No Pain No Gain

Last Wednesday, Helena went into the hospital to have Quengel casts put on her legs. The goal of this procedure is to gradually straighten her knees over time without having to subject her to a surgery. Most kids with knee contractures do have surgery; in fact, there are kids with AMC who have had needed a dozen or more surgeries by the time they have reached Helena’s age. We have only had one – and it was an outpatient procedure. We have spent time with doctors correcting club feet, determining whether her hips or her knees are a bigger issue and if surgery is needed, whether or not her quadriceps can be strengthened, and whether or not a neurological cause is part of the issue- which impacts the efficacy of surgery. If we can avoid it, we prefer that any surgeries are put off until Helena can have a voice in the decision -unless they are determined to be both absolutely necessary and beneficial to her long term quality of life.

Quengel casting is non-surgical, and appealed to us because it was not as invasive and would prevent the buildup of scar tissue, which can lead to problems over time. Furthermore, it will improve her posture and (I hope) will enable her to utilize muscles more effectively and strengthen them.

Helena went through the casting process without a hitch. She woke up very angry – we could hear her fussing two big rooms away. She was grumpy from the anesthesia, VERY angry about the IV, and insecure about the casts; but once she got the anesthesia medication out of her system, her mood improved.

She has also decided through all of this that she HATES taking medicine. Apparently, the Tylenol that is provided through the hospital is commonly known by Scottish Rite patients as the nastiest substance known to mankind! She would rather be in pain than taste it! 😂😂. We went and bought our own in a different flavor so that she would take it, along with ibuprofen as needed. Still, every time the nurse asks if she is in pain, she says “no,” even if she is hurting. Then when the nurse leaves, Helena will go on about how she hates the casts and wants them off. She is a tough (and extremely stubborn) little thing. Sometimes that makes her a little hard to deal with! We have resorted to bribery in various forms.

Helena, complaining with food in mouth…

Probably the biggest complaint she had the first day or so was not being able to move as freely as she had been with her KAFOs. She wanted to stand and move around as she had been doing. We got her a pair of cast shoes and she was able to do that when she wanted.

First moments with cast shoes

The first three days of turning the bolts on the hinges were also relatively easy. But since Saturday, the turns have become much more uncomfortable. On Sunday evening, she had a terrible time sleeping to the point that she continually woke up wailing and screaming. The night nurse had the doctor on call come in and check her casts. She has developed a lot of pressure above the front of her knees, especially the left one. Nonetheless, the pressure appeared to be normal, so we continued.

Helena continued to complain throughout the day yesterday, and hasn’t eaten much. The doctor halved her turns in the morning, and did not turn the right leg at all last night. Today, she slept much better, and the doctor decided that she would like to reapply her cast and check for pressure sores – and that since her left leg is extended fully, she will go ahead and apply a hard cast on that one. (Yea!). Hopefully, these changes will help her be a little more comfortable.

With the pain being the way it is right now, she keeps telling us and the doctor, “I don’t want these on my legs. I want my normal legs. Mommy, please take these things off.” As a mom, these words are hard to hear. The ordeal seems pretty impossible right now. This is hard stuff to handle for a four year old child, let alone a mom. But we all know that if she can have straight legs, it will be so worth the momentary discomfort.

I keep telling her how strong she is – and her response is, “No I’m not. See? I don’t have bumps.” (Meaning muscles in her arms). I’ve tried to explain to her that sometimes being strong doesn’t mean big muscles but instead big courage- she doesn’t quite understand that concept.

Progress during club foot casting
Walking with braces before quengel casting

But as you can see, it is very clear that we have come a long way from her first year – and you don’t have to know what courage is to have it. In fact, she has a lot to teach the world about what it means to be strong.

Helena Update

On Wednesday, Helena had Quengel Casts put on both legs. She is doing well, but is starting to feel the stretching. Here are a few of photos. I plan to post something longer when I get the chance. 🙂

You Can Do This

Last weekend, we spent Saturday trying to wrap up some garden tasks in order to leave it in other capable hands while I’m gone. It was a beautiful day, but very hot! Also – a couple of my helpers were missing.

Helena loves going to the farm, but has to stay inside and away from mosquitos, chiggers, ants, and other biting and stinging pests so that she will have no bites, rashes, or marks on her legs when she gets her casts (today). Until recently, her time spent there has been on pallets set up under the pecan tree canopies. A couple of months ago, Stuart got an idea about getting her a 4-wheeler.

