
Devin's appointment at Mayo went well today. It was a completely different experience than we have had at Gunderson or any other medical facility we have ever been too and we walked away feeling that it was too good to be true.
There are 2 philosophies used for dealing with the hips of children with Spina Bifida. The older philosophy is to make sure that the hips are in socket. This can often mean surgery after surgery to keep them in this position. Even after repeat surgeries it can still be very difficult to keep them in socket because of the muscle imbalance that is present in children with Spina Bifida. The other thing that happens with surgery is that the hips stiffen up, which makes it difficult for children to be in certain positions after surgery. According to Dr. Shaunessy, Devin is at the beginning of this window. It sounds like we could do this up until he is about 7 years of age. After that, the process becomes more difficult to perform.
The other philosophy is that you leave the hips in a dislocated position. In order to implement this, both hips need to be pretty equally dislocated. The thought is that people can and do walk with their hips dislocated. While able bodied individuals may have pain with dislocated hips, people with Spina Bifida do not seem to have the pain sensation in the joints. While Dr. Wintersteen (Gunderson) is indicating that Devin's left hip is out of socket, Dr. Shaunessy feels that they are both out of socket. The left slightly more than the right, but pretty equally. The long term prognosis for each choice seems to have similar out comes.
Dr. Shaunessy was hesitant to make a decision on performing surgery without the advise of the other Spina Bifida Clinic doctors, but did give us information on non-surgical options. Mayo's philosophy is that children who have quadriceps that function should not use KAFO's so he has ordered that we discontinue the use of them. We are hoping to work with our PT to transition to only AFO's but our PT does think that the KAFO's have been a useful tool in getting him walking. Dr. Shaunessy feels that if we can not accomplish walking without the KAFO's that the tendon that causes his foot to turn in should be cut and at that time they will also correct the twisting of the lower legs, as this is not likely to correct itself. Dr. Wintersteen (Gunderson) had thought that this might correct itself. Dr. Shaunessy is thinking that this surgery would be more of a priority than the hips, given that the feet turning in is preventing him from being able to walk without KAFO's. This would involve casts on the lower legs only and would still allow him to stand and crawl.
We have made the decision to discontinue our doctoring at Gunderson. We will go to a local Pediatrician and go to Mayo for all of the Specialists. We will go to our first Spina Bifida Clinic at Mayo in about 3 months.