that her mom opened for her last night).
Her cough is still present, but her breathing continues to remain at a normal pace (25 to 30 breaths per minute) without the use of any accessory muscles for respiration. Her mom and I are periodically doing a little chest physical therapy on her to try to help her evacuate her secretions in her lungs.
With respect to taking medications, she is not resisting taking the not-so-nice tasting cefuroxime (antibiotic), and she does not fuss much either with the albuterol, spacer, and mask apparatus. SiowFong and I think that she is getting accustomed to both of these things.
Photos: Rainforest Cafe, Look at My Tiger
DSC_0004Lydia is holding her Rainforest Cafe covered cup with both hands while wearing her special tiger birthday hat that was provided by the restaurant.
DSC_0023Am I a female version of Indiana Jones?
DSC_0028Now that's a better fit!
Note: SiowFong took these pictures on January 5, 2008 at the Rainforest Cafe in Tukwila, WA.
Photo note: It's helpful if both parents do not mind taking pictures of their child(ren). SiowFong took a number of Lydia's memorable moments at the restaurant (like these three images) while I was adjusting the two flashes to try to maximize the amount of light in this very dark eatery. If SiowFong had not taken these images, we would probably have missed documenting some of them.
The Road Back to Wellness
February 11, 2008
The Road Back to Wellness
Lydia’s journey back to her usual state of health made a good of bit progress today. Lydia was actually walking around this evening and playing with some of her old toys, including sitting in and moving her scooter by herself. I even saw her smile tonight, something that has not happened for days. This is the most activity that I have seen in her in the last week.
SiowFong said that she drank a good bit of milk and water today, and I saw her eating some goldfish crackers. She's continued to have her share of wet diapers commensurate with her increased fluid intake. Earlier today, she also ate a mandarin orange. I'm rather amazed by the apparent speed of her recovery. She still has a cough, and she still isn't saying that much, but it's hard to believe that this girl was tethered to tubes and wires just 24 hours previously at Children's Hospital.
SiowFong looks better than I expected because she had a nap this afternoon with Lydia. She's also off tomorrow so that we can bring Lydia together to see Dr. Bledsoe. She'll return to work on Wednesday.
The Road Back to Wellness
Lydia’s journey back to her usual state of health made a good of bit progress today. Lydia was actually walking around this evening and playing with some of her old toys, including sitting in and moving her scooter by herself. I even saw her smile tonight, something that has not happened for days. This is the most activity that I have seen in her in the last week.
SiowFong said that she drank a good bit of milk and water today, and I saw her eating some goldfish crackers. She's continued to have her share of wet diapers commensurate with her increased fluid intake. Earlier today, she also ate a mandarin orange. I'm rather amazed by the apparent speed of her recovery. She still has a cough, and she still isn't saying that much, but it's hard to believe that this girl was tethered to tubes and wires just 24 hours previously at Children's Hospital.
SiowFong looks better than I expected because she had a nap this afternoon with Lydia. She's also off tomorrow so that we can bring Lydia together to see Dr. Bledsoe. She'll return to work on Wednesday.
Photos: Rainforest Cafe, French Fries
DSC_0045aLydia is dipping a french fry into the ketchup.
DSC_0053Lydia scrutinizes the ketchup on the french fry.
DSC_0059Lydia is eating her ketchup-flavored french fry.
Note: SiowFong took these pictures on January 5, 2008 at the Rainforest Cafe in Tukwila, WA.
Photo note: Taking a series of photos documenting a child's actions is a common method used by children's portraiture professionals. For parents who do not have a video camera, this tactic is a good one to show their little one engaged in an activity.
Friday, February 22, 2008
Going Home!
February 10, 2008
Going Home !
Lydia’s pace of breathing was normal throughout the day, remaining in the twenty to thirty per minute range. Lydia’s need for supplemental oxygen also decreased this afternoon. When Kim, Lydia’s nurse, saw that Lydia’s oxygen saturation levels were at least 95 percent on room air when Lydia was awake, Kim decided to turn off Lydia’s oxygen to see how Lydia would do when she was napping, and Lydia’s oxygen saturation levels remained steady even during her second afternoon nap.
In addition, Lydia’s appetite was beginning to return as she drank another 8 ounces of milk late this afternoon. Dehydration was a problem of the past as Lydia had four saturated diapers today. Kim conveyed this information to Dr. Bishop, who had been doing her rounds on her patients all afternoon, and Dr. Bishop eventually asked that Lydia’s intravenous fluids be discontinued.
After Dr. Bishop examined Lydia around 4:30 PM, she gave me the good news that in light of Lydia’s progress, Lydia would be able to go home today with a prescription for oral cefuroxime, an antibiotic. When I informed SiowFong, who had returned home this morning to eat, shower, nap, and get various home tasks done, SiowFong was ecstatic! When Lydia learned that she was going home today, she was smiling with excitement. Happy about this turn of events, we left the hospital at 6:00 PM, 36 hours after we had arrived.
