Showing posts with label Central fever. Show all posts
Showing posts with label Central fever. Show all posts

Thursday, June 21, 2018

My misdiagnosis

Proteus mirabilis
I'm still wiping the egg off my face.

For the longest time, I've been carping about C.'s neurological fevers. In recent posts, I've noted their increasing frequency and severity. The Hubby and I even wrote to the neurologist about it last week.

But for certainty's sake we brought her to the pediatrician on Wednesday for a clinical exam.

He found nothing pathological. But our thorough prize-of-a-doctor ordered blood and urine tests nonetheless. If those were clear, he said, it would be safe to presume she's really got rising neurological fevers.

On Thursday, after the visiting home nurse drew blood, C.'s fever spiked to 40.2 Celsius (about 104.4 Fahrenheit)!

So despite the difficulty involved, the Hubby rushed C. to the local HMO clinic for the nurse to take urine via a catheter and then rushed the specimen to another clinic for transfer to the lab. (The visiting nurse, a male, refuses to insert catheters into female patients.)

It was immediately clear that C. had a urinary tract infection.

So within an hour, we'd started her on Cefuroxime. Since then, her fever has been steadily dropping. She's back to her usual slightly elevated temperature with an amazing, fluky 36.8 C thrown in last night! In Fahrenheit, that's 98.2. I can't remember her ever having a reading that low.

Her pediatrician surmises this infection has been simmering (and C. silently suffering, of course) for a while.

Today the urine culture results arrived: Proteus mirabilis

It's actually quite a work of art (above).

As for the moral of this story, I'm sure it's obvious. Never presume anything about our complicated children who can't convey to us what they're feeling.

Tuesday, June 12, 2018

Febrile fun and games

C. kicking really well during
last week's hydrotherapy session
C. has been quite unwell these days.

I always feel ridiculous describing her that way when the fact is she is always "quite unwell". But what I mean is she's been running fevers of over 39° C and vomited several times yesterday.

Needless to say, to cap it all off, there were seizures. But, oddly, the seizures weren't any more frequent than with milder fevers. In fact, they subsided without the lowering of fever.

So today she'll be checked by her pediatrician who will tell us whether she can go to hydrotherapy. Tuesday is the one day that our local therapeutic pool admits females. We are all eager to see her in the water, the only context where she flowers.

Last week, while back floating, she kicked vigorously with both legs for the entire session!

Still no word from the local Liberty Swing distributor who promised us he'd deal directly with the reluctant municipality.

And still haven't located an Occupational Therapist or a Speech Therapist experienced in cases like C. who gives receipts. Without names we can't proceed with the pilot project we've been accepted to. The idea is to provide C. at home with the services and therapies she would receive were she warehoused in an institution. Currently, in this country, she can't.

UPDATE: After a thorough exam today, the pediatrician has declared C. fit for hydro. While he couldn't find a cause for her fevers, he recommended doing some blood readings, testing her urine to eliminate UTI and having her elbow wound seen at the wound clinic to eliminate infection. He doubted either is causing the fever. If the tests prove negative, we'll be left with a diagnosis of neurological fever that has climbed higher than ever before. Did I really believe there were improvements on the horizon?

Wednesday, May 30, 2018

Frustration overflow

First a swing update:

The Hubby met with the local distributor of that enticing Liberty Swing I am trying to have installed in our city. Currently there are just two in this entire country, both in a city that's over an hour's drive from us.

The parks department of our municipality won't permit us to donate and install it in one of its playgrounds without first winning the approval of some committee. The first step toward that approval is a written request. But here was their response to the email I sent detailing what we'd like to do:
Equipment of this sort has never been installed in our city. We need to examine the technical details of this item of equipment and determine whether the municipality will be able to maintain this type of equipment. Only after examining the above topic and receipt of authorization from the relevant bodies will it be possible to install such a swing and to maintain it. We will be in touch with you in order to survey possible optimal venues for installation of the swing.
To be clear, Liberty Swing's website lists 215 such swings extant throughout the world - excluding the two in our country. So we're not taking about inventing the wheel here.

But the distributor assured us the ball is now in his court. He'll deal with the municipality directly and hopefully move the project to fruition.

I'll still tackle the crowdsourcing, of course. We'll see whether he delivers on his promises.

