Mason’s Journey through the Land of Brachial Plexus Part V

Pre-game Jitters

The day had finally come after 3.5 weeks of waiting,  time for the cast removal!! The morning of the cast removal we went to a family breakfast.

After the removal we made plans to go to the National Zoo in DC with my family and my mother in law as a post cast celebration.
 

My husband and I were both excited to finally get the cast off.  Although it didn’t seem to be bothering Mason at all it was an adjustment for us. The cast made it a bit difficult to maneuver him and he definitely was a bit heavier to lug around on my hip!

After breakfast we headed over to Kernan.  I was a bit nervous since I wasn’t sure how Mason would handle the saw. He is not a fan of loud noises (cries when the blender is on,  cries when we yell while watching the Ravens play…etc) and I was sure that we were in for some healthy crying while he was getting his cast removed.  After a lengthy wait (I didn’t realize so many kids suffer from broken limbs!) we met with the nurse to check in, then we headed to another room where the magic happens.

Bye Bye Old Friend

 

Neither my husband nor I had ever broken a limb so we weren’t sure what to expect. My husband removed Mason’s shirt so the nurse could see his arm Spica cast. The nurse told us they were going to cut Mason’s cast in 4 places. 

As my husband and the nurse were talking I noticed the saw that they would be using to remove the cast.  While everyone was distracted I snuck a picture,  it looks pretty intimidating.

The nurse took the saw and explained that it just vibrates and that it wouldn’t cut the skin. He turned the saw on and put the blade against his skin and it didn’t even make a scratch. While the saw was running Mason was relaxed and the noise didn’t bother him at all which was a relief. The nurse placed a cover over Mason and my husband’s laps to catch the plaster while he was sawing.  Then the sawing began!

 

As the nurse started sawing, my previously laid back son started to whimper, and then he started to really cry. It definitely wasn’t painful since we know that the saw blade wouldn’t cut him but we think the vibration scared him. As a mom I just wanted to hold him, but unfortunately that would have to wait until the cast was removed. Instead I just stroked his cheek as he sat there looking at me with that “Why the hell are you letting them do this to me?” look on his face.

Free at last

After 10 minutes the cast was off. Sweet freedom! I immediately looked him over to see if his skin was irritated from the cast. Everything looked great.  I was so happy to hug him again. We were moved back to an examination room so the Dr. could evaluate Mason. He immediately saw improvement with his external rotation. The physical therapist also came in make benchmark his progress as well.  Now Mason will resume his occupational and physical therapy next week. We are hoping that he makes great strides!!

Mason is still not crawling yet but we are hoping that once his arm gains some more strength that he will be able to crawl around soon. Guess we better baby proof the house!

 

Mason’s Journey through the Land of Brachial Plexus Part IV

Post Op

Wake up

My husband and I were told that Mason should be ready in an hour so we headed downstairs to get some food. Before we knew it an hour had passed and we returned upstairs to the waiting room.  Dr. Abzug met us in the waiting room to tell us that the procedure was successful and Mason was doing just fine. He also explained that they were just waiting for him to wake up from the anesthesia. After he left it was about another 20 minutes before they escorted us back to Mason’s post op room.

When we walked into the room Mason was lying in his little hospital bed still knocked out from the anesthesia. He had an oxygen hose on his chest to help him breathe. My husband and I sat down and just waited for him to wake up. We were there for another half an hour before Mason started to stir. The first thing Mason did was knock that oxygen tube right off of his chest and onto the floor. Our spunky son was already at it! Here is a picture of him right after he woke up.

 

I nursed him immediately (before his alter ego could appear) and once he was done he started crying. We were really concerned although we were told that children typically wake up crying since they are a bit disoriented from the anesthesia. The nurse removed the IV from Mason’s foot and then gave him some Tylenol. We were told that his throat still be sore from the breathing tube.

After the Tylenol Mason calmed down and just observed everything. My husband had run to the car get the car seat to make sure that Mason would fit with his new hardware.

A RN helped us place Mason in the car seat to see if he would fit. It was a no go. Luckily, the Univ of Md had a program that allows patients to rent car seats for situations like ours.

We received all of our post op instructions from the nurse and I started getting Mason ready to go home, meanwhile my husband and the RN went to get the car and install our loaner car seat.  As I was dressing Mason I realized that the shirt (a size bigger than what he normally wears) that he arrived in was a no –go. The bar on the spica cast was preventing me from putting his arm through the sleeve. So I cut the shirt up one side and just placed it over his head and his left arm.  I knew that I was going to have to find shirts that worked for daycare.
 

Along with assistance from a nurse I adjusted the straps on his stroller, strapped him in, and we were on our way to the car!

Homeward bound

The ride home was short but Mason was fussy. He wasn’t screaming but was whining. The whining continued an hour or two after we arrived home.  My husband and I were stroking him, holding his hand trying to console him but he continued to whine. We were both very concerned and called Mason’s pediatrician to find out how soon we could give him another dose of Tylenol. We just assumed that he was in pain. 

