My daughters 10 and 7 are now experiencing their 4th documented case of strep
since Feb 20 of this year. Two Pediatricians have stopped seeing them
because they feel they can no longer treat them. Besides these present four
cases,during the fall they each had 3 other documented cases. They have been
on 8 different antibiotics along with 4 rounds of the antibiotic shots. The
ENT said our last try was Augmentin double dose 14 days. Whole family was
rechecked and cleared one and a half weeks ago and the surgery was put off.
Now they have strep again. Surgery is reccommended. I noticed in reading
previous notes you said the risk of the surgery sometimes outweighs the
benifit. Please explain. Their strep was diagnosed as Type A beta
hemoliptic, These episodes have caused my oldest to run temperatures of l05
and the doctor said that her tonsils were bleeding and falling apart on just
the rapid strep test sticks. I would do almost anything to avoid any kind of
surgery, but now I am concerned about the possible affects of all these cases
of strep. Please advise. P.S, They have always had at least 4 or 5 cases a
year for a long time now but no one had reccommended the surgery until
these last four bad and resistant cases came up. Thank you
Reply: ----------------------
Your children meet acceptable criteria for consideration of adeno-tonsillectomy. Generally 4-6 episodes of documented strep throat in one year or 8 episodes in 2 years are considered appropriate indications for surgery. The risks of surgery are primarily limited to the risks of general anesthesia and bleeding. The risks of general anesthesia include the potential for allergic or idiosyncractic reactions to anesthetic medications, hyper-sensitivity or exaggerated responses of heart rhythm or lungs to intubation or anesthetic, etc. These risks however are remote in terms of frequency of significant or severe complications largely due to modern monitoring technology and new pharmacologic agents for anesthesia in children. The risk of significant bleeding (that which would require treatment) is closely associated with one's personal history of bleeding problems or family bleeding problems. If there is no history of previous unusual bleeding problems in the patient or patient's family, then the risk of bleeding complication is very low with tonsillectomy. Considering your children's recent tonsil problems, it would appear that the potential benefits of surgery easily outweighs the potential for complication of surgery.
--
Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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