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[Mr.Beat]

My Grandmother is supposed to go through a TKR ( Total Knee Replacement) at Hiranandani Hospital. one of her knee has already been replaced around 3 years back. At that time , she had got some fever for a few days after operation. Now, the problem is for this operation when the blood tests were conducted, the ESR was around 91. My question is that , is it ok to go ahead with the operation with a ESR of 91? Her age is 72 now. What complications can result due to such ESR level?

[BoneCollector]

Originally Posted by Mr.Beat

My Grandmother is supposed to go through a TKR ( Total Knee Replacement) at Hiranandani Hospital. one of her knee has already been replaced around 3 years back. At that time , she had got some fever for a few days after operation. Now, the problem is for this operation when the blood tests were conducted, the ESR was around 91. My question is that , is it ok to go ahead with the operation with a ESR of 91? Her age is 72 now. What complications can result due to such ESR level?

Elevated ESR can be because of many reasons including an infection,low haemoglobin count and many other factors.It does not pin-point anything in particular.I think the doctors there will definitely go through a total checkup before going in for the surgery.

[kalpeshc]

Anybody has any recommendations for hives? I am talking about temporary relief from the itchy sensation. If what I've read is right, there's no permanent solution to non-chronic hives.

[SILVERWOOD]

Originally Posted by Mr.Beat

My Grandmother is supposed to go through a TKR ( Total Knee Replacement) at Hiranandani Hospital.

Originally Posted by BoneCollector

Elevated ESR can be because of many reasons including an infection,low haemoglobin count and many other factors.

Elevated ESR levels are quite common in Rheumatoid Arthritis,the very reason i believe for which your Grandmother is supposed to go undergo a TKR.

[BoneCollector]

Originally Posted by SILVERWOOD

Elevated ESR levels are quite common in Rheumatoid Arthritis,the very reason i believe for which your Grandmother is supposed to go undergo a TKR.

Like i said,there are umpteen reasons for an elevated ESR,you are right in saying that it could be due to RA but then he has not specified anything else so i would not comment on the reasons.

[Mr.Beat]

Originally Posted by BoneCollector

Like i said,there are umpteen reasons for an elevated ESR,you are right in saying that it could be due to RA but then he has not specified anything else so i would not comment on the reasons.

Originally Posted by SILVERWOOD

Elevated ESR levels are quite common in Rheumatoid Arthritis,the very reason i believe for which your Grandmother is supposed to go undergo a TKR.

Yes, this might be the reason. Now the interesting part is that last time we had planned to do this operation, one very senior doctor Dr Sancheti in Pune refused to go ahead with the operation citing risky levels of ESR.

As of today, the current doctor at Hiranandani fortis says he has never done a operation above ESR 25, but recommends taking a risk while other doctors who were consulted had mixed opinions with some saying that it is no big deal while some suggesting to get ESR to normal levels before proceeding with surgery.

[udaydesai]

Need advice from child specialist
My two year son was ok and playing, around 9 pm when we were reading to put him to sleep, we notice that he was having a mild fever, around 11 pm the temp rise to 2. Around that time he shouted aloud and went in to seizer. ( fits. ) and was unconsious , we immediately admitted him to hospital, he was given saline and was normal by morning, we consulted the doctor and he said that it's normal for child to have fits and it's because due to high fever the brain dicharge and this results in fits.
Now 3 weeks have passed my son is normal and good. We did take second opinion and was suggested that we do EEG ( brain mapping ). My question is how necessary is it to do EEG?. The doctor who has treated my child is against it, but the second doctor says do it.

