another not so great update

So . . . our urologist stopped by for a bit yesterday.  He didn't really have a lot of answers.  He doesn't know why D's urine tests and cultures always came back negative.  But from looking at the scans, he is sure that it's a kidney infection. No doubt about that now, it seems.  And it's not something worse, so phew. Apparently, the other thing that can happen is that little abscesses can form. These are little pockets of infection that are incredibly hard to treat.  Our kid would be in the OR already if she had one.  So that's good at least.

Also a good thing is that everyone's sure now of what it is.  Treating it should be relatively easy.  She gets IV antibiotics.  We'll be discharged when she's fever free and doing well, and will then be given a course of oral antibiotics at home.  After that, we'll be changing the daily preventative antibiotic that D has been taking now.  She's taken them for the last year to prevent infection and clearly they're not working.

The good news stops there.  What our urologist also doesn't know is how much damage her kidneys may have already sustained from her infections.  Particularly since this last one was around for potentially a month and a half before they caught it.  And we probably won't know that answer for a while. So far, D's renal function studies are normal which is a good sign.  But I guess kidneys can scar after an infection, so we'll have to wait and see how her body handles this one.

But here's the thing.  She can't have another one.  So this reflux condition that would one day just go away on its own just became a lot more serious.  As long as her urine refluxes backwards, she will be susceptible to infections.  And that's just not allowed.  If even one (and now two) are worrisome there's no way she can have a third.  Especially with them being SO hard to diagnose too.  If we have to run a CT scan every time she has a fever, it's going to be a long four or five years (about how long they thought it would be before her reflux was completely resolved).

So our doc thinks we need to operate.  This was always in the cards if her condition didn't improve eventually, but he was always confident that it would improve.  So it wasn't an option that kept us up at night or anything.  But now, well, it'll probably keep us up at night.  There are two different operations they can do.  One is a simple outpatient procedure.  Our urologist will simply place a block in the tubes to keep the urine from getting to the kidneys.  The problem with this technique is that it has a not-so-great success rate for the long term.  The blocks get eroded and urine leaks through. It's fine for a child who has a less severe reflux, or for a kid who hasn't already had two pretty nasty infections.

Which means we'll probably be looking at the 2nd option:  a fairly extensive open surgery that involves them taking out the tubes completely and repositioning them somewhere else where they won't reflux.  It'd be a big deal. but the success rate is almost 100%.  So my guess is that we'll be going this route, but I'm not happy about it.  We'll see . . . no decisions are going to be made until the little D is completely well.  In a few weeks, assuming her fevers are completely gone, we'll go back in to get a picture of her reflux.  The last time we did this was over a year ago.  We were scheduled to do this again this summer. It's kind of a painful test and our urologist didn't want to keep subjecting our kid to it when changes aren't likely to happen that quickly. So we'll move that up a bit and see if her reflux has improved at all over the last year.  And then we'll have sit down and see what we want to do.  But our doc has pretty much told us that unless the reflux has disappeared completely (which it clearly hasn't since she has a kidney infection), he will probably recommend operating.

In the meantime, of course, we still don't know what we're looking at in the way of past damage.  All we can do is prevent anything more from happening in the future.  So. . . fun times.  

Our "House, M.D." saga . . . continued

Actually, I take that back. The CT was ok, but the night ended up being far from uneventful.  They did come grab us around midnight.  D had managed to doze off again a bit on top of me, and so did I.  We rested in the arm chair until we were woken up around 11:40 by one of the monitors blaring loudly. Not sure what it was trying to signal, but in the process of trying the silence the damn thing, I disconnected some of the cords connected to the kid and before I knew it, it was a whole production that involved the nurse coming and cleaning up all the wires.

The reason for not letting D eat was because they wanted to sedate her for the CT by giving her Ativan.  Said that it would knock her out briefly so that she'd remain still during the scan.  They set her on the table, gave her the meds through her IV, and waited for her to pass out.  Except that she didn't.   She seemed to get a little sleepy but actually smiled and chatted with the nurses for the first time ever. "Hi," she said, kind of smiling.  They finally just did the scan.  She cried and moved a bit, but the tech kept distracting her by telling her to "look at the lights.  See pretty lights.  Red lights.  Blue lights. Where are the lights?"  It could have been out of my brief pot-smoking days, with her dopily trying to reach out and touch the lights.   Is it bad that I was wishing the whole time that I'd had my phone with me so I could grab a video of my drugged up kid?

