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  1. #1
    Simon is offline Ruby level (4000+ posts)
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    Default Help please! Leg pain for nearly 2 years for Ds1, how to follow up w/Drs?

    I'm hoping the network of BBBers will have some suggestions.

    Ds1 has frequent spells of leg pain which have been diagnosed as growing pains or otherwise non-serious. He is quite clear that these are not muscle cramps and not in his joints. Most often his left shin, sometimes up to his thigh and sometimes both legs. Its bad enough he cries, he will crawl rather than walk, and it happens 4-7 days/week for several weeks at a time, then disappears for a few weeks. Yesterday he said he sometimes doesn't tell us when it hurts if it isn't too bad. He has asked to see the Dr. in the past and we've addressed this issue at several appointments. He has had physical exams that turn up nothing obvious. Still, I've reached the point I want to do something more, but I don't know what to do.

    Primary care Dr. is still "wait and see" and most of the time I appreciate the conservative approach but its been so long and this is a bad spell and I'm getting antsy. I want to rule out other things, but I can't imagine what it could be since it lacks the characteristics of the most common things.

    I'll take any ideas you have!
    Ds1 (2006). Ds2 (2010). Ds3 (2012).

  2. #2
    chlobo is offline Diamond level (5000+ posts)
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    I don't know what part of the country you live in but I would get a lyme test. Lyme can cause leg pain.

  3. #3
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    KpbS is offline Red Diamond level (10,000+ posts)
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    Have they run a cbc with diff? That will reveal if he has elevated or lower than normal types of white blood cells, red blood cells, etc. and is a good indicator if something more serious is going on. A blood draw in a young child often isn't easy but it should put your mind to rest. You could also ask for a referral to a physical therapist for an evaluation.
    K

  4. #4
    citymama is offline Pink Diamond level (15,000+ posts)
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    I would definitely get a second or third opinion from an expert to rule out just about everything. That doesn't sound acceptable or typical. Wishing your DS all the best and I hope you get the right answers soon. Hugs.

    for Sandy Hook



  5. #5
    barkley1 is offline Platinum level (1000+ posts)
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    My nephew was experiencing something similar and I suggested my sister buy him some nice shoes instead of Walmart, lol, and whaddya know? It did the trick!
    DC ~ 9
    DC ~ 7

  6. #6
    Simon is offline Ruby level (4000+ posts)
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    Thank you for all the ideas.

    Quote Originally Posted by chlobo View Post
    I don't know what part of the country you live in but I would get a lyme test. Lyme can cause leg pain.
    He could have been exposed to Lyme, but we've never actually found a tick on him and don't live in the areas of heaviest activity. But, I won't rule it out and will ask the Dr. about it.

    Quote Originally Posted by KpbS View Post
    Have they run a cbc with diff? That will reveal if he has elevated or lower than normal types of white blood cells, red blood cells, etc. and is a good indicator if something more serious is going on. A blood draw in a young child often isn't easy but it should put your mind to rest. You could also ask for a referral to a physical therapist for an evaluation.
    Thanks. I agree that sounds like a good idea. They have not done any blood tests and it is a pretty easy first step. We were told that since he lacks fevers and the pain isn't localized it can't be an infection or cancer, which I guess is why they didn't order a blood test. Could a PT help with diagnosis?

    Quote Originally Posted by citymama View Post
    I would definitely get a second or third opinion from an expert to rule out just about everything. That doesn't sound acceptable or typical. Wishing your DS all the best and I hope you get the right answers soon. Hugs.
    Thanks. I am thinking it is atypical by now. What type of specialist should we see? Who takes care of this kind of thing? I am at a loss here. Maybe just another pediatrician?

    Quote Originally Posted by barkley1 View Post
    My nephew was experiencing something similar and I suggested my sister buy him some nice shoes instead of Walmart, lol, and whaddya know? It did the trick!
    I used to wonder about this myself, in fact it was one of my first guesses, but since its been so long, he has had the pain wearing lots of different shoes--Geox, Merrill, Keens, Tevas, Crocs, and some cheep shoes too.

    I have wondered about shin splints, but he isn't the most athletic kid so I think it would be hard for him to get them.
    Ds1 (2006). Ds2 (2010). Ds3 (2012).

