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Ask Dr. Navitsky Your Own Question

Dr. Navitsky
Dr. Navitsky, Board Certified Pediatrician
Category: Paediatrics
Satisfied Customers: 1037
Experience:  US Pediatrician licensed in California living abroad
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Customer Question

need to chat with Jnavits12
Submitted: 3 years ago.
Category: Paediatrics
Expert:  Dr. Navitsky replied 3 years ago.

Jnavits12 :

Hi I have answered on your last feed

Jnavits12 :

I can see the new questions posted....which feed do you want to use?

Jnavits12 :

I am watching both of them to see which one you open. I have reported the last two questions as duplicates though so that you can work off of these and not be charged more than once for the same question.

Jnavits12 :

Hi I would ask about what is pinching the nerve, is it a herniated lumbar disk? Rare in kids but possible....Is it a malformation? Make sure you ask about tumors and that they are not seen, (they would have said something if they saw one so this is great!). Brain MRI although another long test is a good idea to make sure no lesions in the brain itself are impeding her movement. As there are really no harmful effects of MRI it won't hurt her to have it done and probably is a good idea to be complete....but I can't think of anything brain wise that would fit her symptoms while spinal cord did make more sense

Jnavits12 :

This is what I posted on the other URL

Jnavits12 :

I will be around my computer for about 45 more minutes if you happen to see this prior please respond as now is a good time to chat. thanks!

Jnavits12 :

Here is the other URL in case you lost it http://www.justanswer.co.uk/pediatrics/7mwuq-child-10-year-old-uti-not-walk-what.html

Customer :

hi

Customer :

my internet has been a problem...I want your opion

Jnavits12 :

Hi I'm here

Jnavits12 :

Did you see the above paragraph?

Customer :

ok good

Customer :

the MRI show a pinched nerver and the dr say it is not bad and can be treated with med and PT... another dr wants to do a brain mri...is that needed

Customer :

yes i see the above

Jnavits12 :

Also if you could give me an update on her condition, how she is doing now in terms of mobility and urination. Usually a "pinched nerve" in this area hits the pain fibers traveling in the outer aspect of the cord and is quite painful...more than first having loss of function, you should get pain first, but if this is all they see it is better than a mass! I would consider requesting an pediatric neurologist to see her. As far as the brain MRI, it is not a bad idea as above it won't harm her (besides maybe being sedated for it).

Jnavits12 :

It is hard for me to think of brain related things that could cause her loss of mobility and urination but lesions in some areas may although I would expect a different picture....

Customer :

she has been given some med to help her urinate..not results yet...the mri showed no tumors

Jnavits12 :

For example a mass or a bleed in her brain should cause problems caused by swelling or shifting of the brain due to whatever space occupying lesion there is.

Jnavits12 :

Have they commented on her kidney function?

Customer :

she is talking ok..seem alert

Jnavits12 :

This is good!

Customer :

kidney function is ok

Jnavits12 :

Great, but she is still not urinating yet....Has a neurologist been involved in her care?

Jnavits12 :

Make sure to ask them as well what is impinging on the nerve to "pinch it".

Customer :

it is a good idea to do the med and PT ....yea neurologist said that the pinched nerve is not bad and can be treated...then an dr says he want to do brain mri...

Customer :

what is impinging

Jnavits12 :

Ok well if the neurologist has reviewed her MRI you can be more confident that there is nothing scary there. Impinging is a fancy way for saying smooshing.

Jnavits12 :

There has to be some mechanism or reason that the nerve is pinched as in kids this type of condition is really not that common (as compared to adults), a common cause however could be a herniated disk which are the cushions between the vertebrae.

Jnavits12 :

PT and medicines (probably to stop inflammation), should work for a nerve that is pinched but overall you want to know why to see if it will likely resolve on its own or if something surgical is down the road.

Customer :

ok the dr said that is not very bad and can be treated...what should happen before she is discharged from the hospital...uirnating?

Jnavits12 :

Having a normal brain MRI would be comforting and helpful I think. There are some rare illnesses like multiple sclerosis that can cause nerve damage in different parts of the brain/spinal cord that may show up on MRI depending on how old the lesions are. Yes I think she definitely should be urinating prior to discharge, and be mobile enough to not be a fall risk. You had mentioned she may be discharged to a longer term care facility this would be a good step down from the hospital if they want to send her somewhere due to space issues...but she is still not urinating or moving by herself.

