THE BREEZE washed over me gently as I sat under the shade of a tree, watching my daughter play ball with some friends on a Shabbos afternoon. The dog days of summer were nowhere nearly over, and our family was enjoying every day of our temporary respite in the Catskills. Eventually their game ended. The girls dispersed slowly and I could see my nine-year-old daughter Bruchy heading towards our bungalow. That was the first time I noticed that she was limping. “Did you get hurt while you were playing ball?” I asked her when I got inside. “No, not really,” she answered, fixing her hair in front of the mirror. “Then why are you walking like that?” I wanted to know. “I’m not sure.” She was silent, realizing that it sounded foolish to her own ears. How could she not know why she was limping? “Maybe I did get hurt,” she said, not quite convinced. Since there was no other logical explanation, I assumed that she had injured herself while playing but was too busy having fun to notice. I didn’t give it any more thought. Shabbos passed. So did Sunday, Monday and Tuesday, and she was still limping. Her day camp was scheduled to go on a trip to a water park on Wednesday. How could I not allow her to participate? She had a wonderful time and came back very happy, but still with a pronounced limp.
The people in my bungalow colony were beginning to stare and ask questions. I had no answer, not even a single clue as to what was causing my daughter to shuffle around like that. By Thursday morning I decided it was time to see a doctor. So I headed to a local pediatrician a few minutes away from our bungalow. The doctor examined my daughter briefly and asked her some questions about the pain. Where was it, and how bad? Was it constant? My daughter, only a child, had a hard time describing her symptoms. She managed to communicate that it fluctuated between her knee and upper thigh, but she had no memory of having injured herself. The doctor turned to me and said, “The first thing to do is to rule out SCFE (pronounced skiffy).” He looked quite concerned. “Let’s hope it’s not that.” Then, as an afterthought he added, “SCFE is treatable, but it sometimes requires immediate surgery.” After I pressed him a bit more, he explained that SCFE stands for “slipped capital femoral epiphysis,” a condition in which the femoral head of the thighbone slips through the growth plate it was connected to.
One of the signs of SCFE is a limp that gets worse with activity and better with rest. Sometimes SCFE happens suddenly—after a fall or sports injury, for example—but it can also happen gradually with no prior injury. The doctor did not mention that this happens mostly in teens, more often in boys than girls, and typically in children who are obese. My daughter was a preteen and quite slender. I left the office petrified. Googling SCFE on the computer did nothing to alleviate my worries. Many of her symptoms matched. This was not a good thing to have. In my mind’s eye I already saw her draped for surgery as I wept outside in the waiting room. I needed an appointment with an orthopedist as soon as possible. Someone recommended a prestigious doctor in the city, but I couldn’t seem to wangle an emergency appointment. I was waiting for a community liaison with medical connections to help me out when someone else mentioned Dr. Melvin Tepler. I called several people for references and heard glowing reviews. The best part was that he had an office in the Catskills. Dr. Tepler gave me an immediate appointment. He listened to my hysterics over the phone and said he was almost 100 percent certain that it wasn’t SCFE. I wanted to be in the office for his first appointment at nine o’clock, but he didn’t think it was urgent enough to push off his first patient. He advised me to come in at 11 a.m. instead. At 10:59 my daughter hobbled into the office holding on to me for support.
After taking detailed X-rays of her leg and foot, Dr. Tepler immediately ruled out SCFE. I resumed breathing. Still, he couldn’t find anything wrong. He asked my daughter if she was in pain and where. She told him that “nothing hurt.” “So then why are you walking around like that?” he asked.She had no answer. But no matter how hard she tried she just couldn’t walk straight. As soon as she put one foot in front of the other she wobbled all over the place. When I asked Dr. Tepler how to proceed, he suggested that if she was still limping so badly in a week’s time I should take her for blood work. Until then, I was to give her Aleve (naproxen), an anti-inflammatory, every four hours both day and night. I couldn’t wait a week. My anxiety level was off the charts. My healthy, beautiful daughter was lurching around like a drunken sailor and no one knew why! I took the prescription for the blood tests and went to the doctor’s office the very next day, Friday.
