Femoral Plate Removal

Today was our daughter's much anticipated femoral plate removal.  It is accompanied by a sense of satisfaction, as it feels like this plate removal completes a course of treatment that began 18 months ago.  That timeframe may not sound long for adults, but this accounts for approximately half of our little hippie's life thus far.  She still has ongoing needs and about 15 more years at Scottish Rite... but we are breathing a svelte sigh of relief today.

As we dressed this morning, Daddy sang the Cheers  theme song.  After her assorted surgeries and day surgery procedures, today was Hip Chick's sixth OR visit.  Our routine has morphed into a "knee-jerk" series of motions.  I always wear a pendant with her birthstone, inscribed with her name, to the hospital.  The Admissions Rep who checked us in this morning was the same woman who humored my Twelve Drummers Drumming request from Hip Chick's final cast-off last December- she has admitted us on several occasions.  We never eat before we leave home or before she is wheeled to surgery, out of respect for her NPO orders.  While she is in surgery, we always order the same omelettes from the same cook in Scottish Rite's Crayon Cafe.  Today's day surgery nurse had cared for Hip Chick on previous visits.

We always carry the above buzzer while we wait.  If I were a more enterprising woman, I would concoct a means to hang it around our necks- like a VIP pass.  A thought, perhaps, if we have six more of these in our future.

I asked Daddy: "At which point does routine transform into ritual?"  (Or perhaps ritual with a hint of superstition?)  After a deep swig of coffee, my thoughts tacked on a footnote regarding the benefits of a highly caffeinated parenthood...

Fast forward to Hip Chick's appointment.  Much to everyone's delight, Hip Chick presented us with her best disposition to date.  She relaxed while in pre-op with a new favored doll (at top).  Now that Hip Chick has a weekly dance class, she keeps her ballerina close and her ballerina kept her company during surgery today.  Hip Chick willingly swallowed her dose of "goofy juice" and smiled as they wheeled her away.  Upon return from the OR, she snoozed peacefully in my lap.

Her surgeon provided us with the option to retain her femoral plate.  This had not previously crossed our minds, but we accepted the offer.  Scottish Rite sterilized it and bagged it for us (above).  It is, after all, due a bit of gratitude... it held our daughter's femur together as it healed for the past 10 months.

As for today's results, we were excited to see that Hip Chick did not return to us in a spica cast.  There was a small chance that she would need one if a complication was discovered during the procedure.  I found myself gritting my teeth oh-so-slightly as they provided her a choice of cast colors before surgery... just in case.  Daddy and I much prefer the bandage currently residing on her leg to a sixth cast!

So what does all of this mean?  It means that she continues to heal and recover as planned, which is exciting!  Her load bearing restrictions are "as tolerated" until her checkup, with no high impact activities for four to six weeks.  These are standard restrictions after femoral plate removal.  After her post-op checkup next week, she will resume her quarterly imaging and physical appointments in the fall... her progress still has to be monitored to determine whether she needs another major intervention before her fifth birthday.  This continues to match the course outlined to us by her surgeon last fall.

I neglected to note one detail of our surgery rituals above:  For each major hip dysplasia treatment, we give Hip Chick a fairy figurine from a favorite collection.  Today's figurine is the Flower Fairy.  It appears that the fairy is climbing her flowers- much like Hip Chick climbing Scottish Rite's playground, as pictured in yesterday's post.  Each night, we wish her "sweet dreams of fairies" as they line her chest of drawers to watch over her.  The expansion of her collection has been bittersweet, but we have tangible hopes that this will be the last one for the near future.  

Discharged home, with no complications, no cast... and we have no surgeries scheduled for the first time in 18 months!  Hip Chick received her best possible outcome today... and we parents could not be more proud.  Sweet dreams, indeed.

Quarterly Check Up- July 2014

Happy summer!  We have been busy in the Hip Chick household and hope your summer has been as eventful as ours.  Mommy opted to take a blogging sabbatical for the past three months... but we have a plethora of news to relay and have returned with a midsummer's blog.  This has been a happy time for Hip Chick, as her mobility gains accelerated and some exciting milestones have passed.