We decided to hold off on the Tylenol since enough time hadn’t elapsed since his last dose, and just wait it out.  I removed his ripped tee and dressed him in one of my shirts for bed.

 

 Eventually Mason started to calm down and he fell asleep. My husband and I just kept hoping that this would pass once the anesthesia completely wore off.  The first night was hard Mason woke up a few times throughout the night; he was getting adjusted to sleeping in his cast. 

 

The Mornings After
 

Mason was slowly getting back to his normal self. He was playing but still a little fussy (we assumed it was due to a sore throat from the breathing tube).  His grandparents couldn’t wait to see him so they all came over to visit with him. He was quiet but playful. 
 

 

 

Mason still woke up that night but only one time (we were almost back to normal!).  Day Three and Four were much better Mason was playing, talking and even scooting on his belly.

 

We found some little boys shirts (size 10) that were big enough to make their way over his Spica cast. So his shirts are huge but at least we found shirts that fit!!

This experience has been a real eye opener. It’s amazing how resilient children are. Mason’s cast doesn't even phase him. He’s been amazing. He has adjusted great in daycare and has not let his cast slow him down. 

Mason's cast comes off in three weeks!!  Stay tuned for an update on his cast removal and subsequent physical therapy sessions!

Mason’s Journey through the Land of Brachial Plexus Part III

Pre-Op

Alter Ego

Well the day of reckoning finally had arrived. After postponing Mason’s April appointment for his botox procedure (due to a pesky cold!) we rescheduled for Memorial Day weekend.  While people were busy making cookout and pool plans, we were trying to figure out how to dress and cope with our son’s impediment.

Since Mason required anesthesia, he was not allowed to drink milk 4 hours prior to his procedure, and no liquids up to 2 hours before.  I woke him up at 4 am to nurse, then again at 6 am so that he could drink some juice or Pedialyte. He wasn’t feeling the juice or the Pedialyte so I was in panic mode that once we got to the hospital his hungry, and inconsolable alter ego would make an impromptu appearance.  Fortunately, luck was on our side and his alter ego was held at bay due to our son’s deep interest in the other families milling around the hospital waiting room. 

Here is a picture of us before entering the hospital. Mason had no idea what he was in for.

 

Butterflies

After we checked in we waited for the nurse to call us back so they could prep Mason and start the anesthesia.  Every time the door opened we nervously waited for the nurse to beckon the next patient. After about 45 minutes our time had arrived. We were escorted back to Mason’s temporary room.  Dr. Abzug’s assistant walked us through everything that would occur with the procedure and even Mason was paying close attention.

 

Mason was given a hospital gown and we were told to place his clothes in a bag. Next, the anesthesia Dr. and nurse explained the anesthesia process. First, Mason would receive was a rectal pre-anesthesia that would be used to relax Mason so he wasn’t anxious once he was separated from us.  This would make him feel loopy but he would still be conscious. This is a picture of Mason after the pre-anesthesia kicked in. He was loopy, smiling and even trying to babble. This is when my butterflies kicked in. Although I understood that it was necessary I didn’t like seeing my son that way.

 Next Mason would receive another type of anesthesia to put him to sleep and they would also be inserting a breathing tube since Mason would not be breathing on his own. Hold the presses, a breathing tube?  I played it cool but I was very concerned. The butterflies that were already fluttering inside my stomach had morphed into pigeons fighting for pecking order.

I just nodded at the anesthesia Dr. thinking ok this is not their first time to the rodeo and that they were experienced, highly educated people that knew what they were doing. I had to put things into perspective. The purpose of this procedure was to ensure that Mason had a better quality of life and we are hoping that we will see some improvement once the cast is removed.

Dr. Abzug stopped by prior to the procedure to walk us through everything again and make sure that we didn’t have any questions.  Soon after he left the anesthesia Dr. and nurse told us that they were ready for Mason.  My husband and I gave Mason some kisses and he was off to the operating room for his procedure. 

Mason's Journey in the Land of Brachial Plexus Part 1

Part I

What are the odds?

During one to three out of every 1,000 births a child is born with a Brachial Plexus (also referred to as Erbs Palsy) injury. With odds like that it seems highly unlikely to expect that your child would be born with such an injury. Guess the odds were in our favor.

Preparing for birth

Like any other couple my husband and I were ecstatic when we found out that we were expecting. The excitement increased as my due date approached. I remember one night while we were watching TV my husband said what if something is wrong and our child is not healthy. I immediately became upset (why would you say that to a pregnant woman??) and said “Let’s not think that way. Everything will be fine”.  In hindsight, I know that my husband wasn't trying to be a pessimistic, but was trying to prepare me for some of the realities that can occur from childbirth.

Tick-Tock

My original due date was July 20^th however my son was not ready to make an appearance. Needless to say all of the wives tales on how to expedite labor did not work for me. At 41 weeks I was scheduled for an induction. I was extremely nervous about the birthing process after watching endless episodes of Baby Story on TLC and birthing videos.

