Back from Mayo and perplexed again

[fortitudine]

Hi,

Briefly, our then 17-year-old son Eric crashed his bicycle going 70+ km/hr at the World Junior Road Championships in Belgium this past August. We think he hit a guardrail. Open fracture of the clavicle that was surgically repaired and then discovered he couldn't move his arm. Came home and got to work on getting help. As the Canadian health care system is way overburdened and wait times are beyond belief, we also started looking in the US.

We just got back from our first visit to the amazing Mayo trio. A bonus for us, the first person we saw was not one of them, but a Fellow who had done her med school here in Calgary, and in the same class as Eric's referring doctor! As I write about orthopedic ressearch here, we were also able to chat about those docs too. So it kind of warmed things up.

Eventually there were eight or nine people in a room that comfortably holds three! They were all sooooo thorough, we were really impressed. Then Dr. Bishop began, "A month ago, we would have agreed with your surgeon in Calgary (the best BPI doc in Canada), but now we are seeing some slight signals in a couple of the muscles, including the biceps so we'd like to wait another 5 weeks..."

They do not believe there is an avulsion, which is good news, but there are still certain muscles that show no innervation, the deltoid being the most critical. So we know there is surgery no matter what. It would just be nice if we didn't have to worry about the biceps.

Anyway, they aren;t sure whether the regeneration be enough to avoid surgery and want to wait to measure any improvement, since, as we all know, the docs much prefer nerves to heal on their own.

Then, the other difference is that they prefer to do a nerve transfer from the triceps, whereas our NS here wants to preserfve the triceps for cycling and would do a nerve graft from the leg.

We came home not sure what to do next - call the surgeon here, or just go with Mayo. Fortunately or not, that decision was taken out of our hand, since in their incredibly speedy and efficient way, they had already faxed all the reports to him! As they know one another this may be a good thing.

For us it's a tough call, assuming that our NS here agrees with them. Do we stay in Canada and save ourselves $70,000 and have surgery by the best Canadian, who does about 15 a year, or do we say, "Oh to heck with the new Jaguar let's go to the Mayo where they do probably close to 100 per year?" I'm kidding about the Jag, although Eric did say, "I'll stay in Calgary and you can buy me a Porsche". Oh those 18-year-olds!

In the meantime, we have made a date for 6 weeks hence at the Mayo for EMGs and clinical follow-up and we are waiting to hear from our NS here. It will not be an easy decision, but we are very fortunate that we have such excellent options.

If anyone has questions I'll be happy to respond.

[ptrefam]

Sounds a bit like Dustin. They want to use the tricept if they have to rather than the gracilis because it is less complex so less recovery time. Although they did say gracilis is possible and he could have the option. But they felt if he couldn't lift the arm he wouldn't need the tricept as that is used primarily overhead or to push open a door. His tricept is strong as Dr. Bishop found out when he held his arm up and asked him to straighten it directly into the drs face, ooops. So, they are having him super strengthen it just incase. His bicept and deltoids continue to improve so we are also wait and see. But, yes I do think they are very thurough at Mayo. Dustin is able to lift his arm overhead in water and can now hold the arm at a 90 degree angle when he uses his other arm to put it up there. Good luck with your decision!! It is a tough one.
Sue

[ptrefam]

You should check with some of the people who have had the surgery in Canada and see what their success is like compared with those at Mayo if you can. It may help with your decision.
Sue

[jennyb]

One of the most experienced bpi surgeons in the world wrote that it isn't the doctor or hospital that decides how good results from nerve grafts/transfers are, it's how soon after the injury surgery takes place and the age/physical condition of the patient. Do whatever you feel comfortable with.
Secondary surgery such as muscle transfers do require an experienced doctor, that is a whole different story. Mayo are probably the most experienced team on that front in the US.
Good luck
Jen NZ

[admin]

Yup and experienced they are. Dr. Bishop does an average of 150 a year(yes I asked and he knew exact figured for the previous 3 years).

Before my surgery at my consultation, I asked why wouldn't they take a nerve from my leg. In my case, they said it would take longer for it to heal and grow for my situation. They also said that since the nerve that goes down to my wrist and tricep is workable, that would be my best option. So they went ahead and spliced and moved it over to my bi and delt. Every situation is different.

Sorry for the leyman terms.

[EllenB]

Just to piggyback on Jen's post a couple back, I'd add another factor to successful outcome from these surgeries, and that's the motivation of the patient to persist in daily therapy for MONTHS - quite often many - before even the beginning of movement is evident.

Ellen