Jennifer's Story
In the beginning.....
Our lovely little daughter was born by C-section in 1993. Like all babies, she was a doll. Our first hint of a problem was when the doctor told the nurse to save the placenta for genetic tests. Jennifer went to the nursery, mom went to recovery, and dad went to the telephone. A little while later the obstetrician came to the recovery room and told us she was fine, BUT there appeared to be a problem with her left hip. He called the pediatrician and would let him check further. The pediatrician didn't know what the problem was, so he called in an orthopaedic surgeon. The ortho surgeon came in the next day and said he thought our baby had PFFD (the first time we heard the term that has now become so familiar). He wasn't sure what the treatment would be - possibly a prosthesis. Surely he couldn't mean an artificial leg? He must mean some kind of brace while they lengthen her femur. (Denial is a great way to make things easier to bear.) He said he had never seen or treated a PFFD case, so he referred us to a pediatric orthopaedic surgeon.
For the next 6 weeks we just enjoyed our new baby and didn't worry too much about her leg. She has many years ahead of her, so no sense rushing off to the doctor - they probably wouldn't do anything until she got older anyway. But, there always was that nagging doubt about what could they do for our little girl....
...The first dark days
We made our first trip to a pediatric orthopaedic surgeon when Jennifer was about 6 weeks old. He did a very thorough examination and took several X-rays. He explained PFFD by describing each word so that it no longer seemed like just a bizarre acronym. He said that not only was the femur short, the ball at the top of the femur and the hip socket were also not fully developed. He also said that in most cases the knee joint is also missing some of the proper pieces (missing tendons, muscles, etc.). Then came the REALLY bad news. He said the usual treatment is to amputate the foot, fuse the knee, possibly fuse the hip, and fit her with a prosthesis. What!?! Amputate a perfectly good foot!?! Can't we lengthen the femur? He said that if the femur is only slightly short, they might have success with lengthening. In Jennifer's case, he said the femur was very short, and any lengthening attempts would probably result in a very weak bone that would be susceptible to many fractures. He said that past clinical studies found a very low success rate with lengthening. He suggested we think this over and call him with our questions. (Later he would tell us that he knew that after he said amputate that we didn't hear another word he said. How very true.)
We left his office in a state of shock. Up to this point we were sure that Jennifer's leg could be lengthened. Now we had to face the terrible possibility that she would have to wear an artificial leg for the rest of her life. God, this can't be true! Why us? Why our poor little girl? She didn't do anything to deserve this terrible fate. We just sat there in the parking lot and cried.
On the way home, the tears gradually changed to anger and denial. This doctor doesn't know what he's talking about - he probably doesn't know enough about PFFD. We'll search the country (or even the globe for that matter) to find the world's greatest PFFD doctor. After all, this is our little girl we'll talking about here. We'll do whatever it takes to get her the best treatment available.
The fruitless search for info
Remember, 1993 was the early days of the World Wide Web and Mosaic (Mosaic arrived in Sep 93). I didn't have a home PC, and at work we just had an old DOS machine with no internet access. An uncle in California had internet access. He did a Medline search and found 8 items. I took that list to the library at a medical university and was only able to find one of the journals. It described the Van Nes Rotation Procedure. I read it twice before I realized it was describing turning the foot around and using the ankle as a knee joint. This was my first experience reading a medical journal. Whew, what a rude awakening. Lots of terms I didn't understand. Hopefully ,someday, someone will write about PFFD in plain english.
A second and third opinion
We were still in shock, and couldn't believe we would have to amputate a perfectly good foot. We sought a second opinion from another pediatric orthopaedic surgeon in our area. He gave us the same prognosis. The grim truth was starting to set in. An aunt in Pennsylvania did some research at the university where she worked. She discovered that there was an experienced PFFD doctor (Chief of Orthopaedic Staff) at Children's Hospital in Pittsburgh. We made a trip to Pittsburgh in May of 1996. Same prognosis. Looks like we have to face the truth now. How can I bring myself to schedule an appointment for them to cut off my little girl's foot?
OK, we faced the truth, now what happens?
Now that we've heard the same prognosis from three doctors, it's time to face the truth and get more information. We went back to the first doctor to ask lots of questions.
Do we absolutely have to amputate the foot?
Yes. Since her left foot is just below the right knee, the amount of femur lengthening required is too great. The femur would probably be too weak and be susceptible to many fractures. Also, her knee joint appears to be missing pieces and would also be very weak.Fitting a prosthesis over the foot would be difficult, but it could be done.
