A LETTER

Oops. Looks like I've neglected this blog a bit. Mum won't be happy. A very interesting event happened the other day. I like to respect other professions that are seemingly similar but completely different to mine, but sometimes...you need to know your limitations.

To other healthcare professionals reading this, PLEASE:
Don't step outside your scope of practice (double standards, I know, but I don't think being a stand-in teacher is going to harm anyone). Don't think you have the answers to everything. Know what you don't know and admit when you've actually got no freakin' idea. And for crying out loud, DO NOT think or profess that you can cure the children at HSS!!! I have just lost a bit more respect for a certain healthcare profession.

I wrote to my surrogate mentor:

Dear H,

I thought I'd share this story with you. I nearly fainted watching this unfold and I'm not entirely sure why I didn't do anything to intervene. I think I was frozen from shock of the following events:

The background: we have a child with myelodysplasia who is non-ambulant, continent and one of our bright students at school. He's got extremely weak quads, and semi weak hip flexors and extensors. He stands with two people assisting (against no-lift policy in absence of a hoist) and can take 3 steps at his very very best, that is, if his knees don't give way. He's rather overweight and we've been plodding along nicely with diet assistance from a Dietician I befriended at the P hospital and has been doing hydro and daily sessions of weight-bearing exercise (mainly sit-stand, mini-squats, weight-shift/"dancing") and a once weekly extended session for floor-based therapy.

His mother approached me last week and asked if I could attend a specialist spinal Physiotherapist assessment of her son. I asked what kind of specialist this person was, but mum could only tell me that she was from the United States and has had very good results with children with s.b. Being used to the vague Fijian way of explaining things, I knew that more questions would just frustrate mum even further and probably wouldn't get me far anyway. I think I was being skeptical from the start, but I thought there wouldn't be any harm in getting a second opinion from a colleague. I also thought that mum had gotten confused and heard the word "spine" on the radio and "expert" and therefore thought this therapist could help her son, without knowing that the advertisement was probably directed at people with back pain.

So I said yes, of course I'd be happy to attend the clinic, except I thought it was a bit strange that the parents had to pay for this service. Usually overseas assistance comes without a fee as it is provided out of the generousity of overseas-trained staff. Having no idea what I was in for, I soon realised that we were about to see a chiropractor.

We were ushered into a small consultation room where our student was lifted onto the treatment plinth by dad. She was more interested in the therapy I had been doing with the student rather than the reports and scans we'd given her. She proceeded to poke at his back and bend his legs telling the parents that his pelvis was out of alignment because his legs crossed when she bent them. At this point, I was happy with the poking and prodding. All of a sudden, she was poised over him in what i remember as a screw-manip over the thoracic spine at uni. Before I knew it, without finding out more about his condition, without looking at any x-rays or CT scans, crack goes the spine and thump thump thump goes my heart.

After this, she asks my student to see if he can get up and try to take a few steps and walk. So he awkwardly turns over with assitance from Dad stands up, his knees collapse again and he's back to being on the floor. Sorry, but your magic crackin' is not happenin'.

I've since explained to mum about what myelodysplasia involves and how manipulating the spine is both dangerous and is not the most functional-based treatment her son could be receiving. I'm pretty sure that spinal manipulation will not make her son gain strength and may actually be harmful. We're realistic about expectations on his progress and agree that maintenance is far more important than gaining function at the moment.

I've advised mum and dad not to continue with the chiropractor. My gut feeling is that this child's spine shouldn't be manipulated and probably won't help his condition. They want to go back one more time, but do you have any stronger advice? Apparently the chiropractor says she's treated non-wheelchair dependent children with his condition before and has had success.... hmm.

I try so hard to respect other professions, but this makes it really, really, really difficult...