The Rash Revisited: Car Seat Suspect #1

I've decided that Cricket does not have eczema, an autoimmune disorder, MRSA, poison ivy, impetigo, HSV, or chicken pox, which were all theories about what was happening to him. I've decided he's "allergic" to his car seat.

The very device I researched the most, that I thought of as the most essential safety requirement we'd have for him has ended up being the culprit. Or jackass.

It's impossible for me to relate how guilty Partner and I feel about putting him over and over into the car seat, and now knowing that it was that which was causing the burning rash and blisters.

How did we figure out it was the car seat? Well, it started with Brother K, who called with his speculation that perhaps the seat was treated with flame retardant, and maybe, just maybe, Cricket was having a reaction to it? Sounded plausible, we thought. Since the rash had started on the back of his head, we started putting a burp cloth behind his head, mostly because we thought the fabric of the car seat might irritate the rash. We hadn't though previous to Brother K's suggestions that the seat was the cause.

Yet last week when we had him in the car seat in shorts, the rash bloomed again on the outside of both legs, interestingly enough where his legs were touching the seat. Other places the rash has appeared: the elbow on one side only, the side that he prefers to lean to, along with the cheek on that side, and the back of his hand. Never, not once, has this rash appeared on any part of his body that wasn't touching the seat. He's never had it on his shoulders, trunk, upper thighs. And the rash only appeared on other parts other than his head only after we were in South Carolina, where it was even warmer and he wore shorts and short sleeve shirts for the first time while in the car seat.

Here's what I read: some car seats are treated with bromine, chlorine, and even lead. Often these materials break down in the heat causing, for some babies, serious problems. Among the lead offenders is the Graco SafeSeat (for boosters, but I'm clearly suspicious of the infant seat too.) One of the materials used to treat car seats to make then flame retardant is decabrominated diphenyl ether. This has been linked neurological defects, cancer, low sperm counts, permanent learning and memory impairment, and in some cases, even cancer. I'm beginning to think we got off lucky with a rash.

The healthycar.org people have tested and ranked the car seats according to who is the worst offender and whose seats are better. (Read the report here.) I've called Graco to get try and get the low-down on what was on Cricket's car seat. Two trips to the ER, numerous doctor appointments and finally seeing the chair of the dermatology department at fancy-schmancy university hospital-- *sigh*-- all caused by his car seat.

The whole thing makes me sick. We wash all the Cricket's clothes with Dreft. I think about what I eat all the time since it will pass to him via breast milk. We research almost every damn thing that comes into contact with our little man. I wake up at night and put my hand on his chest to be sure he's still breathing. We love him so much and to think we inadvertently caused his rash is making us feel sick. This is actually a very mild picture of what his head looked like. At first it was much more widespread, with pustules that oozed like a bad blistering burn.

The leg here is not as bad as it got either. It actually felt hot to the touch. The thing is, I think back to the La Leche meeting where I accosted the dermatology resident who say Cricket's head when it looked particularly bad. Her words keep echoing, "That doesn't look like eczema to me." Yeah, me neither, sister.

So I'm in the market for a good car seat cover made from 100% cotton and completely untreated. We're now using a cut up tee shirt, which is protecting the kids skin, but a pain in the ass to get him situated correctly

I'm mad as a hornet about the whole thing. As soon as I find out more, I'll let you know what I hear.

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E is for Eczema

Off we went to the pediatric dermatologist at the big fancy hospital. We said before we went that the doctor would probably look at Cricket and wonder why we there, that's how much better he looked.

Indeed, it's as if we were psychic.

Both resident and attending said, "Eczema."

Really, I said, reeeallly? Isn't it strange that five different doctors in two different states wouldn't have picked that up?

Nope, they said blithely.

You really aren't seeing it like it was, I said. It was oozing. Dripping. Our pediatrician said it was the weirdest thing she had seen in fourteen years of practice? And it's just eczema?

Yup.

So we were given some topical steroids, moisturizer to lube him up and told not to worry. We stopped the Clinda because there was continuing to be some small amounts of blood in the stool, and if it is (was?) eczema, not antibiotics should be needed. Right? Right?