Van Nes Rotation could be done. Turn the ankle and foot around and use the ankle as the knee joint. This procedure usually de-rotates over time and would probably need future surgeries too realign. Also, more importantly, cosmetics is a big problem. Imagine a backwards foot at knee heighth.
Best course is to remove foot so that she can be fitted for a prosthesis. Difficult and painful decision, but "a foot does you no good unless you can get it on the floor and use it." (I would tell myself this many times as we approached the surgery date.)
What exactly will be done while in surgery?
The foot will be amputated, and a metal rod will be pushed up through the heel to hold the ankle immobile until the ankle fuses.
When would we amputate the foot?
No need to be in a hurry. This is usually done between 10 and 14 months.
How much would be removed?
The procedure would be a Symes or Boyd amputation. Only the front part of the foot would be removed. The heel pad will be left as a good cushioning surface for when she wants to crawl without the prosthesis.
Will she be in a cast?
Well sort of. Not really a cast, but a rigid sleeve to protect the incision and to hold the ankle until the fusion process is complete. Probably be for about 6-8 weeks.
Just as we finished asking all our questions, the doctor tells us that his receptionist has an 18 year old son who has unilateral PFFD. Would we like to talk to her? Sure - maybe she can help allay some of our fears. As he went to get her, my wife and I discuss what are the odds of this happening. We had never even heard of PFFD and now our doctor has a receptionist with a son with PFFD. Maybe somebody upstairs is looking out for us afterall.
A woman entered the room and introduced herself as Donna. I surely didn't know where to start and felt kind of awkward, but she was very friendly and gradually got us talking. She seemed to know what our concerns and fears were, and we eventually ended up talking about everything she experienced with her son Frank. She experienced the same things - what is this PFFD?, why me?, isn't there another way? Frank had the same course of treatment they were proposing for Jennifer. He even had a hip surgery. She assured us that all went well and Frank is a very active High School student. He plays on the basketball team, wrestles, and even was on the homecoming court. It was a major relief to know that our little girl will probably be able to lead a fairly normal life despite this PFFD handicap.
Praying for a miracle
Ok, we have the answers, we've decided to do the foot amputation and knee fusion, we've picked a surgery date near her first birthday, now let's hurry up and wait. Picking a course of treatment was a very hard decision and it was a relief to finally have a decision. We now had 3 to 4 months to wait until the surgery date. Our main goal during this time was to just enjoy our little girl and try to put the surgery in the back of our mind. Problem was that sometimes we'd lie in bed at night and worry about the future...and wonder if we were doing the right thing. My wife had her mind made up, but I was praying for a miracle. God please make her leg grow so that we don't have to amputate her foot - just a little growth so that we can try limb lengthening. I caught myself many times during diaper changes straightening her leg out and comparing it to her good leg to see if just maybe it had grown a bit. Please God...just a small sign before it's too late.
God never gives us more than we can handle
One of the things that helped keep us going during these tough days was a phrase our priest uses whenever something awful happens. He says "God never gives us more than we can handle". I know there were many days when I thought "I can't handle this", but then I'd think about that phrase and I'd say to myself "if God didn't think I could handle this, he wouldn't have given it to me". I know lots of folks will think this is corny, but it worked for us and that's the most important thing. Use whatever tools you have to get through these tough times.
The really dark days
The last couple weeks before the surgery were probably some of the darkest days of my life. I still didn't know how I would get the strength to take may little girl to the hospital so that they could cut off her foot. I'd lie in bed some nights and just cry for her and some of the things she'll never be able to do. Oh, I know we're not supposed to think like that. Set no limits and let her do whatever she wants, and yes she'll probably do most things. But, we have to face the truth too. Some things are just very hard to do with an artificial leg - ride a tricycle or bicycle? Climb the jungle gym with all the other kids? Run to first base? Jump rope? The list could go on and on...I kept trying to put these thoughts aside, but as the surgery date got closer I kept thinking about them even more. Are we sure we're doing the right thing? Once they cut her foot off there's no turning back. Maybe we should wait until she's older to see if her leg grows. I wish there was some way we could be absolutely sure that this is the right thing to do.
The fateful day came and off we went to the hospital. I still had some doubts, but no turning back now. The doctor met us in the waiting area and asked us if we had any more questions. He did his best to assure us that all would be fine. A nurse came and said that it was time for her to take Jennifer. Oh please, not already!. We kissed our little girl goodbye and stood there with tears in our eyes as our little girl went down the hall and around the corner out of sight. Are we doing the right thing? I reassured myself "a foot does you no good unless you can get it on the floor and use it." I sure hope we're right.
