Dhyey's Terrible Arthritis

I know,It has been a long time since I have posted about dhyey. In this post I am sharing how he was diagnosed with arthritis, his history and some clinical tests performed.

Dhyey was born by LSCS operation for non-prograssive labour. Birth weight was 3.3 kg. he required hospitalization From 19/3/2009 to 28/03/2009 for meconium aspiration syndrome with sepsis with neonatal jaundice.

In March,2010 he was hospitalized for 6 days for pneumonia.

In july,2010 he caught in severe chickenpox, and recovered after a month.

In October,2010  Dhyey  had Fever  103-104F, Skin rashes again , joint pain,& swelling. He  was treated with antibiotics,NSAIDs like paracitamol,Nimesulide,Mefenamic acid,Naproxen etc. antimalarial was also given. There was no response to any of these drugs.

After that I moved to Mumbai, and started treatment at Yewale hospital on 1/11/2010.
performed investigations showed anaemia,leucocytosis, normal platelets, raised ESR, LDH &ferritin. S.Proteins & SGPT were WNL(within normal limits). Hbs Ag test was negative. ASO Titre normal. Urine routine examination was normal. Xray skull was reported as normal. CT Scan study of chest,abdomen & pelvis showed hepatosplenomegaly & multiple enlarged lymphnodes. Lymphnodes were noted in both axillae,illac&inguinal regions.

Investigations(30/11/2010) showed anaemia(hb 7.5/dl),leucocytosys(TLC 18,400/cu.mm) with normal DLC. Platelets normal ESR &CRP are raised.RFT,LFT &Electrolytes are WNL.ANA &RA Factor Negative.LDH & ferritin raised. ELISA testes for HIV Negative. CXR &Sonography Showing hepatosplenomegaly with generalized lymphademopathy. ,

In December,2010 I visited To Dr. Baldev Prajapati First time, at that time Fever  103-104F, Skin rashes again , joint pain,& swelling, and morning stiffness. Multiple joint swelling noted. Multiple , significant (>2cm in size) lymphnodes over cervical , axillary &inguinal  region noted.liver 3 cm in size& spleen 2 cm on palpation. repeat tests for HIV were done,  Dr.Prajapati  advised for lymphnode biopsy and skin biopsy by Dr. Parthiv shah, and visit to Hematologist Dr. Ashwin Patel
Dr.Ashwin Patel suggested  tests for immunoglobulin and immunodeficiency and he did blood testing of mine too.
Report of Biopsy  showed unspecific nodes.
Dr. was almost sure that dhyey had a symptoms of arthritis, so he advised to visit pediatric rheumatologist Dr. R.P.Khubchandani.

In January,2011 we visited to Dr.R.P.Khubchandani, Dr. told us to admit Dhyey for 3 days under observation at Jaslok hospital. Dhyey was hospitalized from 10/01/11 to 13/01/11. at the time of discharge he was 60% fine than the time he was admitted.  Next step was , We had to start the methotrexate injections weekly ,some steroids everyday. Like most parents we were scared and did not want to give it to Dhyey. I asked many questions to Dr.”how will all medicines affect my child?, what are the long term effects of it, etc” Dr. described nicely that we will have great benefits than side effects. we prayed hard and put it in God’s hands because Dhyey had really no good luck for a couple months. We agreed with Dr.’s suggestions .we were told to meet him after one month with his blood test reports.

In February ,2011 we went to Dr. with reports. Dr. found raised WBC and some infections, but again medication helped him walk again. In short Dhyey’s arthritis was manageable with medicines. Dr. had a plan to reduce steroids in next visits.

Next appointment was settled on last week of march,2011, dr. found him very playful, no more complaints he was able to walk properly, and still with some infection but Dr. added that it will take some time to recovered. Infact we were also satisfied with his activities and recovery that he was getting. My Strong little boy always amazes me with his bravery and strength. on his birthday I asked God, is this a life of 2 years old???

Thank you Drs.!!!!!

“you must have to meet that Dr.” this was the sentence after meeting Dr.Baldev Prajapati. A very humble, loving Dr with beautiful mind. It had been a long journey to the doors of Dr. Prajapati’s hospital. i was in ahmedabad to attend my brother’s marriage in December. It had been very difficult time for me .After countless reports and several visits of Drs. We had no result. Dhyey had gone through biopsy, several xrays, sonography. I felt discouraged. Dr prajapati has guided me patiently and gently, I knew that I had to move on. Dr. prajapati suggested to visit very well known Dr. R.P.Khubchandani. I finally traveled from Ahmedabad to Mumbai. R.P.Khubchandani is one of my favourite Doctor. I had been told by other doctors that “Dhyey may need wheelchair through life time”. And I was almost died at that time. But after meeting Dr.R.P.Khubchandani my half pain of fear was almost gone,I became more confident. Dhyey was finally headed in the right direction.he got good treatment that he had not received in past. Medicines and injections are still in his course, but again my lil heart can walk, run and ever jump now. Many Thanks to Dr.Prajapati and Dr.khubchandani.
 Thank you god for giving such a wonderful Drs. in this world.