Going Home !
Lydia’s pace of breathing was normal throughout the day, remaining in the twenty to thirty per minute range. Lydia’s need for supplemental oxygen also decreased this afternoon. When Kim, Lydia’s nurse, saw that Lydia’s oxygen saturation levels were at least 95 percent on room air when Lydia was awake, Kim decided to turn off Lydia’s oxygen to see how Lydia would do when she was napping, and Lydia’s oxygen saturation levels remained steady even during her second afternoon nap.
In addition, Lydia’s appetite was beginning to return as she drank another 8 ounces of milk late this afternoon. Dehydration was a problem of the past as Lydia had four saturated diapers today. Kim conveyed this information to Dr. Bishop, who had been doing her rounds on her patients all afternoon, and Dr. Bishop eventually asked that Lydia’s intravenous fluids be discontinued.
After Dr. Bishop examined Lydia around 4:30 PM, she gave me the good news that in light of Lydia’s progress, Lydia would be able to go home today with a prescription for oral cefuroxime, an antibiotic. When I informed SiowFong, who had returned home this morning to eat, shower, nap, and get various home tasks done, SiowFong was ecstatic! When Lydia learned that she was going home today, she was smiling with excitement. Happy about this turn of events, we left the hospital at 6:00 PM, 36 hours after we had arrived.
Photos: Rainforest Cafe, Birthday Burger
DSC_0024Lydia is prepared for lunch since she is wearing a bib while awaiting her burger.
DSC_0034Lydia, her burger, and her french fries.
Note: These pictures were taken on January 5, 2008 at the Rainforest Cafe in Tukwila, WA.
Photo note: This was the most dimly lit restaurant in which we had eaten in years. Because of the dark forest green canopy that forms the ceiling of the restaurant and the low light levels to simulate a rain forest setting, the place was dark. Adding enough light to these pictures was often a challenge. I used two flashes, but I should have brought four or more to illuminate our table and the nearby surroundings adequately.
Hospital Stay: Day 2, Midday Report
February 10, 2008
Hospital Stay: Day 2, Midday Report
Lydia has been gradually improving her admission to Children’s Hospital and Regional Medical Center in Seattle yesterday. The areas of improvement include her appetite, her fluid status, her breathing.
Unlike yesterday, when Lydia neither ate nor drank anything, she arose this morning with more of an appetite. SiowFong noted that Lydia guzzled eight ounces of milk in two minutes! Lydia also drank a half ounce of water after finishing her milk.
With respect to fluid status, she has had three saturated diapers in the last twelve hours, one at 2:15 AM, one at 8:00 AM, and one at 11:30 AM. The intravenous fluids that she received in the last 30 hours have fixed the mild dehydration that she was having prior to her admission; as a result, her infusion rate was reduced today from 40 milliliters per hour to 20 milliliters per hour.
Her breathing, while not yet normal, has become much more relaxed. For example, her respiratory rate consistently hovers around 30. She no longer utilizes any of her neck muscles to assist her respiration. In addition, the flaring of her nostrils has ceased. Finally, the use of her abdominal muscles to assist her breathing has greatly diminished. The only other area of concern is that her oxygen saturation (which normally should be 98 percent to 100 percent) varies between 87 percent to 100 percent. When she is sleeping, it sometimes dips into the high 80s, which necessitates use of oxygen that is administered to her with a mask that is placed near her face (blow by oxygen). When she is awake, the number tends to average 95 percent. As long as Lydia continues to have any need for oxygen, she will not be allowed to go home.
Hospital Stay: Day 2, Midday Report
Lydia has been gradually improving her admission to Children’s Hospital and Regional Medical Center in Seattle yesterday. The areas of improvement include her appetite, her fluid status, her breathing.
Unlike yesterday, when Lydia neither ate nor drank anything, she arose this morning with more of an appetite. SiowFong noted that Lydia guzzled eight ounces of milk in two minutes! Lydia also drank a half ounce of water after finishing her milk.
With respect to fluid status, she has had three saturated diapers in the last twelve hours, one at 2:15 AM, one at 8:00 AM, and one at 11:30 AM. The intravenous fluids that she received in the last 30 hours have fixed the mild dehydration that she was having prior to her admission; as a result, her infusion rate was reduced today from 40 milliliters per hour to 20 milliliters per hour.
Her breathing, while not yet normal, has become much more relaxed. For example, her respiratory rate consistently hovers around 30. She no longer utilizes any of her neck muscles to assist her respiration. In addition, the flaring of her nostrils has ceased. Finally, the use of her abdominal muscles to assist her breathing has greatly diminished. The only other area of concern is that her oxygen saturation (which normally should be 98 percent to 100 percent) varies between 87 percent to 100 percent. When she is sleeping, it sometimes dips into the high 80s, which necessitates use of oxygen that is administered to her with a mask that is placed near her face (blow by oxygen). When she is awake, the number tends to average 95 percent. As long as Lydia continues to have any need for oxygen, she will not be allowed to go home.
