Ever since she got into her first wheelchair, Namine has always loved to go fast. We went to the park today, as we’ve done in the past, for a bike ride. True to her nature, Namine took a turn too fast and tipped her bike over onto her left side. I was running beside her, but as she picked up speed I had fallen behind.
I saw the bike tip, almost as if in slow motion. I caught up to the bike as it was tipping and grabbed one of the side handles. The momentum was too much for me, and I wasn’t able to pull it back. I realized this too late, and before I could get to the other side, it fell to the ground.
To her credit, Namine had the presence of mind to tuck her head as she fell. The bike landed in the grass — thank goodness for small favors — and because she held onto the bike’s handles, she didn’t hit her arms either. The buckle held fast, so she never fell out of the bike. (We found out later that she did get a pretty good sized bruise on her left shoulder.)
The most damage Namine took was also the most concerning. She fell onto her left side, banging her leg on the handle she uses to help her transfer between the bike and her wheelchair. She’s broken her left leg several times already, and she confirmed (in her usual matter-of-fact way) that it certainly felt like it.
Since it was Memorial Day weekend, we couldn’t bring Namine in to see her orthopedic surgeon, as we preferred to do. We were hesitant to take her into the ER, since last time we did so they misdiagnosed a broken bone as not broken. Namine concurred with our decision — waiting until we could get in to see her regular bone doctor made the most sense. In the meantime, I helped Namine in transferring into and out of her wheelchair instead of letting her climb, just in case her leg was broken.
You’d think a child who potentially had a broken bone would be more visibly upset, but Namine was very stoic about it. Although I suppose if you break bones as easily as she does, it all becomes very much business as usual.
First thing Tuesday morning, we called the orthopedic surgeon’s office. We were greeted with the unfortunate news that Namine’s doctor was out of the office, so our alternatives were to see a doctor she didn’t know there or to take her into the ER — just what we’d wanted to avoid. We opted to see someone there. The ER remains a last resort, at least in dealing with broken bones, potential and otherwise.
We have definitely had better visits to that clinic. I’ll say that right up front. Considering that Namine had two X-rays and a post-image discussion with the doctor, we spent about an hour and a half just sitting and waiting. We’ve spent easily four or five times that in waiting around at the ER, but we usually don’t end up waiting for more than a half hour at this clinic.
After the doctor had examined Namine’s X-rays, he came into the room to talk with us. Even though he’d never met Namine before — or been privy to the substantial experience in caring for her that Dr. Black has — he was able to provide more context to the imaging than we likely would have had in the ER. Along with this visit’s images, he pulled up some past images of the same leg. (I did mention she’s broken this leg before, didn’t I?)
For example, there was a visible artifact just below Namine’s knee which appeared to be a break. At closer inspection that same artifact also appeared in past years’ scans, indicating that it wasn’t a break at all. It was simply a part of her bone structure, and not a cause for alarm.
The doctor concluded that Namine does not, after all, have any broken bones. Contusions, bruising, and swelling, yes — but no breaks. Of course, this conclusion is reached using X-rays, so the results are not definitive. It is possible — and we’ve seen it before — that a break is there, just not visible to the imaging taken. With that in mind, Namine is permitted to do weight-bearing activities (like standing and climbing) as her pain allows. If the pain is too great, we will revisit the orthopedic doctor for stronger imaging like a CT scan.
As a tangentially related subject, I think that last point bears talking about a little more. You might wonder, if the CT scan would provided surer results, why not just do that right away? And you’d be right in asking.
A CT scan emits substantially more radiation — about seventy times more — than an X-ray. With as many times as Namine has required imaging, she’s already been exposed to far more radiation than most children her age (and even most adults, I’d be willing to bet, if I were a bettin’ man). As much as possible, we prefer to not expose her to undue radiation.
Unfortunately, Namine’s bones break easily; X-rays are still the only way to detect the kinds of breaks to which she’s prone: hair-line fractures and other small, nearly undetectable breaks which still cause tremendous pain. So as much as we would like to not expose her to any more radiation, a trade-off must be made. So we make it here: X-rays when necessary, but CT scans only when there is absolutely no other option.