David and Laura Kelly knew adopting a pair of daughters, Nikki and Karah, from Russia would produce a unique set of challenges.
Those challenges were compounded by an injury to the youngest of the pair, Karah. She would require specialized treatment to help her develop into a capable, independent young woman.
While in the Siberian hospital, a nurse left a tourniquet on Karah's left arm after placing an I.V. in the top of her hand when she was 10 months old. It cut off blood supply long enough that doctors had to amputate her middle finger and parts of her wrist, including the growth plates.
The injury and resulting surgeries left Karah's forearm scarred and thin and her hand curled and bent toward her forearm.
Laura and David waited to pursue further surgical treatment for Karah's hand after bringing her daughter home when she was 2 in August of 2000. When she finally asked Karah what she wanted, Laura received a definite response.
"I drew a picture of her hand how it is curled up and another of her hand flat," Laura said. "I asked her which hand she wanted, and she said 'flat' enthusiastically."
When the family lived near Philadelphia, Karah had surgery to remove most of the scar tissue in her hand and to graft on new skin. After they moved to Atlanta nine years ago, they started searching for other options.
"Children's came up because Karah went online and did one of her own searches," Laura said. "She sent me an email out of the blue to check this website out and that she wanted to talk about getting her hand improved."
Coming to Children's
The family met with Allan E. Peljovich, M.D., M.P.H., a pediatric orthopaedic hand surgeon and the Medical Director of the Hand and Upper Extremity Program at Children's.
Rather than opt for more surgery, however, Dr. Peljovich recommended Karah receive a consultation with the limb deficiency team to explore non-surgical options.
"We were thrilled," Laura said. "We weren't leaping into surgery. We are doing a progressive treatment, and then Karah can make that informed decision about having another surgery."
After a comprehensive evaluation of her limitations and abilities, Karah began occupational therapy with Amy Bohn, C.P.A.M., O.T.R./L., at Children's at Meridian Mark in July 2013.
In the first month of therapy, Amy completed scar management techniques, splinting, and range of motion and strength exercises. She also designed an exercise program to help Karah develop strength and function in her left hand.
Karah, who is now 15, will continue to receive hand and upper extremity therapy for another six months to a year before making a decision about more surgical treatments. They are thrilled with the progress their daughter has made.
While the future is still uncertain, Laura said one thing is for sure: Karah will be returning to Children's for the next step in her treatment, whatever that step might be.
"Children's has made her feel really comfortable," Laura said. "They work so well as a team and you can see that. They were so compatible."