Wednesday, July 29, 2015

What is a BPI?

The term Brachial Plexus Injury (BPI) refers to an injury to the complex set of nerves that control the muscles of the fingers, hand, arm, and shoulder. The nerves originate at the spinal cord and are formed in 3 trunks located in the upper shoulder: the upper trunk from spinal cord segments C5 and C6, the middle trunk from segment C7, and the lower trunk from segments C8 and T1. Other Terms for BPI.
Terms used to describe a BPI include Erb's Palsy (an upper trunk injury), Klumpke's Palsy (a lower trunk injury), Brachial Plexus Palsy, Erb-Duchenne Palsy, Horner's Syndrome (when facial nerves are also affected), and "Burners" or "Stingers" (usually associated with sports-related brachial plexus injuries). Torticollis is another term sometimes used in conjunction with brachial plexus injuries.

Types of Injuries

Injuries to the Brachial Plexus can involve:
1. tearing the nerve from the spinal cord (an avulsion)
2. tearing the nerve but not at the spinal cord ( a rupture)
3. scar tissue where an injured nerve has tried to heal putting pressure on the nerve and disrupting signals to the muscles ( a neuroma)
4. stretching but not tearing of the nerve where the nerve is able to heal itself (a praxis).
This a temporary condition where the muscle regains complete function.
Denervated muscle can cause imbalances resulting in muscular and skeletal deformities in the elbow and shoulder. Also, the development of the affected arm can be compromised resulting in a shorter limb.
Injuries to the Brachial Plexus can result in full to partial paralysis of one or both arms with a temporary or, when the nerve cannot completely heal, a life time injury. While compromising muscle function and the ability to grasp, extend, and reach with the affected limb, the injury can also affect physical appearance.

How Injuries Occur

The Brachial Plexus can be damaged in a number of different ways including accidents involving high impact conditions (automobiles, motorcycles, snowmobiles, sports) but most brachial plexus injuries occur during birth with a condition called Shoulder Dystocia (SD). The baby’s shoulder becomes “stuck” against its mother’s pubic bone changing the otherwise normal delivery into an emergency situation. Various SD maneuvers may be used to complete the delivery; but, in the process, excessive force can be applied to the baby’s neck and head resulting in stretching and/or tearing of the Brachial Plexus nerves.
More than one Brachial Plexus trunk can be injured in any of the above conditions, resulting in unique set of nerve injuries for each individual. Thus, diagnosis of the injury requires a careful neurological examination by a brachial plexus specialist to determine which nerves have been affected and the severity of the injury. Such diagnosis should be completed as soon as possible.

Medical Treatment

Brachial plexus injuries are treated with neurosurgery to repair damaged nerves (primary surgery), surgeries to transfer tendons and muscles thereby improving functionality (secondary surgery), physical therapy (PT) to improve strength and range of motion, and occupational therapy (OT) to deal with issues of every day living.

Surgical Treatment

Primary surgeries are usually performed 5-12 months after the injury when it is apparent that the damaged nerves are unable to heal themselves. Secondary surgeries are typically done when skeletal and muscular development has matured to the point where surgical intervention has been demonstrated to be beneficial. This may occur in ages from toddler to adult depending on the injury and the proposed procedure.

The Importance of Therapy

Physical therapy is very important to strengthen partially denervated muscles and other compensating muscles to improve range of motion of the hand, arm, elbow, and shoulder. Also, PT helps to minimize contractures and “freezing” of joints due to under use. Occupational therapy is also important to help with adapting to every day activities such as tying shoes, buttoning clothing, and personal hygiene. Parental participation in PT and OT is necessary to ensure a prescribed regimen is maintained and steady progress is achieved.

The Importance of Medical Experts

The importance of having experienced medical experts treat brachial plexus injuries cannot be over emphasized. The treatment objective is to achieve the maximum possible recovery and that could mean a range of surgical procedures and applicable therapies over a period of time, often years. Specialized surgical and therapy techniques are being used for BPI’s with success. However, surgical procedures (both primary and secondary procedures) used with brachial plexus patients are complex; and, like any medical procedure, can have varied results. An understanding of proposed procedures and their results, use of second opinions, and confidence in the medical practitioner are important considerations for parents and injured adults before initiating a course of treatment.

