Bain Blabber

• Two of her tests indicated strep exposure - ASO & DNASE B
• I now know from my crack med studies, as well as our doctor's appointment, that some forms of rheumatoid arthritis are caused from a strep infection gone wrong.
• Her ANA results are negative - what is ANA?  Well straight from WebMD :  "Antinuclear antibody (ANA), to clarify a child's type of JRA and risk for eye disease (a positive ANA result is a marker for high eye disease risk, usually found in girls who develop pauciarticular JRA at a young age)"
• She had negative rheumatoid factor.  Also from WebMD:  "A rheumatoid factor (RF) blood test measures the amount of the RF antibody present in the blood. Normally, antibodies are produced by the immune system to help destroy and eliminate invading bacteria and viruses that can cause disease. But the RF antibody can attach to normal body tissue, resulting in damage."
• So all of this helps explain the reference to juvenile idiopathic arthritis...  Its simply a dianosis for juvenile arthritis for which there is no immediate known cause.  i.e. her rheumatoid factor is negative, however she has other rheumatoid arthritis type symptoms - joint problems, synovial swelling, etc...

Well folks, you know that I couldn't just stop there and ignore Reagan's results.

• Reagan also exhibits past exposure to strep, however at such low levels that they are probably not related to her current symptoms
• Reagan also had a negative rheumatoid factor
• Reagan did have slightly elevated ANA results.  Although the write up indicates it may be a false positive, I can't help but think to her cute red frames and be worried of the possibilities. 
• ...Relax, you IDIOT, THIS is why you WEREN'T going to find out these results without a doctor's undivided attention to answer all of these CRAZY questions!  IDIOT!
• Reagan's report allows for the possibility of juvenile idiopathic arthritis and recommends continued treatment plan (prescription strength Aleve and further monitoring)

Well there it is.  Raw facts.  Little context.  Worry.  Worry.  Questions.  WebMD search.  Pound out thoughts into blog.  Kiss sleeping girls knowing answers will come and all indications are of definite manageability and lack of severity.  Now to go answer Jason's questions...  Publish...

Since we decided to spend Christmas on Havelka and since it was their birthday, I had told the girls that we could open the gifts that we ordinarily would open on Christmas Eve on Christmas Eve morning.  As Jason and Diego headed out for morning snow removal duties, the girls and I made Pioneer Woman's fabulously sinful cinnamon rolls for delivery to neighbors on Havelka Court.  Delivering pans of warm gooey cinnamon rolls to unsuspecting neighbors on a snowy, snowy Christmas Eve morning was definitely won of this season's highlights for me.

Still forgetting all about the mounds of presents under the tree, the girls then geared up to play in the new mountains of snow with the Havelka Kids Club.  A good mom would have brought out the camera, but...  Well, we've covered that topic!

For a couple of girls that were so keyed up on opening gifts right after Christmas Eve breakfast, I was astounded that it was well after 2pm before anyone even mentioned them!  So astounded that I took a picture of the clock.  Why would I think to take the camera out then??  Who knows...

A few gift opening highlights...  I love the snow covered trees in the window!    

These boots were one of the girls' favorite gifts this year, and began what I expect to be a continued theme when it comes to the girls' clothing.  The more they LOVE it the greater Dad's disapproval...  Jason's longing for the days of onsies!

EDITOR'S NOTE:  This blog was started this afternoon but interrupted by work.  I guess I can't break my no-blogging-during-the-workday rule even when I WANT to!

I'm going to violate my rule against blogging during the work day, because either I:

A)  bang out this blog or

B)  devour the French Silk pie that is hanging out in our fridge...  (Courtesy of Lando - very sweet of him!  I enjoyed a tiny sliver of it and am shipping it off to Jason's coworkers tomorrow.  We enjoyed it, Lando, and the entire SPPD downtown beat will think you are THE BEST tomorrow!)

Option B would be in direct conflict with my New Year's resolution that I have vowed to not blog about.  Lets just say that my history of executing upon heavily blogged about or otherwise highly advertised resolutions is dismal.  Lets have a moment of silence for the Grandma's marathon that I didn't run or the Stillwater half marathon that I bailed from after inviting the entire Facebook universe to run with me.  My resolution this year includes a "shut my pie hole and JUST FREAKING DO IT" clause.  And no, blogging about not blogging about it is not a violation.

