Rash Decisions

Working mom life lesson: Don’t make plans. As soon as you do, you’ll find yourself leaving work early for the Disney Princess Acute Care.

festive urgent care

Last week was supposed to be my week. After a tough cold/flu season and cutting her first four teeth all at once, my daughter was just finishing up an antibiotic for an ear infection and her disposition was turning the corner from sour to sunny. My husband, Brandon, and I have been refining our life-routine since moving to our new apartment in February, and we even made a meal plan for the WHOLE WEEK. This was a monumental accomplishment; as anyone responsible for feeding children will attest, coming up with reasonably healthy meals multiple times a day is brain torture. Especially the meals that get sent to day care.

I can hear the judgement from the teachers as they open my daughters lunch bag: “mmhmm, cottage cheese, again.” 

I had also allotted time in my evenings to work on this blog project. I wanted to polish up the site as I prepared to share with my little world. But my baby Bear had other plans. (Hence no cool favicon yet. Sorry) Following a horrendous night that included hourly wake-ups, on Monday morning we kicked off the day by finding a few suspicious looking spots on her neck and shoulder. We noticed a few dots the previous day, but we felt like we had seen them before, and we chalked it up to being a bit of baby acne, because how could bacteria not get all up in her skin with those grubby little fingers touching everything in reach? But when we were dressing her for school (day care- they call it school, and we like that, so we roll with it. An academy for infants!) the dots were no longer innocent and pimple-like.

photo 44

While we were indeed very concerned about these spots, knowing that her school would freak out if they discovered them boosted the impetus for immediate action. Obviously we would have watched with caution to see how they progressed, but at this early stage it looked curious and perhaps like bug bites- not outright alarming. But school does not take such things things lightly (with good reason), so we had to make a game plan. It was 7:00 am, and her doctors office didn’t open until 9:00. We knew that the likelihood of even getting in at a reasonable time that afternoon was slim, because that’s just how awesomely the system works.

So to the Emergency Department we went. (I initially had mixed feelings/guilt about this decision as I don’t think ER’s should be used for non-critical issues, but read on and you will see I was absolved. Also, she is an infant, and anything happening to a human that can’t tell you how they feel is serious) We live relatively close to the brilliant new Benioff Children’s Hospital, so after a 5 minute drive we were parked and filling out paperwork. Insider Secret: nothing is happening early on Monday morning at a Children’s Hospital ER. We didn’t see any other patients. We walked in, made it through triage and saw a doctor within about 8 minutes of arrival. The triage nurse said things would fire up around 1:00 or 2:00 p.m., when kids started hurting themselves at school or sicknesses on watch at home started worsening. photo 55

The resident and doctor we saw were fabulous, though there was debate about what the rash was. The doctor ultimately called it Erythema Multiforme which is a fancy name for “rash we aren’t totally sure about, but is likely viral or an allergy”. We had given Bear almost every allergenic food we could think of by this point, so we ruled that out. What the doctor was sure of was that it wasn’t contagious and that it wasn’t a rash to be overly concerned with like the measles or impetigo. So they gave us a note to get her in school and we went on our way.

I was only about an hour late to work, so our efficiency that morning felt like a major parenting win. Brandon and I may have high-fived.

I consulted with her pediatrician via phone that day as follow up, and one of my main questions was regarding vaccinations that were scheduled for the next morning. Should she still get them, or should we delay- again? We had already put them off by a couple weeks due to her ear infection. (The vaccinations are potentially less effective at building immunity if your kids body is busy fighting something else when administered). Doc said she was fine to get her shots. So Tuesday morning we take her in. The shots visit was just with the nurse, but we figured if they saw the rash and something they didn’t like, we would be able to ask additional questions. Unfortunately that isn’t how the system works. The nurse did notice the rash, which had blossomed further after another 24 hours. He seemed a bit concerned, and we asked if we could have a few words with our pediatrician. He said no, you have to make an appointment with Acute Care, which meant it would probably take at least a few hours to be seen. I would rather be punched in the face than sit in that petri-dish of a waiting room for that long with an infant. So we left- we weren’t super concerned, yet.

