Dear parent,
Thank you for your query at DoctorSpring.com
I can understand your concerns and empathize with her situation.
Kindly answer a few of my questions for me to fully comprehend the clinical scenario:
1. You say that she has been having pain over the last six months... How frequently did it occur? Daily? Alternate day? Once or twice in a week??
2. Over the last 6 months, how often did she cry because of the pain? Were there times when she refused to stand or walk because of the pain? How often did she wake up in the night from her sleep with pain??
3. Over the last 6 months, has the pain changed locations or has it always been in these three sites ( knee, shin and foot)?? Has she ever had pain in any other bone or joint??
4. Have you noticed any swelling, redness, warmth or tenderness (pain to touch) in any of her muscles or bones or joints??
5. Has she had any loss of weight or appetite over the last 6 months? How is her overall well being?
6. Once the pain starts, how long do these painful episodes last typically?
7. Has she ever had any stiffness of joints or rash or skin nodules??
8. What are the factors that typically relieve the pain and what are the factors that aggravate it? Eg: does exertion increase her pain??
9. Have you ever got her serum calcium, phosphate, alphos and vitamin D levels tested?
10. Have you ever obtained X rays of her lower limbs and knee joints?
Regards
Dr. Saptharishi L G
Patient replied :
Please find my answers below.
1. You say that she has been having pain over the last six months... How frequently did it occur? Daily? Alternate day? Once or twice in a week??
Once every 2 weeks or so
2. Over the last 6 months, how often did she cry because of the pain? Were there times when she refused to stand or walk because of the pain? How often did she wake up in the night from her sleep with pain??
Probably a few times each time it occurs she has cried and not wanted to stand up. She doesn't seem to be in pain at night.
3. Over the last 6 months, has the pain changed locations or has it always been in these three sites ( knee, shin and foot)?? Has she ever had pain in any other bone or joint??
Yesterday I pushed her to be more specific about where the pain is but I don't think it is always in the same place.
4. Have you noticed any swelling, redness, warmth or tenderness (pain to touch) in any of her muscles or bones or joints??
No
5. Has she had any loss of weight or appetite over the last 6 months? How is her overall well being?
No loss of weight or appetite. She is generally well although she has occasional headaches and dizzy spells.
6. Once the pain starts, how long do these painful episodes last typically?
1 or 2 days
7. Has she ever had any stiffness of joints or rash or skin nodules??
No
8. What are the factors that typically relieve the pain and what are the factors that aggravate it? Eg: does exertion increase her pain??
Massage makes her feel better but I don't think it really relieves the pain. It hurts more when she is standing but other than that there doesn't seem to be anything else that aggravates it.
9. Have you ever got her serum calcium, phosphate, alphos and vitamin D levels tested?
No
10. Have you ever obtained X rays of her lower limbs and knee joints?
No
Dear parent,
Thank you for responding to all my questions. Your explanations have definitely thrown some additional light on her problems.
We need to start evaluating her thoroughly. As a first step, personally meet a paediatrician to get a detailed physical examination. This unfortunately cannot be done over the internet. Multiple findings on clinical examination can give valuable clues to the localisation ( muscle, joint or bone) as well as the etiology.
Get the following tests done:
1. Complete hemogram with RBC indices and peripheral smear
2. Metabolic profile including LFTs, RFTs, calcium, phosphate and alkaline phosphatase
3. Serum vitamin D levels
4. X rays of bilateral lower limbs including knees and ankles. AP view and lateral view
5. ANA testing
Till we get these tests done and try to identify the cause, she can take Tab Naproxen to relieve the pain whenever it is severe or impairing her activity.