What A Day!

Brendan slept fairly well last night, but I woke him up early to head to a 9:30 a.m. Clinic appointment that was set at 7:50 a.m.  I somehow thought we could just dash out the door.  But there was no dashing with Brendan.  Moving hurt and he was so tired of the pain.  (In fact, yesterday he just begged to just go to the hospital -- he couldn't take the pain anymore.)  Getting him out of the house and into the car proved quite the feat.  Rachel had him crawl into the wheelchair, pushed him to the garage steps, had him get out and we got on each side of him and had him wrap his arms around our necks and we half dragged, half lifted him down the stairs.  Then we put him back into the wheelchair (after lifting it down the stairs) and wheeled him to the car.  I left him to move himself into the car since touching his leg only caused him to cry out in pain.

We made the trip to Salt Lake smoothly (well, Brendan cried over every little bump) and the process of getting him out of the car and into a wheelchair here at Primary Children's left him whimpering and shaking in pain.  

In clinic, they must have known he was coming, because they quickly whisked him straight into the treatment room where he could lie down.  Brendan allowed them to access his port before it was completely numb with the promise that he would get some pain medication faster.  Blood was drawn and the doctors came to discuss possible causes.

 It looked like we would not be able to get an MRI today -- all the slots were filled.  But we were sent to x-ray to check to see if Brendan's bones had suffered a fracture or if any lesions could be seen.  (I thought it was pretty sad that I was wishing they would just find that his bone was broken.)  The x-rays came back clear.  No fractures, no lesions on the right side -- (though they did see one lesion on the left side -- but not causing pain or looking like a problem.)

In the meantime, Brendan was admitted to the hospital.  The goal -- to get his pain under control and run tests to try to find the cause of all this pain.  So onto the floor we moved.  A new room -- a nice big room!  I didn't know they had such a nice big room in "D" pod.  

Once Brendan was settled into his hospital room, he spiked a fever of 101.8.  What?  Where did that come from?  It may have been covered since he was getting pain medication all weekend.  And when the Tylenol and Ibuprophen wore off it shot up.  Another couple of hours with more medicine and Brendan started feeling a whole lot better!  In fact, he started cracking jokes with the nurses.  Now that's the Brendan I haven't seen for almost a week!

Since we are now inpatient, we were able to get an MRI scheduled for 4:30 p.m.  The orthopedic resident came in before the MRI to check out Brendan.  She explained very clearly and concisely to Brendan (with me listening in) what they were looking for.  Several of Brendan's symptoms point to an infection in the hip joint (the fever, blood work results, and the hip continuing to get worse even when resting it.)  The MRI should pick up fluid on the hip as an indication of an infection.  (She explained to Brendan that the infection draws fluid into the area.) The treatment for an infection in the hip is surgery to clean the infection out of the joint. 

Brendan has hip pain in one specific area on the outside of his leg, below the hip area.  This may indicate that it may bursitis -- an inflamed tendon from overuse.  This is a plausible explanation since Brendan hasn't moved much in the last 6 months, then came home and began to move more than he used to.  The treatment for bursitis is ibuprophen.  Fluid in the tissues can indicate bursitis and will be picked up on the MRI.  (And was felt by the doctor.)

The third explanation of the pain may be osteonecrosis -- bone death -- caused by loss of blood to the bone.  Sometimes, the doctor explained, these bone infarcts cause dead spots in the bone.  (There are many causes for this and happen even to healthy people.)  As the bone heals, new bone fills in.  Sometimes, the bone at the top of the femur dies, then as it grows back, the new bone doesn't form in the same shape as before and causes pain in the joint.  Since Brendan had an MRI of his hip in March, they will be able to compare the two images and are hoping the bone infarct they saw in March will be healed.  (But she says with immunocompromised kids it often takes much longer due to nutritional deficiencies and slower immune responses.

Oh, and there is one more thing that may be causing the pain -- metastasized tumor.  But she just brushed over that possibility with Brendan.  I'm not sure he even realized what she was talking about.

Results from the MRI should be back tonight.