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What Causes Scoliosis And Numbness In Hands Post Delivery?

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Posted on Fri, 3 Jun 2016
Question: Delivered fraternal twins. My daughter vaginally, my son emergency C-section. XXXXXXX was XXXXXXX breech, 2nd twin to be delivered(B). Induced labor with pitocin, labor 14 hours. XXXXXXX apgar 8/9. XXXXXXX 9/9. XXXXXXX needed oxygen immediately. XXXXXXX failed first hearing test. Barely passed second hearing test. Twins were jaundiced. XXXXXXX was more jaundiced. XXXXXXX immediately had difficulty breastfeeding, sucking. GI reflux. Blake's Glucose in nursery after birth was 42. XXXXXXX was 6#8 oz and XXXXXXX was 6#9oz. Reason to induce labor was back discomfort. No foreseen medical reason to induce labor, Delivered at 36 weeks/1 day. XXXXXXX has had chronic medical, health issues including the following: frequent ENT infections, c-diff, myringotomy and tonsillectomy. Several MRI studies of spine and brain. Chairing malformation has been diagnosed by a neurosurgeon and orthopedic surgeon, systemic yeast infection, motor vehicle accident(12/08/2010). Scoliosis. Joint pain in knees, shoulders. Numbness and tingling around mouth, hands, fingers. Dystonia. Difficulty with speaking, articulation seems to be difficult and uncomfortable or painful. New onset crouching at age 9 1/2 after mva of 2010. Difficulty swallowing. Maple syrup urine intermittently. Used to have urinary frequency when younger, then hesitancy while also discovering his mild scoliosis approximately age 6-8y/o. Then could not release urine only once every 24-48 hours. One time he was unable to release full bladder of urine for 46 hours and hospital was unsuccessful catheterizing him due to musculature or sphincter of bladder. XXXXXXX continuously keeps legs drawn up towards trunk of body. Knees always bent continuously whether walking, sleeping, sitting on potty with feet on toilet seat. XXXXXXX used to be physically XXXXXXX and active without restrictions....swimming, running, climbing, jumping on trampoline.....now, he can barely walk 20-40 feet near falling every time. It's like his cord may be tethered. He has multiple bulges in spine throughout. Has difficulty withy bowel and bladder, swallowing, talking. Head pain, posterior neck pain, low back pain. Left shoulder pain since he was very young if not birth. Tight hamstrings diagnosed, also. Multiple skin bumps on elbows, fingers, knees. Chronic intermittent elevated total bilirubin.....jaundice, vomiting, abdominal pain, critical total bilirubin hospitalization last summer, 7/2015. 6/2015 11 day hospital stay with excruciating pain in head and posterior neck with CK levels over 700-800. He seemed to have excruciating pain in his head and posterior neck many times triggered after eating, coughing, sneezing .Chronic elevated BUN,27-60+, elevated creatinine/BUN ratio ex: 59, chronic elevated BCR8, elevated wbc counts, low Na levels at times. Protein sometimes low. Blood pressures have chronically been intermittently high. Tachycardia, pupils large 4mm or more. He failed first PKU test. I really almost think I remember second one was ok, however, false and negative positives.....so I am so concerned as his health seems very brittle.....he appears jaundiced, frequently at least a degree. Dark circles around eyes, no appetite at times, pain, mobility issues, there has to be answers. I believe chairing malformation, tethered cord, brachial plexus nerve injury....I also am concerned of his metabolic issues.....perhaps PKU. He has schmorls nodes in his spine. Curvatures in spine. He is really needing someone who will help.
doctor
Answered by Dr. Diptanshu Das (6 hours later)
Brief Answer:
An inborn error of metabolism is likely to be involved.

Detailed Answer:
Thanks for asking on HealthcareMagic.

I have gone very carefully through the details provided and fully understand your apprehensions. As you have already detailed, you definitely know the details of the case and I do not think that there can be anything more to hide. What might be lacking is a proper explanation linking the details of the case. I would insist you to get a detailed metabolic study or study of inborn errors of metabolism to be done on XXXXXXX The effects of the scoliosis need to be dealt with. If nerve compression is a cause of concern, neurosurgery might be required. Neurosurgery might also be essential for the Chiari Malformation. There are different grades of a Chiari malformation and it depends upon the risk involved.

