Daughters pain- battles with GP. Advice needed

[rachmultiplemum]

Hi all, Just after some thoughts/advice about my 9 year old daughter. We have seen a gp, have since repeatedly rang the GP and now have another appointment booked. However I need to go armed with some way to convince the GP to refer my daughter for further investigation.

Bit of background- I've got multiple children and am not an over protective mum. We are farmers, my kids are always outside handling animals etc. They are tough cookies.

So general time line- just in case anything could be connected- bad riding fall in June. Bruised ribs, small tear to spleen (no treatment was needed- hospital monitored and it healed itself).

August saw her get a tick bite and that classic red dart rash, and get a bit fluey GP put her on a long course of antibiotics for lymes disease.

Mid November she started complaining on and off that her ribs hurt slightly- on questioning i was able to find out that she meant the right side of her ribs, down her side to hip level. She was fit and well so no real concern, we just thought she probably tweaked something when riding.

However at the start of December she was at school and complained about pain in her ribs and then went pale and said she felt faint. I took her to GP. Gp said she had a slight temperature. She felt the area and my daughter winced. She then said it was probably muscles and to go home and take childrens ibuprofen.

Since then the pain has got worse and more frequent. She can be totally fine one minute, in loads of pain the next and then fine again an hour later. She goes pale and quiet with the pain. It's obvious that she is in pain.

Phone conversations to the gp and just involved the words 'pulled muscles', 'are you sure she isn't just making it up to get attention' and 'some children are dramatic'.

She now struggles to do pe, school are being fab and give her heat packs etc and we are constantly communicating about it.

Horse riding is her favourite thing but now she can't even ride as it hurts too much. In her last lesson she literally just sat on the horse through the lesson and gave him cuddles.

I have phoned the gp again this week. Been told again that she might just be making it up (she isn't, my child is one tough little girl and it's obvious when she is in pain). I've insisted on an appointment which they have given me for Thursday but I really don't want to be fobbed off again.

Any advice would be greatfully received.

I’d consider costochondritis.

Also consider that it’s not connected to the fall.
Is there anything that runs in her family?

I did consider costochondritis but everywhere says it should go within weeks and that the pain is normally around where the beast bone joins the ribs and she doesn't have pain there.

No conditions that run in the family. Yeah it could be something totally un related... I am very concerned as my happy active 9 year old is now really struggling x

Just making it up? What a great GP.

Go back to same GP. If she continues on the same path, Ask her, "would you mind recording that in the notes, that last time you suggested dd was quote 'making it up'. Say, actually I'm not happy with that, I think there is something wrong.

Random thought, may not help, I get bad rib pain when my asthma is bad because my muscles have to work harder.

Also, she is describing it as ribs - could it be heart related ie deeper than she thinks?

Pericordial catch?

DS had this (though he was a bit older) and it went on for months. First time he had it he was pale, doubled over, finding deep breaths impossible. He got it after a chest infection.

Says online that common ages are 8-14. DS was as you described your DD; fine one minute, then doubled over groaning and gasping, then an hour later, fine again. At its worst he was having the ‘spasms’ two or three times a day, then it eased off and it has been over a month since he had one. It started nearly a year ago though so went on for a loooong time.

He too described the pain as all the way down to his hip. I think it is a nerve thing, hence the distributed pain.

Your GP sounds shite! I'd be wanting a second opinion.

No possibility there was a liver laceration from the fall as well as spleen? Though I'd have hoped that would be healed by now.

Does it hurt her more when she breathes deeply? I had one sided pain following a virus - turned out I had a pleural effusion (fluid in the pleural cavity). Wasn't constantly painful but deep breaths really hurt. Could also feel a crinkle sensation inside, very odd. Mine lasted for months.

10% of cases of Lyme disease do not respond to antibiotics with her history I would be requesting a Lyme test. It's called antibiotic refractory late Lyme arthritis.

I haven't read all previous replies so this might have already been mentioned, but I'm sure there's a link between Lyme disease and lupus. This might be worth investigation.
I'd also complain about your GP!

Thank you for all the replies. Very helpful x

I would also consider whether this could be slipping rib syndrome. The original fall could easily have predisposed your DD to develop it.

Write down the history
Detail how often she gets struck by the pain and what helps doesn't help
Highlight all the things she is doing that you would expect to try an bow out of and all the things she loves that she can't do. If she's struggling to ride one day something she loves but is able to do chores on another it's hardly to avoid horrid things

It is so hard to get pain recognised. When my sister was a teenager it took nearly 3 years to get her gallstones diagnosed despite being in a and e for morphine every 2 weeks for pain, several short hospital admissions and countless gp and hospital op appointments. It took her developing sepsis after gallstones moved somewhere they shouldn't and having 50:50 odds of surviving the night to get a diagnosis. It took another year to get her health back but she hasn't looked back since.

Document every and in the run up to the appointment and then afterwards. Every time you give pain relief. If they give any suggestions for what it is look up the NICE guidelines for treatment. My daughter has severe reflux that doesn't respond that well to treatment we have had a few appointments where I have had to sit back whilst they tell me all the good things and then when they are starting to summarise I push back with the quality of life angle and is there anything else they can do know that there is stuff they can do. It usually results in a change of tact.

Good luck!