Saturday, July 21, 2012

Last Water Day :'-(


Greetings and a Reminder:

I write this blog as we go through ET Mehta Casting with our daughter Olivia. The blog is intended to inform, possibly inspire, and raise awareness of Infantile Scoliosis and its treatment/cure. Please share our story. For more information please check out http://www.infantilescoliosis.org/ 



Today was Miss Olivia's last day as a bathing beauty for a while. We would like to warmly thank our friends Vanessa and Greg and their beautiful daughter Ella for their hospitality today. Of course Olivia was not as huge a fan of the pool as I anticipated. She loved throwing things into it, but then got off on the wrong foot going in; literally. As I was having her step down into the pool she pretty much belly flopped in. She wasn't in the mood after that. Want to know what she did fall in love with today? A sand table! Go figure. :-) Here are some pictures from today. 


Tomorrow will be Olivia's last bath day. Yes, I plan to embarrass her future teenage self and post bath time pictures. Until then...

















Friday, July 20, 2012

Pre-Op


Greetings and a Reminder:

I write this blog as we go through ET Mehta Casting with our daughter Olivia. The blog is intended to inform, possibly inspire, and raise awareness of Infantile Scoliosis and its treatment/cure. Please share our story. For more information please check out http://www.infantilescoliosis.org/ 

Today was Olivia's pre-op appointment at Children's. Here's a run down of how today went. :-)

Our appointment was at 8 AM. The way traffic has been lately we left at 6 AM to ensure we got there on time. I AM NOT a morning person....

Anyway, we got to the hospital for 7:15, and ate breakfast in the lobby. We then went to pre-op admitting at about 7:55 and was taken in to be seen by Nurse G at 8:10. She asked me a slew of questions about Olivia, family history, you know, the usual gambit. Then she weighed, and measured Olivia and took her temperature. I think Olivia is still traumatized by having an IV placed so she has a very low tolerance for being touched in doctor's offices. Needless to say you would have thought Nurse G was poking her with scissors or something! Her temp was fine and she measured out at 32 inches and weighs 25 pounds! I think she needs to lay off the pancakes. ;-) Following this (and diaper change number one) we were sent back out to the waiting room to wait for round two, which was meeting with the anesthesiologist. 

About another ten minutes goes by. Olivia was entertained by the large fish tank, a toy made out of removable plastic gears, and the other children in the waiting room. We were then seen by anesthesiology. The gentleman was very nice and informed me that they will be using a general anesthesia in the form of gas. For her MRI she was given a strong sedative through an IV, so this will be a different experience. Once she is under then they will then insert an IV for fluids. I was told that due to the short time she will be under she will actually absorb very little of the gas. I signed a consent form and was sent back to the waiting room so I could continue my world tour. 

Sorry if this seems so detailed and boring. I just want to explain as much as possible as a "what to expect" sort of thing as a reference. 

We were in the waiting room maybe 5 minutes this time when we were then sent to billing to cover insurance stuff. The woman there couldn't get over how Olivia knew how to open my wallet and remove it's contents (a skill that I'm sure will never grow old). She also commented on my Alex and Ani bracelets so I wrote down the web address for her so she could check them out. After filling out paperwork and a short survey we were released from Pre-Op and sent up to Orthopaedics.

Allow me to note what an amazingly patient girl Olivia was during all this. It was 10 AM by this point. 

Once on the second floor I was asked by a nice gentleman if I wanted to try out their electronic check-in system. Sure! Why not! He seemed pleased at my interest. I checked in and then filled out a short survey on how I felt about the do it yourself check-in kiosk. It was fine. Of course in the back of my head I think (a perfectly good human needs the job of this kiosk), but I kept my mouth shut. After about another 10 minutes we were sent in to wait to meet with Dr. G and his team. 

We were met by a woman who was representing the Orthopaedics Department on a nationwide research study asking if we could include Olivia as part of the study. It wasn't changing any of the things we were doing. According to the paperwork they are conducting the research study so that they can "evaluate the long-term clinical outcomes of Early Onset Scoliosis." They "want to determine the effectiveness of various treatments in correcting the deformity while allowing for additional spine growth." I said that they could include her. Again, I'm all for awareness and helping in any way that I can for others like Olivia down the road. 

