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Decisions re DS's orthopeadic treatment - did I get it wrong?

61 replies

Blu · 16/01/2006 15:55

I will be upfront, and say that this is mostly a splurge about the responsibility of decision making, and about me worrying.

And please forgive me for this - I am in bits and i just can't talk to anyone about it, so thank you for listening.

DS has no fibula, a missing ray in his foot, and currently a 5cm discrepancy between the length of his 2 legs.

In his first year, we had to decide between courses of action, as he was a borderline case between what could be recommended. We had to decide whether to go for a below the knee amputation and a prosthetic leg, or surgery and bone-lengthening. We sought a second opinion, met parents and children expeiencing both, and our consultant was extremely helpful, but would not 'push' us one way ot the other. Bone lengthening is very confronting, whilst prosthetics have about the same outcome in terms of mobility, for DS's condition.

We went for bone lengthening because the 2nd opinion was v much 'we can take this on, no problem' about the high degree of discrepancy, and since it was beginning to be clear that there was a discrepancy in the femur length, not just tibia, we could have agreed to amputation, only to find that lengthening in the femur was necessary, anyway. However, given the level of surgery, and length of time in fixators, when I once said to our consultant that a prosthetic would perhaps be the way to go, she gave me a look which included everything but a nod.

Now I am worried that we took the 'easy way out'. It was hard trying to make a decision objectively with the thought of my boy's leg going in an incinerator. But we also considered what he would prefer when he hit his 17th birthday - his own leg or a prosthetic.

Surgery to enable him to walk was succesful, and now, with a shoe raise and splints, he is a most active litle boy. His joy since Christmas is to do all the dance routines from Charlie and choc factory.

BUT at our consultants appointment last week, she was concerned that his foot is reverting. She is talking about more surgery to graft tissue from somewhere else into his ankle to supoprt it. She is concerned that the articulation of his ankle is not what she hoped it would be (some bones that should be articulated are fused). The discrepancey in his femur in increasing, and he is at the limit of the amount of shoe raise he can use.

She has arranged an MRI scan, to investigate the bones and how they have grown, and she wants him to use splints in the day as well as night. i am worried that this will restrict his movement (they can't be Dynamic ones) - i know it will - he had them when he was younger.

And I am worried that in the end, he will lose his leg after all - but at an age that it will be far more traumatic for him.

Of course, it may be all right again.

I know we did the best we could in trying to make the decision, but this responsibility is now wrenching me apart.

He has to go into hospital in march, and I can't even tell my friends or my Mum. I just can't open my mouth to talk about it.

OP posts:
motherinferior · 16/01/2006 19:18

And Blu, I just wanted to add that having met your ds, there is no way I could imagine you having got anything 'wrong'. He is, quite simply, lovely.

I know you want to keep this on MN, but you know that if you ever need to talk, or just to practise talking about it, I - like many others, I'm sure - will be more than honoured to listen.

Marina · 16/01/2006 19:30

blu, I have been out today and have only just caught up with this thread. So much wise and humane advice and so much wonderful parenting for Boy Blu from you. The diary letter is a wonderful idea, wherever orthopaedics takes you in the next few years, it will help him and you greatly.
There are no right or wrong decisions, as eefs' friend and you show. For me and other posters, to do all that you could to keep ds' leg for him to do Willy Wonka dances on and scramble up playground equipment terrifyingly fast, does seem the instinctive decision that most parents would go for.
Maybe because it was so instinctive and visceral on one level, you now subconsciously feel it wasn't "reasoned" enough? One of the big pitfalls of modern life IMO is that mothers are compelled and encouraged to distrust their instincts
I know the feeling of wanting and wanting to talk and no words coming. I also know how great a thread can be at those times
When you are ready, the many friends you have made on here will be listening and empathising.

ScummyMummy · 16/01/2006 19:35

Blu I'm so terribly, terribly sorry to read this, honey. I think soapbox and aloha and tamum are so spot on. There just are no right or wrong answers in a situation like this, hindsight is no help at all and crucially it's going to be utterly agonising and bittersweet watching what happens to your wonderful son and his leg. Loads of love to you. xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

ScummyMummy · 16/01/2006 19:36

And Marina- that is a lovely post.

blueteddy · 16/01/2006 20:35

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batters · 16/01/2006 20:55

This reply has been deleted

Message withdrawn at poster's request.

suedonim · 16/01/2006 21:23

I've no advice to offer, Blu, but my heart goes out to you and your family. It seems to me that in the situation you describe there was no easy option. Whichever path you chose was bound to involve much heartsearching and agonising and the responsibility must be overwhelming at times. But you only experience these feelings because you love your little boy so much - that's what makes motherhood so hard. Sending you best wishes for March.

Blu · 16/01/2006 22:13

Marina - you have identified exactly one of my haunting feelings. That to pro-actively opt for amputation in the midst of a 'grey area' felt almost taboo. And so, yes, I then worry that we avoided the 'rational' decision. Given that mobility IS so good with modern prosthetics, had there been no choice, I would have accepted that - but it wasn't something we could pro-actively choose in that damn bloody 'grey area' they kept calling it.

This thread has helped me, very much, both the telling and your posts, and I have talked to two people now. Which makes me feel more normal..

Thank you.

