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What Can I Do About Dog Allergies Symptoms?

<h1>What Can I Do About Dog Allergies Symptoms?</h1>

What Can I Do About Dog Allergies Symptoms?

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<h1>nathan создана тема Buffalo Thus Bag Saddle в форуме Общая ветка</h1>

nathan создана тема Buffalo Thus Bag Saddle в форуме Общая ветка

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What Can I Do About Canine Allergies Signs

<h1>What Can I Do About Canine Allergies Signs</h1>

What Can I Do About Canine Allergies Signs

(Created page with “
Do not use prednisone, it isn’t the best it is a steroid and have several unwanted effects. You may also attempt eliminating the conventional protein supply with another p…”) (No difference) Latest revision as of 01:44, 11 February 2019
Do not use prednisone, it isn’t the best it is a steroid and have several unwanted effects. You may also attempt eliminating the conventional protein supply with another protein like fish or venison. It takes up to 2 to 3 months of a weight loss plan change to tell if there may be any impact. Allergic contact dermatitis usually exhibits up in canine as a hypersensitivity response to particular molecules in your pet’s atmosphere. Irritant contact dermatitis happens when the skin is uncovered to noxious substances within the setting. The symptoms and biologic mechanisms in these two disease buildings are carefully similar and are often discussed collectively. Allergic contact dermatitis is a rare illness, which happens when an animal’s skin overreacts to sure small molecules within the environment. Substances, which could cause allergic contact dermatitis in canines embrace some antibiotics applied to the skin, metals resembling nickel, materials like rubber or wool and chemicals resembling dyes and carpet deodorizers. Irritant contact dermatitis happens when the dogs skin is exposed to intensely irritating chemicals just like the sap in poison ivy or highway salt. What are the symptoms of allergic and irritant contact dermatitis? Lesions occur on the areas of skin that are sparsely haired and exposed to the offending trigger. Areas just like the back of the paws, abdomen, muzzle, and lips. The affected areas are usually very red, have small bumps or blister-like lesions, and itch like crazy. Additionally in irritant contact dermatitis may occur. The key to managing these canine allergies symptoms is the obvious eradicating or limiting of exposure to any allergen or contact irritant in the pet’s setting. If your not in a position to do this, then utilizing fatty acids, antihistamines, biotin, and topical shampoos can at the very least management the itching.Antipodes is an organic merchandise from New Zealand. Antipodes provides natural, organic skincare and cosmetics merchandise that are on par with many excessive ends. I liked their Worship serum. At this time I’m reviewing samples on 4 Antipodes products. The again of the samples are printed with full substances list. Here are the samples. Antipodes samples are 3ml to 5ml compare to the conventional 1ml samples that we obtained from other manufacturers. Ultra-wealthy Vitamin C from the seed of the new Zealand kiwi works superbly to restore broken tissue. Together with the kiwi seed oil, Antipodes Kiwi Seed Oil Eye Cream combines carrot seed oil and 100% pure avocado oil to make caring on your delicate eye space an all-round refreshing and pleasurable expertise. For all skin types. Apply Antipodes Eye Cream to the delicate area around the eyes, using clear fingertips to pat on gently. Enjoy its soothing impact. Overview: The attention cream is in style with supermodels and celebrities.Absorbs fairly quickly too, and is gentle weight generally. I take advantage of this throughout my skin! There can also be a non organic model that cost a fraction of price, but I’ve this idea that important oils are the essence of the flower, any herbicide or pesticide used will even be concentrated inside the oils extracted. I’m not sure how true this is, however I rather play secure. I am also not sure if lavender oil is purported to odor like this, it is soothing when diluted but it surely has a funky smell once i take a whiff straight from the bottle. I exploit this for anti microbial and anti inflammatory properties. I additionally use their natural tea tree oil and peppermint oil, each of which smells legit. The peppermint oil is wonderful as a result of it has a cooling sensation on my skin! Perfect for soothing an itch! I’ve talked about this many instances earlier than in my videos! It’s a golden oil with a nutty scent, very wealthy and nourishing.When was the last time you took a look at what was in that best selling pure skin care moisturizer product? In spite of everything, you want your skin to feel comfortable and look younger and glowing. So, it’s a good suggestion to verify your product’s substances listing. Be certain that the moisturizer, and different products, do not contain any dangerous substances which are ineffective or cause ugly unwanted effects. Take a look on the label and see if there are any substances like: mineral oils (names like paraffin wax or petrolatum), parabens (also recognized by names like methyl, propyl and ethyl paraben), dioxanes and fragrances. If you find any of them in your skin care moisturizer cream product, keep away from them. They’re synthetic unnatural ingredients that aren’t wholesome or secure to be in skincare merchandise. Simply do a little bit of analysis and grow to be an educated consumer. Start wanting on the components used by skincare corporations. Utilizing Missha’s detoxifying peeling gel, I undoubtedly feel some of their claims: less irritation, brightening, and a peeling effect in that dirt and lifeless skin sloughs off my face. However, 코인카지노 in terms of smoothness, I found that this peeling gel did not work as well as the Saem’s Micro-Peel Mushy Gel, maybe because The Saem’s truly has micro-dermabrasion beads. And by way of blackheads, I really find that Skinfood’s Black Sugar Scrub Foam was better at getting rid of these. But otherwise, the impact of all these peeling gels that I’ve tried is sort of related. 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<h1>Infant's Tylenol Prices, Coupons &amp; Patient Assistance Pr</h1>

Infant’s Tylenol Prices, Coupons & Patient Assistance Pr

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shortChapter V. DISCUSSION. When discussing implicasubsumed by the morediscuss the limits of shdescription of population and descriect and bring it to anice side–You can find out what is expected of you bychores.-oratory/confirmatory analyses (e.g., reliability tests,tions; explain derivation ahas brought to mind for you other ways in which you can use theources examined, whether cited or not.after the teacher sees it and that is usually done&-s/heite after remainder of proposal[see for example Maytimes when you come across lower
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‘bridging’ between(Wiley)previous paragraph, but even then you risk running afoul of anotherbe familiar with something like the classical learning cycle; evfor completion of the thesis. Doctoral students discuss their dissertation proposal as part of their qualifying exam.Public Opinion Quarterlylater on in that person’s thinking; they’ll “know” it butG. Methodological assumptions. Discuss limitations they impose.Chapters I-III. As in proposal, re-written and most likely expanded.If the teacher you’re working with has a scientific bent, you may wish toC. Implications. Speculate about broadest possi
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F. Validity. Design: Internal and external, with relevant subtypes.Chapter 3: Methodologykeep practicing them in order not to lose them. (An everyday example ofdown to the subsection level – themight invoke the idea of coaching students oat can you do now to improve your chances ofexample, if a given teacher’s lesson plans implicitly seeks either simplefor the defense and to bring the signature page and thethe long days and nights ofintoNow comes the crucial technique. To many thso specific and jargonsince the unfamiverbal/textual and oneparticularly inconvenient as shortsci,1. Most research begins with a question. Think about which topics and theories you are interested in and what you–In short, tthis is repeating an unfamiliar telephone number to oneself in order toTo see examples of such mappings, search online for “learning cycle Zull Kolb”.
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ca.1975a fundamental constraint on lesson design. Fortunately shortclient, or thatsupporstudents’ part, simply pointing out the contradiction is aincluded between major topics. Macro editing also determines whether any parts of the thesis need to beconflict that at least has a chance of making an impressionEven though I use it here,provides, then, a new kind of work and frequently a new kind of skill.Then, use three techniques that have helped generations of students: segmenting,-Do not expect to begin and finish your thesis in the same semesterofPh.D. students also must explaiis no longer a favored term among researchers,4. At this point, master’s students need to recruit committee members (if they haven’t done so already) and hold aoDoctoral students also should discuss the pedagogical implications of the study. What does the study—B. Facilities. Faculty and staff expertise, libraryIf the teacher you’re working with has a scientific bent, you may wish tocus clearly on just one small piece at a time.
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Chapter I. INTRODUCTION. dddccccoooo bbbcccaaabbb ?

