No Summer Break

For one intense stretch from May to September, Dr. Dror Paley has his orthopedic surgeon's hands full lengthening the limbs of dozens of children.

August 24, 2002|By Patricia Meisol | Patricia Meisol,SUN STAFF

Dr. Dror Paley is midway through his 12-hour day fixing children's arms, legs and hips when he steals away to a staff lounge for a chocolate protein shake.

As he mixes some powdery stuff with ice cubes and turns on the blender, the Baltimore surgeon gets word that his wife and kids are stopping for a meal north of Toronto on the first day of their vacation. He remembers the gourmet chef the family discovered in the middle of nowhere on last year's annual trek to Canada.

"That's probably where they are headed," he muses.

A second is all he has to lament not being with them. People are waiting on him at Sinai Hospital: children from other states, children from other countries, and the parents of a 15-year-old who must drive through the night to Saginaw, Mich., to arrive in time for her first day of school. Hurry, hurry.

Ah, August, the busiest month of the year for a pediatric orthopedic surgeon with a rare specialty: limb lengthening and reconstruction. The season for Paley begins in late May. Surgery is only the start of the process that can add 3 inches to a child's height in a single summer. In the stretching phase, which lasts three months, the bone is held in place with pins. That's when most complications occur, and Paley can't be sloppy; to head them off, he checks on his patients every two weeks.

Beginning in May, then, 10 to 15 patients a week are added to his clinic after surgeries. The load builds until August, when the waiting room of the International Center for Limb Lengthening, which Paley runs with partner John Herzenberg, is out of control.

Outside, traffic in Baltimore has slowed and parking garages are half full as families head for the beach or the mountains; Paley, the most experienced surgeon in the country in his specialty, hasn't noticed. He arrives at 6:30 a.m., often after a 6-mile bicycle ride.

At this hour, a few minutes after 2 p.m., the delay from appointment to actual examination is two hours - not bad, compared with the previous week's five hours. Only one of 58 scheduled patients and five surprises has left in a huff; the others sit or stand patiently, entertaining their children in a large playroom, reading books, glancing at the television or walking up and down the hall.

Paley runs between the X-ray viewing room and patient examining rooms, with an odd trip up a back staircase to operate. The climb up two flights of stairs is the closest he's been to hiking since June, when the family sneaked away for a week to Banff and Jasper national parks in Canada. Paley, who is 46 and Canadian, loves camping, hiking, canoeing, rock climbing, fishing.

But now, instead of being followed by moose and elk in Ontario's Algonquin Park, he is being followed by a couple of residents and a Boston freelance writer researching a book on dwarfs. Five percent of Paley's operations are to lengthen limbs of those born with achondroplasia, a bone disorder that causes dwarfing. Most of his patients have other deformities, such as a short thigh bone or a missing fibula, the narrow bone next to the main shin bone.

Paley brought limb-lengthening to the United States in the 1980s after studying it with experts in Russia and Italy. Doctors still have little use for it, with most recommending amputation rather than growing the bone, a treatment once considered worse than the disease. Paley changed things, writing the textbook for a new generation. Little did he know how much his summers, too, would change.

In one examining room, he gives new instructions to the mother of an 8-year-old girl from New Jersey about the gadget attached to her arm.

`Give the kid a break'

With a Lucite ruler, he measures bone growth on the child's X-ray and calculates how much the mom needs to turn the pins. The turns pull the bone apart, stretching it, so new bone can grow and fill in. The mother is anxious to have the child's other arm lengthened, but Paley is not. Two things have to happen, he says: "The arm muscle has to recover. And, give the kid a break."

A teen-ager on growth hormone gets good news: Her legs are now less than an inch different in length, and Paley is not inclined to operate on the shorter one. "See you back next summer, and maybe you'll be equal," he says.

Before Paley can get to the next examining room, a mother in the waiting room, Crystal Kappenman, spots him and rushes down the hallway with her daughter, Rachel, hoping to salve her worry: The child, who uses a wheelchair, had her leg caught on a carousel over the weekend, she tells him, and now green goop is oozing from the hole where pins are pulling the bone apart. Is the leg infected?

"Let me see," Paley says, but he can't see, not until the bandage is removed. He'll take a look when she gets into an examining room, he says, reassuringly. The mother nods and returns to the waiting room.

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