Decisions

Justin, Amelia, Evelyn, Josie, and I left for Denver to see Dr Georgopoulos. I arranged for Everett to spend the day with Max Rognon. Phillip spent the afternoon with the Rognon's as well. We missed his first soccer game, boo hoo. Michelle reported that the boys had a wonderful time playing! Amelia was happy to have a girl's day plus Dad. We stopped at a bike shop on the drive down to fit Amelia for a bigger bike. We originally planned on just fitting her and buying a bike online. The shop had a used bike just her size for a fraction of the price. She added a new helmet, water cage, bottle, and bell to her new bike. Now she just has to wait for her birthday to ride it. The bike shop was housed in the old train depot of the town we were in. The owner had several cool model trains running along ceiling tracks. Evelyn was quite enthralled. Even more fortuitous was the Del Taco a mile away from the bike shop. Amelia downed 3 tacos in record time. That girl loves hard-shelled tacos. Evelyn ended up squeezing her burrito insides down her dress, onto her car seat straps, and into the buckles. That was a gross clean up.

Dr G walked in and gave us the down low:

4 Stages of Perthes
1. Avascular insult causing asymetrical epiphyseal joint head. Increased density of the femoral head.
2. Fragmentation caused by avascular necrosis, crescent sign which indicates bone collapse, literally no density in femoral head
3. Re-ossification causing density to return and femoral head to reshape
4. Healed bone, can be healed in a deformed manner depending on how bone re-ossifies

Classifications:
A: less than 50% of the femoral head is involved, density remains siginificant, prognosis is good
B: more than 50% of the femoral head is involved, low bone density, loss of femoral head height, ball begins to extrude from socket, prognosis is poor
C: more than 50% loss of femoral head height.


Amelia is in stage 1, classification B, already showing markers of crescent sign near the outer-edge of her femoral head, creating a lip. During re-ossification the crescent dip appears to want to reform in a lip that will get caught on her hip bone causing extra damage to the outer edge of her hip. Her range of motion will be hampered. She advised in Amelia's case that surgery would most likely shorten the duration of Perthes and help the bone re-ossify without the lip of her femur hampering movement. Dr G would cut her femur in half, rotate the femur head up to a more rounded part of the head and plate/pin the bones back together. Amelia would be hospitalized for 2 days since we live farther away. Once the incision site heals she would be free to swim and move. Recovery is 6-8 weeks and is treated as a severe broken bone. A huge plus is there is no casting involved. Dr G said she usually does not suggest this operation for Perthes but in Amelia's case, being older, still in stage 1, and with the apparent divet already forming on her femur head surgery would give her the best chance to avoid hip replacement for a longer period of time. She might be able to make her hip work through her child-bearing years if this surgery is completed now. The MRI showed a painful cyst on the front of her bone, also at the time of the MRI fluid surrounding the joint. Since her pain is not great the fluid is most likely decreased. The Dr also said a few other interesting things that surprised us: crutches will not really help her, physical therapy will not really help, just activity restriction and anti-inflammatory meds. I am thinking maybe a second opinion on crutches and PT would be advised. They sure seem to help at this time. Mia of course wants to avoid surgery, not sure she understands what limited range of motion would mean for her future. We went ahead and scheduled surgery for 26 May 2016 at 9 am. We can always cancel if we change our minds.

We both walked in to the appointment wanting to avoid surgery, we walked out thinking it looks like the best avenue for her specific situation. It is quite sobering to discuss serious surgery with a 9 year old kid. We will weigh our options and make a decision!

Justin "let" Amelia and I shop at Hobby Lobby for a bit. We found cute, cute fabric to make her annual birthday outfit. This year she wants a shirt and skirt combo. I look forward to making these treasures each year. We arrived back home before 8 pm, a long day indeed.