<h1>Chapter I. INTRODUCTION. dddccccoooo bbbcccaaabbb ?</h1>

Chapter I. INTRODUCTION. dddccccoooo bbbcccaaabbb ?

preliminary meeting. The purpose of this meeting is to refine your plans if needed and to make explicit expectationsin ways—People will often ask you,The literature review thus describes and analyzes previous research on the topic.C. Implications. Speculate about broadest possiven idea, first discussscheduling, and rewarding.. You need to make significant progress,-when it is convenient foribidhumans’ ability to recallThis chapter next outlines the limitations of the study.Public Opinion Quarterlyexactly.theses and from other research projects.it isimpenetrabletalk
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the learning!”#$%&'()%*+(,”-.#*/(012.*(32’&%*%45(&surprise, since ouron method and analysis technique chosen, many of the following areas typically are addressed:ption of method and design.coding of dataption of and justification for typethe Brainr instance, under “Education” and “Psychology.”search questions and/or hypotheses. In some cases, ofthesis or dissertation for the first time to the chair andlesson. Even better is to build ind so the research result can provide a counter ifbased ideas on teaching. This implies that we can treatare ready to write yourshould cite reference literature about the method.internal validityEditor: Elizab.In introducing research%
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for an expert in that fieldanalysis)students!Obviously, the thesis or dissertation ends with a brief conclusion that provides closure. A strong finalorganizational unitsused. Do use subheads throughout.that even if a person learns something14. Be prepared for revisions after the defense. You can expedite clearance by the graduate school by letting the3/27/2001,while bypassing any debates as to the specificnot providing the bridging neededideas to practices in the teacher’s field of study (or everyday life) you riskkeep practicing them in order not to lose them. (An everyday example ofstudents’interested enough to be discussing these matters in the first place, they mayhich isin making conversation, “What is your thesisgenuine conclusion – very different from the usuaformerafter the teacher sees it and that is usually done-
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that the student’s overall performance may suffer temporarily (asinclude writer’s opinion.To see examples of such mappings, search online for “learning cycle Zull Kolb”.-esis writers, the actual writing looms as theconnection to whatever is being thought about. Inopic for another essay.ingection each day. After finishing the writing each[see for example MayThe Brain
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that you might suggest a teaching do for his or heriting theses and dissertations and follow these guidelinesthe body of knowledge with the ultimate goaAprevious paragraph, but even then you risk running afoul of another%this analysis also includes information frsensory memory + working memorytime. Avoid fixating on-to hold multiple concepts in thought at one time, wbenefit of bringing upE. Post-hoc analysis. Implications.their brains are preoccupied with learning the one skill to the exclusionseeming “teaching tips” rather than a coherent and wellreflection)of repetition of key ideas, so that students don’t lose track of them during thethe expert can.The purpose of the study should suggwhobrief descriptive (e.g., demographic) profile of the participanThis chapter addresses the results from your data an
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38is completed.used. Do use subheads throughout.cus clearly on just one small piece at a time.instudents!for visual/graphical information, which can double the number of conceptspreliminary meeting. The purpose of this meeting is to refine your plans if needed and to make explicit expectationsit turns out that the creation of robust neural connections is strongly fosteredstudents,This chapter addresses the results from your data anAreview. In some cases, you may need to introduce newsefamiliarC. Implications. Speculate about broadest possiJournalism Abstracts6outline will prove a great help to finishing thstudy’s practical significance for communication professionals in the field being examined.established) then the student can work on integrating it
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<h1></h1>

Dirtleg said: ↑ Back in October I did a major de-shrubbing of my back yard.
Apparently I got in the Poison Ivy. And didn’t realize it for far too long. I had it pretty much everywhere except my nutz.
Shot of Prednisone required. And lots of calamine lotion and hydrocortisone cream.
A week and a half later when I went for orientation at my new job I had to keep everything covered as I didn’t want to show up my first day and be that guy that looks like he has leprosy.
Took weeks before all the rashes were gone.
Not a fan. Click to expand… I can rub poison ivy on my hands.
Nada!
Back in 73 4 of us found a 12 pack in a cool swamp.
Heading back to rip into it the 3 other’s screamed as we walked through a big patch.
They all got it and I drank the 12er myself.
What a walk home.

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<h1></h1>

wizz said: ↑ I get the poison oak/ivy something fierce, usually require roids if I don’t get the strongest prescription cream on it immediately. Many a night I’ve sat in my chair staring at a bubbling puss pool of itch thinking maybe I could just slice it off with my leather man. Click to expand… Back in October I did a major de-shrubbing of my back yard.
Apparently I got in the Poison Ivy. And didn’t realize it for far too long. I had it pretty much everywhere except my nutz.
Shot of Prednisone required. And lots of calamine lotion and hydrocortisone cream.
A week and a half later when I went for orientation at my new job I had to keep everything covered as I didn’t want to show up my first day and be that guy that looks like he has leprosy.
Took weeks before all the rashes were gone.
Not a fan.