Photos: Firegirl Lydia
DSC_0080Lydia borrowed this firefighter's hat from Fei Hung, her cousin who received it at a local county fair this past summer.
DSC_0082Lydia is giving her beloved Tigger the Tiger a noserub.
DSC_0089Look at how serious Lydia looks in this photo.
Note: These pictures were taken on November 22, 2007 in the kitchen of aunt Ginny's and uncle Johnny's home in Fairfax, Virginia.
Photo note: This set of photos illustrates the importance of having a clean, uncluttered background in order to focus the attention of the viewer on the person. In this case, the kitchen's plain white wall was a great backdrop for these images.
Hospital: Day 1
February 9, 2008
Hospital: Day 1
Lydia arrived in her room shortly before noon today in much better shape than when she had first entered the emergency room five hours earlier. The nursing assistant checked Lydia’s vital signs after placing Lydia in her white crib. After the vital signs were completed, Lydia wanted to get out of the white crib, which SiowFong had described as something that looked like a cage.
During the next hour, we met Kim, Lydia’s nurse with twenty years of experience in pediatrics, as well as Dr. Julianne Bishop, a hospital-based pediatrician who was Lydia’s attending physician. Dr. Bishop summarized Lydia’s situation to us, noting that the rapid test for influenza done in the emergency room was negative. (We later learned that the rest of the viral tests were also negative, including tests for influenza A, influenza B, parainfluenza, and respiratory synctitial virus.)
Dr. Bishop also commented that the chest x-ray done today showed a pattern consistent with viral bronchiolitis or viral pneumonia; however, in comparing today’s chest x-ray to the one done yesterday, Dr. Bishop noted that there was a slight shadow on today’s film in Lydia’s right lung that was not present yesterday, and this new finding was suggestive of a bacterial pneumonia. Because of this concern, Dr. Bishop ordered cefuroxime, an antibiotic, for Lydia in addition to continuous monitoring of Lydia’s respirations, the intravenous fluids to treat and prevent dehydration, and the oxygen to support Lydia’s breathing.
Lydia slept in her stroller for the early part of the afternoon. We later moved her to the crib, and she did not resist. Although Lydia did not eat or drink anything today, the intravenous fluids provided plenty of hydration such that Lydia was having wet diapers. SiowFong and I were happy that Lydia’s condition had improved greatly.
The most difficult aspect of the hospital experience involved SiowFong, who remained with Lydia overnight, as her sleep sofa was missing a mattress. Because the hospital was also full of other sick children, many of whom were afflicted with acute respiratory infections like Lydia, and their parents, no other mattresses were available, and SiowFong barely slept during the night because of sleeping in an uncomfortable position and because of the noise from the alarms on Lydia’s monitors when her oxygen saturation levels would periodically but transiently dip below 90 percent.
Hospital: Day 1
Lydia arrived in her room shortly before noon today in much better shape than when she had first entered the emergency room five hours earlier. The nursing assistant checked Lydia’s vital signs after placing Lydia in her white crib. After the vital signs were completed, Lydia wanted to get out of the white crib, which SiowFong had described as something that looked like a cage.
During the next hour, we met Kim, Lydia’s nurse with twenty years of experience in pediatrics, as well as Dr. Julianne Bishop, a hospital-based pediatrician who was Lydia’s attending physician. Dr. Bishop summarized Lydia’s situation to us, noting that the rapid test for influenza done in the emergency room was negative. (We later learned that the rest of the viral tests were also negative, including tests for influenza A, influenza B, parainfluenza, and respiratory synctitial virus.)
Dr. Bishop also commented that the chest x-ray done today showed a pattern consistent with viral bronchiolitis or viral pneumonia; however, in comparing today’s chest x-ray to the one done yesterday, Dr. Bishop noted that there was a slight shadow on today’s film in Lydia’s right lung that was not present yesterday, and this new finding was suggestive of a bacterial pneumonia. Because of this concern, Dr. Bishop ordered cefuroxime, an antibiotic, for Lydia in addition to continuous monitoring of Lydia’s respirations, the intravenous fluids to treat and prevent dehydration, and the oxygen to support Lydia’s breathing.
Lydia slept in her stroller for the early part of the afternoon. We later moved her to the crib, and she did not resist. Although Lydia did not eat or drink anything today, the intravenous fluids provided plenty of hydration such that Lydia was having wet diapers. SiowFong and I were happy that Lydia’s condition had improved greatly.
The most difficult aspect of the hospital experience involved SiowFong, who remained with Lydia overnight, as her sleep sofa was missing a mattress. Because the hospital was also full of other sick children, many of whom were afflicted with acute respiratory infections like Lydia, and their parents, no other mattresses were available, and SiowFong barely slept during the night because of sleeping in an uncomfortable position and because of the noise from the alarms on Lydia’s monitors when her oxygen saturation levels would periodically but transiently dip below 90 percent.