Please guide me on this.
Uday

[vina]

Originally Posted by udaydesai

Need advice from child specialist
My two year son was ok and playing, around 9 pm when we were reading to put him to sleep, we notice that he was having a mild fever, around 11 pm the temp rise to 2. Around that time he shouted aloud and went in to seizer. ( fits. ) and was unconsious , we immediately admitted him to hospital, he was given saline and was normal by morning, we consulted the doctor and he said that it's normal for child to have fits and it's because due to high fever the brain dicharge and this results in fits.
Now 3 weeks have passed my son is normal and good. We did take second opinion and was suggested that we do EEG ( brain mapping ). My question is how necessary is it to do EEG?. The doctor who has treated my child is against it, but the second doctor says do it.

Please guide me on this.
Uday

Electroencephalography - Wikipedia, the free encyclopedia you might want to read up a little yourself.

Of course, this doesn't substitute a doctor's opinion, but keep in mind doctors are humans too and they err too - there is no substitute for you being well informed yourself.

[SILVERWOOD]

Originally Posted by udaydesai

My question is how necessary is it to do EEG?. The doctor who has treated my child is against it, but the second doctor says do it.

There is no harm in taking an EEG since it is a non invasive procedure.

EEG is used to distinguish between various types of seizures, so recommend that you get an EEG asap and consult a pediatric neurologist or an epileptologist.

[m8002?]

Originally Posted by udaydesai

Need advice from child specialist
My two year son was ok and playing, around 9 pm when we were reading to put him to sleep, we notice that he was having a mild fever, around 11 pm the temp rise to 2. Around that time he shouted aloud and went in to seizer. ( fits. ) and was unconsious , we immediately admitted him to hospital, he was given saline and was normal by morning, we consulted the doctor and he said that it's normal for child to have fits and it's because due to high fever the brain dicharge and this results in fits.
Now 3 weeks have passed my son is normal and good. We did take second opinion and was suggested that we do EEG ( brain mapping ). My question is how necessary is it to do EEG?. The doctor who has treated my child is against it, but the second doctor says do it.

Please guide me on this.
Uday

Even my son had it twice...when around 2 years and both the times it happened when he had high fever. I took a second opinion from another pediatrician and also met a neurologist. All of them suggested the below:

1. Seizures happening with high temperatures is common. Its a reflexive & defensive mechanism triggered by the brain to control the body temperature.
2. If it happens in normal course (without fever ) you will have to consider brain mapping.
3. If it continues with fever even after your kid is 5-6 years old, again you might want consider EEG.

The neurologist i met repeatedly assured us that this is common in kids. He later suggested that we do it just to convince ourselves our kid is normal. We didnt do it and my son hasnt had any since then. He is 7 now. Later got to know from my mom that even i had it once when i was 1 year old :-).

So just relax. I know its really unnerving when you see the kid having an seizure. You may meet a neurologist just to calm your nerves.

You may google physiological seizures/Febrile seizures

[vivekiny2k]

I agree, no harm in EEG. But if it was triggered by fever, I doubt EEG will turn up anything.

Do you remember if he was sweating when he had fever? usually does he sweat properly when needed?

You may need to see another doctor if your doctor thinks having seizures is normal.

[Deep Blue]

Originally Posted by udaydesai

Need advice from child specialist
My two year son was ok and playing, around 9 pm when we were reading to put him to sleep, we notice that he was having a mild fever, around 11 pm the temp rise to 2. Around that time he shouted aloud and went in to seizer. ( fits. ) and was unconsious , we immediately admitted him to hospital, he was given saline and was normal by morning, we consulted the doctor and he said that it's normal for child to have fits and it's because due to high fever the brain dicharge and this results in fits.
Now 3 weeks have passed my son is normal and good. We did take second opinion and was suggested that we do EEG ( brain mapping ). My question is how necessary is it to do EEG?. The doctor who has treated my child is against it, but the second doctor says do it.

