12.23.08 - As I mentioned, when we first saw Hana, she was somewhat somnolent. We knew she'd just woken from her nap because we *absolutely* couldn't disturb her during her regimented eat/sleep cycle. She didn't smile (expect to the kids), but she didn't cry or act afraid. We spent about an hour with her, and gave her back. She started rubbing her eyes, and we didn't want to overwhelm her.
We checked her out of the orphanage for a 'day trip' with us. Upon arrival to the Sheraton we gave her a nice warm oatmeal bath. As we undressed her, we noticed some VERY infected, swollen, chickenpox. They were oozing pus, and the surrounding tissue was red and tender. The worse was on her scalp and neck. All I could picture is bacteria, scabies, and whatever else, crawling around in the pox...building little microbial villages!! Her feet were like trench foot, wet looking, skin peeling, between the toes looked like tinea (mixed with pox)...horrible. And her little nails were so long, that her scratching only worsened the situation.
We treated the water with antimicrobial tea tree oil. We washed her hair with lice shampoo. Cleaned behind the ears. We then treated her with Aveeno cream, anti-itch cream, steriod ointment to her body, antibacterial ointment to the infected areas, antifungal/steroid cream to the feet. Anti itch powder to the torso, and desitin to her diaper area (which was very raw from her profuse, watery, urine-appearing diarrea). Seriously, when I pressed on her belly, urine-like stool would squirt out her rectum. I pressed and pressed on her belly, bicycling her legs and patting her belly. She'd intermittently cry (and of course I thought "oh no, she had intusseseption!!" William stood nearby and asked "could she have some sort of obstruction or maybe cholera - as 1000s of people are dying in Zimbabwe of Cholera at the moment). All we could do it pat, pump, and press her belly. We went thru 5 consecutive diapers and 3 large towels...but finally her belly was less distended. The pictures are taken after this process...so you can imagine the "before."
I started her z-pak...but instead of double dose on day one only (or a short course of double dose), I gave her a full 5 days of double dose. I gave her some Tylenol cold (yes, I think it's good for babies). I suctioned her nose, applied erythromycin to her eyes, and cortisporin otic to her ears. I used alcohol swabs to clean between her toes, and her pox. I gave her multivitmins. I gave her the formula she'd been on in the orphanage.
10 minutes after completion of her formula bottle (a bottle she wouldn't/couldn't hold) she started having what appeared to be abdominal pain again...and promptly pooped that clear yellow stuff again. Belly distended.
We went down to the pool, spent an hour in the sun. Then, it was time to go back to the orphanage. We thought it best to take her back as it was Sunday, and the plebotomist was due early Monday morning at Toukoul...and if we/she missed the blood draw...we couldn't have our embassy appointment.
We were able to check her out the next morning. Promptly gave her another oatmeal bath...and repeated the above treatments. Then I decided to switch her formula to soy-based lactose free (prepared with bottled water). I started massive amounts of pedialyte (and even gave her some pediasure which is gluten/lactose-free). I clipped her nails, and fixed her hair. Her infected pox were already looking better.
After the embassy appointment, Hana slept, literally 18 hours. We woke her to change her diaper, and to give her isomil bottles. I considered it was the Tylenol cold...but now (days later as she still gets the tylenol cold) I can say it wasn't that. Her breathing was *much* better with the tylenol cold on board. I think (in retrospect) that she was just overwhelmed, over-stimulated, and now that she was feeling better with less abdominal pain gas/distention, less itching, less congestion, less coughing, etc...she was just relaxed enough to actually sleep soundly!!
I continued to repeat the bath, creams, ointments, meds, antibiotics, pedialyte, isomil, vitamins, tylenol, alchohol swabs, tea tree oil, etc. etc. for the rest of our time there. By day 3-4 she was a TOTALLY different baby. She went from being so uncomfortable and ill-appearing, to an active infant!!
Developmentally she demonstrated only very few milestone accomplishments. She didn't even hold her own bottle, and she's 10 months old!! She didn't reach for people, didn't support her weight on her legs, and her she barely moved her knees/feet. I started thinking that maybe she had some neurologic issue going on. She would draw back her feet when stimulated/tickled, but spontaneously? No.
Also, she held (still holds) her legs in this funny extended, abducted, exterally rotated (like she's in 2nd position doing ballet or something) position. Her hips seemed dislocated and she constantly had her legs open very wide (like she's been riding a horse since she was born - OR more likely, she was born vaginally breech). Her facial features reminded me of a preemie baby. And she would only arch her back and cry as a "request" to be picked up. Very strange.
We've been working on that. She's now holding her own bottle. Her legs still flare out when she's lifted, but she will bring them down and support her weight on them now. She will reach for an object, and even starting to reach for people (instead of simply doing that back arch thing). She kicks her legs (like any other baby)...
...and is only pooping BROWN poop once a day!!!
Her belly is not distended, and she doesn't cry post meal. Her chicken pox are healed, and no longer infected. She no longer has that wet cough, or those "trench feet." She's hydrated enough to drool, cry tears, and her skin looks better. She's babbling louder, has an easy smile, her upper teeth have now broken the gumline, she's crawling now...and all of this wasn't being demonstrated just 1 week ago).
She has her first pedi appointment on 12/26/08. I wrote to the pedi, and gave her the (brief) scoop. Asked for a repeat CXR and blood testing, including hepatitis/HIV. Her tests from Ethiopia are all unremakable...and they did the HIV test 3 times (once for the referral/intake, once a couple of months later, and one last time for her US embassy appointment since the US wants to know HIV status before allowing immigration). All were negative. But, nonetheless...
She's doing well on the Isomil, pediasure, pedialyte. I've continued the Aveeno baths, topical creams and ointments, and multi-vits. I started probiotics. She's eating jar baby food mixed with rice cereal. I've added a bit of fat/butter to her food at times. She sleeps thru the night, despite the time change, travel, etc. She goes to sleep about 8pm, wakes at midnight for a bottle and a diaper change. Then sleeps until about 7am. She'll play with the crib toys for 30 minutes or so...and we get up close to 8am and give her breakfast. After breakfast she'll take a morning nap at 9am...and sleep until 11am. She'll get a bottle, and stay awake until 8pm. At least this is how's it's been the last few days we've been home.
She's doing MUCH better.
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