Saturday, March 28, 2015

Oh, I'm Use To This

I will never get use to this.

Especially when the hits just keep on coming.  No sooner did his stomach bug clear up,  he came down with an infection on his upper arm under a calcium deposit.  Well really its more like a series of calcium deposits all in one place.  And the debate is still out whether or not it truly is infection, or the bodies way of pushing it out, much like a silver.  A tiny silver can produce that annoying pinching pain.  Well, the pain of these calcium deposits are much much much more.  We still are not sure of what is really going on.  We know it hurts very much.  The difference though between these is he will have calcium come out in many ways.....but it does not hurt.  His arm was a small pocket.  So I decided to give him ibuprofen and try warm compresses to get it out.   Four days of agony, and it worked!  He did have to not move around much to stay comfortable.  I was in contact with doctors who did call in an antibiotic.  Which I went and  picked up and had.  But I did not feel comfortable giving it to him unless they were able to see him.   He had been on antibiotics for his little toe in January.  Then again in February for his surgery.  So this would have been the third go around.  They talk so much about the overuse of antibiotics and creating resistant I waited on it.  He was able to have a small birthday party with his friends on Friday.  He participated just fine.  He played basketball, played catch, lots of activity.   I did worry he was over doing it but, it was his birthday.   That night he did wake up crying his muscles hurt so we gave him some aleve.  Worked well.  And then......Saturday morning.....he woke up with a giant knee!!!   Que evil suspenseful music!   My heart sank and I thought NOOOOO.   No, please the arm was terrible.

I decide to buck up and give it a go with his knee, like I did the arm.  When a new eight year old is in pain, it is reflected in attitude as well.  He was rightfully grouchy, but it really was starting to wear me out.   He couldn't walk to well on his knee so we encouraged him to take it easy.  We were able to do warm compresses.  But by Tuesday morning I called and said....Im done.  I am coming into the hospital.  We need help.  He is exhausted.  I am exhausted.   The entire family had it.    They told us to come in through the ER.  We were admitted.
Knee after swelling came down

Lucky for us we were put in isolation.  The constant flow of goo coming from both knees made us contagious.   Both knees were sore but the right knee was like it was broken.  I told the doctor I was there because what if his knee cap is joining in on the liquifying of the calcium.  It was red hot.  He would let no one touch it.  It did test positive for staph infection.

We had lots of people visit our hospital room.  We always do.  Its like a sandwich shop at lunch time. Wound Care came.  Child Life came.  Speech Swallow Study came.  A religious hospital chaplin came.  She offered us anything we needed.  I looked at her and said, "I certainly hope we don't need you".  I mean, I know you always need and could use prayer but all's I could envision was last breath sort of thing so I was kind of like, scram.   Of course I didn't say that but I thought it.  I'm sure it was written all over my face.

So before all this happened we were feeling good enough to go down a little on some medications.  We have been watching closely for signs of any changes that might lead to a flare because of the taper.  The calcium deposits doing this has nothing to do with that.   In my opinion anyway.  The ER had not drawn his JDM labs.  They checked his CRP and then all the counts like white red ect,.  I told rheumatology with all the subtle changes,  I really need to see what those are.  He was getting a little heliotrope a few weeks ago, but it subsided.  He had been showing a little bit of swallowing agitation.  He use to love steak but took one bite, and now he won't touch it because he said its hard to swallow. I was having lots of trouble believing it.  You would think more subtle JDM signs would show, like red knuckles or capillary changes.  Why would swallowing be it.  So I even hesitated to report it because he can eat a chewy bagel no trouble?  That is not someone who is having swallowing trouble?  But I thought when you are inpatient, you are advanced some services that you not when its through the clinic.  People will come right to your room instead of waiting weeks for an appointment.  So they came and we didn't get any answers because its so hard to tell.  If its not every time.  We do have swallow study set up for the end of April now but I was trying to tell them that was pointless.

Welcome back Rituxan.
Our rheumatologist walked in and said so guess what I want to talk about.  She had been mentioning it for months now.  She wanted to give Rituxan a try again.  Her sense of passion and confirmation through her gestures were pretty powerful.  With one sentence I said let me think about it, and then the next, it hit me like a lightening bolt.  Do it.  One look at her face, the need to stay in front of this....I was just like do it.  I found myself trying to back peddle out of fight or flight.  The flight part of me asked for his b cell count which Rituxan targets.  The fight instantly came back in and said, "will the b cell counts change whether or not we run Rituxan."   A solid NO.   So I said don't run the labs then.  They did anyway.  So some med changes.  We are dropping Imuran, replacing it with Rituxan.  I asked for a taper on it, while the Rituxan kicks in.  They agreed.  We are adding back in calcium supplements because his calcium levels are low.  Yet, his body shows a lot of calcium, so confusion but I get it is the wrong kind.   We changed a blood pressure med at my request.  There is one that is used to block calcium in the blood.  They said, sure, why not.  We are also going to spend the summer on Sodium Thiosulfate.  She wants to give it another try.