Please guide me on this.
Uday

Your child probably had a "Simple febrile seizure". These are seen in children between the ages of 6months to 5yrs,occur usually within 24hrs of the onset of fever,short lasting(<15mins),usually generalised(involving all four limb movements and uprolling of eyes). After the seizure, the child is drowsy(sound sleep) for sometime. Either before or after the seizure,the child wouldnt have any neurological deficits.
It does not cause any harm whatsoever, but the child can get a seizure anytime he has a fever subsequently till he is 5yrs of age. Diazepam was commonly prescribed during any subsequent fevers in such children specially during the first 24hrs. But many paediatricians now only suggest to prevent a rapid rise of temperature by timely paracetamol and tepid sponging.
Simple febrile seizures do not require a EEG or any other investigations for the siezure per se. Investigation may be necessary only for evaluating the cause of fever.
I am not a paediatrician, though a paed surgeon.
My son too had a simple febrile seizure at 7months of age. During subsequent febrile episodes we used to give diazepam during the first 24hrs. He has not undergone EEG or any other tests. He is absolutely fine now at 6yrs of age.

[docanurag]

Originally Posted by udaydesai

Need advice from child specialist
My two year son was ok and playing, around 9 pm when we were reading to put him to sleep, we notice that he was having a mild fever, around 11 pm the temp rise to 2. Around that time he shouted aloud and went in to seizer. ( fits. ) and was unconsious , we immediately admitted him to hospital, he was given saline and was normal by morning, we consulted the doctor and he said that it's normal for child to have fits and it's because due to high fever the brain dicharge and this results in fits.
Now 3 weeks have passed my son is normal and good. We did take second opinion and was suggested that we do EEG ( brain mapping ). My question is how necessary is it to do EEG?. The doctor who has treated my child is against it, but the second doctor says do it.

Please guide me on this.
Uday

What your child had is called a 'Febrile Seizure'. Its quite common for young children to through a seizure when they are having high fever. It does not require any further investigation, and most children outgrow it. Only thing you have to be careful about is not let the childs fever go so high again.


EEG is not required and nor is it going to help.

[docaxe]

Originally Posted by Deep Blue

Your child probably had a "Simple febrile seizure". These are seen in children between the ages of 6months to 5yrs,occur usually within 24hrs of the onset of fever,short lasting(<15mins),usually generalised(involving all four limb movements and uprolling of eyes). After the seizure, the child is drowsy(sound sleep) for sometime. Either before or after the seizure,the child wouldnt have any neurological deficits.
It does not cause any harm whatsoever, but the child can get a seizure anytime he has a fever subsequently till he is 5yrs of age. Diazepam was commonly prescribed during any subsequent fevers in such children specially during the first 24hrs. But many paediatricians now only suggest to prevent a rapid rise of temperature by timely paracetamol and tepid sponging.
Simple febrile seizures do not require a EEG or any other investigations for the siezure per se. Investigation may be necessary only for evaluating the cause of fever.
I am not a paediatrician, though a paed surgeon.
My son too had a simple febrile seizure at 7months of age. During subsequent febrile episodes we used to give diazepam during the first 24hrs. He has not undergone EEG or any other tests. He is absolutely fine now at 6yrs of age.

Yes I do agree with all that you've written, EEG not advised for typical febrile seizure. Further we do prescribe fever prophylaxis that is paracetamol or mefenemic acid for controlling fever and clobazam for 3 days to prevent seizure activity.
I am a paediatrician.

[C300]

Originally Posted by Mr.Beat

Yes, this might be the reason. Now the interesting part is that last time we had planned to do this operation, one very senior doctor Dr Sancheti in Pune refused to go ahead with the operation citing risky levels of ESR.

As of today, the current doctor at Hiranandani fortis says he has never done a operation above ESR 25, but recommends taking a risk while other doctors who were consulted had mixed opinions with some saying that it is no big deal while some suggesting to get ESR to normal levels before proceeding with surgery.

Not sure whether this will help but you can take opinion from Dr. Wakankar. He is one of the well known Joint replacement specialist in Pune. He is attached with Deenanath Mangeshkar Hospital and Jehangir Hospital. My dad had a double TKR in the month of Jan and he has recovered really well.

You can visit his webpage here - http://www.jointreplacementinfo.net/