Bumps and Lumps

Sofia is generally covered with a wide array of bumps, bruises, and unidentified owies on her body at all times. She has a nack for falling and even more for bonking heads. I think she could probably make it an olympic sport, bonking heads, yes. Just last week, she ran into Marcelo's room, turned around much to abruptly and slammed her face in the corner of the door frame right across her right eye. Only an hour later, she had a head-on collision with another little girl at daycare when we dropped her off. And so on, and so on.

Anyway, a few weeks ago, while trying to tame back her crazy hair, I brushed my hand up against the side of her face and felt a peculiar bump right in front of her ear. It perplexed me, no, not that there was a bump on her face, but that it didn't have the familiar blue-purple colors that normally accompany these bumps. The skin was completely normal and the bump was much too large not to be associated with a bruise, so it concerned me. The doctor physician's assistant at our after hours pediatrician's office said it was likely an infected lymph node and prescribed antibiotics. The lump decreased slightly in size but didn't go away. So, I decided to take her to the ENT (Ear-Nose-Throat doctor) doctor that put her ear tubes in, as this side of her face coincides with the ear tube that has fallen out and I wondered if there was a small unlikely chance it was related.

Dr Heras, the ENT really had no idea what it was, she prescribed more antibiotics only because the lump appeared to show signs of decreasing with the first round, but she let me know that if it didn't go down in 8 weeks, we would probably need to go to Primary Children's because the lump goes over a critical facial nerve and she wouldn't be able to biopsy it herself. The second round of antibiotics showed no improvement at all, in fact, the lump although now smaller and softer, started turning pink under the skin and is now quite red and the skin has started thining out. I didn't want to wait seven more weeks to confirm the obvious but I wanted Sofia's regular pediatrician's opinion on it too. Dr Arnold also didn't know what it was but agreed there was no need to wait any longer and referred us to the Primary Children's ENT department with yet one more prescription of antibiotics for good measure --omnicef, this time.

So yesterday, we saw Dr Grimmer at Primary Children's. After a brief examination, he quickly concluded it was quite likely an atypical micobacterial infection of the parotid gland. An infection that does not respond to typical antibiotics and can be treated with a 3-6 month course of heavy duty antibiotics with 60% success rate or surgery with 95% success rate. Unfortunately there is no test that will confirm that this is exactly what the lump is so we were sent off to get a CT scan, bloodwork and a TB screen to make sure there were no other affected nodes and to help confirm this diagnosis. We were to meet back at his office after the tests to further discuss the issue.

The whole thing took about three hours. The one-stop-shopping aspect of Primary Children's is nice. We were able to get everything done in one day rather than going to multiple places, making appointments, and waiting for results. I just don't want to think about the bill because IHC is not a preferred provider for our insurance that we pay a small fortune for each pay check. Also, coordination between the departments sucked. I mean, it should have been better otherwise what's the point of having them all together.

We were told to go to the CT scan first but I didn't know the CT scan would require contrast and Sofia would need an IV line until we got there. I also failed to consider, as I was told upon arrival, that we would need to reschedule for a CT with sedation if she was not able to lay still. LAY STILL?! Of course, she can't lay still. She has never laid still in her life, including her unborn life from the moment the her cells started dividing. How many times have I said I thought she was possessed in the womb, and if she could lay still for a moment or two she might not have so many bumps on her head. I braced myself for the worst outcome almost feeling guilty that I would put her through this knowing and not divulging the truth, that it would be unnatural and impossible for her to lay still. The nurse that put the IV in her hand was amazingly great. I say this because everyone else there sucked compared to her. She talked to Sofia in a sweet caring voice, she was not taken aback by Sofia's unfriendly, I-would-rather-start-a-fire-in-your-house-than-say-hello-to-you attitude. The nurse had her sit on Ray's lap tummy to tummy and told her to hug him tight. She explained that she was going to put a straw in her vein and told her every thing she would feel so she would not be scared. Sofia did great and complained just a little when the needle went in. She got the first of many gifts, a doctor bear, for getting through it.


Sofia gave all the signs that she would cooperate beautifully and lay still as they positioned her for the CAT scan. I warned the technician that she should not be so confident because Sofia could flip a switch on that at any moment. She laid still during the no contrast scan. But when they injected the dyes into her IV and told her to lay still again she decided that was enough of that and immediately demanded to get out of her restraints. The tech frantically threw on her lead apron and ran in the room to operate the machine directly. She had to pull out all her tricks, look at the TV, snapping fingers, animal flashlight, etc. I was cringing at the thought of having to leave and come back to do it all over again another day with sedation. I saw the tech slap herself in the forehead in frustration only once but somehow Sofia was able to do it and they got the second scan. What a relief.

