Yesterday Tootle and I went to DC Childrens Hospital for her periodic craniofacial clinic visit, a 4-5 hour marathon where we see about six different medical professionals (dentist, audiologist, speech pathologist, ENT, psychiatrist, and plastic surgeon). Tootle's last appointment there was a year ago, and we were both struck by the now pervasive presence of the hospital's mascot: the lovable Dr. Bear. Tootle pointed out every place she say his image and by the end of the day she was singing a new ditty: "Dr. Bear, Dr. Bear. Dr. Bear is everywhere..." Dr. Bear even came home with us: I turned down her request to buy the $37 stuffed Dr. Bear in the gift shop (complete with a lab coat), but I did spring for a key chain (and she already has a sweatshirt from her hospital stay in November 2006).
We will next see Dr. Bear in 3-6 months when we return for a hearing test and ENT check with Dr. P. One of Tootle's ear tubes came out but it left behind a natural hole, which is currently functioning as the tube. When the hole closes up, fluid build up is likely to once again cause hearing loss, so we'll be monitoring the situation pretty closely.
In the past the dentist and plastic surgeon have hinted at the future need for bone grafting surgery. At this visit, they gave me some more detail. Once Tootle's six-year molars emerge, she will have an expander put in her mouth (like many kids) followed by bone grafting in the upper jaw (not so typical). Bone grafting involves taking a small amount of bone from one place (usually the hip, head, ribs, or leg) and placing it in the area of the cleft near the teeth. The procedure, which will occur in the next few years, provides support for unerupted teeth and teeth next to the cleft, provides support for the lip and nose and improves symmetry, and forms a continuous upper gum ridge, creating a more natural appearance and stability to the ridge. Thus far, Tootle only has one adult tooth and one that will likely emerge in the next month or so, so the expansion part of this process seems to be at least a year away. It will probably work out that just as Doodle finishes with the orthodontist, Tootle begins (although I would prefer a break).
Dr. B., the half way friendly/half way arrogant, well respected plastic surgeon, accompanied by an entourage of four interns, talked about the 2-3 little things he would like to do to improve Tootle's lip and nose, procedures that would take about 30 minutes to complete. We agreed that these procedures (snipping a nose pimple, taking a little skin from her smaller nostril to expand it, and a little lip work) can wait until Tootle is on the table for the bone grafting. If Tootle were being teased by her classmates, I would opt to do this right away. The reality is that no one ever notices her slightly crooked smile, faint surgery scar, and smaller nostril. Dr. B. and the interns opined that that's because she's so cute. I do want this work to be done eventually though because it likely would become a bigger issue once we hit the tween and teen years, but it can wait 2-3 years.
Thank you for being everywhere Dr. Bear. Your presence, and the yummy mac and cheese in the cafeteria, made our day of appointments a lot more bear-able.