When I was 5 months pregnant, we went in for the standard ultrasound to check for facial deformities, presence of organs, and measuring of the femur to check the actual age of our baby. At that appointment, we found out we were having a girl, and the technicians said everything looked fine. At my next appointment with my OB doctor, he told me that it looked as if her right femur was a little shorter than the left one or maybe bent. He ordered another ultrasound, and after that, he told us we could go down to Anchorage to have the closest specialists take a look with better equipment. We decided to forego the expense of travelling from Fairbanks, staying in an over-priced hotel, and having MORE doctor bills only to have the perinatologist tell us there wasn't anything we could do about it until after she was born anyway.
After a rough pregnancy, and a difficult labor ending in an emergency C-section, Emmaly was born October 26, 2007. The pediatricians who examined her during our stay in the hospital all commented on how her right leg seemed to be shorter than her left, and that we should probably have it checked. It didn't seem like that big of a difference to me, and since my own right leg is measurably shorter than my left, my mother's is too and it hasn't caused either of us any major problems, I figured it probably wouldn't be a major problem for Emmaly.
When she was two months old, it became apparent to me that there was a significant difference in the lengths of her femurs. I asked our pediatrician about it, he measured her legs and came up with a 2cm difference. He sent us to an orthopaedic surgeon who was very nice, and straight forward with me--he'd never seen it before. He ordered some x-rays and left us in the examination room for a while so he could look it up. He came back and told me that I could Google search PFFD and read what was there and I'd be more of an expert on the subject than he was! It was done in a lovingly humorous way, so I wasn't mad at him, only discouraged that I was no wiser about what to expect for my daughter. He brought in the x-rays and told me the little he learned about PFFD. He told me she had the mildest form of it since all her other bones seemed to be normal, and that hopefully, her femurs would grow at a proportional rate. If that was the case, she would need special shoes while growing, but wouldn't need surgeries until she was a teenager. He told us to come back when she was 6 months old so we could get more x-rays, and have a better idea of how she was growing, but that was all he could do for us.
After some internet research of my own, and crying over the x-rays and documentation that I didn't fully understand, I was relieved that Emmaly did in fact seem to have the mildest form of PFFD. I'm guessing at the definition of "unilateral" to mean that only one side, or one section of one side of the leg is involved, both of which are the case with Emmaly.
The Orthopaedic doctor called me back a week later, and said he had conferred with a colleague in Tacoma, WA that specializes in Pediatric Orthopaedics, and he said that I would have to go to someone who had more experience since he had only come across a handful of them in his career, and had sent them all elsewhere for treatment. Our doctor in Fairbanks said he would refer us wherever we wanted to go. I cried some more after getting off the phone with him. Living in Fairbanks makes travel extremely expensive. If I can't afford a trip to Anchorage, how can I afford a trip to New York or even Seattle?!
Yesterday, we went back to the Orthopaedic Surgeon. He took another x-ray of her hips and femur, and gave us some encouraging and some discouraging news. He said that it looked as if her hip ball was forming on the right as well as the left. The discouraging news is that it isn't growing at the same rate as her other leg, so surgery to lenghten the bone will be necessary.
More than just the worry over her physical development, I am scared for my daughter's emotional and social developement. I don't know how to help her understand that her leg doesn't make her any less special or important than any other person, and that she can still do anything she sets her mind to. I wish I had taken an anatomy class in college that could help me better understand the information about PFFD. With so many other things out there to worry about, I wonder how I will help her cope with this. And from everything I've read, no one knows what causes PFFD, so how do I explain to her WHY this happened or HOW this happened to her?
I continue to pray for my daughter, for myself, and for all those who she will come into contact with in her life. I pray for us all to have love, compassion, patience, and understanding.
Comments
Some advice
In reading your letter I get the feeling that you aren't yet quite comfortable with PFFD and your daughter. If that's a true assessment I think the first thing you need to do is to become comfortable with PFFD yourself. That's the most important thing because that will help your daughter be ok with it too. But don't worry if you aren't there yet - that can take time and lots of parents have said the same thing at first or felt overwhelmed with information. We were once there too. One thing that helped us was talking to other parents of kids with PFFD and doctors who were specialists in PFFD. (You mentioned the cost of travel - you might want to talk to the Shriners - they will sometimes provide transportation. ) Another thing that helped was watching our daughter enjoy life. Learning to walk, to read, to speak, etc. made us realize that PFFD is no big deal and since it was no big deal for us - it became so for her too. She just says to questioning people "this is my short leg. I was born that way" and that's it. So far for her (5 yrs old) its a complete non-issue.
We talked to lots of parents and one thing that parents have said was that having a core group of friends through the years and into high-school is very helpful for good emotional and social development. Long-term friends will just treat your daughter as just another peer and help be a buffer against the occasional new person who might not be able to self-regulate their behavior.
If you want to talk about it more - you can send me a message and I'd be glad to send you email or phone information.
re: Some advice
Thank you for your comment so long ago. I just replied to another message I got around the same time. I've been ignoring it for the most part. Emmaly is beautiful, strong and healthy! I am now getting back into the subject because we're moving from AK to WA in a couple weeks, and then in September we have our first REAL doctor appointment in Seattle.
Thanks for your encouragement and advice! I hope that Emmaly will have good friends growing up to help others with their behavior issues, and that she'll have the same attitude about her leg as your daughter does!
-Rachael & Emmaly
Worries
I know EVERYTHING (finding specialist, locating resources, exploring causes, preparing for the future and so on....it can be an impressive list) can be SO overwhelming, but I can assure you that as each year passes you will be amazed about how much needless worry and anxiety that you experienced in the start.
First, lets talk about finances briefly. You may qualify for SSI monthly payments or travel assistance from Children's Miracle Network. Also most non-profit hospitals have "Hospital grants". When you find the specialist that you would "dream of using" see if the specialist is affiliated with a non-profit hospital. Then see if that hospital will approve you for a grant. Then go see this "dream" doctor at that non-profit hospital's specialty clinic instead of his/her private practice. In many cases, all services will be free or they hospital will waive your co-pays. Lastly, find out about your state's birth to 3 program and use their case manager to find resources for you.
Second...causes. PFFD has a variety of identified causes. Most are non-genetic. Decide how important knowing the cause is to your family. If you determine it to be important, consider going to a genetic clinic (usually covered by insurance) to have testing to identify if this is a rare genetic condition/syndrome. Keep in mind that you may not know the cause for years and your child will not expect you to know why or how. Consider grief counseling for you and those who support you, as this counsel can help you understand the un-understandable and help you sort valid fears from irrational, overwhelming fears. Yes, it is okay to grieve about the loss of "why and how"! It is VERY natural. Also your state's birth to 3 program may pay for a counselor to come to your home to provide this service.
Third...emotionally healthy child. Children are amazing....they are born with conditions and never know any other option so their condition IS NORMAL. Children with PFFD generally experience minimal grief for the "loss" because many do not consider it a loss. Children with PFFD do NOT require extra special parenting powers or skills. Everything is very typical! If the medical side becomes overwhelming for you or your child, you take a break because unlike devastating conditions like cancer, there is no timeline that must be followed and no deadline for treatment. Treatment options can be followed-up on at any time. You can enjoy your child's growth and development without fear of additional losses unlike progressive disabilities.
Feel free to blog or email me directly with specific issues, if you think I can be of assistance. My background is personal experience and professional case management.