C. is consistently unpredictable these days. We never know whether she'll hand us an hour or so of hard seizing or remain calm. If she seizes, we never know whether it will be accompanied by central fever or not.

When I put her brace and shoes on, I can't predict whether she'll stand erect, walk nicely, bending and straightening her legs. Or whether she'll just tilt her torso sideways and keep her legs stationary.

At mealtimes, I never know whether she'll place her spoon into her mouth independently and swallow her food quickly. Or whether she'll drop her spoon, need to be fed and then store each mouthful in her mouth for eternity.

Definitely not an easy period.

I've been writing locally about my pet peeve - warehousing children with disabilities - and growing increasingly frustrated with my failure to have an impact.

This country's largest chain of warehouse institutions is constantly sprouting new, greedy tentacles. It is partnering with a growing list of organizations, several of which claim to champion true equality and inclusion for people with disabilities. They should know better.

One of its many outrageous operations is a "prisoner rehabilitation" program whereby imprisoned criminals are bused several times a week to its institutions to interact one-on-one with people who have profound disabilities.

Some of the prisoners are serving substantial sentences. But the institution insists they have all been vetted for safety and even permits them to change out of their prison garb into civies during their visits. Yet they concede that the men aren't permitted to interact with female residents or with minor residents. Nor are they admitted to the hydrotherapy pool.

Hmmm. Sound safe to you?

My written inquiries have revealed that in all likelihood no other institution in the world "rehabilitates" prisoners in this manner. Two major prison service entities - one international, one local - assured me they have never heard of one.

If you are aware of such a program, I would very much appreciate your sharing details of it. I would also welcome any tips on how to foster de-institutionalization in countries that are resistant to that transition.

Like mine, of course.

Friday, March 2, 2018

Fever, stress, vomit. Life.

True, we might have gotten bored with the same old, same old. I mean profound developmental impairment both physical and cognitive, central fevers, cortical blindness and refractory epilepsy. They might not have kept us on our toes. So, it's understandable that we've now had retching and vomitting added to the mix.

It's been nearly two weeks since those new symptoms debuted. Last week's exam by the pediatrician didn't explain them so we did blood tests on Monday. We also consulted by email with the neurologist..

The pediatrician - who has kindly acquiesced to keeping C. on despite her nearly 23 years - thought that perhaps one of C.'s anti-epileptics is the culprit. The one added on last is Vimpat/Lacosamide. I recall that the neurologist who saved her from a near-coma during her last hospitalization said then that her Vimpat dosage was too high. But he ultimately left that unchanged because she recovered just by his removal of several other drugs that the hospital team had been administering her.

But the neurologist treating C. now - a member of the above hospital team - dismisses that theory.

The Hubby and E., the caregiver, are convinced that phlegm is to blame for the vomiting. But I'm not. She just shows no signs of phlegm, doesn't have a runny nose and isn't coughing. Besides, she's never vomited from a cold in the past.

We also emailed the gastro who had prescribed Carnitine to repair her liver when it was damaged by the Valproic Acid medication. She's been taking 250 mg. of it three times a day for over a year. Then this past weekend we went away for 24 hours with the entire family. I forgot to pack in the Carnitine and C. did not seize, vomit or retch the entire time.

So I hoped we'd found the cause. But now, after receiving the gastro's OK to stop carnitine, it's clear that was wishful thinking.

So the mystery of the vomiting remains.

C.'s Central Fevers have also increased in frequency and are stumping everybody as well. Her neurologists don't seem to have experience with them at all. In fact, while C. was last hospitalized one of the doctors posited that we have it all back to front: the seizures are inducing the fever.

Now, that's such a presposterous hypothesis, I can't decide where to begin debunking it. One, C. also has seizures without fever. Two, when she has a fever with seizures, they stop once the fever is lowered. Three, central fevers are a known phenomenon. I didn't invent them. But nobody on the team was listening.

I'm hoping that our neurologist will be able to track down a doctor who is familiar with central fevers. We plan to meet up with her for a face-to-face consult next week, something I'm not eager to do since the last time we spoke, in the hospital, I sensed she wasn't enamored with my ideas. (They tended toward pleading for lowering the meds, asap).

In the meantime, it's just stress, stress and more stress. Here's a self-portrait in the works that illustrates that.

