Wednesday, September 28, 2011

Toxic Synovitis - it isn't as bad as it sounds

From June 4, 2011

A little backstory - Hannah and her girls had been up to visit for the week while Merrick was in California working.  On Thursday (the day they left) Ephraim complained that his knee was hurting.  Since he was running and jumping on it, I told him it was growing pains.  On Friday he didn't feel well and was running a fever of 101.  We spent the day watching tv.  (Don't you love when you have to text your friends that your kid is sick the day after they played with them?)

On Saturday morning (the 4th) the kids and I were relaxing in our bed before getting up for the day.  Ephraim said he had to go potty and got off of the bed.  He then told me "Mommy I can't walk."  I told him to crawl to the bathroom (I didn't really believe him).  He did.  I followed him to the bathroom where he couldn't get down off of the toilet.  Ephraim was unable to put any weight on his left leg.  At all.  He could stand on his right leg, but was unable to even put his toes down on the ground on his left leg.

He still had a low fever so I gave him some Motrin, put him in front of the tv and talked to Forrest about what we should do.  It was just weird.  Ephraim hadn't injured his leg, was complaining about his knee hurting, but could crawl if he absolutely needed to.  After talking on the phone with my sister Colleen (a nurse) we decided we should take him to urgent care to see what was going on.  Being the super concerned parents that we are - we decided to go to lunch at Costco first.  I am glad that we did - it would end up being the only food Ephraim got all day.

At urgent care we were actually seen pretty quickly.  Ephraim was running a fever again (101.2) so they decided to give him more Motrin (just a note - the amount they gave E was 7mL - which is more than the bottle tells you to give his age.  Check with your pediatrician about what the correct dose should be for your kiddo - they do it by weight).  After checking out Ephraim the Dr. decided to run some blood work to see if he was fighting an infection and started consulting with the ER at Mary Bridge (Children's hospital in Tacoma).  It was decided we should head to the ER.  We left urgent care (after both kids got popsicles) with no diagnosis and strict instructions to not let E eat or drink anything else.  There was a possibility that he could have an infection in his joint and have excess fluid.  If that was the case they would need to put him under general anesthesia to remove the excess fluid.
Forrest and I headed home to grab some stuff and then stopped by Arby's to get some food.  (it was about 4:30).  I also ran into Safeway to get diapers for Selah - I was all out at home - and picked up a coloring book, crayons and a magnet fishing game.  Both kids slept all the way to Tacoma which was good since neither had napped earlier and we didn't have any clue how long we would be there.  Urgent care said it could be a few hours or possibly overnight if they needed to remove excess fluid.  When we arrived at Mary Bridge ER to check in they already had a wrist band and paperwork printed out for Ephraim and we were immediately taken to triage.  After triage we sat in the waiting room for less than 5 minutes before being taken back to our room.  Ephraim and Forrest played on this neat computer for the 5 minutes.
Once we were taken to our room - everything slowed down like every other ER experience I have ever had.  Ephraim was given more Motrin to see if that allowed him to put weight on his leg.  It didn't.  Ephraim did not like the doctors and nurses asking him questions and having him try to stand on his leg that hurt.  He was glaring at them.  After getting in trouble for glaring - he became more cooperative.  They took Ephraim back for xrays which showed nothing.
The kids did great waiting in the room. Ephraim spent a lot of time fishing with daddy and Selah explored. Ephraim was then taken back to have an ultrasound of his hip.  This was the only aggravating thing about our entire day.  Everything was coming back negative. (Yay!)  They believed the synovial fluid in his joints was inflamed.  99 percent of the time it is the hip joint which is why they did the ultrasound on his hip.  I get it.  My son was complaining about his KNEE.  My son is 3 and isn't going to make up where it hurts.  They could have done an ultrasound of his knee and didn't.  It would have taken a few more minutes.  They diagnosed Ephraim with toxic synovitis (a horrible sounding way to say inflamed synovial fluid that causes one to not be able to bear weight) and sent us home with instructions to see our pediatrician on Monday. We were also instructed to continue dosing Motrin.  We finally left around 9:30pm, tired, but glad to be going home.

When we met with our pediatrician on Monday Ephraim could still not walk.  He no longer had a fever and had figured out that he could still play with all of his toys if he was on the floor and could crawl.  Our pediatrician agreed with the ER diagnosis of toxic synovitis, but said that Ephraim was the 1% of cases where the inflammation is in the knee.  Our pediatrician sees less than 1 case of toxic synovitis a year.  He told us that if Ephraim could still not walk by Wed then we needed to see a pediatric orthopedic surgeon since they would be more familiar with toxic synovitis.

Thankfully by late Monday afternoon - Ephraim was doing this funky bear crawl that had him partially putting weight on his leg.  By bedtime on Monday he was able to walk.  He complained about knee pain for another 3 days so we continued giving him Motrin, but after that he was fine.

Some interesting facts about toxic synovitis.  It is most common in boys 3-10 years old.  There is no known cause.  It usually lasts anywhere from 3-7 days.  There is a 20% chance that it could reoccur.  Motrin is believed to help and cut down the time frame.

Looking back - it was a strange couple of days.  At first it was a hassle to carry both of my kids everywhere, but we adjusted.  Ephraim also learned how to get around without walking and was less dependent on being carried.  We are so thankful that it was nothing serious and are grateful for the good medical care that we received.  Hopefully that is Ephraim's only trip to the ER this year.

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