Today was Day 1 at Children's Hospital Boston. We saw two orthopedic specialists. The first dealt with lower extremities, the second her upper extremities.
The second doctor (upper extremities) really didn't have much to offer. Basically any surgical option would not be advisable for her because of her overall health but he clearly stated that any surgery to fix those shoulders would be counter productive. He was not optimistic that it would fix anything and he said the failure rate, especially for someone like Peyton is very high. In a nutshell, he stated that he tries to weigh hurt vs harm. He did think that she probably experiences some pain as her shoulders pop in and out. Sometimes not as we've seen, but when it gets stuck out of socket and we have a little more difficulty, it probably causes some issues with the muscle and then she winds up in more pain. Pain management is the key but he said nothing that is happening with her shoulders is going to cause "harm" to her. Keep on doing whatever we're doing therapy-wise. He said we're not going to harm her. He also said that there is no bracing that would help. So, that wasn't the most exciting visit but he was very nice and gave honest opinions without being condescending! If this was the ONLY appointment we were here for, I'd be a little unhappy but as it is part of a group of specialists she's seeing, it was good for him to weigh in.
The first doctor was lower extremities. She had some concern about the possibility of pain issues arising in her neck - the spine being pinched somewhere. Peyton had a series of neck x-rays done and they did not show anything, so that is good. On examination, she did note some scoliosis. I also mentioned in one of the doctor notes from MUSC they noted (on a chest xray) some compression at T8 (I think it was T8). She said given her overall condition, these things are not surprising. She didn't say anything about what to do about those - I think it is what it is unfortunately. As far as her hip pain, she felt that it was clearly related to the hip popping in and out. But she said there may be some neurological component there as well. She talked extensively about what our long-term plan is for Peyton - what her plan of care is (i.e. DNR, life expectancy, etc). Basically, what are we looking for for her - a surgical solution or comfort? Of course I told her we want to do what helps her but if that is pain management and comfort, then that is fine. She was really nice - not overly personable - but nice enough and definitely explained things thoroughly. She described the surgical procedure that would be recommended - basically if you do one hip, you have to do both - the thigh bone is shortened and then re-angled into the hip socket, reshaping the pelvis, etc. She said it is a high blood loss surgery and is a pretty major deal. She wants all the specialists we are seeing to weigh in but she feels (as do we) that the effects of the surgery itself might be worse than what she's dealing with now. Pain level now vs. post-surgery/recovery. Will it work and for how long? What benefit is there really for her long term? I think based on the fact that there are other surgeries she theoretically could have (i.e. re-do her nissen fundoplication which is not working properly now, and the potential for mitral valve repair/replacement - cardiology said she would likely not survive that surgery if it became necessary...it's not TODAY...but could be one day)...those surgeries aren't going to be done, so it would likely be that this surgery would not even be an option for her because of her overall health. All that said, she said she could DEFINITELY benefit from a Rhino brace. (See google images here. Peyton had one of these as an infant.) She said when she's drawing up that leg (which she frequently does), she's putting it out of joint and it's staying there. She said that the brace plus the oxycodone we're currently doing should be sufficient to help keep her comfortable....if comfort is what we are trying to achieve for her right now. As to her stander, we can use it, but more in a sitting position. Standing in it will clearly depend on her level of pain. I think she is good with all therapies resuming but she did not offer any specific things that could be done.
So at the end of the day, do we have any real answers and an amazing solution to a big problem? No. This being the day with the two appointments that were the main reason for us being here, was it worth the trip considering all I just said?? Yes. The doctor in Charleston didn't even offer the Rhino brace. He doesn't think there's a problem. He didn't describe the surgery at all. It was good to hear everything she said even if there's no definitive solution to the problem. I am glad we came.
Tomorrow Peyton will see the Pulmonary doctor. This is good especially with her still dealing with the ongoing aspiration pneumonia. She's still dealing with the IV meds for over a little over a week yet. She isn't any better or worse at the moment. We don't have any issues with the Pulmonary clinic in Charleston, but since we're here, we just wanted to see what they'd have to say about her overall respiratory health - just to see if there is anything they would add or change or recommend or test for, etc.
Ron and Moira walked down to Fenway Park this afternoon for a little look see. Peyton and I stayed behind and napped. I'm not sure what all we will do while we're here. It is difficult getting out with Peyton considering all we have to bring every time we head out the door. But I hope to get out and see some sites.
Please continue praying for Peyton's health to improve. As I said, she's no better even while continuing on these two IV antibiotics. But she's no worse, so I guess that's good.
OH...and as for Children's Hospital Boston, it's an amazing place. It's huge. Ron said when you walk in, it's like a train station. There's just so many people everywhere. I'll have to get some pictures. While in the waiting room, I was really impressed with the volunteers helping kids to feel at home. There are tables with coloring pages and crayons/markers laid out in every waiting room we saw. They had clown comedians in the waiting room at one point. They just did a really great job of making people feel at ease. Kudos to CHB!