Matthew's Illness- Delayed MTC Entry 6 Weeks

Matthew horribly ill 30 days after leaving 1 hospital with a "virus"
      Well...As many of you know, Matthew has been very ill since September. 
     It started with Ryan, Hayden and Allie, then me, then Mateo. 
     We took him to LDS hospital on Halloween, because of his fever of 103.6, vomiting and a swollen stiff neck. No labs, no nothing. Took 5 hours for him to convince them to give him and IV for all the lost fluids. Was told it was a virus. 
     For the next 4 weeks, he just sucked it up, rarely being able to handle being out of bed for more than 3 hours. Sunday, the 20th, his neck was so swollen and he was really hurting. He went to the chiropractor, was icing, then heat and ice, then the tens unit, no relief.
     The day before Thanksgiving, I took him to Dr. Wade's office. Sandra, (his wife & CNFP) took blood for labs and did a rapid strep, which was positive. They gave Matthew 2 IM shots in his hips of Penicillin and I finally got some Augmentin, since I had been sick all that time also. 
     For the next couple of days, for some reason, (knowing he needed more because he had been SO SICK...) I gave Matthew some of my antibiotics BID, (twice daily) and he also, knowing he needed more because he had been SO SICK, took them. 
     Thanksgiving his neck was still so sore and he was so sick. He came up and joined the family in the evening. We all watched as he tried to eat and just cried. We all felt so bad and powerless. The next day I was running around on the west side getting some last minute things for his "Fiesta" on Sunday. Got home late. He hadn't eaten. I heated up some Thanksgiving leftovers. He tried to eat. Nada. I reheated it and cut it into itty bitty pieces like when he was a baby. He tried. He just sobbed as I held him. It was horrible. About an hour later I said, "C'mon-we are going to Primary Children's!" He said, "You wanna pay $15,000.00 for a hospital bill?" (Little did we both know how true that would be!) I said, "Absolutely! I'd pay more than that not to lose you!!"
~....To be continued.....~
1 DUMB Dr. WITHOUT ANY LABS, (Matthew says it's slander and I can be sued if I say more, even if it's TRUE!!!!) at Primary Children's also tried to send us home! NEITHER of us were havin' that! I demanded some blood tests and a CT Scan. He refused and said he'd do a mono panel and an Xray. In his extremely condescending way, as he was doing his report, (THANK HEAVENS to the doctor that was coming on,) he mocked us both and you could hear him saying he had a virus and we, and they, and he'd order... 
After the Xray, they ordered that needless CT Scan the irritating mother had asked for and found my son had a Retropharyngeal Abscess about 1 1/8" x 1 1/4" x 1 3/4" in his neck between his spinal cord and the back of his throat from being SO SICK for so long!
Well anyways, this is just too long to continue! He was admitted, put on heavy duty IV antiobiotics. Did not get better. Had surgery. Was released a few days later.
Matthew was still too weak and tired from being sick for 2 months. We decided since he was going to be delayed 6 weeks, we should have his tonsils & adnoids out, (luckily his Dr. was a professor at the University of Utah and thought that it was probably tonsillitis that started it all.
We scheduled a tonsillectomy and adenoidectomy on Dec 12th. It KICKED Matthew's butt! He is just now barely recovered. Still tires easier. His 3rd Farewell is tomorrow and he now leaves Wednesday. I am very worried, as he is still very, very tired.
Some of his friends down from college visiting....