Off to school and work we all go, just another hour or so late due to the vaccinations. But then the dreaded call comes.  I have on-call duty, since her school is right across the street from my office. The sinking feeling in my stomach when I see “day care” flashing on my phone screen is like the moment you realize you are getting your period: “Uggggh.” The Bear was running a low grade fever and was super cranky. They didn’t say she had to go home, but it was implied they would prefer if I picked her up. Mild fevers and crankiness are common following vaccinations, but the rash was also spreading, and trying to de-couple the symptoms was tricky. (in hindsight, my advice to myself would have been simple: delay the shots, dummy)  After further email consultation with the pediatrician, I bought some Benadryl and took the girl home.

photo 12

The following day the rash continued to blossom, just as the ED doc said was likely. It was starting to get intense, but she was in good spirits and didn’t have a fever so off to school she went.

She made it to 11:00 am. I get the phone call. It’s Wednesday, mind you. I’ve already been to the doctor twice, late for work twice, and left work early once. I have to leave again, and this time day care wanted a new doctors note before she came back. She had registered another low-grade fever (101.5) at school and that coupled with a rapidly spreading mysterious rash made them very uncomfortable. As a parent of a child who has been routinely contracting silly illnesses from school, I appreciate their diligence. But as a parent of a kid who had been determined to be of no threat to her peers (and had vaccinations that cause mild fever) I was SUPER frustrated. I truly would not have brought her in if the doctors had mentioned there was even the slightest chance the rash was contagious.

But then I saw the progression:

photo 2 (2)

I conceded their right to be alarmed, and off we went to acute care. This would be the 3rd day in a row of doctors visits.

When you arrive at acute care and put the words “fever” and “rash” on the reason-for-visiting form, you are quickly swept into a room and those that enter come in hazmat suits. We tried to assure the nurse that this had already been seen once and that she was safe, but each visit meant starting over with someone new.

photo 1 (2)We saw two residents and an attending physician at the Acute Care. They all agreed: this rash was not in the sphere of infectious diseases nor contagious. But they also disagreed on what it was, even with the original diagnosis of Erythema Multiforme. The attending physician was irritatingly confident that is wasn’t EM. But she couldn’t commit to what it actually was. Generally the same instructions were handed to us– “give her Benadryl to help with any itching and watch closely. It should go away in 7-10 days, hopefully”.

Seven to ten days? That is just what a parent wants to hear when their baby looks like a cupcake sprinkled with Red Hots.

The only silver lining was a new note to get her back into school as long as there was no fever.

We go home and do as instructed, but work was naturally becoming an issue. Thursday I had some pretty important meetings– my buyers were going to be presenting their strategies for the Holiday season, and not showing up to support them as they presented their biggest investments of the year would be, well, the worst.

I emailed the pediatrician again to make sure she was looped in and asked for clarification on the lack of diagnosis, and next steps regarding daycare, etc. She responded instantly! Oh. Wait. No, that’s just her out of office… she had a baby and thus began maternity leave that very day. The gods were having a field day with me.

Thankfully, Brandon was able to take work off the following day, allowing us a day care reprieve and some time to monitor the situation more closely. He stayed home while I put in my first full day at the office that week. But not without drama. Late in the morning, I get the following photo text:

penicillin allergy

Holy shit.

He sent the same image to the doctors office and they wanted to see her again. Thankfully the attending physician who saw her the previous day was on-call, and looked at the picture of how things progressed before we rushed in for yet another visit. Finally a bit of continuity in our experience! This is when useful things started to happen. Instead of having us come back to Pediatric Acute Care, she placed a call to the Dermatology Department and helped Brandon get an emergency appointment.

