As August melted into September, Grady McCormick counted down the days to the start of first grade. The smiley youngster barely contained his excitement at the prospect of riding the big school bus. “It was a tremendous milestone for Grady,” says his mother Heather.
And when Grady walked off the bus and into the Stratham Memorial Elementary School in Stratham, New Hampshire, it seemed like the entire student body cheered for him.
During the last two years, as the 6-year-old battled Legg-Calve-Perthes disease, a hip condition caused by disruption of the blood flow to the femoral head (ball of the hip), and hobbled on his A-frame brace, he wove his way into the hearts of his school community and developed a special bond with Dr. Benjamin Shore, his orthopedic surgeon at Boston Children’s Hospital Orthopedic Center.
Diagnosing Legg-Calve-Perthes disease
When Grady was 4 in the spring of 2013, Heather and her husband Tag noticed he had developed a limp on his right side. His pediatrician was puzzled and ordered an ultrasound, which was inconclusive.
Next, the pediatrician referred Grady to a rheumatologist, who prescribed anti-inflammatory medication to help manage the joint pain. However, his condition didn’t respond after a few months of treatment, so she ordered an x-ray.
“Grady asked for the picture. When the x-ray tech handed him the image, you could tell something was wrong with his right hip immediately. The left femoral head (where the hip and thigh bone connect) was nice and round and healthy. His right side looked like mashed potatoes,” recalls Heather.
The family was immediately referred to Shore, and two days later Grady met the orthopedic surgeon. He told Heather and Tag their son had Legg-Calve-Perthes disease and started educating the family about what the next two years would bring.
“Dr. Shore told Grady his hip was angry and irritated,” says Heather. The good news, Shore told the family, is the body repairs itself — the bad news is the fastest way to heal is to rest. So the McCormicks rested their active 4-year-old son — for two years.
Treating Grady’s Legg-Calve-Perthes
The McCormicks returned to see Shore in December 2013, so Grady’s legs could be set in a Petrie cast — they needed to be splayed in a V-shape to allow the right hip to rest.
The goals of treatment for patients with Legg-Calve-Perthes disease are to:
- relieve pain
- restore and maintain good hip motion
- decrease the chance of hip arthritis later in life by preventing or minimizing the deformity of the femoral head and helping it reform as round as possible
Grady used a wheelchair until February 2014 and then returned to Boston Children’s to have the cast removed and his leg brace, called an A-Frame Hip Orthoses, made.
Grady was somewhat independent with the brace. He could sit up, bathe and even walk at a fairly rapid clip. Mom and Dad modeled optimism and a can-do attitude for their son, building him a “belly board,” a padded contraption with wheels that he could push himself around on. It was faster and more fun than walking.
The benefits of patient communication
And Shore helped his young patient cope with the condition. “Dr. Shore speaks directly to Grady, and Grady has developed a tremendous respect for him. Grady explains to his friends and classmates, ‘I have a hip disease, and I need to rest to get better,’” says Heather.
Sometimes, though, when you are 4 or 5, the temptation to run and jump is overwhelming.
When the urge strikes Grady, Heather and Tag gently remind him of what Dr. Shore told him about resting his hip. Because Grady thinks so highly of Shore, he complies without complaining.
For children with Legg-Calve-Perthes disease, the condition worsens before it improves. The femoral head collapses for six to eight months, and then it begins to re-grow.
“It generally takes three to four years for patients to progress through the stages of the disease,” explains Shore.
And that’s how the disease unfolded for Grady.
Shore monitored the progression of his disease every three months, reviewing his x-rays with Grady and his parents — a process Grady and his mother mimicked at home.
After the first x-ray, Grady and Heather asked for a copy of every image. “Sometimes we’d lay them out on our table. Eventually, we could start to see re-growth.”
No more hip brace
In March 2015, Shore shared some good news with Grady. His x-ray showed that the femoral head was reforming and healing. That meant he could take the brace off for two to three hours every day.
Three months later, Shore delivered even better news. Grady no longer had to wear the brace when he was awake. The orthopedic surgeon reminded Grady that he continues to heal and to let his parents know if he is tired or sore and needs to rest. Grady happily agreed.
Shore will continue to monitor Grady through adolescence to make sure his hip remains healthy. In the meantime, he’s keeping busy living the life of an active and healthy 6-year-old.
Learn more about the Boston Children’s Child and Young Adult Hip Preservation Program.