Archive for January, 2010

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Please note: we build websites for clients who have their own hosting and have the ability to make changes. Therefore, we cannot guarantee that the websites are still online and that they look as though they did when we created them.

The Old MandaMendoza.com screenshot only


JMJWebsiteDesign.com


OrlandoSwapAndBarter.com


Hero-Jobs.com


How2BeCheap.com


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WeekendWarriorsMoving.com


AbateFireTechnologiesLLC.com


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IzHeReal.com

RoyalMotorsNorth.com

Manda Mendoza Photography Jingle by Dave Belford (left) and Danny Popp (right) of JinglePopp.com

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From Erika, Zach’s Mother

My son, Zach, was born with Shoulder Dystocia and Brachial Plexus Palsy. My husband and I were unaware of what this was or would entail for our family. After a year of occupational and physical therapy, countless specialists, neurosurgeons, neurologists, tests and one surgery, Zach, is improving. However, only about 25% of these specialists and surgeries are covered by insurance. Zach has one more surgery in May and years of therapy to work through. I am writing this article so other parents will be more informed and hopefully, will not have to endure what we have endured.

What is a Brachial Plexus Injury?
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.

Risk Factors for Expectant Parents
In pregnancy books, the birth canal is shown as very straight forward. During the birth, the baby comes down and out and that’s the end of it. But sometimes the baby’s shoulder can get stuck on the mother’s pelvic bone. It is possible for the tender nerves in the baby’s neck to be injured during birth when this birthing emergency, called shoulder dystocia, occurs. This type of injury, called a brachial plexus injury, can cause one or both arms to be paralyzed. Children with permanent and severe brachial plexus injuries suffer a lifetime of pain, therapy, invasive tests, possible surgeries with long recovery times and emotional distress. Unfortunately, birthing practitioners and pregnancy books rarely discuss the possibility of this birthing emergency with expectant mothers.

There are warning signs that may be linked to an increased risk for this birthing emergency. More importantly, there are steps an expectant mother and a high-risk practitioner can take to possibly reduce the risk of injury.

Risk Factors for Shoulder Dystocia:
• Suspected large baby – over 8 lbs. 14 oz.
• Maternal diabetes / gestational diabetes (fetal assymetry)
• Maternal obesity
• An overdue baby – over 40 weeks
• Short maternal stature
• Contracted or flat (platypelloid) pelvis
• Maternal weight gain -more than 35 lbs.
• Protracted first stage of labor
• Prolonged second stage of labor

Risk Factors for Shoulder Dystocia That May Be Associated with Prior Pregnancies:
• A history of shoulder dystocia during a previous delivery
• A history of giving birth to large babies
• Eight years or more since your last birth

Other Factors That May Be Associated with an Increased Risk for Shoulder Dystocia:
Epidural: Because of loss of sensation from an epidural, the mother may not be able to feel the ‘pushing’ sensation and the baby might descend in a slightly awkward position.
Tools: The use of tools (for example, forceps or vacuum) to help the baby descend may possibly increase the risk of shoulder dystocia as well.
Labor Induction: There appears to be a possible association between an increased risk for shoulder dystocia and the use of labor-inducing drugs.
Please Note: Even with these risk factors, more women have uneventful birthing experiences than those whose labors are complicated by shoulder dystocia. Moreover, shoulder dystocia can occur in the absence of these factors.

Risk Factors For Brachial Plexus Injury (without the occurrence of shoulder dystocia):
• Uterine tumors
• Tumors in the neck of the baby
• Viral disease
• Other abnormalities
• Breech fetal position at time of birth

What Can You Do To Try and Lessen Your Risk of Encountering Shoulder Dystocia?
• Discuss with your practitioner your concerns about shoulder dystocia risks, and ask what steps you can take now to try and reduce those risks. For example, he/she may suggest that you follow a gestational diabetes diet throughout your pregnancy. See the list of questions below that you may want to use as a guideline to “Opening up the Conversation” with your practitioner.
• Discuss with your practitioner the appropriateness of the environment in which you plan to give birth. For example, if you do have some of the risk factors for shoulder dystocia or if you have a history of difficult births, you may want to consider a hospital birth instead of a home birth so that you can have better access to emergency facilities, equipment and personnel if needed.
• Ask if he/she thinks that consulting with a specialized high-risk practitioner would be more appropriate for your pregnancy and delivery.
• Ask about his/her shoulder dystocia / brachial plexus injury experience.
• Use the Internet as a research tool, and educate yourself as much as possible.

QUESTIONS TO ASK YOUR PRACTITIONER:
“Opening Up The Conversation”
1. I am concerned about my risk(s) for encountering shoulder dystocia. What can you tell me to alleviate my concerns ?
2. After evaluating my past and current medical and childbearing history, do you think I am a candidate for having a large baby?
3. If it was determined or suspected that I am carrying a large baby, would you recommend a C-section? Under what other circumstances would you recommend a C-section?
4. Have you determined if my pelvic outlet can accommodate the safe passage of a baby? Do I have a flat (platypelloid) or small pelvis?
5. How many times have you encountered shoulder dystocia during the delivery process, and do you feel confident about delivering a baby with an occurrence of shoulder dystocia? What are some of the maneuvers you will use if shoulder dystocia becomes an issue during my birth?
6. Does the hospital I will be delivering at have a specific protocol for handling shoulder
dystocia?
7. What is your opinion of the reliability of using ultrasound to determine fetal weight, and will I be given this test one or more times to estimate fetal weight?
8. If you are unable to attend the delivery of my baby, who will? And are they knowledgeable about shoulder dystocia births? (Be sure to meet with and question all the doctors/midwives in the practice.)
9. Have you ever injured a child during the birth process?

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.

Many people have asked “how can we help”, so we have opened an account for Zach’s… surgeries. It is at Wachovia Bank and it has Zach and Erika’s name on it. The address is Wachovia, Attn: VA 3289, PO Box 26090, Richmond, VA 23260-6090. Please feel free to continue to mail things to us at home at 5607 Deepdale Drive Orlando, FL 32821. For more information or to make a donation please contact Erika Morrell at ehrapp49@comcast.net. We are unsure of what these surgeries will bring and appreciate all the help, support and love from all of you. Please keep us in your prayers!

Purchase our Specially Priced 1 Hour Portrait Session with CD-ROM for just $100 and 50% will go directly to the Morrell Family to help with the cost of little Zach’s surgery. Click HERE to schedule your portrait session today.
or
DONATE directly to the Morrell’s through Paypal now.