As soon as the doctor saw it, she uttered the phrase that we had been fearing… MRSA. That’s the shorthand for a nasty, drug-resistant bug known as methicillin-resistant Staphylococcus aureus. She couldn’t say for certain without culturing it, but she was quite sure we were dealing with MRSA.

How to get rid of MRSA

The recommended treatment regimen was:

• A ten day course of oral antibiotics (Bactrim; sulfamethoxazole-tmp)
• Regular treatment with a topical antibiotic (Bactroban; mupirocin)
• Adding a half cup of bleach to his nightly bath
• To the extent possible, we’re supposed to “express” (squeeze out) the pus – lovely, huh?

To prevent spread, we’ve been keeping it covered with with a large band-aid, which we’ve been changing regularly, washing our hands religiously, and keeping him dressed in long-sleeved shirts.

As far as school attendance goes, our doctor advised that we just keep it covered and send him back. MRSA is (apparently) pretty much everywhere nowadays, and his presence doesn’t present any unique risks to his schoolmates.

Officially diagnosed: MRSA

As far as the official diagnosis goes, we got a call from the doctor just before 5PM this afternoon. The test results were in, and… Yes, it’s MRSA. The good news is that this particular strain does respond to Bactrim, and he’s on the mend.

As for how he got it, we have no idea. More than likely, he had a bug bite that came into contact with it and the infection developed from there.

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During a two month trial in Newport, Rhode Island, researchers found that delaying the start of school from 8:00 AM to 8:30 AM resulted in significantly more sleep for teens. In fact, the number of students getting by on less than seven hours dropped by nearly 80%, and the number of students sleeping at least 8 hours increased from 16.4% to 54.7%.

Other benefits of the later start included increased alertness and fewer students reporting that they were too tired for schoolwork or sports. In addition, fewer students reported feeling unhappy, depressed, irritated, or annoyed, and fewer students skipped class or showed up late.

When I was a kid, high school students started earliest, with middle school students starting a bit later, and elementary school students starting last. In our current community, however, the reverse is true: elementary kids start at 8:00 AM, middle school at 8:30AM, and high school at 9:00 AM. All in all, this seems to work well.

Source: Time.com

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The good news is that his tics became much less apparent, and his behavior also improved dramatically. Unfortunately, we couldn’t tell if the behavioral improvement was because the medicine was working, or because he was feeling so crummy from the side effects — primarily sleep problems, headaches, and nausea.

We switched his dosing schedule so he’s be taking his Intuniv in the evenings, but that didn’t really solve the problem. His sleep patterns did improve, but he was still having bad headaches and some nausea.

Switching to Lexapro

Ultimately, we ended taking him off the Intuniv and switched him over to Lexapro (escitalopram), which is a selective serotonin reuptake inhibitor (SSRI) that is often prescribed as an anti-depressant. The doctor thought that the Lexapro might help reduce his anxiety, and thus solve both the tics and the behavioral issues.

At first, this seemed to work well, but the behavioral issues returned within a few weeks, and his tics have come back with a vengeance. Perhaps the initial benefit was a placebo effect, or perhaps his body adjusted to the Lexapro, or is otherwise having an adverse reaction.

We’re currently thinking of taking him off the Lexapro, letting it clear out of his system, and then trying again. The tics we can live with, but the behavioral problems are taking a toll on the family.

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Treating impetigo, in the beginning

We first started treating his impetigo with Bactroban (mupirocin) ointment accompanied by regular pHisoderm baths. When that didn’t knock out the infection, he went on two rounds of Zithromax Z-Paks (azithromycin). The Z-Paks seemed to do the trick, and the impetigo seemingly disappeared.

Convinced that we had won, we stopped with the Bactroban. Unfortunately, the impetigo came back shortly thereafter. It’s unclear whether he got re-infected or if the original case never completely cleared up. Regardless, we started treating him again.

Treating impetigo, one more time

At this point, we were applying the Bactroban more or less daily. When the impetigo didn’t improve, he went back on a Z-Pak. This time around, there was no improvement, so we got referred out to a dermatologist.