We were then met by two nurse practitioners while we waited for Dr. G. Both were extremely informative and helpful. Here is what I learned in our conversation (Oh, and we're at diaper change two at this point):

- We will be staying on a floor that is specialized in Orthopaedics and will be attended by nurses who are trained in cast care. 
- She will have a roommate (I expected this).
- It gets cold in the rooms so layer up. 
- They will do anything they can to make sure that we are comfortable
- They have special entertainment that goes through the floor. They have put in a special request that the dogs come to visit Olivia. :-)
- Information I already knew but will share here: 
     - There is wi-fi
     - One parent is allowed to sleep bedside (which will be me). There will be a pull out chair or a window bench to sleep on depending on room location.
     - There is "room service". She told me to order a little extra for me :-). They also have a small on on floor kitchen.

Here are the questions and answers from my previous post:

1.) Olivia has fair skin. What can I do to best protect it from irritation? Will I be able to bring moleskin home?

Under the cast she will be wearing a special t-shirt and the entire interior of the cast is a soft cotton. They will line the cast generously with moleskin, and I can also bring some home to use as needed.

2.) What are the pros and cons to having a shirt put on under the cast?

They always put the shirt on under the cast. They cut it out where skin is exposed, so you wouldn't actually know the shirt was there because of the exposed belly. I don't know if there's like an additional shirt of something, but this will do for now. 

3.) When it comes time to change Olivia's cast what is the start to finish process? I'm curious to know about a timeline on X-rays, sedations, and if the skin under the cast gets any breathing time. 

The cast change is a two day process (though this can vary based on your doctor). We will go in to have the cast cut off and they will look over her skin and whatnot. If they find a significant amount of irritation they will wait a few days until the next cast application, otherwise they will cast her the next day. 

They will x-ray when she is in each cast while she is sedated. 

At this point Dr. G came in and we got to meet him. Olivia surprisingly took to him very quickly even leaning against him to play peek-a-boo with one of the nurses. (She's such a flirt) I got to see her initial x-ray again (which I will include in a future post. I forgot to get a copy of it from radiology). Dr. G is measuring her curve at 41 degrees, which is 6 degrees more than originally determined by Dr. H. He also told us to expect the cast to be on at least a year. I was already expecting this however. From all I have read 6 months is rare. 

On a positive note he did feel that her rotation, especially for the curve that she has, wasn't too bad. He doesn't know for certain exactly what the rotation is, but he doesn't feel it's awful.  For those of you who are curious the rotation is a twist in basically the shifting of her ribs to accommodate the curve. 

I was also told by all three that I can email them at any time with any questions that I have and they will get back to me promptly. This is great! I prefer to communicate this way. When it's in writing I don't have to try and remember what was said. If there is a major problem with the cast (she's uncomfortable, she's destroyed it somehow, it's too tight etc) we are to let them know right away and they will see what they can do to remedy it. 

I can't say enough about the men and women that are caring for Olivia. Everyone we've encountered so far has been wonderful. They are patient, understanding and accommodating. It really helps make this whole process less stressful. You can tell that they enjoy what they do and care about the children they treat. It is really a comforting feeling to know that you're in good hands. 

We were done at 11, but didn't leave until 11:30 because I forgot the parking ticket in the car, so I had to schlep Olivia back to the garage, get the ticket, walk back to the hospital to get it validated and then walk back to the garage to pay it. Oh! AND I forgot what floor we parked on! GO ME! We did get out OK and we survived. 

Her casting is scheduled for 7:30 AM Monday morning. We need to be at the hospital by 6. It will be a long day seeing as I haven't seen 4 AM since those late night feedings, but we'll manage. 

Following our appointment we went to visit our dear friend Daniel. I will leave you with a couple of pics. Olivia will enjoy her last opportunity in a swimming pool tomorrow at her friend Ella's house, so I will be sure to take lots of pictures and post them here. 

Until then...

