The diagnosis we never imagined
Kalum is our rainbow baby.
He has been the empowering force in me creating Empowered Life before we even conceived him. He has seen just as many patients as I have. He was my first born son that I hope one day may serve patients like his mommy. However, he has shown so much interest in other things, great thrower for potential baseball player, wants to wrestle like his daddy and extended family has, do "scary" things for the adrenaline rush, build and use tools just like his daddy and maybe even fly a plane or drive a train! He's been my easy kid, the healthy one, the one that eats everything and anything, achieving all his milestones, the one that slept 12 hours straight since 6 months old and is the greatest mommy's help and loves everyone.
Kalum was adjusted at less than an hour old and has been the best chiropractic kid - he's in tune with his body and knows mommy will take care of him when he needs it. That's why when Kalum started saying his knee hurt, I didn't think twice about it. We adjusted and moved on. However, it was mentioned multiple times that day and the next day he kept saying it hurt and was limping. Surely, he just tweaked it from being an active little boy who absolutely loves tumbling, jumping, running! We did all the things, adjustments, he asked for Magnesium Lotion to make it feel better and even our red light therapy laser! Little did I know, the next morning he would be crawling his way around the house because he couldn't walk. All the knee checks were okay. Tender but okay. It didn't hurt anywhere else except directly at his patella (knee cap). Monday morning, we got in for x-rays. Sure enough, "all was clear", he had 0 brusing or swelling and was told to monitor and just keep doing what we were doing. I sent him to Mother's Day Out Tuesday thinking, surely if he see his friends, he'll be "all better" because he loves it there. Well, his teachers watched him, snuggled him, and carried him around because he still was in pain.
Day 5! This is 5 days of my active boy NOT wanting to do anything, saying he can't walk, his knee hurt. What the heck! Kalum KNOWS his body, surely something else was going on. Next morning, I reached out for a referral to a orthopedic doctor for further investigation. Maybe it was a ligament or meniscus issue that wasn't showing any other signs because we've been taking care of it the whole time. After discussing with several of my doctor friends, we got in on Friday, May 10th at Ouch Ortho in Southlake.
We arrived to our appointment and Kalum was his "normal" active self playing with this limp, putting pressure on his knee still but saying it hurt. I discussed with them that I'm concerns it may be steaming from else where like his lumbar/pelvic region. Was something going on deeper we were missing and hoping for more imaging to find the cause. After Dr. Brown examined him, he was suspecting transient synovitis, from a prior viral infection which can cause a joint (most commonly the hip) to go through an inflammatory process. We would only need about 2 weeks of rest and a week of ibuprofen to help with the pain and inflammation and be good to go. We would take xrays of the hips to confirm!
Kalum was a champ at taking another set of xrays even though the machine made a scary noise. He did NOT like that it was his hip though, because his knee hurt, not his hip. I had to try to explain to my three-year old that we have to check his hips because that might be the cause of his knee pain. If only I could just say his knee was referral pain from the root cause of it. The doctor was able to review them and come back in to discuss. Once he came in with several other nurses to help take notes, there was something else on that x-ray. He began with, you probably have learned about Perthes Disease in schooling. I want to show you these x-rays because what I was thinking was TS, is not the case. We gotta throw that out the window for his course of care. When he turned his laptop around, I could see it instantly. There was NO doubt his femoral head was misshapen and almost non-existent.
When your Google search Perthes' Disease or Legg-Calve-Perthes Disease it states it is "an uncommon condition that affects children between the ages of three and 11 years. Blood supply to the head of the thigh bone is disrupted which causes the bone to deteriorate. This can cause pain, limping and limited movement of the hip joint". Kalum is almost four years old, is a active boy, and smaller in stature. Everything we learned in chiropractic school was coming back, we saw these example x-rays so many times, even on our National Boards even though it was "so uncommon", they consistently showed us these far fetched diseases that we "would never see in real life". Well, here I am, my chiropractic child has Perthes' Disease.
Dr. Brown was great at explaining the disease, and proceeding with the first step of treatment needed. There is no true cause or reasoning why he got it but there are options. However, it was be difficult and need to be aggressive with our treatment he explained. NO physical activities- running, jumping, tumbling, sports, recess. Be prepared to carry him, get a stroller or wagon to rest his legs so that we can avoid high impact to his hip and regain vascular function to that hip. Due to his lack of range of motion, we need to be aggressive with our rehab, daily physical therapy by myself but also a pediatric physical therapist that can really push him and that he knows it is not "just mom" doing these weird things to me. Kalum is an outdoor child, he loves earth, he loves playing outside rain or shine and being as active as possible. Surely this won't take long right!? Unfortunately, I was then told this is a slow, long process. We will have to take it month by month with x-ray check ups and could be like this for the next 4-6 months before we notice the vascular system getting to the femoral head to start rebuilding it and hopefully to the shape that we need it to be. Kalum of course didn't understand what was going on but he saw his x-rays and said his "hip is broke". We were told that his swim lessons and taking him to the pool would be our saving grace this summer for energy release.
I'm devastated for my little boy. Not only is this not a quick fix, but how many times will I have to say and explain that sorry son, you need to not do xyz. Don't jump. Don't run. You can't ride your bike or jump on your trampoline. No chasing after your brother and sister. No more potential summer sports camp. No more wrestling with daddy and brother. He was almost to the age he could start wrestling clubs with his cousins. Now, what will this look like moving forward. What will be his potential in life? Will he be back to normal by 5? What if these initial few months don't yield the results we'd like to see?
There are a lot of unknowns with this disease.
We met with our favorite pediatric physical therapy office, Kinactive Kids in Southlake. Dr. Katelyn and myself have been doing extra training with them recently due to the fact, that they have an amazing practice that co-manages conditions with physical therapy and chiropractic care in such a different way. When I was told to get physical therapy, I knew we would be in good hands with KinActive Health with their expertise on more complicated cases. Dr. Matt and I graduated chiropractic school and is graciously helping me walk through these changes to Kal's body and what we have to do with our adjustments. This collaboration they do is one reason why our office keeps growing with the providers in house and look forward to you all meeting the new staff!
Dr. Jaime and the rest of the PT staff are on board to helping us improve his hip range of motion and whatever happens in our next phase of care. He has pretty good strength, but we definitely saw him favoring his left over the right side. We will be doing our therapies in Southlake but also at home and in office every chance we can get.
Over the next few weeks, we’ll have another orthopedic follow-up and meeting with a specialist on Perthes at the Scottish Rite Hospital and hopefully get more clarity on this whole life change that will occur over the next few months to years. Now that summer is in full effect, we will definitely be taking advantage of the pool. I appreciate the thoughts and prayer you all have sent and keep sending moving forward. The community we have grown at Empowered Life is fantastic and am hopeful that we will be able to get his little body functioning and moving the way it should again.
Dr. Ericka Lupardus