  7. #7
    DrSally's Avatar
    DrSally is offline Pink Diamond level (15,000+ posts)
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    has he been to an ortho? They can watch your child walk and see if there are any issues. My DS had pretty bad leg pain, crying at night, sometimes limping. I noticed looking at him from behind one day, that his feet rolled in and his ankles looked "uneven". He has flat feet, and I guess that can get the legs out of alignment enough that it causes more fatigue when walking. We got some inserts at the ortho office and he hardly ever complains of leg pain anymore. Can't remember the last time, used to be several times a week, esp. on heavy activity days. In addition to the above reccs, I would have her check into an ortho that works with kids.
    Sally

    My Joyful DS
    My Lovely DD

    Please excuse the typos. Getting used to a virtual keyboard

  8. #8
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    a co-worker's son was just dx with Perthe's disease here is an excerpt she posted. He wasn't complaining of his hip-he was actually complaining of his other leg under the knee-they just happened to see it in an xray

    Perthes' disease is characterized by a temporary loss of blood flow to the head of the femur (the ball of the hip) in a growing child resulting in avascular necrosis (death of bone cells in the head of the femur). This is usually followed by revascularization (new blood circulation) to the head of the femur over a period of 18 to 24 months. During the revascularization time, the bone is very soft and weak and the head will collapse to some degree. However, over time the head of the femur will heal.
    Outcome:
    The outcome is very closely related to age of the onset. Children younger than age 6, generally having a more favorable outcome and children over the age of 9 having significant residual hip deformity and will need surgery. The amount residual hip deformity will determine whether arthritis as an adult will occur.
    What causes it?
    Various reasons have been researched, but no one knows for sure why there is a loss of blood flow to the head of the femur in a young child. We do know that it occurs more frequently in boys than girls, from age 3 to 10 and that second-hand smoke, lymes and Parvo (yes humans can catch Parvo)is an established risk factor.
    What are the symptoms?
    The child presents with a painless or painful limp that developed over hours or more commonly over weeks. They may complain of pain in the knee, groin or hip that may increase when they participate in physical activity. However, it is not uncommon for a child to go through the entire process and present to the doctor as a young adult with degenerative arthritis in the hip resulting from Perthes'. The majority of patients will have a functioning hip until the 5th or 6th decade of life.
    How do you prevent it?
    Perthes' is not preventable, since we are not sure how or why it occurs.
    However, your Pediatric Orthopaedic doctor will discuss with you the options you
    have to prevent or minimize the collapse the head of the femur, based upon x-rays
    and how your child presents. The treatment options include rest, using non-steroidal anti-inflammatory drugs to help control pain and inflammation, physical therapy and surgery. During the initial stage the child must avoid impact on the painful hip, such as jumping, running, trampolines, playground equipment, playing contact sports, horseback riding etc.....
    so the bone will harden and heal.
    Margaret and
    (DS 2/06) and (DD 3/08)

  9. #9
    mackmama is offline Diamond level (5000+ posts)
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    Quote Originally Posted by DrSally View Post
    has he been to an ortho? They can watch your child walk and see if there are any issues. My DS had pretty bad leg pain, crying at night, sometimes limping. I noticed looking at him from behind one day, that his feet rolled in and his ankles looked "uneven". He has flat feet, and I guess that can get the legs out of alignment enough that it causes more fatigue when walking. We got some inserts at the ortho office and he hardly ever complains of leg pain anymore. Can't remember the last time, used to be several times a week, esp. on heavy activity days. In addition to the above reccs, I would have her check into an ortho that works with kids.
    This is what I was thinking. I'm wondering if your child could have flat feet or an alignment issue.

    My first steps would be to ask for a CBC with diff, plus referrals to an ortho and a physiatrist. A physiatrist diagnoses and treats pain. I'd see the physiatrist before the ortho. I hope your DC finds relief soon.

  10. #10
    dogmom is offline Diamond level (5000+ posts)
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    I suggest you do the following to document, because it will save you a step and show that you are not inflating symptoms to the MD.

    Keep a log of the following for each day:
    1) Did your DS have pain? Ask him every day.
    2) Have him rate it on a 0-10 scale. Use the Wong-Baker Faces pain scale, it is a validated tool all doctors know:
    http://www.partnersagainstpain.com/p...s/A7012AS6.pdf
    3) How long did the pain last? Did it change during that time? Get worse? Move? Get better?
    4) What was he doing before the pain started? Did anything make it better.

    If you do this for a 2-4 weeks and capture enough episodes and go in armed with this information, I am willing to bet it will kick it up past the "wait and see" category.

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