Wednesday, July 18, 2012

Water Play


Greetings and a Reminder:

I write this blog as we go through ET Mehta Casting with our daughter Olivia. The blog is intended to inform, possibly inspire, and raise awareness of Infantile Scoliosis and its treatment/cure. Please share our story. For more information please check out http://www.infantilescoliosis.org/ 

I just wanted to share some pictures of our time today in the splash area of our local zoo. Olivia wasn't a big fan of the water being thrown at her, but I wanted to put these here because I feel these are a great pre-cast memory. 







As "Casting Day" (a new National Bank Holiday maybe?) approaches I begin to have these "moments" (Wow! Ease up on the quotation marks Lady!....and the parentheses). Even though my husband and I have been working very hard at being as positive and optimistic as possible as we embark on this journey one can't help but have some moments of sadness at simple realizations. For as long as Olivia is in this cast I won't be able to rub her back...She won't be cuddly squishy....People are going to stare at her...

Of course I will still "rub her back" (there's those quotation marks again! Oh and parentheses!). I will continue without hesitation to squeeze and cuddle her. Yes, people are going to stare. People will ask questions. The Blue Hairs will not hesitate to comment on her cuteness and in the same sentence ask me if I how this handsome little boy broke his back (Sorry one more set of parentheses here. Olivia is constantly being mistaken for a boy. I know. I know.) Anyway, am I ready for all that? Almost. I think I'll be more ready when it is a reality. 

Want to know what I have done to prepare for the staring? Of course you do! I have made business cards! When people look at us, or approach us with questions, in addition to happily talking to them I will also hand them my card so that they can feel educated at their dinner tables when they talk to their loved ones about the little redhead they saw in the park wearing a cast on her torso. 


I am here to spread the word people! You can help too! Please, if you're reading and following then share! Share on your Twitter! Share on your Facebook! Share on your Pinterest! If you have a blog then share on there! I want as many people as possible to see this blog! If it is shared enough and spread out there then there's more of a chance that people who NEED this information will gain access to it. 

Those of you who have been reading so far, thank you. Thank you for your support, your encouragement, and your positive feedback. It has really touched me the number of people who have reached out, and have offered their help. At this time, the best way you can help is to spread the word. Again, thank you all. 

Olivia's pre-op is Friday. I will be sure to fill you all in on that. I'll leave you with a  couple of questions that I plan on asking the doctors:

1.) Olivia has fair skin. What can I do to best protect it from irritation? Will I be able to bring moleskin home?

2.) What are the pros and cons to having a shirt put on under the cast?

3.) When it comes time to change Olivia's cast what is the start to finish process? I'm curious to know about a timeline on X-rays, sedations, and if the skin under the cast gets any breathing time. 


Thursday, July 12, 2012

Some Factual Stats


Greetings and a Reminder:

I write this blog as we go through ET Mehta Casting with our daughter Olivia. The blog is intended to inform, possibly inspire, and raise awareness of Infantile Scoliosis and its treatment/cure. For more information please check out http://www.infantilescoliosis.org/ 

Yesterday was a fun, light hearted post. Today I'm going to get serious.....ha ha! Well, kind of!

No, seriously. ;-) This entry is to give you a little more concrete information on Infantile Scoliosis and some statistics. 

According to the Scoliosis Research Society (SRS) Infantile Scoliosis is 

"first diagnosed in a child between birth and 3 years old. Congenital scoliosis (malformed and/or connected vertebrae) is also diagnosed during this period. However, these curves are not included in the infantile idiopathic scoliosis category. Many infantile curves will resolve without treatment. Those that do not resolve can be difficult to manage. Your scoliosis specialist may suggest a magnetic resonance imaging (MRI) study to determine if there are any abnormalities of the spinal cord or spinal column. The study is more difficult in small children because sedation or even general anesthesia may be necessary to relax the child enough to obtain good images. Many infantile curves are left-sided curves in the thoracic (chest) area – in contrast to the right-sided curves more common in adolescents. It is more common in boys than girls. In some patients, there is an increased association with hip dysplasia, mental retardation, and congenital heart disease. Many other infants are healthy and normal and simply have a small curvature of the spine."

