Interaction between a well informed mother and her fetus with CTEV (Clubfoot) deformity

Here is a dialogue between a well informed mother and her fetus about CTEV (Clubfoot) deformity. This is all because of the modern sophisticated technology which makes it possible to diagnose certain illnesses before birth by means of USG. Mother takes an opportunity of this modern technology to learn about CTEV deformity before the advent of her special kid named Angel, who will be one amongst the live 1000 infants with idiopathic CTEV (unilateral) deformity.

On a cool sunday in the afternoon, mother during her third trimester makes it a point that she interacts with her fetus about all possible plans that she has for her baby who after birth will be welcomed with honour by family, friends, doctors and therapists. This kind of a dialogue is continued on every weekends till birth.

Mother: Dear Angel are you awake baby? What are you doing?
Angel: Zzzzzzzzzzz.......Zzzzzzzzzzzz......Ah.......Ah........Ah.......mum! have woken up by ur alarm!
Mother: Do you know baby how many plans do we have for you after your birth which we have scheduled in the maternity ward of K.E.M Hospital on one of the cool saturdays of December.
Angel: Oh really! May I know about all your plans. If you permit me I will add mine too as soon as I am born.
Mother: Of course you will be part of our plan and one amongst the decision maker by co-operating with us. Angel you will be one of the special amongst 1000 live infants. As you have a special congenital anomaly known as idiopathic CTEV deformity of your right foot. This part of your body will be the most special and the rest of the body will be common and similar to all the average normal babies.
Angel: Why only right foot of mine will be special and why not whole body of mine be special? If that would have been a case..........then I would have been the most special amongst 1000 babies.
Mother: But still you will be special with a star on your right foot. First of all you will be welcomed by your father, grandmother, grandfather and your little sis with roses; in the hospital and at home. You will recieve beautiful new born baby cards and you will be captured in a photograph with all of us.
Angel: Thats fine with me.......one star hm....hm.....but very special.....as am gonna get roses, cards and photographs!...........mmm..........mmmmmmmmmmm.
Mother: Do you know for your right foot there will be a special program designed by Dr I.V.Ponseti of Iowa, as soon as you are born. The special treatment program will be offered by one of the popular pediatric orthopaedic surgeons of mumbai. I have fetched the list of popular pediatric orthopaedic surgeons from pediatricians, gynaecologists and therapists of K.E.M Hospital. To name one of them is Dr Binoti A. Sheth.
Angel: Oh really.........mum you are so well prepared. Now just tell me about the entire program in detail.
Mother: I know you will be healthier baby with more than 2.75 kgs of weight. So for the first 2-3 days you will be caressed with gentle touch and manipulation. In the first week itself the pediatric orthopaedic surgeon will apply the first Ponseti cast on your right foot. May be of pink or white colour. Is it fine for you?
Angel: No. I want blue and pink both.
Mother: No problem. I will request our pediatric orthopedic doctor to do the needful. You will be called every week for consultation in the OPD to change over to a new cast so that you will not feel itchy and your foot will become more and more supple, free and well oriented just like your left foot. On the day when the 6th cast will be applied we will be informed about a special gift for you. I mean to say a splint. Also in the proces if you are hurt by rashes our pediatric orthopaedic surgeon will guide us needfully.
Angel: Oh really! I will get many gifts! Who will be giving it to me mum.
Mother: The gift will be offered to you either by an Occupational Therapist or by an Orthotist. We have an option. There are many variety of splints available in the hospital and in the surgicals outside the hospital; To name few of these: steenbeek foot abduction orthosis, dennis brown splint, modified plastic ankle foot orthosis, dobbs brace and so on...!
Angel: How about a modified plastic ankle foot orthosis or may be dobbs brace..?
Mother: OK. We will decide with our therapist and pediatric orthopaedic surgeon. Just hold on...You still have many more programs to have fun with..! Now you may have to be with either an Occupational Therapist or a Physical Therapist. Our therapist will teach us how to don and doff the splint and will tell us the times when to remove the splint for keeping your tender little foot clean and tidy. Later you will enjoy the tickles during gentle stretching exercises, peroneal (few of the muscles of your foot) stimulation exercises and so on........till you become 4-5 years old.
Angel: Oh really! You have a 5 year plan for me. And what about the splint...will it remain with me for 5 years?
Mother: No. You will be wearing this splint for about 6 months to a year with intermittent splint and exercise protocols. Later if needed the splint will be worn by you during the night time. But the exercises will continue atleast till 5 yrs of your age. I will take you to the beach to have fun with sand & water when you learn to walk. We will buy attractive sturdy sports shoes for you to walk without tumbling down on the floor/ground.
Angel: Mum you didn't mention the name of the therapist......did you?
Mother: There are many in the list again fetched by me from pediatric orthopaedic surgeons: They are Dr Medini Padhye, Dr Asha Chitnis, Dr Snehal Deshpande, Dr Jyothika Bijlani.........one new comer in the field of pediatric orthopaedic rehabilitation is Dr Punita V. Solanki. She is new but we might approach her as she is in KEM and well informed about CTEV deformity.
Angel: Thats good mum. Thank you. You have worked so hard for me to make me the happiest kid on earth; with your tender care and love.
Mother: Most welcome Angel. Thats my duty and responsibility towards my sweet little baby. But you still have to follow up with the doctor and the therapist after 5 years just to confirm that you are hale and hearty without any troubles in your life.
Angel: Mum you just told me that I am special then where does this trouble come from.
Mother: You are right Angel. You are special but troubles may come to anybody. So before it may catch hold of you...we will protect you and make you the most strongest and healthiest budding athlelete...........so that you can win laurels and medals for us and for yourself.
Angel: Alright mum. Let me come to your world full of surprises and see you soon in person. Let me enjoy the big list of programs and fun that you have planned for me. See you soon. Have a Fun Filled Healthy day. (This dialogue is just before birth).