The whole process took less than 24 hours but I pushed for 2 hours straight and finally Mason was introduced to the world ( I will spare you all of the not so nice details). I wanted them to lay him on my chest but they whisked him away immediately to evaluate him. With all of the excitement it didn't cross my mind that something was wrong.

Psychic Vibes?

Once they cleaned up Mason, swaddled him and dressed him in his hospital cap they laid him on my chest. As all mothers know no words can express the first time that you gaze into your child’s eyes. As he was laying there the Dr. was explaining that Mason suffered an injury to his right arm from the birthing process. She was saying that it’s called Erbs Palsy and usually children recover by the time that they are 3 months. It was hard to process as I had just accomplished to most incredible feat of my life, and was overcome with emotion.

Thinking back to that conversation with my husband, I have to wonder was he getting some type of vibe telling him that something may be wrong?

Recovery and Parent Training

 

I was in the hospital for 3 days after giving birth, during that time I was trying to absorb tons of information from the doctors, nurses, lactation specialist and the physical therapists.  We were told that Mason would need physical therapy to prevent the muscles in his right arm from stiffening and were given exercises to try with him at home on a routine basis.

Although my husband and I were concerned we didn't let his injury overshadow the joy that we were experiencing from being first time parents, plus we were determined to do whatever it took to help our son progress. We never viewed the injury as a way to feel sorry for ourselves, or turn it into a legal battle with the hospital. The injury just makes Mason even more special and loved.

 

Mason's Journey in the Land of Brachial Plexus Part 2

Brachial Plexus Blog Part II

What is a Brachial Plexus birth injury?

As I mentioned before one to three out of every 1,000 births are Brachial Plexus injuries. The Brachial Plexus is actually a complex set of nerves located between the neck and shoulders. These are the same nerves that control muscle function within the upper extremities: shoulder, arms, and hands. So the brain can send signals to the nerves but the nerves are unable to send those signals to the arm, shoulder or hands.
 

This injury is usually caused during a difficult delivery. The injury is caused by stress to the child’s neck, and shoulder area as they pass through the birth canal.
 

There are various levels of injury. Sometimes the nerves are just bruised, stretched or could be severed. Usually when the nerves are just stretched children can show improvement or fully recover within 3 months. Other injuries may be more severe and will take longer to show improvement.

How severe is Mason’s injury?

Mason was able to move his right hand from birth, he always had a firm grip, however he couldn’t bend his arm on his own and his arm was turned out.

After 3 months of weekly physical therapy Mason was showing improvement but couldn’t bend his arm against gravity. Each month we would visit with Dr. Abzug, a Pediatric orthopedic specialist at the University of MD to see how his arm was progressing.
 

My husband and I were hopeful that he would improve even after we passed the 3 month benchmark. Although he wasn’t fully recovered he was making great strides with therapy. In order to avoid a tendon transfer surgery at 6 months Mason had to bend his arm against gravity.

Imagine our surprise during Mason’s 4 month appointment with Dr. Abzug when he bent his right arm against gravity! My husband and I were elated, no surgery at 6 months. However, we were still not out of the woods yet. Mason made progress but he still needed better range of motion.

What’s Next?

Mason has steadily improved but elbow flexion is still a challenge. Basically if you bend his right arm at 90 degrees, keeping the elbow tucked close to the body and attempt to stretch it away from the body it does not have the same range of motion as the left arm.
 

We sought additional assistance from the Brachial Plexus center at Kennedy Kreiger (John’s Hopkins).  He had aggressive Occupational Therapy (OT) twice a week in addition to Physical Therapy (PT) once a week.  Mason did show improvement but the elbow flexion was still an issue. In addition, the therapists felt that we should get an MRI to check the shoulder joint.

 

At 7 months we had an MRI to check Mason’s shoulder. The results showed this slow progression was due to the fact that his shoulder joint is not properly aligned within the socket. Dr. Abzug laid out our choices, we could do three things:

• Nothing
• Botox injections: This would relax the muscles that keep Mason’s arm turned inward. Then he would wear a cast for 3 weeks to stabilize the shoulder and keep stretch his arm outward in the proper position.  Followed by aggressive OT.
•  Wait until he’s closer to a year and have a surgical procedure where he would have to wear a cast for longer than 3 weeks.

Decisions, Decisions

Of course my husband and I want our son to have the best quality of life so doing nothing was not an option. At the time Mason was too young for surgery, so we elected the non-evasive procedure, botoxing. Mason is scheduled to have his procedure done in late May and we are hoping that with the aggressive OT he will continue to improve.

Righty

“Righty” is the nickname we have given to his right arm. Looking at Mason at 9 months you can barely tell that he has an issue. He can pick up things with his right arm: reach, he can even push up on it to get into crawling position (Mason still can’t crawl yet). Righty has some limitations though. He can’t only lift it about 70 degrees in an upward motion and when he bends his arm he uses his shoulder to assist. Other than that Mason has learned to use his right arm the best way he can.  We are hoping that after the procedure Righty will be able to do even more!

 

Stay tuned for his progress during and after the procedure.