UPDATE - Seeking docs to play "House" for real

[Pitts2112]

Apologies if this is the wrong forum, but I really need some help for my dangerously anemic infant daughter (Hgb count 3.6 last week). We cannot identify the cause. The docs at the children's hospital are just about out of ideas.

I'm here looking for doctors who may have the background to suggest avenues for exploration or who have seen similar cases before. I know the limitations of this request but I'm desperate for ideas. We've burned through the first 80% of the Pareto principle and are now well on the back side of that curve. Hemotology has the lead at the moment, neuro and gastro have been consulted with no interest.

Brief background:
10 month old Caucasian female
hospitalised 17 Dec with Hgb count 3.6. 2 tranfusions returned to 11.1 by 22 Dec. Reduced again to 5.6 in only 6 days, 28 Dec.
Orange skin tone first appearing 20 Oct, increasingly apparent as Hgb drops. Eye whites unaffected - still pure white!
RBCs being destroyed yet no evidence in bilirubin (count of 2-3 when Hgb was 3.6), white cell and platelet count normal. RBC production not known (marrow results tomorrow) but suspect near zero.
All common viruses, bacteria test negative

Full lab results available upon request.

That's the basics. If you can offer something to help, please get in touch either on this thread or by PM. If you know experts in ANY field who may be interested, even for the intellectual puzzle element of it, please connect us.

Somewhere, sometime, someone has seen this before - just not at our hospital.


Pitts2112

[HEATHROW DIRECTOR]

My thoughts and prayers are with you. Hope someone comes up with help soon..

[Pitts2112]

Thanks, HD. Every little helps.

[mad_jock]

You could try a pm to DX Wombat, she used to be a pediatric ICU nurse in the Leeds area and could proberly give you a few steers for people to contact.



I echo HD my thoughts are with you.

[DX Wombat]

Pitts, you have a pm. M-J, I'll do my best.
Just had another couple of thoughts since I sent the pm. One is that it may be a metabolic problem of very late onset - most appear shortly after birth, or it may be due to accidental ingestion of a toxic substance [typical things are weedkillers etc] Like everyone else my thoughts are with you.

[Say again s l o w l y]

Pitts, good luck and fingers crossed for your little one.

I'll have a word with my FiL and get him to chat to the Haematologists that he knows.

I don't know if it'll be any use, but we can but try.

[mad_jock]

I had that though as well SAS C Walker in Glasgow. Mind you with that family they could cover a complete hospital of Consultants.

PS and thanks granny

[Capetonian]

Best of luck. I've PM'd you, I know someone who may be able to point you in the right direction.

[Pitts2112]

Already the PPrune readership starts to deliver - thanks loads everyone! But we haven't hit the answer yet so please keep them coming!

New information from today - it appears from the bone marrow test that she is producing healthy RBCs, they're just disappearing leaving no trace anywhere that's been found yet.

Cheers,
Shawn

[Thames virtual]

I'm very sorry to hear about your daughter. You're definitely talking about a problem that needs a haematologist here.

I can't help with diagnostic suggestions I''m afraid (I'm a paediatrician specialising in disability), but my first question would be "which hospital is she attending?" If she's got something incredibly rare that a specialist children's hospital can't identify, then you should seriously think about asking for a second opinion from Great Ormond Street. If she's already under GOSH, then you've already got the best paediatricians in the country working on it.

Please pm me if you wish.

[Pitts2112]

TV,

Thanks for the suggestion. I should probably add that, despite my out-of-date Pprune location, we are in Brazil right now working through a Children's hospital in the city of Curitiba (about 500 km from Sao Paulo). It has a mixed reputation; some say very good, others very bad, all anecdotal. It seems to have a full complement of normal departments, but I think we're out of the realm of the normal. If they run out of ideas, and Sao Paulo or Rio don't have the expertise to help, we'll be on a plane to GOSH as soon as practicable.

I think at this point we need to find people that deal in the weird and the arcane - people who have seen the one-in-a-million cases like this one. The question is, who are they? What area of expertise are we looking at? This doesn't seem to be a hemotology problem, so which department do we turn to next? Just thinking aloud there, by the way.

