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Appendicitis in Italy


LisaKinVA
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A friend of mine's child experienced appendicitis in China.  The protocols were very different from what he would have experienced in his home country (the mother is a nurse, so she was very aware) but it all worked fine.  Different isn't always wrong.

 

Best wishes to you all.

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Well, it's been a day. We started at one hospital, were sent to another, where the doctor insisted to our translator that it was just a stomach flu (it's going around), so then we went to the base hospital, who transferred us to the only pediatric facility in the region. WHEW! Just getting to this point took us 8 hours. Boo was fairly quickly seen, and sent to radiology, labs and ultrasound. Thankfully, ultrasound clearly confirmed appendicitis...so no need for more tests.

 

Also, because her belly is still soft, they are going to try to clear it with antibiotics. Surgery won't happen right away, and possibly not at all. It's now nearly 12 hours later. Boo is resting, though not comfortably, on a gurney. The hospital beds are full. I'm in a room with four other children. Two with the flu, and two who were in accidents. Moms are in chairs, one is in bed with her baby. I'm hoping to eat soon. I'm tired, and glad I followed my instincts.

 

Apparently, the abdominal pain began on Tuesday night. I didn't learn about it until Friday night (she told my husband on Wednesday, but no vomiting or fever,no real problem...) the fever, however began on Thursday mid day. Not a typical presentation for appendicitis, but by this morning, because of how the pain was changing, the fever continuing, and my understanding of when the stomachache, and loss of appetite began, I felt she needed to be seen. The on call nurse agreed, and we are finally here.

 

Boo is upset by not being able to wear her Pajamas, but they don't want her in them because her temp keeps going up to 103-104, even with Tylenol and fluids. I was also just told we could be here for 5 days. The moms are all very helpful. I'm waiting for my husband to get here. He's looking for parking, but the night life is taking up all of the parking.

 

No matter what the difference in care, the doctors here are top notch. Boo is in good hands .

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It's 4:30 in the morning. Boo had an accident, and it took me a little while to find out where the clean Sheets were, so I could change them. As far as I know, we bring food in. But I find I can't eat much, because Boo hasn't eaten in over 40 hours. They don't want her eating. Feeling even a little better (fever mostly down), and she's hungry. They still have her hooked up to the empty IV, but Boo hates the bed pan (I can't blame her, really). She is scared, and the little boy next to her has been crying most of the night (broken collar bone, and looks like broken ribs, with a cough). I have no idea what he's saying, but it sounds like "I'm dying mamma" over and over (he's speaking Italian, so I'm pretty certain what we are hearing isn't what he's saying). I just don't know what the expectations are here. I know I pretty much do everything other than give her medicine, but I don't know if we are supposed to reuse the bed pans (they are cardboard disposable things), or if there are more somewhere. I reused what I had, because I couldn't find any others. Things have settled down enough for me to start getting emotional, and I've been crying a bit. Only one parent can be here at a time, and they don't like visitors. Boo wants her big sister Blondie. I just want this over, but I was told by a friend, they may keep us here 5 days. I don't know if I can make it that long. Driving here is a big deal. It's not easy to get to.

 

But Boo's fever is under control. One round of antibiotics are in. All I wish I could do is snuggle with her, but the gurney isn't big enough for two. I don't know nearly enough Italian for this, and most of those who work here know even less English. I don't want to whine about what might be normal, but I don't know enough to know if something is right or not for their system. I'm dreading the next exam and blood draw. Boo is scared when anyone comes to look at her (they have pushed around her tummy so much, I wanted to yell at them to stop). But she has been a trooper, earning the accolades of the radiologists, EMTs, and our Navy pediatrician.

 

That's all for now. I'm doing my best to keep it together, because I know if I remain calm, I have a better chance to keep her calm, and relaxed...which is much better for her.

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A glorious update! The doctor's rounds concluded with Boo being cleared to eat, because the surgeon feels the threat has passed, and the antibiotics worked. They spoke with the base hospital, and both agreed that she can go home, and we can monitor her from there!

 

I got maybe 3 non-contiguous hours of sleep, but with this post, I will have updated everyone.

 

The system here is very different, to say the very least.

 

This is the only Children's hospital that sees cases for infant to 12, which may require surgery. There are a few others who may evaluate. I think they send OB cases to the first hospital we drove to, but from the look of the ER, locals bring their children here. Keep in mind, that Naples is the most densely populated city in Europe, then add the entire region. That's a lot of cases.

 

Care-wise, it is very much DIY. Oral and rectal medications, temperature, bed pans, sheets, and food all done by the parent or parent's hired nurse (I didn't see any, but I have heard about them). If you need a towel, washcloth, soap, TP...make sure you bring it. Sleep mask is also a good idea, because the lights stay on.

 

At one point there were six children and six parents in our room. I'm currently seated in a folding chair with less than 3 feet total between beds. I feel very badly for the families here. I wish there was something I could do. Their children are in pain, and the mother's are exhausted. I may see if we can bring them some food, or something!

 

I have a feeling, I may put together a "go bag", or at least a list of things we should have. We're just in a fog when you're in the middle of the crisis of your child needing care. And it's awful to have your child in tears, because they soiled themselves, and you can't clean them up properly, let alone put them in clean clothes. We have travel packs all prepped and ready to go, so adding things like socks, underwear, change of clothes, sleeping mat/cot would be easy to add.

 

We are blessed to be going home. We are fortunate that we caught this early. I wish I weren't so afraid of being "that mom." You know, the one who the doctors look at like she's nuts, because she's sure something more serious is wrong with her child. Although, I don't know why I worry about that... our history of ER to admissions is 100%, and this is only our 3rd admit in 15 years. I'm more like 80% for sick visits that I suspect are pneumonia, or require interventions like antibiotics. But, I do.