Then yesterday Cricket and I went out for a walk since it was so beautiful and warm. He fell asleep in his car seat as he is wont to do. We got home, lifted him out of his car seat and voila, the oozing red mass back. Partner slapped some of the steroid cream on it. I tried to not cry.

At our LLL meeting, other mothers with children who have eczema examined Cricket, who is as jolly as ever. And most agreed it didn't look too much like eczema. I had to wipe away the dripping ooze from the back of his head. Poor kid. Then it was revealed that one new mother there with her eleven day old child was derm resident. I hightailed it over to her and shoved my kid's head in her general direction.

She didn't think it looked much like eczema either and was surprised that the two docs her saw said it was. "If it is eczema," she said, "it's infected." She said if Cricket was her patient she'd probably put him on three weeks of antibiotics, Keflex, which frankly seems like too much to me. Three weeks is a long time for kids his age to be on drugs like that. She told me to email the resident (I don't have his email but could easily look it up) and invoke her name as a sort of pass code. take digital pictures and send it to him.

She was so nice and offered to email the resident herself, at which point I copped on. This is a woman with her eleven day old child on her very short maternity leave. My kid's ooze should not be her problem at this point. Unfortunately when your kid is oozing, you forget things like manners sometimes

*Sigh*

We changed the sheets on the co-sleeper twice last night because of the ooze, but it looks a little better this morning. Do we give the steroid cream time to work? Or call panicked again? He's napping now and I dread to think what his head will look like upon waking. If there could be worse place to have a rash eh? On the back his head-- a baby often rests on the back of his head. It's hard to keep it airy.

But in the grand scheme of things, eczema is better than any other diagnosis he has had. I'd rather it be eczema than MRSA or an autoimmune thing. I'm just still not convinced. Time will tell, I suppose. Time will tell.

Our Little Medical Mystery

When we were at the hospital on Saturday, yet another bacterial culture was taken from our boy. That and a CBC. The CBC results were fast: Totally normal with WBC counts in range. That was great news for everyone since it meant there wasn't a raging infection. However for the bacterial culture, we had to wait 40 hours.

It came back yesterday. Nothing. No bacteria. Which is good news/bad news, eh? Because, hurrah!, no bacteria = no MRSA. But if it ain't bacteria, what the hell is it? Partner isn't sure she trusts the culture. She doesn't think the resident got any liquid on his swab, but it's the second bacterial culture. I'm torn: I don't want it to be MRSA, but I'd also like to have an answer.

It's not viral-- the WBC count would probably be up in that case, and they also did a PCR test for viruses, and that also was negative.

I talked to our pediatrician this morning and she said to me, "This is the weirdest case I've ever seen in fourteen years of practice." Great, I told her, I'm glad it's my kid.

If it's not bacterial, what might it be? Our doc didn't know, but is really interested in what the pediatric dermatologist will say. She didn't know if it might some auto-immune thing going on?

So, if you took Bradley birth classes, do you remember the class where you had to rank things about a birth? Less desirable to more desirable? I kinda feel like I'm doing that with the rash-- MRSA ranks pretty high on the less desirable list, but an auto-immune disorder ranks higher than MRSA.

My current theory is this: The head rash and the body rash are unrelated. The body rash is from the sunscreen, which would explain why the antibiotics aren't clearing it up, yet have cleared the initial head rash. The head rash was impetigo and the first culture from it wasn't a good one, which is why the bacterial culture is negative. If there are no more outbreaks, I'm running with this theory. Except for the fact that there appear to be some small dots on his ears, and I'm quite sure I never put sunscreen on his ears.

Oh well. I'm trying.

Mysteries Abounding

When I was in Catholic school there was a fair amount of explanation along these lines: "It's a mystery!" This wasn't really an adequate answer for my little mind who liked explanations for everything. However, even that is a learning experience because, after all, there are somethings that just are, well, mysteries. Learning to accept that fact is probably helpful to one's sanity.