I appreciate you taking time to respond, and offering whatever you can. It all helps!!

Cheers,
Shawn

[Say again s l o w l y]

It's a Haematology problem alright. I wouldn't let them bounce you to another department unless they have some idea of why.

Haemaglobin going missing with no change in billirubin? Skin going orange, which is the classic sign of Haemolitic anemia...

What other department can help? It could be a virus or something like malaria, but you've not been in the country long enough really and I assume Brazilian Docs are fairly used to Malaria.

[Pitts2112]

SAS,

That's interesting because the haemo chief said they'd ruled out haemolitic anemia for some reason. I'll check back on them with that.

As for malaria and stuff, that's another interesting conundrum: Looking back at pictures, she started turning orange around 20 Oct but was acting fine in all other respects. Her "crash" started on 15 Dec with a fever, one-time vomit on 16, and again on 17 Dec when she was taken into the ER with an Hgb count of 3.6.

Since then, her Hgb destruction seems to have been at a high rate. After two transfusions a day apart, her Hgb was up to 11.1, 10.8 a day later, and down to 5.6 after 6 days (from the 11.1 reading). So, it seems to me that her Hgb destruction has accelerated but something was turning her orange for about 6 weeks prior to that. I'm no doctor so have no idea how, or even if, these timelines and conditions are related but something seems to be changing rates.

Coming back to the malaria, it seems like this started while we were in the UK but accelerated recently. Whether that is due to the move or something she contracted here I don't know. I'd be surprised, though, since my mother-in-law is about as OCD as anyone you've ever seen when it comes to germs and the baby. She doesn't even like to let the baby go outside because it's not clean.

We've recently discovered mice are getting into the house, though. Could that have anything to do with it?

Shawn

[Say again s l o w l y]

Not sure, though I've just spoken to my FiL and he gave me a hugely long and considered stream of medical stuff. He's going to jot it all down and send it through to me in a bit once he's had a chance to conference with a friend of his.

The gist is though, he's wondering if she's had some sort of viral infection that has knocked her a bit, but there are a few tests that he's going to suggest. Oh and there were a couple of terms he didn't understand and he'll say what they are. Segurado I think was one of them.

I'll e-mail it through as soon as I get it from him.

Oh and by the way, he hates "House" as they always do 10 tests where 1 would do!

[DX Wombat]

Pitts, you might like to try The Liverpool School of Tropical Medicine (http://www.lath.com/Liverpool-School-of-Tropical-Medicine). There is a "Contact Us" link on the site. Once I learned of your location something elso sprang to mind - Yellow Fever (http://www.nhs.uk/Conditions/Yellow-fever/Pages/Symptoms.aspx)but I am pretty sure you will have had your vaccinations.

[Say again s l o w l y]

E-mail sent Shawn.

[one day soon]

Hi Pitts

My thoughts are with you, however I'm sure as much as you appreciate the best wishes some medical expertise is more valuable so I will hand over to my better half 'Dr One Day Soon'........

Hi, so sorry to hear about your little one. I agree, it may be time to contact someone in tropical diseases for an opinion, but if her signs of a skin colour change started before traveling to Brazil, you may not get answers here either. You do need to double check her bilirubin levels as these would be raised in a haemolytic anaemia (with whatever underlying cause). Her remaining liver function tests as well can give an idea of what else may be going on. I presume they checked a blood film and looked at the nature of the red cells? If this is normal also, then haematological problems may be generally excluded. Have they checked her stools for blood also?

With the issue of mice, it may be wise to ask about a disease called leptospirosis, which is an infection usually caught through rat excretions. It is a long shot, but often presents with a very varied symptoms and therefore gets missed as a diagnosis at the start.

If her bilirubin is normal, you have to consider all the other ways your red cells disappear - bowel is usually the first to consider (hence my comment on her stools) . Is she losing blood in her urine ( is her kidney function ok?) Have they done an ultrasound of her abdomen and looked at her spleen? Is her breathing normal?

Also a very slim chance is an hereditary/genetic issue, are either yourself or your partner of Mediterranean/Latin American/Asian descent? (thinking of possible recessive traits like Thalassaemias).