At first, I absolutely hated the idea. I have known too many kids who have been injured riding on atv’s and didn’t want to risk it. Stuart, however, insisted that I keep an open mind. He soon found one with a governor that would keep the speed slow enough for her to control the 4-wheeler in order to explore the farm independently. So I gave in and told Stuart he could get her that one.

When it arrived, Stuart spent a little time figuring out how to use it himself, then trained Helena to drive it. I remember shaking my head as I left the farm to run errands as she was stuttering all around with quirky movement. Start, stop…start, stop… and the turning was so difficult. It seemed like the 4-wheeler was going to be a little too heavy for her to control, and I wondered if we had made a mistake.

Helena, on the contrary, persisted. She practiced and practiced, and when it was hard, she kept going. Stuart overheard her talking to herself. She said, “Helena, you can do this!” and she kept practicing. . By the time I got back from my errands a couple of hours later, this was what I saw:

As she rode, she was telling us, “You can’t stop me now!” I don’t think anyone ever will stop her. She is stubbornly persistent.

One thing that many people don’t realize is that children born with a disability don’t have an awareness that they are different until someone points it out. The disability is their personal norm and something they have never lived without. So they figure out how to compensate through trial and error. We all have those types of things, don’t we? And yet so often, we stop just short of our goals because they seem unattainable. Persistence is not easy — but when we stick with a challenge (and rely on God’s strength), there is literally nothing we can’t do.

“Growth” Mindset

When I was little, my mom had an amazing garden that she loved very much.  I remember walking into it impressed by the variety of vegetables she had growing .  For years, I couldn’t eat canned green beans from the store, because they just didn’t taste the same as the ones from her garden. And the first pickled okra I ever remember having was grown in my mom’s garden.

This Spring, I have been working hard at my own gardening project. Stuart’s family owns a ranch with a small pecan bottom, and that is where our garden grows. One day soon we will be living out on that property.

Measuring around 12,000 square feet, our garden contains numerous types of vegetables and fruits – corn, squash, beans, cucumbers, strawberries, and chard, just to name a few. We have berry bushes, a peach tree, and designated space to add more trees soon.  We will also have watermelons and cantaloupes in July.  I tilled it, built the rows, planted it and have tended it mostly myself – with a little bit of help from my kids and family. Being out there always makes me happy – and provides me with time outside that I have really missed since I have not been band directing this year. (I never realized how much I’d miss that part of my band gig!)

I almost didn’t do a garden this year. Helena will be going into the hospital on June 4 to start a lengthy casting procedure that will involve the majority of the summer. She will be in the hospital in Dallas for 4-6 weeks, far away from my garden, then will be in a hard plaster cast for 4 weeks.. I will be staying with Helena throughout her hospital stay. When I realized the significant amount of time we’d be in the hospital, I wasn’t sure it would be worth my time and energy to work on a green. I kept thinking – why start if I can’t be there to finish?

After a lot of thought and a discussion with Stuart, I decided that it would be worth starting the garden for the simple purpose of finding out what will work. We decided to go about this by starting lots of seeds in our greenhouse. Seed starting was something I needed to improve upon, so it was a positive use of time. To my surprise, most everything came up!

Next, I had to learn the best way to keep the plants alive coming out of the greenhouse. If you put them out too early, they will die out. If you put them out too late, you stunt their growth.

Since late February, I have been going out to work in my garden at least a couple of times per week after work and on most weekends. There are lots of weeds, bugs, and at times, snakes (yikes) — and it is hard to keep up with that part, but we do what we can.  The garden has taken up a lot of time and effort – but the rewards have been fully worth it!  

I have also spent a lot of time reflecting on how hard we have worked to get Helena to “grow” — and to do the things that others do without thinking.  Helena has worked toward the goal of walking independently since she was born! For her, whether growth in this area was  “worth it” is a non-negotiable issue. It must be a part of her daily life.  She has to come up with solutions as to how to do many things. Just as a garden brings sunlight and freedom to stay away from a grocery line – the solutions we come up with bring her invaluable independence when they finally bear fruit.

As with our garden planting experiments , we have had to experiment with different ways to help Helena – she is truly one of a kind. Some experiments work, some don’t. We purchased rattles with the goal of encouraging arm movement. We purchased phone apps for the sole purpose of distracting Helena when doing stretches daily. We bought several tricycles based on the distance of the pedals from the handle bars and the degree angle between the axle, handle bars and pedals in order because it was worth the try.  We bought monkey bars to enhance upper body strength, and played balance games on the Wii.   Stuart has built special toys to encourage certain types of movement.  And we use lots of toys non-traditionally.  Just like choosing which seed to buy or which organic pest control method is best, much time has been spent analyzing tasks and trying unconventional ways to encourage movement. All of that effort has culminated in some great growth and independence for Helena.

