A day with the doctors

This morning, Andrew, Ryan, and I headed to SLC for appointments.

Ryan had spina bifida clinic. Basically all the specialists he needs to see come to him during a couple hours in the morning.

Orthopedist: Ryan looks great. He has a few minor issues -- twisted calves, in-toed (related), minor weakness. Very impressed with Ryan's activity level. Would like us to keep up the walking and try to encourage Ryan to walk more legs of the treks. Feels Ryan's hunched shoulders is not a concern as spine looks good and has excellent use of his shoulders. But will watch it.

PT: Ryan has lower muscle tone than a non-SB 3 year old in his lower body (has since birth). But is extremely pleased with Ryan's capabilities. Would like Ryan to be enrolled in gymnastics and tumbling as part of his therapy routine (keep up park visits, playing on playyard at home, stairs, and walking around town as well as shoes outside to help with stability). Feels that gymnastics would even greater increase in Ryan's strength and as will help coordination issues with his lower legs. As Ryan ages, would like him to be involved with soccer and other sports for same reasons as gymnastics. But feels gymnastics will provide the biggest advantages. Said that very few SB kids are able to do these things and Ryan should benefit from the opportunities.

Urology: Ryan will need another CMG and renal ultrasound before next clinic visit in 12 months. Ryan needs to be potty trained asap to help evaluate leakage. Must start keeping a log of potty activities and frequency especially accidents.

Neurosurgery: Start keeping a journal of Ryan's stops during walks and play. Check to make sure it isn't pain in his back. BIGGEST concern right now. Ryan could be stopping due to tethered cord pain and not just to catch his breath. If Ryan has a lot of leakage, a lot of back pain, etc, may need MRI and possibly surgery this year. But as he is so small, preference is to keep journal and put off for at least 1 more year, the hope was until he turns 5.

Head of SB Clinic: Need to attend skill building class for potty training. Need to keep potty record to bring to class. Will help evaluate his condition better, determine need for MRI, etc, once he's potty trained.

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Andrew saw the dermatologist regarding his nevus sebaceous -- birth mark made up of oil glands. Will get bigger, but not more than double in size. At puberty will become pussy, pimply, rigid, raised, and generally gross. Lots of parents wait until then to remove it when it becomes so noticeable. As the kids can do it with local anesthesia and at the clinic. His long hair is protecting it. Though in the summer the buzz cut (to keep him cool), the sunblock, etc make it irritated and icky. New study shows that the cancer risk is very small.

I want it gone, it will be one less thing to have to take special care of. The scar may spread a little, but if that thing doubles and then has to be removed because its causing pain and discomfort it will be an even bigger scar. Mark thinks we should wait and watch it. We'll see if the pre-authorization comes in from the insurance. It would be a Friday morning, under general anesthesia, and then he goes home around lunch time.