Friday, June 24, 2016

No silver lining in this cloud

C. wants a drink (explained at the end
of this post)

I haven't posted here for a while because caring for C. has been almost exclusively drudgery, hassles, worry and frustration. Since it's tough to relate the negatives while in the thick of them, I waited for respite to descend but in vain. So now I'll try to blog straight through this cloud.

C.'s pressure sore remains horrific. It's infected, deep, large and persistent. I cringe and shudder each time I re-bandage it. Our dear home visiting nurse instructed me to do that only every two days. But, while I still admire and appreciate him, I've switched to every day.

The makers of the ointment (flaminal hydro) advise to expose and examine the wound every day and to re-dress it when the stuff isn't visible any more. Since C.'s bandage fills with blood and pus within hours, this was a no-brainer for me.

But the sweet nurse seemed annoyed with my disobedience and my panicking. 

Next are the cannabis license hassles. I finally scored a real live voice at the Ministry of Health which told me our renewal license will be at our supplier immediately after the previous one expires.

But there's a major hitch: the dosage on the license - 40mg per kg per day - is way too low. In fact it's lower than the dose I've already risen to. And with the neurologist's approval I had intended to raise it further - perhaps as high as 60mg.

So why had the neurologist requested this dose? She hasn't responded to my email.*

C. is currently staging another of her hunger strikes (here's what I wrote the last time this happened), barely puts the spoon in her mouth and then parks the food there for an eternity. Each meal drags on for ages.

And, the surgeon who will be implanting her VNS (link) warned us that she absolutely must gain weight before the surgery. At this rate, she'll probably lose instead.

Then there are C.'s feet, swollen from fluid retention. She's had this problem before and I know it plagues everyone who spends most of the day sitting or lying down. It usually clears up quickly when I'm careful to keep her legs raised but to be honest, I've neglected to do that of late since they weren't swollen..

The central fevers have been manifesting frequently and C.'s walking hasn't been up to scratch, though I don't believe there's a connection between the two. She often stiffens her right leg and refuses to step with it. I'm forced to struggle to move it forward making the whole effort far more exhausting than usual.

School's about to end - forever
On Sunday, C. officially "graduated" the state's educational system. To mark the end of the academic year, her teacher threw a party. Photo on the right.

In mid-August, the "powers that be" will throw her to the wolves. After that, we have two options. We can either banish her from our home to one of those large, closed institutions that I'm always lambasting. Or we can send her to a "day center" as they're called here where only her most basic needs would be met by some very basic staff members. The staff/student ratio is 2:10 which, I'd say, tells you all you need to know.

Today we met with the school social worker again to discuss those bleak options and the possibility of receiving some therapies at home via our Health Fund.

Now she's a lovely, sweet, kind young woman with what she described as ADD. Her desk is coated with scribbled-on papers that constantly get blown to the floor by the fan. Every time we meet with her, she asks us the same questions, we give her the same answers and she promises to make the same inquiries to the same offices on our behalf. The trouble is she never does and we are always back at square one. I'm reminded of the film "Groundhog Day".

The lobbyist at our local advocacy NGO - with whom I spoke last week (link) - has promised to file a petition to the High Court demanding government funding for therapies and care at home, rather than in an institution.  Toward that end we are hunting for the requisite four other families interested in joining this class action. So far, we've got one. The school's head of therapies has promised to find us three more.

As you see, the good news is currently lying low but at the bottom of the barrel I scraped this up: we're having unseasonably hot weather and C. is always thirsty. I've noticed that whenever she hears me walking over to her, she opens her mouth wide for more water (see photo at the top).

Her mouth stays shut when I'm not in her vicinity. The Hubby and I consider that that a clear sign of some impressive cognitive calculations.

---
* I followed up our unanswered email to the neurologist with a phone call. She said she was taking care of the dosage problem. While she didn't explain why she'd originally requested only 40mg/day, she assured me that she'll now resubmit her request for 60mg/kg/day this time. Now for the bureaucracy budge.

Monday, May 16, 2016

Two nice nurses and a heart-wrenching story

C. after a seizure caused her
to bit her lip

Now back to Tuesday's nurses. One was the VNS company's rep. She observed and photographed C.'s VNS. Then she listened to our history of C.'s epilepsy and gave us an hour's spiel about the VNS.