First milestone was our family's maiden Disney cruise!  It was decided that, after all she experienced in 2013, no one deserved to meet Mickey and Minnie more than Hip Chick.  Mommy had read other 'hip' moms' experiences regarding their hip kids' (in)ability to manage active days post-surgery/casting and wondered whether Hip Chick would straggle behind... but not our little hippie!

We enjoyed two days at the beach, swam most days, and met every Disney character we spotted on ship!  Any volatility on behalf of Hip Chick was more due to too much fun and too little sleep some nights rather than mobility concerns. 

Our vacation was followed by Hip Chick's third birthday!  This was extra-special for our family, as this was the first birthday that she could walk.  Not only walk... she jumped and bounced her heart out at a local bounce house event center.  It was only befitting that she requested a "Brave" theme, as our spunky little princess certainly acted far more like Merida during all of her surgeries and casting last year than Sleeping Beauty.

After her birthday, Hip Chick enrolled in two activities:  her first cooking class and her first weekly dance class!  We naturally cook at home, as Mommy has a passion for cooking.  As we couldn't enroll her in sports this spring, cooking seemed to be a natural fit.

While casted last year, she would watch her little friends attend dance class and then sadly ask when she would be able to dance, too... so the news that we enrolled her was met with grand excitement.  Her first "dance" was to the Pharrell Williams hit Happy and I cannot think of a more fitting welcome.  She has learned to gallop, is crawling through tunnels, and is jumping!  Her dance instructor advised that Hip Chick's standing locomotor skills are fantastic, given her medical challenges.  Her opportunity lies in some of stretching motions the group begins class with.  Namely, she cannot fully draw her left knee to her chest and sometimes compensates with unusual positions on her left side.  At home, this means she has difficulty putting her left sock and shoe on and pulling them off.  Which leads us to her quarterly imaging and physical in mid-July.

While we have enjoyed a significant reduction in her medical needs this year, her July appointment was met with much anticipation.  Not only was this appointment to check her hip's progress, but to also discuss her upcoming femoral plate removal (day surgery).  When we informed Hip Chick of her upcoming appointment, the first thing she mentioned was Scottish Rite's popcorn machine.  Scottish Rite was certainly wise in integrating that sunny spot into its culture.  Mommy would much prefer that her knee-jerk reaction to Scottish Rite is over popcorn than a series of medical procedures.

As usual, we began our appointment in Radiology.  Hip Chick surprised us all with her best xray to date!  Some of our avid readers may recall tales from prior blog posts of three or four adults working together to restrain her for an xray... but those days are (hopefully) behind us.  Now, she can look at an xray and talk about the bones inside her body.  While 18 months is a relatively brief time for us adults, it makes a big difference in a young child's experience.

After a short wait and vitals, Hip Chick met with a Nurse Practitioner.  She performed a few physical tests to determine her range of motion.  Later, she returned with our daughter's surgeon and his team, which included additional physical tests.  We learned that her femur appears to have healed nicely and her femoral head remains in socket.  It remains a little low... but, as mentioned in her last quarterly update, there is time for this to rise into a mid-socket position.

We asked about her dance instructor's observations.  Her surgeon questioned whether her new hip socket has developed a minor "ridge" or "lip" which is limiting her left leg's range of motion as described above.  As with her femoral head's placement, he suspects this will smooth out over time.  Her mobility gains are still very positive, however.  She would have been unable to run, jump, or gallop without surgery and casting, so Mommy and Daddy remain very encouraged with her news.  (The climb above would have been impossible without medical intervention.  Thank you, Scottish Rite!)

We celebrated with a little playtime on Scottish Rite's newly renovated playground.

And so we have another day surgery to go.  As part of the osteotomies last year, a plate was placed onto her femur to stabilize it for recovery.  Adults may have the option to retain any such hardware placement, but young children need these sorts of things removed to prevent any hindrance to growth.  Her surgeon doubts that a spica cast will be necessary for recovery (Whew!).  He advised that the total healing time is approximately three years, but the immediate risk of refracture is during the first few weeks following removal... it appears that our biggest opportunity for this recovery will be making her rest!  She will remain home from preschool for the first couple of weeks to prevent any irresistible temptation lurking at the playground.  A couple of weeks at home as opposed to last year's 26 weeks of casting?  Challenge gladly accepted!

