semiannual trip to mito doc

This past week we made our semiannual Boston trip to see the mito doctor.  We first had an appointment with a physiatrist.  We weren't sure what to expect, and at first thought the appointment might not have been very helpful, but boy were we wrong.  The Dr. spent nearly two hours with us.  Eve was excellent and calmed down very quickly while we talked.  She even let him examine her and laughed when he joked with her.  We talked about the Baclofen she is taking for her legs.  He said that usually muscle spasms don't wake up a child, but that something else does and then the legs spasm.  However, because the Baclofen stopped her nightly wakings immediately, I suppose he agrees it is helping.  He was not at all concerned about her range of motion yet (unlike the previous physiatrist we saw who wanted Eve to immediately have leg immobilizers for nighttime to prevent contractures).  He said she looks great.  He also said that as long as she goes through the full range of motions with her muscles/limbs twice a day (which she probably does with her spastic movements throughout the say), she should be fine.

He did recommend a brace called a swash (standing, walking, and sitting hip orthosis).   When we hold her up and ask her to "walk" or stand, she crosses her feet at the ankles.  This can be bad for her hips (which are already slightly out of socket).  The swash brace keeps her feet/legs from scissoring, and will be great for her hip development.  He said that if we get a rolling stool (like in many doctor's offices), and we hold her up to "walk" in the brace for 5 minutes 2-3 times per day, that it would be awesome for her hips.  He said it would be better for her than the stander.  Although it could be worn when she sits, she wouldn't need it then because she doesn't cross her legs when sitting.  The doc called down to the equipment clinic and had a brace brought up for us to try out.  Eve loved it and it totally helped keep her feet from crossing.  So, he wrote a Rx for it and I can get Eve measured at an orthotics provider closer to home.  Here are some pictures of Eve in the trial brace:

Here she is getting fitted

We also talked about her digestive health.  He recommended increasing fiber to help move stool along her bowels.  As a muscle, her colon is affected by her disease and is slower than that of a typical child.  We also talked about how to get her on a BM schedule so that she could go in the evening (rather than in her diaper in public whenever the urge strikes).  Finally, he gave us his home email address in case we had any questions that needed a quick response or just wanted to consult with him rather than driving to Boston.  It was an amazingly helpful appointment.  Unbelievable, really.  Fantastic doctor.

We then had our appointment with the mito doc.  The previous doctor we had been seeing left the practice, and now it's just Dr. K.  He is pretty well known in the mito world, so we were pleased to see him.  He spent a long time with us and asked lots of questions.  I learned about Eve's heat sensitivity.  Because she really doesn't sweat much, heat can be a major issue for her.  He said it's best to cool her down with water (internally as well as externally) and it's bad news if she gets all pale.  We told him about her eyesight change and I mentioned how her eyes are always dilated.  He said that's because her autonomic nervous system is affected by the mito (e.g.,  the insufficient sweating).  We asked him if we needed to see him every 6 months, or could stretch it out because it's such a massively stressful trip to Boston.  He recommended we make an appt for 6 months from now and if when that time rolls around we feel we don't need it, we can cancel it.  However, he does want to see Eve every 12 months.  He said that his job is to monitor her and ask questions that other specialists might not be asking.  He is recommending further genetic testing to hopefully isolate the location of the mutation.  This would help to get Eve included in clinical trials and tell us if her mito disfuntion is primary or secondary to another disease.

One thing that concerns me is that doesn't seem to be growing much.  Her weight is still 35.5lbs and she is still 39 inches long.  However, she doesn't appear malnourished.  And, actually, the smaller she is the better as long as she is still healthy.  It makes it easier to care for her.  Dr. K should send a letter in the next few weeks detailing the appointment and I will post anything I've forgotten. 

In other news, Eve's dentist appointment is Tuesday morning.  We are also having a portable lift delivered on Wednesday.  That will lift her from bed to chair or chair to floor, etc.  This is so important since I only have 4 weeks until delivery of the new baby and it's getting really hard for me to care for Eve.  After the c-section it will be impossible to lift her for quite a while.  The lift will be vital. 

I'll update this week on the dentist appt and the lift.