Review of "Nurse Florence, What is Muscular Dystrophy?" by Michael Dow

Score: 90+/100 (9.0+ out of 10)

Nurse Florence, What is Muscular Dystrophy? by Michael Dow is yet another educational health-based children's book by Michael Dow, who has put together quite the collection of Nurse Florence books! We've read about a half-dozen in the series so far.

Nurse Florence, What is Muscular Dystrophy? simultaneously embodies the very best and very worst aspects of the series. On one hand, it is one of the longest and most exhaustive books in the series (in a good way)! Even being familiar with the subject matter, we really learned stuff from this book! That's a good thing.

This wasn't just a nothing-burger, this book had substance!

You do not just learn that muscular dystrophy is a “muscle disease” and call it a day. You learn that it is actually a whole family of over thirty genetic conditions, each with its own personality, timeline, and problem spots in the body. The book walks you through the biggest and most commonly discussed types: Duchenne, Becker, Emery-Dreifuss, myotonic dystrophy, facioscapulohumeral muscular dystrophy, congenital muscular dystrophy, limb-girdle muscular dystrophy, and oculopharyngeal muscular dystrophy. You get simple but meaningful distinctions. Duchenne, for example, often shows up in little boys who fall a lot, walk late, and have big calf muscles from scar and fat replacing healthy tissue. Becker looks similar but tends to come on a bit later and progress more slowly.

Emery-Dreifuss is tied to stiff tendons and heart problems. Myotonic dystrophy involves difficulty relaxing muscles, along with issues in the heart and breathing muscles. Facioscapulohumeral muscular dystrophy can show up as weakness in the face and shoulders, sometimes more on one side. Congenital forms show up at birth or in very young infants who seem floppy and miss milestones. Limb-girdle mostly affects the hips and shoulders. Oculopharyngeal causes droopy eyelids and trouble swallowing, often in middle age. That is a lot of nuance for a children’s book to take on, and it actually pulls it off.

The book also does a good job explaining who can be affected. It is very clear that this is not something that only happens to one race, one country, or one type of family. Children and adults of any background can be affected. There is a strong emphasis on family history, since many forms of muscular dystrophy are inherited and run along family lines. There is also an honest acknowledgment that some types are more common in boys than girls because of how certain genes are passed down on the X chromosome. That alone is a big piece of health literacy that many adults do not fully understand, and here it is being introduced to kids in plain, straightforward terms.

On top of that, the book goes deep into signs, symptoms, and complications. Muscle weakness is just the beginning. Readers learn about tight tendons that make it hard to move joints, scoliosis that curves the spine, breathing difficulties and lung infections, heart muscle problems, choking risks when throat muscles are weak, learning challenges in some children, and bones that break more easily because kids are not able to run and jump as much. It really drills home that this is a whole body condition that affects everyday life, not just “tired legs.” At the same time, the illustrations of wheelchairs, braces, ventilators, and posture supports present all of these things in a normalized way. Medical equipment shows up as a tool that helps people, not something to be ashamed of.

The medical side is surprisingly robust. Kids are introduced to genes and how small changes in these microscopic “instructions” can lead to big changes in muscles. The book explains common tests, including blood tests that look for high levels of creatine kinase that leak out of damaged muscles, genetic testing that examines DNA for changes, muscle biopsies that look at the tissue under a microscope, heart and lung testing, and electromyography that measures how muscles respond to electrical signals. It also introduces the idea of a care team. Children are shown that someone with muscular dystrophy might see a neurologist for the nerves and muscles, a cardiologist for the heart, a pulmonologist for the lungs, a rehab doctor and physical therapist for movement and stretching, an occupational therapist for daily tasks, a dietitian for nutrition, and social workers or counselors for emotional and practical support. That is an impressive overview of modern multidisciplinary care.

The book is also very explicit that there is currently no cure for muscular dystrophy. It does not sugarcoat that reality or pretend that a special diet or single pill is going to fix everything. Instead, it leans into the idea of treatment and management. Medicines like corticosteroids are mentioned for preserving muscle strength for as long as possible. Heart medicines help support the heart when it is affected. Gene-targeted therapies and clinical trials are mentioned as active areas of research that give hope for the future. The text covers range of motion exercises to keep joints flexible, braces to support walking, wheelchairs as mobility tools that help people get around, ventilators and breathing machines when lungs need extra help, spinal surgery in some cases of severe scoliosis, pacemakers for heart rhythm problems, and vaccines and regular checkups to help prevent infections that could make things worse. Readers come away with the sense that although there is no cure yet, there are a lot of things doctors, therapists, families, and patients themselves can do.

With that said, that's A LOT to put in a children's book. It can be overwhelming.

This also highlights another strange, awkward, and somewhat negative thing about this book: it seems really unnatural and contrived.

These characters just don't seem like real people. They don't talk like real people.

Who sits down with kids and spontaneously has a 125-page conversation with them about muscular dystrophy, rattling off every subtype, test, specialist, complication, and treatment option in one go? It reads much more like a detailed pamphlet that was chopped into speech bubbles than an actual conversation happening over lunch.

Like, how is Nurse Florence eating her lunch while talking about all this stuff? How is she finishing this entire conversation/lecture + eating her lunch in the 15-30 minutes this book is supposedly takes place in? Don't these girls want to talk about boys? Homework? Pop music? Drama at home?

Oh, and by the way, what prompted them to ask about muscular dystrophy and start talking about it? That's an issue that has lingered throughout this series: characters often lack motivation and seem to exist like cardboard cutouts to facilitate the info-dump.

That is the awkward part. The information is outstanding. The vehicle for the information (the “dialogue") often feels stiff and contrived. The kids rarely talk like kids. They mostly exist to ask perfectly timed textbook questions so Nurse Florence can launch into another long explanation. There are very few jokes, interruptions, misunderstandings, or emotional reactions from them. No one zones out, changes the subject, or needs something repeated. For a 125 page “chat,” it is strangely tidy and perfectly linear.

Because of that, the pacing can feel off. The girls are supposedly in the school cafeteria, yet the discussion keeps drilling deeper and deeper into increasingly specific medical territory with very little break. You rarely get small character beats like “Condi looked worried” or “Sonia needed that part explained again.” Instead, you often get paragraph after paragraph of uninterrupted explanation. It is educational, but it does not feel organic.

We also felt a bit of a missed opportunity on the emotional and human side. With this much space, the book could have easily woven in one or two short case examples of kids living with muscular dystrophy, how they play, go to school, use their wheelchairs, or work with their care team. Instead, almost everything stays in the abstract. We are told what can happen, but we rarely see a specific child or family. That keeps the book squarely in “medical briefing” territory instead of letting it become a fully formed story kids can attach to.

So, we want to be clear: the content is gold. You learn a ton about who muscular dystrophy affects, what the different types are, what medicines and therapies exist, why there is no cure yet, and what hope looks like through research and clinical trials. At the same time, the way that content is delivered can feel dry, overstuffed, and unnatural for a children’s picture book. It is the kind of resource that will shine brightest when an adult is there to pause, paraphrase, and emotionally translate, rather than something kids will naturally breeze through on their own.

With that said, muscular dystrophy (MS) is something that has become increasingly relevant. We know someone who suffers from it. Winners of ours have lived with it. Most notably, recently, the mother of Fernando Mendoza (Heisman Trophy & National Championship winner ) was wheelchair bound throughout the playoffs watching her son play on national television.

So, it's definitely something interesting to learn about and something that's worth learning about.

Check it out on Amazon!