Vaccination Schedule 7-18 years

http://www.cdc.gov/vaccines/who/teens/downloads/parent-version-schedule-7-18yrs.pdf

Vaccination Schedule for birth to 6 years of age

https://www.healthychildren.org/Documents/tips-tools/Immunization%20Schedules/IZSchedule_Childhood.pdf

Osgood-Schlatter Disease

Providing taxi rides to and from practice for every sport offered to an adolescent, eating endless dinners in the car on the way to the practice field or a game, rearranging meetings at work to make sure I could make my taxi pick up at 4:00 pm and wiping the tears from my children after they lost a “game of a lifetime” were nothing compared to the day I had to explain Osgood-Schlatter Disease to my oldest son.

This young man didn’t know the definition of moderation.  Everything he did was higher, faster, longer, or it wasn’t worth doing.  He excelled in athletics from a very young age and loved every minute of practice, but competition was his real “high”.  This child took many hits and falls, but never acknowledged pain.  At age twelve he began to complain that his knees ached and that he was having difficulty sleeping because of the pain.  Having a nurse as a mother is not always the best thing for a boy.  I assumed he had just overdone it and encouraged him to take a hot bath and go to sleep. 

His complaints continued day after day.  He denied having had any high impact injury or having twisted his knees.  I have to admit that I was concerned when the achy feeling in one knee soon became an achy feeling in both knees.  I scheduled an appointment with his pediatrician just to make sure that everything was ok and that he just needed to rest.

X-rays of both knees were taken.  Blood tests were completed and Dr. Brown asked us to return to her office for a follow up visit.    Dr. Brown showed us the x-ray and told my son that he had Osgood-Schlatter Disease.

Osgood-Schlatter Disease is a condition causing pain and swelling at the tibial tuberosity.  The tibia is the large of the two lower leg bones.  The tibial tuberosity is the bump on the front of the tibia, just below the kneecap (patella).   The patellar tendon attaches the quadriceps to this bump or tuberosity.  In the adolescent the tuberosity does not yet have bony attachment to the rest of the tibia.  The mechanical attachment of the patellar tendon to the tuberosity is weak and occasionally causes separation of fragments of bone.  This separation causes pain and swelling in the teenager’s knee or knees.  Usually, this occurs in one knee, but research reveals that 25 % of the time both knee are affected.

My son’s daily athletic endeavors were just too much for his maturing knees.  Activities such as climbing stairs, running and deep knee bends increased his pain. 

The goal of treatment is to decrease the stress and inflammation at the tubercles.  My son was instructed to sit out of practice and games for the next two weeks.  He was given an anti-inflammatory medication to take three times a day and we were then to return to the doctor’s office for a recheck. 

All the way home, my son tried to convince me that the pain wasn’t that bad.  I listened and tried to calm his anger about being taken out of his beloved athletics.  Somehow my family made it through the next two weeks and we return for the follow up visit.  My son told the doctor that the pain was much better in both knees and pleaded to be able to return to his normal activity.  Dr. Brown recommended the anti-inflammatory medication be continued.  He was given permission to return to his regular activities, but was to take it easy for a while and not push his body “to its limits”.  Following any athletic work out he was to immediately ice both knees for twenty minutes.  He anxiously agreed to the treatment plan—anything to get back out on the field! 

My son’s pain slowly dissipated over a period of about three months.  He remained active and was able to do what he loved most-PLAY!  To this day I count my blessings.  Keeping this boy down was almost impossible and miserable for everyone in his life!  Osgood-Schlatter Disease may last over a period of months or years.  It may reoccur intermittently up until about age eighteen at which time the tuberosity fuses to the tibia.

If conservative treatment does not end the pain and swelling, it may be necessary to completely rest the knee or knees with a knee immobilizer or cast.  Luckily, this type treatment is rarely necessary.  The very best news is that Osgood-Schlatter Disease rarely causes any permanent injury except for an enlarged tuberosity (a larger protrusion on the lower portion of the knee).

 

Adhesive Capsulitis

I have had the pleasure of caring for a number of individual   following shoulder surgery over this past year so I am sharing one of the complications that may occur following this type of surgery.  Adhesive capsulitis is the medical term used to describe a substantial range of motion loss in the shoulder.  Sometimes this is referred to as a “frozen shoulder”.  This condition is painful as the shoulder capsule becomes contracted and thickened.  Pain will increase as a person or their physician tries moves the shoulder or tries to passively put the shoulder through the range of motion.

Many of my patient’s hear me say, “I hate shoulders” or after shoulder surgery, “No pain, no gain”.  My experience is that I see “frozen shoulders” after shoulder surgery.  The exact cause of this condition is not well described in the literature and it is not found to be the result of a rotator cuff tear. 

There are however, risk factors associated with this phenomenon.  Individuals with diabetes are more prone to adhesive capsulitis as are women between the ages of 30 and 50.  There may be other underlying diseases such as thyroid disease, Parkinson’s disease or cardiac disease.  This condition is often noted following shoulder surgery following a period of immobilization.

The patient will note a dull, achy pain that increases with motion and/or activity.  The pain is often located in the shoulder itself, but sometimes can occur in the upper arm below the shoulder.  The shoulder’s motion is restricted due to stiffness.

The initial treatment is pain control and physical therapy to restore the shoulder’s motion.  Literature notes that about 95% of those affected with note some improvement or resolution within 2 years.  Aggressive physical therapy is utilized over the first year.  Local nerve blocks may be used to decrease the pain while physical therapy is being utilized. 

If conservative therapy fails, the physician may recommend manipulation under anesthesia or shoulder arthroscopy.  During manipulation under anesthesia, the patient is put to sleep and the surgeon manipulates the shoulder to move forcing the capsule to tear and/or stretch.  The shoulder arthroscopy usually involves a release of the shoulder with small incisions to free the capsule allowing for movement in the area.  Both procedures are followed by intense (usually daily) physical therapy with emphasis on range of motion within the joint.

In summary, physical therapy is sometimes painful, especially when involving the shoulder joint.  I encourage my patient’s to give therapy their very best effort to ensure decreased pain and a return to normal function and range of motion.  It is helpful to take your prescribed pain medication prior to the therapy sessions (at least initially).  Icing of the shoulder joint following therapy also helps to control the pain.  Ask your therapist for instructions on a home exercise program that can be done at home to increase.  Most of all, stay strong as most people regain functional range of motion over time.