Violet had a very full day at Cleft Clinic today. We saw Dr. Singhal (plastic surgeon), the Speech therapist, Audiologist, Social Worker, Dentist, Nutritionist, Radiologist, and Geneticist (Whew!). Some of the highlights (and lowlights, I guess. But mostly highlights, thankfully!) of the day:
-- Dr. Singhal: Violet indeed does have a fistula (aka hole or crack) between her newly-created hard & soft palates. [In the sketch below, the fistula is the vertical dotted line, the arch at the top is the gums and the u-shape at the bottom is the uvula.] I think he was disappointed, but not totally surprised at this development, given the difficulty of her palate repair. He will plan on repairing this fistula at the end of March using a "Z-plasty" method. He said this provides a sort of 'double-breasting' of the palate, which will be more resistant to opening again in the future. This can also help with speech as she develops. Finally, Dr. Singhal requested that she have an x-ray of her jaw done, just to ensure the distraction still looks good after a year, and it did.

-- Dentist: The enamel on Violet's teeth looks fine. I was a bit worried about this, as Calvin's first 4 teeth came in with no enamel on them, and Violet's teeth looked a bit familiar in this respect. The negative aspect of the dental visit was when she revealed that Violet has an underbite. This is a bit ironic, seeing how we worked so hard to bring her jaw out those first 2 months of her life! Oh, well, I guess it's nothing braces can't fix someday. . . Check out my baby in that HUGE dentists' chair!


-- Nutrition: Violet is wieghing in at 19 lbs, 4 oz and measuring 2'4". She is continuing to gain weight (10 grams a day is their goal, and she is meeting that just fine) without the use of her g-tube. I am SO excited about this and can't wait to yank that thing right out of her tummy! They said typically the tube is left in for 6 months of "inactivity" before it it removed, just to be safe. Maybe she'll be looking fine in her bikini this summer after all!
-- Audiology: The majority of our day was spent with the audiologist. We started the morning with another behavioral hearing screen, which Violet totally mocked. I'm pretty sure we won't try another one of these, as she is completely and utterly bored with them and barely participates at all. The results were "unreliable" . . . clearly. They said we really should do another ABR with her (this is the one she passed when she was 2 months old), and if she needs hearing aids, this will determine what settings they would use. Unfortunately, the ABR requires her to be sedated, so we will likely do this with the palate surgery in March. The audiologist told us about a new test (just came out in the last 3 months called Vivosonic) that is being called an "awake ABR" that takes an average of the brain waves to determine if the child can hear in the mid-frequency tones, which includes the typical speech sounds. We had made an appointment to have this done in a couple of weeks, and then it turned out that they had the room available today! The best news of the day is that she is hearing just fine in this range, even down to 20 decibels (whisper volume). So, why she doesn't always respond to sounds is a bit of a mystery yet. . . selective hearing already, perhaps?
She was so good for the hour-long test, perhaps due to the banana that she was chomping on?

This was really quite the hook-up! The machine on her back was blue-tooth connected to the computer, so she could technically wander around the room if she wanted to. Really the only requirement is that she didn't touch any of the contraptions on her head. The audiologist was surprised that she wasn't bothered by it. I wasn't, though; wearing headbands all her life only prepares her for these things, ya know?!?

We left the Cleft Clinic at downtown Mercy and headed to Children's Mercy South to meet with the PT/Orthotist regarding possible orthotics for Violet's feet. I was also very happy with how this appointment went. The PT wasn't all that concerned about Violet's feet. Yes, they are flat, and yes, they turn in, but for the most part, Violet is doing all the things she should be doing to ultimately be an upright human. She was fitted for some shoe inserts called PollyWogs that have heel & arch support. Hopefully, these will give Violet the solid base she needs to take those first steps.
All-in-all, I was very pleased with all of the appointments today. It's really amazing that we could see so many disciplines in one day (and for only one co-pay!). Violet continues to brighten the day of everyone who sees her, and I can't wait to see what progress she has made before her next visit to Cleft Clinic! I just know that our Super-Vi is going to have a super year of progress and milestones!