Post Osteotomies: Seven Month Recap

As we close April, our daughter is seven months post salter (pelvic) and femoral osteotomies and four months post spica... and boy, is she moving!  Most of our news was covered in my last post, but there are a few details to relay.

1.  After cast off last summer, Hip Chick sported shaggy legs... is the extra fuzz still there?

No!  We were advised that her body grew hair to help protect itself from the cast and it fell off over the past few months.  

2.  How are we managing any remaining limitations?

She needs to practice reaching her left foot.  We struggle in coaxing her to do things such as take off her left shoe... but left alone, she will do so on her own terms.  

3.  Have we enrolled her in any enrichment activities?  

With the femoral plate removal scheduled in July, we are waiting until fall.  We see no need to begin an activity she will need to rest from for a month.  Two activities we are eyeing are swimming and/or music lessons.

4.  What play activities are we allowing Hip Chick to attempt?

Most recently, we took her to a friend's roller skating party.  She used the "walker" they offered for new skaters, but felt most comfortable using the walker on a carpeted area (as opposed to the rink).  Playgrounds and play pals are all game!

5.  Do we anticipate any potential summer plans to be hindered by her hip?

Not at all!

Quarterly Check Up- April 2014

Today was Hip Chick's much anticipated check up.  We were uncertain what news to expect, but approached with a mix of hope and reservation.  We knew her mobility is still lacking, but what would her xray show?

We entered the hospital and were immediately greeted with the familiarity of the popcorn stand.  Daddy recently volunteered for an on site game nite and was advised that Scottish Rite opted for the popcorn service upon first opening so that it would not smell like a traditional hospital.   It always lifts Hip Chick's spirits.

Hip Chick inspected each aquarium and model train display along the path to Radiology.   We viewed today's xray as a success- she cried, but we did not have to hold her down.  (Some previous xrays have resulted in three adults restraining her to obtain a clear image.) Two takes today and we were finished.  She earned a roll of stickers and several high fives.

We munched on popcorn while awaiting the results.  Regardless of aromatics, the crunch and pop of a hot, buttery snack helps to alleviate nerves.  Soon we were escorted to an exam room and familiar faces.  Our nurse practitioner spoke more excitedly about the imaging results than Hip Chick's surgeon, but her introduction helped break the ice.  And the results?

Hip Chick's new socket is as her surgeon expected, which is good.  Her femoral head still sits a little low against the hip socket.  There is time for this to rise into socket, but it will likely need to push out some cartilage out in the process.  This is not bad, but also not ideal- we will need to monitor.  Her left leg's range of motion is still compromised.  She has functional mobility, but we still need to monitor for improvement.  If/when her gains stagnate, we may consider physical therapy.

So what happens next?

Our little hippie has another xray and physical in three months.  This will be closely followed by a day surgery to remove the femoral plate which remains from last September's osteotomies.   Our biggest news of the day:  if there are complications with the plate removal (ex: bone overgrowth), she may require another spica cast for recovery... but this would only be a two week casting assignment.

Surgery aside, we will also begin looking for signs of avascular necrosis at her next appointment.  This is a disturbance in blood flow, to the femoral head in Hip Chick's case.  She shows no signs of this now, but it can develop anywhere from nine months to two years after surgery.  Avascular necrosis could cause growth issues for the femoral head, so its growth will be monitored.

To reward Hip Chick's good behavior, we swung by a favorite local custard shop.  Another three months before resuming her medical agenda is quite the gift... but we feel that today's appointment brought us cautious results.  Our frozen treat won the sweet award for today... but as always, we continue to think positively.

Princess For a Day

Hip Chick has a big appointment scheduled this week.  We have enjoyed the three month reprieve from her myriad of medical assignments... but, alas, the respite is drawing to a close.  But first:  A bit of fantasy.