Photos: Christmas, Opening Gifts 2
DSC_0003Lydia: precision present unwrapping personified
DSC_0018Mommy is trying to open a gift for Lydia that Lydia had just unwrapped.
DSC_0033Daddy is watching Lydia as Lydia unwraps the large Doodle Pro gift from Angelica Hernandez, one of daddy's coworkers.
DSC_0056Lydia is holding a bunch of colorful plastic forks and spoons while sitting in front of the large Doodle Pro.
Note: These pictures were taken on January 1, 2008 in the living room of our home.
First Emergency Room Visit
February 9, 2008
First Emergency Room Visit
We arrived at Children’s Hospital’s emergency room at 6:30 AM. In the waiting room, there was only one other family. (The best time to go to an emergency room for medical care is between 4:00 AM and 7:00 AM since this is usually the time when the staff are the least busy during the day.)
After SiowFong dropped us off, she parked the car while I pushed the stroller, in which Lydia was seated, into the emergency room’s reception area. Immediately upon our arrival, the check-in receptionist gave me paperwork to fill out on behalf of Lydia and data entered her information into the computer to generate her patient identification bracelet and a number of other patient identification labels. Within fifteen minutes, the first nurse had placed the bracelet on Lydia’s right hand, was checking Lydia’s vital signs (temperature, heart rate, breathing rate, blood pressure, and weight [22 pounds, which was two to two and a half pounds less than her usual weight]), and asking SiowFong and me about Lydia’s problems.
Ten minutes later, we were in exam room 7, a private exam room. A procession of different staff entered to attend to Lydia’s needs. A second nurse connected Lydia to the electronic monitor so that the staff could continuously check Lydia’s heart rate, breathing rate, and oxygen saturation (a measure of how well oxygenated her blood is). A pediatric resident physician who was doing her emergency room rotation then interviewed us about Lydia’s illness and past medical history and performed a brief physical exam on her. The emergency room clerk then received the paperwork that I had filled out a few minutes ago.
Lydia’s vital signs were not encouraging. She had a fever of 104 degrees Fahrenheit, which was effectively treated with oral Children’s Tylenol suspension in the emergency room. Her heart rate ranged between 180 beats per minute to 200 beats per minute (normal for a toddler is around 120) on the monitor. The monitor also revealed that her breathing rate was frequently in the 50s and 60s, peaking into the low 80s at times (normal for a 2-year old girl is around 30). Finally, her oxygen saturation, which should be at 98 to 100 percent, was around 85 to 90 percent; as a result, the second nurse connected one end of tubing to the oxygen port and the other end to an oxygen mask, placing the mask near Lydia’s face. The nurse then turned on the oxygen so that the flow was at a near maximum of 10 liters per minute. This blow-by oxygen arrangement brought Lydia’s oxygen saturation up to around 95 percent, much better but still not normal.
At 7:00 AM, a change of shift occurred in the emergency room. Around 7:15 AM, Starr, a third nurse who was Lydia’s main emergency room nurse, introduced herself to us and explained to us that Lydia would be receiving a one-hour breathing treatment, during which she would be inhaling two medicines, albuterol and atrovent, to help open up her airways. Within minutes, a second pediatric resident physician arrived along with the attending physician, Dr. Brown. After observing Lydia and hearing about Lydia’s symptoms, both doctors informed us that they were concerned about how hard Lydia was working to breathe; in addition, they mentioned that Lydia would have to be admitted to the hospital for at least an overnight stay until her breathing normalized.
After Lydia’s breathing treatment ended, she had to have a chest x-ray done. While SiowFong was pushing the stroller, in which sat Lydia, Starr, the nurse, was following SiowFong and pushing the tall stand with wheels that was carrying the intravenous pump, electronic monitor, and oxygen tank. After arriving at the radiology department, Lydia clearly communicated to us that she disliked the chest x-ray experience. She fought almost continuously to escape from the chair into which she was placed for the x-rays, and two people had to hold her arms up while the x-rays were done.
After returning to the emergency room, Lydia had two more things done to her. The first was the suctioning of her nostrils to obtain specimens for laboratory testing of influenza A, influenza B, parainfluenza, and respiratory syntitial virus. The second was the placement of an intravenous catheter so that Lydia could receive intravenous fluids to treat her mild dehydration. Lydia cried and fought against these interventions as well, but after they were completed, she gradually calmed down.
By 10:30 AM, we were notified that a room was ready for her, and by 11:00 AM, we arrived at room 2007 in the Giraffe section of the hospital, a private room.
First Emergency Room Visit
We arrived at Children’s Hospital’s emergency room at 6:30 AM. In the waiting room, there was only one other family. (The best time to go to an emergency room for medical care is between 4:00 AM and 7:00 AM since this is usually the time when the staff are the least busy during the day.)
