Unlocking the Mystery of Sidney's Hands

Today was the next step in unlocking the mystery of Sidney’s hands in Iowa City. We met with Sidney’s hand surgeon Dr Lawler, located at the U of Iowa Pediatric Clinic. Her fingers were examined to learn more about what is surgically necessary. Before coming into the office we were only aware of what is visible from the outside and had no x-rays prior to our visit. After learning more about what is possible, Tom and I sense overwhelming relief. This was the day we have been waiting for a long time.

After taking x rays, where Dad donned a large lead apron and Sidney a baby sized lead apron, Dr Lawler and a resident gave Sidney a sticker. After unpeeling an edge of the sticker, the doctor simply sat and observed her dexterity. It is fascinating for me to think about the years of medical expertise which allow a specialist to watch such a simple action and make a determination about medical care which will alter the manner, in which, she functions for the rest of her life.

After a few minutes of analyzing her dexterity, Dr Lawler showed us an x-ray of both hands. She was unaware that I stepped out with the x-ray technician and was able to see them on the computer screen. This was great, because I was prepared that both hands had extra bones. On her right hand, or the hand with syndactyly (webbing), there is an extra bone underneath the nail on one finger. This is one of the fingers which is webbed. This helps to understand why there is a ridge in the middle of her fingernail. I have always wondered why the nail was not flat in the middle until today.

For this hand, the doctor will perform surgery on 1/7/10 to separate them. She is unsure if they will take the extra bone, because taking the extra bone under the nail could change function in the finger. She said it is difficult when the fingernail is involved. Dr Lawler said she will make a decision on how to move forward when she is actually in the operating room. There could be other extra smaller bones which do not show up on the xray.When fingers are separated extra skin is necessary to fill the area on the inside which was fused together. A skin donor site will come from an area which is on the underwear line. For people who are easily grossed out, skip to the next paragraph. If you are like my mother and I with a morbid curiosity, keep reading. The skin donor site will be skin which is cut as deep as possible. For some reason the skin depth needs to be as deep as possible and is several layers. This aids the healing process and has a better appearance after healing. The doctor said there will be minimal scaring at the donor site.

Next Dr Lawler looked at the left hand or the hand with three separate fingers. If you look at Sidney’s fingers on the left hand, it is immediately obvious that the middle finger is quite wide at the base. There are bones which are misshapen and larger than needed in the middle finger. The bone is much larger than needed at the base of the middle finger. This bone is over her growth plate. If something is not done with this particular area, Dr. Lawler said the base of the finger will grow wider and wider, disforming the hand further. The doctor suggested doing the second surgery at least 6 months after the first surgery, so Sidney forgets. My comment was, “so mom forgets!”

At this point, Tom and I feel relieved to finally have answers to all of the questions we have had since we first opened the email with Sidney’s referral information. Nice to know what we are facing and that it is fairly uncomplicated for both procedures. Are we thrilled at the prospect of surgery, no, however we know God placed this child in our hands for a reason. It feels good to do this for her and know that she will grow up normally as a result of something which would have been impossible to do or done incorrectly in China.

One last note which proves how little we think about Sidney’s leg and hands. As the resident assessed Sidney’s hands (for those of you who have not gone to the University of Iowa or live out of state a resident always comes in before the doctor as it is obviously a teaching hospital). As he looked over what I am sure was an interesting case, he asked if Sidney had any other health problems. I confidently responded, “no.” Tom gave me a look like I was crazy, and I shot back, “what?” Tom said, “her leg.” “Oh yeah,” I said. “She has fibular hemimelia and is missing a bone in her leg.”