Oh, and as we were heading off to get the CT, they checked her temp and she was starting to run a fever.  But they couldn't give her anything until after the test.  So the poor thing was shivering a bit on the table.  For the most part though, the test went off without too much of a hitch.  We came back. They checked her again and her fever had gone up higher.  It turned out though that one of the other things that her docs had wanted to do is get a blood culture while she was having the fever to see if they could pinpoint what was going on.  So they couldn't give her drugs until the lab came by and collected more blood, which he finally did around 2.  D lay on me most of the time, but it was a bit funny to watch her.  She was definitely dazed and kind of teetered a little while sitting on my lap, but was also a bit more active than I would have expected. She eventually kind of dozed on my lap though until the lab guy showed up.  I think anyway, because I was passed out.

So now, we're what at like 2:30?  I don't know if it was the catnapping but more likely the Ativan, I'm guessing, but the kid was wired after that. I was dying, ready to drop any minute (Tues night, she'd been up from 1-4:30, Wed had been spent in the ER).  But there was my kid climbing all over my lap and chatting happily.  I'm pretty sure I actually fell asleep a few times while she was climbing because she'd keep waking me up by whacking me in the chest.  She was also pulling on her wires, and every so often, I'd have to get the nurse back in to re-adjust her.

I went home for a while in the evening, and G had been telling me how nice the night nurse was.  But I don't think she liked me much.  Well, unless she likes passive-aggressive whiners, in which case, we should be good friends.  It was probably the lack of sleep and the general feeling of helplessness, but I was definitely having difficulties last night.  I might have asked them "several' times if there were any other options for the CT since our baby was SO hungry and hadn't really eaten all day.  And OMG, if we could just get her to sleep, we may be able to help her forget her debilitating hunger pains, but there was just no way for that to happen in this setting. What with the loud housekeeping and frequent nurse visits.  When she told me about the blood draw, I just kind of looked at her, sighed, and asked if they could maybe come soon because our kid hadn't slept all night and her fever was climbing up to boot.  Every time some one came in to re-adjust D's wires, I'd throw in a comment about how awkward those wires were and so not conducive to sleeping.  I think I mentioned our rough night to every nurse, intern, doctor, and random person in the hallway I could think of last night.  I'm quite sure that I was everyone's absolute favorite parent.  HA, G even mentioned after how all the nurses asked him if he needed anything, if they could go grab him a drink, help him change a diaper, etc.  I'll tell you that I did not get that kind of sympathy.  

Anyway, soon after blood draw, the doc came in.  I mentioned the weird dazed/alert affect and she said, actually in a rare number of cases, Ativan causes this paradoxical effect.  Awesome!  She went on to deliver more good news.  The CT showed that both kidneys were infected.  So yah, that unlikely thing they thought it wasn't?  It totally was.  They don't know why her urine test and cultures have come back negative.  They also don't know why our last ultrasound in urology was normal-looking while our abdominal ultrasound showed swelling.  They don't know if she's had this kidney infection since we were in India (which I suspect she has), and if so, what that means for her long-term kidney function.  Our urologist had told us last year that every infection has the potential to cause some renal damage and it'll be hard to know what until much later in D's life.  So the possibility of a month and a half long infection?  Who knows.  I have lots of questions, but no one's been by yet this morning to discuss yet.  Last night, the doc just had some preliminary results. The radiologist is supposed to go over the CT in more detail today.  The ID folks were in here saying they were going to review the scan as well, and then possibly connect with the urology or nephrology team.  They started antibiotics at 3 in the morning (while D was in my lap pulling out her wires).  Hopefully, we'll have more answers by the end of the day.

In the meantime, I'm happy that they've finally diagnosed her.  Of course, it was what G and I said it was back when she got sick in India and have been wondering about EVERY TIME she's gotten sick in the last month a half.  But hey, we're not doctors, what do we know?  And I guess after all the specialists and testing, my pediatrician's gut had been right all along too.  So anyway, guess we'll see what more we hear during the day.

If I weren't annoyed/confused, I'd be all "I told you so"

So I'd been hoping to start veering away from the sickness posts.  They haven't really been all that fun to write, and honestly, they have all started to sound the same to me.  Can't be much fun to read either.  But I guess when there's nothing else going on in our lives, it's all I got.

So yet again, Tues, the little D got sick. She spiked a fever in daycare, and they called me that evening.  Gregg was actually around the corner to pick her up when they called.  He took her home and checked her temperature -- 102.6!  He took the day off on Wed (it's crazy, we kind of argue now about "whose turn" it is to take the sick day because we're both just running low on time off and SO busy at work).  I called our ped, and we scheduled an appointment for that afternoon.  And it was the same old, same old.  Shivering, then a spike in fever, feeling fine when the meds kicked in and she was fever-free. And of course, a trip to the doc wouldn't be complete without blood work showing super high white blood cell count, indicative of either a bacterial infection or a pretty serious viral one.