This post was provided by united brachial plexus network, inc.

Monday, July 27, 2015

Bean's Not-Quite Home Birth Story

This blog post is provided by the amazing mommy who writes her own blog, The Cozy Den. She wrote her little's birth story on her own blog and has allowed me to share it on mine. Thank you so much, Catrina!

Tuesday, June 10th, was my little man’s due date. I had been hoping that he would come a little early, though not too early, but he was content to stay in for the allotted 40 weeks. Our midwife said early on that we would go full term like most first time moms, but I was just convinced that he would come a week or two early! 

The day before, Bear and I drove the 6 hour round trip to see our midwife. I had been having Braxton Hicks contractions for a few weeks, and they had been getting stronger and more frequent. The morning we went to see our midwife, however, they disappeared almost completely, and I was very disappointed. Both Bean and I did great at our check-up; all of my vitals were fantastic, and Bean’s head was engaged and he was in perfect position. I was happy, but still a little disappointed when our midwife informed me that we could easily go another week or two, as I did not look like a woman about to give birth! On our trip home, I had 7-8 contractions, but they petered off again once I went to bed. 

The next day, they were stronger and more regular than they had been to that date, and by the evening I was having 4-5 contractions an hour, most lasting about a minute or so. I waited a couple hours before calling my midwife; I didn’t want them to calm down again if she was going to make the 3-hour trip. She told me to take some Benadryl and go to bed, and she was going to take a shower and then get on the road. She got to our house at about 1am, checked my vitals, and went to sleep in the guest room. My contractions weren’t picking up any, and she told us to wake her if they did. 

Wednesday morning, Bear had to fill out some paperwork at work and run some errands, which he hadn’t felt comfortable doing before someone was home with me. The contractions had slowed down again, so we just chilled and waited it out. Once Bear got back, we went for a nice long walk with the puppies, and the contractions picked up again. Our midwife suggested I see the Chiropractor to see if that would help move things along. While we were waiting for the Chiropractor to see us, I started doing squats in the adjustment room. Bear laughed at me and told me that it would be at least another week before Bean got here, because there’s no way I’d be able to do that if it was time! The Chiropractor was surprised to see us, said I was about as good as I could be at 40 weeks along, and even felt the baby’s placement and said it couldn’t be better for the home birth we wanted. That night, the contractions still weren’t getting any closer than 10 minutes apart, so another night of Benadryl and sleeping as much as possible before labor started. 

Thursday, our midwife offered to strip my membranes. I had heard about this, but really had no idea what that entailed. It was far more uncomfortable than I had anticipated, but I was so ready for labor to start that I was willing to do pretty much anything she suggested or offered. I rested for a while, and then Bear and I took a walk down the road to see the Chiropractor in his local office. If he was surprised the day before, he was nearly in shock to see us again! That night the contractions were still no closer than 10 minutes apart, so we went to sleep. Midwife offered to go to stay with a local friend for the night, since “a watched pot never boils,” but I honestly did not feel watched at all and was completely comfortable with her being there, so she stayed. 

Friday morning the three of us watched the History Channel and had interesting discussions on religion and other theories. Midwife decided to go out to get a few things she needed, as well as some food. I think she brought me back some flan, but I never had a chance to eat it! 

By late afternoon, the contractions were getting stronger than ever and I was getting uncomfortable. We went to bed about 9, and the contractions were only 4-5 minutes apart. Midwife checked my vitals every hour or so, and I tried to sleep between contractions. About 3:15am, I was in the middle of a contraction and felt a little “pop” in my pelvic region. At first, I thought my water had broken, and waited for the typically talked about “gush”, but never felt it, so I figured it must have been something else. I waited through 2 more contractions before I got up to go to the bathroom. When I stood up, I realized that my water had broken! I made it to the doorway of the bedroom before another contraction hit me and I called Bear over. I told him that he might want to get the midwife up, since my water had broken! Within an hour, the birth pool had been set up and filled, both of the midwife’s assistants were at the house, and the contractions were coming faster.