In the theological realm this seems more palpable than the medical realm. When I had pathophysiology last summer, my teacher (a nice man, but horrible instructor) would often explain away my questions by saying things like, "We don't know the answer to that. It just happens that way." He said this to many people, and more often than not someone in the class would know the real reason and explain to us why something happened the way it did. It was frustrating. Patho should be a fun, but hard class. Instead my patho class was boring and easy.

Unlike my time with Cricket lately. There is nothing fun, boring, or easy about his health right now. I have to say, he's still Cricket: very happy and outgoing, but clearly something is not right with him.

He has another outbreak on his hand, which is surprising after all the antibiotics he's on. His leg looks gross, but is crusting up and seems ready to heal. He has another outbreak forming on his cheek. At least he doesn't look like a lobster anymore from the sulfa drugs.

Our pediatrician is awesome. First of all she said to us that we had been through the wringer. She took time to tell us that it's usually not this hard for new parents and between the NICU, the RSV, and now this, we weren't having a typical experience. I love that she said this to us, because as much as I really want more kids, Cricket's first few months have been emotionally exhausting. It's a good thing he's such a great kid, smiling and talking to us all the time. I adore him. Then the good doctor admitted she had no idea what was going on and scheduled an appointment for us with a pediatric dermatologist at UM. It's not until Wednesday, but I'm relieved because I feel like people are on the case now. Everyone here wants to figure out what's going on. It's no longer sufficient to say, "Hm... It's a mystery." Thank God I live in this college town with people in search of answers.

And More...

Blood in the stool.

I think we're headed back to the ER.

Edited: Okay, we're not going back to the ER, but we are on "wait and see" status. How stressful can this be?

Spider Bites

"How was your vacation, Katie?"

Before we left for vacation, we were lifting the very heavy Cricket out of the car when I remarked to Partner about a bite on the back of his head. "Hm," I said to her innocently enough, "it looks like something bit Cricket. Let's keep an eye on that."

On Thursday the bite was looking a little bit like a rash, so I called the good doctor so we could get it looked at before we left for vacation. Everyone was stymied. Was it viral? It looked a little like HSV, but it also could be bacterial? Or maybe it was just some contact dermatitis? Oh well, the doctor and nurse decided, we'll sample it, but for now, they told us, treat it with the Bactroban. Which we neglected to do until Saturday afternoon when the rash had expanded considerably.

Sunday then it looked better-- why hadn't we started treating with the Bactroban earlier, we asked ourselves. The rash might be gone by now! We patted ourselves on the back for finally starting the treatment the doctor recommended. I consulted Dr. Google and decided Cricket had impetigo. Or poison ivy. But had no idea where he got either, since it's generally not our practice to let children with weepy sores hold him or let him roll around in shiny leaves of three. Oh well, we thought, crisis averted. Bactroban is working!

And then I woke up Monday morning and the back of his head was huge. I mean, it bulged out almost like an abscess and was oozing. We called my mother to come and look at it. We were all a little freaked. I tell you, it looked really bad and angry red. We called our pediatrician in Michigan. And she thought we should take him in somewhere we they regularly treat children ASAP. Although, she wasn't sure what was going on either since the bacteria culture came back negative and so did the rapid virus test.

Luckily there's a fine little practice five minutes from the house and we saw a doctor who agreed it looked really bad. And he had a diagnosis for us: MRSA. That's methicillin-resistent Staphylococcus aureus. And as soon as he said MRSA, that's when I freaked out. The rash was worrying, but MRSA? See, I had this slight obsession with MRSA when I took Microbiology. I watched documentaries on it. I read books about it. Why was I so intrigued? Because this bacteria is a bad motherfucker. People lose limbs to MRSA. Lives even. And now it was on the back of my kid's head? I was a wreck, crying when we left, crying in the car, just holding Cricket and being very scared. I called our pediatrician's office in Michigan.