We discussed our options with the doc.  She had said after the last bout that she was considering checking for malaria, due to our recent travel.  Malaria has sort of a cyclical pattern with fevers going off and on every few days.  The length of the fever and frequency depends on the strain of malaria.  Also, she considered running some immune tests to determine if our kid just had a poor immune system.  Neither theory really fit, but it was the best she could come up.  She's also mentioned it being somehow related to her kidneys but the tests just kept coming back negative.  She first suggested just having us go across the street to the hospital she's linked with and running these two tests to start.  Or she suggested getting admitted there or at Good Sam, where we've been before.  But I started thinking that if our kid had some obscure travel-related disease (and believe me, now, I'd read up on a bunch of them and have managed to sufficiently scare myself shitless), I'd rather she be at Stanford.

Doc agreed that this was a good plan, but that we couldn't just get admitted there.  We'd have to go through the ER, and of course, there were no guarantees that they would admit.  But we decided we'd give it a shot and showed up at the ER at 5:30 in the evening.  And were still there at 11 that evening, being told again and again that it would just be a few more minutes before they could go over our lab results and probably send us home.  I was getting more and more livid.  They did do more tests than we had done previously, but also the same urine and blood work. They ruled out malaria but said that it was actually hard to pick up in infants. Usually they needed to do it three times to rule it out for sure.  They tested for things that I know she didn't have (cuz come on now, I google with the best of them) -- TB, various flu strains, pneumonia, mono, Eppstein-Barr.  At the end of the night, I was feeling like we could have done this much closer to home and probably been home already.  I think they probably would have liked to do a spinal tap to check for meningitis, but they backed off that one when I sounded less than thrilled about it.

At 11, they said they wanted to consult with infectious diseases.  Everything took 3x longer because it's a teaching hospital.  The resident had to check with the attending, same with the ID department - they needed to call back after consulting with the ID attending.  And finally, they decided at 1:30 that they couldn't send us home after all.  To be honest, it was crazy that they ever thought they could although by that point, we were ready to be out of there.  D's white blood cell count had actually INCREASED from the time we took her blood at our doctor's office.  And her blood markers for infection were super high.  As in, apparently, usually the value is like 1 and hers was in the 100s.  But the markers didn't shed any light into what kind of infection, just that she had something.  But given that, it was crazy they wanted to send us home and crazy that we wanted that too.  But I think we were all thinking that not much had changed from the previous times.  Her fever was actually a bit lower than it has been on other hospital visits, and when she didn't have a temperature, she was happy and cheerful.

But the infectious disease folks finally called bullshit and told them to admit us.  It then took a few more hours for them to find us a bed.  We finally "settled in" at 3am, and then handled more than an hour of questioning by the docs.  Incredibly detailed questions about when the fevers started, how frequently did she have them, how long exactly between symptoms, what was she like between symptoms.  Did she have these symptoms . . . etc etc.  You know, I have to say, I bet there are studies that correlate the comfort patients feel when they sense they are being adequately listened to.  Because after that, I decided we were probably in good hands. And it's silly because they didn't tell us anything.  And as it turns out, the things they considered were all completely wrong.  So it's kind of crazy that THIS was all it took to reassure me a bit.  And god, I had no idea, but apparently specific questions are up my alley.  Even while we were in the ER, I had come up with this long timeline of when D had gotten sick, what day she got better, when she spiked again, etc.  It was totally legit too, all spread out on a napkin and everything.  The peds team we talked to that night (everyone here is a "team" -- I'm not sure we've had many conversations with solo docs, usually only while they were waiting for their team to show up) decided that our trip to India was probably the source of our troubles.  They seemed to think that the most likely prospect was this bacterial infection that's caused by drinking unpasteurized milk (which we did in India, but always boiled first which is supposed to remove the bacteria).