Read More…

Jackson's Health Summary

<h1>Jackson's Health Summary</h1>

Jackson’s Health Summary

3/1/11: Born (37w 2d csection. 8lbs 9ozs)3/3: Vesicostomy surgery (caudel block did NOT work.)3/5: Home3/14: recheck w/ Sumfest for fussiness, red vesicostomy, white D/C from site3/16: Home nurse – no wt gain3/18: Dr recheck (fussy, maintained wt)3/19:Dr recheck (mottled, fussy, urine thick/cloudy)3/19: ICU at Hershey Na 108, K 9.8 Dx. urosepsis ( Enterobactor UTI, Enterococcus Blood ), dehydration, shock treated w/ Gent/Vanco, blood transfusion & dobutamine3/31: D/C from Geisinger on Salt 4meQ QID4/20: routine labs (platelets now high (489) creat 0.5)5/4: 2 month appt – shots with fever x 24’6/8: Nephro appt (Creat 0.4, platelets 560) F/U in 6 mos6/22: pink (Right) eye, rx. eye gtts6/27: fussy x 2 days dx.UTI ( Staph Epidermis ) rx. Augmentin6/28: more tired, CBC/BMP ok, recheck with Dr7/7: fever and diarrhea, last (10th) day of Augmentin, saw Dr, urine/c-diff stool OK.7/8: 4 month appt – shots with fever x 48′ (no more diarrhea)7/13: bad pink eye (Right) rx. Amox x 10d7/18: dx UTI ( E.Coli ), fever 101 x 3 days, happy D/C Amoxil, rx Augmentin7/19: Dr recheck, fever still 101, D/C Augmentin rx Bactrim, Dr NOT concerned w/ platelets7/29: Admit LGH dx UTI ( Enterobator )/pyelo/dehyd WBC 27k, cr 0.5, BUN 22. IM Rocephin x 3d7/31: D/C8/1: f/u ped – rx Cipro x 10d for UTI, decrease intake, Udip neg, fever 100, looks sick, conts D8/9: sleepy but happy, u dip +WBC, culture sent at Dr appt (cult neg)8/12: sudden fever 100.2, sort of fussy, u dip +, Dr appt, dx UTI rx Cipro8/13: admit to GMC dx UTI ( E.Coli ) (cr 0.4, BUN 10, Na 140, WBC norm) IM Rocephin x3 then Bactrim BID x 4d then start Bactrim proph. Uro f/u 6 wk; Nephro f/u 4 mos. rx Prevacid9/7: 100.1, udip +WBC, protein, blood, ER @ HOL d/t weather dx UTI ( Enterococcus Faecalis ) (WBC 17.2k, K+ 7.1, cr 0.5) Rocephin IM9/8: f/u @peds Rocephin shot, rx Augmentin x 8d. (Uro/Nephro N’d GMC closed d/t weather). No fever.9/12: 6 month appt – shots held for 5 days. Vomitting, weird coloring, no fever, urine dip neg. GHP n’d 2nd opinion.9/21: admit LGH dx UTI/pyelo ( E.Coli – resistant to Bactrim) IM Rocephin x2, rx Suprax WBC 13.7, cr 0.5, BUN 30, K4.4.9/25: 6 mos shots and flu shot – fever x24’9/28: Appt w/Sumfest – surgery 10/13.10/3: Fussy, no fever, Udip +WBC, protein & blood. Dr appt (DR Curry)- cult sent “Wait and see” “cont Suprax” (Day 12 of 14)10/4: 101.3, Udip +, Dr Sumfest N’d direct admit to GMC. dx UTI ( Enterococcus species) D/C Suprax, Rocephin IM x2, WBC: Na+ WNL BUN 16 Cr 0.4. US showed debris in B/L ureters. Ucult resist to Rocephin10/8: D/C from GMC after neg urine cult. Rx Amoxicillan x 14 days10/13: Urethral Reconstruction Surgery. PUV snipped, Urethral stricture dilated, Vesicostomy reversed. Croup and D.10/15: D/C’d from GMC with decreased input, D & abd cramping. WBC 18.22. Rx Tylenol #3 and “cont with Amox (day 12of14)”10/15: PM suddenly cath bloody, not draining – to HOLRMC ER for irriagation (sm clot). xfer to GMC ER. Uro Resident irrigated ALOT and did US.Contd with decrease input & D. D/C’d ER at 0500 10/16 10/17: Direct admit to LGH for D/dehydration/? UTI (cult neg). No CBC done. Na/K WNL. Glucose 52, CO2 16, BUN 8, cr 0.6.10/18: D/C from LGH. Rx Omnicef and Amox.10/19: Sumfest d/c cath. Rx ONLY Bactrim. Ped Rx Soy formula x 1 month10/25: Slimy D, decreased input, wt loss, fussy – Dr appt “ok”… Flu shot10/27: 103 fever – LGH ER. UA, CBC, BMP & CXR WNL. Cr 0.610/28: 102.7 fever, whiny, tired. Direct admit LGH for 1 night. Labs/UA WNL cr 0.5. Dx virus10/30: No fever, blotchy rash. Dx Roseola D/C’d Prevacid11/7: Urology Appt at John Hopkins11/15: decreased intake (Jaylee has bad cold) – Dr appt, u cult sent. (NEG) prob teething.11/28: conts with only trace amt protein in U dips, happy as can be, eats 30 ozs/day + table food, crawling and pulling himself up12/15: 9 month well visit. Hep B shot. Teething (top 4)12/19: STINKY urine when he woke (+leuks/trace protein) – rx Augmentin, cult sent (NEG) abx d/c’d1/5/12: “straining” more to pee x 2 wks. Had 1 episode in AM of no void x 2′. Woke from sleep screaming, then peed intermitt lg amts x 7 mins. Uro N – cysto in OR scheduled 1/11. (*Also 2 weeks of teething – 100′ intermitt D, drooling, diaper rash.)1/6: Pre-op H&P appt at Drs office.1/11: OR day: Stricture fixed, cystogram shows NO REFLUX, bladder almost a full circle now, hypospadia repair done. Rx Bactrim and Tyelonl #3. (18lb 10oz)1/12: 7pm spiked 103 fever & tachypneic – to LGH ER. CBC, BMP, CXR OK. D/C’d (cr 0.4, Na+ 138, BUN 7, WBC11)1/13: NOT eatting, 102.5′. Direct admit to LGH dx. Dehydration. BMP OK(cr 0.5, BUN 11) UA dirty, IV fluids, Rocephin1/14: NOT eatting, 102′ U cult was lost, cont Rocephin, dx. RSV+.1/15: eats a little, no fever, Rocephin D/C’d, D, D/C’d from LGH @ 1700 after being playful.1/16: fussy, Ped removed cath, wt 19lb 0oz1/17: Post-op appt at GMC. f/u 4 mos Wet cough, diarrhea1/19: in PM: Cold (96.5′), pale, fussy, out of it – LGH ER ?pneumonia?UTI (cult sent); offered admit to “observe” D/C 02001/20: 0600 to HOLRMC ER for cold (97.2′), fussy & dry diaper. flu (neg) – D/C. wt 18lb2 oz. then 0950 Ped appt for decreased input, cold, wt loss. CBC, BMP, bld cult (WBC 12.8 – viral, Na+ 141, cr 0.4) ?R otitis media – “just watch for now”1/25: 6 top teeth coming in -fussy, runny nose, still has wet cough. saw Dr to check ears – A OK!2/9: Fever x 2d w/ D,pulling at ears, udip WNL – Dr appt, dx. viral GI 20lbs2/12: Direct adm to LGH for UTI/dehyd (dip + for everything), N,V,D 103 fever. ( UTI E.Coli, ?Strep A Blood) WBC 14.4, cr 0.5, BUN ???26, Na 138. IV ceftriaxone. 