Limping

We spent last Wednesday at Children's Hospital with Pookie. We were there to see her orthopedic surgeon. Normally we see him every six months to check on her spine. Her scoliosis has been progressing in fits and spurts for the past six years. When she grows, it grows. And then she needs a new brace.

But we weren't there for a standard brace/spine check. We were there because her gait had been steadily deteriorating. Her waddling walk had become a definitive limp and then started approaching a staggering sort of limp. We let her parade around naked after bathtime trying to get a sense of where the limp originated: her feet? knees? hips? spine? Our guess was her left knee, but we couldn't say why.

The doctor came with his standard accompaniment - an intern, resident, or in this case, an orthopedic surgeon visiting from Palestine for a few weeks. He watched her walk with and without her brace. He poked a bit. He moved her joints through their full range of motion trying to feel the resistance someplace. He hypothesized it was her hip. He knew from previous x-rays that her hips aren't formed exactly right. Perhaps something had changed. He sent us down to radiology. Hips and spine please - just to make sure it wasn't related to the curve.

X-ray technology is pretty amazing. The digital films can be screened immediately by the technicians. And by us. I love seeing them and asking about what I'm seeing when I don't understand. The technicians are always friendly, and this time they were also impressively proficient at getting the x-rays. Sometimes it doesn't go so well because Pookie won't hold still. They were quick with the button.

We learned from the initial screening that her latest brace constrains her lumbar curve quite well. But then that just means the torque in her spine pops out in her thoracic curve. That looked, uh, not so good. And we asked about that dark patch in her belly. Um... yeah. We thought she might be backed up...

Her orthopedic surgeon looked at the x-rays. No evidence of anything that would drive such a limp. We went back to our hypothesis about her knee. She sat in her jogger and allowed him to work with her knees. He thought he could talk himself into believing there was some swelling. He noted that he couldn't quite get full extension. We reminded him of her high tolerance for pain. She gets mighty upset by unpleasant surprises, but doesn't complain about any pain that is anything like chronic. She didn't know that her reflux hurt until we fixed it. Now she knows to ask for her medicine if it's bothering her.

We all watched as he attempted to straighten her leg. She was distracted by whatever she was doing, but there was just a hint of stiffening throughout her body. He decided that was enough to warrant x-rays. Back to radiology: two views, both knees. I jokingly asked if we should just do her ankles and feet at the same time...

After all the requisite waiting before and after the x-rays, then waiting to be seen by the doctor again, he took a look at her new x-rays. We learned that Pookie's right knee cap had either formed in two parts or been fractured sometime in the past. Did I mention her high tolerance for pain? But that wasn't causing any problems, it was merely an interesting side note.

Her left knee cap isn't where it's supposed to be. It's high and to the outside. He examined it again and was surprised to find fluid around her knee. She had walked from the waiting room to the exam room, perhaps fifty feet. That was enough to make a presumptive diagnosis that her knee was the cause of her limp. He referred us to the hip and knee specialist. Speculation is that an MRI might be in order. That would require sedation. Pookie has a significant anesthesia risk - just ask the team over at Eye & Ear. Her orthopedic surgeon wants an MRI of her spine if we need one of her knees. Double check for a tethered cord. He also referred us down to the orthotists for yet another brace.

Pookie did not want another brace. She managed to wrestle her pant leg up over the brace and then ripped off the brace within about twenty minutes. I sighed. We discussed how to make it more difficult for her to remove it. Turns out we didn't need to. Each time I put it on I explained that it was to help her knee feel better. She's a smart kid. She can tell it helps.

The next evening we were out for dinner. I noticed her limp was less pronounced and that she was walking faster. Then she went up a small step leading with her left foot. I can't remember the last time that she did that. So we know we've identified part of the problem. Next month we go back to meet the hip and knee guy. I wonder what he'll discover?