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How Long Is The Healing Process After A Hip Osteotomy?

Posted on Wed, 1 Feb 2017

Question: My question is that my son is 2.5 year old and 14 kg..recently he underwent osteotomy to correct hip dyplsia of right hip..10 weeks would be getting completed on 2 January post surgery..the doctor is of the opinion that the healing is a little slow ..can you recommend any supplement that would boost healing of bones ,tissue and muscles? He is currently on calcimax P 5 ml twice a day and raricap L 5 ml once a day..please suggest anything that would help us to get his healing boosted up a little..his vitamin d3 is been on borderline always..

Answered by Dr. Sumanth Amperayani (4 hours later)

Brief Answer:
You can use vitamin C supplements

Detailed Answer:
Hi... you are already using iron and vitamin D supplements.

For healing process you can use vitamin C supplements. It is available as 500mg tablet. You can give him half tablet daily once for a month.

Regarding borderline vitamin D deficiency, I suggest you give him 30000 units of vitamin D weekly once for 6 weeks and then recheck the vitamin D levels.

Regards - Dr. Sumanth

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumanth Amperayani (1 hour later)

Dear sir,
Can u prescribe the name of the supplement? He doesn't take solid stuff as he is in plaster ..can u Telme any vitamin c supplement in syrup form??also the ml according to his weight???how many ml and how many times per day?? Also if I give him 30000 units of vitamins d then do I have to stop calcimax p or continue using it along with it?? Please let me know in detail..ur help is truly appreciated

Answered by Dr. Sumanth Amperayani (1 hour later)

Brief Answer:
Suggestions on vitamin C and D supplements

Detailed Answer:
Hi...I understand your concern. Coming to your queries one by one -

1. The vitamin C supplement is available as Cartis tablet. It contains 50mg of Vitamin C. You can give him half tablet, powder it and mix it in honey or water and give it please. Give it once a day for 1 month.

2. Vitamin C alone as syrup formulation is difficult to obtain.

3. No need to stop Calcimax. Vitamin D is available as Jusdee 60000 sachets and you need to give half XXXXXXX once a week for 6 weeks. For easy remembrance give it every Sunday for 6 Sundays. After finishing off the schedule, recheck the vitamin D level.

Hope my answer was helpful for you. I am happy to help any time. Further clarifications and consultations on Health care magic are welcome. If you do not have any clarifications, you can close the discussion and rate the answer. Wish your kid good health.

Regards - Dr. Sumanth MBBS., DCH., DNB (Paed).,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumanth Amperayani (8 hours later)

Sir I conaulted his pediatrician today ..
He prescribed exactly what you did but changed one thing
Uprise d3 60k liquid bottle for kids everyday after meal for 10 days..he said he wants 6 lakhs units to go in 10 days to aid better healing...is it safe to give this everyday for 10 days????

Answered by Dr. Sumanth Amperayani (49 minutes later)

Brief Answer:
There is no harm in doing so - but I suggest it over 6 weeks

Detailed Answer:
Hi...There is no harm in doing so. It is safe only. You can do what your pediatrician suggested also. In the past the treatment used to be 6 lakh units given as intramuscular injection as a single shot. So no harm in giving it over 10 days. It is acceptable.

I have written a review article in a renowned medical journal in XXXXXXX regarding vitamin D deficiency and treatment. I am herewith providing you with the link for the same. You can read it and you can even give it to your pediatrician.

http://www.indianpediatrics.net/july2013/july-669-675.htm

I wish your kid a speedy recovery. If you need any future medical consultation and suggestions, I will be glad to help. You can approach me at the following link.
Once the page opens there will be an option below my image as – ASK ME A QUESTION – click on it.

Please find the link below -

www.healthcaremagic.com/doctors/dr-sumanth-amperayani/67696

Regards - Dr. Sumanth

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumanth Amperayani (1 hour later)

Dear sir,
One last question is ..it won't cause any toxicity if this dosage is given everyday for 10 days?? Shall I give every alternate day?? Because we haven't done any blood test to detect the levels..but when we checked last time it was on borderline (not too good not too bad)..I don't want any other problems happening to my child that's y double checking with u..please advice

Answered by Dr. Sumanth Amperayani (9 minutes later)

Brief Answer:
It won't cause any toxicity - you can give it on alternate days too

Detailed Answer:
Hi...You can give it daily for 10 days or on alternate days too. It wont cause any toxicity.

But I suggest that you do the testing for vitamin D levels 48 hours after completing the course. In that way we will know the vitamin D level and then we can plan further daily dosage for your son.