Since drowning my concerns in French Silk pie is NOT an option, I'll spend my nervous energy blabbering...  So here goes...

So after tests and tests and surgery and more surgery, we had an appointment this morning with Dr. Vehe, the director of pediatric rheumatology at Gillette.  I say that only because I'm a skeptic at heart and the title of DIRECTOR helps this mama be satisfied that we're not wasting our time talking to the wrong doctor.  Or a complete quack.  The daugher of Doctor Beth Medicine Woman is always skeptical.

First the bad, but not unexpected news...  Dr. Vehe does not see many kids with trigger fingers, and kids with multiple trigger fingers are almost unheard of.  Twins with multiple trigger fingers?  Lets just say that if we were to host a rally for twins with trigger fingers, the Bain Train would be the only attendees.  Oh goodie - a medical mystery.  Those hoping for a diagnosis and concrete treatment plan (JASON!) will end the day sorely disappointed.

The good news?  We did get some clues that lend themselves to additional tests, which might help move us along to diagnosis and a concrete treatment plan.  After a YEAR - this is progress, people!! 

First, Dr. VanHeest was able to biopsy the "nodule" she removed from Rylee's tendon and the results from pathology indicate that the tissue was (or contained?  Bear with me folks, I only play a doctor on the internet...) inflammed synovial tissue.  Here is a picture of a normal joint and a joint with an inflamed synovial lining:

And oh lookie - the title of the slide includes the phrase "rheumatoid arthritis".  A possible rheumatoid arthritis diagnosis from the rheumatologist?  Who's surprised?  I am not surprised by any means to be going down this path, however WAS surprised that there was something this concrete to go from. 

I did appreciate Dr. Vehe's thoroughness in understanding all facts before attempting to diagnose.  So instead of jumping on the juvenile rheumatoid arthritis band wagon, he ordered a series of tests for further information.  Rylee's physical examination showed that her left knee (the one she's been complaining of "clicking" was slightly swollen and warm to the touch.  Otherwise, both girls' physical exams were only notable because of the locking fingers.  They both had knee and hand x-rays.  He also ordered another round of blood tests, one of which was for rheumatoid factor. Sorry, Erin, I told you that I had the list of blood tests at home and I've since realized that what I had was the LAB ORDERS that I turned into the LAB.  OYYY!!!  A good mom would be rocking the journal and would have precise notes as to all appointments, test, results, dates, etc.  I have a foggy memory, a blog, and blind faith that all of this is being captured in their charts to be referenced when we need it.  Yes, I realize this makes me completely worthless on a phone conversation in the car.  "Ummm....  Its the joint lining...  It starts with an s..."  IDIOT!

We have a follow up appointment in six weeks to go over results.  Logical question: do you really have to wait SIX LONG weeks for results?  Well, I didn't think to ask that.  I was too busy counseling Jason over the fact that we weren't going to walk out of there today with a ten year treatment plan.  And playing cheerleader to the girls who FREAKED OUT over the unscheduled blood draw. 

A quick funny (or not so funny) story...  On the way down to the lab, Rylee planted herself outside the elevator and REFUSED to go in.  No way.  No how.  She wasn't going.  And there were tears.  And yelling.  And rivers of snot.  I told her that there were kids in the lab waiting room and that she had to pull herself together before going in so that she wouldn't scare them.  She attempted to pull things together and walked in.  My luck - the waiting room was deserted except for an OLD FAT guy.  Rylee took one look at him and it was GAME ON hysterics.  Oh Lord.  Well cheerleader mom turned into a torture agent.  I sat with one in the waiting area while Jason utilized advanced police technique to immoblize the patient.  It was U-G-L-Y.  I literally sat in the waiting room and listened to the screams through the hospital duct work.  While I am totally at peace with my inadequate documentation techniques, I need to do something to better prepare them for what inevitably will be the next blood draw.

Tonight finds me with still frazzled nerves over today's traumatic labs and trying to wrap my head around possibilities of an auto-immune issue.  At this point, I'm happy to have some clues as to next steps and will try to be patient for six weeks and try my best to react logically to whatever else may come our way.  And I'm totally ignoring that French Silk pie lurking in the fridge!