Your doctor speaks II; Juvenile Amputees

The University of Illinois Medical Center campus in Chicago presents. Your doctor speaks during this series doctors in the colleges of medicine dentistry pharmacy nursing and graduate college at the University of Iowa and I will discuss the latest advances in cancer and heart research. Painless dentistry psychiatry nursing care and modern drugs. All of these and more will be presented on your doctor speaks. Your host for this series is Jack Reed AMA coordinator of public service radio and TV programming for the University of Illinois Medical Center campus and champagne Urbana. This is Jack recovered bringing another program that we do with faculty members from the University of Illinois Medical Center campus Chicago. Our guest today is Dr. Claude Lambert professor of orthopedic surgery University online and attending orthopedic surgeon at Presbyterian St. Luke's Hospital and he's also the director of the amputee clinic at the University of Illinois.

And we're going to discuss juvenile amputee doctor I want to is a juvenile amputee juvenile amputee is one who is not yet skeletal a mature play that the child is still growing and still has a definite amount of growth potential because of this growth potential. We feel that these children come into a separate category because they are continuing to grow their changing and shape. There are many reasons why the child differs from an adult the child let's say dynamic malleable. In a way to I'm not set in their ways which would more likely be like the adult would be the child is totally and totally dependent upon someone for his care or his prosthetic fitting for his economics. On the other hand

if a child with an amputation as a school age we can outline what we want this child to have in the way of schooling and build his schooling around his handicap. Any adult person who has already has a vocation and then has an amputation license it may be necessary to change that vocation. The child we can direct it to the proper channel already other differences besides. Well the obvious one that you mention and of course the child is still growing and maturing an adult has already reached this particular area. Are there others which you have to take into consideration. Well yes they are. The fact that this child is within a family group. This is reflected socially psychologically as well as our schooling and we have to educate not only the parents of the child but we also have to educate the child's playmates. We also have to educate schoolteachers to

consider this child. If he has only one or two limb deficiency that he has a relatively normal and of a child and he should go on and participate in all of the activities at regular school. No we don't have a lot of these children who are multi handicapped. They have three and even four extremities involved. I know this girl. I definitely those that need special schooling special care and that is in this group where we have to educate the teachers and the principals in schools more to allow this child to do everything and anything that it can and isn't their normal manner as possible. That's a good point. They're normal as possible. Doctor as an orthopedic surgeon you know me you know how and actually with the surgery that might be in a case like this but you're probably the whole being of the person and the psychological and

emotional aspects that would be caused by enacting this. This is very definite. Well there are two kinds of juvenile amputees. We classify them one as those which have acquired amputation. These are children who have been born with normal extremities but for some reason or other they have lost an extremity of being at an upper or a lower. These are usually in relation to some form of trauma. I don't feel injuries burns gunshot wounds as a child playing with a with a sad gun goes off his leg or arm. Illinois is a farm state and a lot of our youngsters have their extremities amputated with fine machinery. They get caught in a corn picker they get caught in the side and similar things but these are almost always in relation of some form of trauma. Now

this girl has had normal extremities and all of a sudden they have lost one or more. Now this is an entirely different type of amputee than the child who was born without arms or legs or both felt any traumatic growth by the acquired growth. These are basically normal children. They have had a normal life normal play normal schooling up until the time that they had this accident and misfortune of losing an extremity. They have already started out with their coordination and in most cases have put it well into society. Our job then is to get this youngster back into society just as rapidly as we possibly can. There is no need for delaying filling of oppressed places and a child with an acquired amputee and we

fail if this child should be fitted just as soon as the stump as a result of the accident has healed and be fitted with a brass they system. But back to relatively normal life. No they can Senator growth is a far different cry. We didn't know we still don't know what makes these concern little amputations. This little mite episode in Germany brought a great deal of attention throughout the whole world to this problem. Interestingly enough we have seen in our clinic every one of the types of congenital amputations reported from Philip might in Germany. We have seen here where we've had no little mice so there are other factors. It's probably a good bet that some drug

infestation might be a causative factor. We always ask the mother of a congenital amputee that amputation what drugs or drugs did she take particularly in the first three months of pregnancy. Most of the time the mothers have long since forgotten. Often times the mother didn't know she was pregnant until she was about two months pregnant. We've been able to pinpoint the time of the insult in the case of the little mite too about the thirty seven and a thirty eighth day of pregnancy. Wow. We haven't been able to be so specific on any other drug so you can readily see that if a mother were taking drugs and this early in pregnancy she might not realize she was pregnant so as a safer rule we suggest now that a pregnant