The next "morning" (because you know, 4am is totally the middle of the night), it was a slew of people one after another.  A med student coming in to get more history so she could prepare to "present" us while on rounds, the entire pediatric group, infectious diseases folks, nurses in all shapes and forms, lab guys sucking more and more blood out of our kid's veins, some one from the peds team again to clarify a few things because they had been discussing us and had more questions.  Somewhere in the middle of it all, I called to update our pediatrician and she brought up again that she was highly suspicious of it being kidney related. This is something she's said to us often, during our multiple visits.  And yesterday morning, she said again that I should be pushy about that, ask them to try to do some type of kidney related test to rule that out.   Look, she said, we know she has this probably already.  If she were a kid with asthma, I wouldn't be questioning the lab results.  But if you have a likelihood for one thing that causes fevers, why go reaching for more exotic options.  I brought that up to the peds group, and they said it was highly unlikely that she'd have a kidney infection (or as our ped wondered an abscess -- which is basically a little pocket of infection that may not show up on urine tests).  But they are keeping all options open.  And in fact, her abdominal ultrasound which they had also run in the ER did show swelling in her ureters, a difference from our last urology ultrasound.  So they weren't ruling it out, but the urine tests should have picked up something if that were the case.

The ID folks came in the afternoon, and if I thoughts peds had a lot of specific questions, they had even more.  At the end of our talk, they told us that the unpasteurized milk was pretty unlikely but we'd wait for the tests before ruling it out.  I guess usually that's linked with lower white blood cell counts.  They also said they'd continue with the malaria testing but didn't see her fitting that pattern either.   Yes, it's a cyclical fever, but more like every 2 days.  There wouldn't be such long gaps between sickness.   They said according to the literature, it could be every 48-72 hours max. But honestly, they'd rarely seen a fever break for more than a day.  So . . . what did they think?  Well, what do you know, they also wondered about an abscess of some sort, either in the kidneys or somewhere near by.  I think basically what that means is that bacteria aren't all flowing around in there but have kind of congregated into little pockets of infection. So easily missed on a test.  Not easy to treat, but it would explain the symptoms and why her urine tests have always come back negative.  They ordered a CT-scan.  The message from ID seemed to be, yes, we'd consider all options, but it was looking like our India trip may not be the culprit after all.

They did the CT at midnight last night, and had us stop all food by 6:30.  Actually, at some point they asked us when she'd last eaten and said they needed to wait 6 hours from that time.  Except the problem was that by eating, we really just meant she'd taken a sip of milk and a few bites of cereal, not what you'd really call a meal.  Her appetite was crap all day, and if we'd known of the cutoff ahead of time, we  may have tried a little harder to convince her to eat.   Or stuffed her full of cookies at least.  So it was a fun time because around 9, D decided she wanted nana and mi (banana and milk) and there was no distracting her from the thought.  Rather than sleeping, she spent a chunk of the time asking for food and drink.  And it was so sad/cute.  She'd start crying at times, calm down and let herself be distracted but then smile and ask us cheerfully "mi?" like she was JUST realizing she may be thirsty.  G was able to finally calm her down a bit (he actually had her sleeping even until housekeeping came in and threw garbage cans around all over the room for five minutes).  He then left for the night-- oh yah, we've also been driving the 45-minutes back and forth to the house during all this to deal with the dogs.   We figured the CT would be relatively painless, so no need for both of us to hang out.  How wrong that was!

Oops, to be continued . . . probably later today once the docs are out of the room. . .

what a week

The sickness at our house continues, as the little D again spiked a fever last night. She had one ok day and one good day (with corresponding full nights of sleeps for all) before this new round.  Last week, our doc told us that if she didn't get better, she was going to start testing for obscure things, like malaria.  But then her temp started to drop, and I thought we may finally be out of the woods.  I guess this round isn't enough to get excited about yet.  It was 102.8 last night, but much lower since.  She got up at 3 (the magic hour, it seems, when she's sick), asked for some milk and promptly projectile vomited all over me.  Since then, things have been a bit calmer.  I called in sick again and have been hanging out with her.  Just low grade fevers for the most part, getting as high at 101.3 at some point before I medicated.  And no more vomiting.  Kinda cranky but kinda not (think screaming fit one minute because I won't pick her up and hold her at a precise spot by the window and then smiling and making goofy faces the next).  It could be worse.  And I could have it worse, too, I suppose.  On the one hand, people at work probably don't remember that I work there anymore.  But on the other hand, no work! and I can't really do much around the house even.  When awake, she's been demanding.  When asleep, the dogs follow me around too much every time I try to do something and she starts to stir from the patter of their footsteps.  So yay, no excuse to not sit on the couch and read/blog/surf/watch TV.

In other news (because I'm SO tired of blogging about illness), I think our kid may have strung two words together yesterday. Guess what they were?  "Bye Mia."  Go figure, right?  We were heading out the door to daycare/work and there it was.  She was waving to the dogs like she usually does and randomly saying bye along with their names occasionally, and suddenly, she was connecting the two together.  OK, so there was a definite long pause between the two words, so she may have been just saying them individually.  But I like to think otherwise. It's been a long time since I've happened to catch a milestone first, so just give me this one, all right?  