The thing about going to a teaching hospital (UCSF is one of the best in the country) is that you see of lot of residents. And when you have a curious case, everybody wants a look. When Brandon arrived at dermatology with a purple baby, he had the entire department’s attention. They swooped in and evaluated. And finally reached some consensus with the official diagnosis: remember that ear infection and antibiotics? This was an allergic reaction to penicillin, and a rather dramatic one. (Though thankfully not anaphylaxis). The purple spots are kind of like bruises- little capillaries under the skin bursting as they react to the unwelcome invader.

Fun facts: penicillin allergies can reveal themselves during or up to two weeks after the antibiotic is administered, but will typically only occur after a 2nd exposure. Due to an awesome series of nasty colds making the rounds at school, this was our Bear’s 3rd ear infection in 6 months, and thus her 3rd exposure to penicillin. Also, having had my first ear infection a month ago, I am re-thinking future treatment plans for my baby. I took antibiotics myself which helped at first, but the infection quickly came back a week or so later. This time I controlled the pain with ibuprofen until it resolved. It wasn’t a picnic, but it was manageable. My doctor always advised us to wait until the baby was very uncomfortable/running high fever before pursing antibiotics and now I understand why. Allergies, Super Bugs: these things are no joke..

But back to the situation at hand. A prescription for a stronger antihistamine was given, and the directions to watch and wait remained, however the dermatologists believed the reaction was reaching its peak.

Friday, Bear went back to school and we tried to prep her teachers for what they would find when they changed her diaper. She was in great spirits, and even just a half-day later, the spots started to fade. Friday would be the first day all week we had no day care calls or doctors visits. Win!

healing

We are on day 8 of the reaction now, and things are really looking positive. I’m so grateful my baby is on the up and up and that we know the root of the issue. Unfortunately, our bedtime routine has been lengthened by a solid 15 minutes to account for all of the things: drops and Motrin for teething, Benadryl, oats and petroleum jelly for itching, and now she is sprouting a new cough and runny nose, so here comes the nasal spray. Holy high-maintenance baby, batman.

photo-2

We have decided to just hit refresh on our plans for last week and start over. (Definitely hitting copy/paste for the daily meals) I’m still making this blog public according to my original timeline, but it’s probably not as crisp as I hoped. And then there is cleaning the house. And getting caught up on work and emails. And making new plans, and then contingency plans for when all of the plans get thrown out the window. You’d think I would learn my lesson, but I keep believing I can out maneuver my kid. We’ll see how she proves me wrong this week.

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7 thoughts on “Rash Decisions

  1. Pingback: Moms to Marvel: Meet Jesse, My Momspiration | i am a working mom blog

  2. This is absolutely terrifying. Love you, Brandon, and of course little bear! Can’t believe how rational you got about this. Halfway through reading it last week I dove head first into the interwebs and successfully frightened Eric and myself from ever creating a human child.

    So glad it didn’t seem to disrupt little miss too much, and that you and Brandon were able to be somewhat flexible with the rest of life while you found some resolution!

    Like

  3. Ugh that poor sweet little boo! What a horrible experience! Not that dog problems and child problems are the same thing, but Oliver has a ton of allergies, and is also not able to tell me about them, so I understand the frustration of figuring out what is wrong with this tiny creature who can’t just tell you. I’m so glad you figured out what it is and that she is ok!

    Liked by 1 person

  4. Oh my goodness, I cannot believe what a strong reaction she had, how terrifying!! So glad that you guys figured out what it was and can now steer clear! My LO got hives from something we assumed was eggs but allergy tests were clear, leaving us having no idea what the culprit was. I never even thought of meds, I’m so glad you posted this, I will definitely be asking her pediatrician, thanks Martha!! So glad your LO is on the mend!

    Liked by 1 person

  5. Holy shit!!!!! Poor bear, and poor parents! Allergies are the worst, but on the upside, at least you caught it this early and it wasn’t anaphylaxis. Carrying that epipen in my purse gives me nightmares, but go ahead and add purple babies to the list. The motherhood medal of the week goes to you, my friend.

    Liked by 1 person

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