After SiowFong dropped us off, she parked the car while I pushed the stroller, in which Lydia was seated, into the emergency room’s reception area. Immediately upon our arrival, the check-in receptionist gave me paperwork to fill out on behalf of Lydia and data entered her information into the computer to generate her patient identification bracelet and a number of other patient identification labels. Within fifteen minutes, the first nurse had placed the bracelet on Lydia’s right hand, was checking Lydia’s vital signs (temperature, heart rate, breathing rate, blood pressure, and weight [22 pounds, which was two to two and a half pounds less than her usual weight]), and asking SiowFong and me about Lydia’s problems.
Ten minutes later, we were in exam room 7, a private exam room. A procession of different staff entered to attend to Lydia’s needs. A second nurse connected Lydia to the electronic monitor so that the staff could continuously check Lydia’s heart rate, breathing rate, and oxygen saturation (a measure of how well oxygenated her blood is). A pediatric resident physician who was doing her emergency room rotation then interviewed us about Lydia’s illness and past medical history and performed a brief physical exam on her. The emergency room clerk then received the paperwork that I had filled out a few minutes ago.
Lydia’s vital signs were not encouraging. She had a fever of 104 degrees Fahrenheit, which was effectively treated with oral Children’s Tylenol suspension in the emergency room. Her heart rate ranged between 180 beats per minute to 200 beats per minute (normal for a toddler is around 120) on the monitor. The monitor also revealed that her breathing rate was frequently in the 50s and 60s, peaking into the low 80s at times (normal for a 2-year old girl is around 30). Finally, her oxygen saturation, which should be at 98 to 100 percent, was around 85 to 90 percent; as a result, the second nurse connected one end of tubing to the oxygen port and the other end to an oxygen mask, placing the mask near Lydia’s face. The nurse then turned on the oxygen so that the flow was at a near maximum of 10 liters per minute. This blow-by oxygen arrangement brought Lydia’s oxygen saturation up to around 95 percent, much better but still not normal.
At 7:00 AM, a change of shift occurred in the emergency room. Around 7:15 AM, Starr, a third nurse who was Lydia’s main emergency room nurse, introduced herself to us and explained to us that Lydia would be receiving a one-hour breathing treatment, during which she would be inhaling two medicines, albuterol and atrovent, to help open up her airways. Within minutes, a second pediatric resident physician arrived along with the attending physician, Dr. Brown. After observing Lydia and hearing about Lydia’s symptoms, both doctors informed us that they were concerned about how hard Lydia was working to breathe; in addition, they mentioned that Lydia would have to be admitted to the hospital for at least an overnight stay until her breathing normalized.
After Lydia’s breathing treatment ended, she had to have a chest x-ray done. While SiowFong was pushing the stroller, in which sat Lydia, Starr, the nurse, was following SiowFong and pushing the tall stand with wheels that was carrying the intravenous pump, electronic monitor, and oxygen tank. After arriving at the radiology department, Lydia clearly communicated to us that she disliked the chest x-ray experience. She fought almost continuously to escape from the chair into which she was placed for the x-rays, and two people had to hold her arms up while the x-rays were done.
After returning to the emergency room, Lydia had two more things done to her. The first was the suctioning of her nostrils to obtain specimens for laboratory testing of influenza A, influenza B, parainfluenza, and respiratory syntitial virus. The second was the placement of an intravenous catheter so that Lydia could receive intravenous fluids to treat her mild dehydration. Lydia cried and fought against these interventions as well, but after they were completed, she gradually calmed down.
By 10:30 AM, we were notified that a room was ready for her, and by 11:00 AM, we arrived at room 2007 in the Giraffe section of the hospital, a private room.
Photos: Christmas, Opening Gifts 1
DSC_0005Christmas on New Year's Day
Lydia is sitting in dad's lap and looking at an article of clothing that she received as a gift.
Since we were not home during Christmas, this was the first opportunity that Lydia had to open her presents after we returned home.
DSC_0014Lydia is carefully unwrapping a gift while SiowFong is examining a set of purple clothes that Lydia had just opened.
DSC_0016Lydia's method of opening presents is slow and methodical as she tears open the gift wrap piece by piece.
Note: These pictures were taken on January 1, 2008 in the living room of our home.
Acute Respiratory Distress
February 9, 2008
Acute Respiratory Distress
Many Americans realize that heart disease is the number one killer of adults in this country. The American Heart Association, a nonprofit organization whose goal is to educate the public about heart disease, mailed a letter to our home today. Enclosed with that letter was a slip of paper entitled “Heart Attack Warning Signs”, a list of the common symptoms that could indicate that a person was having a heart attack. Those symptoms included chest discomfort, discomfort in other areas of the upper body, shortness of breath, breaking out in a cold sweat, nausea, or lightheadness. The notice continued, “If you or someone you’re with has one or more of these signs, call 9-1-1. . .Get to the hospital right away.”