Also, I've started to think about potty training.  It's on the early side, but for a while now, daycare has been telling us that they sit her on the toilet with the big kids and she goes! They kind of rave about it, actually, and how great she is at it.  It seems like some days, she doesn't go in her diaper at all.  So they think she's a natural.  Hear that, folks, my kid is a natural and pooping and peeing.  :)  Plus, she's started to tell us when she's going "poo poo" or "pee pee".  Although she tends to call most things poo poo, even her farts and pee.  And she says it as she's doing it, not before.  I've been working on at least getting her to differentiate her "toots" so we'll see.  And oh, she laughs sometimes when she farts now, which just goes to show you that she's definitely her father's daughter.  So anyway, G went out and bought a portable toilet a few months ago, but we've run into a few snags. First, I tried to sit her on it, and she cried.  We left it there hoping she'd just sit on it all by herself and think it was her idea. It's been months now and she hasn't touched it once.  Plus, I got a few more details from daycare.  It turns out that they leave her (as well as the other kids) there for 20+ minutes at times and wait for her to go. I don't know that I have that kind of patience.  But I was there one day last week as she was just about to poop. They tried to set her on the toilet, and I think she was constipated.  And she just sat there trying to work out, and they brought her sips of water and slices of apple. Dude, while she was sitting there on the shitter!!  Ew right?   Also, the toilets they have at daycare are miniature regular toilets that flush and everything (they're so cute). The portable one that we have at home seems like it'd be so gross to clean out.  It's just a little bucket basically.  So we'll see. Although she may be getting ready, I'm not sure that Mom is just yet.

At night, she sleeps with a lovey blanket. The ones we have are square pieces of fabric with animal heads on them. And she adores them.  We can't get her to sleep without one, and she's chewed the corners all up until they're disgusting.  We have a cow, dog, frog, and rabbit.  But lately, she's been getting attached to her "doggie" and asks for that one over all others.  So G bought her a little monkey one this week, thinking she's super into monkeys now ("unkey, ooh ooh ooh") so maybe we can get her attached to a new favorite.  Because sometimes it sucks when the doggie is in the wash and she decides that's the one she wants.  And the whole point of having 4 is so that she'd never get attached to one.  So we gave her the monkey the other night. And she was excited to see it, but wanted nothing to do with it after.  Actually we gave it to her instead of her "fwoggie" that she was holding, and I'd say about the only thing we accomplished is getting her attached to her frog blanket too, so maybe things worked out fine after all.  She screamed for the frog back.  (In fact, the next night, which was last night, she threw up on the frog and wouldn't stop screaming for it back even after we exchanged it with the doggie).  That night, we decided to throw the monkey one into the corner of her crib after she fell asleep.  We often have an extra one in there because she moves around a lot while sleeping, and sometimes, if she wakes up, she screams if she can't find her blanket.  Anyway, we figured the monkey could be the extra that night, and she wouldn't know the difference in the dark. Well, let me tell you, if her random bouts of screaming that night were any indication, she definitely knew the difference.

In non-baby news, I started working out this week.  Well, last week but so far I've gone only twice. It doesn't help that the gym is near my work (the point is to go at lunch time) and I've only been at work for a total of 3 days since I joined.  It's another NY resolution that I made about a month ago and finally decided to focus on.  I'm also monitoring what I eat, which basically means that I'm usually hungry and thinking about food.  So we'll see how long I can keep this up.

Also, I've joined the Hunger Games fan club, meaning I've read more in the last couple of weeks than I have in a long time.

And wow, that's all I can think of that's not sickness-related. Is that sad or what?   

the illness that will not go away

Last week, for a couple of days, D had a fever, and we briefly freaked out as we always do when she gets a fever.  Because we've had 2 hospitalizations now due to high fevers, and of course there's this whole kidney reflux issue that makes us constantly worry she has a UTI.

But by Thurs morning, we were sure she didn't.  By Fri, she was mostly back to her normal self.  Although it turns out that collecting urine through a catheter results in unbearable pain while peeing for the next few days.  I found out because for the next couple of days, the poor kid would be happy one second and suddenly clutching at me and screaming in pain the next.  It was scary as shit, and early on, I guessed that it happened when she peed.  So the next day, I called the urology clinic, and what do you know, the nurse said, yes, as a matter of fact, she's probably experiencing a burning sensation every time she urinates.  Awesome.  But it should go away within a couple of days, the nurse said.