She "repped" so well that she swung me from lukewarm to ga-ga about the idea. She told us that the VNS' benefits aren't limited to seizure reduction, which is pretty impressive in itself - 62% of implantees improve either in number of seizures, length/intensity of them or in recovery time after each one.

But we learned that the VNS can also provide benefits unrelated to seizures, in cognition and memory. The nurse/rep emphasized that C. is not likely to ever enjoy any dramatic improvement in those areas, just tiny changes.

Well, as I've mentioned before,  tiny smidgeons of progress are very alluring to us. Of course, dramatic would be a lot more welcome but we're realistic. So the chance of tiny smidgeons won us over.

We already have an appointment to have C. assessed by the surgeon (early June).

Nurse #2, our health fund savior, arrived while the VNS nurse/rep was still around. He assessed and re-bandaged C.'s pressure sore and gave it what sounded like a D+ for healing progress. Ah, well, can't win them all.

Most intriguing about his visit, though, was what he told me about his wife who, after months of bureaucratic hurdles, finally scored a medicinal cannabis license a few weeks ago. Last visit, he told me it was controlling the pain nicely. But this time he said she has stopped using the stuff because it was triggering her nightmares.

Champion nurse/rep chimed in with an anecdote about an epileptic child who became irreversibly psychotic on cannabis and whose neurologist is beside herself with concern now. Hmmm. Of course this reached us 3rd or 4th hand so we took it with a bucketful of salt.

Over here, we are still enduring "bad days", with C.'s old "central fevers" in the picture too. THC continues to help but this period has been very debilitating for her and me. Yesterday, after one seizure we found her like this (see photo at the top).

The source turned out to be a small cut on her lower lip which stopped bleeding immediately after I wiped her clean. Her lip is a bit swollen today but doesn't qualify as a major concern.

In light of the current seizure situation, the VNS is looking increasingly attractive. I just hope the surgeon doesn't reject her as "too complicated a case" because of her current VNS which was implanted in December 1999. It's a possibility the nurse warned us of.

Now for the heart-wrencher alluded to in the title - an Israeli opinion article I found on line, unrelated to our nurses. (though it does feature a nurse).  It will undoubtedly resonate with many of you. Caution: keep the tissue box close by.

A child isn’t a lollipop
Alon Idan | Haaretz (Israel - Hebrew), May 5, 2016

He looks at me for a moment as if he wants to say something but immediately lowers his eyes. I notice that on his left knee lies the head of an adolescent girl. I walk back to the bench I had been sitting on.

“Listen...” he is nearly stuttering now, a few seconds later, “Can you perhaps help me?” I tell him yes but don’t understand what help he needs. “I need you to help me hold her,” he answers looking in the direction of the head that is resting on his left knee.

Patients in waiting room (in Birmingham AL as it happens)
We are outside the ultrasound rooms in a hospital with people lying on beds scattered along  the length of corridor, most of them old, wrinkled,  eyes stricken, but the head  lying on his knee is the head of a young pretty girl. I ask: “Help holding her?”

He nearly apologizes: “She is mentally retarded, she doesn’t speak at all and the last time they wouldn’t x-ray her because she got wild, and everything she eats she immediately vomits up, for a long time now, and I must have her x-rayed, must.”

He’s her father and is over the age of 50, and he’s an Ethiopian immigrant from many years ago and now sits alone on a hospital bench, and his daughter is lying on his left knee, and when he speaks about her in a mix of apology and pleading she suddenly raises her head, opens her beautiful eyes and looks at him, and afterwards at me, and says nothing.

He has an orange hat, and under it is a man who works every day in a hotel, the night shift, always the night shift, “so that I’ll be able to be with her in the mornings and afternoons until my wife returns from work.” And he returns from his shift at 2 at night and falls asleep on the sofa beside her. “I fall asleep like this”, he demonstrates. “Sitting, I fall asleep sitting. There’s not much room in the living room, and I must be beside her at night, in case she wakes up suddenly and does something.”

An orange hat and a hand that is now resting on it, while I sit beside him and don’t know what to tell him. “It’s hard”, he suddenly says, his voice cracking, “This life is hard, very hard.” I nod, helpless. “It’s not a life.... nobody comes to us, and I don’t go to anybody, and everything revolves around the child.”

