Fever of Unknown Origin

In nursing school, there was a saying "if you hear hoof beats, look for horses and not zebras".  This means look for the common illnesses such as ear infections, strep, urinary tract infections, pneumonia, etc. before considering more rare disorders/infections. The thing is, if you are an overly anxious mother who happens to work in medicine, you only hear zebras.  

Photo: www.livescience.com

Bear has missed a fair amount of school and therapies and play dates due to random, recurrent fevers.  These fevers are not all that exciting.  They are low grade--ranging from 100.5-101.2.  They typically last less than 24 hours and present mostly in the mornings within a few hours upon waking.  Her only symptoms include decreased appetite and agitation.  There is no pattern to these fevers.  They occur anywhere from 2.5-7 days apart.  

At first, I wasn't tracking them.  Then I noticed that there seems to be an inordinate number of fevers in a short period of time.  I thought perhaps Ellie just ran hot.  Maybe 100.5 is her normal temperature.  Twice daily tracking proved otherwise.  I thought perhaps it was the thermometer so I bought another one just to be sure.  Two thermometers cannot be wrong.  I was not paranoid. For a while I just chalked it up to a 24 hour virus.

someone forgot to tell her that she is supposed to be "sick"

This Mama Bear doesn't tend to rush The Chunky Chicken to the doctor at the first sign of fever.  I like to wait.  And wait.  And wait.  Yes, I avoid the pedi unless it is absolutely necessary.  I do not like doctor's offices (yeah, I know.  I went into the wrong field).  In the past 31 days, Ellie has experienced 7 different febrile episodes.  Seven.  Only one of them lasted more than 24 hours--it lasted the 3 days.  That was when I bucked up and took her to the PCP because she might be, you know, ill.  Ellie sauntered into the office with two baby dolls and her plastic stethoscope.  Both baby and Ellie's physical exam was baseline.  As in normal.  As in they couldn't find anything 'wrong' with her. They drew a CBC and it looked okay.  We were told to follow up with Infectious Disease [ID] if these fevers continued for 2 more weeks.  The Bear is and enigma.  Yay!

What do you do when the hoof beats are not horses?

You start to look for zebras.



Seeing as our pedi was at a total loss, I went to the best medical source possible--Facebook!  I got some great differential diagnoses and started to monitor Ellie's fevers more closely.  I got the idea to call her old allergist/immunologist who also referred us to ID.

When Ellie's fever return after 56 hours, I lost it.  I was actually stuck in the Austin airport for several and I mean several hours while trying to get to a wedding in St. Louis.  I had my iPad and a speedy Internet connection.  With too much time on my hands near gates 13-17, I consulted the best medical manual around--Google.   

In case anyone is wondering, if you type in "frequent fever Down syndrome" you get:

LEUKEMIA

When clearly my daughter really has malaria or nephrotic diabetes insipidus or PFAPA.

Which brings me to this important life lesson: avoid Googling!!!!!


Upon returning to Austin and reuniting with the my baby girl, I immediately set up an appointment with Infectious Disease. I was certain I would have to wait a few months but they worked us in for the next day. . . today.  I felt a bit ridiculous walking into the clinic today--yeah, my daughter has fevers but she looks great and acts great and seems perfectly healthy!  

Of course, this is the kid who once had coxsackie, a staph infection, and sinusitis all a the same time and was excitedly signing "play".  She is also the kiddo who got pneumonia while on an antibiotic. This kid rarely acts sick. 

Our visit went alot like this:

Dr: Does she have a cough or runny nose?

me: No 

Dr: Does she have any drainage from her ear tubes?

me: No

Dr: Does she have any swollen joints?

me: No

Dr: Any diarrhea or vomiting?

me: No

Dr:  any throat infections, problems breathing, runny nose, stuffy nose, foul smelling urine, swollen lymph nodes, stomach pain, throat pain, head pain, wounds that don't heal, or rashes, etc. etc. etc?

me: no, no, no, no, no, uh she is nonverbal and cannot tell me what, if anything hurts

Dr: Does she have any bruises or petechiae?

me: She always has some petechiae.  It really isn't impressive.  More like pressure petechiae, see? [I show the Doc her waist line and shoulders--areas where her waist band and seat-belt left petechiae]

Mild petechiae from laying on ear, tourniquet during blood draw, and crying/screaming

The physical exam goes like this:  normal, normal, normal, normal, normal, normal, hyperactive

This is all GOOD!!!!

