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post-tonsillectomy tonsil culture - help needed to understand!


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Hi, my 12 year old son had his very cryptic tonsils removed last Thursday. He had been on 500 mg. of Zithromax daily for at least 3 months, before that he was on Augmentin daily for several months. During the past three months, especially the week before the operation, he was on additional antibiotics in addition to the Zithromax (Augmentin or Keflex). All of his most recent excacerbations of symptoms did not result in positive strep tests and all of his strep titers were normal. In extended blood work,the only thing that showed up were that he had one low subclass of IgG and had had Epstein-Barr virus at some point.

 

When the doctor removed them, he told me they were worse than they had looked and that they were "full of holes and full of stuff". I had asked for them to be cultured. I received the results today at his post-op visit. He said there was definitely infection and lots of white blood cells. He said they could not be specific to strep or anything b/c there was so much different stuff it was difficult to isolate. Below is what the printout says, and I do not understand what any of it means, including what 4+, 3+, etc... means,

 

So if anyone with a medical background can help me understand this, I'd greatly appreciate it!

 

Smear result:

4+

WBCs

3+

Gram positive cocci

in pairs and chains

2+

Gram positive diptheroid-like bacilli

 

Culture:

4+

Mixed anaerobes

unable to isolate for identification

 

Thank you!

Dawn

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3+

Gram positive cocci

in pairs and chains

 

This just means that some bacteria, both diplococci (a pair of cells- there are certain species that occur this way) and some type of streptococci, not specific.

2+

Gram positive diptheroid-like bacilli

 

These are rod shaped bacteria that resemble the bacteria that cause diptheria (doesn't mean it is).

 

Culture:

4+

Mixed anaerobes

unable to isolate for identification

 

Anaerobic bacteria are usually pathogenic bacteria. They are nasty bugs, able to live where there is little or no oxygen. This means they are hard to culture and challenging to kill.

 

As you can see, this is not very useful. If they have the culture plates still in the lab, they could isolate any of the colonies found in this culture, perform physiological tests and accurately identify any of these. They did not because they weren't ordered to do so.

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Wow! Well, that is pretty good evidence that being on long term full-strength antibiotics does not mean that your child will be strep (or pathogen-PITANDS) free. I'm so glad those tonsils are gone! It sounds like tonsilectomy was really appropriate in your son's situation.

 

Where your son's tonsils infected looking even before the surgery? Or did they only find out how bad they were once they removed them? In other words, was it pretty obvious that he needed them out?

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They did not look infected nor did he have any recent positive strep tests. However, you could see that they were full of holes and he would often get those lovely little "tonsil stones" stuck in a hole. (I get those too). We were considering IVIG, but I said I did not want to pay $13,000 for the strep to come back if they were hiding in his tonsils. His cousin had her tonsils out at age 5 and her doctor said they were so cryptic, antibiotics would never have gotten all the strep. They were not cultured however. So, my doctor gave me the name of an ENT who does not always go by the strict standards of x number of strep tests etc.... I am so glad I followed my instincts!

 

Turns out the ENT is interested in PANDAS, said he had one other case where as soon as her tonsils were out, PANDAS was gone. He wants me to email him an update on his PANDAS symptoms in a month. (doctor also has a Ph.D. in neurobiology!).

 

Thanks for the explanations too - I had asked for it to be fully cultured, specifically for strep and HIB, but the ENT said "they'll do all that" - guess not!

 

Thanks - Dawn

Edited by DawnMCH
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Dawn - My son had his tonsils out at age 7 and it ended the cycle of sinus infection --> Antibotics --> yeast --> Sinus infection.... etc.

 

It turns out my sons tonsils were quite cryptic (though he did not have anything growing when they cultured them). My son's PANDAS symptoms decreased dramatically after the tonsils were out, but we needed to do quite a bit of yeast work (he had not been on diflucan at that time). He stayed pretty clear with managable PANDAS symptoms for about 6 years after that.

 

All the best to you!

