Friday, June 28, 2013

Emily's Arm

On Sunday, June 23rd, our daughter, Emily, suffered a silent injury where she lost almost all mobility in her left arm. We don't know how it happened and are unaware of any way we could have prevented the problem from occurring. All we know is that at one point, she stopped using her left arm and hand for touching things and playing.

When we first noticed the problem, we panicked and called a doctor on call. We were told she needed to be seen right away. So we went to the KidsCare clinic in Taylorsville. Emily was diagnosed with Nursemaids Elbow, a nice name for a dislocated elbow. The doctor tried several times to flex Emily's elbow to elicit a pop sound to indicate the joint was back in place, but no pop sound was heard and Emily still could not move her arm. After X-rays and examination, Emily was set up in a splint and a sling to give her arm a rest. We were advised to go to Emily's primary care physician and follow up the next day.

While visiting her primary care pediatrician, we observed Emily's doctor flexing her elbow to see if she could restore motion for Emily, but that didn't work, either. The doctor here had nothing more to offer except for us to wait a week and see what happens. If motion is not restored, we should call.

We were determined to get to the solution, so we called the University of Utah Orthopaedics Clinic. There, we were referred to Dr. Angela Wang, a 16-year veteran of orthopaedics. Numerous attempts were made to flex her elbow to see if motion could be restored, but all efforts failed. Even after examining X-rays from the day before, they called for new X-rays. All X-rays indicated normal conditions in Emily's arm. They could find nothing out of the ordinary.

I note with interest, that Dr. Wang is not a pediatric orthopedist. She specializes in hand surgery. When we went there, I was under the impression that we were working with someone who specializes in kids care, but we were not. Why this clinic did not refer us to someone more qualified, I'm not sure. Maybe she was all they had on hand that day.

While I was in downtown to run another errand, I asked a former employer about a neurologist that specializes in kids. A pediatric neurologist. I got some names and went home. At home, I called the U and found that they don't have neurologists for anyone under 18. I called Intermountain Healthcare and found that they have pediatric neuromuscular specialists. That's great! We need to set an appointment, what's the earliest date? Mid-August - two months away.

I was astonished. I was also worried that by the time we got to that appointment, atrophy of the muscles in Emily's arm may become a problem.

My experience here brings up another interesting point. For quite some time, there has been a debate over "socialized medicine". Supporters claim that socialized medicine could mean the end of families going bankrupt over medical bills. That there would be more physicians to handle the load of healthcare. Opponents claim that socialized medicine would lead to rationed healthcare.

Often, I have to wait a few days or even a week to get an appointment with a doctor. Sometimes more than a month. I called to talk to our pediatrician one day early this week around 3pm and she had already left for the day. Talk about bankers hours. If the demand is so great, why are they leaving early? Where is the backup? I'd say that rationing is already here for those who have a hard time keeping up with the costs. A real rationing program would be a concern for those who can keep up.

The average salary of an orthopedic surgeon in Utah is about $148,000 a year. That's just the average which means that the upper bounds is going to be quite high for specialists. That kind of pay is double what the same occupation makes in Europe or Japan and is almost five times the mean salary of Americans.

If we're concerned about rationing healthcare, that's already been done. Health care consumes about 18% of GDP now. Which seems like an interesting number when conservatives complain that government spending is higher than 18%. I wonder why I hardly ever hear them complain about a protected healthcare industry that continues to take greater and greater chunks of GDP every year.

For now, we're just going to check on Emily to see that she does recover use of her arm. We're also considering a trip to at least one clinic in Southern California. I've seen some more movement this this week and that's encouraging.

Since that day, Emily has been recovering some functioning in her arm. She is able to move her hand and can grasp objects of her desire. But her range of motion appears to be limited by her shoulder. She is not able to raise her arm very high and that is troubling. I am however, gratified to see that she is moving it at all. I'm starting to think that she is experiencing pain and some mechanical resistance, but am not sure of the source.

Only time will tell, and I will keep you all posted. In the meantime, I want to ask you all: Who do you know who could help us? If you know of a specialist or some gifted healer, let me know.

Thank you.

Update - 6/30/13

After about a week, significant improvements have been realized, with no help from the doctors involved earlier in the week. For example, we have noticed she has a particular fascination with the clear green Perrier bottle and have exploited that to motivate her to use her left arm.

I started with just putting the bottle top with the cap on, in the palm of her left hand and then propping the bottle up with her right hand on the other end. Throughout the week, she became more adept at managing the bottle in her hands again.

My wife Alice has spent hours playing with Emily by presenting her with toys. Emily will grasp the toy with her right hand and, it seems that through sheer desire, brought her left hand up to examine the toy further.

  • Emily can now move her fingers much more than before.
  • She can bend her elbow.
  • She can grasp objects with her left hand.
  • She can lift her left hand to meet her right hand.
She still has significant impairment to her left arm, though. She still tends to keep the arm down when in an upright position. She cannot lift her left arm above her shoulder like the right arm. And she seems to forget her left arm unless some other motivation overtakes her.

I have some reassurance that these impairments may resolve in the coming weeks as Emily grows up. I hope so. But in the meantime, I'm looking at other resources to consider to assist Emily's recovery.

Thanks again.
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