Arthritis in Kids

Arthritis is a medical term used to describe a group of disorders that affect the joints and muscles in the human body. There are more than a hundred different forms of arthritis, each affecting one or more parts of the body. Rheumatoid arthritis and osteoarthritis are the most common types of this disease. Areas such as hands, elbows, feet, spine and knees fall prey to arthritis. What are the symptoms of arthritis? Inflammation, pain in joints, and inability to freely move the joints, are some of the most common symptoms of arthritis. Other (less common) symptoms include loss of appetite, weight loss, painful swelling and inflammation, fever and anemia. Joint arthritis damages the cartilage, which is a fluid-like substance that holds a lubricant to facilitate movement. Being a form of chronic disease, arthritis stays with the patient for years. One must understand that arthritis is a complex degenerative disorder that can affect people at any stage of life. Anti-inflammatory drugs and other medications can provide temporary relief to patients. However, a healthy, disciplined lifestyle, which includes healthy food and regular exercise, can help arrest the development of arthritis. The most prevalent form of juvenile arthritis is juvenile rheumatoid arthritis, or JRA. It affects approximately 50,000 children in the United States. JRA also called juvenile idiopathic arthritis (JIA) because it is very different from adult rheumatoid arthritis.

What Causes JRA?

It's not known exactly what causes JRA in kids. Research indicates that it is an autoimmune disease. In autoimmune diseases, white blood cells lose the ability to tell the difference between the body's own healthy cells and harmful invaders like bacteria and viruses. The immune system, which is supposed to protect the body from these harmful invaders, instead releases chemicals that can damage healthy tissues and cause inflammation and pain.To effectively manage and minimize the effects of arthritis, an early and accurate diagnosis is essential. By understanding the symptoms and characteristics of each type of JRA, you can help your child maintain an active, productive lifestyle.

Signs and Symptoms

The first signs of arthritis can be subtle or obvious. Signs may include limping or a sore wrist, finger, or knee. Joints may suddenly swell and remain enlarged. Stiffness in the neck, hips, or other joints can also occur. Rashes may suddenly appear and disappear, developing in one area and then another. High fevers that tend to spike in the evenings and suddenly disappear are characteristic of systemic juvenile rheumatoid arthritis.

Diagnosis

To diagnose JRA, the doctor will take a detailed medical history and conduct a thorough physical examination. The doctor may order X-rays to exclude other conditions that can produce similar symptoms

Treatments

In many cases, JRA may be treated with a combination of medication, physical therapy, and exercise. In specific situations, your child may require injection of corticosteroids into the joint or surgery. Your child's health care providers, including the primary care physician, rheumatologist, and physical therapist, will work together to develop the best method of treatment.
The goals of treatment are to relieve pain and inflammation, slow down or prevent the destruction of joints, and restore use and function of the joints to promote optimal growth, physical activity, and social and emotional development in your child

Why Do Kids Get JRA?

No one really knows what causes JRA. Something in the environment such as a virus may trigger the disease in kids that already have certain genes that make it more likely for them to get JRA. JRA is not contagious, so you can't catch it from someone else.
JRA is an autoimmune (say: aw-toe-i-myoon) disease. Normally, a kid's immune system sends out white blood cells to protect the body and fight outside invaders like bacteria and viruses that can make a kid sick. With JRA, the immune system makes a mistake and targets healthy cells as if they were harmful.
Instead of recognizing the healthy cells and saying, "Hi, nice to see you," the immune system thinks the healthy cells need to be destroyed and releases chemicals to fight the healthy cells. The chemicals the immune system releases cause the pain and swelling that a kid with JRA experiences.

What Do Doctors Do?

Just because a joint hurts doesn't mean a kid has JRA. A joint might hurt for a lot of different reasons, which is why it's important to see a doctor to figure out what the problem is.
The doctor will ask a lot of questions. How long has the kid had joint problems? Does he or she feel stiff when getting up or after resting? Are the joints swollen? Was there an injury? Could another problem be causing arthritis, such as Lyme disease? Is there a family history of arthritis or other autoimmune diseases?
Knowing these answers and doing a physical exam, blood tests, and X-rays will help the doctor figure out if it is JRA. If your doctor suspects that you may have JRA, he or she may send you to see a doctor who specializes in the diagnosis and treatment of arthritis. This kind of doctor is called a rheumatologist (say: roo-muh-tol-oh-jist).
From:
http://www.arthritisblog.org/
http://kidshealth.org/parent/medical/arthritis/jra.html

Dhyey at nana-nani's home

my taklu.. i love you!!!

we went 2 ahmedabad for dhyey's mundan vidhi... my god my taklu was so crying at the time of mundan..  he had a chicken pox few months back so.. v did not make him clean cut, still he looks tako mundo.. i call him" mari takli". harshy chickenpox has spoiled my jaan's skin. requesting god to protect my little life.

