Back at the hospital

Nicholas has a different pediatrician than his brother and sister. Because of his needs, he is seen by a doctor that speciizes in high needs kids and is also directly connected to the hospital. We have a nurse that we can contact directly (we text her frequently enough to feel slightly guilty though she promises that it's always welcome), and receive a very high level of care. Not that Zachary and Emily's pediatrician doesn't provide fantastic care, Nicholas's is just so much more specialized.

He had had a bad night. Fussing through his feed, moaning the whole night. Mike had stopped his continuous overnight feed more than once to vent him, hoping some of his discomfort was due to being gassy. Because of the nissen, it was nearly impossible for Nicholas to burp his gas out. Instead, we connect an empty syringe to his extension tube (which is connected to his button) and the gas escapes that way. It comes with Nicholas pushing the contents of his stomach into the syringe, which we then let gravity drain back into his stomach. 

Each time he was vented, significant amounts of mucous came with it. In the morning, we decided to get in touch with his nurse to find out what she thought. They decided to have him come into the clinic to take a look at him. Mike packed him up, I stayed home with Zachary and Emily and off they went. 

After about an hour of being gone, Mike called me. They had decided to admit him to the pediatric floor. Apparently when they measured his head circumference, it had increased by 2 cm. That, combined with the fussiness, and the apparent discomfort was concerning. They were worried that his shunt had failed and the pressure was increasing in his brain again as cerebral spinal fluid was unable to leave. A CT scan was immediately ordered. And now we wait. 

The next morning, the PA from the neurosurgeon's office along with Nicholas's pediatrician reviewed the CT scan. The ventricles were smaller than they had ever been and more brain was visible than they had ever seen before. When the ventricles are enlarged, they push the brain out of the way. This was actually a very encouraging result. 

A shunt series was ordered. This is a series of x-Rays that look at the shunt from top to bottom to make sure that nothing has happened to the catheter. Maybe a kink in the line? Maybe it broke off somewhere? Shunt failure or malfunction is one of the most common problems with hydrocephalus. We were praying it wasn't that. The only fix is to place a new shunt. Which means another brain surgery. The shunt series showed a perfectly intact shunt, another promising result. 

The next test was to find out the pressure in Nicholas's brain. This would show if the shunt was working for sure. This required a needle to be placed into the area where the shunt is to measure the pressure. Normal. It appeared that the shunt was still doing its job and Nicholas wouldn't be in surgery. 

Because they were preparing for possible surgery, they had stopped all feeds the night before. After not feeding for 12 hours, Nicholas took his first feed like a champ with no fussiness or apparent discomfort. 

We still don't know why his head circumference increased or why he was so fussy but he was discharged home again.