I ask him whether the state helps, and he answers that “there’s no state that helps like this one, but I’m not prepared to give her away, not prepared.” And then he says a sentence that he will repeat over and over again: “A child isn’t a lollipop, you don’t give away a child like that. She’s my child. Who will care for her the way I do? I will care for her as long as I am able to, until I die. A child isn’t a lollipop.”

The door opens and shuts but nobody looks at him. He begins to fear that I might need to leave. “I’m holding you up”, he says to me “I’m holding you up.” I say that it’s OK, he shouldn’t get stressed and he relaxes a bit. “You understand,” he continues, his hand rests again on his orange hat trying to crush it into his skull, “I don’t leave the house, only to work, it’s hard like this, it isn’t a life.” And a moment before I say to him that I understand – can you really understand? – he breaks: “There are no friends, nobody, alone all the time.”

A grown man, a child lying on his knee, now sits on a hospital bench and cries.

Presently they call him. It’s time for the examination. We walk towards the door: the father, his daughter and a total stranger. “Who are you?" the nurse asks me. And the father immediately cries: “He’s with us.” “Why does he have to be with you,” she asks and the father says: “Because she moves a bit and he’ll help us hold her.” “Hold her?” She’s suspicious and immediately determines: If it’s “a case like that” then the ultrasound can’t be done.

The father is stressed. He says everything will be alright, that his daughter must be checked,  just as a large-bodied janitor approaches us: “Come, come a minute,”  the father asks and the janitor doesn’t understand. “I need you to help us too,” he says, and the nurse looks on in disbelief. Suddenly, without asking, the father raises his daughter – long, thin and frightened like a baby – and simply lays her down on the examination bed. Before the nurse has a chance to object, he says: “You’ll hold her legs, and you’ll hold this hand and I’ll hold her like this.” The nurse is about to say something, apparently to object, but she never finishes the sentence she begins to formulate.

Lying on the bed in a darkened room, three men gripping her body, a strange device, perhaps painful, threatens to touch her – the child trembles from fear and begins to go wild. “Don’t be afraid, my darling” the father cries and caresses her face, “don’t be afraid, everything will be OK.” Now the janitor, his face large, a yarmulke on his head, his eyes moist, says to her: “Don’t be afraid, don’t be afraid.” I too join the plea, as her right hand struggles forcefully to escape my grip.

But the girl is still going wild and the nurse is still hesitant, and now the father strokes his daughter’s face again, repeating the words: “Don’t be afraid, darling, don’t be afraid.”

He stands directly above her, his head above hers, so frightened that the nurse won’t perform the examination. “Don’t be afraid, darling,” he continues; now it is truly a prayer. “Don’t be afraid darling”. But she continues to move, to go wild, to resist, when suddenly I notice tears trickling onto her face. The father is sobbing on his little girl. Sobbing onto her and begging: “Don’t move, please, don’t move, let her check you, you must be checked, please.”

And the nurse, who can no longer avoid the sadness and the power and the beauty of life that coalesce in the tear drops flowing from the pure heart of the father to the frightened face of his daughter, immediately smears the gel on the girl’s stomach and places the scanner on her.

(Translation: Frimet Roth)

Thursday, August 27, 2015

Frazzled by fevers

After three very good days with almost no seizures, we have been plagued by several awful ones. That blasted central fever and the many seizures it triggers have become  daily (and even twice-daily)  fixtures. Only after 1000 i.u. of Advil, cool compresses and a couple of hours does C. settle down.

It's not only the frequency that's increased. The fever itself is now higher: around 38+ degrees Celsius, rectally.

I Googled about central fever and epilepsy for the first time today and learned two things:
  • This blog comes up as link number 7 with a post in which I wrote about it.
  • Central fever is associated with acute neurological patients; those who are critically ill in some way other than "mere" neurological impairment. 
It seems that doctors often find it difficult to distinguish between fevers in such patients that are caused by infections and those that aren't. The articles tend to tackle that problem.

But I couldn't find any discussing  such fever in a neurologically-impaired but otherwise healthy patient.

Until now, C.'s doctor hasn't been concerned whenever I mention the fevers. I suppose I could let her know about their increased frequency. But since I'm sure she won't have a cure for it, I don't think I'll bother.

Here (on the right) is C. during one of her three recent great days. I didn't dare post this photo for fear of the jinx. No need to worry about that any more.