Most children fortunately are not afflicted with heart disease. Much more common are respiratory diseases. Signs of a “lung attack” include coughing, cyanosis (lips, fingernails, and / or toenails turning blue), a fast rate of breathing, a fast heart rate, nasal flaring (this occurs when the muscles around the nostrils move to open the nostrils further), preference for the sitting position, shortness of breath, use of other muscles to assist breathing (such as those in the neck and abdomen), and wheezing.
Around 2:00 AM, Lydia awoke in respiratory distress. She was breathing fast (at 50 to 60 breaths per minute), coughing several times a minute, sitting up in bed, and using her neck, nose, and abdominal muscles to help her breathe. In addition, her heart was racing around 180 beats per minute. SiowFong and I gave her four puffs of her albuterol inhaler that we administed through her spacer and mask, but Lydia fought us the entire time. Then we put her back to sleep.
At 5:00 AM, Lydia awoke again with the same symptoms that disrupted her sleep at 2:00 AM. After giving her three more inhalations of albuterol, we observed her. Since she did not improve by 5:30 AM, we decided to bring her to the emergency room at Children’s Hospital and Regional Medical Center in Seattle, a facility that is among the nation’s top ten children’s hospitals as rated by US News and World Report.
Acute Respiratory Distress
Many Americans realize that heart disease is the number one killer of adults in this country. The American Heart Association, a nonprofit organization whose goal is to educate the public about heart disease, mailed a letter to our home today. Enclosed with that letter was a slip of paper entitled “Heart Attack Warning Signs”, a list of the common symptoms that could indicate that a person was having a heart attack. Those symptoms included chest discomfort, discomfort in other areas of the upper body, shortness of breath, breaking out in a cold sweat, nausea, or lightheadness. The notice continued, “If you or someone you’re with has one or more of these signs, call 9-1-1. . .Get to the hospital right away.”
Most children fortunately are not afflicted with heart disease. Much more common are respiratory diseases. Signs of a “lung attack” include coughing, cyanosis (lips, fingernails, and / or toenails turning blue), a fast rate of breathing, a fast heart rate, nasal flaring (this occurs when the muscles around the nostrils move to open the nostrils further), preference for the sitting position, shortness of breath, use of other muscles to assist breathing (such as those in the neck and abdomen), and wheezing.
Around 2:00 AM, Lydia awoke in respiratory distress. She was breathing fast (at 50 to 60 breaths per minute), coughing several times a minute, sitting up in bed, and using her neck, nose, and abdominal muscles to help her breathe. In addition, her heart was racing around 180 beats per minute. SiowFong and I gave her four puffs of her albuterol inhaler that we administed through her spacer and mask, but Lydia fought us the entire time. Then we put her back to sleep.
At 5:00 AM, Lydia awoke again with the same symptoms that disrupted her sleep at 2:00 AM. After giving her three more inhalations of albuterol, we observed her. Since she did not improve by 5:30 AM, we decided to bring her to the emergency room at Children’s Hospital and Regional Medical Center in Seattle, a facility that is among the nation’s top ten children’s hospitals as rated by US News and World Report.
Wednesday, February 20, 2008
Photos: At the Poons
DSC_0096Lydia is riding Eden's rocking horse, something she really enjoyed as she returned to this toy several times this morning.
DSC_0100Group photo (left to right): Lydia, Wee Kao (Eden's mom), and Eden Poon
In 2008, Lydia is having smaller playgroup experiences at friends' homes.
DSC_0102Lydia is trying to communicate something to Eden's mom.
Note: These pictures were taken on January 18, 2008 in the upstairs family room at the Poon home in Issaquah, WA.
Chinese New Year's Dinner
February 8, 2008
Chinese New Year’s Dinner
Ever since we have been married, we have had a dinner to celebrate Chinese New Year’s either at our home or at the home of our friend, Peng Liew. Tonight’s celebration, which had been planned about two months ago, was at our place.
Ma Wee prepared the supper last year, and in Ma Wee’s absence, SiowFong did it this year. SiowFong prepared much of it on Thursday when she was home with Lydia. SiowFong’s entrees included stuffed Shitake mushrooms with pork in black bean and garlic sauce, stuffed tofu with pork in black bean and garlic sauce, steamed sea bass with ginger and onions, shredded cabbage stir-fried with dried prawns, prawn curry, chicken curry, and steamed rice.
In addition to Peng, Steven, Tammy, and Nicholas Chew were among the guests, and everyone arrived at 6:00 PM. Because of Lydia’s illness, we knew that we did not have any time to buy the roast duck from Ranch 99 today, so SiowFong asked the Chews to buy one, which they kindly did.
The mood tonight was somewhat less festive than in past years because everybody was concerned about Lydia. Lydia did not eat any Chinese New Year’s supper tonight as she slept on the red sofa in the living room to sleep after she returned home. The good news was that Lydia’s breathing was more relaxed than it had been in the last day and a half.