The dermatologist suggested stepping up to twice daily Bactroban treatments accompanied by daily baths with a hypo-allergenic soap. He also recommended putting some Bactroban in his nostrils and on his anus once per day (nostrils first!).

When the dermatologist’s suggestions didn’t help, we went back to our family doctor who recommended that we try a new oral antibiotic. This time around, we went home with a prescription for Omnicef (cefdinir). We’re about halfway through that prescription and have seen a huge improvement.

As of today, his sores are on the mend, but we’re still hitting them Bactroban twice per day, and will continue to do so until we can’t find any spots to treat. We’re hopeful that we’ve finally got the upper hand, but we aren’t holding our breath. While we’ve dealt with impetigo in the past, it has never been this stubborn.

As an aside, we haven’t seen any red urine (a known side effect of Omnicef) this time around.

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Unfortunately, shortly after he started taking Intuniv, he started having problems with insomnia. He’d fall asleep just fine but would wake up at 2AM or 3AM and then be unable to get back to sleep. After consulting with the doctor (who also checked with the pharmaceutical rep) we ended up switching from morning to evening doses.

The good news is that the nighttime sleep problems are gone. The bad news is that he now comes home from school absolutely exhausted. And by that I mean completely and totally wiped out. We’re hoping that he adjusts to the Intuniv in the coming weeks such that he’s no longer so tired in the afternoons, or so we can switch him back to morning doses without disrupting his sleep.

I’ll update when we know more…

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This past fall, our son (eleven years old at the time) started middle school, and shortly thereafter the tics returned. They’ve presented as eye blinking, nose wrinkling, and a funny little mouth stretch (for lack of a better term). While we kept hoping they’d go away, they haven’t.

We’re now pushing six months, our eleven year old has turned twelve, and there have been no signs of improvement. Since this is by far the longest he’s had them, we decided to have him checked out.

After evaluating him, the doctor recommended two possible pharmaceutical solutions. I should note here that, in addition to the tics, he’s rather high strung, and we’ve also been having some issues with his aggression toward his brothers.

Lexapro vs. Intuniv

The two options that we were given were Lexapro (escitalopram) and Intuniv (guanfacine; the time release version of Tenex). Lexapro is a selective serotonin reuptake inhibitor (SSRI) that is often prescribed as an anti-depressant. This would help with his anxiety, and could also reduce the incidence of his tics.

Intuniv, on the other hand, is an alpha-2-adrenergic agent that is often prescribed for ADHD, and is also thought to be effective in treating tics. After a good bit of research, as well as consultation with our family practitioner, we decided to go with the Intuniv.

He started on a 1mg/day dose for the first week, going up to 2mg/day this week, and 3mg/day next week. We’ll then take him back in to get checked out by the doctor. While we still haven’t seen an effect, we’re still ramping up to therapeutic levels. I’ll update when we know more.

Real-world side effects of Intuniv

While our son hasn’t been on Intuniv for very long, we have noticed some minor side effects. For example, he’s had a bit of an upset stomach and reduced appetite, especially since we increased the dosage to 2mg/day. He’s also been more tired than normal, and has been waking up at night and having trouble falling back asleep.

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Well… He recently, he came out of the bathroom and said “Daddy, my pee is bloody.” When I went in to check, I was surprised (and a bit disturbed) to see how red it was. I called my wife into the bathroom, and she concurred. It looked a lot like blood.

Fortunately, a quick phone call to the pediatrician was enough to put our minds at ease. As it turns out, one of the side effects of the antibiotic Omnicef (i.e., cefdinir) is discoloration of urine. Sure enough, he’s been taking Omnicef, and the color change is fully consistent with what the doctor has seen in other patients.

Phew. He’s been totally football-obsessed as of late, and we were starting to think that he’d gotten hurt rough-housing with his big brothers.

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In the beginning

At the time, we though that he just had a nasty virus, but we now suspect that he was a walking bug bomb. His “virus” eventually led to impetigo due to crusty, cracked nostrils. As unfortuante as that sounds, it may have turned out to be a blessing in disguise for him, as we think that the antibiotics took care of something else… Strep.

Anatomy of an outbreak

Last Friday, I came home from work early feeling like crap. Sore throat, achy, and exhausted, I crawled into bed and tried to recover. I felt better when flying high on my ibuprofen/acetaminophen cocktail, but otherwise I suffered through the weekend.