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I didn't have my son's cultured but when I had his out the ENT said they were "a shriveled up infected mess". He has had strep (without ever complaining of a sore throat) in the past but didn't meet the criteria for removal based on total number of strep in a certain period of time. I had an ENT who was also open to learning about pandas and he understood that also one reason he might not have had more positive strep cultures technically is because he had been on antibiotics for quite some time. He was happy to remove them for me on the pandas basis alone.... He told me that often the ones that are infected the most look small and ok when you look... but in fact they aren't really so small, just shriveled and squished... ick. Basically he said the same thing when he removed my daughters (she had documented strep with sore throats enough to meet the criteria).... that her tonsils looked small and ok but he suspected they would show lots of signs of infection..sure enough they did.

 

 

Interesting on a side note is that my kids dentist asked me if my son got sick a lot... he really didn't that I know of... I mean obviously with the exception of pandas... but not colds and infections that I was aware of and he had been strep free for a while I thought.... she said that the buildup behind his front teeth could be genetic or was an indication of infections.... my daughters were that way but she said having strep throat a lot and colds would do it.... Will be interesting to see if she notices a difference at his next checkup in how much build up since having his tonsils out... They have no cavities and no other teeth issues...

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Dawn - My son had his tonsils out at age 7 and it ended the cycle of sinus infection --> Antibotics --> yeast --> Sinus infection.... etc.

 

It turns out my sons tonsils were quite cryptic (though he did not have anything growing when they cultured them). My son's PANDAS symptoms decreased dramatically after the tonsils were out, but we needed to do quite a bit of yeast work (he had not been on diflucan at that time). He stayed pretty clear with managable PANDAS symptoms for about 6 years after that.

 

All the best to you!

Kim,

Can you share your experiences with Diflucan? Do you use it prophylacticallY? I don't want to hijack this thread, so please feel free to PM me. I tried to PM you but got a message saying you couldn't receive messages.

 

Laura

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  • 4 weeks later...

first i was hoping for an update on the t&a..did that kick the pandas.or closer to kicking pandas

 

i am in the proces of lining this up..as any future work would seem silly if this is crucial key...

 

again i know we just discussed this...but...

being on abx during and after is key...

ds is on 250 mg zith..he is 80lbs...is that enough when we do this...

should i switch/double the dose/ add a second abx..

 

then we were going to take another break for a month or 2 to see if that was the final piece we needed..from my mouth to God's ears....

ent thinks they look ok...at one point are age 6 we were discussing t&a never happened..we moved alot too....

so i wonder how ds' will look..

i need to remember to ask for culture

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can someone answer..(.waiting on letter from doc to procede with TA...)

at one point when ds was 5-6 we were talking about tonsils coming out, since so many streps...doc never thought a real issue, so it was dropped...maybe moved?

ent wont do it w/o letter from a pandas doc to procede as they do not look bad to him

is there a reason to keep them...

 

just got off phone with dh..i talked about this site and all the experiences with tonsils looking normal and once out, all the stuff wrong with them....

hubby goes...hmmmm....maybe i should have mine out too...he does have mild tic...he gets strep 1-3 times a year...

 

is there any reason to keep tonsils..i realize that they are supposed to fight infections..

and ds look normal..

should dh have his out too....i may have answered my own question..but would like to hear more info

 

ps..need to redraw dh antidnase..was still high a couple of months ago....

argh..he just started new job..i heard it takes a week..and his job involves alot of talking..(fits him well)

Edited by Fixit
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hmmm. I wonder if dh is a "source" of infection for ds. Will someone rx some good abs for dh as well? It'll be interesting if the combo. helps decrease tics.

 

I would vote for T and A for both.

 

I think it's just hard to say for sure how beneficial it will be. I think it helps a lot for some...when the tonsils are persistantly infected, it just can't be good for a PANDAS kid.

 

But, it seems it is hard to tell just by "looking" if the tonsils need to come out.

 

Definitely culture if you do!

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hmmm. I wonder if dh is a "source" of infection for ds. Will someone rx some good abs for dh as well? It'll be interesting if the combo. helps decrease tics.

 

I would vote for T and A for both.

 

I think it's just hard to say for sure how beneficial it will be. I think it helps a lot for some...when the tonsils are persistantly infected, it just can't be good for a PANDAS kid.

 

But, it seems it is hard to tell just by "looking" if the tonsils need to come out.

