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Juliana Bernacchi

SOLVING THE MYSTERY

After various doctor visits, 18-month-old Juliana Bernacchi’s increasing lethargy, fever and cough were puzzling. So late one night when the little girl’s fever spiked at 105 degrees and her white blood cell count soared to more than triple what it should be, her parents wanted the mystery solved more than ever.

“They told us her white blood cell count was over 34,000 and she needed to be transferred to Children’s Hospital,” recalls Rebecca Bernacchi, Juliana’s mom, referencing an emergency room visit near where they live in Hanford. “It was a slow-motion moment in time, when a chunk of me got taken away.”

En route to Children’s, “We thought, ‘Is this how it starts for people?’ When you know life is about to change forever?” says Ryan Bernacchi, Juliana’s dad. While children tolerate higher fevers compared to adults, significantly elevated white blood cell counts can sometimes be a symptom of a serious condition including leukemia, meningitis and autoimmune disease.

Looking for clues

Previously, Juliana had seen several different doctors to determine why she wasn’t feeling well. “They thought it’s probably allergies and gave her medication but there was no improvement,” says Ryan. “Juliana was a mystery.”

Dr. Robert Kezirian, a longtime pediatric emergency room physician at Children’s, just happens to like mysteries. “I love solving problems,” he says grinning. “I go by how the patient looks and their symptoms.”
Noticing Juliana’s dark undereye circles, swelling and difficult breathing, Dr. Kezirian immediately considered acute sinusitis as the diagnosis – but he wanted to be sure. Acute sinusitis causes the cavities around the nasal passages to inflame and enlarge. This interferes with drainage and causes mucus to build up. Persistent sinusitis can lead to serious infections and other complications.

A chest X-ray revealed nothing unusual but a CT scan targeting only Juliana’s tiny sinuses showed infection. As a result, Dr. Kezirian prescribed a different antibiotic to be administered in Juliana’s IV and her white blood cell count greatly decreased.

“‘Dr. K’ was so reassuring and calm,” says Rebecca, as Juliana, now 2, giggles while sitting on her lap at home. “You could tell he knew what he was doing.”

“Everyone was so nice – the doctors, nurses, technicians,” says Ryan. “Dr. K made us feel like we were his only patients, that he cared.”
While Dr. Kezirian wanted to continue Juliana on the medication, he sent the family home to rest and come back the next day. To avoid a second stick, he kept the IV in Juliana’s arm and showed her parents how to safely clean it. “It’s a new dynamic way of taking care of patients,” says Dr. Kezirian. “Not many hospitals do this. It’s a better option than admitting the child to the hospital.”

“It was easy to do,” says Ryan. “If it meant keeping that in or staying in the Hospital, we knew Juliana would be more comfortable in her own bed.”

The Bernacchis recognized other ways Children’s kid-friendly facility makes things easier for young patients, including CT scans offered with sedation, miniature blood-pressure cuffs, forehead swipe thermometers and colorful décor. “They even have things on TV in the rooms geared toward kids,” says Ryan.

Cracking the code

Juliana’s next round of antibiotic treatment the following day seemed to do the trick. “She was amazingly better, like a new person,” says Ryan.
Young children typically don’t get acute sinusitis because their sinuses aren’t very developed. “Juliana’s probably started with a viral infection,” says Dr. Kezirian.

Fortunately, Juliana’s condition was not terribly serious but at Children’s Hospital Central California, every child’s health issue is important. “This was an unresolved illness that caused discomfort,” says
Dr. Kezirian. “No condition is too small.”

 Tears in her eyes, Rebecca agrees: “When that chunk of me got taken away in that moment, I got it back at Children’s. We had our little girl again.”

“Dr. K cracked the code – he put all the pieces together,” says Ryan. “We’re very grateful.”