Tip of the Iceberg

Evenings in our house are pretty much always spent the same way.  Kaylee gets a bedtime story and put to bed, then I spend time reading with Cameron, when he gets put to bed I spend time reading with Brendan, then finally he gets put to bed as well.  It makes for a hectic hour and a half, but I love the time I get to spend reading with the kids.

Brendan and I usually bring our books into my bedroom and sit on my bed together to read.  We prop up our pillows against the headboard and lean back into them.  It’s quite comfortable and provides a quiet, intimate setting where we are less likely to get interrupted or distracted from our reading.  However, over the summer I began to notice that Brendan would begin bobbing his head at random times during my reading.  He’d do it for about 30 seconds to maybe a minute and then would quit.

I didn’t think anything about it at first.  Brendan has always had nervous ticks.  Back in Kindergarten he used to pull all the hair out of one eyebrow, in first grade he would chew on the neck or sleeves of his shirt.  Second grade was the worst, he was so stressed at school that he actually pulled out so much hair at the back of his head that he developed a small bald spot for a while.

But after a while the head bobbing began happening so often that it would be very distracting for me and he would frequently lose his place in the book.  I finally stopped in the middle of reading one night and asked him why he did that.  I expected him to say he didn’t know or something along those lines.  One other nervous tick he has is to run back and forth across our basement.  We’re not quite sure what sparks him to do that particular one but if you stop him and ask why he’s running he will either say he doesn’t know or he needs exercise.  But as soon as you call his attention to it he stops.

What I was not expecting was for him to tell me it’s because his shoulder hurt.  A little more probing got him to tell me that anytime he sits still his shoulder starts to ache causing him to move around to make it stop hurting.  That night I told Matt about it, but I’m not really sure I described the situation very accurately because at first he wasn’t sure we needed to do anything about it.  He recommended that we try a few different positions to read in and see if that helped alleviate the pain in his shoulder.

So we did.  We tried reading in the bed sitting up more fully, and with more support behind his back, and when that didn’t work moved our reading out into the living room where we could sit in chairs rather than leaning in the bed.  Neither seemed to help, and as we were sitting in the living room reading one night Matt got to see for himself the issue and agreed that we needed to have it looked at.

Around that same time I noticed Brendan messing with the tip of one of his fingers.  Again I asked what he was doing and he said that finger was bothering him.  He said it didn’t hurt, but it wouldn’t straighten out completely.  I took a look at it and sure enough the first knuckle on his middle finger was bent and would only straighten out if you did it manually.  He could not raise the knuckle himself.

Well that settled it, I called and got the next available appointment with our pediatrician.  He went through his examination of Brendan and asked him questions about these two problems.  He wanted to know how long the problem had been going on.  For his shoulder Brendan told him it had hurt for as long as he could remember, the finger for a few months.  The doctor and I both tried to impress upon Brendan the importance of letting someone know when he was hurting or having a problem.  Who knows if it actually sunk in though.

Meanwhile the doctor decided to X-ray both Brendan’s shoulder and hand and refer us to an orthopedist.  We did the X-rays that day, but the orthopedist that our pediatrician recommended didn’t have an appointment for another month.  We decided to go ahead and wait for that appointment.  This particular orthopedist came highly recommended by our pediatrician and we’ve found him to always steer us right with specialists.  So if he said this guy was good then that’s who we wanted to see.

It was an agonizing and nerve wracking month to wait and see what the doctor would say about Brendan, but there was nothing we could do but wait.  Finally, after what felt like an eternity, the day of his appointment arrived.  I picked Brendan up from school yesterday and took him over to the orthopedists office.  As soon as we met with the doctor I knew we had been right to hold out for this guy.

As he examined Brendan and walked through his explanation with us he reminded me a lot of our pediatrician.  What I like about him so much is that he never makes me feel stupid for bringing the kids in to see him even if it ends up there was nothing wrong with them.  I’ve always said he could make a paper cut seem like something I should have brought the kids in for.  In writing that down I don’t feel like I’ve done our pediatrician justice.  But if you’ve ever gone to a doctor and walked out of the room feeling like an idiot for having done so then you know what I’m talking about.

The orthopedist looked at Brendan’s finger first.  It only took a short examination to determine the problem.  I had done some internet research in the time between the pediatrician’s appointment and the orthopedist’s appointment.  I’d found a potential cause of his finger problem called mallet finger and as it turns out that is exactly what the problem is.

The basic explanation is that the tendon that controls the movement of the first knuckle on his finger became un-attached from his bone and therefore he couldn’t move that finger tip like he should have been able to.  The doctor said when caught early on they can splint the finger and the damage can be healed with immobilization of the finger for 4-6 weeks.  However since this happened so long ago there was a chance that the damage had already healed and if that was the case that they would have to do surgery to repair the damage.

I felt horrible that this had been going on for so long, but honestly I don’t spend my every waking moment examining my children’s hands.  If you’re just watching Brendan do something and don’t know that he’s having this issue with the one knuckle you won’t notice it with a cursory glance.  It’s not until he stops what he’s doing and specifically shows you his hand that the problem becomes apparent.  So the four weeks we had to wait for our appointment didn’t make or break the injury, but the two to three months that Brendan didn’t tell us about the problem did. They decided it wouldn’t hurt to try the splint anyway, since there was a chance it could still work.

The examination of his shoulder wasn’t so clear cut.  They looked at everything; the position of the bones, Brendan’s posture, the range of motion, and ability to resist or push against an object.  In every case he checked out normal.  The X-ray showed no damage either.  The orthopedist finally explained that there were a couple of potential causes for the pain.  He said it could just be growing pains.  A reasonable explanation as Brendan had some pretty bad growing pains in his legs around the time he was four.

He also said that the problem could be psychological.  Basically how he explained it was that when Brendan was active his mind would be active too, which is why he has no pain when he’s moving around.  But when he’s still he doesn’t have as much to occupy his mind.  So his brain sends a signal to his shoulder to ache causing him to start moving around to get rid of the phantom pain.  His advice at this point was to wait and see.  He said to bring him back immediately if the problem seemed to get worse, but otherwise see if things got better with time.

While it’s always hard to hear that there isn’t really a problem (or at least one they can find) both of his diagnosis fit the situation.  Having growing pains isn’t unprecedented for Brendan, and if it is psychological that goes back to my original thought that it’s one of Brendan’s nervous ticks.

Any way you look at it, it’s nice to know there is nothing physically wrong with his shoulder and to have someone monitoring the problem.  As for the finger, Brendan is not digging the whole splint thing.  He was in tears after we left the doctor because it’s his right hand and he’s not sure how he’s going to write, or play his cello, or participate in gym class etc.  Matt and I both spent a lot of the evening comforting him and telling him that having a splint wasn’t the end of the world.  His biggest worry was that his teachers weren’t going to understand so we also explained that he’s, by far, not the first kid to have to deal with this, nor will he be the last and that his teachers would work with him to accommodate.

That seemed to help some and he spent the remainder of the night learning how to work around the splint.  After he’d gone to bed I sent some quick emails off to his classroom teacher, his orchestra teacher, and his gym teachers.  I figured a brief heads up couldn’t hurt and would make it easier on Brendan because he wouldn’t have to explain the situation and they could potentially have a plan in place before he even got to school.  We will just have to wait and see.


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