The surgery took about 2 hours. The doctor came out and said everything went very well and she was in recovery. About an hour later, the receptionist said we could go in to see her. My first reaction was 'oh, the poor thing'. I think everybody usually looks pretty awful after surgery, but it's alot worse when it's your little baby. She just looked so tired and uncomfortable. Her leg was wrapped in a big sleeve with an ace bandage wrapped around it. God, it's just not fair that little kids have to go through this ordeal.
We spent the night in the hospital. Well actually, Jennifer and my wife did. I stayed at the Ronald McDonald house next door. A great place and I strongly recommend it to anyone who has kids spending the night in the hospital.
I seem to recall that the recovery process was fairly easy. I remember being hesitant about our trip to the doctor for the first checkup. I wasn't sure if I'd be able to watch as they took the sleeve off. Remember, I had never seen a stump before, and I guess I had a horrible looking vision in my mind. As they took the sleeve off I could see that the leg was wrapped in gauze which was soaked with dried blood in the incision area. Ooh, maybe this is going to be pretty bad. The gauze came off and revealed an incision with stitches. Much to my surprise and relief, it wasn't as bad as I had envisioned and the sight of my daughter without a foot didn't really disturb me. Whew, what a relief! The wire sticking out of the heel was sort of gross, but I knew that would be coming out soon. Everything looked ok, so the gauze, sleeve, and bandage went back on until the next checkup. Back at home, as Jennifer started to feel better, she started crawling around even with the sleeve on. It didn't seem to bother her too much. The stitches were removed at about 3 weeks, and the wire and sleeve were removed at 6 weeks. Once the sleeve was off, Jennifer still complained that the leg was sensitive. We had to keep it wrapped in an ace bandage for several weeks. She also refused to take a bath. She said the water hurt her leg. She was afraid to get the scab wet and afraid to get water on the small hole in her heel where the wire had been. No amount of coaxing could get her in the tub. Finally after many frustrating weeks, the scab came off and we finally got her into the tub. Hooray - one ordeal done and over with!
On the day the sleeve was removed, we took her for her first prosthetic fitting.We had talked to Dave the prosthetist before the surgery, but we never got any details about the steps involved. The first step was molding a plaster cast around her leg. Imagine trying to put a cast on a wiggly, screaming 1 year old - not fun. Jennifer wasn't very happy, especially when it came to step 2 - cutting the cast off. Poor Dave sure didn't make friends with her that day. Dave took several measurements and said he would use the plaster cast as a mold to make the prosthesis. He said it should be ready in a few weeks.
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The exciting day came when we finally got her first leg. I don't know who was more excited - Jennifer or mommy and daddy. Dave brought out the leg and I must admit that I was disappointed. I had visions of a nice natural looking flesh colored leg. Instead, it was a white plastic socket with a wooden foot. It had a small plastic door with a hinge made of brown webbing which was attached to the plastic sleeve with rivets. A velcro strap held the door closed. Definitely not very appealing looking, but I guess function is the key. |
Dave showed us how to put it on. First, 2 or 3 socks, then a brown fiber type sleeve, then the leg, and finally close the door and secure it with the velcro. Dave had to make some minor adjustments - adjust the length, add some padding here, take some padding off there. Finally we were on our way.
Our first problem appeared a day or two later. We could not get the prosthesis all the way on. No matter what we did there always seemed to be a gap between the end of her stump and the bottom of the leg socket. Back to Dave we went. He almost died laughing. This prosthesis is not an end bearing type and the leg is not supposed to touch the bottom of the socket. Boy did we feel stupid. The point here is to ask lots of questions before you leave the prosthetist's office. If we had we could have saved ourselves alot of time and trouble.
Our next problem lasted for several weeks. Jennifer just plain refused to wear her leg. Sometimes she would put it on for brief periods, but would never try walking. Finally one day when she was about 18 months old, the babysitter got her to put it on and she took her first steps. Oh what a happy day!!!
