Orthopedic Update

Orthopedic Doctor A - November 15, 2016

We first heard the word surgery at our initial appointment with Dr. A a year ago. The goal is to improve Kevin’s walking in regards to his left foot which is inverted or rotating in when he walks and a severely hyperextended big toe, which has a constant sore due to rubbing on top of his shoe. His achilles tendon is super tight which prevents his heel from ever touching the floor.

In addition to the foot/heel/toe problems his left hip is subluxed. We are told that this will likely cause him arthritic pain in the future if not corrected. Once corrected this will end up leaving his left leg additionally shorter than the current leg discrepancy that he currently has. The good news is that comparing last years hip x-ray to this year’s - there has been no change - which means it’s not worse and this gives us time to make an informed decision.

November 15, was our second appointment with Dr. A nearly a year later. At the conclusion of our appointment with him we left not feeling very confident. One of the reasons for this was that last year he had recommended surgical procedure X for the achilles heel, which is the most invasive type. Last month when we met with the Spasticity team that orthopedic doctor recommended surgical procedure Y for the achilles heel, which was a little less invasive. During our appointment with Dr. A he agreed with procedure Y (possibly due to a change in Kevin since the last time we saw him). But then later during the appointment, Jon, my husband who is not in the medical field, questioned if surgical procedure Z could be an option and it almost seemed like a light bulb went off and he agreed this would be a good procedure. This along with another disagreement on whether or not to leave the pin in Kevin’s ankle - the orthopedic doctors we have met don’t seem to like these pins and prefer to take them out. But when we questioned whether Kevin’s ankle would collapse in on him after taking the pin out he couldn’t reassure us.

So all in all, we left not feeling very confident about the surgery. I left wondering if this is just the way it is…especially with CP (cerebral palsy) kids. Because it’s a neurological issue in the brain causing the motor output and deformity in the foot and walking. Does the surgeon just not know until he starts the surgery exactly what he is going to do? Which again, does not make me feel very confident and worries me about what we are going to end up with. We felt like Dr. A was just telling us what we wanted to hear. I went home that night not able to talk about it without feeling very emotional and crying. 

So the day after Dr. A’s appointment I called another well known hospital less than an hour away to obtain a second opinion. They advertise next day appointments and we scheduled with Orthopedic Doctor B.

Orthopedic Doctor B - November 21, 2016

We gave Dr. B only the X-ray’s, no doctor notes, so that we could get an unbiased opinion. He recommended surgical procedure Z to the achilles heel - not having any of the previous information that was exchanged in our other doctor appointments. He also recommended a different procedure to fix the hyperextended big toe. 

We also obtained some new information from Dr. B, he told us to not do the hip and foot surgeries together. He said that this will be a very long surgery and was concerned about the surgeon becoming fatigued - after working for 3 hours on his hip and then working for another 3 hours on the multiple procedures for his foot/heel/toe. Not to mention, the added risk for Kevin being under surgery for so long. It will be a long and painful recovery as well. 

We felt Dr. B was more forthcoming with what we should expect and not expect with performing surgery. He said that the purpose of surgery to the foot would be to get it in a better position to have it in an orthopedic brace and prevent the big toe from getting sores from rubbing the top of the shoe. Once he recovered from the foot surgery we could then proceed with the hip surgery about six months later. 

Dr. B will no longer be performing surgery after the end of this year. In regards to his opinion on splitting up the foot and hip surgery - Jon agrees with him, but I see both sides of this decision. I want to do what is best and easiest for Kevin and I’m not so sure about putting him through this twice or likely three times - because after the hip surgery he will likely need surgery again to correct the leg discrepancy. I am wondering if Dr. B as he is ending his surgery days is older and wiser or older and (with respect) possibly tired.

As you can see, this is not an easy decision and we want to take our time to make the best decision for Kevin. Because Dr. B will no longer be doing surgery we have scheduled an appointment with another orthopedic doctor at this alternate clinic. So we will see what his opinion is regarding Kevin’s foot and hip. 

Dr. Nemeh - October 27, 2016

Our appointment with Dr. Nemeh was a week after meeting with the Spasticity team (and before meeting with Dr A and Dr B) when we agreed surgery was our best option for Kevin. I didn’t think I was going to tell Dr. Nemeh that we decided on surgery because last year he had advised against surgery. But I decided to share this information with him and he seemed to agree that this was our best option. 

This was our second visit with the PEMF (Pulsed Electromagnetic Field Therapy) device - using electrical energy to direct a series of magnetic pulses though injured tissue whereby each magnetic pulse induces a tiny electrical signal that stimulates cellular repair. PEMF benefits are increased circulation, enhanced muscle function, decreased inflammation, stress reduction, bone healing, and blood oxygenation.

Not long after our previous appointment and first appointment with PEMF, I had sprained my ankle and kept having problems with it. At this visit, I used the PEMF on my ankle and haven’t experienced any discomfort or tightness since - nearly 2 months later. I have some other areas of my body that I need to work on - and I am hoping will have lasting results as well. I hope Kevin is experiencing the same relief with any daily discomfort he may have in his body.

Upcoming appointments: 

Dec. 13 - Orthopedic Doctor C 

Dec. 15 - Dr Nemeh