It was a good thing I did. When we talked to one of the doctors in the practice he reminded me that CA-MRSA (community acquired) is very different from HA-MRSA (hospital acquired). He said that CA-MRSA is pretty common these days. He said he would have prescribed the same drugs, the same dose as the island doctor. He told me if I was concerned about Cricket's GI system (and I was) I could give him a pro-biotic yogurt. I felt so much better and by Tuesday, it seemed like the antibiotic was working.

We were happy again and as I fed him Wednesday morning, Partner slathered the Bactroban onto Cricket's head. We were heading out for the day, so she really globbed a bunch on there. Cricket himself seemed normal, as he had through all of us, but maybe a little warm. We took our thermometer and a little vasoline and headed off. In the late afternoon after touring the very cool South Carolina aquarium, I went to change his diaper and take a temp. 99.8. Not soaring, but warm. And then I flipped him over to inspect his little head. And holy shit, the rash had expanded again, tons of little dots all over the back of his head. Bright angry red again. And then lo and behold, dots on his arms. Legs. Hands. Cheeks. Another call the Michigan pediatrician, who said, take him in ASAP. And so Wednesday night found us at the MUSC Children's hospital.

Are you getting the idea that vacation wasn't very vacation like for us?

The doctor at the children's hospital felt the rash looked like classic MRSA too, but she thought that the topical ointment was irritating his head so we should stop. Who knows what the other dots were? Don't worry. Go home. Come back if the temp goes over 101. Or he gets an outbreak on his trunk.

After this trip, I was convinced that the head rash and the arms and legs were two separate rashes dastardly coinciding with each other. The arm and leg rash seemed to be confined to where I had put sunscreen on him. Nothing on the trunk or upper arms, and I never put sunscreen there. Ha. I had figured it out. (Don't tell me the six month rule for sunscreen: Our pediatrician noted it's better to put sunscreen on him than not, and the oral antibiotic he was taking made him extra-susceptible to burning.)

Once again, we were convinced he was getting better. But don't let your guard down, because by now clearly we now the trajectory of this story: One day good, one day bad. So Thursday = good day. Friday, well, the one cluster of dots on his leg was looking like shit. We were concerned. And then Saturday, yesterday, the day we were leaving, we woke up and took off Cricket's pajamas and he was bright red. Everywhere. His back was aflame. He stomach, his arms, his head, around his eyes. Everything either bright red or pin-pricked red. Once again, we called the doctor's office where the nurse manning the phone told us to take him to be seen before we got on a plane. We ignored her advice and instead got on an earlier flight. By this point I think we were both convinced that any hospital he went to was going to check him in. As much as we love South Carolina, we wanted to come home.

The child looked bad. It was scary. My mom cried a little when looking at him. I was worried because Staph aureus sometimes produces a toxin that causes something called Scalded Skin Syndrome. Or he was allergic to the antibiotic. We decided to skip the morning dose.

We took him straight the hospital here. By this point he had a fever. They got us in to see a doctor very fast. Where once again we were told it looked like MRSA alright. And the redness? Definitely an allergy to the drugs. Stop the drugs. Now know that kid is allergic to sulfa drugs. Start new drugs. Hope new drugs work because only two drugs can treat the MRSA and he's allergic to one! He had blood cultures taken, a CBC, and an IV dose of the new antibiotic. We were there for hours.

I'm exhausted. He looks better today, seems to be happy to be home. He's napping again and maybe getting back on his schedule will help him get better faster. We're praying the new antibiotic works and that his allergy resolves quickly. Hopefully it isn't MRSA because if it really is, this all might happen again and again and again until we go through a decontamination procedure. I don't know what that entails, but I can tell you, I think I won't like it. I think there'll be some assumption that we're all colonized. Even though I'm terrified of the MRSA, I want to go back to the micro lab and do a culture from my nose and Cricket's nose. All I need is a mannitol salt agar or blood agar....

I'm also hoping that our pattern of good-day-bad-day is over and that they all start to be good days. Because today is good. I'll have to die of exhaustion if tomorrow is a bad day.

I'm so ready to start Organic Biochem on Tuesday. It's going to feel like a walk in the park compared with this past week.

And that's how our "vacation" was.