On February 6, 2002 one day before my due date, my water broke and I was admitted into the maternity ward at Easton Hospital. It was a long day. After I had dilated to three centimeters and had been given significant doses of Pitocin I asked for an epidural. Fourteen hours after I was admitted finally it was time to begin pushing (and pushing and pushing). I pushed for nearly five hours. With little progress made by pushing and a failed attempt at delivery with the aid of a suction vacuum my obstetrician readied the operating room for a cesarean. But like other moms in labor who were determined to delivery “naturally” I continued to push and after a second attempt with the vacuum, my little girl began to emerge. But as she began to come out it became clear something was holding her back. She was stuck. Finally the delivery doctor was able to slip the umbilical cord off of Molly’s right shoulder and my baby girl flew out. Shortly after Molly’s birth the doctor told us that Molly had suffered what he called a “brachial plexus injury” to her right arm. In addition to the injury to her arm, Molly was also in need of phototherapy for jaundice. About two days after Molly’s birth my husband Anthony and I met with the hospital’s orthopedic doctor and he told us that we had better get used to the fact that our daughter may never use her right arm. Before leaving the hospital the therapists at the hospital fitted Molly for a tiny brace that would keep her wrist in an upright position. They also told us that we should be sure to do what we could to help Molly become aware of her right arm.

     After we arrived home we did our best to make sure Molly knew she had two hands. Shortly after returning home from the hospital I was diagnosed with Post Partum Depression, it was a difficult time for the whole family. At one month Molly had her first of many trips to Philadelphia, Pennsylvania. Her first visit was with Dr. Yum at St. Christopher’s Hospital. When Molly was two months old she started physical therapy with Michele F. at a private therapist’s office at Physical Therapy Plus in Pohatcong, New Jersey. She saw Michele twice in April and got fitted for a new wrist splint. With continued physical therapy and second visit to Dr. Yum we began seeing progress in April as Molly began raising her right arm and engaging it with her unaffected arm.

     In June we visited three more doctors in Pennsylvania. We first met with Dr. Berger of VSAS Orthopedics in Allentown, Pennsylvania, then Dr. Herman of St. Christopher’s Hospital in Philadelphia, Pennsylvania and finally Dr. Kozin at Shriners Hospital in Philadelphia. From the beginning Dr. Kozin was very personable and kind and he, his nurse assistant Linda Fillipone and the Shriners organization left a very positive impression on us. Dr Kozin suggested we have an MRI to establish a base line of the damage to Molly’s arm. Needless to say, we were very nervous about Molly’s first planned sedation induced MRI and the possibility of a recommendation for surgery. Prior to the MRI, Dr. Kozin was unsure if Molly would require nerve graft surgery.

     At five months Molly began to belly crawl. On July 13th, she had her first MRI. My husband and I were both nervous wrecks. We had to watch our five month old daughter get sedated. I was so worried; I hated it when they took her away from me. I paced the halls until I could see her again.

     On August 12, Molly was admitted to Shriners Hospital. She was six months of age and having her first surgery. At this time, Dr. Kozin was still unsure of Molly’s surgery. Dr. Kozin could not determine whether or not to perform the nerve graph surgery on Molly because she was showing a slight twitch of movement in her right bicep. Not until the next morning, after Molly was sedated and was being wheeled to the operating room, did Dr. Kozin tell us that he was not going to perform the nerve graft. I was so relieved. Dr. Kozin told us that he would be performing a closed reduction on the right shoulder, a transfer of lattisimus and teres major to rotator cuff, and lengthening the pectoralis major. After what seemed like an eternity to me, Molly emerged with a large pink cast that positioned here right arm almost directly to her side. I do not recall exactly what Dr. Kozin said to us after the surgery except that everything was okay and that Molly had a beautiful pink cast. Also, that she was fitted for a brace that would be worn after six to eight weeks when the cast was removed.

     While Molly was casted, Project First Step from Washington, New Jersey's Early Intervention Program came to our home to meet with us and to discuss Molly’s therapy program that would begin in October after her cast was removed. At the end of August we returned for a follow up visit with Dr. Kozin. I believe we discuss plans for Molly’s stay at Shriners following the removal of her cast. Molly and I would be staying at the hospital for five days to work with the therapists at Shriners.