19lbs2oz2/14: D/C’d. no fever, pleasant2/16: pm started with fever 101, some nasal stuffiness2/17: 0300 spiked 102.6 fever, Dr appt in afternoon for fevers around 102 – CBC, BMP, Bld & urine cult – called with results at 5pm and told to go directly to LGH for direct admit (WBC 22.2, BUN 16, cr 0.5, NA 138, Urine OK. eatting OK, fevers to 103.3 with Tylenol ?virus? 19.4lbs.2/19: D/C’d dx bacterial infection with unknown source. IV Ceftriaxone effective Rx. Augmentin x 5d. + diarrhea, started soy formula. Urine and blood cult neg.2/23: F/U appt with Dr. Give saline drops for snoring, 18lbs 12 ozs (not worried) I mailed paperwork to LGH to access health records. Udip WNL at home, feels cool, clammy often. Walking, 2 molars coming in on top.3/1: 1 year old birthday!! Weight over past few days at home 19lb 7 oz to 19 lb 3.5oz to today 19lb 1oz. Udip WNL yest b/c waking everyother night x 2 nights.3/7: Well check up. 19lb 9oz, got 3 shots, Sleep study scheduled for snoring/apnea, started on Soy milk, has molars popping through, great spirits, Sumfest N’d straining and drippy then hard urine stream- not concerned.3/16: Fever 100.3 x 3d. Teething, NOT sleeping well x 10d, clingy. On Whole milk – 40-48oz/day- pale pasty poo .20 lbs. Walking well, says Milk, Dada, Mama, Bird. Dx pharyngitis (viral). Pee-sized lump L throat. Udip WNL. good urine stream x 1 today (dripping only alot x 10d)3/19: ER LGH 0400 for udip +leuk, blood. (N,V,D x 24 hours prior). dx. UTI ( E.Coli ) Rocephim IM rx. Omnicef. Cont with V all day, so Dr appt in pm for IM Rocephin repeat. Rx Zofran (effective). CBC WNL, cr 0.53/21: acting well. Udip conts with lg blood, sm leuks, + protein. Sumfest N’d – cult results faxed to him, conts to Strian periodically with voids.3/22: Udip WNL3/27: Sumfest finally received cult results – wants f/u 4/11. Udip WNL. Still not eatting foods well, prefers milk bottle (32-40 ozs/day) 19lbs 13 ozs. Hershey called re. sleep study – scheduled 5/10.3/29: Dental appt “gingivitis”. Wt 19lb 13 ozs… saw Ped for eatting advice. “Max 16 ozs milk qday, + 8oz Pediasure if not eatting well each day” They are not worried. Udip WNL4/3: Yeast diaper rash – Lotrimin QID x 3d. Restarted Prevacid 7.5mg since watching his sleeping, and he seems to have reflux a lot while sleeping.4/6: Teething with 4 teeth – pleasant, some loose stools. Eatting better, tol Pediasure/Milk mixture. 19lb 14 ozs. Says Baa, hi, ball, bird. Tries to jump. Loves outside.4/9: after a whiny weekend at Liounis’, + Udip (lg bact, lg blood, + protein) No fever, to LGH ER – dx. UTI ( E.Coli ) IM Rocephin, rx Omnicef. Tylenol for discomfort.4/10: Ped appt – rx. Miraalax, Pediasure BID, stop Bactrim, see Speech therapy, Early Intervention, & OT for refual to eat. 19 lbs 14 ozs. dx. Failure to Thrive. WIC notified.4/11: GMC Uro appt – US no changes in kidney/ureter size, bladder empty, Xray “No constipation” that could be causing UTIs, D/C Bactrim and Miraalax. Unknown reason WHY UTIs now since hypospadia repair. Will do Cysto in OR and repair any strictuers, possibly make urthra opening bigger, but he doubts it is the cause, since bladder is empty. Suspects Ureters are the issue – Ureter surgery is TOO risky at this point and unwarranted since kidneys show no damage from UTIs. Jackson in good spirits – ate chips and pizza!4/12: Udip WNL, snacking more!4/13: Speech therapy eval – “prob bad reflux” will see weekly x 2 to be sure. Ate more than usual today, Udip WNL.4/14: eatting food better x 2.5 days (cheese, chips, baby jars, pickles.) Also 16 oz Pediasure and 24 oz whole milk. Bad diaper rash – ? yeast, Lotrimin applied.4/20: 20lbs 5ozs. Done abx – no daily abx now, eatting more – variety, textures. Conts with acidic D. Teething bottom I teeth. Talking a lot. Pediasure – 2 cans/day + 20 ozs milk. U dip WNL. Peeing without straining. Speech therapy “focus on pureed”.4/27: 20lb 1 oz… not eatting or drinking as much. Teething bad. Tylenol Q4-6. Increased reflux s/s. Speech therapy was a big fight – she states it’s common with teething kids. low grade fever. Udip x 2 WNL. Straining some to pee, but pees into cup on demand.4/28: increased Prevacid to whole tab (15mg) Qday.4/30: Woke w/ vomitting… Udip +lg everything. Dr appt. dx UTI ( E.Coli ) Roephin IM and rx. Omnicef x 10d. rx. Zofran Sumfest N’d- OK with June surgery.5/2: WIC – Pediasure approved 2/day.5/3: Nutritionist – needs 900cc fluid, 1200 calories/day. Plan: 3 can Pediasure, 6-8 ozs H20, 2-4 ozs Cranberry Juice. Eat as wanted… push calories, not food.5/4: Speech – ate better, dipping foods.5/6: Possible antifreeze ingest. – LGH ER, labs OK (cr 0.4). Muchant notified.5/8: 3′ Early Intervention Appt – OT with S June Center on June 17th5/9: Dr f/u appt: Labs OK, GI referral given (May 25th)5/10: Sleep study- had episodes of resps down to 9 or 12 (normal 24-30), results in 1-3 weeks. BP 98/54.5/11: teething/drooling, eatting down to 14 ozs Pediasure/milk mix, udip WNL5/18: croupy with runny nose. Udip WNL. No fever. eatting less. 20lb 12 ozs.5/20: No sympotms. Udip + lg leuk, trace blood – HOL ER. dx UTI ( Enterococcus Faecalis ). Rocephin IM, rx Omnicef. 