Meanwhile, Son #1 started feeling crappy on Saturday, a situation that deteriorated as time wore on. By Monday he puking and my throat still hurt. On Tuesday morning we went to the doctor. I was diagnosed with strep, whereas Son #1 was diagnosed with sinusitis (the resulting drainage was irritating his throat and upsetting his stomach). I got Omnicef, and he got a Z-Pac.

Puking in triplicate

Around that same time, my wife picked up Son #3 from school with a fever. Son #2 was still fine, so he stayed for the remainder of the day. By evening, they both hurled (after eating some pizza and drinking some red fruit punch). Lovely. Counting Son #1′s pre-dawn hurl, that meant that three of our four kids threw up that day. Son #4 was blissfully ignorant of the havoc that he had created, as he had long since recovered.

Recovery? Not so fast

On Wednesday, I was staring to feel better, but my lovely and talented wife was starting to feel like crap. On top of that, Son #1 was developing a bad cough reminiscent of an earlier bout with pneumonia. And Son #2 was still in pretty rough shape with a fever all day long, dizziness, and a sore throat. So…

This morning my wife, Son #1, and Son #2 all headed back to the doctor. She just called. The good news is that Son #1 doesn’t have pneumonia. Another bit of good news is that nobody else has strep (lucky me!). The bad news is that they’re now all on antibiotics combatting a sinus infection.

And so it goes. At least it’s not H. pylori, and nobody got hurt.

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Beyond sitting down and talking things through with him, we also wanted to get him some books to help satisfy his curiosity. Unfortunately, the pickings are pretty slim at our local library, so…

Now that we’re back from vacation and things are settling down, my lovely and talented wife and I spent some time last night perusing Amazon.com for suitable titles. As it turns out, there are a ton of books available on the subject, and it’s pretty hard to tell what’s good and what isn’t without being able to look through them. We picked through the reviews as best we could, wound up picking three that sounded pretty good and were targeted to kids his age.

» It’s Perfectly Normal: Changing Bodies, Growing Up, Sex, and Sexual Health

» What’s Going on Down There? Answers to Questions Boys Find Hard to Ask

» The American Medical Association Boy’s Guide to Becoming a Teen

If anyone out there has already been through this, we’d love to hear your recommendations. And, of course, we’ll be sure to post our thoughts on the books listed above after we’ve had a chance to pick through them.

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As an aside, it seems like the frequency of illness goes up exponentially with the number of kids in the house.

Anyway, Son #4 is currently on antibiotics. Earlier this week he came down with what we thought was a virus. As things progressed, however, we got a bit more worried. He developed a “gagging” cough that bordered on uncontrollable at times, and was also running a consistent fever. We also learned that a little girl in his preschool class was recently hospitalized with a Mycoplasma infection that resulted in atypical (i.e., walking) pneumonia.

Given his symptoms and the this little tidbit of information, the doctor prescribed antibiotics (azithromycin in the form of a Zithromax Z-Pack). And guess what? This morning, he’s noticeably better. The cough still comes back a bit, but it’s much improved and the fever is gone.

Next up… Son #3 has been feeling a bit under the weather for the past couple of weeks. We’ve attributed much of this to his continuing recovery from his tonsilectomy and adenoidectomy. We’re confident that he doesn’t have an ear infection despite periodic ear discomfort. However, strep has been going around the elementary school, and he was starting to show signs consistent with a strep infection. So… We took him in for a throat culture. Negative. But this Mycoplasma issue has us wondering. The doctor wrote us a prescription for azithromycin (in the form of another Z-Pack) just in case, but we’ve opted against having it filled until we have a better handle on what’s going on.

Finally, Son #1 awoke this morning with a raging sore throat. Given his history with strep as well as its prevalence at school right now, we’re not taking any chances. The jury is still out on this one

That leaves Son #2. After a rough baby- and toddlerhood, when it seemed like he caught every bug on the face of the earth and had almost continual ear infections, he’s pretty much bulletproof at this point. He’s like the anti-germ. I suspect he’s resistant to pretty much everything because he’s already had it all.

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