Everyone was very quiet, except for the mocking bird that still doesn’t know the difference between night and day, and the house was calm and peaceful. I labored in bed as long as I could, kneeling with pillows under my chest, listening to the song I had picked as my labor song. After about 30 minutes, I got sick of the song and turned it off! Shortly after, I asked midwife, “Can I pleeeease get in the pool now?” She told me that I could do anything that I wanted, and I almost jumped in! The warm water was such a relief. Bear held my hands, fed me ice chips, and kept a cool cloth on my neck and face for hours. He was (and is) my rock, my partner, and the best support I could ever hope for. Midwife checked my vitals and baby’s heartbeat regularly, and around 9am she announced that I was at 6cm and that I was progressing beautifully. Bean’s heartbeat was steadily in the 120-140 BPM range, both during and between contractions.

My labor was like nothing I could have imagined. The contractions felt like they came from the deepest part of my being. I did my best to keep my moans and groans in the lowest register possible. I quickly learned the progression of the contractions, and started coaching myself through them. "Another is starting... and it's getting stronger... I can do this. It's peaking and it hurts so bad, but that means it will be over soon." Eventually, the pain became too much for me to talk myself through, and I asked Bear to do it for me. Through each contraction, as I squeezed his hands, he kept his head close to mine, telling me quietly that I could do this, I was strong, it was almost over, that I was doing wonderfully. In all honesty, I felt like a huge baby, especially with the number of times I whined, "Can you just get it out of me?" and, "Is it over yet?" Between contractions, Bear encouraged me to drink my water and even eat a few grapes. I counted time by the sky as it grew bright through the window by the pool.

A little after 11am, my contractions were stacking on top of each other, and the midwife told me we were heading into transition. She said that I was at 8cm, and that my cervix had a bit of a lip that she could slide back to let Bean’s head come through. I decided I wanted to let my cervix dilate completely on it’s own. Midwife checked baby’s heartbeat again, and it was beautiful. She told Bear to get ready to get into the pool, since he wanted to catch the baby, and she stepped out of the room for a minute. At that point, I was reclining in the pool with Bear behind me. Suddenly, I felt a jerk in my stomach. Bear saw it, and said the whole pool moved. I guess my moaning changed, because the midwife was back by my side asking how I felt. I said, “It burns, it hurts so bad.” Labor had certainly been painful to that point, but this was a completely different pain. 

She checked for baby’s heartbeat and couldn’t find it. She had me flip over in the pool to all fours and still couldn’t find his heartbeat. She checked my cervix again and found that it had swollen back down to 6cm. Calmly but firmly, she told me to get out of the pool now. I struggled, as the contractions were right on top of each other at that point. Bear and Midwife got me onto the birth stool, which was right next to the pool. She finally found baby’s heart rate, which during contractions was dropping dangerously low into the 50’s. She immediately turned to her assistants and told one to call 911, and then had the other put the oxygen mask on me. As soon as she said that, I prayed out loud, “God, just give me my baby.” 

My whole labor to that point had been surreal, on a different plane, primal and grounding. As soon as I said my prayer, I was in a completely different space. Part of me was vaguely aware that I could be panicking, but I wasn’t. I was enveloped in God’s peace and love, which continued through Bean’s birth. I could hear the fear in Bear’s voice (his mother had almost lost her life during her cesarean section with him), and I wanted so bad to comfort him, but I had to concentrate all of my energy on Bean. 

As soon as she had given her instructions to her assistants, the midwife and Robert got me onto the couch and on my side to try to slow the contractions. Thankfully, Bean’s heart rate was recovering into the 130’s between contractions. Midwife coached me to breathe through the contractions, to breathe for my baby. The paramedics arrived within minutes, and everything was a whirlwind from there. Midwife rode in the ambulance with me, tracking Bean’s heart rate the whole time, and Bear drove the car right behind us. Midwife kept eye contact with me, constantly reminding me to breathe, and I could feel love and strength emanate from her and fill me. Bean’s heart rate was recovering faster by this point, so that’s what I focused my energy on. Contractions that had moments ago had me near screaming, I was now breathing through with barely a moan or two. Thinking back, God was extremely present with me. I didn't flinch, and was even able to watch, as the paramedic flawlessly placed two IVs in my left arm (I have a terrible fear of needles).

We quickly arrived at the hospital, and I was immediately taken to Labor and Delivery. Midwife stayed by my side, and Bear was there shortly after we arrived. I was informed that they would need to perform an emergency cesarean section, and right away. I was presented with a handful of papers that I was instructed to sign, and was whisked away to the OR. The OB on call, along with a nurse or two, helped me onto the operating table. While the anesthesiologist informed me of the medications she was already beginning to give me, a nurse inserted the catheter while another nurse prepped my stomach for the surgery. I vaguely remember feeling a burning sensation around my IV site, and then nothing.

