Dentist and the ER

Zoe has been home sick with pneumonia and residual cough for almost a week.  She felt finally well enough to go back to school today ... but not before a stop at the dentist first. 

We knew her teeth were bad ...but I had no clue just HOW bad.  (sigh)

When we first got home from China almost 4 years ago, we immediately took her to this dentist and he worked on 10 of her 15 teeth.  Well... we're about that bad again.  (Yes she brushes ... well.  Cleft kids tend to have a lot of issues with porus teeth and cavities.) 

After many xrays, they made their plan.  They won't have an exact plan until he talks to the Craniofacial surgeon but he has his proposal. Basically, he will put silver crowns on several teeth (try to save them until it's time for them to fall out and the silver crowns are the best bet).  He will also extract several teeth.  The problem is... 3 of the ones he needs to extract (due to extensive nerve involvement) are IN the palate.  If he takes them out, they run the risk of collapsing her palate. But if he extracts them and they immediately start working on palate expansion in preparation for the bone graft. 

Basically, her 3 silver crowns she has are fine.  Her 3 permanent teeth she has are fine.  The rest ... ALL are getting work!  There is so much work to be done, he wants to take her to the hospital and put her under and do it all at once. (Much more merciful this way.)


Now about the other reason we were there ... the Cleft surgeon wanted to get a Panorex (panoramic view of her teeth to see what teeth might be erupting soon).  HIS take on it was that the bone graft would need to be done in about 6-9 months.  But he also said this wasn't his call.  Her xrays have already been forwared to the surgeon.  But if she agrees, this means we need to start fairly soon with the Orthodontist to work on expanding her palate. 

Zoe being a "statue" ... the only pic that turned out unfortunately of her dentist visit. 

So ... now we wait for the VPI test (to see if she needs pharyngeal flap surgery) and if so, they'll combine the teeth and that surgery.  If not, we'll do the dental work soon.  In the meantime, she's on antibiotic as she currently has abcesses.  (Poor baby!  She must be in so much pain but never says anything.) 

I eventually got her back to school.  And then I noticed that Manny's one cast (remember, he wiggled out of the other one on Saturday) was slipping.  Several of his toes were no where to be found.  The toes I *COULD* see were turning blue and he was in pain.  So I prayed about it and felt I needed to get him to the ER.  In the van, I tried one time to see if I could slip it off (it was that low).  And he SCREAMED.  So ... no. 

Into our Local ER.  The front desk nurse couldn't figure out what I needed ... even though I provided him the script from the PT/orthotist which says this child is in a serial casting program, it's only for stretching, not for breaks or surgery.  The note says if a child presents with pain, they are to remove the cast and not recast it.  Seemed straight forward to me.  I showed him the green line where his toes WERE and where his toes were now.  Thankfully a second desk triage nurse understood and sent us right through.

This doesn't show proper depth perception. But the big toe is about 2 1/2 inches down from the green line.  The little toes are not visible as the foot is so far down and rotated.

Once in the back, we got a nurse we've had before.  In fact, the last time I was there, she was telling me about her granddaughter who'd just been diagnosed with heart hole and wanted prayer and advice on a good cardiologist.  So today I asked about her and there was a praise report! 

And then the ER doc was one we've had before.  He immediately knew what to do and calmly ordered the right equipment. The last time there, he was very concerned about Manny as his heart rate was almost 200.  He was really trying to get to the bottom of the diagnosis.  So today I told him that even though it was unrelated, we knew his diagnosis.  He asked the complications and I told him.  One is lung ... and he immediately walked over to listen to his lungs.  (So sweet.)

 I loved that it was a doc and nurse who knew us so they didn't think we were nuts or anything.

The guy cutting the cast off was ... uh, scared.  I don't know why he was the guy but he was scared.  He kiddingly asked if I'd sign a waiver if he accidentally cut the baby.  I told him how they usually cut it off and coached him through it.  He did great.  He was much relieved when it came off.  Manny was also thrilled and kept saying, "Boot off!"

The baby's foot looked HORRIBLE.  There was a lot of skin abrasion.  But the most concerning part was an actual cut on his foot (not from the guy who cut it off).  I have no clue how there could be such an injury on his foot.  Strange.  His toes immediately started to look better.  His circulation was being cut off quickly.  I don't know how long it would have been before there was a major problem ... but not long.  That's for sure.  I made the right call.  

poor little foot ... doesn't do justice to how horribly painful it looked

We were in and out in like 1 hour.  (record).  And the whole time, Manny was quite entertaining.  He was talking (which they've never heard because he's usually very sick when we take him there).  He saw the number 3 over the bed and said, "QRS".  I told him it was the number three.  To which he said, "4,5,6".  He was crackin' everyone up! 

The rest of the day was pretty uneventful.  (Well, if you count that I still have the flu uneventful.)