Wednesday, March 18, 2009

Doctor #3 Says...

Well, Drew's Mom came the closest with Nolan's funny rash and fever! She was closer than doctor #1 (who thought it was teething, possibly) and WAYYY closer than doctor #2 who thought it was bug bites and that 100 degrees wasn't a fever. It isn't Roseola, though- the fever was never high enough for that to be in the running. Doctor #3 believes that he has some virus (not sure which) and the rash is definitely viral. She couldn't believe that doctor #2 thought that this type of rash could possibly be due to insect bites (no inflammation, and only on the torso- apparently bug bites are more common on the extremities).

This makes me feel a WHOLE lot better, because a viral rash and fever makes sense. Random bug bites (about 50 in total) and an unrelated fever that won't go away do NOT make sense!

We are holding off on his vaccinations, though, until the fever resolves (we're on day 8) and until some additional lab work comes back clean. Somehow, my history of vesicoureteral reflux (VUR) didn't make it on to Nolan's medical history. Matt had a kidney ultrasound when he was born to screen for it, but Nolan has never had a kidney ultrasound.

Add in that he's below the 3% for weight (now a whopping 20 pounds, 13 ounces- the size of your average 9 month old) and has the hearing loss to boot... there are a few things that ring the "worry meter."

She drew another CBC today and the results indicate that there is something viral going on (normal WBC but elevated lymphocytes). In addition to that, she drew a chem panel to check his electrolytes, BUN, and creatinine levels. We expect these to be normal, but it doesn't hurt to be sure.

We're also doing some urine collection for a urinalysis. If it comes back clean, then that means no urinary tract infection. If it comes back positive, then we have to do a straight cath to be 100% sure of the source of infection. We should have the results by Friday (I'm taking the sample in tomorrow).

She also ordered a renal ultrasound, of the same type Matt received when he was a newborn. This should have been done on Nolan as well, but was missed from his work-up. Kidney ultrasounds are not that specific for VUR, however, so she wants to do a voiding cystourethrogram (VCUG).

I wouldn't want to go that far ordinarily (it's not a fun test), but it turns out that VUR is thought to be a dominant trait. Which means my kids have about a 50% chance of inheriting it. It has variable penetrance, though, so some kids show more symptoms than others. If Nolan's VCOG comes back positive for reflux, then Matt will have to have one, too. Hopefully it will be negative.

Other than his low weight, unrelentant fever, hearing loss, and funny rash, though- he looks great! He's in the 25% for height (31.5 inches) and is doing everything else he is supposed to be doing. When they asked if he had 4-12 words, I said, "Pshaw! Try around 50! And some 3 word sentences!"

He might be a little thing, but he's got a lot to say!


Julie said...

Wow. I had no idea about any of that. You are such an on-the-ball mom :0)

You're wise to get it all checked out.

From a non-professional viewpoint, it sure seems like his overall development is great - even without factoring in hearing loss - and I tend not to worry too much about the size. Two of my three are quite small-for-age. As long as they're healthy and hitting their developmental milestones I tend not to worry much.

You're a great mom, Leah. You guys are all going to come through just fine :0)

leah said...

I'm fairly sure that he's probably just a really picky eater who has had an unfair share of viruses this winter, but my history has been niggling at me. Especially since this kid will often go all day and eat only four grapes! I guess some studies have shown that 50-66% of kids can inherit the VUR from their mothers, so we really do need to have the little guy checked out. I don't think he has a UTI (that usually results in high fevers).

Pattie said...

Leah, sounds like you are the one in control (um, as always!). What did the dr say about the chances of VUR?

WOW! Nolan has a lot of spoken words! Andrew has 3 that he uses spontaneously. I am waiting for the rest to start pouring out...but keeping it the back of my mind that he could very well have what his big sister has....

Good job, mama! You need a vacation!