Correct Diagnosis

Two weeks ago, just before we ventured to Atlanta to meet up with good friends from long ago and far away, P had a couple of tiny bumps in the middle of his back. He tends toward dry, itchy skin if we don't moisturize well (Eucerin Aquaphor, we thank you) and perhaps I had neglected the upper middle back.

By the end of the emotionally-charged but fabulous weekend, the rash had grown, spreading toward the shoulder blades. It looked, to me, suspiciously like a case of ringworm. *Note to gentle readers: ringworm is not caused by a worm. It is caused by a fungus, which, admittedly, does not sound any less gross. But it is prevalent in about 20% of the population, especially children, at any one time. And easily treatable. So, meh, a quick trip to the doc for clortimazole (or something like that) should clear that right up. But our doctor could not accommodate an appointment in the two 15-minute windows I offered on Monday. So we swung by the Little Clinic on the way home.

The doctor thought ringworm, but also maybe eczema, as the rash had a mix of itchy bumps. We got the prescription, picked up more aquaphor, and slathered away.

A week later the medicine is gone, but the rash is worse, much worse. No one else in the family had even the mildest case of ringworm, which made me say, "Hmmm," as it is quite contagious. I had a bit more of a window on Tuesday, and our pediatrician could squeeze us in after lunch.

I love our pediatrician. Love, love. She is thorough and caring and has experience working with homegrown teenagers like our S as well as with international adoptees and developmental trauma. She moves carefully and talks softly and respects his space and calms his fears. We are blessed. (And also that we have a high-deductible HSA, so whether the practice stays in-network or moves out-of-network we plan to continue with them, paying as we go.) She checked him thoroughly. "I don't think it's ringworm," she said. She pointed out the similarities and the differences. Then, "Has he had strep or complained of a sore throat?"

He had gone through a period of visiting the school nurse several weeks before, complaining of a sore throat, but no fever and no redness and no swelling. We thought it was maybe anxiety because the complaints generally came during phonics and reading time.

"I think it's guttate psoriasis," she said, "but let me do a little more research." A few minutes later she came back with pictures and symptomology. Sure enough. *Note to gentle readers: guttate psoriasis sounds creepy, but it's kinda fascinating. It's a rash caused by the body's immune system responding to the streptococcal bacteria. By the time the rash appears (and in many people during the initial sore throat/respiratory strep infection stage) the strep test is negative and the person is not contagious. But without treatment the rash can last three months or more - very itchy - which can lead to other difficulties.

A couple of days on antibiotics and hydrocortisol cream and the rash is quickly disappearing.

Which made me feel grateful for a correct diagnosis and the appropriate treatment. It makes all the difference.

Sometimes in my school counseling job our best laid guidance and classroom clinical interventions don't seem to help. We want students to feel successful emotionally, socially and behaviorally as well as academically. But what will best help this particular student, with his particular strengths, difficulties, family life and experiences? Psychological and educational diagnosis are admittedly more difficult than, say, a strep test. The brain is so amazing and complicated, and is impacted by so many variables. But the incredible strides in brain-based research over the last decade, shedding light on neurodevelopmental complications such as the autism spectum, fetal alcohol effects, ADHD, developmental trauma, post-traumatic stress, anxiety, depression gives me hope for the healing benefits of a correct diagnosis and insight into interventions that provide opportunities for every student to learn and engage and look forward to a future filled with hope. 

Uplifters

I'm having one of those down days. Maybe you know the one - kind of headachy and run down, nothing seriously major enough to warrant the weepy breakdown this morning all day long, but a lot of little things from a lot of different areas in life all circling like vultures.

I needed a good cry, I surely did. Ad Vingerhoets, a leading expert on crying (yes, there is such a thing), notes that "situations that induce crying are always related to loss or separation." Today happens to be the birthday of my longtime boss and mentor, Gary Rowe. Even after I moved several times and changed jobs several times he was my go-to guy, one of the few people I could call when work in the counseling world felt too heavy. By nature counseling is a private profession; we tend to hold others' hurts silent and close to our hearts, but he was my load sharer. He had a wit and wisdom that put my role in even the most difficult of situations into a hopeful perspective. Gary passed away six months before we got Paul (oh, he would have loved Paul!) after a six year battle with cancer.