The next year and half were typical for a growing child - with a few exceptions. I think the learning to walk process was probably very similar to what you would experience with a 'normal' child. Jennifer seemed to adjust to the prosthesis pretty well. Still had times when she wouldn't wear it, and lots of times she preferred to just leave her leg off and crawl around the house. At times it was very frustrating because she can be a stubborn little girl who does what she wants when she wants.We just tried to encourage (and cajole), but the final decision was always up to her. We had our share of fitting and adjustment problems. Sometimes 2 socks were needed, other times 1 was enough. I think we probably made at least 4 or 5 trips back to Dave for minor adjustments and lengthening.
The knee fusion surgery was scheduled for October 5, 1995 when Jennifer was 2 1/2. This surgery will fuse the femur to the fibia/tibia and shut down the growth plate at the bottom end of the femur. The goal of this surgery is to create a long single bone which will act as a long lever arm to fit inside the prosthesis. The growth plate is shut down so that eventually the stump will be above the other knee so that the prosthesis can have a knee joint level with the other knee. The biggest problem is that she'll have to be in a lower body cast for 3-4 months. OUCH! How will an active 2 yr old accept being immobile for 3 months? We're definitely not looking forward to this. We're much more comfortable with this surgery than the first one, but this body cast sounds like a nightmare. How do we change diapers? How will she ride in her car seat? How do we bath her? I guess we'll learn as we go.
As we approached the surgery we recalled how much we hated watching a stranger carry our little girl off to the operating room. Somebody told us that other hospitals allow a parent to accompany the child into the OR until they go to sleep - excellent idea! Surgery day came and the asst anesthesiologist came out to ask the typical questions. We told him we wanted to accompany her into OR. He said he'd see what he could do. A short time later, the chief anesthesiologist came out and said that they normally don't allow it due to some past problems, but if we wanted to he would allow it. My wife suited up in scrubs, I kissed Jennifer goodbye, and off they went. It was definitely much easier watching her head off to surgery in the arms of my wife rather than in the arms of a stranger. My wife came out about 10 minutes later and said she hugged Jennifer until they put the mask on her and put her to sleep. She said it was tough watching her own child be put to sleep and she would not look forward to having to do it again.
The surgery lasted about 3 hours. Halfway through, a nurse came out and said everything was going fine and asked us what color cast we wanted. Blue it is. A short while later the doctor came out and said everything went fine and the surgery team was finishing up with the cast. He said they tried to hold the knee stable by pushing a rod up through the heel and tibia and through the knee joint and into the femur. (OUCH!) He said the bones were too soft and the rod wouldn't stay, so instead they put two rods criss-crossed across the knee joint. These rods would be removed when the cast came off. When we finally got to see her in recovery she looked terrible, but not as bad as after the first surgery. We spent the night and got to go home the next day.
Pain didn't seem to be too bad. She had a pain killer for about the first 4-5 days, but never complained about very much pain.
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The cast was made of blue fiberglass with internal padding and a 'Tyvek' type liner material. It completely enclosed her left leg and extended down to just above the knee on the right leg. At the top it went to just above her belly button. The legs were fixed in a sitting position and spread open. The groin area was open so that we could change diapers - had to just kind of stuff the diapers in and push them up in the front and the back. No real way to get in there to fasten them. |
Our first problem showed up when we went to get into the car for the trip home. Lower body casts don't fit into child car seats. My wife ended up holding Jennifer on a pillow on her lap in the back seat. Illegal for sure, but I didn't see any better way. Did it that way for the entire time that she had the cast.
Problem two was a cleaning problem. Since it was difficult to get the diapers on properly, we frequently had leaks, especially at night. The inside of the cast would get soaking wet, even though the liner material was supposed to be waterproof. It even got soaked to the point that the inside plaster/padding became mushy and soggy. We came up with the idea of using a hair dryer to dry the inside of the cast. It dried it well, but it left a urine smell behind. My wife did her best to try to clean the inside, but it quickly became discolored and smelly and by the time it came off it looked pretty disgusting.
Entertaining a 2 year old who is immobile in a lower body cast wasn't as bad as we feared. Luckily for all of us, Jennifer always was the calm, reserved type child who leans towards games, puzzles, coloring, TV watching, etc. Most of these activities were not restrained by the cast. Some of them required strange sitting positions with pillows as props, but generally she did OK. I'm sure she missed being able to crawl around, but she wasn't too cranky.
After only 6 weeks the doctor gave us the great news that the cast could come off and be replaced by a small leg cast. The bad news was that she would have to go into surgery to have this done. Oh boy - here we go again. These 'nothing to eat or drink after midnight' ordeals are getting to be a pain. At least this surgery was brief and we got to come home the same day. The prosthetist took a cast mold of her leg while she was out during the surgery, so that was one less ordeal to deal with later on. Plus, now her new leg would be ready and waiting for her when she got the leg cast off. We were all very happy to be rid of that stinky body cast. Jennifer was now able to crawl around and life returned to fairly normal. The leg cast was on for about 6 weeks, so the total time with the two casts was about 12 weeks.