mother taking no drugs whatsoever except under a specific doctor's prescription and she's taken into screaming like that for tranquilizers and they're going to see anything Halloran we don't know very solidly. But we do know that experimentally they same type of deformities can't be produced in laboratory animals with high doses of celestial AIDS so Islay family being a parent family of which aspirin is the most common. So it's possible to do this experimentally. They're radically then it could happen in the pregnant mother. Now again a factor that we asked the mother. Did she go to a dentist and have a tooth extracted under nitric oxide anesthesia. This period under niter sacs at any stage it would be in a period of relative access or a lack of oxygen and it's possible that even with a

short duration anesthetic like this that this might affect the fetus at the first or second month. We also asked the parent or the mother if she went for a ride in a pressurized airplane. Because at 5000 feet you go from Chicago out to Denver for instance in Denver you have 20 percent less oxygen right on the ground. Now if you go up in an airplane 10000 feet and it's on pressurized you're dropping off your oxygen content to about 40 percent less. Another factor is did the parent make a trip to the Rocky Mountains when she was about five weeks pregnant. These are factors that we're trying to pinpoint. I have no definite answers for this yet but sometime in the future we hope we might be able to get a better cause for some of the sample stations at least we have a start and we sure were in their investigations going on and as you said a good a good rule for a pregnant woman

is to not take drugs unless they specifically recommended for some other reason by her attending doctor. Well for instance if a mother has diabetes and she's under diabetic control she must continue her insulin during the time of pregnancy. Some of these you know some of these concern are the anomalies are in relation to diabetic mothers. But if the mother is diabetic she certainly should stay on diabetic control entirely throughout her pregnancy. Oh how I make sense that makes. Doctor how are there other factors which might produce applications of the much of much think we pretty well well yes there's 32 more on either one main group would be some neurological deficit a child born with a spine a by foot or having no sensation in the lower extremities these often end up as amputations. Another

definite grope as a child with a malignant bone tumor. Unfortunately they smell like not bone tumors are not uncommon in children and the bad part is that they are really very malignant. You know it used to be a help until 5 or 10 years ago at the latest that the outlook was so poor and they sold it had to have an amputation for a malignant tumor that we did not recommend a prosthesis prostheses cost money and if this child was not going to survive more than a few months perhaps we should not fill them with a price they service. However we're changing our philosophy on this. Because a certain percentage of our tours are living another percentage of them are living at least one to two years and we fill up the child with an amputation as a result of it. They have a malignant tumor deserves to

have a prosthesis as long as he or she may live. Therefore our present philosophy is that we are fitting these children with the press they sister at the end of three months if provided at that time. They do not show extensive metastases and it's true that we we do not have a long survival in some of these. On the other hand if we can have one to two years where the child is certainly much better off they can get back into circulation. As far as his playmates are concerned and it is a great big help to the family psychologically again to have the child treated with a prosthesis. So these are the major etiology factors or causes. Let's get into law. What you do as far as fitting a child with the prostheses not when do you give a process to it's not course you mention if the child fits so I choir then of course

naturally it's going to wait till it heals and you would crown but what about the congenital. All right all right I have problems in both these areas. Yes there are problems but I recommendation again is for early felling. Let us take for example a child with bilateral both sides upper extremity amputations. What is the first thing that a normal child does if he has arms. He turns himself around in bed he pushes where they sometimes he learns to hold his bottle between their hands and he plays patty cake. This is fine this is a normal reaction. What about the child that doesn't have arms. Well we recommend that the child have press they seize the time that he needs it. Now a 3 month old child with both upper extremities and needs prosthesis at age three months. Therefore since the

need is present at three months we give lower prices to three months. Now this is basically a nonfunctioning prostates this it's more that plastic but it's sufficient that the child can hold a bottle that can patty cake and these arms the system I'm turning over. Now let's go to the lower extremity the normal child usually sets at about 6 months of age. He'll usually stands somewhere around 9 months of age and takes walking from 10 months to 14 months of age. All of you with children know how the timely tiny Tyler picks himself up and falls and picks himself up in four hours. Learning this standing walking balance. Now it's difficult enough for a child with two legs. But suppose the child only had 1 like 4 had no legs. Then by the same token as we said we would fit the upper extremity at 3 months if it needed it at