Sorry for the barrage of information/questions but it seems there are lots of possibilities and without the specific results it is difficult to streamline thought processes.

On the plus side, her bone marrow was normal, which is reassuring. Please try to keep positive, sometimes these things do take time to unfold before revealing the truth, and, fingers crossed this will happen soon. It is always difficult when dealing with hospitals you are not familiar with, but it sounds like you have been on top of things which is entirely the right thing to do. Keep going.

Hope all improves and feel free to contact anytime via this thread or pm and I will pass on the questions/developments, Good luck

[Pitts2112]

Thanks very much to everyone for the help so far.

We brought Anna-Nicole home until Monday after another transfusion today (and one yesterday). She's doing fine and shouting up a storm downstairs with Grandma right now.

We're no closer to a solution to the mystery, though, and we're bringing her back for a checkup on Monday, when I fully anticipate we'll need to give her another transfusion.

Test for parvo is still pending, as are the full results of the bone marrow sample. Both expected next week.

As an added bit of data, bilirubin numbers quoted to me today were:
Indirect-unconjugated = 1.3
Direct - conjugated = .2

No real idea what that means but I'm told it's normal and doesn't lead us to a solution.

Initial bone marrow results show she's making cells but next question is whether those cells are making it out of the bone and into the bloodstream. Full results next week should tell us that, apparently.

Until then, I'm staying on freq here and continuing to find as many medical minds as I can to lead us to a solution. Someone, somewhere has seen this before. We just need to find that person. It's a "six degrees of separation" kind of a thing, I'm sure.

Shawn

[Loose rivets]

Hi, Shawn. Check your PMs. Just a lateral thinking long shot.

[Bad medicine]

Hi all, and especially Shawn.

The mods are happy for you to try to glean some extra information on the site here, but please remember that this is an aviation rumour site, and you must be careful how much emphasis you place on the information posted here. There is nothing wrong with your search for answers, but please make sure you back it up with those who are aware of all the details of your daughter's case. It is the team of specialists looking after her that will need to advise you on the best way ahead in the end.

All the best, and good luck.

BM

[Pitts2112]

BM-
You're absolutely right, and I appreciate everyone's patience while I abuse the purpose of Pprune for this. I'm taking all suggestions straight to our docs for their consideration and am not acting on any information on my own. I've already shared several of the e-mails I've recieved with the docs and they're grateful that we're getting extra brainpower to help us.

I'm really here to try to expand the network of knowledge and experience working on the case and, to that end, Ppruners have been absolutely brilliant. I am very grateful to you moderators and the readers for the help. Incidentally, most of this is being done offline by e-mail or PM, so as not to clutter up the bulletin board itself.

Honestly, next time I post here it's gonna be about laser eye surgery and the CAA or something, I swear! :)

Shawn

[homonculus]

I am very sorry to learn of your problems. Medical care in Brazil is variable but even with the limited information you have posted, I really think you should consider going to a developed world childrens' centre. Great Ormond Street has been mentioned and it is excellent but Miami Childrens' is much closer and on par.

Distance diagnosing is inherently difficult and a face to face consultation is always better than pilots on a website asking friends who may be medically qualified!

However, I think it is a bit excessive to consider this a rare or exotic disease at this stage - it is more than likely that a reputable developed world centre can get to the bottom of this and offer you the advice and support you need.

Good luck and feel free to pm me if you need specific advice

[Loose rivets]

Shawn, thanks for the PM.


Carrots. When I mentioned this to my wife, she recalled a case of a guy that went orange and became extremely ill.

What the mechanism of this illness was she doesn't know.

She's a vegetarian health-food fanatic, and tries to filter out the nonsense when reading these things. This item was from a considerable time ago, but she recalled that it was far from an isolated case.

I would be a little cautious about the sudden removal of betacaratine going in, but I'd feel happier to have it instantly withdrawn than carry on with too much.

Quite what connection there might be to the prime issue I'm not clear about, but it is a matter of, as I said, removing variables. There is just a chance that the carrots are making her ill in other ways.

During this next period, I would wash her without ANY soaps. Don't allow anything to contaminate the utensils. I say this with a certain passion. In my dotage, I've become profoundly allergic to some soaps/washing up liquids. The symptoms extend way beyond swollen red hands. I become 'globally' affected with a multiplicity of symptoms. Again, just one more thing to get out of the equation.