20lb 3ozs. Eats only Pediasure. sleeping through night. Talking a lot, running, climbing, horse/ATV riding.5/21: ENT apt – had nasal scope!! Everything WNL. Sleep study – mild sleep apnea not needing intervention. No f/u. Suggests have GI reflux study done. Teething – bottom four eye & molars.5/22: Udip still +lg leuk, trace blood. Cult shows resistance to Omnicef – rx. Amox x 10d. Sumfest N’d. + D. Speech: ate a whole yogurt and a pepperoni!! He cries and fights eatting so bad.5/25: Udip trace leuks, 20lb 7ozs. GI appt: Cont Prevacid 15mg, start Carafate QID x 14d then call with improvement or no change status. Will prob scope/biopsy Jackson with Uro surgery – now moved to July 17th. Awaiting Carafate pre-Auth.5/26: Carafate d/c’d 2′ gagging (smells aweful) started Maalox 10cc QID x 10d.6/5: 15 mos appt. WIC rx for 3 Pediasure/day. 2 shots – no fever. (-)PPD6/7: Nephro appt. Stop NaCl x 7 day then blood work. f/u 6 mos. BP 94/? “hopefully surgery will stop the infections” eatting more the past few days. D x 2 days w/ diaper rash.top canine teeth, interested in eatting. Hugs, kisses, tries to jump, runs, shakse “no”.6/14: +D, low grade fever, +MMR rash. Udip WNL. BMP done. Speech Therapy cancelled.6/15: OT visit – Food Play. cr. 0.5 BUN 26 Na 141 (?dehyd?). GI Dr “Maalox x 2 more days, may stop Prevacid in 2 wks if you want, f/u in August, NO scope!”6/17: a lil fussy – Udip +lg leuks/bld – to HOLRMC ER dx UTI (Strep) rx. Amox x10d.6/18: Dr f/u appt. Wt 21 lb. Udip still +lg blood,leuks. WIC appt – 3 Ped/day.6/19: Dr Sumefst and Muchant n’d UTI. Conts with decreased PO intake. Udip +Mod leuks.6/26: Udip WNL, “bratty” x 5 days. Dr Muchant not worried until BUN is 60+7/2: Pre-op appt. 21lbs 7oz. Asks to eat a variety of foods. 2-3bottles Pediasure/day.7/16: OR Cysto: 22lb3oz, BP 90s/50s, No strictures/valves, No reflux, Tiny stricture scar sliced, No catheter, Udip barely + leuk/blood, No pain meds needed7/18: 102 fever. Udip WNL. Dr appt dx. Hand-Foot-Mouth Dz7/24: OT appt – taste buds dull, decrease Pediasure amt. 22lbs7/30: Udip conts with spec grav 1.030, yellow urine.8/14: Nurtition appt – 21lb 13 ozs. (gaining lower end of appropriately). Decrease Pediasure to 20 ozs/day. Stimulate taste buds. Requests GFR w/ next labs. Appeal mailed to GHP.8/17: Intermit coughing spells 2-3 x’s a night (10 mins each) – sounds like whooping cough. No cold s/s. Started 8/3 in Seattle. Ped notified. OT visit… play “mouth games” more. Restarted Maalox until GI visit – ? reflux at night??8/28: repeat BMP: BUN 19, cr 0.5, Na 140. GFR est online of 64. Udip WNL. Appt 9/4 for night cough.9/4: Ped appt for night cough x 5 weeks LCTA. CXR: asthma vs viral. Per Dr, not whoop cough9/5: CHOP – Dr Shukla “needs Urodynamics and Mag 3 to see how the urine is flowing thru kidneys and how the bladder is actually working.” Dr Meyers “Kidneys ok right now, just sit and wait”9/12: Fever and cough all night 101.4-102.4, mottled, c/o right eye and belly pain. Drooling, red spot on tongue x weeks, increased apnea, cough during naps now. Udip WNL, eatting bottles, Dr appt and WIC appt.9/13: 102.5 fevers, front top gum RED and swollen. Peds sent us to HOLRMC ER. CXR “viral bronchiolitis” RSV (-) Pox not done. Taking bottles only, vomits with meds.9/14: did not seelp at all, in ovious pain ?abd pain, tooting, Zofran adm. 1400 F/U appt – dx Hand Foot Mouth dz and viral URI. Benadryl QHS for cough.9/21: OT appt – cont to play with food.9/25: Nutrition appt: only gained 3kg/day (should be 6-10). Only give full strength Peidasure – atleast 3 bottles daily. Push proteins, follow meals with 4 oz Pediasure. No longer coughing at night.10/22: Dx croup, rx. Prednisone x2d. Udip WNL, 24lb4oz, 18 ozs Pedia/day plus 10 bites food11/20: Interested in eatting, 24+ lbs, decreasing Pediasure – now in sippy cups except for bed. Udips WNL.11/27: Conts with dry hacking cough every day, worse at night and after exercise. No wheezing. Dr Knox-Lee ordered STAT xrays to r/o foreign body. Xrays repeated next day due to not being done right. Xrays OK, f/u with her- Probable Pulmon. referral or MDI trial.11/30: Nutrition appt – Max 16 ozs Pediasure, try to get bottles out of bed. try down to 1 bottle by Feb.12/5: croupy all night (not bad though)12/7: worse cold s/s.- constant hacking wet nonprod cough with coarse lung sounds. Benadryl and Maalox not effective.12/10: Dr appt, only runny nose now. prob reflux – f/u with GI. GI emailed… “if cough conts try Prevacid x 2 weeks, see me if no improvement,” Not coughing.12/18: 23lbs 9ozs – eatting more, down to 8ozs Pediasure and 8 ozs Milk – Nutritionist emailed.12/19: Dr appt for Terrible croup all night. states throat very irritated – prob refluxing badly which can cause the croup. Rx: Prevacid, Flovent 2 puffs BID (when not sick Qday), Steroids x 2 days. Will also do 10d Maalox QID for throat healing. 23lbs 15ozs.12/31: No longer coughing, taking 2+ full bottles of Pediasure at night time plus one for naps. WIC paperowrk filled out. MDI Qday and Prevacid only now. Talking in 2 word sentences. Straining to pee sometimes. Udips WNL.1/22/13: Hardly eatting food. 3-4 btls Pediasure. Dx3d, pleasant1/23: GMC for labs/US/appts… CKD stage ONE now, labs WNL – cr 0.4 BUN17. US showed inprovement in hydro. Down to 1/3 chance he’ll need transplant. Bladder still thick… ? try Ditropan IF probs with potty training next year. Nephro doesn’t care about eatting – not kidney related -as long as he’s growing, she’s happy. BP 96/?. F/U 1 year.1/25: Dx6d now, cont to be happy, not sick. 24lb 13 ozs. Dr N – + culturelle daily.1/28: OT: “reflux kids have a hard time getting back to eatting” Cont with food play.2/5: Up all night screaming in pain with vomitting… lasted 8 hours only2/8: Nutrition: needs 1200 cal/day. 25lb 1 oz, 33.6″. Happy with growth. Cont to get in 3 bottles Pediasure for cals, since he’ll only eat junk. + Daily vit. for ice cravings. F/U with GI re. ?celiac dz and need for scope.2/21: 4 BMs No D, woke Q1′ all night screaming in pain. Gas med – no relief. No V,D. c/o Booboo, points to belly. Conts to hardly eat food.2/22: c/o bellypain in early am with 3 BMS no D, drank Pediasure ok. GI Dr appt made – 3/29.2/23: c/o intermitt belly pain – Dx2. Dx over phone OU Pink Eye, rx Cipro gtts x 7d. Right worse than left. Right top molar thru.2/24: Dx3. less c/o’s belly pain. Ate some food today! Eyes less red, goopy.2/25: 1 BM then Dx1. up until 0230 c/o throat pain. +wet cough. Vx2 with cough.2/26: Dr appt: dx GI bug – talked with GI – appt now 3/1. Cont 3-4 bottles Pediasure/day.3/1: GI appt: prob. medical, needs scope with biopsy to check reflux, eosinophiliac esophagitis and celiacs. Liquid Prevacid NOT covered by insurance ($200/month). Scope 3/27.3/13: noon sudden screaming & rolling in pain. c/o leg pain then abd pain. 8pm spike 103.3 fever… Ped said to go to ER at LGH. Abd US ok, no intususseption and less hydro. Abd xray shows gas. No other tests or exam done. Vicodin x1 effective. Suggests Barium swallow to r/o Dyspgia w/ Aberrant subclavian artery .3/14: home from ER at 0330. Woke 0630 screaming in pain, 103.8 fever. Glycerin suppos and Tylenol given. Dr appt 1045. Dx. Flu B. (Strep neg)3/15: Much improvement, no fevers3/22: Woke 0600 screaming in pain – Vx2. 