Bean was born at 12:14pm on June 14, 2014, less than an hour after he decided to flip. His protests on being removed from the womb were heard in the waiting room. It breaks my heart that neither Bear nor I were able to see him being born, but I am so thankful that he was healthy! Bear got to see and hold Bean while I was in recovery, and took some pictures for me so that I could see my beautiful baby boy.

When I woke up, Bear and Midwife were both there. Since we had waited until birth to learn the gender of our child, Bear was super excited to tell me we had a boy! At first I was shocked (I come from a family of 6 girls, no brothers, and have 2 nieces), and then overwhelmed with joy. Shortly after, they wheeled me into our hospital room (hitting every corner and wall on the way, haha!), and I requested a breast pump, as I had been informed that Bean was not to be brought to me for several hours yet. Within a few minutes, Midwife entered the room and announced, “Well, we weren’t able to find a breast pump, but we found the next best thing.” And Bean was brought into the room in his bassinet! 

People say that you don’t know real love until you have a child. I already loved him so immensely, so beyond measure, from the moment I knew I was pregnant, but even that love paled in comparison to what I felt when I held him for the first time. My beautiful son.

I am so happy and blessed to have my sweet boy with me, healthy and growing like a weed. But, his birth was not my ideal. In fact, it ended in almost the least anticipated or desired way possible. My heart still breaks 5 weeks later when I think about Bear not being able to be in the room when Bean was born, not being able to see him arrive earthside, not being the first to hold him. I feel guilty when I see the pictures of him with all the wires and IV, when I remember the multiple IV sites, when I think of our 1-week hospital stay because he caught an infection in the nursery. I get frustrated because I am still unable to do things physically that I should have been able to do weeks ago. “At least he is healthy!” Yes, but that is only part of it. Sometimes, even a mother forgets that she was a huge part of the birth experience, and she has a right to feel good about the process.

I have been so blessed with family and friends coming and helping with the baby, with the chores, with food. Bear has been my rock, he always knows when I’m upset and helps me work through it instead of bottling it up. My midwife continues to check on and encourage me. I’m healing physically and getting more active. I am hurting, I am grieving, but it gets a little easier every day. 

Thursday, July 16, 2015

Joshua's Birth Story

This birth story is provided by Jeanette Tolmie. Thank you so much, Jeanette!

On the morning of January 8th I woke up and was getting ready for the day. I was walking up the stairs and felt a gush. I went to the washroom and saw lots of blood. I stood up, and then a big clot fell out. I called my midwives and she told me to go to the hospital to get checked. While on the way I could feel contractions. 
 When we got to the hospital I was hooked up to monitors right away. Joshua's heartbeat was perfect and my contractions were 2-3 mins apart but my blood pressure was super high. They were checking me for preeclampsia. They said I didn't have it. The doctor said that we both looked good. They gave me morphine for the pain so that I could rest. At that point my contractions were every 4-5 minsutes, so they said they would keep me over night for observation. 
At 10 pm my contractions got stronger and closer together.  I was 2 cm at midnight and the pain was getting worse. I was dozing off and on between the contractions.  At 3 am I was 5 cm. And at 5:30 am I was fully dilated and was taken to the delivery room.
I pushed for an hour and then my baby boy was born. He was born at 6:04 am at 34 weeks 1 day. He weighed 5lbs 1 oz. His APGAR score was 9/9. 
He was taken away to the nicu because he was born with a dislocated left knee and hip dysplasia.  I was kept in the delivery room for awhile because I was hemorrhaging and and needed two stitches. I wasn't able to see Joshua until 11 am. He was in an incubator and he was hook up to all the monitors.
I finally got to hold him at 2 pm. It was the best feeling in the world. 
I was in the hospital for 5 days because my blood pressure was still super high. I found out that I did have preeclamcia and they didn't find out until an hour after Joshua was born. I left the hospital with blood pressure meds and iron pills for anemia. Keegan and I had to stay at a place called almost home so we were close to Joshua. He finally came home after 2 weeks.

