Many of you know about my troubles with Lauren lately. I’ll give you all the whole story, start to finish.
On January 13, I took Lauren to a new doctor, Dr. Gold, for her six-year well-check appointment. I was a couple of months late, as I had actually forgotten about a well-check at the time of her birthday. I expected this appointment to go as our well-checks always have. You know, “Growth’s on track, she seems well-nourished, have her wear a bike helmet.” And really, it did go that way. But at the end of the appointment, the doctor casually mentioned, “I’d like her to have a TB skin test. I have all my six-year old patients have one, and I just think it’s a good idea.” No problem, I thought. I am a teacher. I’ve had what seems like hundreds of TB skin tests. No big deal.
Well, it’s really no big deal if your skin test is negative, which mine always were. You get a little prick, and bubble forms under the skin, and it goes away within a day. Two days later, you go back to the doctor’s office, a nurse looks at your arm and says, “You’re clear, see you in a couple of years.” Since I had no reason to think Lauren’s would be any different, I actually forgot about her test. It was the kind of thing where I’d be making lunch or something and I’d think, “Damn, I have to remember to bring Lauren back to the doctor on Thursday to get her arm checked! Don’t forget, don’t forget, don’t forget. . .”
So on Thursday morning, I said to the kids at breakfast, “We have to remember to take Lauren to the doctor today to get her arm checked. Don’t let me forget!”
“Mom, will I have to get another one?”
“No, hon, why would you have to get another. . .” And I noticed her arm. Still, it didn’t register with me.
“Lauren, did you get a mosquito bite?”
“No, Mom, that’s where the doctor gave me the shot.”
“It is? Does it itch?” I gave her welt a little scratch and she pulled her arm away.
“No, Mom! It doesn’t feel like anything! It’s not a mosquito bite. Don’t scratch it!”
So I examined her arm closely, and it looked like a big mosquito bite, except it had several tiny little blisters on it, and it felt lumpy. No TB skin test I ever had reacted this way, so I was a little concerned. I called my mom, because that’s who I call when I get concerned about stuff like this. Both my parents tried to dismiss it. My dad said, “There’s no way she has TB. Where on Earth would she pick something like that up? That would be, like, big news!” My mom just asked what it looked like and advised that I take her in after school to have it looked at, and that her reaction was probably within the realm of normal reactions. So I hoped and hoped that this was a normal reaction to a skin test.
But I still called Rick before I took her to the doctor. “You know, hon, her reaction just doesn’t look right to me. I’ve had a lot of these tests, and you know, it’s just not right.” Rick just tried to reassure me and told me not to worry about it before I had it checked out. But you know, I’m learning not to discount my motherly instinct. I hoped it was just a negative, if unusual, reaction. But deep down, I knew it wasn’t.
Well, you must know by now how it’s turned out. Her test was positive. The doctor came in with a little ruler and measured her welt in millimeters, and confirmed my fears. So Lauren has been exposed to tuberculosis at some point in her young life. He peppered me with questions:
“Have you traveled out of the country recently?” No.
“Does anyone come to work in your house? Maybe a housekeeper?” No.
“Have you visited anyone in a hospital recently?” No.
“Do you have any idea where she might have picked this up?” No.
“Well, really, it’s just impossible to know where people pick up these things. It could’ve been anywhere.” Great.
The doctor ordered X-rays and a complete blood test to be done before she was to go back to school, so could I take her over to the hospital right away for her tests, please? The doctor told me she was most likely not contagious, since she had no symptoms of TB, and he expected her X-ray to be clear. But still, with a positive skin test, she really could not enter back into school until they knew for sure her lungs were clear. Also, the doctor went on to tell me, when children test positive for TB, they were to go on a 9-month course of antibiotics, and the antibiotics could potentially inflame the liver, so they needed to do regular blood tests to make sure her liver was tolerating the medicine well. Also, our whole family had to be tested. And, oh, by the way, he also needed to notify the Ventura County Public Health Office, so they would most likely be contacting me.
I left the doctor’s office stunned.
I sat in the laboratory waiting room at the hospital with my head spinning. Nine months of antibiotics? Potentially inflamed liver? X-ray? Tuberculosis?! Were antibiotics the only choice? Antibiotics that can give her hepatitis (doesn’t hepatitis mean “inflamed liver”)? Tuberculosis?! We all have to be tested? Could we all test positive for TB? I mean, my brain went into hamster-wheel overdrive. What does all this mean?
Thankfully, I have a good friend from college who is now a doctor on the east coast. I went to bed on Thursday night with my head buzzing, and when I woke up the next morning, I knew I had to contact him. He’s informed. He’s intelligent. He will listen to any rant I have without judgment. He’s a friend. He cares.
So I called Richard (my friend who cares, obviously). Richard explained the difference between latent TB, and active TB. Latent TB is when you have been exposed to the bacteria. Your immune system holds onto it, and does it’s best to not let it become active TB. Your body develops antibodies to TB, and that’s what goes crazy in your arm when you have a skin test. If you have no antibodies, your body will do nothing when you are given a skin test (no TB exposure). One in ten of these latent TB cases become active TB, and active TB is when you cough up blood, you lose weight, you are contagious, and if it goes untreated, it can kill you. And the treatment is no picnic, either—a cocktail of four antibiotics that are even harder on your body than the one antibiotic the doctor was asking I give Lauren—for six to nine months.
If Richard reads this, I hope I haven’t mangled what he told me too much.
Okay, I asked him next, “Is a nine-month course of antibiotics the only way to eradicate this bacteria from her system?” Yes.
“Will it harm her liver?” Most likely, no.
“Are we more likely to get liver damage from the antibiotic? Or are we more likely to develop active tuberculosis?”
So this is where I had to weigh my options. The chances of the antibiotic harming her liver are small (kids tolerate this medication quite well, apparently, as most kids don’t have a history of hepatitis or alcohol abuse). The chances of her developing active tuberculosis are also small. However, if she does develop active TB, the illness and treatment are horrible.
So, I’ve decided to put her on a nine-month course of INH. I don’t want to mess around with an illness like tuberculosis. I want it gone.
Ryan and I have tested negative for TB. Rick gets tested on Thursday.
Of course, there are only two pharmacies in the county can give me this medication in a form that is good for a six-year old. That is, in a somewhat palatable syrup. And of course, it still tastes horrible. Lauren actually spit out her first dose. I’ve already lost my Mother of the Year trophy with my reaction to that. I think I hissed something like, “Lauren! You are going to take this medicine if your father has to sit on you and I have to shove it down your throat!”
I quickly recovered, though. I apologized, and told her I got mad at her because I was scared. I reminded her she had TB, and while it wasn’t serious now, it could be. The only way we could get rid of it was to take this yucky medicine. And yes, she has to take it for a long time—almost until Halloween. Maybe if she took it with a little apple juice right after she swallowed, the taste would disappear quickly. But soon, it would all be over, and she’d be better. She was okay with that, and we tried again, the second time with an apple juice chaser.
So believe it or not, I haven’t lost any sleep over this. She has never had any symptoms, and she will most likely be fine. But when I wake up at 1:00 in the morning, it’s the first thing I think about. When I wake up in the morning, it’s foremost in my mind. When I go in to give her the final kiss at night on her sleeping head, it’s in my thoughts. And during the day, when my mind wanders, her diagnosis is right there. I’m not overly stressed, but it’s present. Hopefully, as this all gets a little more routine, it will move out of my mind for a while, and give me a break!
It’s amazing, isn’t it? The love, the worry for our children?
P.S. Thank you, Richard.
P.S.S. Ryan’s been exposed to lice.
