Monday, October 14, 2013

Serial Casting (No Botox for Joshua...Again)

So, today we once again saw the Visiting Paediatric Rehabilitation team from Adelaide.  At our last appointment 3 months ago, it was recommended that Joshua have Botox injections.  They offered to do it that very next day, but I elected to wait three months until the clinic this week.  
When his Physio assessed him last Friday, she felt that they might not do the Botox this time, but if so, just a small dose.
Today we saw the Doctor and the physio from Adelaide and the consensus was No Botox for Joshua.  This is the second time that Joshua has been scheduled for Botox and it has been decided not to go ahead with it.  
What they are saying now, is that Joshua does have some spasticity, but that it is quite mild really, and that the real problem is that Joshua has a deformed foot.  The deformity is being caused by his calf muscle, which is too short.  The short muscle in his calf pulls up on the muscles in his foot and creates a deformity.  They feel that he will probably always have a degree of deformity in his foot but that the best way to help it, is to stretch the calf muscle.  Injecting Botox into the muscle would relax it, but they don't think this is really going to do anything much for him, they can't confidently say that we would see results by doing Botox, and that we are better off trying other ways to stretch that muscle.  He says the way it presents is more like a congenital short muscle rather than something related to spasticity.  So what happens is Joshua's leg will be placed in a cast that holds his leg in a position that stretches that muscle.  The cast will be left on for 5-7 days, removed and evaluated.  Sometimes a new cast will be applied straight away, or sometimes the casting may just be repeated at intervals of
6-12 months.  It really depends on the results of the casting.  The problem is basically being caused by growth.  As he grows, the calf muscle isn't growing with him.  Some children will need to have surgery to fix this, but he said not usually until about 8-10 years old would they do that.  And that he still may need Botox in the future, but for right now they feel the best option is to try the casting.  
So that's what we will do,  I now just need to wait to hear from the Physio about the logistics of that.  
We took Joshua last week for his annual hip X-ray and thankfully his hips are still normal.  They feel that he isn't going to have any hip problems and that it probably isn't necessary for him to continue having annual hip X-rays.  They recommend that he have another one at 5 years old, and depending on how that looks, he might not have to have another one until he is about 10 years old.  So I guess that is one less thing to do, and it's also a bit of a relief because Joshua has been a w-sitter for a long time and that is notorious for being bad for the hips, so thankfully he hasn't yet suffered any ill effects of that.  
When I get the report from the Doctor I will share what he has written but they are basically classifying him now as Spastic Hemiplegia Level 2 on the Gross Motor Function Classification System (GMFCS).  Not bad for a kid that started out Level 3 Spastic Quadriplegia. 
Over the past three months we have seen a big improvement in Joshua's speech, he now has about 60 words including a few two word combinations.  This is still significantly delayed for a 3.5 year old, but is obviously a massive improvement considering 3 months ago he was only at about 30 words.  Slow and steady wins the race.