I was pretty nervous, hospitals are for sick people and my baby is far from sick. He is happy, healthy, and thriving and yet we're choosing to explore all our options with his unique thumb. I'm torn when it comes to considering surgery. I don't know what to do and I definitely don't want to regret a decision that can't be changed. Hence, our trip to children's. I wanted to talk with the expert about our options.
First off, I was super impressed with everything at the children's hospital. From the receptionist who scheduled our appointment and left me a detailed message about where to park and how to find the office to our actual doctor. Everyone was kind, organized, and very thorough. Having all the logistics go smoothly definitely calmed my heart.
Upon arrival, we checked in and waiting in the cheery orthopedic wing. We saw a number of older children with broken limbs (sports injuries?) and one other baby. Our nurse got us checked in and took my word on Max's weight and length. I always appreciate when we can skip the cry-inducing undressing can be skipped. Then, Dr. Silas arrived. She was wonderful ... knowledgeable and patient with an air of motherhood. I teared up a little after choking out the word "surgery" and she promptly handed me a tissue and spoke her understanding of how hard it is to hand over your baby for any procedure, no matter how big or small.
Dr. Silas assessed Max's thumb and we talked about how it is built - two bones (we know this not only from feeling, but also because he has a nail on both thumbs and you can't have a bone without nail) fused at the joint (the x-ray showed cartilage which will later turn into bone) connected by skin (and muscle/ligaments) at the knuckle. She also noticed that his right hand is a little stronger than his left (I don't know how you can tell this in a 2 month old, but she saw a difference). Because of this, we won't be surprised if he is right handed. The main thumb on his left hand is a little smaller than his single right thumb (maybe because there are two thumbs and taking that into account his left thumb is actually bigger?) and Dr. Silas expects that if his second thumb is removed that the remaining left thumb will always be a little smaller than the right.
After the assessment we launched into our questions ...
- How does this happen? We had a long discussion about this that ended with ... no one really knows. It all happens very early in cellular development. Nothing I did or didn't do, although multiple digits is hereditary. As far as we know, there aren't any relatives with this condition called polydactyly.
- What if we don't do anything? What would function be like? This is a big unknown. As Max grows we'll see how his two thumbs interact and function. It could become frustrating for him with grasping, crawling, etc. We won't know until we get there. When he starts using his hands more his brain will start mapping the second thumb's existence on his cortex. Depending on when/if it is removed this mapping might be disturbed some and in effect, he'll have to relearn how to do things with a new-to-his-brain thumb. On the emotional side, we're considering how others will treat him and how he'll feel about it. Plus, where do you find gloves for double thumbs? :)
- At what age is surgery recommended? Because of the whole brain mapping thing this particular surgery is usually done between 6-18 months. 6 months is when the risk if anesthesia goes down and according to other observations little ones are able to gain the best function if they have their new thumb by 18 months. Also, the cartilage isn't fully set into bone at this time so they can use a knife during the surgery instead of a saw.
- What does the surgery entail? Surgery is an out patient procedure lasting about an hour. From start to finish we would be at the hospital for 5-6 hours. During surgery, Dr. Silas would make an incision to remove the second thumb. She would tuck in any extra ligaments and sew it up with dissolving stitches. There is alot more to it than that, but those are the basics.
- What is recovery like? Max's hand would be casted to protect his wound for about a month. Dr. Silas said recovery pain is minimal, lasting a day or two and managed with Tylenol.
At this point we are going to keep a close eye on Max's hand development and function. If his double thumb begins to cause him grief I'll feel more comfortable moving forward with the surgery. If not, I'm leaning towards waiting until he is a little older so we can talk about his preference. One side of me really wants to get it done and taken care of when he can't remember the procedure and recovery. It will be harder on me, but much easier on him. On the other hand, I want to respect that he may not mind his unique thumb ... maybe even like it. I'm ok making the decision for him if it comes down to functionality, I definitely don't want his double thumb to hold him back. If it's a cosmetic decision, I'd rather get his input. Either way, at this point we are waiting and will most likely reassess at 6, 12, and 18 months. We'll know more at those stages in regard to function.
Other than it being an emotional day for me, we had a nice time as a little family of three (Jemma stayed with her Mimi so we could focus 100% on Max). Here's an iPhone view of our day ...