OP posts:
Marina · 17/01/2006 11:39

hmmm. I did wonder my love, because that's what would have done me in. You do know that when we next all see each other we can spend hours getting monstered and making the whole lovely time free of your agonising pre-occupation - or we can all listen, and listen, and mull it over. Your call. But you will know on one level it is the start of a problem shared.
Have been thinking of you so much. XXX

Dinosaur · 17/01/2006 11:47

Yes, me too Blu.

xx

batters · 17/01/2006 12:53

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Message withdrawn at poster's request.

motherinferior · 17/01/2006 12:56

And me.

Bink · 17/01/2006 15:22

Blu, I keep thinking about you too, and all these lovely wise messages.

Potty1 · 17/01/2006 15:45

Me too Blu. How are you feeling today?

Blu · 19/01/2006 21:53

I am just re-visiting this thread to say a very big thank you to everyone, for your wisdom and kindness.
I have had a long talk with DP, and we are feeling much calmer, and therfore, of course, much more clear-headed for supoprting DS. I have broken the whole thing down into 'bite sized chunks' and it is no longer weighing me down.DS will go for an MRI scan on March 9th, and a few weeks after that we will see his consultant to see what she thinks about the stability, growth and development of his ankle and tibia. If she recomends anything invasive, we will seek a second opinion. I will keep in mind that everything has to have it's place in a longer plan, and will always ask how any suggested procedure fits in.
meanwhile, we will go through the new orthotics appointments.
Eefs freinds experience has really emphasised the fact that we all do make the best decision in our individual circumstances - and we probably all do have doubts and guilt at some stage.

I had frozen myself into a state, but the 'anonymity' of MN, and all your posts have freed me up. As Marina said it would.

XXXXXXXXX

OP posts:
Potty1 · 19/01/2006 22:03

Glad that it's all a little clearer now Blu. Be kind to yourself.

tamum · 19/01/2006 22:03

Oh Blu, I have been worrying about you. I am so pleased that you are feeling more able to deal with it all, and your course of action sounds just right.
xxxxx

Davros · 19/01/2006 22:10

Blu, sorry but I haven't read the whole thread. From what you say in your first thread it seems to me that you took the right decision. Presumably you can still go to amputation at some point if necessary? So you took the best option. Either way, you have done your best. I so relate to not being able to talk to friend/relatives about these decisions because you HAVE to make those decisions yourselves and you've done your best.
How about coming to meet us next week?

mummytosteven · 19/01/2006 22:12

Glad you've sorted things out a little in your mind, and feel a bit more comfortable.

batters · 19/01/2006 22:19

This reply has been deleted

Message withdrawn at poster's request.

Blu · 10/05/2006 13:39

This thread was very important to me when i started in in january, and i wanted to let you all know what has happened.This morning was the appointment with the consultant following the MRI scan, to see what is going on inside DS's leg, what has been causing the 'drift' of his ankle, and what is recommended.

The news for now is good. The MRI scan reveals that the tipping of the ankle is caused by the way DS's ankle bones have fused together as they have grown, and is not caused by a breakdown of the soft tissue. This is apparantly better news than if the soft tissue was not holding his ankle securely, and we have always known that some of his bones are fused rather than articulated. It WILL need surgery to correct it, or at least to improve it, but not before DS is 6. (he will be 5 this summer). Then she does not anticipate starting bone surgery until he is 7 at the earliest. The ankle surgery will be fairly daunting - a long time in plaster - but not as bad as repeated soft tissue surgery where tissue has to be taken from another part of the body and inserted - possibly repeatedly.

She brought in another consultant for a 2nd opinion and a discussion - she always does this for any proposed treatments, surgery or decisions, so I feel quite confident.

DS has started wearing a splint during the day during the last couple of weeks. It has reduced his flexibility and mobility quite a bit, as I knew it would, but typically he is forging ahead undaunted and the fact that with the splint he can have a wider choice of shoes beyond Piedros has meant TRAINERS for the first time, which has distracted him from the splint itself. The consultant is referring us to a specialist service to sort out how he can learn to ride a bike with a completely ridgid splinted ankle.

I had really thought, after our last appt, that we would come out of todays meeting with a date for surgery, and I have been shoving it to the back of my mind. I feel sort of prepared to get used to surgery next summer....

Eefs - I might e mail you again - about making contact with your friends, if that's ok?

Thank you all for ongoing support, it has made a big difference.

OP posts:
tweetyfish · 10/05/2006 13:47

Hello blu.. I'm so glad that you received good news at your appointment today Smile

You helped me a great deal when My DD was told she had a positional foot deformity, and I have admired your strength in dealing with everything, and I admire your son for not letting anything stand in his way! I'm sure he'll be riding that bike in no time, much too quickly and very very proudly!

blueteddy · 10/05/2006 17:40

Oh, Blu, I am SO pleased to hear that you received good news today.
I was thinking of you today & wondering how it was all going. I feel so relieved to hear that the news was far better than you were expecting.
xxxx

Saggarmakersbottomknocker · 10/05/2006 17:49

Blu - been thinking of you and little Blu. Glad it was OK today.

Hope you can find a way to allow him to ride his bike Smile

dinosaure · 10/05/2006 17:52

So glad that the news has been good. Have been thinking of you and Boy Blu.