As we prepare to take Helena to Scottish Rite Hospital in Dallas next week, we will be preparing ourselves for yet another unconventional way of treatment.  Quengel casting is not a common procedure for AMC.  It was previously used on polio patients, and recently been revived as a treatment option that doctors are now trying as an alternative to surgery.  Most kids with arthrogryposis have multiple surgeries before they turn 18.    These surgical options, while very necessary at times, could eventually result in a buildup of scar tissue and affect her as an adult.  The Quengel casting option is lengthy, but is a non-surgical method that we feel is worth a try. 

Our family has never been the type to just jump at the most convenient option.  Sometimes the lengthy path to a desired result is the best in the end, and reaps the greatest rewards.  And so I will bid my garden farewell in a few days.  Worth it?  You bet.

Everything worth doing in life requires work.  

“Far and away the best prize that life has to offer is the chance to work hard at work worth doing.”

― Theodore Roosevelt

Perfection Redefined

The month of June is Arthrogryposis Awareness month. As we go through this month, I hope to reflect each day on our experiences with Helena’s condition. AMC is an umbrella condition that affects around 1 in 3,000 births. This post, originally published on May 19, 2019 when Helena was 4, is the first reflection.

“Something’s wrong, isn’t there?” I asked Stuart immediately after the ultrasound technician left the room. We were at our 20 week checkup, excited to find out that our baby was a girl. But the technician was just a little too quiet, and a little too focused on her work.

“Try not to worry,” Stuart said. And then he continued trying to distract me from what he saw going on. His distractions had been working for a while — until I finally noticed that the technician was concerned.

What I didn’t realize until later was that they were having trouble detecting her heartbeat. The technician was also alarmed because there was no evidence of movement. When she returned to the room, she brought another technician back with her and they found Helena’s heartbeat. After they finished looking at some other measurements, they explained that my doctor needed to meet with us. My heart rate soared, my blood pressure went up, and I sank into sorrow. What was wrong with the baby?

A couple of weeks later, we met with a neonatologist and were told that our daughter Helena would be born with a condition called Arthrogryposis Multiplex Congenita (AMC). AMC affects 1 in every 3,000 births and is defined as the development of multiple joint contractures affecting two or more areas of the body prior to birth . The neonatologist noted that Helena had clubbed feet, seemed to be in a lotus position, and had straight arms. The doctor explained that there was really no way of knowing how severe it would be until she was born. We were told of the possibility of limited locomotor movement, possible breathing problems, and difficulty doing many of the daily tasks of living that most of us take for granted.

I was furious after this diagnosis. I was mad at the ultrasound tech. I was mad at the doctor. I was mad at the nurses who took my blood pressure and vital signs. And I was mad at God. How could God allow this to happen to my baby – or any baby? No one knew if she would be able to care for herself, or even breathe without help. The worst part for me was that I could do NOTHING to help her, or so I thought. I sulked and stewed for days over the fact that this time, I could not control the situation I was dealt. I talked with Stuart about my anger on numerous occasions, and at one point, Stuart finally said this:

“Jennifer – who are you to think you know better than God what is best? God made Helena in his image. He doesn’t think anything is wrong with her. He thinks she is perfect the way she is. Who are you to judge God’s perception of what is beautiful and complete in His eyes? God thinks Helena is His perfect creation, created in His Image and you need to wrap your brain around that.”

Stuart’s words were both honest and perplexing. How can God think this situation is perfect? Is he kidding me? The more I thought, the more my questions changed toward conviction: If this was God’s vision of perfection, then why was I judging God’s decision about what was perfect? Why did I have the idea that God was unable to work through this situation as he had in so many other moments in my life? Who was I to limit God?

As I sorted through an array of questions and emotions, I was able to move forward and learn more about AMC and parenting a child with a disability. It has been a journey much like going up a creek without a paddle because every AMCer is different, and very often, we are doing things very few others have had to do. Making decisions in this situation can be very isolated and lonely. What we have learned most of all is that what we think God considers to be creative perfection isn’t really the case – we limit God in so many ways, and in doing so, we limit ourselves, we limit others, and we limit what is possible. Helena is now four and a half — and If I had been able to look forward, I would have been relieved to know that there is no limit to what the future holds for her.