Regards - Dr. Sumanth

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumanth Amperayani (4 days later)

Dear sir,
I gave him 2 bottle of uprise d3 60k..so 1.20 lacs unit went in the span of 4 days..now I got the doctor to check his blood for vitamin d and I was shocked to see his vitamin d is 104...safe limit is 40-100 in the report ..am I in some kind of problem?? Also I would like to share something with you since I gave the second bottle of vitamin d he had fever for 2 days of 99.5-101..and also vomit few times..please advice ..is this high because we have done blood test in between of the course???or is it toxic on my baby already???
I am really worried ..please help me

Answered by Dr. Sumanth Amperayani (1 hour later)

Brief Answer:
Stop vitamin D hereafter - you baby is not in toxicity - dont worry

Detailed Answer:
Hi...Don''t worry.Your baby is not in toxicity. Fever is not related to this vitamin D administration.

As of now stop giving the medicine and well reccheck the levels in another 10 days.

I have a few questions -

1. Is he complaining of headache?
2. Is there any vomiting or nausea?

Please get back to me with answers and I will guide you further.

Regards - Dr. Sumanth

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumanth Amperayani (53 minutes later)

He doesn't have any headache..today fever has subsided too..yes he feels nausea and sometimes vomits also..not every time ..we checked his blood and all the levels are normal except esr which is 19 normal range 5-10..hb is 12.20..platlet is 215 normal (200-450)..rbc 4.29
Normal range (4-5.2)...wbc 5.2 normal range (5.5-15.5)..neutrophils 47 normal (29-51)
Eosinophils 1 normal range (1-6)
Lymphocytes 48 normal (32-62)
Monocytes 4normal (2-10)
Basophils 0 normal (0-2)
Crp negative
Urine calcium : creatinine ratio is 0.6..y is the esr high and wbc a bit low?? Leukopenia?? Any problem??? Please suggest further ..thanks in advance ..also do we need to continue calcimax and raricap?? Please answer in detail covering all my points ..your help is highly appreciated

Answered by Dr. Sumanth Amperayani (5 minutes later)

Brief Answer:
Suggestion on the lab reports

Detailed Answer:
Hi...coming to your queries directly.

1. CBC is normal...nothing to worry....WBC is normal for age.

2. CRP is negative means - no acute infection or inflammation is going on.

3. ESR is also normal - we need to worry about it only if it is more than 70-100.

4. Calcium Creatinine ratio is high (Usually it should be less than or equal to 0.2) - this means that the propensity of kidney stone formation is high. So stop Calcimax and Raricap and Vitamin D supplements. We will recheck the vitamin D level in 10 days. I feel either the earlier report of vitamin D or this report should be erroneous. Anyhow we will decide on in in 10 days.

5. If the kid is not having continuous vomiting almost 15-20 times per day the possibility of vitamin D toxicity is very very unlikely.

Regards - Dr. Sumanth

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumanth Amperayani (35 minutes later)

Sir,
The vomitting is not there so much..just once kr twice..also could this ratio be because of the high dose of vitamin d given by us?? Could this be temperory??? Also in the urine report there was nothing of this sort written?? So u mean either the urine routine is wrong or either thisnis wrong ??? Could we do anything to bring this level down?? Please help??

Answered by Dr. Sumanth Amperayani (11 minutes later)

Brief Answer:
Suggestions on calcium creatinine ratio

Detailed Answer:
Hi....Coming to your queries directly -

1. The high ratio is not because of the vitamin D given.

2. This might as well be temporary - that is the reason why I am telling that we will re-check the tests in another 10 days.

3. I meant the high vitamin D level in the blood might be wrong. So we will check - in another 10 days - Vitamin D level in the blood and urinary spot calcium and creatinine ratio.

4. Right now as he is not symptomatic we need not to anything. There are no medicines to bring down the level of vitamin D. It will come down by itself.

Regards - Dr. Sumanth

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumanth Amperayani (3 hours later)

dear sir,
the doctor has said that the ratio is really high and ordered serum creatnine and serum calcium reports...along with urine 24 hours...now he said that it might be from childhood....how can he say that? i have done serum calcium and serum creatnine report alomst 5 times since he is born ..the last one was done at 30 april and both the serum creatnine and serum calcium were always within the prescribed limits....if it was somethng serious it shoulf have reflected in any of the 5 reports...please revert asap as i am worried that this could damage kidneys?thats what he told me..the ratio is really really high...he also said iit could be because he is lying down in plaster since 2.5 months...please answer suitably covering all my concerns...

