Monday, May 24, 2010

Club foot update

We saw Dr. Mosca at Children's Hospital today for George's 21 month check-up.  Dr. Mosca was very pleased and said that George is doing great.  He said he was glad that George only had one club foot, as it was good to have a comparison with his other foot since he is so flexible.  George seems to have inherited Chris's extreme flexibility and double jointedness.  At George's 18 month appointment with Dr. Mosca, Dr. M had a several interns, residents and students with him.  He was explaining that George's foot was extremely flexible for a club foot, and showing them by pulling George's toes towards his ankle.  Then he did it with George's left foot as a comparison and was pretty surprised when George's toes nearly touched his shin.  It showed Dr. Mosca that George's club foot doesn't quite have as much flex as he'd thought it had.  And showed us that George is extremely flexible.  But at today's appointment Dr. Mosca explained that George's muscle tone looks great, his arch is very flat as they like to see with a clubfoot, and that his Achilles tendon is loose and his other ligaments and muscles seem balanced.  Dr. Mosca was very pleased.  The only muscle trouble George seems to have at this stage is with his toes.  They pull to the side (towards the big toe) pretty severely, so they always seem tucked under.  But Dr. Mosca said that that tends to work itself out over time, usually a bit later than everything else.  He has never had to do a surgery just for toes.  So, at least for now, it is looking like George may be able to avoid surgery completely.  Again, we give thanks to Dr. Ponseti for his work with this birth defect and his amazing non-surgical procedure for correction.  And we are always extremely grateful that we have Seattle Children's Hospital at our disposal, and Dr. Mosca as George's doctor.

I was talking with my brother Andy about this recently.  It was interesting to hear it from an outside perspective.  Andy lives out of state and has not had much exposure to George.  He met him when he had a cast on, then again when he was in only in his brace at night.  But as he put it, to George this is only a blip on the radar.  He'll probably have no memory of any of it.  And for us, with our first child, it hasn't been a hardship, as it is all we know.  And it's all George knows.  He doesn't know that other children don't put on socks and shoes and a brace to go to sleep each night.  It is all he knows, so it is normal.  When you put his brace on, he knows it's bedtime and starts calming down.  It may really disrupt his sleep schedule when he quits wearing the brace when he is 4.  And for us, some things were a little bit harder, but not very. I was somewhat limited in what positions I could nurse in due to the cast in the beginning and the brace later, but we nursed for 20 months.  So it didn't hurt.  He wasn't able to get a full bath as an infant due to the casts, but we found the joys of bathing "over" the sink instead of in it.  It was pretty terrible when they severed his achilles tendon.  We were surprised that they did not use any anesthesia (other than topical emla cream and an ice pack) until after they made the cut.  It was so hard to hold George while he screamed in shock and pain, but the whole procedure took about 40 seconds, and George only cried for about 5 minutes.  And he only took two doses of tylenol with codeine.  So it was much easier than anticipated, and such a miracle to know that his tendon was completely severed, yet grew and reattached itself in less than 3 weeks.  Sometimes we got some strange looks having an infant in a cast, but were able to explain what a club foot was and how common it is to some people who were interested.  If we have another child, we have a 40% chance of having another with a club foot.  That doesn't bother us at all.  I would almost feel bad if our second child didn't, because then George might realize that not all kids sleep in a brace.  I would never wish a birth defect on anyone, but if you have to have one, this is the one to have.

So once again, as I've done so many times in the past two years or so (we met Dr. Mosca when I was 21 weeks pregnant with George and already knew he had a club foot), I give thanks for Dr. Ponseti, Seattle Children's Hospital (and Orthotics pro Gregory Becker), and Dr. Vincent Mosca.

Some pictures from George's very early days:
















Before he was born I was so worried I would cry when I saw his foot.  But when George arrived, I found it every bit as beautiful as every other part of him.  It almost hurt to correct it, as he was so perfect.  But had we not, he would have been quite disabled, and now he will not be in the slightest bit.









The casts were so big for such a little guy.  But his core is so strong due to wearing this extra weight.  He was holding his entire torso up from his tummy at 4 weeks.  He also rolled over far before other children usually do.  We was rolling back to front at 12 or 13 weeks.






















George only had his casts on for his first 3 months.  Then his Achilles tendon was severed and he wore a cast for 3 more weeks.  Then he wore the brace 23 hours out of every 24 until he was six months old.  So it didn't interfere with or delay learning to crawl (9 months) and learning to walk (14 months).  Since then he wears his brace for 12 to 13 hours each day, only at bedtime and throughout the night.  He'll continue to wear it like this until he is 4 years old.