Of course we went to Quizno's after her blood draw

The doctor leaves the room and comes back in with an list of labs to run--CBC with manual review, ESR, C-reactive Protean, all sorts of immunoglobin levels, strep pneumonia serotypes, uric acid, lactic acid, metabolic panel.  Essentially she is checking for inflammation and her antibodies.   The doctor is confident that based off of Ellie's physical exam and the CBC performed at the pedi's office last week that her fevers are not the result of something hematologic.  As in NOT a leukemia.  Whew!!!!  Happy dance.  She does think that these fevers could be immune-related. Oh goody [sarcasm].  It does make sense. . . I sort of forgot that Ellie had SNOT from January to April thanks to a monstrous sinus infection that just would not quit--hence the adenoidectomy.



Five vials of blood later, I have decided that my daughter's awesome physical exam and lack of symptoms point her to just being an "odd duck".  

A FB friend once told me that "every kid seems to have 'thing'".  Maybe these fevers are Ellie's "thing". 

I am grateful that she looks great.  I am.  Believe me.  Yet, I am peeing my pants over here with anxiety.  

Unexpected Kindness

Hold onto your cowboy hats, readers for I am posting a heart-warming story!

Photo: idelhearts.com

Last weekend had taken the Chunky Chicken to Fuddruckers because Andrew and I had a desperate craving for burgers. . . with melted cheese. . . and crisp smoked bacon. . . and 2,000 lbs of grease.  Okay, I didn't have a craving for the grease or the calories, but there was a definite need for those delicious buttery buns and meat, especially the bacon.  In fact, I could go for some bacon right about now.

Anyway. . . 

Ellie is "talking" loudly "AYE!!!! AYE!!!!  AYE!!!!!! MAMA MAMAMAMAMA" so I am relatively certain the entire restaurant and surrounding areas knew we were there.  Fortunately, it was only 4pm and as such there were only a few other patrons dining at the fair hamburger joint and they all seemed to understand  that "AYE!!!!!!!AAAAAYYYYE" meant "hi". (hey, this is a step-up from Ellie's old DIE DIE).

Shortly after corralling my Spider Monkey into a high chair, this young high-schooler approached Ellie.  He looked right at her, clutching this bright orange and yellow plush duck, and said "I thought you might like to have this".  He had won it using Claw machine.  True to Ellie form after I had her sign "thank you", she shook her head "noooooo" at the duck.  The unappreciative turkey!

I nearly cried.  I thanked him profusely for being so generous and thoughtful and also for talking to my little girl.  Then, I talked to his parents (who were actually the grandparents--dang, they looked young!) saying that their son/grandson is a kind, polite young man.

When I returned to the table, there was my daughter, feeding this new, plush duck PB crackers.  Nom nom nom.

Goodness, I really seem to be on a manners kick lately.  

Looking through the window: the day I cried at preschool

Ellie enjoyed one full week of summer vacation before I enrolled her in a part-time, private summer preschool.  Ellie was in this school last summer to sort of "ease her way" into going to school full-time.  This year she is in a slightly bigger class room.  That means more kids per teacher.  While Bear will be 4 years-old in just 3 months, many of the kids in her class have recently, or are just turning 3 yo.  I think that this will be a good fit for her.

A Little Mama

Yesterday was her first day and Ellie saunters into the school like she owns the place.  She does what I affectionately refer to as "the waitress walk"--hips swaying with one arm in the air as though she is balancing a tray.  A little sashay if you will.  I have a small amount of time to help show the teacher what Ellie Bear's key signs are--yes, no, eat, water, potty, and Ellie.  The Bear immediately starts to explore the room and completely ignores me.  A good start!

When I return for pick-up, the director says "Anna, she did great today!"  I walk up to the classroom door and peer through the glass window.  I see Miss M reading a book with all the children gathered around her.  All of the children except one.  Mine.  My eyes sweep the room.  There is Ellie quietly sitting in the corner parenting three baby dolls.

I started to silently cry.  I say to the director with my voice cracking: "did she play with any of the kids?  Is she trying to make friends?  Did she remain alone the whole time?"

"Is it because she doesn't talk or because she puts everything in her mouth?", I blubber.

Seriously, what is it with kids and the naked babies?