Around 8:30 PM, SiowFong, Peng, Tammy, and I gave Lydia her first albuterol treatment at home using the handheld inhaler with spacer and mask, and once again, Lydia unsuccessfully fought it. By 9:00 PM, we said our goodbyes, and our guests headed back to their homes.
Chinese New Year’s Dinner
Ever since we have been married, we have had a dinner to celebrate Chinese New Year’s either at our home or at the home of our friend, Peng Liew. Tonight’s celebration, which had been planned about two months ago, was at our place.
Ma Wee prepared the supper last year, and in Ma Wee’s absence, SiowFong did it this year. SiowFong prepared much of it on Thursday when she was home with Lydia. SiowFong’s entrees included stuffed Shitake mushrooms with pork in black bean and garlic sauce, stuffed tofu with pork in black bean and garlic sauce, steamed sea bass with ginger and onions, shredded cabbage stir-fried with dried prawns, prawn curry, chicken curry, and steamed rice.
In addition to Peng, Steven, Tammy, and Nicholas Chew were among the guests, and everyone arrived at 6:00 PM. Because of Lydia’s illness, we knew that we did not have any time to buy the roast duck from Ranch 99 today, so SiowFong asked the Chews to buy one, which they kindly did.
The mood tonight was somewhat less festive than in past years because everybody was concerned about Lydia. Lydia did not eat any Chinese New Year’s supper tonight as she slept on the red sofa in the living room to sleep after she returned home. The good news was that Lydia’s breathing was more relaxed than it had been in the last day and a half.
Around 8:30 PM, SiowFong, Peng, Tammy, and I gave Lydia her first albuterol treatment at home using the handheld inhaler with spacer and mask, and once again, Lydia unsuccessfully fought it. By 9:00 PM, we said our goodbyes, and our guests headed back to their homes.
Photos: Lydia & Miss Kitty
DSC_0132Lydia is lying on Miss Kitty, a large soft toy that she received as a Christmas gift from her great uncle Mike and great aunt Helen. Lydia often treats Miss Kitty like a large pillow.
DSC_0135Doesn't Lydia look pretty comfortable on the red sofa?
Note: SiowFong took both of these pictures on January 28, 2008 in the living room of our home.
Sick Visit
February 8, 2008
Sick Visit
As Dr. Bledsoe has every Friday off from work, Lydia saw Dr. Jennifer Montoya, a third-year pediatric resident, and Dr. Heather McPhillips, the attending physician. Their main concern about Lydia centered on Lydia’s breathing, specifically her rate of breathing (which averaged 40 to 50 breaths per minute [normal for a toddler is 25 to 30 breaths per minute]) and her work of breathing (which was evident because she was using her stomach muscles to help her breathe). In addition, Lydia’s oxygen saturation level, a measure of how much oxygen was in her bloodstream, was lower than normal at 95% (it should be 99 to 100 %).
To address Lydia’s respiratory problems, her doctors ordered two twenty-minute long breathing treatments for Lydia to try to expand her airways and to clear up some of the airway congestion. Although Lydia tolerated the measurement of vital signs and the doctors’ physical exams, Lydia did not like the breathing treatments one bit. Lydia did not like the white mist that was coming out from the breathing tube that I was constantly trying to place near her nose and mouth, and she did not care for the noise generated by the nebulizer, the machine that delivers the breathing treatment. During these two sessions, Lydia was batting away the breathing tube with her hands and constantly turning her face from the right to the left. Despite her attempts to avoid the treatments, they seemed to exert a beneficial effect on her as both her rate of breathing and work of breathing decreased.
After her breathing treatments concluded, she had to had a chest x-ray taken. After reviewing the results of the chest x-ray, which showed a process consistent with viral bronchiolitis or viral pneumonia, and seeing the improvement in Lydia’s breathing as a result of the albuterol treatments, Dr. Montoya explained that Lydia had viral bronchiolitis or a viral pneumonia that was causing her breathing problems, wrote a prescription so that Lydia could receive albuterol breathing treatments at home, and asked me to call the office tomorrow morning for an appointment to bring Lydia to the acute care clinic at Children’s Hospital for a follow up visit tomorrow. By this time, it was 5:00 PM, and Lydia was ready to go home.
Sick Visit
As Dr. Bledsoe has every Friday off from work, Lydia saw Dr. Jennifer Montoya, a third-year pediatric resident, and Dr. Heather McPhillips, the attending physician. Their main concern about Lydia centered on Lydia’s breathing, specifically her rate of breathing (which averaged 40 to 50 breaths per minute [normal for a toddler is 25 to 30 breaths per minute]) and her work of breathing (which was evident because she was using her stomach muscles to help her breathe). In addition, Lydia’s oxygen saturation level, a measure of how much oxygen was in her bloodstream, was lower than normal at 95% (it should be 99 to 100 %).
