Monday, March 30, 2009

The Progression of Hives, Mixed Blessings, Etc.

I was just reading my last post and thinking it feels like a year ago. We just got home last night from the hospital, where we had been since Sunday afternoon.
Prednisolone did nothing. That, or it kept the Kittyboy from developing anaphylaxis, for which we would be quite grateful if that's the case, but did nothing we could SEE. Saturday night, his back looked like this first picture.
Sunday morning, he woke up quite irritable (yup, steroids! is what we thought) and so we gave him his morning's dose and he stayed home from church with daddy while I went. I got home, and those suckers were BIG, had greatly multiplied, and looked very, very ANGRY. His hands, feet, elbows and knees were swollen, and he was not happy. He went back to Dr. Hendricks (I love having a doctor whose clinic hours are on Sunday) and he said it was the worst case by far he had EVER seen on a toddler, and that since the steroids weren't having the desired effect, go to the hospital. Here is how Kittyboy's back looked in the ER, laying on Husband's chest, and below that picture is one from the front.
The ER doctors were QUITE alarmed, in particular because he wasn't scratching. Their minds would have been greatly at ease were he scratching up a storm, because there are diseases which make the skin look spectacularly freakish but do NOT cause itching, all of which are bad things to have. We did keep mentioning that he completely ignored mosquito bites last year, he has this surprisingly high pain tolerance for certain types of pain and discomfort... I don't think they bought the idea that he could have hives like that and truly not feel it ("really, he probably doesn't know it's there" I told them). So they put in an IV port (took about two and a half tries) and drew a heck of a lot of blood (three tries). A full blood panel along with many other things showed that he didn't have anything exotic or vascular. They really were "just hives". Hives that didn't react to steroids and barely reacted to intravenous Benadryl. Poor precious has my veins - tiny, sneaky, and playful - hence the numerous sticks from nurses experienced with toddler blood-drawing. And needles are NOT a type of pain he ignores, he had Husband holding legs, me holding chest, and a nurse on each arm as a third nurse was trying with the needle. After that, he started crying every time a nurse came near him.
So Sunday afternoon we were admitted, and around 5, moved into a room. I seriously erred in my preparations for our overnight stay. I had gone home for his Elmo, Pooh, and musical seahorse, but I did NOT bring back his weighted pillowcase. I really, really should have. Apparently I am an idiot.
He finally gave up about 10 p.m. and went to sleep (mostly). I fell asleep on the couch sometime after 11, and woke about 12:30 to the sound of fierce combat in his bed, as a nurse was trying in vain to get his vitals. He was not about to surrender so much as a pulse rate to anyone in scrubs without a fight. Poor nurse had been trying not to wake me. I got him back to sleep sometime after 1. Quarter to three, he was up - for the day, he seemed to think. He went down again by 4, until 7 a.m. at which time he really WAS up for the day.
Husband, who had spent the night at home in our nice comfy bed with peace and quiet (not that I'm jealous, of course) was back at the hospital by 8, with coffee. We spent the morning holding Kittyboy for nurses, who still couldn't get vitals or administer medication without a struggle, telling him NOT TO SCRATCH, as he was starting to, and around 10, the long awaited allergist Dr. Lehman arrived. He felt that in the first place, it wasn't food or plant/bug/animal related. A reaction to the amoxicillin Kittyboy had been on for an ear infection was possible, but not probable. He said it was most likely a virus! Viruses can cause hives, and be resistant to treatment, as they tend to develop and then leave on their own timetable regardless of whatever you do. Food, pet, plant and other standard allergies can develop suddenly at the age of two, but not THAT dramatically out of the blue, and he also said it didn't "look" allergic. I assume when one is the Go-to Allergy Dude of a major hospital, one has developed a feel for what is likely to be caused by what.
So Kittyboy probably has a virus (we'll also be very cautious about "cillin" antibiotics in the future, as that was the next most likely suspect). Dr. L also said that the grayish blueish centers developing in the larger spots, which looked QUITE alarming by then, were not cause for alarm. They were bruises surfacing as the hives were receding. Bad hives will do that. He had seen much, much worse caused by a virus (he interned at St. Jude's), and all you can do is treat the symptoms (i.e. Benadryl for itching, rest, etc). If lunch went well, we'd be discharged soon after. We watched Monsters Inc and ordered lunch. Here's a picture of the start of the bruises on his back. That's basically what every large hive turned into!
