A rash of rashes (Don't fear the fever, Part 2)

With all the fun and exciting things that happened to our family this summer, we also had two crummy illnesses thrown into the mix, just to keep us on our toes (or should I say, knees?).

My husband and I had planned a getaway trip to Boston at the end of June, but my daughter had other plans: she got pretty sick about a week or so before our trip. I blogged about the experience, and mainly how we were deciding not to overdo it on the Tylenol/Motrin thing and just let her body do its thing to fight whatever she had. And of course, people wanted to know how things turned out.

After a visit to the peds, he diagnosed her with Coxsackie Virus, based on her rash features: sort of random, slightly raised red bumps. She had it on her hands, and it definitely looked like HFM (hand-foot-mouth). She also had it in a cluster on her torso, but nothing on her feet or in her mouth. I thought perhaps some Tylenol to keep her comfortable and we'd just ride it out, thankful that she didn't have the telltale mouth sores that many kids get.

Well, I was wrong. We ended up in pediatric urgent care, where they observed that her rash features had changed - she had something called erythema multiforme. They decided they couldn't tell conclusively if it was a viral agent or something called Kawasaki Disease, a vasculitis (which causes swelling of the blood vessels) that seems to affect primarily Japanese and American children. While it's pretty rare, it can pose serious complications if left untreated, including catastrophic heart damage that can lead to sudden death episodes. (Think John Travolta's son) W.T.F. I freaked. I held onto the notion that perhaps this was a particular strain of Coxsackie Virus, which can cause erythema multiforme.

In the end, they decided to treat her as if she had Kawasaki's, because they felt that the benefit outweighed the risks. She had a mixed bag of symptoms, some of which met Kawasaki's criteria. They waited at least a day and a half to treat her simply because the medication is insanely expensive and they weren't 100 percent sure - they even called in a delightfully old gentleman in infectious diseases who, I later suspected with horror, was a retired physician they called in to consult. Heck - the guy even carried a doctor's bag.

She had fluid around her heart - a possible sign of Kawasaki's, or something viral, or simply from being sick. Red, strawberry tongue - also a sign of Kawasaki's, but not conclusive enough to diagnose, and could also be a sign of dehydration. Whatever it was, it was kicking her butt. They gave her a round of IV IG - intravenous immunoglobulin, purified blood plasma that is supposed to boost her immune system and apparently costs around $3,000 per dose. Thankfully she tolerated it well and was able to leave the hospital after 2 1/2 days.

I still don't want to "fear the fever," but when it's accompanied by a rash - especially one that you've never seen before - it's probably a cause for concern. In the mom's guide to rashes stuff I've seen, this one hasn't been listed, and even though Kawasaki's is rare, it does need to be treated swiftly. One definite cause for alarm with regards to fever is one that lasts more than four or five days, which was a concern to doctors - at one point I was out in the hallway with the attending and his medical students, and felt like I was stuck in a surreal episode of House M.D. I don't ever want to do that again.

Just for your memory files, this is what it typically looks like after the red spots change - target or bullet-like lesions that sort of fan out from the center. It kind of reminded me of a head of cauliflower.

Erythema multiforme. Photo: Wikipedia Commons.

Our last hurrah for the summer was a trip to my mom's in Ohio, where I unfortunately spent the week with a sore throat. It would subside some during the day, but at night it was almost unbearable, and Advil only made a slight difference. At one point as I tried to fall asleep, I thought I was choking on saliva and a moment of panic set in. But otherwise I could function - I didn't feel too terrible during the day, and if I did, chalked it up to crummy food and not enough sleep. I thought I had a cold, until I suddenly realized it was getting worse instead of better, and hadn't gone away in the usual time a sore throat from a cold does. Do I have strep throat?! I thought. I wasn't sure.