To address Lydia’s respiratory problems, her doctors ordered two twenty-minute long breathing treatments for Lydia to try to expand her airways and to clear up some of the airway congestion. Although Lydia tolerated the measurement of vital signs and the doctors’ physical exams, Lydia did not like the breathing treatments one bit. Lydia did not like the white mist that was coming out from the breathing tube that I was constantly trying to place near her nose and mouth, and she did not care for the noise generated by the nebulizer, the machine that delivers the breathing treatment. During these two sessions, Lydia was batting away the breathing tube with her hands and constantly turning her face from the right to the left. Despite her attempts to avoid the treatments, they seemed to exert a beneficial effect on her as both her rate of breathing and work of breathing decreased.
After her breathing treatments concluded, she had to had a chest x-ray taken. After reviewing the results of the chest x-ray, which showed a process consistent with viral bronchiolitis or viral pneumonia, and seeing the improvement in Lydia’s breathing as a result of the albuterol treatments, Dr. Montoya explained that Lydia had viral bronchiolitis or a viral pneumonia that was causing her breathing problems, wrote a prescription so that Lydia could receive albuterol breathing treatments at home, and asked me to call the office tomorrow morning for an appointment to bring Lydia to the acute care clinic at Children’s Hospital for a follow up visit tomorrow. By this time, it was 5:00 PM, and Lydia was ready to go home.
Photos: Snowbaby
DSC_0021SiowFong used the term "snowbaby" to describe how Lydia looked with her new knit cap.
DSC_0031Children's expressions can easily vary moment to moment. Here Lydia is smiling for the camera.
DSC_0038Lydia is hugging her beloved Tigger the Tiger stuffed animal.
Note: All of these pictures were taken on November 3, 2007 in the upper landing area of our home.
Slumber, Slumber, Slumber
February 8, 2008
Slumber, Slumber, Slumber
Because Lydia’s activity level in the last 24 hours had diminished further as she slept virtually the entire day yesterday and her breathing was faster and harder than normal, we decided to call Dr. Bledsoe’s office this morning so that Lydia could be seen for her illness.
Since we were right in the middle of cold and flu season, we knew that many other parents had sick children just like Lydia, and because today was Friday, a number of them would be calling their doctor’s office so that their ill child(ren) could be seen today before the weekend. We also knew that to maximize our chance that Lydia would be seen today, we would have to Dr. Bledsoe’s office early. Our attempts at 7:00 AM and 7:30 AM resulted in the activation of the pre-recorded answering machine message as the office had not yet opened for business. After SiowFong left for work, I tried again at 8:11 AM and secured a 2:00 PM appointment for Lydia.
Similar to yesterday, Lydia slept nearly the entire morning, awakening just to drink 5 ounces of milk and 1 ounce of water around 9:00 AM. At 12:30 PM, I called her name a number of times, and she emerged from her slumber so that I could change her diaper and her clothes before we left our home for Dr. Bledsoe’s office. At 1:15 PM, both of us were in the car, but I had problems starting the car. After the third unsuccessful attempt, I thought about us missing Lydia’s doctor’s appointment, said a short prayer to ask for God’s help in this process, and waited a few minutes. On the fourth try, the engine finally ignited and sputtered into action, and we were on our way!
Slumber, Slumber, Slumber
Because Lydia’s activity level in the last 24 hours had diminished further as she slept virtually the entire day yesterday and her breathing was faster and harder than normal, we decided to call Dr. Bledsoe’s office this morning so that Lydia could be seen for her illness.
Since we were right in the middle of cold and flu season, we knew that many other parents had sick children just like Lydia, and because today was Friday, a number of them would be calling their doctor’s office so that their ill child(ren) could be seen today before the weekend. We also knew that to maximize our chance that Lydia would be seen today, we would have to Dr. Bledsoe’s office early. Our attempts at 7:00 AM and 7:30 AM resulted in the activation of the pre-recorded answering machine message as the office had not yet opened for business. After SiowFong left for work, I tried again at 8:11 AM and secured a 2:00 PM appointment for Lydia.
Similar to yesterday, Lydia slept nearly the entire morning, awakening just to drink 5 ounces of milk and 1 ounce of water around 9:00 AM. At 12:30 PM, I called her name a number of times, and she emerged from her slumber so that I could change her diaper and her clothes before we left our home for Dr. Bledsoe’s office. At 1:15 PM, both of us were in the car, but I had problems starting the car. After the third unsuccessful attempt, I thought about us missing Lydia’s doctor’s appointment, said a short prayer to ask for God’s help in this process, and waited a few minutes. On the fourth try, the engine finally ignited and sputtered into action, and we were on our way!
Photos: Christmas Reading
DSC_0055Auntie Linda is reading a book to Lydia while dad is sitting nearby.
(left to right): dad, Lydia, auntie Linda
December 26, 2007
DSC_0066Mom is reading a book to Lydia
December 26, 2007
DSC_0196Lydia is looking at a book by herself.
December 28, 2007
Note: All these pictures were taken in the living room of Pa and Ma Chin's home in Chesapeake, VA.
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