 

Definitely culture if you do!

 

yes...i would like to have dh see one of these docs b,l,t, to get long term abx(one doc just did give us more)

i feel commited to now to doing this.......and to wanting hubby to follow all the same protocals..i may send him to doc b or doc l...(timing,((new job,)) time((new job, 3 kids and not being able to talk)))(i look forward to that) money and patient care...i dont have anything left to help dh in anyway at this point)

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I don't have any insight on the lab results, but your situation sounds just like our situation. Our 11 year old son had his tonsils out on April 1 (fitting day) becaues an MRI had found a cyst on his adenoid. When they went to do the T&A, the cyst was gone because it had ruptured, but the doctor said his tonsiles were extremely inflammed and in much worse condition than he anticipated. He said they were so enlarged that we needed to consider this a major surgery instead of a minor surgery as he recovered. I found it strange that in his 11 years of life, no one ever said his tonsils looked bad after all the checks in his throat. The surgery was scheduled because of the cyst and not the tonsils - we got luck with the ENT. I can also say our son had Epstein-Barr when he was 4 1/2, which was followed by a strep infection and PANDAS symptoms about 2 weeks later. I often wonder if there is some connection with Epstein-Barr and strep making their immune systems vulnerable to PANDAS.

 

Hi, my 12 year old son had his very cryptic tonsils removed last Thursday. He had been on 500 mg. of Zithromax daily for at least 3 months, before that he was on Augmentin daily for several months. During the past three months, especially the week before the operation, he was on additional antibiotics in addition to the Zithromax (Augmentin or Keflex). All of his most recent excacerbations of symptoms did not result in positive strep tests and all of his strep titers were normal. In extended blood work,the only thing that showed up were that he had one low subclass of IgG and had had Epstein-Barr virus at some point.

 

When the doctor removed them, he told me they were worse than they had looked and that they were "full of holes and full of stuff". I had asked for them to be cultured. I received the results today at his post-op visit. He said there was definitely infection and lots of white blood cells. He said they could not be specific to strep or anything b/c there was so much different stuff it was difficult to isolate. Below is what the printout says, and I do not understand what any of it means, including what 4+, 3+, etc... means,

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I don't have any insight on the lab results, but your situation sounds just like our situation. Our 11 year old son had his tonsils out on April 1 (fitting day) becaues an MRI had found a cyst on his adenoid. When they went to do the T&A, the cyst was gone because it had ruptured, but the doctor said his tonsiles were extremely inflammed and in much worse condition than he anticipated. He said they were so enlarged that we needed to consider this a major surgery instead of a minor surgery as he recovered. I found it strange that in his 11 years of life, no one ever said his tonsils looked bad after all the checks in his throat. The surgery was scheduled because of the cyst and not the tonsils - we got luck with the ENT. I can also say our son had Epstein-Barr when he was 4 1/2, which was followed by a strep infection and PANDAS symptoms about 2 weeks later. I often wonder if there is some connection with Epstein-Barr and strep making their immune systems vulnerable to PANDAS.

 

Hi, my 12 year old son had his very cryptic tonsils removed last Thursday. He had been on 500 mg. of Zithromax daily for at least 3 months, before that he was on Augmentin daily for several months. During the past three months, especially the week before the operation, he was on additional antibiotics in addition to the Zithromax (Augmentin or Keflex). All of his most recent excacerbations of symptoms did not result in positive strep tests and all of his strep titers were normal. In extended blood work,the only thing that showed up were that he had one low subclass of IgG and had had Epstein-Barr virus at some point.

 

When the doctor removed them, he told me they were worse than they had looked and that they were "full of holes and full of stuff". I had asked for them to be cultured. I received the results today at his post-op visit. He said there was definitely infection and lots of white blood cells. He said they could not be specific to strep or anything b/c there was so much different stuff it was difficult to isolate. Below is what the printout says, and I do not understand what any of it means, including what 4+, 3+, etc... means,

 

 

 

thanks that makes me feel even better...the ent staff is trying to arrange it though i have not yet gotten the letter that was requested...hopefully i will have it tomorrow..and surgerys SOON...

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