dr fricks response to my questions

[Guest guest]

Please make another appointment with and we can

go over things again and plan for surgery if you wish. I have

inserted some answers to your questions below.

L. Frick, MD

Residency Program Director

Dept. of Orthopaedic Surgery

Carolinas Medical Center

questions regarding patient Grace Boothe

Dr Frick,

We brought our daughter Grace Boothe to you for a 3rd opinion

near the end of November. She had been experiencing multiple

problems since first going into the DBB at 7/8 months old. She had

been casted from birth to 5 mos by a military podiatrist and then by

Dr at Chapel Hill. Both where unsuccesful treatments. Dr

had performed a " test " tenotomy on Graces right foot prior

to her clubfoot deformity being fully corrected. We then had her

casted once more by him before I took her to Iowa to be treated by

Dr Ponseti. Dr Ponseti said he would be able to fully correct

Graces feet with 2 additional casts and tenotomy. He said the first

tenot. had been done way too soon. Treatment went as planned and we

were sent home with her final cast and the DBB. Final cast was

removed, feet looked great and we proceeded as prescribed. One

month later Graces ankles were nearly touching the floor when

standing and Dr Ponseti diagnosed her with loose ligaments and had

us discontinue using the brace 24/7 and we were told to go to

night/nap time use only. She was less than a year old at the

time.

I know you have all of this information in Graces records

however I wanted to remind you of her past history. I have had so

many physicians tell me that " something is wrong " not one can tell

me what should be done or what the actual problem(s) are. She has

had an MRI to rule out any major problems associated with her

premature birth. Findings were a tiny area indicating PVL. I was

told that it was so small that it would probably have no noticeable

symptoms. However, that is in the area of the brain that would

affect the lower extremeties. She has had boneage testing and

recently full body XRAYS. When I brought her to you; you mentioned

Spondyloepiphyseal dysplasia as a concern. I had the XRays done and

was told that there is no indications of this at the time. However;

I have researched this and found that only one type would be present

on Xray at 3years old. I found that the other type is usually not

noticeable until age 5-8. Do you have any other suggestions on how

I should go about testing for this? I am very concerned. SLF- Some

things only become evident with time – no further testing is needed

and I think the chance she has SED is very low. Please bring me the

xrays to review.

I do want to go ahead and schedule Grace for surgery as you

suggested. However, I do have a few questions first. Is it

possible that the cause of Graces weakness in her legs and

combination of loose joints/muscle tightness has been caused by

walking on an uncorrected clubfoot for the past year and a half? I

do not think so. (It was corrected at one time so I do not feel it

has been this way all along) Or from the first tenotomy being

performed before her foot was fully corrected and then having

another less than a month and a half later? It just doesn't seem

like a coincidence to me that her initially most severe left foot is

fine and the right foot that has had 2 tenots. is very abnormal and

tight. It is hard to judge severity of clubfeet in young infants.

Also several phys. have commented on how large her first tenot. scar

is and I have wondered if it is possible that too much was done? I

doubt it . It is not that I want someone to blame but just that I

would like a bit of relief that possibley there is no underlying

cause i.e. cerebral palsy, or what you had mentioned. Clubfoot is

much easier to deal with than continuing to search for another

cause. It would be a bit of a relief to me to hear that this " COULD

HAVE " resulted from her foot not being fully corrected. I do

understand how toe walking causes sever leg issues in CP children

and wonder if this could compare to how Grace has more or less never

walked with her heels fully planted on the ground .........could

this have caused similar problems?? CP and clubfoot are different

issues and not comparable. Also I know that she has rockerbottom

for over a year and a half. I have done some research on

rockerbottom to find that the main cause is from the tight achilles

or from not correcting the hindfoot first in clubfoot treatment.

Rockerbottom is poorly understood. However no one has ever mentioned

trying to recast Grace to see if her heels could be brought down

(even at her follow up last Jan. when the rockerbottom was first

seen). Is it too late now to try casting? Maybe not – see Ponseti

email. I am assuming it is since she is over the age of 3. She had

good dorsiflexion immediately coming out of her final cast but is

has gradually reduced over time. Are there less invasive ways to

possibley lengthen the achilles since the rest of her foot is well

corrected? See Herzenberg email - What exactly do you plan to do?

A few casts, open tendo Achhilles lengthening and likely post

release. I know you mentioned posterior release. Will this involve

opening the ankle capsule as well? Probably Will the surgery

possibley further weaken the leg muscles? Yes Is it safe to say

that she could have much improvement in how she walks, and a

reduction in the leg tightness as well from the surgery? Yes I just

want to know what to expect. I apologize for having so many

questions I just want to be sure that the right decisioin is being

made. Me too – we will do our best. I fully agree that to not do

anything is the wrong answer. I guess I also want to be sure that

you are aware of the fact that her entire leg seems to be affected

in some way. I understand. Therapists have said she has a strange

combination of tight muscles along with loose ligaments. She also

drags her right foot when she walks (swings it to the side a bit)

and walks with a very stiff leg that sortive bends out at the knee.

I would like to know your opinion regarding the cause of this. Just

an opinion.........I understand the difference between fact and

opinion! If it would be helpful to see a video of her walking or

any additional medical records please let me know. I would like to

see her again and watch her walk.

I am curious if you discussed Grace with Dr Ponseti as you

had mentioned doing so. And what was his opinion. I am already

sure that the wait and see route is not right. Agreed. But would

still like to hear his opinion. I sent his email to you.

Dr Frick you were recommended to me by several parents that

have brought their babies to you. I was told that you are very

caring for the children (hopefully) and that you take the time to

answer questions (try to) and to do what you can to help

(absolutely). I know I am asking you so much. It is my job. You

do not have to give your opinion if you do not want to. I was told

last year that Grace could have Cerebral palsy and that I should

have her examined. I have done my best to find out why she is

having so many problems and no one can give me an answer. I am told

over an over again that if she has CP it is extremely mild. I agree-

if she has it, she has a very mild case Have you ever seen a child

with so many leg problems related to clubfoot? yes Would having a

tenotomy done early before the foot was corrected have led to the

rockerbottom? I don't think so As my own findings have led me to

believe Yes; I would like your opinion. An early tenotomy means a

less tight heel cord,a nd we think a tight heel cord is one of the

causes rockerbottom Could walking for a year and half on a foot

with rockerbottom and very tight achilles have caused Grace to

develop the gait issues (yes)or the tight muscles that are

resembling mild CP?

Lastly, I had alot of trouble scheduling an appointment with

you. (sorry) The receptionist named told me you would not

treat Grace because you do not accept Tricare. ( I will check in to

this) Tricare is the insurance provided to us by the United States

army. I may not be able to schedule surgery with you if I am denied

due to the type of insurance I have. However I was told by another

receptionist that you do accept tricare. ( I hope we do) Please

verify with me if you accept tricare as there is no way I can afford

out of pocket! I would very much prefer having the surgery done by

a Dr that has been spoken so well of.

I am anxious to hear back from you. I am hoping that you feel

the surgery will help Grace very much and am looking forward to

having it behind me. Please let me know if any additional

information ( just the xrays she has had) will be of any assistance

or if you wish to see Grace again prior to surgery (yes). Thank you

very much for your time. You are welcome. SF

Mrs Boothe

>

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