5 yr old daughter's behavior changed overnight.

[Marguerite]

Strep is a weird bug. We had some run-ins with it, mostly me & easy child at various times. Strep B normally lives in the throat and nose area and grows aerobically (ie with lots of oxygen). According to my microbiologist mate, when you culture strep that's been growing aerobically, you get largish patches of colonies.

Our problems happened when we got strep under the skin, growing anaerobically - without oxygen. Conditions had to be just right for this to happen - there were other bug involved (more later). But when this is cultured (usually only aerobically, since strep prefers oxygen unless it's had to adapt to manage without it), they often will report back a nil finding, even though they grew SOMETHING - because anaerobic strep tends to grow smaller colonies when cultured.

What happened with us - we got an initial staph infection. Everyone has staph aureus on their skin. People panic when you mention 'golden staph' but the REALLY scary one they mean, is the antibiotic resistant strains of golden staph (staph aureus). Pimples - staph aureus. But for easy child, and later me on a few occasions, we got a tiny break in the skin, so tiny you could barely see it. Staph entered, began to multiply and slight swelling immediately closed off the tiny opening. The bugs then, to survive, had to begin growing anaerobically, without oxygen. These can turn into really nasty, painful boils.
But the real nasty happens when you have somehow got a strep B infection in the same spot. These two bugs, growing anaerobically, begin to do nasty things. The strep actually moves into the tissues at the edge of the wound and soften it up. The skin begins to lift away at t his edge, which allows the anaerobic staph to move in as well. The swelling from the staph then gives the strep more room to advance.
Basically, this can quickly turn into something resembling flesh-eating bacteria. And because of the localised swelling, blood-borne antibiotics have trouble getting in to the wound area. Applying antibiotics topically is also difficult because the wound is still closed.
Nasty.
Now, this is still the gospel according to my microbiologist - to treat this effectively, you open the wound (it's blasted painful anyway) and drain it. Culture the muck and request that it be cultured aerobically AND anaerobically. They should also do a sensitivity.
Once it's been opened the swelling should reduce and the oral antibiotics should be more able to get to the infection. To help though, hot packs or hot salt water every three hours helps to dilate blood vessels and let the blood carry more antibiotics to the problem area.

I had to have surgery on my toe because I kept getting repeated anaerobic staph infections. Fortunately, I only ever once had the strep B associated with it and got onto it fast. easy child had a couple - one on her finger, which took some time to recover. Nothing for fifteen years.

Whenever you're watching surgeons on TV, especially makeover shows and the like, keep an eye out for the naughty surgeons who stick their nose above their masks. According to my micro mate, this is how strep infections can end up in surgical wounds - from being breathed out the surgeon's nose directly onto the surgical site.

Most of the time, strep infections will manifest as a sore throat, but these bugs are opportunistic, they will try to grow wherever they can, under whatever conditions they have to. If I could get it in my big toe, deep in the tissues...

These days a lot of pathology labs have automated as much as possible, even to reading the size of colonies grown. If you have concerns, don't hesitate to ask for a consult with the microbiologist who is in charge of the lab. You should at least be able to talk to him/her over the phone. It's saved me a lot of grief at times, to get the results confirmed (or otherwise) from the horse's mouth, so to speak.

Having a microbiologist as a neighbour was very useful at times! Entertaining, too, just not at the dinner table...

Marg

 

[smallworld]

Almostcrazy, I was not offended at all -- I just wanted to clarify what I meant (and what our pediatrician told me). Last summer my daughter had a red rash in her vaginal area, and our pediatrician cultured it for strep. So I know it can and does occur. As Marg indicated, strep commonly occurs as a red and sore throat, but it can also occur just about anywhere in the body. Impetigo, for example, is a common skin infection caused by either strep or staph bacteria.

So what's the plan now that you're awaiting the blood tests? Are you trying to get in to see a child psychiatrist? Even if it's PANDAs, your daughter is going to need treatment for Obsessive Compulsive Disorder (OCD). That should include therapy, but she may also need medications. Her obsessions and compulsions sound quite strong.

Good luck. Sending positive thoughts your way.

 

[busywend]

almost, you should also read up on Sensory Integration Disorder (SID) - Sensory Integration Disorder.

Have you read The Chandler Papers in the FAQ/Board Help forum of the site?

 

[almostcrazy]

Marg, You sound like a doctor. As a matter of fact, you sound more informed than most I have talked to. Thanks for all of the info. I'll keep you up to date on my daughter's condition.

Smallworld, I am at present awaiting a call back from pediatrician. Don't I need a referral for psychiatrist? That's what I was assuming. I had called the local Mental Health Center shortly after this had started, and was told to contact her doctor first. That is what got to where we are now. I did read about Sensory Integration Disorder (SID), but that was earlier on. The stronger compulsions are just now rearing, and I am still researching. I have not read The Chandler Papers, but I will.

