Resistance vs Responsibility

Today I just got to know on how US parents went through financial difficulty in order to get the best non-surgical treatment for their clubfoot children. In States, they have Shriners, Ronald McDonald house, church houses, Kiwanis, charity flights e.g. Angel flight to fly them to Iowa Hospital, St Louis Hospital.

See, Mazila told me once, she had no choice but to stay with Dr Lyn Azura. She said if she got money, of course she will be flying to Bangkok like us. The good news is Dr Amnuay wants to sponsor their flight, accomodation & treatment. There are angels in Bangkok rather than here!

Dr Amnuay told me this clubfoot thingy is just a small issue in Thailand’s medical field.They have gone through a lot of resistance, challenges and egoism among the big doctors. At least they do have some physicians who cares about a child like Dania.

I think in Malaysia, this clubfoot is still considered as a small issue.
I remember a doctor told me via my personal blog that I should be thankful that my daughter do not have hole-in-heart problem. This is not about thankful or whatever you want to name it, this is about the credibility of a physician and their responsibility to their patient
>to cure their sickness,
>to ease their pain,
>to treat their illness with the CORRECT method without prejudice, without any modification, and without any delays.

Anyhow, in my personal opinion, whether you are rich or not, it is your responsibility to seek for the best treatment and work out all the possibilities to assist your child to get a better life.
The rest, is in God willing.

To Malaysian Orthopedics Association delegates who are going to Sutera Harbor this week, Selamat Bersidang.

Note : I can't wait to meet up my neurosurgeon coming July for annual MRI.Yippi yeahhh!!

Surgery vs Non-surgical

Today I've read about something that I've almost let it happen to Dania about a year ago.

This clubfoot patient went through casting from 3 days old to 11 months, 2 weeks on and 2 weeks off.When she was 14 months she had the Achilles lengthen and bones moves around with the pin to hold everything together.Now she is 10 1/2 and she has a screw planted in her bone which stayed for a year. According to the parent their orthopedics had plan B where they plan take out some of the growth plate, to stop the growth.

Fuhhssss....,'screw' sounds scary to me...Why is this parents allow such painful treatment to his child? I think I know...When a nurse took off the operation's clips from my head a year ago, I was so scared and as expected, it was a painful experience to me. Then when Dania's early physicians plan to have 3rd surgery on her feet, I feel something is so wrong. Furthermore the physicians said they only can decide which part they want to cut on the day of operation itself. Scary eh?? They also are not sure what they wanted to do.

What if my neurosurgeon told me that he do not know which part to start to remove the tumor and he can only decide on the operation day itself? I think I'm going to faint again..

As one of my circle of clubfoot friend said which I most agreed is 'one of the greatest aspects of the Ponseti method is that it is gentle and not painful. '

Below photos are our experience from Ponseti method and the outcome...no screw no pain,only 2 scar from previous modified Ponseti method..to see the scar, double click at the most right photo..Btw, Dania clubfoot feet is at her right foot...:)





Note : Dania is 25 months old...still follow up at Bumrungrad Bangkok under supervision of Dr Amnuay Jirasirikul, the certified physician of Ponseti Method..

Dania & her dancing time at Tokyo Disneyland

Last year, I keep my finger cross and I'm so sceptical whether Dania can walk by herself in Tokyo Disneyland. She just starts walking 2 months ago...on Valentine's day. In our recent visit to Tokyo Disneyland, she danced and sang happily..one of the best moment in my life...:)

She doesn't look like a clubfoot baby, don't u think so?

Jawapan yang akan membantu...

Sekiranya amalan perubatan yang diterima oleh anak anda tidak sama dengan jawapan2 dibawah, anda perlu bertukar pakar dan cari pakar yang layak mengubati kaki anak anda..:)


1. "Apakah jenis simen yang akan digunakan untuk membetulkan kaki anak saya?"

Panjang Simen adalah dari ibu jari sehingga ke lutut. Simen adalah dari bahan kapur dan bukan dari ‘fiberglass’ (selalunye utk digunakan untuk dewasa). Walau bagaimanapoun, kanak-kanak dewasa mungkin memerlukan simen kapur yang digunakan bersama ‘fiberglass’ untuk mengukuhkan lagi simen tersebut.

2. "Secara purata, berapa lama untuk membetulkan kaki tersebut dan berapa kali perlu kaki anak disemen?"


Sepatutnya, pembetulan kaki sepenuhnya mengambil masa dengan purata 5 - 7 kali simen, yang ditukar ganti setiap 5 - 7 hari. Tidak perlu disimen lebih dari 9 kali KECUALI kes rumit seperti ‘arthrogryposis’. Simen TIDAK PERLU ditanggalkan malam sebelum appointment. Sekiranya kaki ditinggalkan tidak bersimen untuk beberapa jam, sedikit atau semua usaha membetulkan kaki tersebut akan sia-sia.

3. "Adakah pembedahan masih diperlukan untuk membaiki masalah clubfoot?"


