{"id":27869,"date":"2013-07-18T15:28:51","date_gmt":"2013-07-18T14:28:51","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmj\/?p=27869"},"modified":"2013-07-18T15:28:51","modified_gmt":"2013-07-18T14:28:51","slug":"eva-dumann-so-this-is-victory-treating-adolescent-idiopathic-scoliosis","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmj\/2013\/07\/18\/eva-dumann-so-this-is-victory-treating-adolescent-idiopathic-scoliosis\/","title":{"rendered":"Eva Dumann: So this is victory\u2014treating adolescent idiopathic scoliosis"},"content":{"rendered":"

\"Foto1\"<\/a>One of the great things about being a BMJ<\/em> Clegg scholar is unlimited access to BMJ<\/em> articles, coupled with enough free time to read about the weird and wonderful topics that the \u201creal\u201d medical world concerns itself with. Sometimes, however, the findings are not so pleasing. A recent Clinical review<\/a> on adolescent idiopathic scoliosis (AIS) managed to muddle up my feelings and thoughts quite a bit with the simple statement: \u201cBracing in AIS is controversial, with treatment effectiveness remaining questionable based on available evidence.\u201d<\/p>\n

I was diagnosed with scoliosis at the age of 13. My curve angle was never dramatic, and it wasn\u2019t until my last routine check-up that the paediatrician recognized that I wasn\u2019t quite straight. An orthopaedic specialist prescribed a brace, to be worn until I stopped growing. The brace looked like a piece of medieval armour, battered by a few cannon balls to bulge out on one side and cave in on the other, made of hard plastic, held tight by two huge buckled straps. <\/p>\n

The review states that \u201cVarious factors can hinder successful brace treatment. Poor adherence is common.\u201d I agree. But I was adhering strictly. With the mad discipline that probably characterizes medical students to-be, I even wore my brace on holiday at the beach. It wasn\u2019t easy, especially in the first weeks when I woke up at night because the brace intentionally left little space to breathe except into the bulges. I had to change my undershirts every few hours because under the tight plastic they got drenched in sweat even on a cold day and then rubbed on the skin, leaving huge scarlet bruises. Add to that the tears of a teenager throwing out all tight-fitting clothes because they accentuated the clumpy shapelessness of the brace, and I can\u2019t blame anyone in this situation who didn\u2019t have the same sense of adherence, or compliance, or obedience. As a teenager you have an awkward attitude to your body anyway, which is horribly exacerbated by a clumpy device, which in trying to correct deformity makes it all the more obvious for everybody else to see.<\/p>\n

However, this sense of blame pervaded every appointment at the orthopaedist. It also came across more subtly in the well-meaning, but daunting stories told by (mostly adult) friends about girls they knew, or had heard of, who had only worn their brace at night for vanity\u2019s sake, and, as a result, they implied, come out as kinked as ever. The review takes a rather more cautious stance. \u201cFamilies must be counselled that there is a risk that bracing may not be successful, but that the chances of success are improved with discipline and adherence to wearing the brace for the recommended time.\u201d The need for discipline was made rather clear to me, but I was unaware that there was controversy about success rates, and as to what \u201csuccess\u201d was. I naturally assumed that the objective was to straighten me out. In those days, my trust in doctors was unquestioning, so if I didn\u2019t wear my brace 23 out of 24 hours a day, I would have only myself to blame for retaining the ugly kink.<\/p>\n

After two years at medical school, I\u2019d be rather more cautious, because it sometimes seems that even simple decisions can run up against a wall of controversy. Would I strap myself into the device as willingly, now that I know it has “questionable treatment efficiency?\u201d Probably not. Thinking back to the orthopaedic appointments now makes me shudder. This doctor with his paternalistic attitude, who was capable and well-meaning, but never explained any procedure or decision, gave no differentiated view including the possibility of treatment failure, and sought no cooperation except compliance, to me now embodies everything I don\u2019t want to become as a doctor.<\/p>\n

However, that said, the issue I haven\u2019t yet managed to resolve for myself is that he might have done exactly the right thing. The blame strategy worked. My curve hasn\u2019t gone away, which to me seemed like a failure, but at the latest check-up it hadn\u2019t become bigger either. Today, from the review, I discovered that \u201cThe primary goal of bracing for scoliosis is to halt curve progression.\u201d Is this victory? Maybe my na\u00efve discipline, sustained by paternalism, and lack of information, was useful after all. Would I have been as determined when faced with \u201cbuts\u201d and \u201cifs\u201d? I don\u2019t know.<\/p>\n

Eva Dumann<\/strong> is a BMJ Clegg scholar and has just completed her second year of undergraduate medicine at Peterhouse college, Cambridge.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

One of the great things about being a BMJ Clegg scholar is unlimited access to BMJ articles, coupled with enough free time to read about the weird and wonderful topics that the \u201creal\u201d medical world concerns itself with. Sometimes, however, the findings are not so pleasing. A recent Clinical review on adolescent idiopathic scoliosis (AIS) […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[224],"tags":[],"class_list":["post-27869","post","type-post","status-publish","format-standard","hentry","category-students"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/27869","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/comments?post=27869"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/27869\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media?parent=27869"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/categories?post=27869"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/tags?post=27869"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}