CINDY ELLEN RUSSELL CRUSSELL@STARBULLETIN.COM
Skye Crawford, 2 1/2, played in her back yard Sunday with her collection of stuffed animals, gifts from Dr. Susan Yandow while undergoing treatment for streptococcus, which causes gangrene. While battling streptococcus, Skye was diagnosed with leukemia, for which she is currently undergoing chemotherapy.
She is a toddler who has lost her fingers
and is losing toes. She is battling leukemia.
But she is also a fighter who has won
the hearts of her doctors and nurses.
A charmer ...
Skye Crawford giggles and laughs when she looks at the purple polish on her right thumbnail -- the only finger the 2 1/2-year-old has.
"We see only one fingernail; she looks down and sees how pretty it is," said Dr. Darryl Glaser, assistant professor of pediatrics, Kapiolani Medical Center for Women & Children.
"She is such a delight. ... Her power to adapt and her family's power to adapt just amazes me."
The daughter of Dawn and Brodie Crawford, of Alewa Heights, Skye is usually bubbly and energetic, unfazed by her medical plight, says her mother. Mittens on her hands and socks on her feet conceal the loss of her fingers and likely loss of her blackened toes to gangrene because of a streptococcus infection.
She also has leukemia.
But her parents are thankful.
"She might lose her fingers and toes, but she's here," her mother said.
The child has won the hearts of her doctors and nurses, including Glaser, Dr. Marian Melish, professor of pediatrics and infectious disease specialist at Kapiolani, and Dr. Suzanne Yandow, professor of orthopedics and assistant chief of staff at Shriners Hospital for Children.
"She has a spark of life, this little girl," Melish said. "She's a tough cookie, and that shows up in her personality. ... Her parents have the most resilient and forgiving human spirit," and "she has the best possible support system," including brothers Tristan, 7, and Sage, 5, Melish added.
CINDY ELLEN RUSSELL CRUSSELL@STARBULLETIN.COM
Skye Crawford is fighting leukemia and streptococcus-induced gangrene with the help of medical experts, parents Dawn and Brodie Crawford, and brothers Tristan and Sage.
Skye, born July 28, 2001, began to run a fever on Memorial Day last year that her pediatrician thought was a reaction to immunizations, Dawn Crawford said. "One morning, she wasn't acting herself. I had a weird feeling and took her to ER. I thought it would be an in-and-out thing, and we ended up there 45 days," she said.
Melish, working in the emergency room when Skye arrived, said the child had seen a doctor three days earlier, and her exam was normal. Even in the emergency room, she did not look particularly ill at first to her or the pediatric nurse, she said. However, the child had an enlarged spleen, which was attributed to the infection, Melish said. It could have been caused by leukemia, but, if so, the disease was hidden, she said.
Within an hour after a battery of blood tests, X-rays and a throat culture, Skye became sicker and less responsive, was breathing faster and her hands and feet were cold, Melish said. "Soon after that, it was clear she was in shock. Blood tests were quite abnormal."
The infant was started on antibiotics and given a lot of fluids and drugs to raise her blood pressure, Melish said. But circulation worsened to her hands and feet, which became dark purple, then black, she said. "She simply wasn't sending oxygen-rich blood throughout her body."
Within 24 hours the child's organs were affected, Melish said. "She was on life support and in intensive care for at least three weeks."
On the critical first day, the child's mother said: "The doctor took us aside and said likely we would lose our daughter. Her face was all swollen, and she was hooked to all the machines. If they didn't tell me it was Skye, I wouldn't have known her."
She said she probably would have broken down if not for her parents, her husband's parents, aunts, cousins and other family members. "All were there in the waiting room. It lifted our spirits."
Melish said Skye's case, with a streptococcus organism getting into the blood and sending the body into shock and "a shutdown mode," is rare.
She said it looked like the child could not survive, but she seemed to do well for several months. The ends of her dead fingers slowly dried up and "auto-amputated," falling off naturally, leaving clean scars and no infection, she said.
Her fingers are gone up to the knuckles on her left hand, and, other than her thumb, she has lost the fingers on her right hand. But she can grasp a pencil with her thumb and hand, Melish said. "She is actually using her hands well."
In September, Skye had a swollen wrist, and her parents took her to Shriners, which had been monitoring her for infections. A bone biopsy was done, her mother said. "Again, we thought it was routine," she said, but her daughter began bleeding and was sent to Kapiolani.
The next day, she said, the doctor told them Skye had leukemia.
"I said: 'You've got to be kidding me. We got through a terrible trauma thing, and now leukemia.' It took a week to straighten this out in our heads. I'm not sure it is straightened out, but the more we talked to the doctor, the more optimistic we were."
Glaser said chemotherapy treatments began Sept. 17, and by Oct. 2 the child was in remission -- "a very good response." He said Skye has a common type of leukemia that "used to be uniformly fatal," but cure rates are approaching 90 percent with today's treatments. However, she is susceptible to infections because of the chemotherapy and dying tissue in her limbs, he said.
"She has a much better chance of surviving leukemia and getting well than she did getting over the strep infection that was so rapidly progressing, all evolving and severe," Melish said.
The family makes frequent trips to the hospital for treatments and whenever Skye's temperature climbs.
Skye was back in the hospital Dec. 30 because of a high fever and a new infection in her feet, which appear black to above the ankles because of dead tissue, Melish said. The doctors hope the tissue will naturally fall off and heal as her fingers did, without surgical amputation, she said.
Yandow cleaned and dressed the wounds in Skye's feet from dry gangrene every day at Kapiolani and taught her mother how to do it at home. She will lose both feet because of the infections and require prosthetics when she is older, Yandow said.
Shriners will help her with artificial limbs, she added. "Prostheses for children are very successful. The are numerous examples of children running track."
Skye scooted all over the playroom when she was in the hospital and has happily explored every room since returning home Jan. 27, her mother said. "She is doing really good."
Radiation technicians at the hospital started her on a Beanie Baby collection, giving her one after every painful dressing of her feet, Yandow said. "She is a precious child. After I've done dressing changes and had to give her narcotics, this child will give me a big hug."
Yandow said Skye's strength and the "extraordinary strength" of her parents "inspires me as a parent."
Skye clings to her mother when her father is at work as a state correctional officer. "I think I'm her security blanket," Dawn said.
If she stops and thinks about her daughter's medical condition, she said, "I get real upset, but I'm doing things with the boys. I don't have time to think about it. What keeps me going, she's so strong through this. She's unbelievable. She's been through so much stuff."