hips and rhinos and spines, oh my!

suffice it to say, we are becoming quite well acquainted with the orthopedic department at Children's! at Greta's well visit last month, our pediatrician found a subtle but noticeable asymmetry during the forward bend test to check her spine. she reassured us that it could just be the result of muscle tightness or a slight shift in position, but ordered a spine x-ray series to check for scoliosis. a few days later, we went to the satellite outpatient Children's center for the x-rays (as well as a screening cholesterol panel which is apparently routine now to check at age 9? who knew!). after the x-rays were done, the radiology tech showed us the images on her screen. we both laughed at how our eyes immediately picked out the stud earrings in her ears :) but then, turning our attention to the spine, we could also see a very slight C curve in the thoracic spine between the shoulder blades. on the formal radiologist report, the curve was measured at 10 degrees, which is just at the cutoff for when orthopedic consultation is recommended (although generally no specific treatment, like physical therapy or bracing, is recommended unless the curve is more than 20 degrees, and surgery would typically only be done for a curve greater than 40 or 50 degrees). 

I like Victoria's orthopedist so much that I called to schedule Greta's evaluation with him, only to be told that any cases of scoliosis need to be evaluated by one of the spine specialists. this makes perfect sense, especially when the scheduler told me that the spine clinic at Children's consists of a whole team of physicians, nurse educators and physical therapists, as well as access to low-radiation x-rays. 

apart from her initial consultation at the main Children's hospital, all of Victoria's follow-up appointments have been at the outpatient satellite office, but the spine specialists only see patients at the main Children's location. when Greta and I walked through the doors of the ortho clinic, it was like re-living that July appointment when two-week-old Victoria was diagnosed with a dislocated left hip from hip dysplasia. that was only two months ago but in some ways it feels like a lifetime! 

fortunately, Greta's appointment had a much happier outcome. the doctor examined her briefly and then explained that on his own read of her films, the thoracic curve is still within the range where it may straighten on its own as she grows. he said, "I see so many cases like this and I like to compare them to acorns. most acorns get eaten by squirrels and nothing ever happens. occasionally, an acorn does grow into an oak tree though, so we do want to keep an eye on it." he said she has no limitations and he wouldn't even diagnose her with scoliosis at this point. he'll see her back in a year with repeat x-rays! 

striking a pose before we headed back to school! 

Victoria also had a good report at her last ortho appointment two weeks ago. after wearing the Pavlik harness around the clock for 7 weeks, she had an ultrasound done first in the harness, and then out of it. when the tech asked me to remove the harness, I didn't know which strap to undo first! the first glimpse of her tiny toes almost brought tears to my eyes. then, I wanted to cry again seeing how her lower legs were misshapen and her right foot was hyperflexed from the pressure of the leg straps. her poor skin was so dry and flaky, too. 

waiting for the radiologist to come in and finish scanning her -- they had a really hard time getting a good picture of the left hip. her poor little legs reminded me of squished playdough. I kept massaging them. 

finally done with the ultrasound, and waiting for the doctor!

it was all worth it when we got into the ortho room after the ultrasound was done and he gave us the good news: her left hip angle has improved to the normal range! the right hip is still considered immature, but the doctor was very pleased with her progress. he said she's done with the Pavlik and will transition to a rigid abduction rhino brace that comes off for diaper changes and car rides. they asked me if I wanted to keep the Pavlik and I said "absolutely not" and tossed it in the trash. :) it was so stained and stinky from almost two months' worth of spit up and diaper blowouts. I immediately checked in all of her little leg folds and creases and the spot where the chest strap had encircled her trunk, and was so relieved not to find any skin breakdown or yeast! 

of course I forgot to bring socks for her after having the built in "socks" in the harness. fortunately it was a gorgeous 75 degree day so she didn't really need them!

when we got home, I finally gave her her very first bath! her umbilical cord stump was still attached when we went to the first ortho visit, and then the harness had been on ever since. she immediately loved it, smiling and cooing right away. she even started kicking and splashing a bit by the end. and I just can't describe how wonderful it was to feel her soft little body snuggled up in the towel afterwards. 

the next few days were a rough transition to the rhino brace, however. she couldn't get comfortable lying down and even when I held her, she would startle every few minutes and start crying. eventually I figured out that I could wear her in the Ergo (another first, since the bottom of the Ergo put pressure on the harness straps) and she finally took a good nap. after researching more, I did give her some Tylenol and then set up her bed as recommended by the ortho clinic, although it petrified me from a safe sleep perspective: a pillow under her upper back and head to elevate her and take pressure off where the brace dug into her low back, and a Boppy pillow turned so the arms of the pillow were under her feet and the brace could rest into the hollow. amazingly, she slept all night with this setup (and was still breathing every time I checked on her!).

a short-lived moment of happiness that first day. she can still fit in the mamaroo and bouncer with blankets rolled up to make the seat more shallow (and I do buckle her in!). 

the next day she was still pretty fussy in the brace, and we did let her stay out of it for a few hours that evening while Kim babysat for us to go out for my birthday dinner. knowing that I'd be starting back to work at the end of the month, I panicked about how daycare was going to manage her if she couldn't be laid down comfortably somewhere. but over the next few days, the foam padding in the brace softened up and started to mold to her body more, and I think she also just got used to it. the brace doesn't seem to bother her at all anymore -- and she can finally wear pants and sleepers again! she now sleeps comfortably with just a regular pillow at the end of the bed to support her feet, and nothing under her head, thank goodness.

after a week in the brace, her legs can rest at a more comfortable angle

she goes back for another ortho appointment on October 12, and she'll have x-rays done instead of an ultrasound at that visit since her bones will have ossified more. my impression is that she'll wear the rhino brace for at least another few months. I hope that she's completely finished with treatment before she remembers anything about it!