Both the teacher and director reassured me that throughout the day there was a lot of parallel play among all the kids  That Ellie is doing the same type of play as her classmates.  The children sitting by each other playing.  That Ellie did not keep herself isolated, but did follow kids around on the playground.  They also told me that sitting for story time is not required.  That it was her choice to keep playing with the babies. (It should also be noted, that true to Ellie form she was covered in blue paint.  Seriously, it was like she thought it was sunscreen or something.  All over.  I can tell they tried to wipe it off, but this girl had punk-rock hair going on like her mama. . .only in dark blue).

I know. . . I should have taken a picture of my little Picasso sporting the blue paint.

I recognize that Ellie's play is appropriate for her developmental age.  I know this.  I do.  She is doing pretend play with the babies, but not with other kids.  It is okay for her to play next to and not with other children.  I do not fully understand my crying reaction.  She was happy.  She was playing.  In fact, she was sitting, which we all know is no small feat with her hyperactivity issues.  I just couldn't handle seeing my little girl all alone. . . even if it was by choice.

Today was a better day.  Even the director and the teacher said so.  Just like yesterday, I observed through the window.  There were no tears this time.  I watched my oral-seeking daughter stand at an activity table with another girl manipulating with play-doh with a rolling pin and cookie cutters.  She did not put any of it in her mouth!  The teacher told me that she engaged in this activity for over 20 minutes and only tried to "taste" the home-made play-doh a few times.   I was also informed that two seconds after I left, Ellie climbed into the water table which necessitated a change of clothing.  Additionally, Ellie sat in circle time. . . with her own book (apparently the group book was boring).  True to Ellie-fashion, she had to do things her own way!

My little girl is growing up and meeting all of her milestones right on time--Ellie Time.  I need to step back and allow her to do what she needs to do.  I am proud of her.  She is a RockStar.

What happened to manners?

 The children now love luxury; they have bad manners, contempt for authority; they show disrespect for elders and love chatter in place of exercise. Children are now tyrants, not the servants of their households. They no longer rise when elders enter the room. They contradict their parents, chatter before company, gobble up dainties at the table, cross their legs, and tyrannize their teachers.     - Socrates

Growing up, my brother and I were taught to say "please" and "thank you".  We learned that you must asked to be excused from the table after dinner and that it is common courtesy to hold a door open from someone.  Thank-you phone calls were always made after receiving birthday cards.  All gifts acknowledged with notes.  Apologizing for a wrong was expected.  

Today, I feel as though our children and even many adults are seriously lacking in the manners department.   Common courtesy.  Respect.  Showing appreciation.  Whatever you want to call it.

Contrary to how this appears, Ellie is not choking Jack.  She is actually hugging him.  Er, tackle hugging him.
Currently we are trying to teach her to not just run up and hug friends, but to ask first and to be gentle.

My college roommate and I once handed out goodies to 300+ kids at a Philadelphia elementary school.  Guess how many children thanked us?  One.  One child out of three-hundred.  Too many times to count, I have found myself weighed down with a 10 lb diaper bag while pushing a stroller restraining a cranky toddler-Bear and I  would be the one holding the door open for children, teenagers, and adults. (Let me tell you, I rarely receive a smile let alone a thank you so perhaps I need to start letting the door slam in their faces.) I occasionally pass out from shock when a young school-aged child holds the door for me.  So much so that I thank him profusely and then inform his parents of his awesome manners.  There is hope for our youth! 

Or what about sorry? If my charming "angel" pulls your child's shirt because it has a ball on it or glitter, I help her sign "sorry" .  Yet so many times I am left fuming because a parent witnesses her own little darling shove Ellie and ignores it.  I am not upset with the child, after all he or she is learning, but I am rather annoyed with the parent. I get that kids push, shove, and steal toys, but if no one tells her not to do it and that it isn't nice then child grows up thinking that all is hers for the taking.    

Some things just shouldn't be shared.  Like viruses, snot, and chewy tubes.

It used to be that if you found a wallet, you turned it in.  Of course you turn it in.  It doesn't belong to you. That is honesty.  Now, if you find money or a wallet and turn it in, you make the news!  Because being honest is rare, I suppose.  The chant Finders Keepers, Losers Weepers is running through my head right now. I do not mean to sound like a sanctimonious little snot, but rudeness really does grate on my nerves.  

