Sunday, May 6, 2012

More Botox......

 The Orthopedic surgeon wants to do more Botox.  Oh dear. What have I started?

It has been 3 months since Corbin had 29 injections of Botox into his aductors, hamstrings and calves.  The effects can last up to about 6 months - In my opinion the effect of the Botox has all but gone for Corbin - I do conceed that perhaps the only lasting effect has been in his hamstrings - there is still a little extra range here.  His feet position has returned to pretty much normal or should I say pre botox, ie the left foot rolling in so that he stands on his the top of his arch area in weight bearing and the right rolls out (and toes point in) so he stands on the outside of his foot in weight bearing.  In the walking frame his gait is again all over the place with significant pelvic twist occurring to help him step. 
The physio still believes the Botox has been a huge success - to me it depends on what you define as success.  I do not believe that the fact that he had the ability to walk in severe pain and discomfort  for very short lengths of time with his heals down, for approximately 2 months maximum is a success.  Was there an improvement in function - NO.  Was there a long term improvement in anything - NO - As I said his walking gait is pretty much back to pre botox.

The Surgeon is impressed with what the physio said happened, but all of a sudden he is very concerned about Corbins left foot (the left leg being the better of the 2) and the fact that he rolls the foot position so far inwards during weight bearing that he is actually standing on a bone in his foot that he shouldnt be.  So this is the main reason he now wants to do more botox to release the left leg in the calf area to allow him to get his ankle at 90 degrees angle without rolling in inwards to relieve the pressure on this bone that he stands on.  I might add here that he has stood in weight bearing on the left leg exactly the same way for at least 2 years.  During this time we have seen the same Orthopedic surgeon at least 5 times and this is the first time he has even noticed, much less shown concern, about the position of his feet (despite me specifically pointing Corbins right foot position out to him 12 months ago because this is what I wanted him to look at and consider doing something about in the first place).  I just don't get it.  It seems to me that there is something different the medical powers that be hone in on every time we see them. It doesn't give me much confidence.

Over the past 15 years my experience with mild-moderate cerebral palsey is that the kids can change from one hour to the next (let alone week to week or month to month or 6mthly appointment to appointment) in flexibility, range of movement, standing stance and walking gait.  This can all change due to fatigue levels, hunger, level of agitation, level of concentration, body and room temperature etc etc etc.  How on earth can an Orthopedic surgeon make an accurate assessment as to what and where botox (or surgery for that matter) is required when all they see is a 5-10min window of the big picture???  Maybe it is as I am inclined to believe - they are only guessing.  It is very much a case of lets try this and see what happens.  I can't help but think where is this going to end.  Initially, not so long ago, the Orthopedic surgeon (and a neurological specialist as well) did not believe that Botox would do anything for Corbin, now after the first round we see that it did reduce his tone to allow him to use the flexibility he has always had to get his heals down, and legs straight for a short amount of time - now he wants to try using Botox to correct Corbins foot position.  Ah the saga continues...................

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