I'm putting feelers out for more information. Despite the fact that there are some good people on this forum, your logic is sound: Just somewhere, there might be someone that has heard of an exact same set of symptoms.

[DX Wombat]

Carrots. When I mentioned this to my wife, she recalled a case of a guy that went orange and became extremely ill.

What the mechanism of this illness was she doesn't know. The answer is quite simple - too much Betacarotene. It's the stuff they feed to flamingos kept in zoos to keep their pink colouration which they get from their normal diet when in the wild.
Miami Childrens' is much closer. That may be so, but as a British Citizen payment would be required for any treatment whereas it would be completely free of charge in the UK. I know I sometimes moan about the NHS [usually about the way it treats its staff] but it really IS the best in the world. Where else could you get the best treatment free?

[Pitts2112]

Humonculus,

Thank you very much for writing. I really appreciate it.

I think you might have a valid point, and is one of the reasons I posted here and have been touching base with medical friends. So far, everyone I've talked to seems to corroborate the care and the approach we're getting from the docs here. The response I've had from people here has helped give me confidence in the medical team. We're in a specialist pediatric hospital that deals only with children and they seem to have a pretty full range of departments available for consultation. I'm reasonably confident of their knowledge and expertise, even if some of the facilities are not to my liking (1930s hospital, no air conditioning in most wards, the general paeds ward is unclean, but ICU and Haemo look OK).

I've already started thinking about a flight back to London to GOSH if the hospital here comes up empty in another couple of weeks (Thanks DX!).

LR-
The orange and carrots thing is bugging me. Ana and I agreed tonight that we're backing off on the carrots and papaya to see if that makes a difference. I don't know how long it takes for betacarotine to process out of the system, but I expect her Hgb count is going to be low again in a few days, so we may see something then. At least we stand a chance of eliminating a useless complicator. You make a good point about other contaminants. I'll see what we can do about that. We already sterilise all her eating utensils and bottles, and don't use soap to wash her, but there may be other stuff that we need to look at, too.

To all of you who have responded or are merely following this thread, I wish you a very happy New Year and hope it brings you want you need in life. See you on the other side!

Cheers,
Shawn

[DX Wombat]

For anyone who may be interested:I would be a little cautious about the sudden removal of betacaratine going in, but I'd feel happier to have it instantly withdrawn than carry on with too much.Betacarotene is converted to Vitamin A which is fat-soluble so abrupt cessation will not have any immediate effect.
This (http://www.vitamins-supplements.org/beta-carotene.php) seems to be a reasonably comprehensive article on the subject but I'm sure there will probably better ones out there on the internet. A word of caution though about using internet sites for medical information as not all of the information has been properly researched and there are many self-proclaimed experts out there. I am NOT one.
I've had a look at several articles but cannot find any reference to betacarotene being the cause of haemolysis.

[Say again s l o w l y]

There isn't really a link according to FiL. He had one case of Orange skin in his entire career and that was a body builder who'd been taking carotene supplements.

[Loose rivets]

Again, although there is no specific mechanism to link the two, I wonder if the presence of something the body objects to might trigger a quite different problem.

This soap thing. If I go to make tea (with filtered water from a dispenser in the fridge door) and the water shows the slightest tendency to bubble, I sling it and rinse the cup again thoroughly to remove the slightest traces of dishwasher soap that may remain. In my case it is because of a possible link with anaphylaxis, but if traces of soap can cause a life threatening allergic reaction, it's possible that it might trigger something else.

Just Occam's razor again.


