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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:
Twiglett · 10/05/2006 18:06

Blu .. hugs to you and little boy blu .. so glad the news is positive

2shoes · 10/05/2006 18:30

glad to hear things went well:o

ggglimpopo · 10/05/2006 18:58

How did I miss this thread? Blu, my dd - you know, the one with the make up and boyfriends and teen angst, well, it seems like just yesterday that I was worried if she would ever walk....

She has the same leg length discrepancy and your little boy, but has a tibia, albeit an abnormal tibia which is not straight but twisted like a screw. When her legs are straight her left patella is almost behind her knee. She had no heel at birth.

She had bone lengthening and straightening (Ilizarov ) done at Chertsey after years of tendon lengthening and crossing and remedial work done on the talipes itself.

Her main gripe now is the fact that she finds it difficult to fit into Jimmy Choos (dream on!) but orthopaedically speaking she should have a correction done to stop the very mild scoliosis caused by her leg discrepancy. She wears insoles (supposedly) and only someone "in the know" would be able to pick up on her difference.

I can remember all the dilemmas and choices and feeling so responsible for making the right decision.

But I do so want to encourage you and wish you well. you will get there. Dd was described as very severe and her chances of walking were minimal. If you could see her now......

Blu · 10/05/2006 19:14

Thank you all.
ggg - yes, I saw that your dd had had bone lengthening on one of potty-saggars threads- and I pushed it to the far reaches of my mind because it was when i was grappling with all this, and you and pottysaggy were saying that your dds were refusing to have any more lengthening done....or were trying to avoid lengthening at all costs, and knowing that is the decision we had taken..I was in deepest denial! BUT it is brilliant to hear how well your dd has done. It sounds as if her case was v severe, and i uinderstand that tendon lengthening is actually the more difficult part of any bone-lengthening procedure because they resist growth and stretching.

It is possible that DS will need 2 or 3 lengthenings, esp as his femur is a bit short...all to be monitored.

LOL at the JimmyChoos...anyway HopalongBlu is bugging me...but thanks to you all...and ggg and saggy, I will need you as we go alongg - as DS may also need the procedure MissSaggyJunior had last year.

OP posts:
tamum · 10/05/2006 19:38

Fantastic news Blu, I was thinking of you all today :) :)

GarfieldsGirl · 10/05/2006 19:42

Blu - I've just stumbled across your thread here, and just wanted to say you nust be an amazingly strong lady. My dp has just had an ilizarov fixator removed following a work accident a year ago. It's been an incredibly hard year for us, and there were so many times he just wanted to tell the drs to amputate, so you have definately not taken the easy option. I cannot begin to imagine what you must have been going through. I have sen pics of LOs in ex fix's on various ewbsites and it always makes me cry. I will remember to show this thread to dp whenever he is feeling sorry for himself as he's had it easy. I'm wishing you and your family all the best. Stay strong xx

Blu · 10/05/2006 22:50

I can't bear to think that DS might one day be looking up at me asking why the f* we put him through it....GarfieldsGirl: what stopped your ds just telling them to amputate?

OP posts:
Twiglett · 11/05/2006 08:46

Blu .. unfortunately whatever you do your DS too will one day be a teenager and everything down to the colour of his eyes will be 'why the f&^ did you* do that to me' .. you'll ride it out then too .. safe and secure in the knowledge that you are both wonderful parents and have done everything possible to make little boy blu safe, secure, happy and healthy .. everything possible! .. everything!

GarfieldsGirl · 12/05/2006 18:55

Blu - sorry, haven' been on fir a couple of days, baby on lap, so please excuse typing! He was unconscious for the 1st week after accident, so drs had already taken the decision to try and save leg, although he was only given 50/50 chance and told that if he ever got fed up then he just had to say the word and they would amputate. There were so many times that he just sat there and wished they had just mputated, but the main reason was that he was scared about ehat ds's would think of him if he only had one leg. He thought they'd shun him if h had a prosthetic and felt he couldn't be a 'proper dad' with only one leg. He couldn't see that they'd love him no matter what. There was also the fact that he wants to go back to his job, and can't do that unless he has full mobility.

It looks like the drs made the right decision as the bone has now grown, and fused together, although still soft so he has a 'beckham boot' but now he is glad that they didn't just amputate.

You've got to remember that when he's older ds will question everthing you've ever done no matter how big or small. If you'd chosen to amputate, he'd question why you did that (and you'd be questioing it too, like you're questioning this decision). By choosing the treatment, you are giving him the chance of having his own leg, which i'm sure h will understand in his own way once he's older.

Blu · 12/05/2006 19:02

GG Thanks. Very pleased to hear your dp is doing so well - it sounds like a horrendous accident, you must have had a terrible time.

I think in the end we do all tend towards preserving what we were born with, for better for worse, and that is what swayed our decision for DS. But the reality of a fixator - as your dp has experienced - is so daunting.

It's also possible that your dp's experience was bad becuause an accident causes such a mess to the bone. At least in a controlled lengthening procedure the break is clean and in the optimum place, and there shouldn't be all the extra problems with soft tissue caused by a serious accident such as your dp's.

Bone does grow and re-generate to it's original strength, so hopefully your dp will be recovering more fully soon.

OP posts:
GarfieldsGirl · 12/05/2006 19:48

Thanks Blu Smile

Certainly has been a tough time, not made easier as i was pg at time of accident, but yes, for us there is an end in sight, and he's been a lot happier this week since he's got his leg back (to a degree!).

I think I said this in my first post, but you sound amazingly strong to be going through this with your ds. i hope you have plenty of support in RL, i'm sure you do. I will be thinking of you & your family, if you ever need to chat, i'm here.

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