Saturday, July 11, 2015

Hudson's Birth Story

     This birth story is provided by Brittany Reed who also has her own blog, twocatswithkittens. Check it out! Thank you so much for sharing your story. 

     To Make You Feel My Love; The Birth Of Hudson Blaine
This song played numerous times while I was in labor. It will always stick out as Hudson's song straight from fate. 

To Make You Feel My Love from Billy Joel on Myspace.

     Around 2 am Saturday morning(sept 20), I was at Waffle House with My wife, and our friends Becca and Kayla. I had been having some small stomach cramps but didn't think a whole lot about it, we finished eating and while Kristen was paying I went to the bathroom only to realize that I was bleeding. I sorta freaked out, told Kristen, and we made the decision to call Jo, our midwife. She immediately told us to go to bed and to rest while we could, this was the real deal! Our baby boy would be here soon!! She told us when I woke up to time my contractions for 30 minutes to an hour. We started timing contractions at 3:55am, and they were 5-6 minutes apart lasting around 45 seconds a piece. We tried our best to sleep but of course it wasn't easy. Around 2pm Saturday, Jo and Mary arrived(midwife and doula), Jo waited around and assured me that I was definitely in labor. Things were going kinda slow so Kristen, Mary, and I went to the park and walked a few laps to try to get things moving, it definitely worked!!! We came back to the house and around 8 or 9 Jo checked me and told me I was 4 centimeters and completely effaced. I instantly got just a little broken hearted, I had been at it for so long already and felt I had gotten absolutely no where. As the night went on and contractions got longer and closer together I was getting exhausted already. Jo sent Kristen to my moms for phenagren so that we could try sleeping between contractions. Talk about ridiculous!! Sleeping 3 or 4 minutes at a time was not fun! But we took it in stride. Sunday I got in the birth pool 3 times total. It was such a relief! I will never go through labor without one, it was the only place I could relax and half way give into my contractions. The entire day was spent between the birth pool and bouncing like crazy on my exercise ball. I would sit, and every time a contraction would hit bounce as hard as I could; with Mary behind me doing counter pressure, me focusing on the duct tape holding the blind closed in the bedroom and Kristen holding my hand telling me that I had this and I was doing great. Flash forward to around 7ish, Jo checked me and I was at a 6! Woohoo right? No! I was so upset, I had been in labor forever, thought I was doing so well! Only to be told I'm still quite a bit away. Not too long after I'm still in the birth pool and my mom shows up, just barges through the door to start yelling at me, trying to fight with Kristen. I tried to stay focused but I couldn't. I remember telling her to just leave that I didn't want her there. Kristen ended up having to call the cops. She was refusing. After that my labor went all sorts of downhill. We waited a little bit and Jo checked me again, I was at 7 cm and a 1inch lip popped up in my cervix out of nowhere. We were all upset and uncomfortable. Jo left it up to me and I decided I wanted to transfer, I was exhausted, upset, and in pain. All I kept thinking was "I can't do this. I can't do this." Kristen rushed to pack us a bag since we had neglected to do so! I was so determined to make it happen that I didn't find it necessary. We finally left and were on the way to the hospital, talk about pain and frustration!! It was awful! I screamed and cried and was hateful. It was the only time I had truly been grouchy towards Kristen. According to her I threw a box cutter at her! Not one but 2 cars decided to pull out in front of us, I was doubting whether we would even make it to the hospital. But after an agonizing trip we finally did! We went upstairs and the lady checked us in and put us in a labor suite. I bounced on my ball and filled out some paper work that I ended up not finishing until the next day! They hooked me up to the monitors, which was worse than the contractions! Someone had to actually hold the monitor on Hudson because he kept running away. I decided to get an epidural; the one thing I didn't want, people messing with my back is beyond scary to me. The guy came in and Jo asked if he could do a bolus, just enough medicine to help me rest. I wanted it out of my system by the time I was ready to push! He agreed and placed my epidural, talk about amazing!! After 40+ hours of labor I was finally able to rest, I giggled as my toes were tingling! Dr. Edge came in and placed a fetal probe to monitor little Hudson, and something to monitor my contractions and broke my water. At that point I remember just giggling and freaking out a little because she hadn't broke my water yet. But Kristen assured me that she had broke it, it just didn't gush like people talk about sometimes. I got some rest and woke up around 1 or 2am, I honestly don't remember. But I woke up feeling