I came across this a while back. It's interesting in some ways, but I'm not really sure that it's a useful link.


http://jn.nutrition.org/cgi/reprint/13/2/143.pdf

[DX Wombat]

Babies and Haemoglobin: Newborn babies arrive in this world with HbF [Foetal Haemoglobin] which is gradually replaced by normal haemoglobin. Prior to birth this form of Hb helps the baby absorb as much oxygen as possible from the mother's bloodstream. Neonates also have a fairly high level of Hb which also aids in this process but because the baby no longer needs such a high level of HbF to help absorb oxygen it starts to get rid of the excess cells. It is the breakdown products of this process, combined with a slightly immature liver, which produce the very common Neonatal Jaundice which resolves quickly and may or may not require phototherapy. The neonate has a lot of growing to do and red blood cell production may not quite keep pace with this growth giving an apparently low Hb. This is compounded by the fact that milk does not contain much iron or folic acid. This is all perfectly normal and usually resolves itself once the baby starts mixed feeding. There isn't usually any need for extra supplements and, to be sensible, none should be given unless prescribed by a doctor.

[Thames virtual]

It might be worth your while ringing Great Ormond Street, and seeing if you can talk to a haematologist (I'm not sure how easy that will be to do).. Explain the situation and that you are considering bringing her back to the UK and see what they advise.

DXWombat, I'm not sure what you are thinking of regarding the normal loss of Fetal haemoglobin. Your statement is indeed correct, but it shouldn't cause an Hb much below 10.

[DX Wombat]

TV, don't worry, the post was really just to try to explain the relevance, or rather the lack of it, in the link given in the previous post and the fact that neonates have a different form of Hb from older babies and children. This is not mentioned in that link. I assume that article was written for people with some medical knowledge. My own feeling is that it is a prime example of how those without appropriate knowledge can be seriously misled by information on the internet and in turn can mislead others with perhaps fatal consequences. I should, perhaps have explained myself a bit better.

[Say again s l o w l y]

That's the truth DX. The first thing that FiL said when I mentioned this to him was "I don't know anything about babies..."
Now, whilst that's obviously not completely true, when it comes to serious illnesses or medical conundrums like this, then you need the real experts and even someone who is highly qualified, but in a slightly different field, might start getting things mucked up. All Drs use caveats if it isn't an area of specific knowledge. (Well, good ones do anyway!)

You wouldn't ask an Airbus pilot about a Boeing. They might know the basics, but unless they know the systems in and out, then things might get confused.

[Thames virtual]

My apologies DXW, I hadn't looked at the link, and hadn't realised that's what you were referring to - you are absolutely right. The article is a classic one published in 1936 about haemoglobin in babies (under 6 months old), and doesn't have any relevance to this thread.

Agreed with all who are pointing out this is highly specialist stuff, which is why I too am only suggesting expert sources to investigate. I'm also happy to explain any techie stuff you find if needed, as that sort of task is a lot of my job.

[Pitts2112]

TV,
And it's the sources that I'm actually looking for, rather than an on-line or e-mail diagnosis because I know how difficult, if not impossible, that kind of thing is. I simply think this situation is just beyond the experience of the staff at the hospital - meaning none of them has personally seen this before. But somewhere, someone has, and it's that person I'm hoping to find eventually; someone who can say "Well, yeah, I saw just this kind of thing about 5 years ago. It turned out to be (insert something dead easy to fix here)". If I show her symptoms around far and wide enough, eventually they'll ring a bell with someone.

On an update note, Anna-Nicole is doing very well, though she can't seem to catch a break. She was just stung by a bee about an hour ago. When you're already traumatised by being stuck with way too many big needles in the hospital, getting stuck by a bee when you're in your own safe play-space just isn't fair! Other than that, though, she's very happy, eating well, and playing all the time.

We're back in on Monday, so more news then. Many thanks again!

Shawn

[DX Wombat]

Oh the poor little girl, :{ bee stings aren't nice for anyone. One question for you Pitts - are the doctors using something like Emla cream or other topical local anaesthetic before they stick needles into her? If they aren't, ask them why not and request that they do so in future. The only excuses for not using it are a known, proven allergy to the constituents or an immediately life-threatening situation where time is of the essence. We used it on babies as young as 24 weeks gestation and sometimes less.
TV, as I said, I should probably have explained myself better. Pitts will tell you that the first thing I said was that he should get an immediate referral to GOSH - that became a little more complicated once I learned of his actual, as opposed to PPRuNe, location, but, as I told him, there is absolutely nothing to stop the doctors in Brazil requesting a referral as Anna-Nicole is a British citizen, born in Britain so there are no costing worries.
Pitts, as in any profession the good practitioners recognise their limitations and shout for help sooner rather than later. I hope things are looking up when you go back on Monday.

