Today was the annual Cleft Team Evaluation. It's a long day, but it actually went really well. To give you an idea of how these appointments go, let me break it down.
First, I must give compliments to my GPS as Boston is a little confusing to navigate. Plus, I am directionally challenged.
We arrived at Children's Hospital at 1:30. The first task was to get Roger's picture taken. While waiting, the kid ahead of us was screaming bloody murder. I kind of smirked to myself, because a couple of years ago, Roger did the same thing. There was nothing you could say to convince him that it was just a camera and the man was just going to take his picture. But, today, thankfully, Roger was in good spirits. I told him that the photographer was going to tell him not to smile. Roger showed me a big scowl and asked if he should make his face like that. I told him to just have a normal face. Finally it was our turn, and the photographer said, "Don't smile." He took a picture of him straight on, the profile, and a view of him with his head tilted up. When we were done, he told the next kid, "You don't have to smile."
We waited in the waiting room where Roger joined a group of kids playing basketball in the waiting room.
At 2:00, we went to have his speech evaluated. She had him look at a book of pictures and had him name the object. She also asked him some questions, like "What is your favorite movie?" He said, "Cars." Then she asked "What happened in the movie?" His response was, "I don't know." She asked too many open ended questions like that. She said that he has improved quite a bit from last year, but that he still wasn't quite where she thought he should be. She recommended that he get speech therapy 3 times a week, rather than 2. She also suggested a pharyngeal flap, which closes off the nasal cavity in the back of the throat to prevent any nasal sounds, which no amount of speech therapy would help. She didn't know when the best time for this would be. She would have to talk to the surgeon. Then, we went back to the waiting room again.
2:30 - 4:15 -- I talked to another mom. Roger played with her ten year old son and they got along well. For some reason, this amount of time flew by and it really didn't seem like it was that long.
At 4:15 we saw Dr. Mulliken, the plastic surgeon. He said that Roger's lip looked good and that his scars looked good and that his nose was not too wide. Then he measured all his various parts and the numbers showed that his nose was actually a little wide, but to him, it didn't look wide. These were all great compliments coming from him because he his very blunt and to the point. He doesn't sugar-coat anything. We talked about the pharyngeal flap and he thought that it needed to be done within a year. He wants to fix his nose, but before that is done, we need to push the premaxilla back. For that, we needed to talk to the orthodontists.
We went to another room to talk to the orthodontists, Dr. Bruun and Dr. Kennedy. They looked at his teeth and thought Roger was an interesting case because his premaxilla houses both lateral incisors (the teeth next to the two center teeth) where as most cleft kids are missing those. They thought it would be a good idea to get impressions of his teeth to see how he would tolerate that. If he tolerates it well, then they will consider putting a fixed appliance on his teeth to push back the premaxilla in the "keystone" position.
Once his teeth are in position, they would do a bone graft to fill in the cleft in his gumline, and then, Dr. Mulliken would fix his nose.
I am not sure on the timeline of all of this . . .I am just taking one step at a time. First, we will take pictures and impressions of his teeth, and we will go from there.
At 5:00, we started back home. Again, thank you, GPS.
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