Rapid downhill slide

Rory frightened me this morning.  He woke at 5am with a painful stomach (scale 7) and nausea.  He vomited up his morning medication.  He has been off colour since Thursday with a sore stomach, nausea and loss of appetite.  I suspected he didn’t have enough cortisol in his body so yesterday I started giving him additional hydrocortisone.  The stress dose is double the normal dose at double the frequency.  When he felt better yesterday afternoon I thought we had averted an Addisonian (Adrenal) crisis.  He slept through the night, but this morning was in a bad way.  I rushed him to Taranaki Base Hospital.  In the car he became drowsy and started nodding off.  I was worried he would fall unconscious so I talked to him to keep him awake.  We were seen promptly at the emergency department (ED) but it takes time to get treatment underway.  Rory’s file is a foot thick and he is medically complex.  He is almost overwhelming for a ‘normal’ Doctor, especially one who has been working all night.  Rory’s blood pressure was very low and his heart rate was high.  His port was accessed, blood samples were collected and they started him on IV fluids.  It was a stroke of luck Dr Yvonne was on call today.  She has been Rory’s Paediatric Endocrinologist for many years, so knows Rory well, and is an excellent doctor.  Dr Yvonne came straight in to look at Rory and took over.  He was given a large dose of IV hydrocortisone to manage the Addisonian crisis and IV paracetamol for the pain.  His blood results show he is severely neutropenic, his platelets are very low and he has a high CRP which is a marker for inflammation.  Dr Yvonne spoke to specialists at Starship and Greenlane Hospital for advice.  Mid-morning Rory was stable and transferred from ED to the isolation room on the Children’s ward (2B).  He has received; a platelet transfusion, IV antibiotics, additional hydrocortisone, pain relief and continuous IV fluids.  Thankfully he is a little better, more alert and in less pain.  He is likely to be in hospital at least 48 hours.  It was frightening watching him slide downhill so quickly and being unable to do anything about it.

Rory has had a quiet couple of days as he has been off-colour.  The District Health Nurse has been twice to check and dress the wound on his neck.  Poppa Honnor and Daff Emmett came over yesterday afternoon to put up a step and the rails in the house for Rory.  They worked solidly for three hours, not bad for a couple of semi-retired blokes in their 70s and 80s.  Thank you both very much xox Thank you also to our neighbours Brian and Christine for the grocery voucher.