Olivia had an MRI done and happily it all came back clear. Here are some pics of her in recovery:


SRS continues by describing treatment. Why I feel this part is important is because the treatment for Infantile Scoliosis is not the same as treatment for adolescent scoliosis, because the body makeup is different at this age. 

"When scoliosis occurs at a very young age, there are several important implications for
management and treatment. For example, a 60o idiopathic curve (cause of scoliosis unknown) in a teenager is typically managed quite successfully with a posterior instrumented fusion. The same 60o curve in a 2-year old is managed very differently. The 2-year old needs many years to maximize their trunk height and lung size. A fusion in a young child would prevent further growth of the instrumented segment. Furthermore, depending on the type of instrumentation used, the anterior spine may continue to grow leading to 'crankshaft phenomenon'. In this situation, the scoliosis continues to progress despite the posterior fusion. For this reason, other treatments have been developed for the management of early onset scoliosis. These techniques take into account the growth of the spine as well as the growth of the rib cage and lungs. If implants are necessary, multiple expansions or lengthenings may be necessary (usually twice per year) to keep up with growth in the young spine."

Here are some additional facts from the Scoliosis Center of New York Presbyterian Hospital:


  • Most infants that develop abnormal curves do so in the first 6 months of life
  • Infantile scoliosis is a rare condition, accounting for less than 1% of all cases of idiopathic scoliosis
  • The condition is more common in Europe than in the U.S.
  • For unknown reasons, the curve in the spine tends to bend to the left in infants with scoliosis. However, girls who develop curves that bend to the right have a worse prognosis than other infants.
  • While there are several types of scoliosis for which the causes or origins of the disease are well understood, infantile scoliosis is considered idiopathic, which means the causes are, for the most part, unknown.
  • For reasons not yet understood, it has been found that children who develop scoliosis before the age of 5 are more likely to have cardiopulmonary abnormalities in infancy.
  • Infants with idiopathic scoliosis usually do not experience any pain from the condition.



Though this type of scoliosis is considered idiopathic there have been some hypotheses as to what causes it. The Scoliosis Center of New York says:

"There is evidence to suggest that intrauterine molding may be responsible for the development of infantile scoliosis. With intrauterine molding, the spine is affected during fetal growth because of abnormal pressures exerted by the walls of the uterus on one side of the fetus’ body, or abnormal positioning of the fetus within the uterus. This hypothesis is supported by epidemiological data, which demonstrate that there are higher rates of plagiocephaly (a slight flattening of one side of the head) and developmental dysplasia of the hip (a condition that affects one of the hips) on the same side as the spinal curve in infants with idiopathic scoliosis. A second theory suggests that postnatal external pressures are exerted on the spine after birth, perhaps due to an infant being positioned on his/her back for extended periods of time in the crib. This may explain the higher incidence of the condition in Europe, where infants have traditionally been positioned more on their backs and less on their abdomens, compared to in North America. However, a few years ago the American Academy of Pediatrics (AAP) announced a formal recommendation that newborns be positioned on their backs when sleeping, due to research studies suggesting that Sudden Infant Death Syndrome (SIDS) and other respiratory problems are associated with babies being positioned on their abdomens. Despite the possible relation of this recommended position to infantile scoliosis, our pediatric orthopaedic group supports the policy of the AAP. A final hypothesis for a possible cause of infantile scoliosis is that of genetic inheritance. While the exact genes that may be involved have yet to be identified, research has shown that there is a higher incidence of the condition within some families, lending considerable weight to the probability of a genetic component.

Despite the notable amount evidence for these hypotheses, much about the condition remains to be discovered and fully understood. As a result, there is ongoing research at a number of academic medical centers throughout the U.S., attempting to further uncover the keys to the development of infantile scoliosis and improve the treatment and prevention of the condition."

I have highlighted one of the hypotheses here, because if I were to pick one that would best fit Olivia that would be it. She had reflux in her first few months preventing us from having her on her back for extended periods. She slept on an incline. Then she was able to tolerate her back but HATED being placed on her stomach. Tummy time for her was like a chore. It would not surprise me if further research suggests that this hypothesis is true.



