December 22, 2011

Pyogenic Granuloma

Even though this is a bit out of date, I wanted to post about S's latest health "issue". Kids have a way of helping you find out all about weird things you've never heard of or thought of before!

In August, S developed a little red spot on his right cheek, near his eye. You can just barely see it on the left side in this picture, taken August 6th. That little spot on the apple of his cheek. It was red, round and flat against his skin, not raised.

This was not too long after he began walking and was always running into stuff, falling, etc. Here is another shot, taken one week later, after he had fallen A LOT when we were in Maine, to demonstrate his pitiful state, and show the spot again. All that walking on uneven surfaces didn't work out for him. Poor kid. But you can see that the spot is still pretty small. I just thought that maybe he had spent too much time in the sun. Baby skin is sensitive, and we're pretty white anyway, so it was a definite possibility. So, I thought it best to wait and see if it would fade.

It stayed small for quite a while. By October first, it was a little larger, but not much. Here is another picture, for reference:
Another month went by and it was still growing slowly. People started to ask what was on his face. I was still reluctant to take him to the doctor. I've had far too many experiences at the doctor when other people have freaked out and I've gone down that "what if this is one of those things that is really serious and can only be caught early" thought road, but then when I see the doctor, they tell me it's nothing. So I waste lots of time, go through extra effort (that is usually tough on the kids in some way, because they've been cooped up in an office for over an hour, sometimes in a state of undress, waiting to be told to just go home and wait it out), spend money for the co-pay and get nothing in return. Anyway, I wanted to avoid that.

By November 18th, more than three months after the spot first appeared, it was getting a lot bigger.
You can kind of see it here. The spot was raised from the skin, red and kind of an imperfectly shaped circle. It looked like a red mole. Once it got to this point, I knew we should go in to the doctor. I would touch the spot to see how it felt or if it hurt S at all, but he never had any reaction. The spot was soft and fleshy and didn't seem like it had any fluid in it. But by this point I was ready to see the doctor about it. A growth that keeps getting bigger on the face of my 19-month-old was not a good thing!

Of course, this was the week before Thanksgiving and everything was crazy. We were preparing to leave for Ohio to visit family for a week, so I planned to get an appointment when we got home. I waited too long, however.

While in Ohio, the spot started getting larger and looking strained, like it was growing too fast and filling up. On Thanksgiving Day (naturally) I was cleaning S's face after he ate dessert and saw what looked like chocolate on the spot. I wiped it a little more and it started pouring blood! Not a fun thing to see on your baby! We rushed him to the bathroom, cleaned him up and fashioned a bandage to stop the bleeding and keep it covered. Takes a little finagling to make grown up gauze and tape fit a tiny face without getting in his eyes, covering his nose or getting too close to his mouth. Daddy held him while we opened presents (we do Christmas with my sister-in-law's family then since that's when we're all together) and S was pretty worn out and quiet for a while. He cried about the cleaning and bandaging, but I think it was mostly because he didn't want to be restrained and didn't quite understand.
By that night, the bleeding had already stopped and S had taken off the bandage. He had a scab at the bottom of the spot, where it had opened up, but there was still a pronounced bump remaining.
It was fine all day, but that night when I took his shirt off to change him into pajamas, it started bleeding again. We re-bandaged it with a band-aid and he left it on until the middle of the night. I put a new one on in the morning, to protect it, and all was fine until he woke up from his nap in the afternoon. I came in to get him when he was crying to find S covered in blood! Face, hair, hands, clothes, bed, etc. Another terrible site for a mother's eyes! Cleaned him up and kept him bandaged non-stop after that. It wasn't as easy to stop the bleeding anymore, but it was OK while covered. The bloody nap scene was repeated the next day, but thankfully that was also the day we were going back home.

I called the pediatrician in the car and got an appointment for the next morning. Had to find a baby-sitter for K next, because he freaks out whenever something is happening to his brother. It's very sweet how much he cares about S, actually. The triage nurse thought it was something that was essentially a bundle of veins that break the surface of the skin, but I can't remember the name she gave it.

The pediatrician didn't seem to know what it was when he saw it and referred us to a plastic surgeon. Because it was on S's face, they wanted someone with very specific skills to take care of it. We saw him that night and finally got a diagnosis: pyogenic granuloma. It is caused by some kind of injury, either surface or something that pierced the skin. Then the blood begins to pool in the area and increases. This is his face right after taking the bandage off to show the surgeon (on November 29, if you are keeping track of the timeline):

It had finally stopped bleeding (we had to keep changing the bandage and using a lot of gauze for two days before). You can see it was still raised, but this was honestly about 1/3 the size it was before it broke! The plastic surgeon had to shoot novocaine into S's cheek (definitely the worst part for S) to numb it. I held his body down, the nurse held his head, and the surgeon then cut the bump off with a scalpel and cauterized it with silver nitrate (which comes on a stick that looks like a large, gray tipped match). They put a band-aid on it and we were done!

S did so well with the whole thing! He cried, but didn't try to squirm away or really even fight against our restraint. I was so proud of him! He had also let the doctors and nurses remove and apply the bandages, look at his face and everything else that day with barely a peep. He had even left the bandages alone for most of the time we had them on over the few days. And this is a kid who won't leave a hat on for more than five seconds! God really protected him, and I think S figured out it was helping him to have the bandage. The doctor and nurse were impressed with him too and said he did better than most adults do! As soon as I lifted him up after the procedure, he calmed down and went back to normal. I was so thankful that he didn't seem too affected by the whole thing.

By December 3rd, he looked like this:
He had a little bruise near the area, and half of that redness is from the injection site for the novocaine.

Here is a shot from this past Sunday, when we went to the zoo:
Not a super close shot, but you can see that it is healing very well! We had the first follow up with the plastic surgeon, and the next (and last) one is January 12th. So far, so good.

From what I read online and what the doctor said, it is possible for something like this to happen again. At least now I know what it is and who to call. And, like my mom said, if your kids have to go through something medical, at least it was something pretty minor and fixable like this!