Thursday May 21st Appointment...

Thursday May 21st Appointment for Camden

Current Illness - Began Sat 5/16 in the AM
Symptoms: mucousy cough, fever (99-103.9), ear infection, abdominal pain, back pain, neck pain(sore throat?), loss of appetite, stomach hurts when eating, chills, hearing loss, dizzy

SAT: Began with 102 Fever and sore throat/tongue, chills, occassional cough
Fever broke on its own (no meds) Sat night and stayed at 99 on Sunday, cough increases
MON: Fever at 99. Lots of mucousy cough. Went to doctor at Bunks Med Center, nothing of concern found
Monday evening her fever spikes again and she has a headache and ear pain. Begin ibuprofen. Slept poorly. Extreme ear pain. Added Tylenol.
TUE: Woke up in tears with extreme abdominal and ear pain. Wasn't due for more meds yet but gave tylenol and ibuprofen anyway due to extreme pain. Went back to Bunks and was prescribed zithromax. Could not palpate any acute reason for abdominal pain at Dr. Tue evening she deteriorated more. Started Zithromax
WED: Woke with extreme abdominal, neck and back pain. In tears. Had to be carried because it hurt her stomach to move. Symptoms mostly abated after an hour of tylenol and ibuprofen. Hearing loss, could not hear me when yelling at her when I was behind her. Hearing loss appears to be in left ear. Improved some by evening. Unmedicated her fever reached 103.9.

Recent Symptoms When NOT Ill with virus/infection:

Legs hurt: complains of joint (knees, ankles) and muscle pain (calves, thighs)
Back hurts
Neck hurts
Will often say "my whole body hurts" or "I feel sick but I'm really not"
Dizziness, will sometimes sit down because of being dizzy
Little Energy: Will only play in spurts, complains of leg pain after walking, had to be pushed in stroller after playing at park, stops dancing because her legs hurt. Lays on the couch for much of the day.
Most recent symptom is chest pain. She has said, "it feels like there is a lump in my chest"
Stomach pain. She says very frequently, "my stomach hurts" but not in a throw-up way
Her complaints are increasing with time, not decreasing. She is getting more tired and more achey.

Background:

All of this began in early February with a seemingly typical virus. She recovered and was then hit with a nasty virus which we thought was pertussis. She was swabbed and it was negative but she was ruled as a "probable" case based on symptoms. During this illness (which lasted over a month) she developed joint pain which was dismissed as being related to her fevers. She would complain of her knees, hands, ankles and hands hurting. Since then she has been sick back to back. During this illness she had daily fevers. Towards the end she had daily fevers for almost 3 weeks. They would spike and break on their own every day but come back the next day. She was finally put on amoxicillan and it went away.

Frequent illnesses/infections. Longest period not ill was 1 month (she was gluten/dairy free at the time). After reintroducing dairy she came down with this current illness within one week of being back on gluten/dairy.
She has had the following infections: conjunctivitis, ear infections, bronchitis. She has been on amoxicillan and zithromax.
She's had unexplained fevers. The daily cyclical fevers in March and also in April she developed a fever with no other symptoms except for a headache and dizziness. She was fairly incoherent. It spiked to 104.5 even while on ibuprofen. It stayed at 101-102 for 2 days afterwards, no other symptoms ever appeared.
Her stools have been regular
Her appetite has been very small
During her gluten free/dairy free trial she did not get sick but her muscle/joint/stomach pain and lethargy continued to increase in both frequency and intensity. She also developed chest pain while GFDF. She was put back on gluten and dairy for her scope at Seattle Childrens
She has been VERY irritable but it is hard to say what is age related or illness related
She and her brother have a consult at Seattle Childrens Hospital with a pediatric GI on June 19th. Her brother is being evaluated for Eosinophilic Gastrointestinal Disorder (EGID) and will be tested for EE and possibly celiacs. Since EGID is known to be genetic in many circumstances and since Camden's symptoms could possibly be related to EGID I asked that she be referred to a pediatric GI as well. However, I am not sure this is the most prudent department for her to see. I am willing to consider ruling out other diagnoses as well.
She has had one CBC and differential done at my request to look for anemia or other causes for the frequent illness and the results were "normal" except her mch was elevated by 32%. She is scheduled for more bloodwork tomorrow and will have another CBC as well as others. She is also completing a urine and stool test at Seattle Childrens request.

My concerns:

My immediate concern is to confirm diagnostically that her abdominal pain is not serious in nature. I am not comfortable leaving it for another month while we wait for our consult.

I have serious concerns about cancer. I would like to test/rule this out. I am not sure if this needs to be addressed in Seattle or not.
I would like to explore/rule out other conditions (besides EGID, Celiac or other GI issues) that could be causing her symptoms. Do we need to consider things like Juvenile Rheumatoid Arthritis, Lyme, lupus etc...