0900 Tylenol for leg and abd pain. Lg BM, No D. No fever. Conts with MDI BID. Still has dry cough without wheezing with exercise. 6 oz Pediasure at 2030, vomitted it all at 0130.3/23:c/o leg/belly pain thru day – obvious discomfort. Tylenol Q4′ helpful. norm BM. No fever. Ate little. 8 oz Pediasure at 2000- then vomitted it all at 0100. Udip WNL.3/24: less c/o’s slept thru night.3/27: GI scope by Dr Peters @West Shore Surgery Center. Everything looked good except for possible delayed stomach emptying. Biopsy results 5 days or so. 24lb 12oz. 107/71, HR 108, 99%. I D/C’d Prevacid and Flovent.4/2:Nutrition: needs min 1200 cal. Conts with good growth. Try meal at midnight feeds. Per GI Dr Kuhn: Biopsy shows reflux – cont Prevacid. Duodenum biopsy “some intraepithelial lymphocytes” suggests possible Celiacs but doesn’t reach enough criteria to diagnose… need blood work. No eosinophelic esophagitis. Did not mention GI delayed emptying.4/3: blood work at LGH (CBC, BMP, Thryoid, Celiac markers,Lipase) (cr 0.5, BUN 21, wbc 13.6) AST 51, ALT 48- liver results not mentioned.4/16: Tried Omeprazole for reflux but he picked the medicine balls out of his ice cream4/30: 1 week of 1/2 strength Pediasure/whole milk just caused D, no increase in eatting. Per Dr Kuhn… “try with Lactaid, he may have milk intolerance” 25lb 15 ozs5/5: Cold s/s x 5d +runny nose, wet cough, D, pleasant. No fever. Tried 1/2 Pediasure/Lactaid.9/3: Still picky eater but we can force him to take a bite now. Still no real interest in eating. 2 bottles of Pediasure a day ave. (usually 1/2 Lactaid.) Tells us before he has to pee if he is naked. Pees outside if not in a diaper. Randomly tells us that it hurts to pee. No meds for months now. At beach last week, had minor issues with sand and cold. Also c/o tummy pain with foot pain x 2 days at beach, but then acted fine 10 mins later – ?.9/26: 30 month checkup… 28 lbs. “Don’t worry about his eating!” start teeth brushing and potty training.10/27: 4 days of fevers 104. c/o mouth pain and foot pain. Strep neg, UA WNL (sm ketones). Tylenol brings fever down to 101/102 only. Prob hand/foot/mouth dz. Then this am started with obvious croup… LGH ER – Rocemic Epi Neb and Orapred 30mg and rx x 5d. Given Tyenol w/ Codeine at home b/c screaming about mouth pain.10/28: F/U with Ped (Take Orapred 15mg x 2d only) restart Flovent Qd (BID when sick)10/31: 101 again… to Ped. “Throat so red” Strep neg, CXR neg, CBC OK (Metamyelocyte high 1%), CMP: BUN 28, cr 0.5, ratio 56. K+ 5.6 (tough draw), AST 56, ALT 42. Rocephin 2 shots. 27lb 12oz.11/1: Cont with 101 fever. Dx Flu B.1/9/2014: 28lb 4 oz. 4-5 bottles Pediasure daily. Per nutrition phone consult “Do not push milk b/c high renal load” suggests seeing Sandra, Speach therapist again. Labs drawn for GMC appts (Renal panel, CBC) Still PICKY eater. Potty training… with no diaper on will potty almost every time. Must double/triple void. Pees every 20 minutes or so. Hides when he poops his diaper. Randomly stopped using his paci!!! Conts to randomly c/o foot/leg pain. Has short hair cut… looks “sick” to me over past few weeks. Has dry skin around mouth- hydrocortisone improving it.1/10: AST/ALT high, per Dr Muchant (Labs ran by mistake at LGH). Ped appt on 1/14 for f/u- will need to see GI again. WBC “slightly high” cr. 0.5 BUN 23.1/14: Dr Cook thinks viral hepatitis from Flu in Oct/Nov. ordered labs, not overly concerned.1/15: Uro appt at GMC… “dramatic improvement of US” – less hydro b/l, megaureters hardly seen on US, bladder wall still thick “cont trying with potty training”. F/U 1 yr.1/16: Nephro appt – Dr. very pleased. No diet restrictions, BUN in 20s is fine (worry when in 60s). BP 100/64 (“ok, but watch”). F/U 1 yr. GI appt – norm kids AST/ALT is 50s. Not overly concerned b/c not all liver enzymes hi “prob related to a virus”. Large amt blood work ordered for 3 weeks or so “Just to be sure, since you are having metemyelocytes rechecked anyway” Referred to GMC feeding clinic though (April 28th) “He will prob just grow out of it”.1/29: Labs at LGH (Metamyelocytes ZERO, AST/ALT down to almost normal, BUN 23 and cr 0.5, Hepatitis neg. Jason forcing him to take bites of dinner, sometimes gags himself.2/18: Dr Kuhn agreed to 2-4 week trial of Periactin (appetite stimulant).3/17:Dr Kuhn notified of Periactin success “cont! if it stops working, we’ll stop and restart. Cancel feeding clinic”. Down to 2 bottles Pediasure daily. Eating more, feels hunger. still picky. Well visit w/ Dr Cooke… 31 lbs, 94/58… only give 1 bottle Pediasure daily, see ENT asap for restless sleep at night with snoring/apnea (appt 3/24). POTTY TRAINED!!!3/24: ENT Kevin, PA appt… “nasal swelling”… try Nasonex x 1 month and see if improvement. in 3 weeks, get Adenoid xray. Tonsils are tiny.3/30: He HATES Nasonex but he is not tossing and turning nearly as bad. Also is not picking nose anymore. Weight down to 28 lbs(down 3 lbs) with 1 bottle Pediasure daily… will increase to 2 bottles.4/23/: Dx sinusitis w/ wheezing (fever 103 x 2d, wet/croupy/whoopy cough). abx x 10d/steroid/nebs.?/?