We in the Hip Chick household are preparing for a visit with a celebrated m-o-u-s-e in the coming days.  After a 2013 filled with traction, two major surgeries, four day surgery procedures, and a total of 26 weeks in five casts, it was decided that we all deserved a vacation- especially Hip Chick.  Details were double and triple-checked prior to solidifying reservations... and yet imagine our surprise when we learned that a two week technicality may disallow Hip Chick from realizing her bippidi-boppity dream as a famous book-loving, yellow-gowned princess!   

When a member of our local renaissance fair heard of this unfortunate setback, she was aghast... there is no "age limit" on becoming a princess!  A special part in an important ceremony was lovingly planned for our little hippie and off we set, for a strange, new land, filled with magic and fantasy:

Neither Daddy nor I had previously visited this mysterious land and so our little hippie's princess inauguration was an adventure for all three.  I cannot pinpoint with certainty what our expectations were, but they were certainly no match for what awaited us.  Fairies... check!  Gandalf... check!  Whip cracking contests, turkey legs, medieval speech, kilted men, human chess boards, glass blowing, and jousting... all check!

We began with a visit to Scottish Court, for conference with the Queen.  Hip Chick was invited on stage.  After a promise to eat her vegetables (even the yucky ones) and an extra sprinkling of magic dust... *poof*... we had Princess Hip Chick!  We were curious as to whether she would shy away from the celebrity, but Princess Hip Chick gleefully waved and exclaimed, "Mommy, Daddy... I'm on stage!"  After standing with the Queen's Court and dancing on the human chess board, Princess Hip Chick held hands with our guide, a certain honorable Lady, as she began exploring the strange land.

She met another Queen and Prince's acquaintance.

Knights bowed before her, exclaiming their honor to meet the Fair Princess.

She shielded her snowy white skin (come on... this blog entry begged for that quip) with a beautiful parasol.

We crossed paths with a fairy who granted an extra special sprinkling of dust and soon our little hippie donned wings to become a fairy princess.

However prim and proper the fair maiden may have been dressed, the truth of the matter is that she begged for the largest and most dangerous ride she stumbled across.  We attempted to substitute the excitement with an elephant ride (what magical land doesn't feature elephants and camels down the street from Mermaid Lagoon?), but Her Majesty had a royal meltdown when the elephant's ear flapped her leg at the ride's end.

Princess Hip Chick regained composure by joining every drum circle she found.  No matter how dressed and fussed over, our little girl will forever be more of a hippie than princess. 

She also wanted to crash a young lady's gypsy dancing performance, which is where Queen Mommy drew the line.  (We failed to snap a pic, but the young lady also balanced a sword on her head... and princesses do no such thing!)

A very special day, indeed.

And now we have the appointment.  There is a smidge of angst heading into it, as this week's xray will be the determining factor for the remainder of Hip Chick's year.  At best, she has a day surgery this coming summer, to remove the femoral plate which remains from last September's osteotomies.  And if her xray shows that her hip is redislocating?  Well, I feel safe in saying that nearly every 'hip' parent I have crossed (whose child was diagnosed late) has these sorts of roller-coaster experiences.  As always, we think positively.

Post Osteotomies: Six Month Recap

Time has flown!   Hip Chick has completed six months since her pelvic and femoral osteotomies and three months since cast-off.  We have enjoyed a much-deserved hiatus from last year's succession of appointments and procedures, but are preparing for an upcoming checkup.  Below are our latest thoughts.

1.  How is Hip Chick's mobility?
She still displays a marked difference between her left and right side's mobility.   Most recently, she has gained a notable amount of speed.  She is almost running.  She still cannot fully (un)dress her lower left side, but she can accomplish what she sets her sights on.

2.  How is her overall disposition?
She is a boisterous, defiant, imaginative, busy, energized little girl!  We had read that some other children have had difficulty maintaining pace with their peers, but we are hard pressed to wear her out.  She is obviously catching up on lost time!

3.  Prior posts indicated lingering issues with nightmares... has this continued?
She does not seem to have any unordinary sleep issues at this time.  Every night, she still claims to dream of fairies and flying- which is a holdover from the fall casting phases.  She occasionally has a bad dream, but never mentions her surgeries or casting when we discuss the dreams with her.