 

I know we are also very fortunate to have so many people drop their own life needs to watch children, bring food, or simply cover our family in prayer.

 

Thank you, hive, for putting up with me this past 24 hours.

 

Hoping they will bring our discharge and care instructions soon, so we can leave whenever my husband can get here.

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Wow!  so glad everything is going so well!  

Hospitals in foreign countries are so different.  My dad was in one in China and my poor mother had to change his bedpans and do everything for him, too.  She really got the real cultural experience.  Although super hard to be somewhere you can't speak the language or understand the culture, they also experienced the generosity and kindness of so many complete strangers--huge blessing.

Have a god night's sleep in your own beds :)

-K

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Wow - hoping you are home where you can fall apart a bit and get some rest! Thank you for the updates -

 

FWIW, my mom had to be "that mom" when my sister was (I think) in her early 30s. She has Chrone's disease and was feeling sick, so went to the ER. The doctor gave her some medicine and said she'd be OK by morning, but my sister just felt it was much worse. My mom (who lived in the same town) came to pick her up and after talking with her, made her way through the hospital until she found a gastro-intestinal specialist and basically knocked on his office door and begged him to come and see my sister. He did and within a couple of hours my sister was in surgery. The specialist said she would have been dead by morning.

 

Don't ever worry about being that mom - (((Lisa)))

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:grouphug:

 

I am so glad all is well and you can both go home and get some real rest...and food! I will keep you all in prayer, for the infection to be gone permanently.

I have been told that it comes back, by the mom whose son was there for his 3rd time. We were right next to a family whose son's appendix ruptured. If we were Italians, and didn't have the base doctors available to follow up with, they would not have released us until the pain was completely gone. But, they need beds.

 

Boo is up, wanting breakfast. She says the pain is better today than yesterday. We have the first of many follow ups at the base today. They won't like that she's still in pain, and that it's the classic rebound pain of appendicitis. I can't say I'm 100% comfortable. It's a bit like having a ticking time bomb. If you don't recognize the signs, or misjudged them....really bad things happen.

 

Since we've eliminated all of the OTHER causes of pain (IV, mild constipation due to appendicitis, bladder pain, possibly related), she can better feel this specific pain from her appendix. I'm keeping her close, and I seem to be in constant evaluation mode, but who wouldn't be?

 

I am mostly just tired, and dreading driving us back to the base. But, it's very necessary that she be seen. I'd much rather be caring for her from here, than in the ward.

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Wow - hoping you are home where you can fall apart a bit and get some rest! Thank you for the updates -

 

FWIW, my mom had to be "that mom" when my sister was (I think) in her early 30s. She has Chrone's disease and was feeling sick, so went to the ER. The doctor gave her some medicine and said she'd be OK by morning, but my sister just felt it was much worse. My mom (who lived in the same town) came to pick her up and after talking with her, made her way through the hospital until she found a gastro-intestinal specialist and basically knocked on his office door and begged him to come and see my sister. He did and within a couple of hours my sister was in surgery. The specialist said she would have been dead by morning.

 

Don't ever worry about being that mom - (((Lisa)))

Thank you. When push comes to shove, I usually don't. Especially when it's something like this. I've just gotten too used to expecting patronizing doctors. They make life difficult.

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I have been told that it comes back, by the mom whose son was there for his 3rd time. We were right next to a family whose son's appendix ruptured. If we were Italians, and didn't have the base doctors available to follow up with, they would not have released us until the pain was completely gone. But, they need beds.

 

Boo is up, wanting breakfast. She says the pain is better today than yesterday. We have the first of many follow ups at the base today. They won't like that she's still in pain, and that it's the classic rebound pain of appendicitis. I can't say I'm 100% comfortable. It's a bit like having a ticking time bomb. If you don't recognize the signs, or misjudged them....really bad things happen.

 

Since we've eliminated all of the OTHER causes of pain (IV, mild constipation due to appendicitis, bladder pain, possibly related), she can better feel this specific pain from her appendix. I'm keeping her close, and I seem to be in constant evaluation mode, but who wouldn't be?

 

I am mostly just tired, and dreading driving us back to the base. But, it's very necessary that she be seen. I'd much rather be caring for her from here, than in the ward.

 

More  :grouphug:  and best wishes that all goes well.

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Can the base rule out that it didn't rupture? a rupture will decrease the pain but is still a very serious issue.

 

Hope you get answers.

She had x-rays and ultrasound to confirm appendicitis, and that it had not ruptured. We actually caught it in a fairly early stage. The antibiotics are doing their job. Boo only has mild discomfort today...and internally, things are moving properly. If her appendix had ruptured, there may have been momentary pain reduction, but it should have come back worse than ever. That, and I doubt her high fever (fever of any sort), would have vanished.

 

We saw the pediatrician today, I went over Boo's past hours at home...eating, playing, disposition, elimination... there was a quick exam and nothing to indicate anything but a positive outcome.

 

This isn't to say that the appendicitis can't come back in a week or a year, but right now, she's doing very well. That said, she's excused from PE tomorrow, as hard exercise is still painful (and they will be running the high school track). No PE for a week. She has a mild diet for a few more days as well, but otherwise can do whatever she wishes (as long as it's within house rules...even chores).

 

She's sleeping with me again tonight, but tomorrow I'll probably put her back in her room.

 

The worst part of her days is the augmentin. I made that tolerable by giving her a spoon of ice cream. We'll start adding probiotics to her diet on Sunday, once we finish the antibiotics.

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