Wednesday, March 24, 2010

Orthopaedic Surgeon

On Monday, we went to the specialist whom I personally think is the most important at the moment. Not that Jonah's speech etc aren't important, but all of those specialists could only tell me what I already knew, and confirm what the pediatrician has already told us. But on Monday, I had no clue what to expect the Orthopaedic Surgeon to tell me. All that I knew was that my son doesn't walk, and his feet and ankles look very odd compared to other children's feet and ankles.

I suppose that I had a slight clue. The pediatrician had given me two terms that she felt Jonah might be diagnosed with: metarsus adductus, and tight heel cords. We discussed what the treatment for these might be, and she said that it varies from case to case. Most often, the child outgrows either condition by 12 months. For slight cases, special orthopaedic shoes could be worn. More severe cases require braces that can be adjusted as time goes on, to force the feet into the correct position. Another option would be castings.

This is all of the information that I had going into the orthopaedic surgeon's office. I did not know what to expect of the exam, other than they would look at Jonah's feet and probably watch him walk and crawl. I was anxious and kind of excited about this exam. Not happy excited, but I knew relief would be coming soon. I know how to help Jonah with his speech issues and cognitive delays. I desperately needed help getting him to walk properly. I was happy to finally be getting him the help he needs in this area.

As far as visits to doctors' offices go, so far Dr. M's office takes the gold star. It was a very comfortable office for children, with toys and interesting things hung on the walls right at Jonah's access level. In other doctors' offices, it's been a battle to get Jonah's attention away from the medical equipment, but the staff at this office seemed to have the insight to place more fun distractions at appropriate levels. I severely appreciated this. The staff is also the most friendly of all the offices, and one nurse is assigned to each doctor. So we will always see Nurse H or talk to Nurse H on the phone when we call with questions. That is very warm to me, to have the same smiling face helping us with each visit.

After waiting for a little while in the exam room, the resident who works with Dr. M came in and did his own evaluation. I was told this was for practice, and he would be comparing his notes with Dr. M's to see if he did everything properly and made the right judgements. He also explained to me what to expect. I was actually very grateful for the resident. He did the exam in slow motion, and explained most of what he was doing. When Dr. M came in, it was like a hurricane. He was extremely focused, and extremely fast. He contorted Jonah into all sorts of weird positions, looking at his joints and the way that the muscles were bending. He called out numbers and degrees to the nurse who was writing faster than I'd ever seen anyone write.

Then I was asked some questions about Jonah and his history, and his developmental problems. He asked me to take Jonah's shirt and diaper off, and watched Jonah walk naked. Jonah would only take a few steps, but it was enough. Dr. M remarked that Jonah must have just started walking recently. I corrected him, saying that he has actually been walking since November. I explained to him how we kept waiting for his balance to improve and his toe walking to stop, and it never did. He is still at the same level of walking now as he was then. This really seemed to concern him, as I feel it should have. He started talking to the resident about possible underlying causes of everything. He visually noticed very low muscle tone in Jonah's lower body, and also noticed when he put Jonah down that he did not try to put much weight on his legs. He told me that this concerned him with the knowledge that Jonah had been trying to walk for so long.

Dr. M decided that the best thing to do for now would be to treat Jonah for slight metatarsus adductus in the right foot, severe in the left (both hind and forefoot, if anyone is taking notes) and extreme congenital tight heel cords. I was somewhat relieved to hear the familiar terms that I had already discussed with the pediatrician. I had come prepared, almost expecting, to take Jonah home in either braces or castings, so it was actually a relief to hear that the outcome was something that I was prepared for (as opposed to something that would require surgery, which I was not prepared for) After these problems are treated, Jonah may still need to use an orthopaedic device, or wear braces, to help with the muscle tone. Our hope is that once these problems are fixed, the muscle tone will help to fix itself.

Metatarsus adductus is the opposite of what is commonly known as club foot. Everyone has been asking me if Jonah has club foot. The answer is no, he has the extreme opposite! With club foot, the feet are turned outward. Jonah's feet, particularly his left, are turned inward. This is thought to happen because of the way the feet are positioned in the womb when those bones begin to develop. Tight heel cords means that the muscles in the heels have not developed properly with the feet. The doctor explained to me that sometimes at night a child's bones will develop very quickly, and the muscles don't have time to catch up. This makes it impossible for the muscles to stretch with the bones in the joint, because they aren't long enough. Thus, Jonah's feet are always pointed, and he cannot lay them flat on the floor to walk.

We discussed the options of both braces and castings. I thought that braces would be easier to handle, but the doctor was really recommending the castings. He told me that with a case as severe as Jonah's, braces would take much longer to work. He also told me that with Jonah's age, braces are a bit more of a hassle. So my little boy had casts put on both feet and lower legs. It really broke my heart. Jonah was a trooper though. He was as good as gold while they manipulated his feet into the position they needed, and put the casts on. He eventually even fell asleep. The nurse turned out the light in the casting room and told me to let him get a little sleep before heading out. He laid there so peacefully and precious. I suddenly felt really guilty for what had just happened. I wish that there were some way that I could explain it to him, and make him understand. These casts will be a huge adjustment, and I wondered if he could handle it. But for the moment, I just let him sleep.

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