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Lab work and Antibiotics


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Hi, I am new here I feel like you guys are just as helpful as the Dr's I have seen so far.

 

My question: My son is on 250mg of Azith and will be done shortly. How long must I wait to get all his blood work done?

 

I am getting: Mycoplasma, Pneumococcal anti body, aso titers, Anti-DNase B titers, Streptozyme, and a bunch of others.

 

I called Dr. T but he hasn't responded to my question as of yet.....

 

 

Thank you to all who answer.

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Thanks arial,

 

 

I am VERY confused now, as Dr. T said my son can start blood work as soon as he's done with abx. :wacko:

 

I just don't understand since my pediatrician said 2 weeks!?

 

 

Dr. T is respected and known in his field but I wonder why he doesn't think it's an issue to wait and other Dr's do??

 

Another phone call to make to an already hard to reach Dr. .................great!

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I have never heard the recommendation to wait on these tests until off of antibiotics. We see 2 pandas docs, and also saw a sympathetic ID doc. Many pandas children remain on antibiotics indefinitely, and still do these tests.

 

Maybe someone can chime in on any reasoning, otherwise, I would go ahead and get the testing done.

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I would think that if your intention is to do a single course of abx and then re-check titers to see if the strep infection has cleared, then it would make sense to run an ASO 1-3 weeks after you finished the abx (assuming you have already checked them once and have a baseline number). Anti-DNase B titers rise 4-6? weeks after an infection, so theoretically, if you checked these at the same time (10 days post-infection plus 2-3 weeks), these would be peaking.

 

But since you're testing for infections that aren't necessarily effected by zith, I can see where Dr T would say it doesn't matter when you have the tests done. The only test I can see being effected would be ASO, which it doesn't sound like you're doing. If you have myco, the zith probably didn't touch it. The pneumo titers you're checking are likely checking to see if a previous pneumo vaccine was effective rather than checking for current infection (unless of course your child has current symptoms). I'm not as familiar with streptozyme or how it would be effected by current zith.

 

Just guessing on all this, but thought I'd toss it out in the hopes it might help reconcile how different doctors could give such different advice.

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I have never heard the recommendation to wait on these tests until off of antibiotics. We see 2 pandas docs, and also saw a sympathetic ID doc. Many pandas children remain on antibiotics indefinitely, and still do these tests.

 

Maybe someone can chime in on any reasoning, otherwise, I would go ahead and get the testing done.

 

Thanks dcmom, I am dying to get on with it, but don't want to make a wrong move.

 

The thought of waiting 3 weeks takes my breath away......I just need answers.

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I would think that if your intention is to do a single course of abx and then re-check titers to see if the strep infection has cleared, then it would make sense to run an ASO 1-3 weeks after you finished the abx (assuming you have already checked them once and have a baseline number). Anti-DNase B titers rise 4-6? weeks after an infection, so theoretically, if you checked these at the same time (10 days post-infection plus 2-3 weeks), these would be peaking.

 

But since you're testing for infections that aren't necessarily effected by zith, I can see where Dr T would say it doesn't matter when you have the tests done. The only test I can see being effected would be ASO, which it doesn't sound like you're doing. If you have myco, the zith probably didn't touch it. The pneumo titers you're checking are likely checking to see if a previous pneumo vaccine was effective rather than checking for current infection (unless of course your child has current symptoms). I'm not as familiar with streptozyme or how it would be effected by current zith.

 

Just guessing on all this, but thought I'd toss it out in the hopes it might help reconcile how different doctors could give such different advice.

 

LLM, I am awed by your knowledge in this area, as I am so new and overwhelmed! My son had titers done on day 5 of abx @ CHLA on Xmas.

 

ASO: less than 25 AntiDNase B less than 95 Dr. T is asking for them again and it's only been 11 days since they were done.

 

 

BTW- I still don't even understand these numbers except that i was told not all kids have high titers.

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I would think that if your intention is to do a single course of abx and then re-check titers to see if the strep infection has cleared, then it would make sense to run an ASO 1-3 weeks after you finished the abx (assuming you have already checked them once and have a baseline number). Anti-DNase B titers rise 4-6? weeks after an infection, so theoretically, if you checked these at the same time (10 days post-infection plus 2-3 weeks), these would be peaking.

 

But since you're testing for infections that aren't necessarily effected by zith, I can see where Dr T would say it doesn't matter when you have the tests done. The only test I can see being effected would be ASO, which it doesn't sound like you're doing. If you have myco, the zith probably didn't touch it. The pneumo titers you're checking are likely checking to see if a previous pneumo vaccine was effective rather than checking for current infection (unless of course your child has current symptoms). I'm not as familiar with streptozyme or how it would be effected by current zith.