"An attempt to educate patient's parents about CTEV deformity in brief in a dialogue form" More information can be gathered from one of the experienced pediatric orthopaedic surgeons and therapists who are well versed with congenital anomalies!
Successful outcome is solely based on the compliance on the part of the family members/caregivers; right from the time of birth till the child learns to jump, skip, hop and run.

Our Patients Need a Human Touch

I have had an opportunity to work at D. B. Orthopaedic centre Occupational Therapy Out Patient Department for the past 9-10 years. During this clinical working period I have managed patients majorly from Orthopaedics, General Surgery and General Medicine Departments. I took enough experience in disability evaluation procedures by trial and error method; from seniors; through clinical cases; through undergraduate classroom teaching and one unique experience at DMER. I even wrote a letter to the Director of Ministry of Social Justice and Empowerment through proper channels on paper and via electronic mail to send us the latest manual for evaluation. We at Occupational Therapy department were honoured to have a response from them and to recieve a copy of the manual free of cost for use by our staff and students.
Based on these clinical experiences I have had some examples of cases where I had an opportunity to take decisions for the betterment of our patient's future. I have one case to cite here to highlight the title of my blog topic. We had a 36 years old adult male patient working as a mechanic/electrician at BEST since the past few years and the sole earning member of the family. His family included his wife, elderly parents, school going son and a daughter; making a family of 6 dependant on 1. Unfortunately this young gentleman had an episode of stroke leaving him with paralytic dominant right upper and lower extremities. He consulted us 4 months post onset of illness by fluke because he was referred for unfit evaluation to our department by the managing physician and not for rehabilitation...........though not a rare situation to be faced by us. Family members including the patient were in despair and sad about the healthcare facility or to say underdeveloped facility as per their opinion. They were all the more worried because the patient was the only earning member of the family and was told to take unfit certificate at a very young age of 36 without any trials of treatment options.....! I couldn't accept this. I spent an hour or so to convince the patient and the family members especially patient's wife and father to comply on our treatment and give us a chance to bring about some improvement so that he could get back to his job though not full time and may not be for the same designation. Asked them to wait for disability evaluation. Patient and family members; both agreed to my opinion. Patient religiously attended our department for a period of 6-8 months 5 days a week. He even followed the home exercise program as per our advice. Guess what; patient showed clinically visible improvement to be able to perform all his basic activities of daily living; commute to and fro from home to our department via public transport independently. We took a chance as; BEST has a clause of sick leave for their employees for nearly a period of 1 year; and light duty facilities. We took the benefit of this and got maximum patient's cooperation. A day came when we did his disability evaluation and suggested light duty. Hospital physician and BEST physician agreed with our evaluation and patient was taken up for light duty in BEST.

That was the happiest moment for our patient and his family members. This could be seen when patient's father came to me just to say thank you and that "My son (our patient) has resumed light duty from today". It was so nice of him to trust us and get back to us just to acknowledge our treatment. This is human touch..........for which every patient of ours are longing for; from us.....care and not only cure is needed by them; it solves most of their problems which otherwise appear to be unbearable added to their already existing problems of life. This does not mean to encourage them by mere false hopes, but offer them practical solutions rather than be harsh towards their illness and poverty. If every patient of ours recieves quality treatment I would say heaven is here at KEM for our patients and nowhere else. This does not mean that the present scenario is reverse but the goal is not too far.......! Our approach is enough at times to care and cure them. We are here to treat patients as a whole; as human and not a case of one system of the body.......!