When did we stop teaching our children common courtesy?  Is it when we became so absorbed in our smart phones to look up and pay attention to our progeny?  Do parents just not have the time?  Or maybe the parents themselves lack manners (which sadly I have seen all to often). Yes, I realize that I am placing a fair amount of blame on the parents here.  I do believe that children can pick up good behaviors from teachers and other kids, but I also believe it starts at home, at the earliest of ages. We seem to feed into our current generation's sense of entitlement and it is only going to hurt our children later on in life.  

Clearly, not very ladylike.

Perhaps my views of social politeness are a bit antiquated.  Although, I am not asking for married woman to refer to their husbands or partners as "Mr./Mrs. Smith" as opposed to his/her first name nor am I requesting that A lady ought to adopt a modest and measured gait; too great hurry injures the grace which ought to characterize her. She should not turn her head on one side and on the other, especially in large towns or cities, where this bad habit seems to be an invitation to the impertinent. A lady should not present herself alone in a library, or a museum, unless she goes there to study, or work as an artist. (Good Manners for Young Ladies, 1800s), because, well, I have failed this horribly.  Me, ladylike?  Yeah, right! However, I still expect the usual please, thank you and I feel as though Chick-Fil-A is the only place that has it mastered.  Come on McDonald's, step it up a bit!

Ellie is still learning to navigate the world, but she is slowly learning that courteous words/signs should to used in certain situations. I am trying very hard to teach Ellie the basic foundation of kindness.  She scribbles on thank-you notes, signs "sorry", "please", and "thank you".  She cleans the table after all meals even if she sometimes mixes up the trash vs. sink.  Ellie may not understand exactly why we are doing these things yet, but in time she will.  However, I am beginning to think that keeping her feet off the table will be a long battle. . . along with wearing shoes in public places.  Oh and not running up to random men and calling them "dada".   

Ah dinner etiquette.  At least her elbows are not on the table.

Cupcake Thief: not okay.

A common scenario:

Ellie sees a child playing with a ball

E: BALL!!!!!!!  

signs "my turn, share, please"

yanks ball out of child's hand, aka stealing and hands him whatever toy she was playing with (she was going for a trade transaction)

signs "thank you, sorry"

The poor kid has no idea what has hit him (or what on Earth Ellie was doing with her hands). 

It is a start.  It isn't perfect. It is a work in progress. 

The art of sharing

Even with my rant about lack of manners, I do need to tell you that several of my friends are doing great with their children.  They try to teach the little bambinos about sharing and they help them write Thank-You notes after birthday parties.  My one friends little girl is particularly verbose and is by far the most polite child I have even met.  
She is 3.5 years-old and our conversations go like this:

B: "Uh excuse me, Miss Anna, may I (I know, may I) please have some water?"

me: Yes, you may.

B:  Thank you, ma'am

She then proceeded to tell her mama that Ellie doesn't have nice manners (snicker snicker).  I don't think I ever laughed so hard.  Hah!  

Clearly my good friend has read Parents 25 Manners Every Kid Should Know By Age 9. . . in fact, I think she had the goal of her kid mastering them by age 3.  How did she teach Little B?  By modeling.  

As per Rachel Coleman of the Signing Time! series: "please, thank you, sorry makes everyone feel good."

Other articles:

Narcissistic and Entitled to Everything! Does Gen Y Have Too Much Self Esteem?


Grandmothers blame lazy parenting for children's rudeness and lack of table manners  Daily UK

How to teach manners to toddlers, kids, and tweens.  Babble.com (2010)

Raising your child to have good manners.  ForDummies.com

The Liebster Award: Part 1

I would like to thank April from Living by Faith and Linda at Out One Ear for honoring me with the Liebster Award.  I am fairy certain that the lovely Linda figured I had forgotten all about this seeing as she first notified me about the award back in February.  Yes, February.

The literal translation of the German word liebster is: dearest, sweetest, kindest.  April and Linda, are you sure I should be getting this award????

As with any blogging reward, there are rules.  Here they are:

Liebster Award Rules
1. You must thank the person who gave you this award
2. You must display the Liebster heart on your blog
3. You should nominate 3 to 5 up-and-coming blogs with less than 200 subscribers
4. Each person must post 11 random things about themselves
5. Answer the questions given to you by the blogger who nominated you
6. Create 11 questions for those you nominate to answer
7. Notify your nominees and provide a link back to your post.
8.  You’re not supposed to do “ping-backs”

I shall try my best to follow them. . . err most of them!  I will be answering a combination of the questions posted by April and Linda because I am certain that all of you will leave me if I attempt to answer all 22 questions.  Longtime followers know that my blog is an open book so there truly isn't too much you all don't know about me.  That being said, I have shared 11 random things in a previous meme and that can be found here.  (Random question: why is it always eleven questions?) More randomness and hilarity can be found on my post How I Got Here: From Combat Shoes to Cowgirl Boots, which will actually make you feel very sorry for my parents and say that all of Ellie's antics are payback.