3 months. Now we will see that the lower extremity amputee with some form of press they says to enable it first of all to learn sitting balance at an age when he should be learning it is actually six months. It would be better with the press they sister learned to stand when the normal child would stand which would be at approximately 9 months and hopefully that by a year or shortly after that having two legs now of equal length and being able to stand they could learn some Orkin balance so therefore give these children the press they sis at the time when they need it. Now these are not totally finished prostheses by that I mean we don't have a lot of gadgets on them. They may be the most simple or prostheses but we have found it when we put a prosthesis on this young child he adapts to it very early. On the other hand we do not want to overdo

it. We don't want to put a lot of extra controls because the normal child at one here doesn't know how to open a door. Turning a door knob is quite a feat. The child has not yet learned its own neuro muscular coordination. Therefore we must not expect more from the amputee child than what we would expect from a normal child of a comparable age. Now let's go back to the upper extremity child the moment I said these press Stacey's that we would put on it three months would be passive in nature. By the time that the child is 15 18 20 months of age he needs more active controls. And here is where we started the child out where the child sized hook as the terminal device and the child rapidly learns to open and close the book. You know if the child is a below elbow

and this is actually the most common level most common room this thing every child can learn to actively operate this book as a terminal device. But somewhere between 18 and 24 months of age. But if the child is an above elbow and Kitty. This past places it's more complicated because we have to add an elbow joint as well as the hook on the end. And while we will fit the child early it may be 24 to even 36 months of age before the child has gained this innate neuro muscular coordination to allow him to work his terminal device. So we try to tailor our Pressley season to prescriptions for at least to suit the individual needs. Now prior to the advent of our empathy clinic care at the university and

particularly on these children with upper extremities we said like everyone else in the country that we're sorry we can't do anything for you so you'll have to wait until we see what comes out. Well this has happened now. We have things and so we can recommend this fairly setting. When we first started our program most of our congenital islands were being brought in. Oh somewhere between age 5 and age 10. Nothing had been available before that. No way save them from age 11 days and we think this is the proper time to see the child. Even at 11 days we can outline to the parents our general plan of progress in this youngster setting out what type of Presley's this we would expect him to use and the ages which we would expect him to use it. We also find out that the younger that the child is fitted with a

prosthesis and trained the better prosthetic Where is he now. Children are like adults and even in those that have the acquired traumatic amputation if they are not fitted with a prosthesis for several months or years they then are not as good where is because they have learned to be I want armed individuals. I see. And one other happened so yes ma'am ones with their bad habits as far as we're concerned. Doctors shouldn't yeah on a child with an aptitude should you go to a regular school or should you go to a special school. Well I mentioned earlier and as if the child has a single extremity involved for instance one leg or one arm. Yes we feel this is a normal child and this child should go to regular school. Now we don't have much difficulty in the child with the lower extremity amputation because everybody wants to walk.

Most everybody has seen a lower extremity breast a sister and the child is pretty well accepted at school. However we have had some difficulty in the child with an upper extremity prosthesis because we use hooks as a terminal device and it has been stated that the child with a hook at school this hook as a dangerous weapon. Now we have five almost eight hundred juvenile amputees and we have yet to have a child deliberately injure another child with a hook. Now there have been a few scuffles and minor things. But to do it deliberately I've aften often asked the boys that have gotten into fights. What about this. And they always tell me why they always take their prices off because the stump underneath is the best batter I'm going to say as a good writer good where I attack. So but with this fear that another child might be injured we

had to go to schools and explain it to the teacher into the principal that this child should be allowed in school and that the hook that he is wearing to help him is not the dangerous weapon that some people thought it was. So any more education is an area for a not only parents but for teachers and so forth. And we need education medically to doctors have been insufficiently trained. We hope that this will not continue because we know they have caught courses at both Northwestern University and UCLA in Los Angeles and NYU and New York specific. The prosthetics courses for doctors and then almost all of the places around the country the present residence. You know it's a basic surgery are attending these courses so that they will be more knowledgeable as far as the children and perhaps places in general are concerned and this is going to be a big help to us the

whole future looks very good in this whole area. Yes particularly because they are still making the effort to get better and better press AC's. I think I think we're going to end on that hopeful note the fact that things will be are better and the future looks very good doctor we just run out of time it's unfortunate right. Our guest has been Dr. Claude Lampard professor of orthopedic surgery at the University of Illinois attending orthopedic surgeon at Presbyterian St. Luke's Hospital and he also is director of the amputee clinic at the university online and we've been talking about juvenile amputees. You have just another in the series your doctor speaks produced by the University of Illinois Medical Center campus in Chicago in cooperation with this station during this series. Such topics as cancer and heart research painless dentistry psychiatry nursing care and modern drugs will be presented on your doctor

speaks. Your host for this series is Jack Gray camera coordinator of public service radio and TV programming for the universe their own II Medical Center campus and Champaign Urbana. Your doctor speaks is produced and directed by Mr. Reagan. This program was distributed by the national educational radio network.