STORY BYKathryn Nowlin-Castellese grinned as she slowly made her way to the stage. She didn’t care that she was holding up the line. This was her moment.
The fact that she was walking on her own was as much of a milestone as the high school diploma she was about to receive. The soon-to-be graduates behind her would just have to wait their turns.
Kathryn thought she may not be able to walk across the stage at graduation or dance at her senior prom. Her juvenile rheumatoid arthritis was causing so much pain in her hips and her back that she had to rely on a scooter to transport her to class.
Improved joint replacement parts and surgery helped her stand up straight again and walk a painless path to recovery.
Terry Clyburn, M.D., assistant professor and director of research in the Department of Orthopaedic Surgery at The University of Texas Medical School at Houston, says joint replacement parts, once designed for older patients, are now made to last longer. With the development of metal-on-metal and ceramic replacement parts, there is a reasonable chance that the benefits of a joint replacement performed on a teenager could last the life of the patient.
“Once the joint is replaced, the arthritis in that joint is alleviated, and the arthritis does not come back,” Clyburn says. “Patients with juvenile rheumatoid arthritis (JRA) often have severe joint pain from almost the time they are born, so to be able to offer them the opportunity to live without some of that pain is quite significant.”
Nearly 300,000 children in American have some form of arthritis or rheumatic disease. JRA is the most common, according to the Arthritis Foundation.
The disease contributes to smaller, brittle bones and medication can soften the bones, so there are more risks associated with joint replacement in JRA patients. However, Clyburn says, minimally-invasive techniques often can be performed, and screws and clips can be used, if necessary, to anchor and reinforce the joint replacement.
For successful rehabilitation in patients with severe rheumatoid arthritis in their hips, Clyburn recommends a bilateral hip replacement. Otherwise, the untreated joint may be too stiff to do physical therapy after surgery.
Nowlin-Castellese, now 19, was 18 months old when a physician diagnosed her with juvenile rheumatoid arthritis. Throughout the years, she has taken methotrexate, Enbrel and other medications to help her maintain mobility. Even still, the pain in her hips and back progressed, and during her senior year, it became debilitating.
“I wanted to be able to dance at my prom,” Nowlin-Castellese recalls. “I wanted to walk with my class at graduation and get my diploma like everyone else.”
Clyburn replaced her hips with metal stems and sockets and ceramic balls five months before graduation. Today she walks with no pain. “I’m even a little taller,” Nowlin-Castellese says. “I used to be in so much pain that I was crying and I couldn’t concentrate on my work at school. Now that I have the new hips, I can do the things I want to do with my life.”
UPDATED: 6-24-2005
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Dr. Terry Clyburn is an assistant professor and director of research in the Department of Orthopaedic Surgery at the UT Medical School.
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Tetanus booster for adults
Tetanus does not result from the rusty nail or whatever created the wound. The danger lies in the bacteria Clostridium tetani that lives in the soil or manure on that nail or gardening tool. When these spores get into a wound—deep or shallow—they can produce a potent toxin. Also called lockjaw, tetanus seriously affects the central nervous system and can be fatal.
Onset of symptoms can occur anytime from three days to three weeks. Call your health care provider if you have an open wound, particularly if:
Adults should have a tetanus booster shot every 10 years, known as the Td vaccine. It is a "2-in-1" vaccine that protects against tetanus and diphtheria. It contains a slightly different dose of diphtheria vaccine than what you received as a child. It can be given to anyone older than 7 years and is injected, usually into the arm.
Instead of the standard Td booster every 10 years, adults between the ages of 19 and 65 should receive Tdap one time in their adulthood to boost the immune system for pertussis, as well as tetanus and diphtheria.
Diphtheria, a contagious bacterial infection created that causes severe inflammation of the throat and larynx and can also affect the whole body. Pertussis or “whooping cough” is a serious bacterial infection that afflicted children and infants before vaccines were available. Adults may be infected later in life as their immunities wane. Neither of these infections are related to tetanus, but both vaccines are compatible and convenient to use with the tetanus booster.
