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.
No comments:
Post a Comment