4.  Does she show concern over her scars?
Hardly.  She will talk about her femoral scar on occasion,  but never her pelvic scar.  We tell her that her scar is where her doctor helped make her leg and hip better.  She seems happy with this explanation and can repeat it back.

5.  She transitioned into her childcare center's Lower Preschool class early this year- how does her development compare to her peers?
She has now caught up with her original classmates and has rejoined their class!  She is starting to tell us which sounds letters make and is learning to spell her name.  She is two months from her third birthday and I just bought her 48 piece puzzles to work on at home.  Clearly, physical disability does not automatically implicate a child to mental disability.

6.  Is Hip Chick enrolled in any enrichment activities at this time?
We would love for her to enjoy dance or swim classes with friends, but we felt it best to wait.  Her surgeon advised her hip would be stiff and her mobility would incrementally improve for at least six months post-casting, if not nine months and beyond.  We will wait until she recovers from her femoral plate removal to enroll her in activities beyond her standard preschool curriculum.

7.  What is next for Hip Chick?
She has an xray appointment at Scottish Rite in about two weeks.  Her surgeon will check her hip's positioning and discuss more firm timing for her upcoming femoral plate removal.  Her imaging results will help determine what additional needs, if anything, she may require this year.

Gold Medal

One year ago today was one of the most difficult days in our life.  One year ago today, Daddy and I awoke with much dread and hardly choked back our tears through the day.  One year ago today... Hip Chick was placed into traction for the onset of her DDH treatment.

Yes, it was the beginning of a very challenging year... and look where Hip Chick is today!

With this anniversary in mind, it may seem odd timing to bring sports into discussion, but I cannot think of a more appropriate topic.  Big Sis, Hip Chick, Daddy and I welcomed the recent winter olympic opening ceremonies (hosted in Sochi) with a bit of festive cheer.  We snuggled together in our living room, drinking sbiten, a popular Russian mulled honey (or wine) drink, recipe here:

Sbiten Recipe

And indulged in a little chocolate babka.

As we watched the parade of nations, we cheered the world's greatest athletes.  Undoubtedly, each of them has overcome great odds to reach this competition... yet the question begged itself:  "Which olympians overcame even greater physical odds than their typical counterparts?"

Today's post is dedicated to some of these athletes, who I discovered in my oh-so-humble scientific method of internet surfing.

1. Natalie Du Toit, link here:  Amputee Swimmer
    Ms. Du Toit was the first female amputee in able-bodied olympics.

2. Kieren Perkens, link here:  Swimhero
    Mr. Perkens began swimming at age eight, as rehabilitation for a serious leg injury.  He later became one of the world's greatest long-distance swimmers.

3. Greg Barton, link here:  Gold Medal Kayaker
    Mr. Barton became a double gold olympic winner despite being born with two club feet.

Those featured above are a just a short list- there are many more athletes who have overcome remarkable physical hindrances to excel their full-bodied counterparts.  A popular commercial playing during the current Olympic games recognizes the parents behind today's Olympians.  I think the parents of the Olympians listed above (and those like them) are the true heroes.

This is appropriate timing, as I have recently come to a level of acceptance regarding Hip Chick's physical condition.  As you watch her play, it is obvious that her left leg does not match her right leg's fully mobility.  She obviously favors her right leg.  But it does not slow her down.  She can twirl, climb, and "run" to her own content.  She is happy.  She is capable of achieving what she sets her sights on.

 I have often remarked to people that Hip Chick has the personality and drive to compete despite a physical disability, if that were to be here calling.  As mentioned before, the day she was diagnosed with hip dysplasia, her classmates held a race.  Hip Chick was inconsolable that she did not finish first... and she did not finish last.  Exactly what will a little girl who outran her classmates with a dislocated hip achieve? 

Still, it is too early to tell whether she will ever truly "run."  She may never compete for her high school team.  I am confident, however, that she will achieve happiness.  And that is worth cheering for each day.