In the name of Allah; the Merciful; the Compassionate - بِسْمِ اللَّهِ الرَّحْمَـٰنِ الرَّحِيمِ
May the peace, mercy, and blessings of Allah be with you - السلام عليكم ورحمة الله وبركاته
On Wednesday I took Muja to PMH to see an orthopedic to review her dislocating hips as a result of her tight and stiff muscles. Previously in the hips surveillance clinic she attended on March showed that her right hip migrated to 38%, while her left hip was stable at 28%. Alhamdulillah ala kulli hal - Praise be to Allah in all circumstances.
The muscles of people with Cerebral Plasy like Muja can be so stiff or tight. Muja has Spastic cerebral palsy. Spasticity means stiffness or tightness of muscles. The muscles are stiff because the message to the muscles is sent incorrectly through the damaged part of the brain.
When people without cerebral palsy perform a movement, some groups of muscles become tighter and some groups of muscles relax. In people with spastic cerebral palsy, both groups of muscles may become tighter. This makes movement difficult or even impossible and also pull her femur away from its hips sockets.
Muja receives Botox injection which is a therapeutic muscle-relaxing agent that reduces the rigidity of muscles or unwanted spasms in her hamstring and abductor muscles. It begins to take effect by blocking transmission between the nerves and the affected muscles. Usually it's effect last for four months.
The injection stops the signal between the nerve and the muscle, relaxing the muscle and reducing stiffness. Botox only affects the muscles that are injected and once the muscles are relaxed, therapists are able to stretch the muscles and stimulate normal growth.
Masha Allah, apparently the tightness of her muscle is so severe even Botox injection could not prevent her hips from dislocation and pain.
I was praying that Muja won't need any surgery to fix her dislocated hips. I was hoping that there is other option than surgery. I was shocked when the doctor mentioned about hips reposition surgery. Not another surgery for Muja. Allahu Akbar! There is no power and no strength except with Allah.
Muja had her hips x-ray again. Alhamdulillah her hips was the same like the one she had on March. Her right hip migration is still at 38%. Alhamdulillah it does not get worse. After looking at the new x-ray the doctors were discussing whether to do the hips surgery or not. Alhamdulillah, there is another way which sound less painful and concern or dread. Instead of doing hips surgery, it will be soft tissues surgery. The aim of this surgery is to reduce subluxation/dislocation and to relieve pain, improve symmetry and aid management.
So what is soft tissues surgery? Alhamdulillah, the procedure does not require cutting into the hip. The surgeon makes an incision and cuts tight tendons to help increase the hip's mobility. The hip is then externally manipulated to bring the head of the femur back into the acetabulum(The cup-shaped hollow in the hipbone into which the head of the femur fits to form a ball-and-socket joint).
A spica cast is applied to stabilize the hip. The spica cast prevent the joint from moving and allows the bones and tendons to heal. The cast is made out of plaster or fiberglass and usually has a cotton liner for comfort.
After the operation the pain and spasm were managed by intravenous midazolam and epidural anaesthesia for two to four days. At six weeks, the spica cast will be removed. Then continued to have daily community physiotherapy for one month.
I am worrying about how I am going to manage her in that spica cast. I have looked at the image online and its not comfortable at all. How am I going to carry her around? Will she be comfortable with that? How about nappy change? What position will she be in when sleeping and sitting?
I guess I have too much concern about this surgery because I don't know what to expect. I don't know what to do except asking Allah to guide me. Poor my child. She just had her PEG surgery last month and now she need soft tissues surgery. Insha Allah more decision to make and more istikharah prayer to perform but hopefully no stress for me. I pray to Allah to guide me in making the best decision for Muja beneficial.
May Allah help us, Ameen. Please make doa for us.
References: Bilateral hip surgery in severe cerebral palsy