So aside from that, the kid actually got better fairly quickly.  She seemed happy hanging out with my brother and sister-in-law on Sat while G and I went to a wedding.  And aside from her naps being all haywire, she seemed to be in good spirits.

But then I picked her up from daycare Tuesday and she felt a bit warm.  She was screaming when I got her and it turned out that she was trying to poop but nothing would come out.  The kid's also been constipated off and on since her fever, but then when she does manage to get any out, her poops are these monstrous, runny, disasters that end up EVERYWHERE.  So I'm not really sure how I should be medicating or feeding her.  Anyway, they tried to stick her in the toilet to poop and all that came out was this little black turd sticking inside her butt still (I freaked out about that too until I remembered she'd had a huge handful of blueberries the night before).

I took her home and she collapsed on me.  We hung out on the couch for a good hour and a half before she perked up a little and asked for some food.  She ate while we were sitting on the couch and then just rested her head on me again, which is how G found us when he came home a little later.  She passed out soon after, but slept restlessly until she woke up again at 2.  At which point, I brought her back to our bed and lay her on top of me.  She tossed and turned on me for a good two and a half hours or so.  At some point, we both fell asleep.  A little before 5, I had G take her from me and put her in her crib.

She woke up again by 6:30 yesterday and spent most of the morning laying on top of me.  Sometimes asleep, and sometimes just laying there.  I took a sick day and mostly resigned myself to being a pillow.  I was finally able to transfer her to the crib (and have her stay asleep) around 1 pm.  By that point, I had finished my book (Yay for Kindle), started another, and watched 3 episodes of Parenthood while she slept.  And my arm hurt like hell, I hadn't eaten all day, and I had to pee.  Plus Mia was outside, tapping on the glass to be let in.

We had an appointment with our pediatrician in the afternoon.  I actually postponed it once because she pretty much slept from 10am - 4pm, and even then only got up when I went to wake her for the last available appointment at 4:30.  I'd called our doctor earlier in the day, expecting her to say what she usually did.  She'll be fine, no need to waste your money on a co-pay.  But for once our doc actually suggested bringing her in.  9 times out of 10, I've called our pediatrician and she'd told me not to bother coming in.  I think what that means is that I call our doctor a lot, but just the fact that she wanted me to bring her in worried me a little.  To top things off, G had to take a last-minute work trip yesterdayay, so I was mostly on my own.  He was on his way out for an early morning flight when I had him move the kid back into her crib in the morning.

Turns out that the kid now has a throat infection.  White blood cell counts were through the roof and her throat was red and inflamed.  So the doc thinks she has a bacterial throat infection.  No way to definitely rule out a kidney infection without yet another urine culture, but the throat clearly stood out as the first, most obvious culprit.  So we'll see.  She got an antibiotic shot yesterday, and we have to go back for another today.  But if that's all it is, we should start seeing a drop in her white blood cell counts by this afternoon.

So lately, I've been feeling exhausted.  I feel like our house has been filled with one illness after another. Our little sleeper is no longer that great at it . . . we went from being able to lay her in her crib at bedtime to sitting with her forever.  She's up randomly, and if she does sleep through the night, I'm up anyway because either she's been restless or I've just gotten used to getting up at 3 in the morning.   And she's not the only one who's been sick.  Taking care of a sick kid when you're already feeling like crap is no picnic either.  And did I mention how much my arm hurts from holding her all the damn time.  But it's at these times - when I see her poor little body in a hospital bed with an IV sticking out of her arm or just laying listlessly on my lap - that I feel most like a parent.  It sounds cheesy but I'd give up a fair number of body parts if it meant she could be always healthy and smiling.  Last week, she'd clutch at me desperately every time she peed, and I felt so helpless for her.  When we were at the hospital in India, she'd look at me, hold out the arm with her IV, and say, "Ow" or "no".  Last time we went through this, she wasn't old enough to communicate like this.  And I didn't know what to say to her.  Her face looked pitiful and pained, and she was oh-so-clear about what she wanted.  Yesterday, while I was happy to be able to transfer her to her crib finally, I actually would have held her all day, because it feels like at this point, it's about all I can really do for her.  And man, the feeling sucks.

Anyway, hopefully it's just a throat thing and she'll get past it quickly.  And we've already had a long talk with her.  She's agreed, no more sicknesses this winter.  We're done with it.  

where we decide that local hospital experiences are just not challenging enough anymore

The Little D is sick again, making it the second time in a month, but really, she's been sick most of the time throughout too.  The first time was in India. Well, that's not even true either.   The morning of our flight (literally on our way to the airport), we stopped by our pediatrician's office to be told that she had an ear infection.  Which is exactly WHAT we wanted for her before a 24 hour flight.  By the way, she handled it like a pro, and seemed mostly ok after we got there.  We count dripping noses as "ok" around here.  