Well, there is your scoliosis lesson for this evening. If you "just can't get enough" in addition to citing the websites mentioned here I have also included an additional list of websites for you to peruse at your leisure. 

Resources:

Scoliosis Research Society. MedImagery.net. 2012. <http://www.srs.org/patient_and_family/scoliosis/idiopathic/infantile/index.htm>.

Division of Pediatric Orthopaedics. David P. Roye, Jr., M.D., Joshua E. Hyman, M.D., Francis Y. Lee, M.D., Michael G. Vitale, M.D., M.P.H.. 2012. Morgan Stanley Children's Hospital of New York.  <http://www.childrensorthopaedics.com/Scoliosis.htm#infantile>.

For Additional Information:

Parental Awareness


Greetings and a Reminder:

I write this blog as we go through ET Mehta Casting with our daughter Olivia. The blog is intended to inform, possibly inspire, and raise awareness of Infantile Scoliosis and its treatment/cure. For more information please check out http://www.infantilescoliosis.org/ 

    Just a quick post. I wanted to emphasize that Olivia's scoliosis was not originally detected by her pediatrician. It, like many of the other scoliosis stories I've been reading, was detected by us, her parents and grandparents. Please be aware that if you're reading this and have a little one at home checking their back periodically is not a bad idea. It was definitely something I never thought I would have to do or worry about. When we think of scoliosis we think of back checks from our school nurse or gym teachers. 

    Click here for an informative guide created by the Infantile Scoliosis Outreach Program for parents as well as pediatricians about simple ways to screen your little ones.  

Wednesday, July 11, 2012

Beach Day!

Greetings and a Reminder:


I write this blog as we go through ET Mehta Casting with our daughter Olivia. The blog is intended to inform, possibly inspire, and raise awareness of Infantile Scoliosis and its treatment/cure. For more information please check out http://www.infantilescoliosis.org/  


    The countdown is on! Olivia will receive her first cast in 12 days. My husband and I wanted to get one beach day in with O before the beach becomes a "no go zone" for who knows how long. We went to Oakland Beach in Warwick RI. We weren't looking for any bells and whistles. Just a small place with sand and water that we could take her that wasn't too far. This beach was about 45 minutes away, which was perfect. We have learned from our experience at the Children's Museum, and the beach that Olivia does not care for sand, so there will be no huge loss being banned from the beach for a while.

     I mean, really, there are many positives to be anti-beach thus far: she hates sand, and she's the color of powder. Clearly, the beach is not meant to be her friend at this time and it's OK. Of course the teacher in me has this fear that she will develop a sensory issue when it comes to sand due to lack of exposure. That, compounded with hearing Mommy saying in her panicky voice "She can't be near that sand!", and she will be on the road to Eremikophobia! (I am totally kidding here of course!...well...sort of...)

    Anyway, we still had a wonderful time! O loved sitting in her chair and having Daddy pour water on her. She screamed and squealed like it was Splash Mountain!




    She may not miss sand play, but she will definitely miss water play. It's so funny, I feel like once she has this cast on she's going to be like Elphaba (for you nonreaders/anti-musical folk she's the Wicked Witch of the West). Of course another way to look at is that she has become ssssoooo sweet with her cast on that we don't want her to melt!


    I read that a great way to "waterproof" the cast from leaks (be it drool, water, pee, etc...TMI?) is to line the cast in duct tape. Well, I got some fancy Hello Kitty duct tape today so we will be ready to go! I plan on covering it so it looks like one of those fancy duct tape crafts you see on the commercials! Here's a picture of the tape. Get ready to be wowed folks when I post the before and after pics of this cast! ;-)

Monday, July 9, 2012

Short Video

Greetings and a Reminder:

I write this blog as we go through ET Mehta Casting with our daughter Olivia. The blog is intended to inform, possibly inspire, and raise awareness of Infantile Scoliosis and its treatment/cure. For more information please check out http://www.infantilescoliosis.org/  

A quick video featuring Peter Gallagher. It has some great cast images in it.