Severe Chickenpox

I am a one who is a sure of all the vaccinations that children are required to take. With the case of Chicken Pox I do think that all babies should get vaccinated. Chicken Pox is a virus also known as varicella zoster virus (VZV), which is highly contagious as everyone knows. I did the same with my master boy dhyey, we had an appointment for chickenpox vaccine on first week of July, it was long delayed as dhyey was suffering from pneumonia and other skin infections, so it was compulsion to give it after all things get cleared. And finally we got appointment on first week of july, but we were unsuccessful in it. dhyey has come down with chicken pox on 30th June. he was covered in huge blisters for more than 25 days, even Dhyey's Ped. dr.Vijay Viswanathan was surprised to see that puss filled pox in huge numbers, and added that he had never seen such pox in his history. I did not like the feeling of not understanding what was going on, I surfed about this virus, and asked questions concerning how different people sorted it out and I could get a better grasp on the answer. All that I could is kept him cool and applied calamine lotion as often as needed. Dhyey’s dr. has given him Atarex to quell the itching. All together dermatologists cured him as well. More I cant write down here, and I don’t want to recall those terrible moments again, I just want to share some photos here.

After 10 days of Pox:

appointment to dermatologist

one of my friend recommended  Dr.Jyotsna Deo (dermatologist ), as her son also got the same hives and was recovered by this expert, so i taken him there, according to her, dhyey has an urticaria, she is 100% sure, and has given some medicines, we have to follow up that for three weeks. hope, everything will be fine.

Fifteen Month

dhyey's activities during this month:

he is able to point to one-two body parts.
he indicates what he want by pulling and by communication.
he can find some objects placed out of sight.
he has started scribbling with crayon
he tries to climb up furniture.
he can sit in a chair without falling over
he Repeats words heard in conversation
he Uses "archa" and "dedda" words when reminded
he Uses three words regularly
he Walks backward
he Puts his fingers to his mouth and says "shhh"
he Empties containers of contents since 13th month.
he can Match lids with appropriate containers
he Holds out arm or leg to help me dress him

Fourteenth month

Dhyey is leaving babyhood behind, and he is entering into his bright world, yes he has completed 14 months by this week. He looks much taller now, many of my friends says he has a nice height. He has moved from walking to jumping, dancing and running confidently. He is pretty good at running and he likes to push and pull things while he toddles. He walks backward and mimics lips movement, and points to doggies, aeroplane and cars. He takes an interest in going up and down the stairs. I took him to the garden to chat with other kids. He likes look at the books, also turn pages , he likes playing cars and sometimes with making “bhrum bhroom” sound. Still he likes “ a cat came fiddling “. He bend over and picks objects. He always wants to talk on mobile, when I give him, he just hold it up, and laugh. He laughs at some advertisements. And most enjoyable thing of him is dancing , he likes dancing on his favourite songs. this is the last week for his medicine, still some hives appears on his body sometimes, but as per drs. Suggesion we have to come to an end. We got final xray and blood reports normal this month, so feeling little relief. but for hives again i have an assignment to find good dr. in reputed hospital. almost 5 month has passed in period of this hives' "bugs".

beginning of the second year!!!!

Through out the year dhyey was very healthy child, but the year end was terrible for him. In my previous writing I put down about dhyey’s cold and cough. Usually I didn't panic over the appearance of fever, cough and all that. What worried me was that there seemed other symptoms like he seemed with bad appetite. His breathing was rapid and noisy. He seemed all the time tired and Continuous quite high fever at 104 [degrees]. And most unusual symptom- hives, red pinkish to red bumps on the body. Foremost I thought it was mosquito bites, but unfortunately it was not that. So we decided to take him to pediatrician and dermatologist rather than treating the fever with over-the-counter remedies – my typical habit. i was in ahmedabad to attend my bro's angagement, so we continued his cure in ahmedabad. doctor proceeded to carry out his usual thorough physical examination, after which he announced that he was unable to find a clear source for hives.And finally he concluded pnemonia by taking an X-ray, and several blood testing. And for hives he recommended to visit the skin specialist. According to skin expert that hives was due to increased WBC counts and also it may cause by pneumonia. Subsequently he recommended to keep on with pneumonia treatment, and given the way out that when pneumonia will recovered, hives will automatically be vanished. All these required him to be hospitalized for six days, and further told to continue antibiotics at home for 1 month. But I had an attack of intuition and somehow felt that this was not the explanation, although i did not want to contradict our doctor whom my father in law had respected many years, as they are our neighbor. and also a decent dr., prafull patel. so i did nothing until Dhyey got fever down. All through this instant Dhyey finished first year, we could not celebrate his first birthday. his 13th month was finished by same routine as 12th , but hives was not vanished. So we taken him to the Dr. Raju.C.Shah- Ankur Institute Of Child Health, very intelligent and city-famous pediatrician.But again medicine did not work on him, and shuffled skin expert Dr. Ramesh Poria. Now Dhyey has entered into 14th month, hives expansion has decresed now, we have to observe it for 15 days more as per dr’s estimation. Lets see what happens after that. If it would not be vanished in these 15 days afterward we are scheduling next appointment in breach candy or hinduja  hospital, in our city. we wish the whole thing would be all right.