But about a week into the trip, she developed a fever.  It started off low grade.  We noticed it when we went on a weekend trip with my family.  She seemed tired and out of sorts, and not really sleeping well.  But it was hard to say what that was related to really.  We had just driven up to this resort town for the weekend.  It was a good 4 hour drive, and the last bit was super windy.  Being the brilliant travelers that we are, we pulled out a video for the kid just before we got to our destination.  And realized that driving on a windy road and watching a video just don't go hand in hand.  And by realized, I mean, G got vomited on.  One second everything seemed ok and the next, meals from the last 3 days seemed to be erupting from our kid and onto G's lap.  God, can you imagine what that would have been like if I'd been the one holding her??  We were less than five minutes from our destination and woefully underprepared for the vomit.    So good times all around.  

Anyway, we assumed she was carsick, and blamed ourselves for the video.  And assumed that she didn't want to nap because she had slept in the car.  Or because there were a million monkeys outside our hotel room and she was having way too fun pointing every single one of them out, with a "inkey -- oooh ooh oooh."  It was only later that afternoon that we realized she felt a little warm.  The next day, on our way back, she fell asleep on me for most of the trip and felt HOT.  I was already to starting to freak out at this point.  D hasn't gotten that many fevers in her life, and the only time she did, we discovered she had a kidney condition.  So of course I started to worry about her having a break through infection despite her daily antibiotic dose.  But it was a Sunday, and we didn't really know where to take her.  She seemed to be hanging in there, and that evening, I had my mom call a doctor.  Earlier in the week, we had taken D to a doctor because she kept poking at her ears and we wondered if she still had an ear infection.  She didn't.  My mom called him again that evening, and eventually, he picked up.  At this point, we had already been dosing her, but we did again.  Checked her temperature again a while later and it was 105!  

So we freaked out and asked to take her to the hospital.  The thing is, we've been lucky.  We've never had to take D to the emergency room at home.  She's supported by a pretty amazing medical staff.  Man, that makes her sound like a cancer kid or something.  But you know, we've called our doctor at home on a Sunday rather than going int the ER.  We've never had to wait with a sick child in anything other than a doctor's office.  So imagine having to do that for the first time in another country. Where the "waiting room" is the hallway and mosquitos are swarming left and right.  Where there appears to be no line whatsoever and the nurses seem unclear as to whether there's even a pediatrician around who can see our kid.  

They gave us some random medicine to give to her and told us to take her clothes off and wipe her down with water.  When we were finally seen, it was whatever doctor was on call.  I explained about her VUR and that I was worried this could somehow be related to that.  It turned out that all he was prepared to do was send us home with meds.  He didn't really know how to deal with the extra VUR component.  So finally, they got us into see a pediatrician.  Walking upstairs to see him, we wandered past the wards.  And I'm telling you, it was like a scene from a war-torn country or something.  It was a children's hospital, and basically there were rows and rows of beds with kids in them.  The beds looked ratty.  Families were sleeping in hallways and the foot of their kid's beds.  I've dealt with the Indian health care system before, and have gotten pretty good care overall, but I gotta say that I'm lot more tolerant when it comes to myself than I am with our baby.  And I'm betting G was freaking out as we were walking up.  

So the ped didn't seem super convinced by my diagnosis.  I was thinking after that he must see it all the time.  Random pushy people trying to say they know what's wrong with their kid and berating him for not giving more meds.  I don't know.  Maybe.  But at the time I was pissed, because of course I know that I'm not most people.  I'm usually right for one thing.  :)  OK, so maybe that makes me sound like it a know-it-all.  But I am fairly involved when it comes to this stuff and have a fair bit of insight into D's various medical conditions.  And I know that while her fever could be viral, with her history, the possibility of a bacterial infection was too high to ignore.  And I guess this doc didn't know that I wasn't just some pushy "American" parent, but that's exactly what he wanted to do, ignore the possibility altogether.  Well, not entirely.  He thought we should collect urine and get it tested.  And he finally prescribed antibiotics but made it clear that he was doing it only to appease me.  Didn't bother to mention that we should collect the urine before starting the antibiotics.  And told us to head down to the labs downstairs to give the urine sample.  