Customer :

i am not sure what to do at this point... you suggest a brain mri would be good ...she is in a hospital way far from home...at her home area there is no room in rehab...out patient only at best

Jnavits12 :

Probably the head MRI will take at least a day to get done which buys you time. It depends on your situation at home and perhaps you can have a compromise with some home health care nurse or aides to help her so that family doesn't have to do the medical type care. If she is still not urinating though you will likely run into some problems as you did when she was first discharged thus it may be safer to wait at least a short amount of time near the hospital in rehab for example a week...to avoid another bounce back.

Jnavits12 :

You also may getlucky and have space open up near home in the next few days!

Customer :

philippines is not famouis fot home health care

Customer :

fot home health care

Jnavits12 :

I know I'm sorry there are a lot of options available in the US that are not elsewhere...we get spoiled!

Customer :

yes we are

Jnavits12 :

Maybe being further from home but at a safer place is better in the short term though as those who have to travel are able bodied and not sick (unlike her)....you also will be much more relieved with more care at least until you are less scared for her health.

Customer :

there it is money cash up front no insurance

Jnavits12 :

Thus the consideration whether to do the head MRI or not...

Customer :

so r\we will do brain mri and buy some time there as you mention

Jnavits12 :

Best of luck. I have to go and pick my kids up from school but again feel free to get back to me later!

Customer :

it enters my mind that they might take advantage of me

Customer :

ok later

Jnavits12 :

Ha well you do have a situation in which it is tough to judge from afar. However the MRI seems complete to me as well as the hospitalizations thus far...but it is tough to be in your shoes! Bye

Customer :

scheduled Brain MRI.. she has some control of urinating. med seems to be doing ..she can also move more and is help to the bathroom

Customer :

the pinch nerve in herinated

Customer :

disc

Jnavits12 :

Morning I hope you are now sleeping!

Jnavits12 :

Here is a nice review although a bit medically worded and not easy to read for lay public but recent and you should skip to the spots that interest you http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2899810/

Jnavits12 :

Her progress this morning sounds promising!

Customer :

she seems to be eating good and sleeping now is good. she seems to able to talk better

Customer :

thank you for the article i will read it

Jnavits12 :

You are welcome I hope she just continues to improve!

Customer :

hi

Customer :

brain mri came with no fillings..only found a sinus...discharged from hospital...

Customer :

she is eating well, walking partly, having movements urinating on her own

Customer :

what ever meds they gave her was pretty good

Customer :

not sure what follow up will be needed the home local hopital

Jnavits12 :

This is excellent to hear. Very reassuring that nothing was discovered on the brain MRI, sinus inflammation is often an incidental finding if she is not clinically sick from her sinuses you may elect to do nothing.

Jnavits12 :

Hopefully she will continue to do well, anti-inflammatory medicines are very beneficial when used in the proper way for sure! Make sure she has follow up with either an orthopedist and or a neurologist and that she completes physical therapy as instructed.

Jnavits12 :

The goal is to make the area around her disc no longer inflammed and thus hopefully decrease the amount of nerve compression. Her activity should be somewhat limited though to things that won't be to jarring.

Customer :

she is walking limited with help. her left leg is sore to put weigth on. she is eating well, talking is back to normal. and still has 50 per cent of urinating. she is home now will be taken there for now with help of a brother and sister which patient care training. at present she has a follow up appointment with her dr on april 8

Customer :

so bed rest is recommened you think with some PT to help build leg muscles?

Customer :

what is a cause of the bacteria build up in her urine to begib with.....is it in food, water, hygeine,

Jnavits12 :

The likely cause of her urine infection was as I mentioned before (either on this feed or your prior one), stasis or lack of movement of urine out due to the retention issues she was having from the pinched nerve. Yes by all mean PT is recommended to not only build up leg but also trunk muscles and try to support the area well in the future and get by without any surgery.

Jnavits12 :

Kids are not great bed rest candidates...too hard to stay in bed. Right now with her pain it may be best to limit activity but it is hard to reinforce strict bed rest thus I would limit activity the most you can until she is feeling much better, and even then try to avoid activity that may destabilize the area like for example soccer, or cheerleading with lots of jarring motion.

Jnavits12 :

She will need exercise but I would follow her PTs recommendation on what, walking, swimming, are good candidates when things are much improved.

Jnavits12 :

Best of luck to you and to her and I hope that things continue to improve. Let me know if I can be of help in the future. Thanks!

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