[Bob the Doc]

A few thoughts

I am an anaesthetist and neither a paediatrician nor a haematologist so I can't really help with the diagnosis side...

EMLA is great (or Ametop) but it needs to be on for a good 45 mins to an hour before it makes significant difference. It may or may not be available at the hospital in Brazil (although I would like to think it would be). The biggest trouble we have in the gas board with these creams is it not being on long enough before the child is brought for cannulation.

If you do get a referral to GOSH/Miami kids/Alder Hey or any other paeds centre, give due consideration to how you are going to get there. Many airlines might refuse to fly children in this situation. Your travel insurance may pay for it but it is wise to check. Getting a medical team from the UK to fly a sick child back can be very expensive.

If you are going to fly back, it is worth making sure that the child has been recently transfused (or at least has a recent haemoglobin (last 24 hours or so)) to a level of 10 g/dl (or equivalent). As you will no doubt be aware, the oxygen levels in commercial aircraft are significantly lower than at sea level and with a low Haemoglobin, this will be a significant problem for the child, even if they are fine on the ground. 10g/dl should be enough to fly without needing oxygen (a lot of ladies have Haemoglobins that low for a few days every month).

Hope you get a diagnosis soon and that the treatment is not too arduous.

BtD

[Pitts2112]

I wanted to take a minute to thank everyone who's responded with information, contacts, and support for us on this.

As it stands, outwardly, our daughter is the picture of health and happiness. INwardly, the doctors suspect she has a condition known as dyserythropoiesis. Her initial bone marrow test results seem to support this theory. I can't even pronounce it, but what it means is that her bone marrow is not producing enough healthy red blood cells that are making it into the bloodstream. Test results due in two weeks will tell us if it is genetic (and, therefore, requires a bone marrow transplant), or if it isn't. If it isn't, we're back to not knowing what has caused this. There is another test out, with results also due in a couple of weeks, looking for a wide range of viruses and infectious diseases. Hopefully either that result turns up something or this mysteriously heals itself and goes into the "Well, I'll be damned..." category.

The hospital here has a relationship with St. Jude's hospital in Memphis and is going to consult with them for a second opinion.

Thanks again for the help. You have no idea how much we have appreciated it. Pprune readers came through in spades for us and restored my faith in humanity.

Many, many thanks
Shawn

[Thames virtual]

Thank you for reporting back, Shawn. I've just been looking at St Jude's website and they are clearly heavily involved in research in haematology, and active in the American Society of Haematology.

I'm glad your daughter is well in herself - at least it makes the waiting for results a bit easier. Hang in there! and keep us posted.

[lemony]

I'm presuming the haematologists have looked at a blood film to make sure that the red cells are actually a normal size and shape?? As the first conditions which I considered were spherocytosis and thalassaemia. (although in the case of spherocytosis I have seen the whites of the eyes were pigmented, but this would account for the normal bilirubin)
Also is the white count normal?
Have they done a count of reticulocytes (immature red cells)?
Does she have haemoglobinuria? (different from haematuria)
Dyserythropoeisis is usually associated with jaundice and this does usually affect the white of the eyes (abnormalities should be seen on a film, although this wouldnt confirm the condition)
It will be interesting to see the final diagnosis as I am currently doing an MSc in haematology.
Hope all is well and that she is able to come home soon

[lemony]

Just been reading over the symptoms again, dont know if its of any relevance any longer, but auto-immune destruction of red-cells could be possible.

Wiley InterScience :: Session Cookies (http://www3.interscience.wiley.com/journal/120730406/abstract?CRETRY=1&SRETRY=0)

[Pitts2112]

It's been a long time since Anna-Nicole had this serious problem with anemia and I've owed those that helped an update for quite some time. The short story is that Anna-Nicole is a fine as frog hair and the cause of her anemia still remains a mystery. As suddenly as it set in, it seemed to cure itself as well. We don't know why, we're just glad it did.

She was first hospitalised in mid Dec '09. Christmas and most of January were very tense times as her Hgb count yo-yoed over the weeks. But it finally began to settle and she was given the all clear by Feb '10.

