Appointment with the Plastic Surgeon

It's been over four and a half years since we've seen Rachel's plastic surgeon. The last time we saw him was at Rachel's post op appointment following her palate repair in November 2005.The plastic surgeon that we've seen the last few years at our annual craniofacial appointments has been one of the other plastic surgeons.

For years, we've been saying Rachel's next major surgery will be when she's between the ages of six and eight years old for a bone graft to repair the cleft in her alveolar ridge. And well, we're at that point of officially discussing the next surgical phase of this journey. Rachel will be six years old at the end of the month.

After talking about the affects of her cleft gum on her speech with Dr. D'Antonio, and another concern we have in regards to her nose, we made an appointment and this afternoon, was our appointment.

Because we keep in contact with Joy, Aiden's Mommy, who also has the same doctors as Rachel, we anticipated a very long wait in the waiting room. Joy has waited for appointments for up to three hours just in the waiting room, not even being placed into an exam room, well after the business day hours have come to a close. Therefore we came well equipped - the laptop, our iPad, snacks, and Rachel's homework! It worked out perfectly and helped pass the time now that WiFi is offered within the clinics. I was entertained on the laptop, while Steven and Rachel watched a movie on the iPad. The almost 2 hours of waiting in the waiting room, waiting to be placed in an exam room were almost bearable thanks to the diversion of modern day technology!

There were four things we had on our list to discuss with Dr. Martin.

1) For months we've noticed this odor. For the longest time, we thought it was Rachel's hands and the constant putting of them in her mouth, dried saliva, etc. But the smell was noticeable even after her baths and being clean, etc. Steven came to the conclusion in the recent mont or two that the smell was coming from her nose. She has an extra flap of skin in one of her nostrils, so who knows what could be going on in there.

Dr Martin thought it could be a number of things.

Cleft children sometimes will have extra teeth up in their gums, going undetected, hard to brush, etc, therefore will decay, rot, and smell.

But after looking at Rachel's nose and seeing the flap of skin in her one nostril, he thought it was highly possible for stuff to just collect there and that's what could be smelling.

2) The bone graft to the aveolar ridge. We've always been told this happens when her permanent teeth start to appear, etc. We've also been told recently that Dr. Martin is doing this type of surgery earlier. And after talking to him, he thinks Rachel is a great candidate for having a bone graft surgery to her alveolar ridge now.

3) The relationship between her upper jaw and her lower jaw is affecting her speech in some areas of pronunciation and articulation and we were wondering if at what point that might be fixed. Because the face doesn't fully stop growing in girls until they are 16-17 years of age, there will be no work done on moving her jaw until then. Dr. Martin thinks her disproportion is minimal and we can wait until she's in her late teens to fix that. We will need to just follow up year year and monitor her growth, etc.

4) Nasal touch up, aka, nose job. Some people don't notice Rachel's lopsided, flat on one side nose. It's not all that noticeable to those she is frequent contact with. It's part of her. It's part of what makes her so cute, in my loving mother's opinion. But the harsh reality is, her nose is lopsided and flat and needs a lift.

When we brought this to the attention of the plastic surgeon at our annual craniofacial team appointment in January, the plastic surgeon we saw had a differing opinion on doing a nose job now. She thought it best to wait.

Dr. Martin's idea is different. His view is that Rachel is at an age where socially, she could start to be made fun of, etc. And thus, he agreed, that a nose lift is in order.So what does this all mean??

It means that we most definitely are at the next phase of Rachel's journey.

Dr. Martin will do a nose job (lift it and make it perky), and he will repair the cleft in her alveolar ridge. He will fix that cleft in her gum by taking a piece of the soft tissue in her hip bone and implanting it into her alveolar ridge. After agreeing that this is the step we want to take, we were directed to the surgery schedulers office and we scheduled surgery!

Rachel will be admitted and have her surgery on Wednesday, November 17th. She will need to stay one night in the hospital, assuming there are no complications, etc.

We scheduled it on this date, as the girls will be on Thanksgiving break and will be out of school for two weeks. Dr Martin says Rachel will be just fine to return to school the week following Thanksgiving assuming she's feeling good, etc.

It feels good to know what's next. Feels good to know we'll be getting it done sooner than later. And yet, it feels like "here we go".

What about all the unknowns-like how will she react to being in the hospital? How will she do recovery wise? Pain tolerance wise? What will her nose look like??

Rachel was just 15 months old the last time she had major surgery. She was just a baby. She's a little person now. How will she take all this?

Two things are for sure: I know we don't have to worry. I have faith in our Lord that He'll carry Rachel, and us, through all of it. We have our loving family and friends and church family who will be praying for her and her doctors, and secondly, that little girl will probably get lots of lovin' from all the above during those couple of weeks of recovery!