On Sunday morning, while I was in the pool, I missed a call from the doctor’s office. The message on my voicemail told me to call right away. I felt the bile rising in my throat. What could they have found that was so urgent? I called the office and spoke with the doctor on call, who had not actually seen my daughter. He looked up her file and said that the results of the blood test seemed to show a slight strep infection in the body, which was possibly making her limp. He suggested a round of antibiotics. When I asked him if I should run out immediately for the meds he said it could wait until the next day. On Monday morning I headed to the office to pick up the prescription. The doctor who had examined my daughter was there, and he reviewed some of the test results. He told me that he wasn’t convinced the strep was causing the limp because they had detected only trace amounts.
Nonetheless, by then my daughter’s limp was so pronounced that I was ready to try anything. The doctor administered a double dose of antibiotics in the office to jump-start the process. But it never took effect at all. After an entire week of medication it was clear that her limp wasn’t going anywhere. Throughout it all I remained in touch with Dr. Tepler. After I told him that she hadn’t responded to the antibiotic, he suggested a bone scan. The worst part of all of it was the uncertainty. One day it seemed better, the next day worse. Sometimes I thought we must be at the tail end, while other times it seemed like it would never go away. Following Dr. Tepler’s advice I made an appointment with a pediatric orthopedist in Tarrytown for that Friday afternoon. When I mentioned it to my husband on Wednesday, he asked me to reschedule, not wanting to risk traveling so close to Shabbos. The next morning I got an appointment for the beginning of September, the first available slot. In the back of my mind I was hoping we wouldn’t need to see him anymore. Around that time I heard that our regular pediatrician, Dr. Yana Bron, was staying in the Catskills for a week. I ran to see her with my daughter hobbling closely behind.
One of the most remarkable things about Dr. Bron is that she really listens; she took note of every symptom and sign. She told me that it was significant that after periods of rest the limp was worse, and after periods of activity it got better. She also asked important questions, such as if Bruchy had recently had a cold. “Yes, she did,” I recalled. “About three weeks ago.” She then reread all the notes in her chart and pronounced triumphantly: “post-viral synovitis.” “What’s that?” I’d certainly never heard of it before but I decided to trust her. She was so sure of her diagnosis that there was no room for doubt. She explained that after a virus seems to have left the body or a cold clears up, the virus actually relocates and infects a joint, which was what was causing Bruchy to limp. Because there’s no treatment for a viral infection, the only thing to do is to wait it out. And while it doesn’t usually last four weeks (the amount of time my daughter had been limping), she was certain that’s what it was. Nonetheless, I still wasn’t ready to cancel the appointment at the orthopedist—yet. By the time we left for home my daughter was still limping, albeit a bit less.I remember looking at her and thinking that I couldn’t recall what she looked like when she wasn’t limping. I despaired of her ever walking normally again. School started and Bruchy was still wobbly.
One day I met Dr. Bron in the street and pleaded with her, “Dr. Bron, are you really sure of your diagnosis? My daughter still isn’t walking right.” I needed reassurance very badly. “It’s like a cough,” she explained. “It doesn’t just leave, it dissipates slowly. But it’s going to go away. Please believe me.” Dr. Bron exuded confidence and did much to alleviate my anxiety. In fact, that very day I cancelled the appointment for the bone scan. And just as Dr. Bron predicted, the limp slowly went away. In December, when I met some friends from the bungalow colony, they all asked me about Bruchy’s limp. I had forgotten how worried they’d been. I shuddered at the memory of how I’d been robbed of what could have been a carefree summer. The worst part was that for four weeks no one knew what it was and kept sending us for more testing.
In retrospect, I am extremely grateful to have had a pediatrician who took the time to speak with me. Most interesting was that there was no treatment; I just had to wait it out. I have now learned that it is possible for viruses to take a toll on a child’s body and that sometimes it has to heal on its own; there’s no need to run for more testing or exams. I also believe that if you are under an experienced doctor’s care and you are confident in his or her diagnosis, you’re already way ahead of the game. What did I learn? That patience is a virtue. Especially when it comes to post-viral synovitis. It is my hope that publicizing my story will spare parents and children much anxiety and put them at ease through awareness and understanding of this condition.