 

Just guessing on all this, but thought I'd toss it out in the hopes it might help reconcile how different doctors could give such different advice.

 

LLM, I am awed by your knowledge in this area, as I am so new and overwhelmed! My son had titers done on day 5 of abx @ CHLA on Xmas.

 

ASO: less than 25 AntiDNase B less than 95 Dr. T is asking for them again and it's only been 11 days since they were done.

 

 

BTW- I still don't even understand these numbers except that i was told not all kids have high titers.

 

My son has high titers, especially anti-DNASE B, even when on long-term abx, so I don't think it matters too much.

 

One thing to make sure is that it is actually the anti-DNASE B that was ordered. There is a lupus DNA test that often gets ordered by mistake (lab techs can make the mistake, too) -- it's happened to us twice and to other people as well. So make sure you yourself see the lab results to make sure it's the right test!

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LLM, I am awed by your knowledge in this area, as I am so new and overwhelmed! My son had titers done on day 5 of abx @ CHLA on Xmas.

ASO: less than 25 AntiDNase B less than 95 Dr. T is asking for them again and it's only been 11 days since they were done.

 

BTW- I still don't even understand these numbers except that i was told not all kids have high titers.

 

My knowledge comes from all the other parents on this forum. There was a time when this was Geek Central and all sorts of medical papers were discussed/explained as we all tried to comprehend what just happened to our kids. You can find some information on titers under the Helpful Threads at the top of the forum.

 

In a nutshell, ASO is an antibody that your body usually makes when it sees strep. These antibodies generally show up between 1-3 weeks after the initial infection. Anti-DNAse B is another type of antibody that your body makes against strep - it peaks somewhere between 3-6 weeks after infection. But everyone has a different "baseline" - labs establish general "norms" but some people, especially kids, have individual "norms" that are higher or lower than the average. So a good practice is to check ASO and Anti-DNase B titers at least 2-3 times to look not at the specific number but at the direction the numbers are moving. If the numbers move up - you likely had a recent infection. If they move down, it's more likely the infection has or is resolving. But it's all rear-view mirror measurements. They're helpful, but clinical symptoms are more useful for guiding current treatment than labs that show what happened a few weeks ago.

 

Personally, it seems early to be re-checking. But I'm not a doctor and I'd follow your doctor's advice. When you get conflicting directions, follow your gut or the doctor you have the most confidence in. It doesn't mean one doctor doesn't know what he/she is talking about. It means they have a different perspective or are looking at the test for different reasons. Dr T might want the test early to cacth a rising ASO, which would be gone 3 weeks from now. Your pedi might just be looking to see if the infection has cleared and checking ASO in 2 weeks would give you that answer. Hard to speculate.

 

In either case, I tend to come back to DCmom's conclusion. Being on abx at the time of blood draw doesn't seem to be a biggie. It's more a matter of how much time has lapsed since the initial infection and what you're trying to take a picture of with the test. If you want to "catch" rising titers, test sooner. If you want to see if the infection has resolved, check later.

 

But as you said, some kids don't produce titer levels that are considered high, in spite of having confirmed strep swabs/cultures. There are research papers that show this and there's a lot of anecdotal support on this forum. So the test is very useful if you have a kid who produces these antibodies. But not helpful if you don't. My son didn't have high titers after confirmed strep. Could be because we tested too late after the initial infection. Could be because he was eventually diagnosed with a zinc deficiency that compromised his immune system.

 

What's most important is that you educate yourself as much as possible - it will help you feel less out of control. You have a Pandas-friendly doctor and he will help you get beyond this crisis. All of the Pandas docs have their own take on things, and their particular approaches work for some and not for others. In a way, patients become self-selecting, eventually moving to doctors whose protocols match their kids' needs. I respect all of the Pandas docs and don't want you to get the idea you should be with anyone other than your current docs. But as your own understanding of this disease evolves, you will slowly feel more comfortable with being more active in your son's care and will become a co-pilot, which also helps you feel less helpless. I guess if I could give you one piece of "knowledge" it's that this episode will likely be your worst. You have very quickly found the right resources and that is a very very good thing that you should be very proud of. Even if a subsequent crises comes with it's own OMG moments, you won't be as blown away as you are now. You learn to cope and advocate. It gets better. Honest.

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