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The surgery timing was ideal because she had just about outgrown her first leg and was due for a new one. She got her new leg about 2 weeks after the cast came off. The new leg was basically the same as the first one - plastic socket and plastic door with web hinge and velcro strap latch. One change was the foot was now soft, rubbery feeling and tan colored. Another change was that we no longer had the separate sleeve - this sleeve is permanently attached to the inside of the plastic socket. One big addition is a strap that goes around her waist to help pull the leg inward and apparently try to offer some hip support. The belt is a 5/8 inch wide nylon strap with velcro on one end. It is riveted to the back of the socket, wraps around her waist, slips into a D-ring riveted to the front of the socket, then folds back on itself for the velcro latch. It generally seems to work pretty well, but Jennifer can't put it on by herself and that is currently causing problems as we try to get her potty trained. The doctor and the prosthetist seem to think the strap can probably be removed, but Jennifer insists on keeping it on. |
One problem that has nagged us since her first day with the waist strap is that it tends to slide down off her hip and constantly has to be unhooked and repositioned. We asked our prosthetist about this and he tried to attach it higher on the socket but the problem still persisted. Finally, after a year of frustration, I said we've got to come up with some way of keeping that darn strap in place. The basic problem is that the nylon strap is too slippery and slides on her underpants. The fix would be to make it less slippery or maybe even sticky - EUREKA! Double stick carpet tape is sticky on both sides! I cut a piece as wide as the strap and about 4-5 inches long and stuck it to the strap at the spot where it rests on her hip bone. Works great - no more sliding strap. It does tend to loose it's stickiness and peel off the strap after a week or so, but it's very cheap and easily replaced. The moral of this story is don't be afraid to improvise. Just because your prosthetist doesn't know how to fix a problem doesn't mean you can't come up with something that works. I'm sure others can share similar stories.
I can still vividly recall those long days and nights when I prayed for a miracle. Oh God, please make her leg grow so that we won't have to amputate her foot! Please just do this one thing for me and I'll never ask for anything again. Well, the miracle didn't happen and we had to amputate our little girl's foot. To this day, that is still one of the hardest things I've ever had to do in my life. But, it was something that had to be done, and now I'm glad that we did it. If I had gotten my miracle and saw some leg growth, we'd still be dealing with a bulky prosthesis over her foot, an unstable knee joint, and years of uncertainty praying for yet another miracle - eventually probably ending up with the same course of treatment but at a much older and more difficult age. Instead, today, all of our surgeries are already behind us and Jennifer walks just like any other 4 year old. Sure, she has problems with rough terrain and she can't run as fast as other kids, but she walks quite well and her handicap is not a very big problem. We fully expect that she'll lead a fairly normal life - with only minor adjustments to deal with an artificial leg. I never thought I'd feel this way - especially when I remember those dark days when we first learned of her birth defect and that we would have to amputate her foot.
As I look back on it all now, I think of a song I heard by Garth Brooks. He was singing about a high school love that never happened, but the words ring very true for me in this experience too.
And each night I'd spend prayin' that God would make her mine
And if he'd only grant me this wish I wished back then
I'd never ask for anything again
Sometimes I thank God for unanswered prayers
Remember when you're talkin' to the man upstairs
That just because he doesn't answer doesn't mean he don't care
Some of God's greatest gifts are unanswered prayers
I guess the Lord knows what he's doin' after all
And as she walked away and I looked at my wife
And then and there I thanked the good Lord
For the gifts in my life
Children are great gifts and a child with a birth defect is an even more
special gift. Jennifer is our special little gift, and I wouldn't want to
change a thing about her. In fact, she just wouldn't seem like Jennifer if
she had two 'normal' legs. I just can't picture her any other way. We're
all looking forward to the future when she'll get a leg with a knee and ankle
joint which will allow her to walk even better and do more things.
If you're reading this because you just found out that your child has PFFD, I hope we were able to help and give you some encouragement. PFFD has caused us our share of heartaches and sadness, but today is a happy day and I expect the future will be even happier.
If you have questions or want to talk, just send an e-mail to Mike and Cindy at pffdvsg@gmail.com