Hips Don't Lie

Today Owen had a follow-up appointment with his orthopedist. We haven't been there in 6 months. The purpose of the appointment was to check the growth of his hips as well as measure his bones in order to keep tabs on his leg length discrepancy (LLD). We got to the office and Owen was doing laps around the waiting room. He would run past another waiting patient and stop to say hi. Again, he brought smiles to so many people waiting. He kept going over to the door that leads back to the exam rooms, looking at me and laughing. When it was finally his turn to go back I scooped him up and followed the nurse, knowing that his time for exploring and playing happily had ended. The boy is not a fan of doctors' offices, and really who can blame him. The nurse commented on how much he was running around and was happy to see it.

A radiology tech came in to get us to come take Owen for his x-rays. Wes and I both suited up with lead skirts (for lack of a better word) to protect us from the radiation. The way the x-ray is taken, Owen has to stand up on a step-stool looking thing with his back against the x-ray board. He has to stand with his left leg on about a 3 inch block. Today it was 2 boards and a children's Bible. I stifled a laugh at the irony of him standing on a Bible. He actually did well, much better than last time. He moved right when they took the first x-ray so another had to be taken, but last time we could barely get him to stand there.

The doctor came into the exam room and told us that his hips look great. That is one of the most important things with Owen regarding his LLD. First of all, he had hip dysplasia, so making sure his hips are developing and forming well is critical. Also, without the structure of a strong, well developed hip, a leg cannot be lengthened. Since that is what will correct his LLD, we need his hips to be in top notch condition. They look great, and hips don't lie! Great news.

We expected the discrepancy between Owen's legs to have increased. It did not. His left leg is still about 3 cm shorter than his right. It is GREAT that the discrepancy did not increase. The doctor (I don't know if I've mentioned but I love her) insists that it will eventually increase, but I choose to hold out hope that it will not. She watched him walk (and run and climb) and said that no way did he need a shoe lift at this point. I was thrilled to hear that. I feel that we should wait to open that can of worms until it is absolutely necessary medically. He gets around amazingly, and really doesn't even notice the difference. Even MORE good news, we don't have to go back for another follow-up for a year. A year. This is the first specialist that has allowed that long between visits.

We discussed the lengthening procedure. She believes that she will have to perform two lengthening surgeries. A bone can only be lengthened by 20% at a time. I don't like the thought of it, but the good news is that she feels she will only need to lengthen his femur and not his tibia. She thinks the discrepancy in the tibia will be so minor that the length can be made up in the femur. This is promising because only one bone will need to be broken. One thing that was quite shocking was when she shared with us that at the last deformity class that she attended, there was discussion about beginning the lengthening process at the age of 4. Previously we had been told age 8 at the earliest. I just didn't feel great about the idea of a leg lengthening surgery at the age of 4. She agrees, saying that she is not sure how comfortable she is with the idea. I am not sure how she is thinking about it as a surgeon, but as a mom who has a 4 year old I am aghast at the idea of keeping him non-weight bearing, about turning screws in an external fixation device to grow his bone when he can't truly understand what that means. After the lengthening is complete a child can walk, but it is very important not to bear weight during the actually process of growing bone. The screws can only be turned 1mm per day, so it isn't an extremely expedient process. The good news is that we still have 2 1/2 years of medical advancement and time for the medical to community to decide what is best. It is not a decision that needs to be now.

I think one of the most satisfying aspects of today's appointment for me is that according to what the doctor said when she first began seeing Owen, this would have been when he started to walk. Instead he has been walking for 8 months and is now running, climbing and getting around like he has no idea that he has LLD. Again, he amazes me, I am so proud of him. The doctor was too, it was clear.