My First Outstation Journey With My Classmates - Golden Memories

After our final year exams of Bachelors of Occupational Therapy we were told that the AIOTA Annual National Conference would be at Hyderabad in January 1996. Most of our classmates were geared up to pack their luggages to travel for fun cum academic tour to Hyderabad. Some of my close classmates/friends insisted that I should make up my mind to join them for this conference, as we never knew when we would meet or be together later in life. This was the last opportunity to have fun with graduate friends. (And the first AIOTA Conference for us).
Though my pockets didnt allow me, I convinced my maternal grandmother to sponsor me for this academic tour following which I promised her, will never ask for anything more in life from her and that I will earn and escort her in her old age ! ..........as I always was dependant on her since the age of 10 months and I grew up with her till my masters study.

During this Conference we had a schedule of 12 days of journey to Bangalore, Mysore and Hyderabad and the conference days were 7th to 9th January 1996. Atlas the day arosed and on 1st January 1996 at about 10.00 pm we had a train to be boarded at Kurla station ( the place I saw for the first time; as I hardly travelled to places other than Malad to Goregaon and later Malad to Parel).
On 2nd night we reached Bangalore; where we stayed at New Krishna Bhavan till 5th January. For these 3 days we visited many places in Bangalore such as Tipu Palace; Ulsur Lake; Bull Temple; Tiger and Lion Safari; Zoo and a Museum. One of these days we had one day sight seeing at Mysore where we explored places like Chamundeshwari Temple; Bull Temple at Chamunda Hill; Lalit Mahal Palace and one of the Churhes. As it is well said too many cooks spoil the broth; our journey was a an amalgum of fun and fights/arguments (though all verbal); Mind you I was the most quiet person witnessing the to and fro exchange of words/fire between classmates. There were sensational periods of "cool and hot spots" or would say "waxing and wanning" of emotions. But the end result was always a ceasefire..........!
We also took the pleasure of window shopping at Big Kids Kemp at M. G. Road and later at Commercial Street in the evening on 5th January. On the same day we started off for Hyderabad; where we reached the next day morning i.e. 6th January. Here we had our accomodation at Pradeep Bhavan; which was a typical Gujju environment and topped with Gujju food; reminded me of home and my grandmom/moms recipes..! As it was a free day for us prior to the Conference we all decided to attack (mind you not a terror attack) one of the best theatres in Hyderabad (Maheshwari Theatre) and watch a movie with popcorns (usual scenario in the theatres; though it was one of my naive experience as I rarely stepped in any of the movie theatres). We saw "DDLJ" one of the best movies of Shahrukh Khan and Kajol.
Later; three days we spent some time at the conference venue and for some time we managed to disappear to the trade exhibition outside the venue (not connected to the conference); just for fun and shopping the rare entities/make of India. On 9th & 10th we had Hyderabad Darshan; we visited Salarjan Museum, Shangi Temple, Charminar, Birla Temple, Nehru Park, Golconda Fort etc. A humorous story to add hear is: I do have motion sickness; for which I took perinorm instead of avomin; early morning before we started our bus journey to Salarjan museum. And guess what? I was soooooo drowsy that I couldn't open my eyes to have a visual pleasure of all the wonderful collections of the museum...When everyone was enjoying the beauty of the museum....I use to enter from one door and come out of the other; would sleep and wait on the stair cases till the others finished each rooms of the museum........was a very funny sight. My classmates laughed at me for not being able to wake up inspite of eye wash with water...Finally the last thing I could witness was the huge clock at 12.00 pm.

On 11th afternoon we started off our journey to our own place on earth "Amchi Mumbai" and reached on 12th morning at about 7.00 am at Dadar Station (Great Relief for a mumbai buddy like me; as I am a very home sick person)......But this outstation journey was one of the memorable chapters of my life!
"This is the time when you learn about each others (friends) and learn the importance of your own family members; when you decide that you will never criticize any recipes cooked by your beloved grandmom/mom. I do have food fuss traits in me and so had least experience or exposure to hotel/restaurant food. Was proved when I had to be admitted in a nursing home for 2 days as a case of acute gastroentritis and severe dehydration. Was also under the stress of waiting for final year results............all in all .......illness and stress made me sick again with chicken pox! I remain healthy in Amchi Mumbai where we get a typical tasteless crystal clear water. (Though not true in the present days...........!)

"I didnt have a camera of my own and never had an opportunity to meet up with friends later to preserve these memorable days in photo form. In this busy times we all were lost in different parts of our own earth"........................Isn't this writing too nostalgic?
Am not a great writer but have managed to put my thoughts and pleasant experiences of my past in few little touchy words!

Occupational Therapy at Seth G. S. Medical College

To know more about Occupational Therapy at Seth G. S. Medical College & K.E.M Hospital, Parel, Mumbai, India; Visit: http://www.kem.edu/dept/occupational/index.htm.

Bombay Branch AIOTA Blogspot

Check out the Bombay Branch AIOTA Blog/Website for more information on Occupational Therapy Practice in Mumbai, India: http://www.bbaiota.blogspot.com.