Spring-Summer-Fall 2005
(March - November)
Lots has happened over the last 8 months! Joshua celebrated his first birthday on July 19. He's been growing by leaps and bounds, and is such a little angel!
A brief look back...
March: Not much new -- we managed to make it through RSV season unscathed, and with spring around the corner, things were looking up. We had a follow-up with the Pediatric Development Clinic, and Joshua was right on target (actually ahead in several categories) for his gestational age (the age he should have been had he been born on his due date).
April: Not too much new -- we had pictures made in April, and Joshua hammed it up for the camera. He discovered that he loves to eat, and added new foods to his diet on a very regular basis.
May: Mama was almost finished with school, so we all looked forward to having the summer to play! Mama celebrated her 30th birthday, and Joshua got one of his first bites of CAKE!!!
June: Joshua saw Dr. Mirenda at Roanoke Orthopedic for his foot. Found out that Mirenda would be leaving Roanoke in the fall, so he referred us up to UVA to Dr. Romness. While most people rave about Dr. Mirenda, I think we ended up with him during a bad period of his career in Roanoke, and I think that Joshua kind of "fell through the cracks" a little. At this point, we were actually happy to be getting to see a second doctor, because we were ready for a more aggressive approach to Joshua's care.
July: Joshua celebrated his first birthday! We had a small family gathering on his actual birthday, then a big party the following weekend. What a great time! Quite a few people were able to make it in for the party, and it was great to see everyone and to celebrate such a milestone. Joshua had his 1 year "well child check" and his doctor told us that he was on track with most babies his actual age (in other words, he was ahead for a baby of his gestational age). After such a rough start, that was such good news!
Fall: We took Joshua for what would be the first of quite a few visits to UVA to see Dr. Romness. We met with him for the first time, and left that day with Josh's leg in a cast up to his thigh. Dr. Romness felt the best way to treat his little foot was as if it were a positional club foot; the way they attempt to correct that is with casting. They straighten the foot with a cast, changing the cast once a week for 4 - 6 weeks, each time, straightening the foot a little further. Joshua cried the whole way home (not a fun 3 hour drive!), and cried until he couldn't cry any more, which was around 4:30 a.m.; he woke back up around 7:00 and started crying again. Things got a little better throughout the week; we finally found at the end of the week that his cast had rubbed a blister on his little foot, and his whole foot was sore. We took the cast off a couple of days early, relieved the pressure off the blister, and he was a new person. One thing I really liked about Dr. Romness was that he told us first thing that if anything seemed "wrong" about Josh's leg or foot in the cast, we should take it off -- he said that he trusts mother's intuition above all else. He took a very aggressive approach to Josh's foot, and I think it paid off. We went back to have the 3rd or 4th cast put on (we had been told it could take anywhere between 4 and 6 weeks to get any kind of results...we noticed measurable results even after the first week); Dr. Romness told us at that time to leave the last cast on for 2 weeks instead of 1, and once it came off to keep him in his brace 8-10 hours a day (while he was sleeping would be ideal), and he'd see us in a couple of months...he felt that Joshua's foot had straightened out significantly enough that we didn't need further casting. Dr. Romness also took a quick look at Josh's hand and seemed to think that we needed to see about getting his fingers separated as soon as possible, and referred us to Dr. Chhabra at UVA, who is their "go-to guy" for pediatric hand surgery. We already had an appointment scheduled with Dr. Hagan in Roanoke, but wanted to get Dr. Chhabra's opinion as well...our general experiences with the doctors at Roanoke Orthopedic has been that they take a "wait and see" approach, which might be entirely appropriate for an adult (give it time, then try therapy, and do surgery as a last resort), but with a baby, I feel like it's best to act early, particularly when it is something dealing with bone structure (because their bones aren't fully calcified, I think a more aggressive approach (i.e. the casting that Dr. Romness did) can help avoid the necessity for surgery because the shape and structure can be "trained" while the bones are still pliable). Anyway, I felt like getting 2 opinions on Josh's hand would be a good idea.
We saw Dr. Chhabra for the first time, and once again, I was impressed with the aggressiveness of the UVA doctors. Dr. Chhabra answered every question we had (and we had a whole typewritten page of questions), and then some, and we left that day with an appointment for Joshua to have the first of (at least) 2 surgeries to separate his fingers. We went ahead and kept the other appointment in Roanoke, figuring if both doctors said the same thing, we could look into doing the surgery in Roanoke (and canceling the one at UVA), but it was better to be on the schedule at UVA (easier to cancel than to schedule). Dr. Hagan was very nice, but took what I'm beginning to call the "Roanoke Orthopedic Wait-and-See" approach. He indicated that since Josh was doing OK without his fingers being separated, why bother separating them. He went so far as to say that he expected Dr. Chhabra to give the same opinion (we wanted a totally unbiased opinion, so we didn't tell him we'd already been to UVA) because he (and the other doctors at Roanoke Orthopedic) "trained Dr. Chhabra." He also indicated that surgically separating a child's fingers in a situation like this was really more for the parents than the child. To some extent, I can see his point; why put Josh through all that trauma if he's doing fine the way he is? However, I also keep asking myself, why NOT put him through the trauma if (1) he won't LOSE any of what he already has and (2) it gives him the chance to be much better than "fine"?? Chris and I talked it over a great deal; we sent Dr. Chhabra an email (which he replied to within an hour, which is pretty impressive considering that we sent it at 9:30 at night) asking him to clarify some of what he told us so that we could make an informed decision. We ended up making a follow-up appointment with Dr. Chhabra to discuss everything, and got all our questions answered. We decided to put the surgery off until after the first of the year (insurance purposes as much as anything else) -- the surgery is scheduled for January 19. We are going to separate his "index" finger first, to hopefully enable him to gain a little of the "pinching" fine motor skills. He is right-handed, so we also feel like it will make it easier for him to write, type, eat, hold things, etc. if we release the index finger first. After that surgery, we'll decide if we think he got enough benefit from it to go ahead with a second surgery to separate out the other two fingers -- that's just going to be a wait-and-see kind of thing. Even if we do separate out all his fingers, the entire process should be finished within 6 months. There's always the chance of what's called "residual webbing" which would require minor follow-up surgeries to remove scar tissue build-up that would "web" his fingers, but the major time-intensive, labor-intensive, rehab-intensive surgical procedures will be over within about 6 months.
November: We had Joshua baptized at Our Lady of Nazareth Catholic Church on Sunday, November 6. We did a private baptism so that Josh wouldn't be exposed to such a large crowd (we were denied the Synagis shots this year, so we're trying to be careful about where we take him during RSV season since he's still at an elevated risk). It was a nice ceremony -- not too formal, but fairly traditional and simple. My cousin, Amy Vest, is his godmother. We followed that with a reception at the house -- got to see even more people who we haven't seen in awhile (it worked out that many of the people who were unable to come to Josh's birthday were able to come to the baptism, and vice versa).
That's about it for the moment -- since it's been so long since I updated, I just put the bare-bones "short" version up...just to give a general idea of what we've been doing for the past 8 months. I'll try to be better about updates; particularly once Joshua has his surgery.
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