I think I've had strep throat once - I can't even remember if that's what it was - and wished I had thought more about seeing the doctor when we returned home. I had cold symptoms the following week after the sore throat went away, and didn't think any more of it. Until I developed quarter-sized red bumps on my lower legs, serious joint pain in my knees and ankles, and just generally still felt like crap. I thought maybe it was from shaving. After a few days I decided I couldn't take it anymore and headed to the doctor.

I had done some googling but wasn't sure what I was looking at was really what I was looking at. I ended up seeing the Pretend Doctor, and after that visit have decided never again. I like my regular doctor, but I'm not sure where he found this person: she said it looked like a vasculitis (similar to the rash my daughter had), and I silently freaked out. But she also blubbered on about a "chest X-ray, punch biopsy," and a bunch of other stuff that had me wondering. I absently said I would like a second opinion from the doctor (thank God he was there that day) and he cheerfully came in and examined me quickly. His diagnosis was pretty succinct and seemed to match up with what I had read, and Pretend Doctor got a tad defensive (and after Dr. Real Doctor left, said, "I know what I'm talking about," a little confidently), but who cares. No punch biopsy for me (which I read later is only required in cases where the cause cannot be determined, and mostly for localized outbreaks or something, whatever that means). I had to laugh when I came across the words "Any experienced doctor should be able to diagnose based on clinical symptoms. Rarely is a biopsy needed." Hahahaha (this is me laughing hysterically in my altered mental state)

The final word was that I had developed erythema nodosum, a rash that (most commonly, I read!) is caused by a recent strep infection. I felt like a detective. I now knew more about stupid erythematous rashes than most people would care to, and was sick of the word 'erythema.' I had punched in that stupid search criteria into my computer so many times I barely had to type the letters e r y before the term came up.

In case you've never heard of it, erythema nodosum is a bumpy rash that is most often confined to the lower legs and shins, and feels pretty much like you played rugby for six hours in high heels and then were kicked in the shins by the entire team. It also includes ankle swelling, joint pain and general malaise, and as a result I've been sucking down more Advil than I ever thought possible.

I know some are skeptical of the effectiveness of taking antibiotics for strep infections, but I'm wondering if this could have all been avoided if I had seen the doctor sooner. The pain at times is almost unbearable, and I have a pretty high tolerance for pain. Sometimes Motrin works well, sometimes not. I'd rather risk potentially disturbed gut flora from a course of prophylactic antibiotics (which I'm on anyway right now, just in case) than deal with this again. Cases of rheumatic fever are virtually non-existant in the US now as a result of antibiotics after strep throat, but some people report pockets recurring - which I'm wondering is either because parents aren't recognizing the sore throat or think it's unnecessary and don't want to contribute to antibiotic abuse. I can appreciate that, to some degree. But even if don't have strep complications, you can still have rheumatic fever, which can have serious, life-long (and sometimes life-threatening) complications.

Erythema nodosum. Photo: MedicalPictures.net

Rheumatic fever is pretty rare in adults and mostly strikes children (like it did my grandma as a kid, before penicillin was even discovered) but that doesn't stop me from worrying about it, of course. In the meantime, I have a date with the heating pad. This should hopefully resolve itself ... in about three to six weeks. *frown*

More reading:
Your child has a rash: do you know what to do? 

Don't fear the fever

*Cue the Blue Oyster Cult soundtrack...*


A few days ago my daughter went to bed with a stomachache (nothing highly unusual for her, since without her bran flakes, she gets kind of constipated). Anyway, by Saturday afternoon we were running a high fever (103.5) and a mystery rash appeared that night. Panic! No, wait, don't panic. I love Dr. Sears - not only because he's a dad of a small army - but because that's the first thing he says: "Don't panic!"

Due to an earlier outbreak of something mysterious when my oldest was about her age, I knew a little bit about fevers - enough to know, in my copious reading, that fever is not always a bad thing. After all, it's the body's natural defense mechanism against invading germs, and therefore I only give fever reducers sparingly now - like only if they're horribly miserable. Even then, fluids and an early bedtime usually does wonders.