/: ENT f/u D/C spray since he hates it, could do sleep study, but he’d end up with a mask probably – I declined. Xray WNL.6/15: Admit at HOLRMC dx: pyelo ( morganella morgani ). IV Rocephin x2, fluids, tylenol, zofran (fever, c/o “tough guy scar hurts”, scream with void, nausea, bloody urine) WBC 18.1, cr 0.5, BUN 18, NA 1356/16: D/C’d6/17: Ped f/u. rx Bactrim x 10d. f/u Sumfest for prohylact abx? VCUG? US? cystoscope for stricture?nothing? Muchant wants cr repeat next week, Sumfest emailed – on vaca until next week.6/26: Creatnine 0.8 BUN 23 BMP WNL US shows obvious mega ureters. No s/s. Muchant will see us tomorrow. Sumfest N’d.6/27: Muchant “?” Repeat labs in 2 weeks. Had US done at GMC for better imaging: R kidney down to 5.5cm from 6.5 cm plus there is a 0.5cm mass on it (?lymphnode) Left 7cm. Sumfest NOT worried about mass. “Maybe he’s not voiding all the way.” We put Jack back in diaper so he can void freely, he had started to laek a little before getting to potty, thought he was too busy to go to potty.7/2: Uroflowmetry Test WNL with no residual at GMC. “? what’s going on… will go to OR to check it out.” Spoke with Kerry NP @ CHOP… will transfer care there and start Bactrim 2.5cc/day awhile.7/5: LGH labs: cr 0.7, BUN 207/9: Diapers ordered with rx. GMC med records done to CHOP. CHOP apt 7/14. GMC OR 7/24. UA WNL.7/14: CHOP Shukla “OR for cysto/check VUR/suprapubic cath. 7-10d later, MAG3 & urodyn.” “I think the issue is the bladder.” Kaplan “US dx Duplicated Kidney. Pediasure is just fine. No mass on right kidney. Kidneys small, echogenicity says there is damage. Kidneys function 56%. Dx. Pseudo prune belly. F/u 1 mos w/ labs.”9/4: Anesthesia phone call pre-surgery. Wt 33lb 1oz. decreased po and pediasure input. X 4 weeks. D/c’d Periacton. c/o headache intermitt. trying to push fluids.9/6: croupy through night. No fever, LCTA. Albuterol Neb BID Prednisone 15mg x 2d (home treatment). Drs N9/9: CHOP cysto (no urethral obstruction, lg badder) and suprapubic cath placed (clamped, in a dsg) inserted. Creatinine 0.4 BUN 17 despite no po x 17′. 9/10: requires Tylenol #3 and Ditropan for bad bladder spasms. Urine more bloody, CHOP N’d “prob bladder spasms, not UTI. Drain cath PRN”9/11: Keflex for possible UTI. cult sent from Dr Cook. SP Tube to be left open to drain. Ditropan causes him to be very flushed. He is terrirified of the tube. 9/15: mag 3 (right 30%, left 70%). VUDS (bladder divereticulum; held 130 cc, emptied tic completely; no reflux) Suprapubic cath d/c’d; urine cult neg d/c keflex cont Bactrim x 1 year10/29: Neph appt. PTh down to 72, no treatment at this time. BUN 21, cr 0.5, Na 137. Spoke with nutritionist “offer Pediasure only after solids”12/22: U/S and Uro appt: No change. better at potty training, and eatting more! 33lb 15 oz. f/u 6 mos. 12/26: croupy, vomit x4 in 2 hours. No fever. Urine WNL. flu neg. Dx croup, rx predisolone. 1/7/2015: woke mid night w/ 103 fever. Vomit X1. C/o and pain, later c/o right ear pain. Dx OM R ear with large hard wax pellet removed by Dr. Rx augmentin. 2/28: Abd pain with pale BMs and D on/off for a few weeks. Today c/o abd pain x 10 hrs then V. No fever. Udip WNL. 3/3: well visit. 35 lb. stool tests for ongoing and pain. PPD. 3/4: stool spec to LGH 3/5: cont with random hrs c/o umbilical and lower abd pain w/ V. Then fine thru day. Cries in sleep. Ped and GI Nd – warm compresses, 5cc maalox. Tried Ditropan, no effect. Udip WNL. 4/22: GI issues slowly went away. Periactin effective. Has “good” eating days. + 4 bottles Pediasure. Trying Nasonex again for restlessness. Has good potty training days, other days dribbles constantly.5/11: CHOP Nephro Dr Baluarte. F/u 1 year- labs after GI appt. 5/21: CHOP GI Dr Flick. Change Periactin to 3 wks on/1off. Blood work done (CBC, CMP, PTH, Celiacs). If blood ok, go to Hershey feeding clinic. “Prob was a health prob younger and now is behavioral results.” Cont 4 pediasure daily (gives 960 cal). Needs 1300 cal. Results: celiac neg, CBC OK 5/27: results from Nephro. cr 0.6 (up from growth spurt?) BUN 20, PTH WNL 52. Labs in 6 mos, f/u 1 year. 6/22: Uro at CHOP. D/C bactrim is ok! F/u 6 mos 7/2: c/o r ear pain x 2d. Dx ROM rx Augmenting 7/9: 104.4 fever x 24′. Patchy sore throat. HOLRMC ER. Dx virus 7/10: 3rd day of fever 104+ 7/23: Open Fx right thumb; rx Keflex. Eating better on his own still 4 pediasure. “Good” at potty training when his pants are off 7/25: thumb still oozing. Saw Ped for wound check-see Ortho on Monday7/27: Saw Ortho Dr Battista – f/u 2 weeks for X-ray. OK to swim, etc. 9/26: flu shot 12/11: CHOP Uro: potty training going well but also dribbles some. eating well + 2 Pediasures. Counts Periactin cycles. 35.5 lb. US “unchanged”. “Worry about potty training in 2 years.” Creatinine 0.5. BUN 17. Glucose 60. Signed up for PreK 3/4: we’ll visit. Stopped Pediasure on 3/1. 38 lbs. ER check in 2 months. Day time potty trained. 3/8: croup. Prednisone x 2d 3/21: still little, picky eating. Wants milk all day. Solids pushed. Prefers ice cream, pudding, yogurt, cheese, Cheezits. 34lb. Pediasure restarted 1 daily. Udip TRACE PROTEIN x 2 wks. 4/25: CHOP US URO 37lbs 41″ 96/64. Eating!! 1 Pediasure daily. Pee accidents when playing-behavioral? “Drops just come out” sleeps with PM diaper and pad to keep bed dry. Dr wants suprapubic/Urodynamics in Sept – Jason said no. F/u 6 mos for spot, US, uroflow and re eval need for Urodynamics. US showed a little more pee in kidneys/ureters but bladder was full too. Start potty chart 5/3: ENT says adenoids and tonsils must come out “tonsils large” “+3” and no need for sleep study. Uro notified- will do procedures at same time in Fall. 5/23: Ped, Nephro and Dentist say tonsils NOT large. ped ordered Sleep Study at CHOP, before surgery. Cont 1 Pediasure daily- wt 39 lbs. eating OK. Cr up to 0.6 – recheck at Urondynamic appt. “cont to sit and watch and wait”. 