That’s basically what my son, Ray, was told when he and Annette recently took Maddie, four years old, to the doctor suggesting that she had appendicitis. It didn’t matter that all three of Ray’s brothers and one of his four sisters had undergone appendectomies, not to mention Maddie’s brother and a sister who already had their appendixes taken out. That skepticism, combined with Maddie’s high tolerance for pain, especially in a formal social situation, plus the fact that it is rare in 4-year-olds, led to being misdiagnosed with a UTI and ending up with a perforated appendix.
So this is why I’m writing this post. Just for the record: Appendicitis runs in our family. My former husband’s mom had an appendectomy while she was pregnant with him. So far, half of our eight kids have had that little tail on the large intestine cut off. Now, the only son who did not have it himself has passed it on to three of his five kids. So the numbers are becoming increasingly significant with 7/13 kids in the two families having acute appendicitis, the most common surgical emergency today.
I respect and appreciate doctors very much. Some of my family would not be here now were it not for doctors. It is interesting though that as important as family history is now days when it comes to heart disease and cancer, that some doctors still view with suspicion an inherited tendency for appendicitis. I remember being told pretty much the same thing back in the ’80’s when three of our children had their turn with it. We were thinking it had to be more than coincidence by the time the third incident happened.
Back then we didn’t have Google to confirm that appendicitis runs in families. For more information this website is a good one. Here’s something that was nice to see: “A genetic predisposition for appendicitis exists. A history of appendicitis in a first-degree relative is associated with a 3.5 to 10-fold relative risk for developing this disorder.”
Fortunately, all of our children presented with classic symptoms. Taber’s Cyclopedic Medical Dictionary states that “Classic presentations, which occur about 60% of the time, include abdominal pain (initially diffuse, gradually localizing to the right lower quadrant), loss of appetite, nausea, fever, and an elevated white blood cell count.”
I called and talked to my daughter, Emily, to refresh my memory on her case. She was the only one of our four who came close to being misdiagnosed. She was seven at the time and recalled how she was always excited to go places and socialize, and was just “too happy”, as the doctor observed. She laughed at his jokes and didn’t seem to be in much pain at all. She remembers waking up on a Saturday morning with her stomach hurting and then going to breakfast and trying to eat, but everything “seemed gross.” Her best friend came over later and stayed with her the whole day with Emily mostly just laying on the floor.
She recalls that evening being in the family room and hearing her dad and I chuckling and saying, “It couldn’t be appendicitis, we’ve already had two kids with appendicitis.” At that point in our thinking, the odds seemed to be reversed. Three kids in five or six years? No way! But as the pain localized more in the right side, we figured we’d better head for the hospital. She passed enough of the criteria, in spite of her very good nature, to have them check her white blood cell count.
The WBC is what stands out in my experience of having my children diagnosed with appendicitis. They do the WBC, it comes back high, and they proceed with surgery. I was surprised that with Maddie, they didn’t do that right away.
Here’s Maddie’s case history: Saturday, June 16 at 8:00 p.m. she threw up. She woke up on Sunday at about 7:45 complaining that her stomach hurt. She didn’t want to get out of bed, and when she did, she was bent over, holding her stomach. She also had a pretty high fever. Ray had Annette take Maddie to the hospital because he believed it was appendicitis. Because her symptoms were atypical–pain was not consistently localized over the RLQ, and she was able to perform tests such as hopping up and down (which usually isn’t possible with someone with appendicitis)– they figured it was a UTI. Maddie was given IV antibiotics and sent home around 11:30 a.m. They were instructed to come back if she got worse. Around 5:45 p.m. she had a temperature of 104.8 even though her next scheduled dose of Ibuprofen was not for two hours. They took her back to the hospital and got the impression from the first two doctors that they were wondering why they came back. The one doctor had scoffed at the notion that appendicitis can run in families and asked if all those family cases “were confirmed.”
Later a third doctor, who was more familiar with atypical presentation of appendicitis in young children, engaged Maddie in conversation and observed how she reacted when the nurse tried three times to get a needle in for some blood. She flinched a little. The doctor said, “She’s a tough one.” He said that even with the atypical results on the different tests, “I am not convinced that this is not appendicitis.” He then ordered the blood test for the white blood cell count and when it came back quite high, he scheduled an appendiceal CT scan. A second urine test came back negative for UTI. She had her scan at 11:00 p.m. and the doctor came back to tell them that it was appendicitis and that the radiologist believed it was perforated.
So Maddie had her surgery early the next morning. The surgeon said that it was “perforated but contained.” Her appendectomy was performed laparoscopically. She’s got three little scars and had a very speedy recovery. She was a real trooper. One of the hardest things for her was going so long without eating. Ray figures it was 66 hours from when she lost her appetite until she was able to have food and drink the normal way. We went to visit her Monday night and three or four times she said, “I want food” or “I’m hungry” and would almost cry but then she would just “deal with it” and watch her show and hold her stuffed animal. She wasn’t allowed anything til Tuesday morning. Whew!
Okay, just for fun, here is a guide to doing appendicitis the right way:
Be between the ages of 10 and 30. Don’t do it as an infant, you can’t report the pain. Don’t do it when elderly, the pain is often minimal. Your chances are better if you are a guy. Be able to describe the nature, timing, location, pattern, and severity of pain and symptoms. Demonstrate rebound tenderness and guarding. Rebound tenderness is when the doctor presses on a part of the abdomen and you feel more tenderness when the pressure is released than when it is applied. Guarding refers to the tensing of muscles in response to touch. Go ahead and be very guarded. Don’t appear to be enjoying yourself too much. It looks too suspicious. And finally, mention that all your siblings and your dad have already had their appendixes removed–it might get you somewhere but then again, maybe not!
