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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Recurring Fever. Kidney Stones Detected, Rupture Of Ovarian Cyst. ESR Level High. How To Treat It?

Hi, My wife has recurrent low grad fever for last 3 months. Following is the history of her illness and tretment done so far: 1. 26th March: Severe Abdominal Pain: Ultrasound and other tests done. Ultrasound also detected kidney stone and suspected appendicitis . 2. 27th March: During operation appenidx was found normal and instead rupture of Ovarian Cyst was seen, hence the cyst was operated with assistance from a Gynechologist. 3. 29th : Discharged from Hospital. Was on medication till next 7 days. Also took 10 Gentamicin injection due to urin infection reported in urin culture report. 4. 4th April: Doctors review suggested normal recovery. Antibotics stopped 5. 9th April: Some problem of stomach ache, loose motion, and fever (upto 102 degress reported). Ultrasound and CBC done done but were normal(other than the Kidney stone reported), Antibiotics: OfloxTz given. Pain subsided and fever gone 6. 17th April: Re-review showed normal recovery. 7. Low grade Fever ( 98.6 any other time 14. July 1 st Fever gone. 15. July 15th Fever reoccured and is ranging between 98-98.6 (in morning) to 98.7-99.3(in evening) The tempreture chart in each occurence is something like Morning Afternon Evening Night 98.0-98.6 98.4-99.1 98.7-99.3 98.7-99.3 There are no other symptoms. So far, I havent seen tempreture going above 99.4 Blood test shows high ESR (38), however other things are normal. Ultrasound says normal except for a small kidney stone There are no visible lumps or tumours visible in lymph node areas. No weight loss till now (only .5 kg) I have got her examined by two general physicians as well. I am really scared of something serous happening.
Fri, 18 Oct 2013
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Ayurveda Specialist,  's  Response
**
1. ESR is a nonspecific screening test which reflects change in plasma proteins, and suggests either acute infection, severe anemia, vasculitis, malignancy.[because it is not very high, thus other causes are excluded], you can check with CRP [C-reactive protein which helps to distinguish infection [high] from disease activity [not high].

PS
. Additional lab tests [repeat ultrasound,Chest X-Ray] will allow the physician to narrow down the possibilities.

2. when ovarian cyst cause pain, it is typically felt in lower abdomen [thus was mistaken with appendicitis].
3. since it was an emergency thus surgical removal was the choice instead of conventional treatment.
4. fever [low grade] could be due to the associated inflammation [repair period] after operation causing releasing of cytokines and fever
5. kidney stone might be the possible cause for urine infection

PS
i. high ESR could be due to any stress to the body: surgery or infection. [Multiple ESR tests over longer periods of time may be needed to get a more specific result].
ii. If the ESR is elevated, doctor may then order a fibrinogen level (a clotting protein that is another marker of inflammation) and a serum protein electrophoresis to determine the cause of elevated ESR.
iii. consult with a urologist regarding, whether these symptoms are associated with kidney stone.
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Recurring Fever. Kidney Stones Detected, Rupture Of Ovarian Cyst. ESR Level High. How To Treat It?

** 1. ESR is a nonspecific screening test which reflects change in plasma proteins, and suggests either acute infection, severe anemia, vasculitis, malignancy.[because it is not very high, thus other causes are excluded], you can check with CRP [C-reactive protein which helps to distinguish infection [high] from disease activity [not high]. PS . Additional lab tests [repeat ultrasound,Chest X-Ray] will allow the physician to narrow down the possibilities. 2. when ovarian cyst cause pain, it is typically felt in lower abdomen [thus was mistaken with appendicitis]. 3. since it was an emergency thus surgical removal was the choice instead of conventional treatment. 4. fever [low grade] could be due to the associated inflammation [repair period] after operation causing releasing of cytokines and fever 5. kidney stone might be the possible cause for urine infection PS i. high ESR could be due to any stress to the body: surgery or infection. [Multiple ESR tests over longer periods of time may be needed to get a more specific result]. ii. If the ESR is elevated, doctor may then order a fibrinogen level (a clotting protein that is another marker of inflammation) and a serum protein electrophoresis to determine the cause of elevated ESR. iii. consult with a urologist regarding, whether these symptoms are associated with kidney stone.