Back in ER

(Warning: lots of details... for the sake of our family who I'm sure long to be thoroughly updated.)

This was our first time back in the ER since sometime in 2010, I believe.

Melanie gave a few clues during the day that something was brewing. She asked for a nap 2 hours earlier than usual and then slept for about 3.5 hours. She woke up a bit cranky and 'off.'  And for a few days she's had an itchy nose and ouchy sneezes, and Mom has noticed a slight decline in overall wellness.  So I wasn't too shocked when she had a seizure yesterday.

I opened the back door to go pick up James from school, and Melanie just stood there, looking at the ground. When I nudged her forward, her legs buckled and I caught her. I had a friend bring James home, as I attended to Melanie on the dining room floor. Convulsions lasted about 20 minutes. This was our first time using the two small-dose "boosters" of diastat, her rescue med.  Well, it's rather apparent to me now that diastat likely does nothing to stop her seizures. I've suspected it all along, but now I'm sure, after she had 5mg more than her normal 7.5mg, and this was the longest one she's had since our scare two years ago, when a nearly lethal combination of drugs in the ER landed her in the PICU with a breathing tube.  We might have been facing a similar situation this time, if we hadn't waited an hour before taking her in. By the time we got to our local ER and they had her hooked up, she had ambiguously slipped into her post-ictal state of occasional voluntary movements.

I'd guess that the entire seizure was roughly 80 minutes, the last hour of which was NCSE (non-convulsive status epilepticus): in that stage she is limp, unconscious, jaw tightly fixed, and her eyes "dance," usually with dilated pupils. Unfortunatly, her post-ictal (post seizure) state looks very similar to that, but with slight voluntary movements and her eyes, though vacant, aren't as 'dancey' and pupils are reactive. Even still, we're still playing the guessing game nearly every time-- even after more than 3 years experience.

We had a very good and understanding ER doctor. It was clear to him right away that we knew what we were doing, and I made a comment early on which I could see in his face clearly communicated that we won't be "told" what to do if we know it's not best for Melanie. Call it a quick "flash of the Tiger Mom claw."  I had to flash it again when 3 different NICU nurses tried unsuccessfully for too long to find a vein to draw blood, and at the same time her other nurses were messing with her bad IV. One nurse went out to ask the doc what he wanted them to do, and I spoke up to say that she needs to be left alone completely. If she doesn't get a chance to sleep and then wake on her own, she'll never shake it off.  Well, what do you know, it worked. After 20 min or so of uninterrupted sleep, she stirred on her own for the first time and drank some water. This went on a bit longer, until the doc came in and asked if we'd like to go home.  He never tried to play any games with us, which is SO refreshing.

We got out of the ER in 3.5 hours, which is record time for us (probably for most people). The doctor sent us home with a script for amoxicillin for the ear infection he detected. We haven't filled it yet. Nick is more anxious to start it right away than I am. I want to spare her the regression and loss of two weeks of her life, but I hate to give her yet ANOTHER round of antibiotics and risk long-term harm... We'll make the decision today.

We got the green light on Friday to start tapering Melanie's depakote. I'm so thankful that I have providentially forgotten, for three days, to lower her morning dose. If I had, I would definitely be wondering now if that were the reason for this extra-long seizure.  As it is, we are wondering if our keppra taper had anything to do with it; but she has been at her current dose for a week and a half now, so I'm not too sure that has much to do with it. I'll be in contact with our neurologist about it.

Today so far, she woke up cheery yet extremely wobbley. The diastat stays in her system at least 24 hours, so she'll be druggy for the rest of the day at least- especially with the extra 5mg she got. She watched Pooh (of course) and munched some pretzels and drank half a Pediasure. She's sleeping again now, and won't be as cheery the rest of the day. Tomorrow is when the real crankies will come, and the sickies will show up.

James was with us during our whole ER ordeal. He and Dad left for a while to get dinner, change and retrieve things from home. James later told me that he had prayed two times for Melanie, on his own. I praised him for his tender heart and for turning to God on behalf of his beloved sister.  Then, as we were packing up to leave the ER, I turned around to see him standing at the foot of her bed with his eyes squeezed closed, praying for her again. That sweet boy has a way of melting his mama's heart.