"Every child is gifted. They just unwrap their packages at different times." -- unknown
Ryan's still having a little trouble bearing weight and walking. He is resistant to even putting down his legs to stand for a second while supported so after a month since the original trip to the hospital I decided to see an orthopedist. Last time at Medek therapy Ryan was really crying out and refusing to do any weight bearing at all and Azriel felt the tenderness was in his ankle.
Dr Avella felt Ryan was still showing a little tenderness in his lower leg and ankle but not in the knee which was the original site of soreness and swelling He x-rayed his complete leg and foot but couldn't see any hair line fractures or any evidence that there had been one a month ago and was now healing. He did note that Ryan has alot of Harris lines in his leg, probably due to periods of illness or stress. These lines typically show up after periods of malnutrician but Ryan has a great diet, takes regular vitamins and supplements so I'm sure that's not the case. It did get me thinking about malabsorption as Ive always wondered what Ryan did with all the food he eats as it certainly doesn't make him fat. His bone was significantly light for his age, but this comes with the territory as its probably due to not weight bearing like a regular 4 year old.
He reviewed the blood tests carried out in the hospital and one of the inflammatory markers, the sed rate was very high, (100 when normal is 20). He thought this was unusual as the other inflammatory markers were normal, but the normal one is usually quicker to return to normal values so he thought there might have been an infection and the blood taken 4 weeks ago was showing that it was healing. He mentioned Transient Synovitis which is a painful joint infection usually in the knee or hip of young children usually proceeded by illness. As Ryan had a bad gastro virus while in Canada we are suspecting this to be the cause. Luckily the inflammation as the name suggests is self limiting and Ryan should begin to slowly get back to normal.
He wants us to go at Ryan's pace for the next 2 weeks, if he wants to stand / walk then let him, if not don't push it. His thoughts were if there is something there hidden in the x-ray then 2 weeks should be enough to heal it. Ryan is doing a little better at home, each day he's walking and standing a little more but still its not his first choice and he needs alot of motivation, but doesn't seem uncomfortable when he actually does walk or stand, so I'm thinking some of this could be behavioral at this point.
This week we also visited Dr Jordan, Ryans brace guru who is actually a podiatrist to check out Ryan's braces to make sure they were not adding to Ryan's leg problem. Dr Jordan was a little surprised at the sed rate being so high as well. He couldn't find any pain response in Ryan's left leg and was very pleased with the lessening of tightness in Ryan's hamstrings and heal cords. He is not minding the foot pronation as now Ryan's heel is on the ground where as before it was lifting, so he feels we are heading in the right direction and with more weight bearing and walking etc Ryan will start to use his muscles etc better and his leg and feet will come into line. He made some changes to the braces, straightening the left brace so its now more upright as Ryan's hamstrings have lengthened. Dr Jordan didn't feel the serial casting was necessary at this point but Ryan will be seeing his Physiatrist this week for his annual school visit and I will be interested in what he has to say. Day by day Ryan is more and more willing to stand and walk assisted and did great at medek therapy this week standing unassisted so we are hoping this little step backwards is behind us.