We headed downstairs.  It was almost 10 by this point, and the lab was about to close.  They gave us a little cup to collect her urine in and told us to drop it off within the next half hour.  Um, yes, that's exactly how I would collect urine from an infant. Just hold the cup under her and tell her to go.  We pointed this out to the nurse there and she finally said that if we wanted, we could go buy some bags at the pharmacy downstairs and stick one in her diaper.  So I don't know if you guys remember my last attempt at urine collecting with a bag.  Well, these were the exact same ones.  So I headed back upstairs to find the doc again, and explained that the chances of D urinating in that thing was next to nothing, so what about if we used a catheter instead?

As luck would have it, as I was explaining, the other doc, the one that we had seen previously, actually showed up!  I guess that's why he had asked my mom to call him later.  He usually did rounds at this hospital anyway, and figured we could see him then if needed.  I'd actually liked him when we'd seen him the week before, so when he jumped into take a quick look, I was relieved.  Rather than a sign of appeasement, he agreed that we should start antibiotics, and reminded us to wait until we'd collected the urine before giving them.  We knew this from our scare last year -- by the time we were able to collect any urine, we'd already started antibiotics, so the urine test didn't pick up any bacteria.  It was #1 reason they hadn't been able to diagnosis her VUR right away.  So yah, we know better but I had been pissed at the first doc for not mentioning it.  But this doc still didn't buy that a catheter was necessary.  It's invasive and painful, he said, why make her go through it?  And how can I argue with that?

So anyway, off we went back home.  By this point, D's fever had dropped a little.  We stuck the bag in her diaper and waited for her to pee.  She fell asleep but we kept waking her every hour or so to check her diaper.  Actually, we noticed though that she cried every time she peed and that was a signal to wake her up.  That didn't bode well for the UTI.  But like before, she managed to pee everywhere but the bag.  Sometime around 1 or 2, she cried again, and I grabbed her to soothe her back to sleep.  And realized she was shivering.  She shook and shook uncontrollably.  After about 10 minutes of it, we were officially freaked out.  We woke the whole household and ran her back to the hospital.  She shook the whole way there, and vomited while we were waiting to see the doc.  Soon after the shivers stopped, her fever started to climb, and she must have gone from no temperature to 104 in under half hour.  At this point, they decided to admit us.  When we went upstairs, the staff pediatrician was still there, and agreed that admitting was the best course.  I guess the shaking and crying during peeing were the new symptoms that convinced him that a bacterial infection was likely.  They started antibiotics and I didn't care that we didn't have any pee collected by this point.  

So there's more to the hospital stay, of course, and I'll continue the story next time.  But yesterday, she got sick again, and I was struck by how differently everything went this time around.  We happened to have an appointment with a urologist already scheduled yesterday.  And the day before, when it seemed like D was feverish again, I'd called and scheduled an appointment with our pediatrician also.  At the urology appointment, she got her usual 6 month ultrasound and then we saw our doc.  We'd already mentioned her fever to the nurse.  The doc came in and immediately said that he wanted to cath her and collect urine.   The catheter is a terrible procedure to watch and clearly painful, but it was nice to have it done by some one who was super competent at doing them.  He looked at the urine and said that it didn't look too cloudy, so he felt comfortable not amping up her antibiotics right away.  If there had been more particles floating around, he'd have suggested otherwise.  But at any right, we'll know by tomorrow if this is a UTI.  We then went to our ped's office, who collected blood, and had immediate results showing that this is unlikely to be a bacterial infection.  So all signs point to good news so far.  Our ped suggested that we have the urology clinic cc her on the urine culture results because they're not open on the weekend.  But she would call us as soon as she got them.  By 10:30 yesterday morning,  I was heading home feeling loads lighter than I had been when we woke up.  Our experience last year was very different, of course, so it's hard for me to blame the Indian hospital/doctors.  But it just feels so nice to now be part of such a well-oiled machine.  

another kicker

because you know, the day just didn't have enough. . . I came home the other day to check out what this spare key actually looked like.  Because I swear, I checked our bowl of keys over and over again and just DIDN'T see it anywhere.  It must not look like a car key, I decided, while I sitting at work replaying the morning's events.  Completely obscure, maybe looking more like the garage key or something.  

Well, I present the following, and then never want to hear about this again.  EVER.  You hear me?

In case, it's not clear in the picture, the little icon on the key is most definitely the Subaru image.  But you know, if I didn't know that from seeing it on my car for the last 6 months, I believe the tag clearly says Subaru Outback Graphite Gray (not that we have any other Subarus in the house anyway).  Yah.  All righty then.  My eyesight's been great since I got Lasik, thanks for asking.