Thursday, July 1, 2010
I was measuring the leg lengths and calf girths of a lady the other day. She said " Are they the same"? " Nope", I said, "They are never the same"! " How come"? she said. "Well", I said, "God was never an engineer, He has always been an artist, so we are not made from a slide rule". Well, she thought that was the funniest thing she had heard all day and laughed and laughed and laughed. It's not the first time I've used that silly response with a patient. Even a little knowledge of embryology, is a great thing. R.I.Harris, the doyen of Canadian orthopedics, measured the leg lengths of one thousand consecutive young army recruits in 1941. Up to 3/4 of an inch of discrepancy was determined by him to be within normal limits. Most of recruits never knew they had a leg length discrepancy. Asymmetry is the order of the day for human beings, unrelated to disease or disorder. If you have ever seen a composite made of the two sides of your face, the nature of asymmetry becomes readily apparent. You will hardly recognize yourself! Of course the extent of variability of asymmetry has to have a baseline of normalcy. Woe betide the surgeon who succumbs and falls for a plea that breaches the nuanced acceptable differences the Creation Artist provided. If something goes wrong in a surgical case where the indications were marginal, he may find himself up the creek without a paddle. One shoulder is lower than the other, one nut is lower and smaller than the other, breasts are at different levels. That's what makes us interesting and unique. Vive La Difference!