Anyway, I was beginning to freak out, because yes, that does seem high. She started throwing up Sunday, and while it wasn't every 20 minutes or anything, it was concerning. And there was that rash. I wondered: she had strep throat last fall, could it be scarlet fever? Hand-Foot-And-Mouth Disease? Chicken pox? I jumped with glee a little inside at the thought of that, because she's only had one shot - and after all, chicken pox is a "normal childhood illness." (Depending on who you ask, anyway... more on that later.)

Of course, being the dummy that I am, I posted a message on Facebook: something about misery, a high fever and prayers (perhaps not so much for her, but for my sanity, as I had concurrently had a three-year-old regressing in toilet habits all day long thanks to one too many bran muffins. Never again.) Anyway, it wasn't long before my mom called. All in a tizzy, of course.

I reassured her we were fine, we were dealing with it, keeping an eye on her, and that was it. We exchanged mutters and disgust over the chicken pox vaccine and how really, it's better to just get the actual illness, stuff like that. Then we hung up.

I had done my research, was confident that yes, I was doing the right thing. My husband encouraged me to stop worrying and get out of the house. I took a nap. I went swimming. I even enjoyed it.

Later, she called me back. In an even bigger tizzy. This time she'd talked to my well-meaning but totally drinking the KoolAid nurse relatives who thought, along with the bombastic, condescending, interrupting fill-in on-call pediatrician, that she should be taken in. I started to feel the panic rise up again, the second-guessing: Was I doing the right thing? Was I being stupid? She had done her share of Google searches, as I had, and came up with even stranger results: all I remember was something about typhoid fever. Seriously? I pictured in my mind a quick visual of Typhoid Mary cooking over a hot stove, shedding her virus into everyone's food, then snapped back to reality. "Mom, it's not typhoid."

"Well, it's 104. What about those bugs you have?"

"Mom, it is not 104. And those bugs are Mayflies. They're dead now - they go away at the end of May. And don't you remember when Oldest Kid had a fever of 104 for a few days? Afterwards I talked to the pediatrician and he thought maybe it was swine flu - and I didn't even know to be freaked out and panic, we just treated it!"

We've had conversations before, interestingly, about how my close relative who happens to be a nurse thinks medicating for everything is necessary and always a good idea; sort of "if it's there, you might as well use it" approach. I don't disagree that sometimes it is a good idea, but when people are overdosing their children on Tylenol, you come to realize that our medical culture definitely has a "more is better" approach, which is probably more dangerous in the long run than just monitoring and caring for the child in the first place.

I still remember some movie - not even sure what it was - where a mom is worriedly hovering over her young child, who is running a very high fever. Fast forward to the hospital - she's in an ice bath (the last thing you want to do, apparently), there's an angel coming to take her away kind of deal, and that's all I remember. I don't think I was even a mom yet, but of course it freaked me out - kids are sick, no one knows what's wrong, kids are dying, I can't watch this anymore. Of course, that scene is the first thing I think of when my child's fever gets high. Wonderful.

When you think about it, what is a fever, exactly? The medical community thinks that it's the body's response to get rid of an invading bacteria or virus. In some ways, fevers are kind of misunderstood and much maligned, which causes us to run around and panic more than anything else. So if it's the body natural response to fighting illness, which is just built right in (in most people, that is, unless your immune system is compromised), what does constantly throwing a fever reducer do to it? It lowers the body's natural defenses, letting more invaders in!

Doubling up on Motrin and Tylenol? Even worse. If a fever doesn't respond to either, then perhaps it's some cause for a call to the doctor - but when you douse it with both at one time, those "stubborn fevers" are just going to get even more stubborn - in fact, they may actually prolong the illness. Just what you always wanted, right?

Now we're seeing more variant strains of chicken pox (yes, even with vaccination!), scarlet fever and Coxsackie virus - that produce unusual symptoms. Could this be from gradual overuse of fever reducers? Who knows. But every time your child runs a fever, you could be thwarting the body's own natural defenses by not giving them half a chance to do their job, which leaves a child perhaps even more vulnerable to these new strains that keep showing up.