Gotta have a Greg Olsen pix wherever you go!
 Retropharyngeal abscess  (RPA) produces the symptoms of sore throat, fever, neck stiffness, and stridor. Retropharyngeal abscess occurs much less commonly today than in the past because of the widespread use of antibiotics for suppurative upper respiratory infections. Retropharyngeal abscess, once almost exclusively a disease of children, is observed with increasing frequency in adults. Retropharyngeal abscess poses a diagnostic challenge for the emergency physician because of its infrequent occurrence and variable presentation.
Early recognition and aggressive management of retropharyngeal abscess are essential because it still carries significant morbidity and mortality.
he retropharyngeal space is posterior to the pharynx, bound by the buccopharyngeal fascia anteriorly, the prevertebral fascia posteriorly, and the carotid sheaths laterally. It extends superiorly to the base of the skull and inferiorly to the mediastinum.
Abscesses in this space can be caused by the following organisms:
·                            Aerobic organisms, such as beta-hemolytic streptococci and Staphylococcus aureus
·                            Anaerobic organisms, such as species of Bacteroides and Veillonella
·                            Gram-negative organisms, such as Haemophilus parainfluenzae and Bartonella henselae
The high mortality rate of retropharyngeal abscess is owing to its association with airway obstruction, mediastinitis, aspiration pneumonia, epidural abscess, jugular venous thrombosis, necrotizing fasciitis, sepsis, and erosion into the carotid artery.
Once mediastinitis occurs, mortality approaches 50%, even with antibiotic therapy. Retropharyngeal abscess can also cause internal jugular vein thrombosis, carotid artery erosion, pericarditis, and epidural abscess. In addition to invasion of contiguous structures, retropharyngeal abscess can cause sepsis and airway compromise.
Overall mortality rate was 1% in a review of deep cervical space infections in Taiwan.[4]
In a study of 234 adults with deep space infections of the neck in Germany, the mortality rate was 2.6%. The cause of death was primarily sepsis with multiorgan failure.[5]
In the United States, in 2003, a review of the Kids' Inpatient Database (KID) revealed 1321 pediatric admissions with RPA, with no fatalities.[2]
A case series from Children's National Medical Center in Washington DC presents 4 children of ages ranging from 8 months to 18 months with RPA who developed mediastinitis. All 4 were treated aggressively with antibiotics and surgical drainage of RPA, and 3 patients required thoracoscopic debridement. All 4 children survived without sequelae.[6]
History is variable, depending on the age group. Symptoms of retropharyngeal abscess are different for adults, children, and infants.
Symptoms in adults
Sore throat
Dysphagia (In dysphagia, the affected person experiences difficulty in swallowing.)
Odynophagia (In odynophagia, the affected person experiences pain in swallowing.)                                         Neck pain
Dyspnea (Shortness of breath or hunger for air)
Retropharyngeal abscess develops secondary to lymphatic drainage or contiguous spread of upper respiratory or oral infections. Pharyngeal trauma from endotracheal intubation, nasogastric tube insertion,[12] endoscopy, foreign body ingestion, and foreign body removal may cause a subsequent retropharyngeal abscess. Patients who are immunocompromised or chronically ill, such as persons with diabetes, cancer, alcoholism, or AIDS, are at increased risk for retropharyngeal abscess.
The most common organisms causing retropharyngeal abscesses include aerobes and anaerobes; gram-negative organisms also may be observed. Often, mixed flora are cultured.
·                            Organisms causing retropharyngeal abscess in adults[13]
o                                              Beta-hemolytic streptococci
o                                              Streptococcus viridans
o                                              S aureus
o                                              Methicillin-resistant Staphylococcus aureus ( MRSA)[14]
o                                              Klebsiella pneumoniae
o                                              Bacteroides species
o                                              Staphylococcus epidermidis
o                                              Anaerobic streptococci
o                                              Bartonella henselae
o                                              Eikenella corrodens
o                                              Escherichia coli
o                                              Prevotella species
o                                              Mycobacterium tuberculosis[15]
o                                              Actinomycetes[16]
Being the EMT he is, heard his SAT level was way low,
said IMPOSSIBLE and grabbed the Oxygen! 
Abscesses that are left untreated can rupture spontaneously into the pharynx leading to aspiration. 
Asphyxia resulting from direct pressure or from sudden rupture of the abscess and also from hemorrhage is the major complication of these infections. Other complications include extension of infection laterally to the side of the neck, or dissection into the posterior mediastinum through facial planes and the prevertebral space, cerebral abscess, meningitis, and sepsis. Death can occur from aspiration, airway obstruction, erosion into major blood vessels, or extension to the mediastinum.
Immediately after surgery to drain the abscess, he had the girls in stitches!

Surgical drainage and antimicrobial therapy are essential for the prompt recovery and prevention of complications of these abscesses, such as bacteremia, aspiration pneumonia, and lung abscess after spontaneous rupture.

Peritonsillar abscess
Quinsy; Abscess - peritonsillar
Last reviewed: November 23, 2010.
Peritonsillar abscess is a collection of infected material in the area around the tonsils.
See also:
Causes, incidence, and risk factors
Peritonsillar abscess is a complication of tonsillitis. It is most often caused by a type of bacteria called group A beta-hemolytic streptococcus.
Peritonsillar abscess is usually a disease of older children, adolescents, and young adults. It has become uncommon with the use of antibiotics to treat tonsillitis.
One or both tonsils become infected. The infection may spread over the roof of the mouth (palate), and to the neck and chest, including the lungs. Swollen tissues may block the airway, which is a life-threatening medical emergency.
The abscess can break open (rupture) into the throat, infecting or further blocking the airway.
Symptoms of peritonsillar abscess include:
  • Chills
  • Difficulty opening the mouth, and pain with opening the mouth
  • Difficulty swallowing
  • Drooling or inability to swallow saliva
  • Facial swelling
  • Fever
  • Headache
  • Muffled voice
  • Sore throat (may be severe and is usually on one side)
  • Tender glands of the jaw and throat
Signs and tests
An examination of the throat often shows swelling on one side and on the roof of the mouth.
The uvula in the back of the throat may be shifted away from the swelling. The neck and throat may be red and swollen on one or both sides.
The following tests may be done:
If the infection is caught early, you will be given antibiotics. More likely, if an abscess has developed, it will need to be drained with a needle or by cutting it open.
Sometimes, the abscess may be drained and the tonsils removed at the same time. You will be prescribed painkillers.
Expectations (prognosis)
Peritonsillar abscess usually goes away with treatment, although the infection may return in the future.

More info:
2nd day at the MTC with his companion and school friend David can see he is still tired...:(

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