Sebanyak 80% kes diperlukan untuk memanjangkan tendon Achilles dengan prosedur yang dinamakan ‘tenotomy’. Ponseti Method menggunakan ‘percutaneous tenotomy’ yang bermaksud satu prosedur yang mengunakan jarum untuk membetulkan tisu-tisu berkaitan tanpa memerlukan pembedahan terbuka. Prosedur ini tidak memerlukan masa yang panjang (10-15 minit sahaja)dan hanya dilakukan di dalam pejabat/klinik dengan ‘local anesthesia’ (bius dis tempat tersebut sahaja). Jarum akan dimasukkan ke belakang tumit. Prosedur ini tidak memerlukan jahitan untuk menutup luka dan kesan luka hanya sekecil gigitan semut. Sekiranya doktor anda memilih untuk menggunakan ‘general anesthetic’ (bius satu badan), pastikan dia masih memilih menggunakan ‘percutaneous tenotomy’ dan bukan prosedure terbuka. Selepas prosedur ini, kaki akan disimen semula selama 3 minggu untuk menyembuhkan tendon. Tenotomy hanya akan dilakukan sekiranya semua aspek clubfoot telah diperbetulkan kerana setelah simen ini ditanggalkan, kaki clubfoot sepatutnya telah pulih sepenuhnya.


4. "Berapa peratus kah sesorang pesakit memerlukan pembedahan pembetulan atau pembedahan besar untuk membaiki kaki clubfoot?"


Sekiranya doktor anda mengunakan teknik Ponseti dengan betul, beliau perlu membuktikan yang beliau telah membetulkan kaki clubfoot dengan teknik yang betul sebanyak 90% atau lebih. Maknanya, doktor anda hanya perlukan cara simen yang betul dan percutaneous tenotomy sahaja. Anda pelu bertanya kepada doktor tesebut sejak bila dia mula praktis Ponseti Method ini secara eksklusif, berapa ramai psakit yang telah beliau bantu dan berapa banyak pesakit yang telah berjaya dibantu tanpa sebarang pembedahan. Doktor anda sepatut boleh berkongsi testimonial pesakit2 lain.


5. "Apakah jenis kasut yang akan digunakan setelah pembetulan telah dicapai?"


Apabila simen terakhir ditanggalkan, pesakit memerlukan pemakaian kasut sokongan. Standard protokol ialah pesakit diperlukan memakai kasut sokongan tersebut sepenuh hari selama 2-3 bulan (23 hours/day) dan waktu malam atau tido siang selama 16-18 jam/sejari dan seterusnya 10-12 jam/sehari sehingga umur pesakit mencapai 4-5 tahun. Tidak ada alatan lain atau AFO (ankle-foot orthotic) digunakan didalam Ponseti Method ini. Risiko untuk kes berulang adalah tinggi sehingga umur 4 hingga 5 tahun. Anda boleh bertanya kepada doktor anda peratusan kes berulang dan cara-cara untuk mengubati kes ulangan.

6. "Apakah rupa bentuk kaki pesakit semasa waktu pembetulan dan selepasnya?"


Perubahan kepada kaki clubfoot akan dilihat secara beransur dan dramatik. Sebelum simen terakhir, kaki akan diletakkan pada arah 70° (akan dilihat over corrected tetapi memang akan diperlakukan sebegitu). Arah 70° itu juga akan di letakkan semasa pesakit memakai kasut sokongan. Kurang dari 70° adalah tidak boleh diterma pakai. Ada kajian oleh Universiti Iowa bahawa risiko kes berulang adalah tinggi sekira kaki diletakkan pada kurang dari 70°. Tambahan pula sekiranya kes berulang, pendekatan untuk melakukan pembedahan adalah tinggi. Kaki clubfoot perlu dipulihkan sebelum memakai kasut sokongaan. Kasut sokongan perlu dipakai bersama palang (bar).

Satu lagi, sekiranya doktor anda mengaku yang dia pernah menjalani latihan di bawah kelolaan Dr Ponseti atau pernah ke Iowa University atau mengaku beliau yang mengamalkan Ponseti Method tidak bermakna dia pakar dalam teknik ini.Oleh itu, anda perlu mencari rujukan dari pakar lain.

>Terjemahan dari http://members.tripod.com/ponseti_links-ivil/id13.html<

Good Article..by Dr Matthew Dobbs

For our reading..

http://orthoinfo.aaos.org/topic.cfm?topic=A00296&return_link=0

by the way, this is our photo with Dr Amnuay Jirasirikul, the certified Ponseti Doctor in Bangkok.

Markell vs Mitchells

Both FAB shoes are used to ensure the corrected feet stay corrected.

But what is the difference?

The Ponseti AFO Brace (also known as the Mitchell brace) made by MD Orthopaedics has been available since 2005. It's more expensive than the Markell FAB but is more comfortable and easier for the baby to adjust to. Dr Ponseti is involved in the design of the Ponseti AFO/ Mitchell brace and it is especially recommended for children with very small feet or complex clubfoot.

Mitchell shoes was originally developed for atypical clubfoot.

All of my clubfoot circle in Malaysia wears Markell since it easily can be purchased locally..Globally, now everybody is supporting the Mitchell shoes...and now we have new patented BAR developed by Dr Dobbs..:)

Dania is wearing Mitchell since a year ago..She is comfortable with Mitchell..I noticed with Mitchell we can ensure the heel is flatten from the heel window..Previously when we we got our false treatment in HKL, there a lot of clubfoot patient wearing markell without a brace..There is no point to wear the FAB without the brace..There is also some patients wear it as a walking shoes...

What do u say?

Finally..she can walk

In nosurgery forum, there are parents who had clubfoot child is worried about the delayed walking.
I'm worried too and I've plan to bring Dania to physio theraphy..But she is now standing tall and walk officially on her 22 months 13 days..I will find a good video on her first walk..

So parents out there, dont worry, they will walk soon as they are ready..

cheers everyone!!