I was happy that went fairly well, Sofia got another prize, a bouncy ball. Why people? Why would you give a small child a sticky bouncy ball in a hospital! With success and confidence, we were headed to the blood lab as the CT tech informed us, that the IV would not work for them to draw the blood and they would have to poke her again. Had they coordinated their efforts, we should have been sent to the blood lab first and then to the CT scan. That upset me. She said there was a small chance they could reuse the IV line so she left it in. I think she didn't want to upset me further as there was a small unspoken incident at the end of the procedure that I think she was hoping I hadn't noticed. When we got to the blood lab, there was an issue over the fact that we had no green ID bracelet and Sofia's name was spelled wrong in the registration system. We headed to the registration office to fix this and to the report the incident at the CT lab. A patient relations person came down to meet us and then stuck to us like a fly. At first it was annoying as she followed us into the 4x6 foot room where they were about to draw Sofia's blood. It was a caravan of people, baby, bags, and bundle of Sofia's prizes in a very small area.

I told the tech there how annoyed I was that no one coordinated the whole IV thing and that I didn't want her poked again. He said the dye injection for the CT scan usually fries the vein making it no good for drawing blood but he was very nice and he tried anyway. Lucky for us again, in the 100 to 1 odds as he told me, it worked. He held up a baby doll and bottle of bubbles to Sofia and asked her which one she wanted. Obviously, this guy could never stand up to a battle of wits with Sofia. She answered, "both ... I want both", duh. Things were going very well and I never expect that things will, so I was quiet happy again but not for long. Another tech came in to do the tuberculosis screen. The tuberculosis screen was not to look for TB, but to further confirm the initial diagnosis which apparently shows up positive for TB 50% of the time. This tech, however was an absolute, well you know, not very smart person. She somehow managed to give her the control for the screen and not the actual TB part and then didn't know what to do. She wanted to have us go ask the doctor what he wanted and started blaming the other guy for laying the stuff out for her . And I guess it was his fault too that she didn't look at what the hell it was she was injecting into my daughter. Why are these people allowed to work in the medical field, why. Anyway, this is were the patient relations lady really came in handy. She took over the matter and cleared up the confusion. She offered to take the materials for the rest of the test and administer it herself (she was also a nurse) at Dr Grimmer's office being that we needed to go back there at the end of all this testing anyway. It was great, like having your own personal assistant to deal with the bureaucracy, inefficiency and stupidity of people. I wish she could go with me everywhere. I no longer had to wait in line or talk to anyone. It was like being in VIP status. I guess you are a VIP when you witness an "incident" in their hospital. Must remember to always witness a potential incident when you are at a hospital.

We didn't wait too long to see Dr Grimmer, we got our own little waiting room where Sofia was able to bounce her bouncy ball all over the place without it going into other peoples diaper bags. After reviewing the CT scan, the doctor said the lump had a tail going back towards her ear canal. There was also another possible diagnosis, Branchial Cleft Cyst, a mass resulting from incomplete involution of the branchial apparatus or possibly from ectopic epithelial cells growing along the course of branchial clefts. Regardless, it needs to be removed surgically. He asked if we wanted to think about it before scheduling the surgery but we went ahead and scheduled it right then. What's there to think about, if it has to be done, it has to be done. He will have to make a cut similar to the cut that would be made for a face lift, dissect out the facial nerve, and commence to remove the material. A bit nerve wracking to say the least. She is scheduled for surgery next month. It will require an overnight stay.

I hate that Sofia has to go through this and the potential risk to damaging the facial nerve, but I can only think, at least it's not something much worse.

Oh, another funny tidbit about Sofia -- when the patient relations nurse injected her with the TB screen, Sofia did not respond as well as she had with the initial poke earlier. She's a quick learner and she cried out immediately. The nurse, with her keen patient relations skills, reacted quickly and asked her if she wanted to give the baby doll a shot. Sofia stopped the screeching cry immediately. An offer to poke someone else with a needle? hell yes! You should have seen the look on her face. The nurse put the cap on the needle and handed Sofia the empty syringe. Sofia immediately went for the cap to take it off. If she was going to poke the baby, she sure wasn't going to do it with the protective cover. For a split second I almost thought we might have another incident on our hands but really I was very impressed and relieved that the nurse handled her reaction so well. I think this is a technique I may very well be able to use in other situations, so I need to stock myself up with syringes. I think I may finally have an effective tool to stop whining and crying in its tracks. Just don't be alarmed if Sofia tries to give you an injection next time you see her.