His JDM labs finally came back.  Like we discussed with the doctors, there is so much going on in his body with the viruses, infections.  It was hard to tease out whether or not the taper was leading him into a flare.  His AST and ALT did pop up a little.  Labs often don't match what is going on but time the subtle signs match the subtle labs.

So much to think about.  I feel like its so much to figure out.  We are still on for surgery next week.  His bottom has been bothering him still so I know it is so much for the little guy but I want that him to get some relief with that.  He has dealt with calcium on his bum far too long, and I don't want to miss the opportunity.

We go back in two weeks for our second round of Rituxan.  It will be an admit.  I will turn forty there in that room.  I guess as long as I am with him, there no is no place I'd rather be??  I would not like to be in say Vegas where we originally planned to go.   No way am I feeling sorry for myself though.  It is just fine.  I am so grateful for the care.  I am so grateful we are still able to keep this quiet and battle back, until it (Gary's immune system) decides its done.

Thank you so much to my baby sister.  She made us dinner Friday night when we returned home.  It was so nice.

Happy 8th Birthday Gary.  Are these boys cute or what?!

Thursday, March 5, 2015

The Viral Times

These are germ sharing times.  We can't seem to get away from them.  Bleach and fruits and vegetables was my recommendation.  Oh and hand washing, all that jazz.  Honestly, I think it all helps but unless you walk around in a bubble.

Then trying to figure out viruses with a child that is immune all messed up is like being squeezed.   What if its not a virus, what if its something else.  What if its an infection?  What if a flare?  What if it his port?   In my mind my face is going in every direction while my head stays still.  Drives you crazy.  Then if it truly is a virus, what if I catch it?  Am I feeling sick?  I think I am feeling sick?  Does my stomach hurt? Scream STOP.    Get it under control.

Last night Gary popped up with a I don't want to eat dinner.   Fine with me.  No dinner, nothing else than.  Later in the evening I offered again.  Still a no, and I have a headache.  I get this often from my child.  He does not like going to school so much he will set the stage for the next day.  So headache complaints must be at least 6 or 7 times before I will pay attention to you.  This time however, he said "I'm cold".   Then violent shaking, headache.  I gave him tylenol of for the headache.  We covered him in every quilt our friend Sue has sewn for us.   He really started to feel unwell.  The staging for no school the next day was going a bit far.  So far that this is the real deal.   And just like that 20 minutes later 102.6.  Blankets off, but I'm still cold.    No vomiting,   no action at the toilet.   He was miserable.  It took longer for the tylenol to kick in than I thought.     He finally fell asleep later that night with a  washcloth over his eyes.  I figure I would call the doctors in the morning to report.  Luckily the severe symptoms have subsided.  He woke up the next morning, better but really tired.  Achy tummy.

In February Gary had his first round of plastic surgery.  They removed three calcium deposits.  One from each elbow and the one under his chin.  It went pretty well.  Healing was a little tricky, we knew it would be.  When Gary came out of surgery they told us his skin is thin from all the years of steroid use.  They double nylon stitched him closed to ensure the incision stayed together.  We did go on some antibiotics because we suspected a little bit of infection but other than that they look beautiful!!!    It is definitely tough on him but so worth it in both our opinions.  I know my son feels the same way.  Monday we have our post op appointment.  We will find out if the surgeon is willing to do more or if that is it.   Right after that surgery,  while Gary was still under, they ran him thru the MRI.  NO evidence of muscle inflammation.  So that was terrific news!  His labs have been fine as well.  Nail capillaries are pretty nice looking so all signs are pointing to lets pull back slowly off of some of these medicines.   I can't really say that with extreme confidence because it has been a long six years of this dance.  I don't mean to be negative but the been there done that comes to my heart and mind.   And the not best part of this whole thing is even if we can wean him off medications, then you have sit there and worry he will flare again and you have to start all over again?  I mean, I have known this all along but I.....wait...what?