And with regards to Coxsackie virus, look for signs, be vigilant about watching temps and all that stuff - but please! Do yourself a favor and do not go all crazy with media reports - because they are going to make you psychotic with worry. There have been deaths from things like chicken pox, coxsackie virus, H1N1, etc. - and I wonder: were they using fever reducers? In the case of Swine Flu, it can actually increase the risk of death if you use it, which sounds contrary to what our government and health professionals tell us.

Even the American Academy of Pediatrics (FTW this time!) says "fever is good for you" and that the media (and just about everyone, it seems) has a "fever phobia." You'll probably notice this quickly - that stupid movie I watched didn't even treat it correctly. An ice bath is not recommended, because it can cause shivering, which actually raises the body's core temperature. And as far as brain damage is concerned, that generally happens around 107.6 degrees. What a difference a few degrees makes, huh?

More reading:
Scarlet fever on the rise
H1N1 and Fever Reducers: A Deadly Combination
Atypical strain of coxsackievirus caused outbreak of HFMD in four states
Pediatric Parenting Myths: Fever is Bad for You
Fighting Fever Phobia: The AAP

Life is Fragile; Handle with Prayer

Yesterday was our visit with the pediatric cardiologist. I want to say that they've found the answer for my son's fainting episode, but honestly, I blocked out so much of the visit I'm not even sure what I learned from it.

It didn't help that, when we first entered the office waiting area, I crossed paths with a man on his cell phone who told someone on the other end, "The baby didn't make it." It wasn't even my child, but I nearly lost it. That sort of put things into perspective for me - that it could always be worse. Much, much worse.

We're finishing the last three-quarters of a 24-hour session with a holter monitor, because the EKG didn't tell the doctor a whole lot. What it did reveal, though, is something called "ectopic atrial pacemaker," which basically means that my son's 'natural pacemaker' is on the opposite side of his heart than it should be. While the results looked promising, and the doctor reassured me he just wanted to be sure that everything was okay, the mere mention of the words "sudden death episode" sent me into a downward spiral. I think my brain blocked out all the positive words of encouragement he offered, like the fact that my son shows no 'alarm signs' that could possibly lead to such an episode.

Normally I'm a 'research nut' and will look up anything to learn more. But at times like this, Google is definitely not my friend. I've decided that, after a basic cursory search, I'm not interested in raising my blood pressure that much and will wait patiently to see what the doctor says. 

Of course any questions I had, I thought of after our visit. And it doesn't help that the first thing that came to mind was a young man whom my husband knew in college who collapsed and died suddenly while playing floor hockey. I am trying very hard to banish that image from my mind.

If anything, this episode serves as a wake-up call. To appreciate my children more. To be more patient with an otherwise normally trying, active six-year-old. To spend more time enjoying my children. To pick my battles better and not freak out about the stupid, unimportant stuff that doesn't even matter. Sometimes that wake-up call is subtle; sometimes it's like a two-by-four smacking you upside the head to get your attention NOW. I guess this would be one of those times.

I look back over my time so far with my oldest and kind of laugh, jokingly thinking about how he's been a "troublemaker" since his days in the womb. When I was four months pregnant, I had an unexplained bleeding episode that resolved itself. At six months old, he had minor surgery to repair a clubfoot, which was done on an outpatient basis at our local children's hospital. I overheard a couple talking to their child's doctor about "biopsies," which put things into perspective for me. I thought about that couple yesterday, and the worries that I've had about my child over the years. What if something did happen? What if I lost my son? That is definitely something that no parent should ever have to think, but unfortunately some do, every day.

In the meantime, we are taking one day at a time. Doing our normal thing, trying to ignore the possible black cloud that might be lurking in the background, and praying to God that it has a silver lining.