Now, on to the questions!

1. What is your favorite travel destination and why?  Mittenwald, Regensburg, and Detwang, Germany.  My husband's father used to live in Germany and regaled Andrew with stories of his youth.  In fact, Andrew's eldest brother was born in Frankfurt, Germany.  For these reasons, we decided to honeymoon in Germany--in more rural, lesser known parts of Germany [except for Regensburg which is more densely populated].  The stark beauty of the country is breathtaking.  The Bavarian villages that quietly scatter the mountainous countryside is like something from an old novel.  The food.  Oh the food is delicious.  The architecture--imagine the German, Roman, and French Napoleon influences in Regensburg  The hospitality of the people is something rarely seen in the U.S.  By that, I mean everyone we met in Germany was kind, gracious, and not trying to con us into or out of something.  The weather beats this desert of a place and by desert, I mean Texas.  There is just something about lush, green hills and jackets and fuzzy socks.  Germany is a symbol of our "young" love and the beginning of our marriage.  I hope to go back with Andrew in the future.  The fact that I do not speak German is besides the point.  I can say "One more coffee, please." which is enough for me to get by!

2. If you had one hour to yourself, how would you spend that time?  Sleeping.  Provided that I could actually fall asleep right away.  Otherwise, a cup of coffee and a good book.

Where's Ellie?  Seriously, how is it a child can just fall asleep on the floor?
Notice the new paint job?  We are still finishing up the room renovation.

3. Do you own any pets?  If so, what kind?  Oh yes.  My first baby is a black bombay rescue cat from the ghetto streets of Camden, NJ.  Tama.  Tama is loosely translated to mean "lightening storm" in Native American.  She is full of teenage angst.  Although she is more middle-aged now.  Maybe a midlife cranky crisis?  Surprisingly, she meows with a Texan drawl and has a soft spot for our dog. Amelie is my second baby.  She is also a rescue kitty.  The day after we returned from our honeymoon, I walked into a PetsMart to pick up kitty liter and dog food and walked out with Amelie (the rescue shelter was there!).  I have since been forbidden to shop at a Pet Store.  Ame is tortoiseshell kitty full of spunk.  She is bowlegged with a Michael-Jackson glove/paw.  She actually carries on a conversation  .  Then there is the Sophie Princess Puppy Paws.  She thinks she is a cat.  A rather big cat.  She is a "South of the Border" collie.  She protects Ellie, but tries to herd the vacuum cleaner.  This is why I rarely vacuum.  

I cannot forget my first puppy.  Our rescue, Border Collie Rodeo.  He was Andrew's puppy and when I moved in with Andrew, he was so protective.  Rodeo would sprawl sideways across the bed so that I couldn't be near Andrew.  In the end, he knew I was his loving mommy.  RIP Rodeo.

4. What story does your family like to tell about you? There are many and yet, this one has been repeated many times.

This is my daughter:

Sometimes bibs just don't cut it.

Apparently, Ellie gets it from me.  Perkin's Restaurant in St. Louis used to have this pancake covered in delectable whipped cream.  It was my 1st birthday and my parents ordered this sugary confection to celebrate. My parents claim that I was so incredibly messy that the restaurant  had to shut down.  The cake was mashed into the carpet and the whipped cream was everywhere, but my mouth.  I will have you know this---they shut down after I was 7 years-old because I distinctly remember my father loading my brother into the car, but failing to unlock my door.  He tried to drive away with me banging on the car and shrieking.  I was 7 years-old and nearly stranded at a freaking Perkins.  They closed sometime after that after incident.




5. How do you motivate yourself to exercise?  Who says I exercise?  Seriously, I am still looking for motivation.  Help me!  I was the Zumba Queen of Sexiness until my car accident when I was physically unable to work-out for a few months.  It should be noted that I was cleared for physical activity at the end of December.  Here it is June and I have only worked out a few times.

Random Ellie Pic

I will finish this up later and then include my nominations and questions for them in the next Liebster post!