The fever protocol

As I write, we’ve been on fever watch for the past day or so and are hoping for everyone’s sake that his temperature stays below 100.3 for the next five hours.

When we’re not in hospital we live by several protocols, the most important of which is the fever protocol, shown here. If you’ve ever had a kid, or just been one, you know that 100.4F isn’t much of a fever, but it’s enough to send us to the ER if he merely hits that number 3 times in 24 hours, even if he’s mostly staying well under. There’s little room for error here, so the protocol is strict and conservative, as fevers are an indicator for all sorts of potential conditions that could be disastrous. With his compromised immune system, he’s unable to fight off the minor bugs and mild infections that are practically the hallmark of toddlers.

After most chemotherapies his temperature has spiked, and this last has been no different. The methotrexate, in particular, is really rough on the body, and he’s had a terrible diaper rash – blistering bad – soon after both times he’s had it, and his ability to get over it is severely limited.

Update: it hit 100.4 again. Fuck.

Update 2: after calling in, the onco team offered to have him come to the satellite hospital in King of Prussia where he receives most of his out-patient work, rather than going to the ER in Philadelphia. They’ll monitor him, work up a culture and see what’s what – it’s possible he won’t have to be admitted for overnight, but at least the initial eval will be in a more comfortable place with faces he knows and loves, rather than the scary chaos of the ER.

Update 3: we have a lot going on, so Stephanie is going to take him for evaluation while I run errands and try to make some progress towards preparing for the childbirth that’s coming whether we are ready or not. If he ends up getting admitted for overnight, I’ll head to Philadelphia too.

Update 4: they did labs, administered antibiotics, and prescribed a medicated cream for the diaper rash. The labs showed his ANC at a remarkable 2500 – he was at 20 just over a week ago – and all other signs were good, so they were sent home mid-afternoon to await the blood culture results – no news, so far, is good news! His temp is still fluctuating and running a bit high, but since he’s already been checked out and nothing was of concern, he’s eating, drinking and sleeping well, and his numbers looked great, we can live with slightly elevated temperature unless it gets substantially worse or other symptoms arise. Phew.