I'm really pissed at cancer.

I suppose my crying jag is fitting because I cried a lot with Gary. In retrospect, that probably wasn't very professional of me. This was my first grownup job. He was my boss. But he was the kind of person who made it okay, who helped you through the cry and out the other side a better counselor and a better person.

One thing about Gary - he really enjoyed life. He savored it. I grew up with the impression that Christians ought turn up their noses at the pleasures of this world - in the world but not of it, that sort of thing - but Gary held the opposite stance. He figured that Jesus got accused of being a glutton and a drunk, and so he should walk VERY closely in His footsteps. He was that kind of fun.

He nurtured and maintained my addiction to very good, very expensive coffee. So today I drank one two three cups of Joybean Coffee in his honor. (Because really, where's the fun in moderation?) Sam brought me a bag of Joybean Coffee from her mission trip to Nicaragua, JUST after my Lenten coffee fast. (I have since purchased three more bags.) Everything about this coffee makes me smile - high-altitude Arabica coffee grown organically, bought at fair- and living-wage prices, roasted and sold to benefit the children at Metanoia Children's Home in Nicaragua. It's uplifting, just like Gary.

Is It Still Dark at MIS?

Paul loves to know what time it is at MIS, the care center where he used to live. The six hour time diffence is both puzzling and fascinating. (To me, also.) Yesterday afternoon we were driving from school to the offices of Kentucky Refugee Ministry. (That detail seemed relevant to me at the time. Maybe it is. I'm not sure.) "Is it dark at MIS?" Paul asked.

I looked at the clock. 3:45 pm Kentucky time = 9:45 pm Lesotho time. "Yeah, buddy, it's dark in Lesotho. The kids are probably all sleeping."

"Not the big kids," Paul said. "They's having a campfire for a little bit."

I stayed quiet, although I was curious. A campfire? Sometimes, if I don't press, these remembrances continue. And sometimes, not always, I can ferret out true happenings in his past from fantasy wish fulfillment. He didn't elaborate, though, but continued to draw in his journal.

"Will all the kids get 'dopted?" he asked after a few minutes.

Interestingly, we had just gotten an email from a friend in Lesotho updating the lastest match meeting. Eleven children (out of approximately 200,000 orphans in the entire country) were matched. Which is wonderful, yes, but fewer than the possible 16 allowed per match meeting. (Four children per adopting country.) "Well, we can pray that all the kids will be adopted into a family that loves them," I said.

"But will they?" (He's my realist.)

"Probably not," I answered truthfully.

"Will the big kids get 'dopted?" he asked.

"I don't know, buddy." By now my eyes are prickling and I'm trying not to cry. The faces of two particular big kids are etched in my mind. One, a boy with a soccer ball tucked under his arm and a megawatt smile, is Paul's abuti, the brother figure who looked out for him at the care center. Another, a tall, thin girl with shy eyes is Paul's best friend's sister. As David Platt said, "Orphans are easier to ignore before you know their names."

"What they gonna do with no famb'ly?"

"I don't know." I thought of the street kids we'd met in Lesotho. What are they gonna do?

"Some kids won't get 'dopted," he said. "Retsedesie died. Why?"

Now I'm crying and I'm realizing in just a few minutes I have to convince the KRM youth director that Sam and I are emotionally stable enough to tutor refugee children, who are also from hard places. "He got really sick, buddy. But he was with M'e Mamonyane and Miss Nancy and his sister and KB, and they all really loved him."

"At MIS, if a kid got a big hurt, he just laid down. Sometimes a M'e helped, but sometimes they's busy. We didn't have a doctor. Some kids went to hospital, but then they stayed there."

Sometimes the world is a terrible place. "It's really hard, isn't it?"

He was quiet for a minute. "Is it still dark at MIS?"

"Yeah, buddy. It's still dark."

P.S - If you feel called to support children from hard places, many of whom won't get 'dopted, I encourage you to visit Ministry of Hope, working in Malawi and Lesotho to provide feeding centers, educational scholarships, and support for single mothers. Or check out Orphan Care Alliance and their work with vulnerable children in Louisville and around the world.

P.P.S - MIS, the care center where Paul lived, was shut down in March. Many of those children went to Beautiful Gate, Ministry of Hope and other locations (including the street) throughout the country.