     In addition to Molly’s Brachial Plexus injury she also had reflux which entailed new medicine, more doctors and more x-rays. If that wasn’t enough, Molly was colicky. We are not sure if it was the reflux, the brachial plexus or just plain old colic but Molly was a cranky baby. Everyday she cried, usually at nighttime. We would have to put her to sleep using fans and vacuums. She also constantly wore a bib because of the reflux. But despite all this, and in her cast, Molly never missed her weekly visits to Gymboree. Everyone in our class was wonderful and caring about Molly’s arm and surgery.

     On September 18th we returned to Shriners Hospital. The purpose of this visit was for Molly to have her cast removed and for her to have a post surgery MRI evaluation. While under sedation from the MRI, Molly’s cast was removed. This was to protect Molly from the trauma and stress of the experience of having her cast sawed off. I wanted to save a piece of the cast but, after the saw had done its work, there wasn’t much left to save. After Molly’s cast was off she was fitted for a brace that replicated the cast but could be removed for therapy. Molly and I were scheduled to stay at Shriners for five days of intensive therapy. At our therapy sessions we had the pleasure of working with Cheryl from the Occupational Therapy Department at the hospital. As a result of Molly’s work with Cheryl she began grabbing with her right hand and slightly bending her right elbow. Molly and Cheryl became good friends. In fact, Molly made a lot of friends at Shriners. The staff was amazing. They even went to the store to buy us a blender to make Molly’s formula. One of Molly’s favorite activities was to play chase with the other children. Molly in her infant walker and the other kids in their wheelchairs raced up and down the hallways and in the playroom. We also spent a good deal of time on the roof top playground. Molly saw her first clown and completed her first finger painting while at the hospital.

       At eight months, Molly started sitting up on her own.  On October 10^th we went for a checkup with Dr. Kozin.  October also signified the beginning of our weekly therapy regimen.  Molly had physical therapy twice weekly with Michele F. at Physical Therapy Plus in Pohatcong, New Jersey.Once weekly a therapist from Project First Step came into our home to perform occupational therapy.  Our professional therapy sessions were supplemented by daily therapy sessions I die with Molly at home. Molly became very found of the Baby Einstein videos during this period.  These programs allowed Molly to relax during most of her sessions and helped her get the most of this work. We are very proud of how good she was for all the therapy sessions we put her through.

     In Molly’s ninth month she began to “army crawl”.  She also grabbed her foot with her right hand.  On November 6 we made a trip to Philadelphia for an appointment with Dr. Kozin. We continued with our weekly Gymboree class and during this month Molly was able to crawl UP the slide!

     This month Molly began to crawl and cruise on the furniture.  We continued therapy and visited Dr. Kozin on December 18^th.  Molly took her first steps on Christmas day at 11 months.  The month of January continued the same as the previous month. Molly continued private physical therapy twice a month and Project First Step once a week.  Molly is now grabbing things with her right hand.  She is also holding her sippy cup with BOTH hands. Amazing!

     During the course of her second year Molly continued therapy and visits to Dr. Kozin.  Unfortunately Molly’s shoulder began to push out the back.  I believe this was happening because the development of her muscles was unbalanced.  Molly had a third MRI in the spring of 2004 and it indicated that Molly’s shoulder socket was forming in an oblong rather than round manner.  Due to her bicep and shoulder abnormalities, it was recommended she have another surgery.  On May 10^th, 2004 when Molly was a little over two years old she had arthroscopic posterior capsulectomy.  It was amazing how fast Molly recovered.  We had planned to spend the night at Shriners Hospital .  We were in a room and prepared to stay the night.  However, Molly was doing so well that they let us go home that night.