I would also suggest you to go for a genetic counselling following a metabolic workup.

I would need you to specify the things that you wish me to enlighten you upon. Based on that I would definitely try to help you further.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Diptanshu Das (9 hours later)
Thank you very much for your time and consideration for my son, XXXXXXX XXXXXXX has had multiple sets of genetic testing. All negative. I do understand from experience, that when medicine does not have the explanation, genetics appears to be an umbrella diagnostic cover.
What laboratory and medical findings should I be most concerned about if I am considering birth injury? What laboratory findings are hallmark for PKU from a standpoint of a 14 year old boy? What labs should be consistently found relevant and abnormal findings for a chronic missed diagnosis of PKU?? If I am to look for phenylalanine in his lab tests, what is comparable?? Ketones? Total Bilirubin, maple syrup urine disorder, BUN, creatinine? Do we get new PKU? I mean it seems to make sense that XXXXXXX seems affected greatly by diet, especially gluten, dairy.....why would a child suddenly and intermittently turn jaundiced, mental status changes, nausea, vomiting, pain, significantly elevated liver enzymes, RBC counts....

Do you not consider the induced labor of 14 hours turned to emergency C-section subsequent from XXXXXXX breech presentation after deliver of his twin sister delivered vaginally? Hypoxia in neonate, jaundice, glucose 42, failed hearing test #1 and barely passing # 2, moderate difficulty sucking, breastfeeding, swallowing, speaking, and choking spells significant? PKU test repeated due to positive 1st test? Significant shoulder pain, numbness and tingling in face and fingers and hands? Difficulty with bowel and bladder? Scoliosis? Kyphotic curvature, scoliosis, pain in head and posterior neck, pain in low back, loss of mobility significantly after Mva in 2010?
doctor
Answered by Dr. Diptanshu Das (2 hours later)
Brief Answer:
Get a metabolic workup done.

Detailed Answer:
Thanks for writing back.

It is not that what medicine cannot explain is brought under genetic cover. The functioning of the body is governed by the functioning of the underlying genes. If there is something wrong with some genes, an array of problems can follow. From the pattern of problems that XXXXXXX has, it seems to have a genetic basis. The problem is that it is at the microscopic level and unless the specific locus (the specific location of the problem) can be predicted, it is hard to confirm. It is like searching the entire city for a single culprit without proper idea of his looks. A negative result in such a situation does not necessarily mean that the culprit does not exist.

Birth injury would not lead to the array of metabolic problems even if it were present. That is the reason for my insisting on getting a metabolic panel workup done to evaluate for inborn errors of metabolism. That will include PKU and similar ailments. However, hypoxia, if present, could certainly have complicated the presentation. Hypoxia could be contributory to the failed hearing tests, increase in muscle tone etc. If hypoxia was present, it was more likely to be due to the prolonged labor rather than the C-section (which, if done earlier, would have reduced the likelihood of hypoxia).

I understand your queries, but it is hard for me to connect all the dots sitting at a distance. Such a thing requires proper clinical correlation which requires simultaneous consideration of a large number of factors in a fairly detailed manner.

Regards
Note: For further queries related to your child health, Talk to a Pediatrician. Click here to Book a Consultation.

Above answer was peer-reviewed by : Dr. Prasad
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Answered by
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Dr. Diptanshu Das

Pediatrician

Practicing since :2005

Answered : 3877 Questions

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What Causes Scoliosis And Numbness In Hands Post Delivery?

Brief Answer: An inborn error of metabolism is likely to be involved. Detailed Answer: Thanks for asking on HealthcareMagic. I have gone very carefully through the details provided and fully understand your apprehensions. As you have already detailed, you definitely know the details of the case and I do not think that there can be anything more to hide. What might be lacking is a proper explanation linking the details of the case. I would insist you to get a detailed metabolic study or study of inborn errors of metabolism to be done on XXXXXXX The effects of the scoliosis need to be dealt with. If nerve compression is a cause of concern, neurosurgery might be required. Neurosurgery might also be essential for the Chiari Malformation. There are different grades of a Chiari malformation and it depends upon the risk involved. I would also suggest you to go for a genetic counselling following a metabolic workup. I would need you to specify the things that you wish me to enlighten you upon. Based on that I would definitely try to help you further. Regards