contractions and pressure. Turns out I was ready to start pushing whenever I wanted! Our sweet little boy was going to be earth side real soon!! We were both so excited we couldn't believe it, after the long 40+ hours of back labor our handsome man was almost here! After the nurse left the room Jo fixed the bed, making me a "throne." She dropped the bottom out and told me I should be pushing whenever I felt the urge. She crossed my arms and we would pull each other and I was pushing during! I never expected pushing could actually feel that good! The nurse came back and had me pushing on my back; we tried with Kristen and Mary holding my legs, me holding my legs, and the stirrups. None of which worked. At one point she asked me if I expected him to have hair, which of course I said yes. She tried telling me he was bald and I argued and told her that meant baby belly’s sonographer lied to me! I was so heartbroken. I told her I needed to turn over, to get on my knees. She wasn't a fan of it cause I had gotten an epidural but she didn't try stopping me. I ended up getting a contraction mid turn and instantly pulled my knee up and pushed. Once it was over I was on my knees! Still in pain I held on to the head of the bed. To push I would drop my bottom to the very end of the bed and then pull myself back to the head and rest until the next contraction. The room was a whirlwind as the nurses were getting everything ready for Dr. Edge. He's almost here! When the Dr. finally came in she asked why I was in the position I was but never once asked me to move to make her more comfortable. Although she did keep looking at my vagina upside down! The one thing that stands out to me more than anything else is how hot I was! My entire body felt like it was on fire the entire time; I remember continuously asking for ice, water, or a cold washcloth. I told Jo and Kristen both numerous times that I couldn’t do it. I was pushing with all my might but felt like I was getting nowhere! The nurse kept telling me to be quiet, I was making low moaning noises with each push, but I would have been damned if I couldn’t make those noises. I am however very proud that I didn’t cuss the entire time!!! Kristen whispered in my ear in between every contraction about how great I was, how I could do this, how proud she was of me, and how close we were to meeting our baby boy. I couldn’t have done it without these words of encouragement. I kept pushing and remember sort of shrieking at one point and freaking Kristen out hard core, the ring of fire? Yeah that’s real! It wasn’t near as bad as I thought it would be though. I felt his head coming out and tried extra hard to push him out slow to prevent tearing. While pushing I felt his body turning, my boy was born sunny side up! His head was out and all I had to do was push one more good time to get his shoulders out. Talk about relief! His shoulders were out and I felt the rest of his little squishy body follow. Jo made the comment that his body was like a cork because when he came out all the amniotic fluid came gushing out as well! He was out and I heard him crying, I was still on my knees but couldn’t flip over because the umbilical cord. They tried telling me which way to turn but I was way too excited to meet my boy and could barely comprehend what they were saying. Kristen cut the cord and he started crying on the table, instantly she just picked him up and suddenly everyone was freaking out because she didn't have a green towel between them. But that was our baby, she couldn't just let him lay there alone and cry! He was supposed to come straight to me but had ended up really wet so they had to suction him a lot. Inside I was freaking out, no one really told me what was going on, Kristen assured me he was okay just being suctioned and then brought him to me. I took one look at him and couldn’t get over how perfect he was, we kept looking at him and at each other and said “we did it” at least a dozen times. He was the most beautiful baby I had ever laid eyes on!
I've known it from the moment that we met
No doubt in my mind where you belong.
     The placenta came out with ease and Dr. Edge told me she was going to have to put 2 stitches in. I had never had stitches and felt ridiculous for being scared of a measly stitch after everything that just happened. Jo took a look and later told me I didn’t really need the stitches but as a hospitalist she could lose her job for not doing it. They cleaned everything up, pushed on my belly, congratulated us and left. Jo and Mary left not too long after and it was just our little family. Our absolutely perfect little family. After a while the nurse came back in to weigh him, he weighed 7lbs 8.6oz but they rounded up to 7lb 9oz. They did the rest of the measurements later on but he was 21 inches long, head circumference of 14 inches, and had long toes and fingers. Hudson Blaine was perfect in every way possible. After 49 hours of labor at3:25am he was earth side. I couldn’t have done it without Kristen, Jo, or Mary. They were everything I needed right when I needed it.