 

[DDD]

Your insurance company probably will require a referral but you
can check with the insurance company and get the names of the
"child and adolescent" Psychiatrists in your area. by the way, some of
us drive two hours or more from home to get someone who is well
qualified. Not all MDs are created equal...lol...so try to find
the best available. Your Pediatrician may or may not know who is
best.

No, you don't have to reply to each response. Some people who
are "computer gifted" know how to cut & paste and they respond
in one post to many questions or responses. Most of us just try
to mention others when we have time or when we have a specific
area that we need to revisit. This is a very supportive and warm
group of men and women. Very, very, very rarely is their a negative vibe passed between CD members. When it does happen it
is usually because of a bad hair day and is forgotten pdq.

If no one has suggested it yet, get a notebook and make entries
each day on what your child has done, what you have done including the names and phone number of EVERY person you contact
as you train as a Warrior Mom. The names are very important.
It's overwhelming but I'm confident you are going to do well. DDD

 

[BusynMember]

almostcrazy, please don't get any one diagnosis stuck in your mind. That can be a mistake. I did that with bipolar and I got what I asked about. I found that doctors can be suggestive to what WE tell them because they really don't have a clue half the time. I agree with you that even the best doctors make terrible errors at times. My neuropsychologist (I still recommend a neuropsychologist over a Psyschiatrist, but it's your choice),--ours was an alumnus of Mayo Clinic. He had worked there for ten years before moving to private practice in WIsconsin and he told us straight out, "Mayo Clinc makes mistakes ALL THE TIME. EVERY PROFESSIONAL makes mistakes all the time." It's so hard to get a correct diagnosis. and treatment. When we went to this neuropsychologist, we didn't say a word about what he felt may be wrong with our son. We just let him do all the tests with an open mind. He tested for twelve hours, which is why I like Neuropsychs. They run all sorts of cognitive and behavioral tests that nobody else does. At any rate, even though your daughter's onset of new and scary symptoms was fast, it may NOT be PANDAS. Mental illness can start on a dime. My first debilitating depression happened this way: I was sitting up in my bed looking out the window one night. I had just turned 13. One moment I was as fine as always (I'd never been quite right, but I'd always functioned.) Suddenly, in the time frame of less than a second, I felt something like an anchor falling in the pit of my stomach (best description I can come up with--I still remember the moment well) and suddenly I started to bawl. I was depressed, so depressed that I didn't go out with my friends or feel able to smile for a whole year. The only thing that may have caused this split second mood switch was that I got my period about a month later, but I have no clue if that was it. The depression remitted in a second, just as fast as it came on. One day I was in the library at high school and I felt that anchor lifting from my stomach and I felt high. VERY high, but not quite high enough to make me psychotic. I could FEEL the mood switches, unlike some who wake up depressed or manic. I was wide awake for both phases and the drastic switches. Hey, it could be PANDAS, but please don't let yourself get stuck on one diagnosis. I found that to be a mistake that cost my son many years of wrongful treatment. Let the doctor figure it out himself. JMO Good luck :smile:

 

[DDD]

Good point, MWM. All of us have to "go with the flow" as there are often multiple issues that get all intertwined. I keep saying that I don't care which part of the alphabet applies to difficult child so long as I have direction in the way to guide him. Actually
that is not 100% true. Even after decades of being a Warrior Mom
I would love to have a diagnosis. that is solved with a medication or two. DDD

 

[BusynMember]

I was lucky to FINALLY get a diagnosis. that fits. I think that many Warrior Moms go thru hell and back and don't get a diagnosis that makes any sense. Since I had so much trouble with wrong diagnosis, treatment and medications of my son, I am very leery of snap diagnosis., and I learned not to babble my own ideas to "professionals." They tend to give me what I want, diagnosis.-wise. Too bad there are no blood tests! It's a guess every time. We just have to do the best we can. For us, that was a neuropsychologist. At least he saw my son for a prolonged period of time, and tested him extensively, before jumping to a diagnosis. And you know what? He was actually RIGHT. My son couldn't be more autistic--I'm appalled that two MDEs and three Psychiatrists missed it. It's scary how fast they threw "ADHD" and "Bipolar" at us. Of course, nobody actually tested my son to the extent that the neuropsychologist did, not even the MDE was as intensive. However, at least after the MDE they DID say "autistic trait" although they stuck to "bipolar." Almost four years off medications, I know this child is not a mood-disordered kid. It's really scary how the psychiatrists, no matter how good, can make mistakes that can cost your kids years of their lives.