The time in between then and now has been "interesting" on a personal front, which explains why this update has been so long in coming, but Anna-Nicole has been fine and continues to grow like the proverbial weed, run around everywhere, and dance and sing like most 2 year olds. She is so fast at repeating what you say that it's like having an echo in the place. She is an absolute delight to be with and you would never know there was anything ever wrong.

I want to extend a personal, and heartfelt, thank-you to everyone who offered help, advice, and empathy during that time:

Bruce Wayne
Capetonian
Bertie Thruster
Loose Rivets
Selfin
Mad Jock
HEC
Airclues
One Day Soon
Bad Medicine (for letting the thread stand)

Special mention goes out to:
DX Wombat, who, I was reliably informed by Mad Jock, would get on a plane and camp out with us until AN recovered - and nearly did! DX, your help and reassurance were fantastic!

Taff Lightning, for putting me in touch with the father-in-law. Dr. Clow was terrific and spent quite a lot of time reviewing medical reports and assuring us that we were getting all the right care. Please pass on my thanks to the good doctor.

Say Again Slowly, for pulling in top notch intellects from beyond Hadrian's Wall to advise us on the case and relaying messages to and from.

My deepest thanks to you all for coming up on freq when the mayday went out.

And here's my little one today:

http://i193.photobucket.com/albums/z250/Pitts2112/IMG_5176.jpg
http://i193.photobucket.com/albums/z250/Pitts2112/MeandANrubbingnoses.jpg

[mad_jock]

Cracking!!!

Gorgeous kid.

And thanks for sticking photo's up ;-)

[HEATHROW DIRECTOR]

Most excellent news..... God Bless and keep her safe for a verrrrry long time.

[SassyPilotsWife]

Thank you for sharing! While I never caught this thread in 09, I began reading today and so happy to see God intervened and took care of business.

Just an FYI, God forbid the problems ever come back but if they do, at the earliest sign, let us know. While I'm not a doctor, I am a Paramedic from Memphis that has taken patients to St. Jude. I am familiar with patient receiving protocol as well as some of the doctors there. Every child that comes in those doors is received and treated regardless of ability to pay. There is never a bill owed. The resources for families is absolutely amazing. And the work they do is phenomenal. The difference they have made to thousands of children all over the world is overwhelming.

Although we live in the ME now, our home is always open, ready for guest and 25 minutes from St. Jude. Mi Casa es su Casa. :ok:

[Flyin'Dutch']

Never read the thread when it was running way back when.

Very good to read that all has settled and that she is thriving so well.

:ok:

[Say again s l o w l y]

Glad to hear that it's all sorted Pitts, I just saw my FiL and he said to pass on his best too.

[DX Wombat]

I'm sitting writing this with tears running down my face - I am so delighted. I had been thinking a lot about Anna-Nicole and yourself recently and was trying to summon up the courage to contact you. Those are two of the three best photos I have seen. (The third was of another sick baby who made a good recovery). She is delightful. May you all have very long and very happy and healthy lives ahead of you. Thank you so much for posting those photos.
By the way, if she is starting to repeat everything she hears - BEWARE! My younger niece in Oz was in the car with her dad and I when he described the Antonov (great big aircraft with umpteen engines) as being "Bl***y enormous". Thirty seconds later a little voice piped up from the back singing happily to herself "Bl***y 'mormus, bl***y 'mormus". Cue brother "I see I'll have to be careful what I say from now on" :O Enjoy her and all she does. Please DO keep us updated from time to time.

[WaspJunior]

I've followed this thread on and off for a while I was so pleased to hear the good news. As a father blessed with two healthy daughters I just wanted to send Anna-Nicole and her parents best wishes for a happy and healthy life. :)

[Capetonian]

That's very moving, inspiring, and fantastic news. Best wishes to all of you.

Thank you for sharing and acknowledging.

[Pitts2112]

Thanks for the wishes, gang. It's been my absolute pleasure to (be able) to post such a good update and I'm glad people have taken an interest (again)!

Health and prosperity to you all!

Shawn

[stuckgear]

good to hear shawn

stuckgear (aka Bruce Wayne)