Appendices

Back at the beginning of August, dd3 was very sick with a gastrointestinal bug. Because it lingered so long and caused her so much pain, we worried that it might be appendicitis. Because urgent care facilities have limited abilities to rule out a diagnosis of appendicitis, I took her to the emergency room, where she continued to feel terrible for hours but eventually threw up and felt better. So it did look just like a regular GI bug. Just to be safe, since it looked like she might also have had a urinary tract infection based on the quick test strip they used on her urine, the hospital gave her IV antibiotics and a prescription for oral antibiotics for the next ten days. The urine culture came back negative two days later, so I felt really foolish for taking her to the ER for a mere stomach bug. But I gave her the whole course of antibiotics anyway because I still worried about appendicitis. It's misdiagnosed with alarming frequency, especially in young children. GI illnesses increase the risk of developing appendicitis soon after, and since appendicitis can often be treated successfully with antibiotics, I decided to be better safe than sorry.

The very day that dd3 was being evaluated at the ER, my sister who lives an hour away came to visit us overnight. Her kids ended up getting sick and vomiting, too. Fast forward to last week...she and her children were dealing with a bad flu-like illness.

My sister called me on Friday night wanting advice about whether to take her seven-year-old daughter to the hospital, as her family doctor was worried about low electrolyte levels that were showing up in her daughter's blood test. I talked with her for a while then recommended she talk to our brother who is in medical school and whose wife had appendicitis a couple of years ago.

This morning I found out that they had taken my niece to the urgent care on Saturday, from which she was taken by ambulance to the hospital and put on an IV for hydration. Medical personnel still couldn't figure out what was wrong with her, though. Finally, they did surgery on her this morning and found a burst appendix. She's a big, healthy girl normally, so I think she'll come through this in the end, but she's in for days or even weeks of hospitalization, IVs, and lots of antibiotics.

I keep thinking various things: 1) Did I contribute to this mess by passing on the stomach bug to my niece? 2) Did I make things worse by not telling my sister to follow her doctor's advice on Friday night? 3) Why is appendicitis so blasted hard to diagnose correctly?

I've heard it said that a maxim of emergency medical practice is that if a woman of childbearing years presents with abdominal pain, the first thing to rule out is an ectopic pregnancy. Perhaps there is a similar maxim for children, vomiting and abdominal pain, and appendicitis? If not, maybe there should be?

UPDATE: She did not actually have surgery yet. They diagnosed her this morning through ultrasound. They did a CAT scan this evening. They think the appendix is perforated and that it happened a few days ago. She might have surgery tomorrow. If all goes well, she might even get to go home at the end of the week. We are all praying a lot for her.