Answered by Dr. Sumanth Amperayani (1 hour later)

Brief Answer:
You are referring to serum report and your doctor - urine report

Detailed Answer:
Hi.... I understand your concern. But please do not panic and get confused.

Your doctor is referring to urine calcium creatinine ratio which is 0.6, where as I too had mentioned that the normal value is only 0.2. This is why he might have told that it has been there since long.

But what you are referring to is serum creatinine and serum calcium values and both would have been normal. Both of you are right.

Normal serum creatinine and normal serum calcium values do not reflect that urine spot calcium creatinine ratio is normal.

It is not that it will damage Kidneys. It only suggests that the propensity for kidney stone formation is high. Where as if really Kidneys are damaged the serum creatinine would have been elevated, which is not so in your child's case.

I suggest -

1. Repeat serum creatinine, vitamin D level, urine spot calcium creatinine ration after 10 days.

2. Meanwhile get an ultrasound abdomen done and if it is showing Calcium deposits in the kidney or if there is anything suggestive of kidney stone formation, then we will repeat the above tests immediately.

3. Sedentary lifestyle can sometimes cause these reports.

Regards - Dr. Sumanth

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumanth Amperayani (2 days later)

dear sir,
since you are well aware of the situation i wont ask the question in breif.
we checked his serum calcium value which is 9.0 normal range 8-10.6
serum creatnine 0.1 normal range 0.2 to 0.6
urine calcium 24 hours 34.80 normal range 100-250
the question here is the report says low calcium in urine but doctor suggests that it is high but not as before reports..he says my child is 13 kgs so it comes up to 2.6 and the cutoff is 2.0..i dont know which calculation he used to come up to 2.6??
also seeing the reports what are your current suggestions and your opinion?
he says serum reports are perfectly fine and normal...please reply accordingly..
secondly i have read an article which says that Values exceeding 0.20 are found in patients with hypercalciuria. In children, the calcium:creatinine ratio decreases steadily with time until approximately age 6. It is important to note this fact since most children will be falsely flagged as hypercalciuric using adult cut-offs.what is ur say on this??
kindly let me know in detail covering all aspects of my questions..your answers seem to satisfy me much more than what explanation my child doctor gives..your help is truly appreciated..

Answered by Dr. Sumanth Amperayani (3 hours later)

Brief Answer:
Suggestions on calcium creatinine ratio

Detailed Answer:
Hi...thank you for your trust in me.

Coming to your queries one by one -

1. I also do not understand how he arrived at the value of 2.6.

2. Calcium creatinine ratio in urine spot sample is only an indicator that there might be a risk of hypercalciuria. It does not mean that the child has excess calcium in the urine. As the urine calcium level is normal you need not worry about it.

3. I agree with you that sometime children are flagged as high as false positive report. This is the exact reason why I wanted you to repeat the tests in another 10 days in my last interaction.

Regards - Dr. Sumanth

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Sumanth Amperayani (16 hours later)

Dear sir,
I repeated the calcium creatnine ratio urine test today..the results are 0.17.....now what is your say?
Shall we still stop calcimax p and raricap L?? Do u still feel there might be any problem after knowing all the history of my son and seeing all the lab reports?

Answered by Dr. Sumanth Amperayani (1 hour later)

Brief Answer:
There is no problem but we will repeat Tests in 10 days

Detailed Answer:
Hi.... I am glad that the calcium creatinine ratio has come down to normal value. This is the exact reason why I wanted you to check the values in another 10 days. But we have not yet seen vitamin D levels repeat value.

I suggest you not to use any Calcium and Iron supplements till we document normal vitamin D levels and another normal urine spot calcium creatinine ratio.

There is no problem at all for your son. But I am telling you to repeat the tests again after 10 days because we had an abnormal value and the vitamin D level were high.

Please repeat vitamin D level, urine spot calcium creatinine ratio and hemoglobin level after 10 days and get back to me with the report.

Regards - Dr. Sumanth

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumanth Amperayani (47 hours later)

Dear sir,
The reason why i asked u this question was his pediatrician is admunt on starting my child on thiazide diuretics even after seeing a normal report..i just dont feel the need for it..what are your suggestions?

Answered by Dr. Sumanth Amperayani (23 minutes later)

Brief Answer:
I don't see the need to start on thiazide diuretics right now

Detailed Answer:
Hi.... I do not see any need to start thiazide diuretics right now. I agree that one of the reports was abnormal. But another report why normal and most importantly the child is not showing any clinical signs and symptoms of hypercalciuria. This is the exact reason why I want to wait and also repeat the test after 10 days. Hope this makes things clear to you.

Regards - Dr. Sumanth

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar