“…once our eyes are opened, we can't pretend we don't know what to do. God, who weighs our hearts and keeps our souls, knows that we know, and holds us responsible to act.”
~Proverbs 24:12

Monday, January 17, 2011

A Scar Explained and a "Diagnosis" Made

Wednesday was B and C's first trip to the pediatricianand Mama and Papa's (as parents) too! Many international adoptive parents choose to take their children to an "International Adoption Pediatrician" and a specialized international adoption clinic. There is one in Nashville. I'm sure it's absolutely wonderful. However, we didn't feel the need to go that route. We knew once we met our kiddos that they arethank the Lordhealthy and not too far behind physically or developmentally. So, after receiving a recommendation from another adoptive family and doing our own research, we decided to go with Dr. S and are so glad we did! Dr. S has adopted internationally, so it's wonderful to have someone that canshed some insight.

He was absolutely wonderful with our babies! We weren't expecting things to go so smoothly, especially after our experience with Dr. Boris in Moscow. (Maybe it was the moustache, maybe it was the lazy eye, but there was something about the Russian doctor that Bennett didn't like. Celia, on the other hand, loved the guy!) Taking into consideration the fear and insecurities B and C were most likely feeling anyways and the fact that they each received four shots, one TB skin test and three blood draws, the kids were great! Less than 60 seconds after her shots, Celia was smiling and making silly faces at the nurse. The sweet nurse later said she has "never" seen such a happy babyand she's obviously seen a lot. Bennett, true to form, was all strength. He held it together so well and when he felt he was in a safe place againback in his Papa's armshe let out the cries.

We noticed once we brought Bennett home that he has a scar on his upper left arm. I greived a bit for my little guy over thinking we'd never know how he got it. Derek was ready to help him come up with fun and exciting stories to ease the loss. Much to our surprise, our pediatrician educated us on what most likely it was from. Bennett received a BCG vaccine when in Russia. It's common for a child his age raised in a Russian orphanage to have this shot so as to prevent childhood tuberculosis. Dr. S indicated that his scar is most likely from where he was injected with the vaccine. He warned us that there was a good chance that B's TB skin test would come back positive due to his receiving the vaccine. We were told to come back on Friday to have it checked out.

Dinner on Wednesday was amazing! I was looking forward to giving our kiddos soup, as we were told they had soup each day for lunch in their baby homes. Bennett devoured the vegetable and beef concoction. Celia didn't do as well, but the transition we have been trying to make from baby food has not been successful.

Thursday's dinner was so wonderful that we scarffed it down before taking any pictures. Sorry Nate and Kelly! Your food was just too good!

On Friday we went back to the pediatrician's office to get B's TB skin test looked at. We knew after monitoring it for the last several hours that it didn't look good... After two physicians took a look at it, it was decided. B did indeed have a postive reation.


Even though he most likely has never come into contact with someone with TB and the result was simply caused by his earlier vaccine, he will have to be treated. We took hom to Vanderbilt's Children's Hospital for a chest X-ray to completely eliminate the chance of him having an active case of tuberculosis. Thank God everything came back great and he doesn't have it. Nevertheless, the CDC requires that people in our situation go through the proper treatment anyways. So... poor Bennettafter everything he's already had to go throughwill be taking the TB treatment every day for nine months. However, we are so thankful that our babies are perfectly healthy other than this. Bennett is in the 50th percentile or above on all physical charts. Celia is also above average except for weight, but I'm sure that will improve the longer we are home. We are so blessed!

That night we were treated to another fantastic mealone which I had before and requested from this amazing cook. Chicken and dressing and homemade mac and cheese! Mmmmmm!!



Jen said...

Hi! Throwing my two cents out there...hope I'm not crossing a line.

Our daughter also had a TB vaccine (scar on her arm) and had a reaction to the TB test but we aren't doing treatment. Our doctor said it was due to the vaccine. Maybe get a second opinion? I'm not sure what the treatment entails but nine months of anything medicine wise with a toddler doesn't sound fun!

Glad to hear the kiddos are doing so well.

Jen said...

Sorry, don't mean to harp on this but your post got me thinking so I looked at the CDC site and plan on talking to our pedi on Friday at our appt :). It looks like a blood test can distinguish between latent TB and a positive caused by the BCG vaccine (I'm wondering if our dr. did the blood test also and that's why we're not treating?).

Testing for TB in BCG-Vaccinated Persons
BCG, or bacille Calmette-Guérin, is a vaccine for TB disease. Many persons born outside of the United States have been BCG-vaccinated. BCG vaccination may cause a positive reaction to the TB skin test, which may complicate decisions about prescribing treatment. Despite this potential for BCG to interfere with test results, the TB skin test is not contraindicated for persons who have been vaccinated with BCG. The presence or size of a TB skin test reaction in these persons does not predict whether BCG will provide any protection against TB disease. Furthermore, the size of a TB skin test reaction in a BCG-vaccinated person is not a factor in determining whether the reaction is caused by latent TB infection (LTBI) or the prior BCG vaccination.

TB blood tests (interferon-gamma release assays or IGRAs), unlike the TB skin tests, are not affected by prior BCG vaccination and are not expected to give a false-positive result in persons who have received prior BCG vaccination.


Sorry for multiple posts, but it just seems like we're getting conflicting info and I don't want to NOT be treating if we should be.

Kat said...

Jen - thank you for that information! That is actually something that was brought to our attention a few days ago and we are looking into it. I definitely agree with you--don't treat if we can help it, but if he truly needs it and the CDC requires it, we will. I will post an update when we figure out if that is an option for us. Thank you again!!!

Kat said...

We heard back from our pediatrician today. He called our local children's teaching hospital for more information, particularly regarding the blood test. He was told that, unfortunately for us, they will not do the blood test for a child under five. I found this on the CDC Web site and perhaps that explains it:

"In addition, persons in the following high-risk groups should be considered for treatment of LTBI if their reaction to the TST is at least 10 mm of induration or they have a positive result using a TB blood test:... Children less than 4 years of age, or children and adolescents exposed to adults in high-risk categories."

So it looks like we have no choice but to move forward with the treatment. We have yet to hear from our local Health Department, but chances are they will call soon to ensure we are doing the treatment.

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