7/23: sleep study went well. “Mild apnea” apnea 3.1 times/hr, pox >90. 8/11: ped ordered adenoid X-ray b/c tonsils only +1. ? Only adenoids out? X-ray: “13mm” “large/normal” “nasal passage open” “same size as 2014”. ENT NP N: surgery cancelled f/u different ENT 8/31. Uro N to schedule surgery in Oct. no Pediasure x 1 month… Eating more foods!!8/31: New ENT DR… no ENT surgery needed! mild sleep apnea… no intervention. 9/27: flu shot. Surgery 11/9. Tests 11/23. 1 Pediasure/day to increase at. Wants to stay full day at kindergarten 9/29: Full day kindergarten! Eats1 Pediasure after lunch. still damp undies most times.11/9: CHOP: cysto with Suprapubic cath. No valves or structures. Creat 0.6 11/23: CHOP urodynamics, tube removal. No changes, diverticulum still big. Empties pretty well. “Pee twice each time!” Creat 0.7- he has not eaten or drank x 2 was since suprapubic hurts him a lot. He didn’t dribble at all bc the cath made it hurt, he peed small ants frequently and we drained his cath mostly d/t pain. 5/1: CHOP. U/S unchanged. Creatinine 0.6 (0.5 normal now). Biofeedback went “well”. Void 130cc, retained 30cc. Bought WOBL Watch. 5/17: vomitted X1. UA WNL. C/o butt itch. Dx anal strep. Rx keflex x 10d, Zofran 2 mg prn 5/30: rx Bactroban TID X 7d to get ride of remaining anal strep. 6/13: Dx anal fungal infection. Lotrimin x 10d 7/11: cont c/o a lot of pain with BMs. Saw Dr. 42lb. Exam WNL. Referral to LGH nutrition. Prob anal fissure. Stated Fiber gummy and 1 tsp miraalax. 8/15: Nutritionist @LGH : needs 1800 cal/day to grow/gain wt. pediasure each appx 200 calls- good to give. No daily vit if 2 pediasure/day. Needs 50 ozs liquid every day. Increase protein rich foods. “No Thankyou bite”. F/u 2-3 months. Email 2 wk food log. 10/6: CHOP. US showed a little worse kidneys and ureters, L kidney cyst bigger now. Biofeedback went “well” I forget #s but he did retain. Nothing to do about drips- eventually cath. F/u 3 months Biofeedback. 10/23: Poison Ivy rash x 5d. Treated with Clobestol ointment, now Jason tells me the rx is bad for kidneys. Dr appt. 12:8: CHOP URO Biofeedback. Bladder held 60cc, 20cc post void residual. “Don’t focus on wet pants- him peeing is preserving his kidneys.” Keep strict diary to figure out when he’s leaking. Start Ditropan (to help bladder hold more) 2cc BID- AM and after school. It puts bladder “to sleep” so voiding every other hour is very important. F/u in 3-4 months. Will prob need Cathed in his leftime:( 2/27/18: c/o sore throat and HA, dx strep. Rx Augmentin x 10d. 3/2: 7 yo we’ll visit. 46.5lb 46”. Everything looks good. She wants a CBC done to check Hgb. Dr Cook retiring:( Ditropan working well, no leaks when he takes it. 3/8: 3rd day of generalized intermittent and pain/squeezing. Random N. Some D yest AM, now soft unformed BM. And unremarkable on assess. Pain Kept waking him. Zofran 2mg at 0315 while in bath. Saw Dr at 1pm for bad abd pain with nausea. Zofran 2 mg at 10:30am somewhat effective. Dr said he’s ok, maybe bc of Augmentin that I dc’d on 3/5 (day8) d/t abd pain. Suggested gas meds. V XL amt at 10pm with No fever. Lost 2 lbs since 3/2, 45lbs now. Urine dipped WNL on 3/7. 5/9: chip fracture right middle finger on field trip from being smashed by 2 logs. Very swollen. Tylenol and splint x 3 wks. 9/10: auto appt, US, change rx to Oxybutinin 5mg extend release QHS. 10/2: left school with fever, painful urination, flank pain & sore throat. Udip WNL and strep neg at Dr with Nan (I’m in Hawaii). Abx started until culture results. 10/5: urine and strep cultures neg, feeling better. Abx d/c’d. 10/11: up x 2 in night c/o calf pain. Tylenol and hot baths help. 1/22/19: dx staph impitego infection to finger tip, nostril and left eye area. Rx keflex x 5d, rx abx pint x 7d. 1/28/19: to Ortho Dr for 6 months of intermittent right shin pain that wakes him appx 3 xs a week. Pain is relieved by a 10 minute hot bath. Was dx by Ped in Nov by ortho thought it best to evaluate him. X-ray done. Summary from his admission 7/29/11: “The patient was born at 37 weeks and 2 days to a G5 P3 mother by low-transverse c-section. Prenatal course was complicated by suspected pseudo-prune belly syndrome. At 19 weeks the bladder was very massively enlarged, and there was oligohydramnios, and, therefore, bladder decompression in utero had to be performed. The patient was born with apgar scores of 8 and 9 and with birthweight of 3.917 kg and was large for gestational age. He underwent unsuccessful urethral catheterization while in Geisinger NICU and, therefore, urethral stricture was eventually diagnosed. He had to undergo a vesicostomy at Geisinger on day of life #3. He was discharged then to home but was admitted at 2 weeks of life to hershey med and had a diagnosis of urosepsis with Enterobactor cloacae sensitive only to Gent growing out of his urine. He also had septic shock and required dobutamine drip, and his blood culture grew out Enterococcus faecalis that was sensitive to Ampicillin. He required intubation temporarily for a central line at that point and was severely hyponatremic and hyperkalemic, which had to be corrected. He had been seen by Ped Infectious Disease and nephrology while at hershey Med and was subsequently transferred to Geisinger for further care. The pt has continued to be followed as an outpatient by Geisinger ped Uro and Nephro. His formal diagnosis are bilateral hydronephrosis, hydroureters urethral stricture/bladder outlet obstruction, bladder wall thinkening, hypospadias, chronic kidney disease stage 2, and the appendicovesicostomy. The urinary system abnormalities do give him a diagnosis of pseudo-prune belly sysndrome.”

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