The Doctor Over the Mountains

Yesterday Zoe and I took a day trip over the mountains to see the Director of Craniofacial Surgery at the Children's Hospital and talk about her future surgical needs and ongoing care. We've been waiting all summer to do this and finally the day was here.

I obviously wasn't thinking when I booked the appointment for 9am. Children's Hospital is in downtown L.A. which means battling the morning rush hour traffic and a pre-dawn wake up call for us. So around 5:45 a.m. I crammed a still sleeping Zoe into jeans and a tee-shirt and poured her into her carseat. She woke up with the sun rising over the mountains and glaring into her eyes. To escape it she put her woobie over her head and soon dozed off again, missing the bulk of the stop and go morning traffic.

It took us three hours to get there but we made it on time only to wait in the waiting room for over an hour. The Children's Hospital is a lovely place though and each waiting room has its own theme and play equipment. We were in the underwater room which had a huge fish tank and a play house shaped to look like a sandcastle, so Zoe was kept very occupied.

The doctor we were seeing is a very sought after surgeon with a clinic day only once a week and judging from the patients waiting to see him, he specializes in the most complex craniofacial cases. It was heartwrenching to see the babies, toddlers, kids and teenagers in the various stages of a myriad of different craniofacial disorders and the parents who care for them. The doctor is well known for his work with children diagnosed with craniosyntosis, or skull deformities, so there were many babies there who had just had or were about to undergo skull surgeries.

We brought with us our medical records from Dr. Noonan and in the waiting room I read through all his notes, reliving the conversations, advice and procedures discussed in the first weeks of Zoe's life. I enjoyed the last entries where Dr. Noonan would effusively describe his joy at her results "Actually looks spectacular" and "Amazing results" were some of his words. He always beamed with pride when he looked at Zoe in her surgical follow up visits. I remember he was especially proud of her nose.

The new Dr. agreed that she did have great surgical results, a "cute little girl" he said in his note recorder, although he said he saw a few things he would want to fix. The puffiness on the afflicted side of her lip, "extra vermillion" is what he called it, he said he would reduce and move over so that the "tip" of her lip is in the center. He saw no need for any additional nose surgeries yet and agreed it looked great.

He also felt that the gap in her aveolar ridge was "significant" enough to possibly effect her speech and, if that was the case, he may recommend surgery to attach it. This proposed surgery would bring together the soft tissue to prevent air escaping through the gap when she spoke (but she would loose the tooth that's growing in the gap). The bone grafting aveolar ridge surgery would still not be scheduled until her adult incisors come in (around 9 or 10 years old) and he is a proponent of a new procedure that injects hormones to grow bone rather than taking a piece from the hip.

Although the Children's Hospital has a 25 person Craniofacial team, he didn't see a reason for us to see them all as most of them would not be relevant to us. He only recommends we have regular visits with a pediatric dentist in our hometown (which we already do). He did want us to see his Speech Pathologist right away to determine the clarity of Zoe's speech. That meant another hour in the waiting room. We finally met with her but she was unable to determine where the air was coming from in Zoe's speech, she did hear air, but didn't think it was coming from her gum line. Zoe refused to open her mouth for her and let her look. So she asked us to come back for a full Speech Pathology analysis in six months.

The doctor wants to see Zoe again in one year and would not recommend another surgery until the summer of 2011, when she is almost five. He wants to see how she grows and thinks some of the extra tissue on her lip will correct itself. Scar tissue grows less rapidly than normal tissue, so having a little bit extra right there may be a good thing.

The only question that remains is this: is this the right care for Zoe? I agonized over choosing her first plastic surgeon, looked at all the celebrity plastic surgeons in New York and finally chose Dr. Noonan because he came highly recommended, he was so sweet and he called me back and had long reassuring phone conversations with me when I was freaking out.

This new guy is in the forefront of craniofacial surgery, leading his field in skull and jaw reconstructions. His patients have severe deformities and he is supposedly amazing BUT, is Zoe's little cleft the right case for him? He spends so much of his time on such complicated surgeries, and putting everything in the right place, is the detail work Zoe needs really his skill?

The good news is we have a couple of years to figure it all out.