Lunch did NOT go well. He took five little bites of pizza, drank an ounce of milk, and rejected everything else. We saw that the bruised areas were getting much darker in places, and he seemed unable to get comfortable in any position. The nurse got a resident for us, who left messages for our doctor and the allergist. He (resident) asked me if it was a matter of discomfort, or of pain, the distinction being that discomfort can be dealt with at home and may be alleviated by BEING home, whereas pain would be cause to stay in the hospital, both for managing it as closely as possible and to make certain that there's no other cause for the pain. I couldn't say either way, as he does have this sporadically high tolerance - was it just a discomfort of a type he couldn't ignore, or was something hurting so badly even HE was in pain from it? I told the resident that's a really hard call to make with this boy, and I couldn't make it. Kittyboy just lay on Husband's chest making unhappy noises. Around three, I grabbed my purse and cell phone and went for a walk, because my nerves were just a bit shredded. I found a comfy chair outside the gift shop and talked through my nerves on the cell phone (thank you, Carey!).
I came back to the room probably an hour later with a teddybear wearing scrubs. It was so cute, I couldn't resist, and Kittyboy's quite fond of bears. Happily, he was sitting upright, had eaten some cottage cheese, drunk some milk, and seemed to be feeling much better! The time spent horizontal had evened out the bruising, and it was more obviously just that - the bruises are bad, they make him sore and achey, but they really are just bruises, not internal bleeding or anything truly serious. And he grabbed for that teddybear!
The next nurse who came in was old enough to have given birth to every nurse we had had up to that point - not to say that she was old, but that all our other nurses had looked my age or younger. And SHE, having possibly been a nurse as long as our other nurses had been able to walk, got vitals with no fuss whatsoever. "Oh, I like that bear! His clothes look just like mine, don't they? Can I listen to your bear's chest? Oh, what a good boy he is. Yup, everything sounds good! Can I listen to you now?" The same for temp, the same for blood pressure. Not a PEEP from Kittyboy. Easy as pie. I first thought, "Oh duh, we've had Elmo and Pooh here all along, we should have thought of that!" but this nurse had been around the block far more times than we OR our other nurses had.
And, she said we could start packing up, because she'd been told to start on discharge papers!
So here we are, home as of about six last night - he slept twelve hours straight, has watched two Veggie Tales videos and two Pooh videos this morning, drank juice, ate applesauce, and seems to be slowly mending. Any movement is slow and uncomfortable. His back is an even color and texture (not quite a HEALED color and texture, but getting there), his front, arms, legs and face are very mottled. Some places look bruised, the overall effect is that he got scalded or burned. But he is napping, and reasonably comfortable.
The first picture, Saturday night, had been just so we could so grandparents before it faded, which we assumed it'd be doing soon. Sunday afternoon, Husband pulled out his phone on which he'd taken the pictures, to show the doctors, "Look, here's what it was last night," and they were so impressed and glad to be able to see it, that we just kept photographing each stage so that each shift of residents who came on duty could see how it started, what it turned into next, etc. And now, they're proof of what hives can do, because I never would have believed it if I hadn't seen them myself!
God is very, very good! Our little guy is on the mend!


Mimi said...

Oh, those photos just make my eyes tear up. Poor guy.

I'm glad to hear he's doing better.

Pres. Kathy said...

I too cried when I saw the pictures. It is so sad when little kids are in pain like that. I too am happy that he is doing better. He will be in our prayers for a speedy recovery.

Jennifer Courville said...

My 2 year old daughter is currently going through the same type of hives (believed to have been from the strep virus she was fighting). The hives developed after day 5 on the antibiotics and we were told to stop the antibiotics then. We are at the stage of the brusing and it seems to be quite painful and still very itchy. I feel the Benadryl only does so much to help with the itch. My daughter also is running a fever, which I'm hoping is normal due to her system fighting off the virus.

Either way, I just wanted to thank you so much for posting your experience along with the pictures. It helped to calm me somewhat, as it is helpful to hear that she is not alone with this. Any and all help or advice is much appreciated! Thanks again Caeseria!!