     Throughout Molly’s recoveries and despite three surgical procedures Molly’s right shoulder continued to wing outward.  Also her right arm did not rest in a “normal” downward position.  Molly’s arm rested at a midline position and in external rotation.  Her bicep muscle continued to harden.  From mid 2004 on Molly continued with physical therapy once a week.  She also was fitted for an elbow brace for her to wear nightly to help straighten her elbow.  At age three, Project First Step and Early Intervention concluded and we began to go to our local hospital’s outpatient occupational therapy.  In March of 2005 we once again took Molly in for Botox injections. This time they were designed to help with her elbow flexors.  We also tried serial casting to straighten her elbow.   Serial casting is a process of putting a soft flexible cast on Molly’s right elbow area for an extended period of time, approximately seven to ten days (if I recall correctly). However, after a period of a couple of months we stopped casting because Molly began to lose elbow flexion.

     Just prior to Molly’s third birthday in November 2004 I gave birth to twins.  Their names are Anthony and Zoe.  Once again I was diagnosed with Post Partum Depression.  It was a difficult pregnancy since I was diagnosed with Gestational Diabetes.   The twins were in the NICU for 8 to 10 days, but now are very healthy and full of life.

     When Molly was four, we discussed with Dr. Kozin another possible surgery for her.  It was hard to believe we were going to do it all again.  But I wanted to be able to tell Molly someday that we did everything we could to help her live a normal life with her “lucky arm”.  After a lot of thought, many discussions and tears for fear of Molly undergoing sedation again we elected to proceed with another surgery, but not before her fourth MRI.  The surgery would entail placing a titanium plate and six screws in her arm in conjunction with a humeral osteotomy.   Which means they would break her right humerous and internally rotated it about 30 degrees.  She will have this plate the rest of her life.

     This surgery caused us the most anxiety. Because Molly was now able to somewhat understood what was going to happen we had ultimately had a reluctant patient on our hands.  While we thought we were doing the best for our daughter, at this age it was so much more difficult to put her through this surgery. Coincidentally, Molly’s dad was having shoulder surgery on his right rotator cuff.  Anthony inadvertently and to his chagrin told Molly he was having surgery so the doctor would fix his arm.  Molly immediately picked up on this and told her daddy that she wanted Dr. Kozin to fix her arm.  While we had an additional surgery scheduled, at that time Molly did not know.  But this conversation opened the door for a discussion about Molly’s upcoming surgery.  I told Molly that I had talked to Dr. Kozin and that he wanted to help fix her arm so that she hopefully would be able to touch her belly and more easily put on a pair of pants.

     On November 9^th, 2006 Molly went into surgery at Temple University Children’s Hospital, which used to be adjacent to Shriners.  She was excited about the surgery all the way up to the operating room.  She was happy in her scrubs while playing in the waiting room and walking to surgery but all that changed when she got into pre-op.  She began to sob and said “I changed my mind. I don’t want Dr. Kozin to fix my arm.”  Dr. Kozin was delayed and our little Molly was so scared. It seemed like an eternity before they finally gave her the “silly juice”. 

     After the sedation, Molly was so silly that I almost peed my pants.   She finally was wheeled into surgery and while I was relieved it was finally happening, we had waited so long, I was once again anxious. After about two hours, she was out of surgery and I was so happy to see her in recovery but she was really out of it.  Once again Molly recovered remarkably fast.  There was no pain.  She was in a soft cast for 2 to 3 weeks.

     We then went right back into therapy.  We would now focus a good deal on her reaching her midline.  She is now able to touch her belly and pull up her pants a little easier but with continued therapy and strengthening Molly will be able to do even better!

     Molly is presently 7 years old.  She is a wonderful soul and a beautiful young lady.  She continues with her therapy twice a week.  She goes to Warren Hospitaland now gets weekly occupational therapy at her school.  God has blessed us with a beautiful daughter and we would not change one thing about her, yes we would love for her arm to be perfect but we are so blessed by such a wonderful child!  We are not sure what the future holds for Molly and any future surgeries.  We will forever be grateful for the Shriners organization and especially for Dr. Kozin.  We will continue to visit him and continue to look for others ways to help Molly improve her range of motion and function of her right arm.  Molly is a lefty and a wonderful artist.  She still has limitations but we think she is unlimited in what she can accomplish.   She is in her fourth year of dance and is looking forward to playing field hockey in the fall of 2009.

     If you would like to contact me for further information or for support please feel free to send me an email.  If you are in the New Jerseyarea or Philadelphia we welcome you to visit with us and Molly.