Tuesday, May 26, 2009

Preliminary ophthalmology results

The past few days were really good for Ava and the Lopez family. I had not mentioned everything over the past few days so let’s catch-up a little.

We have discussed Ava’s eyes and not being sure whether or not she is focusing on/tracking objects that are in her field of view. Given her occipital injury (the posterior part of the brain that is responsible for vision) this was a big question mark. That her eyes didn’t seem to be fixing on anything made it an even bigger question mark.

Ava had an ophthalmology exam last week (by the way, one of the questions on my ophthalmology rotation exam in medical school was “How do you spell Ophthalmology?” I'm telling you, med school was tough! It is O…P…H…T…H… In case you were interested). So at any rate the result of the exam was that she had no retinal or optic nerve atrophy. This was very reassuring because it gives her a good opportunity to rewire areas of her brain that may not be able to see. Everyone has a small blind spot on each retina. We never see it because the brain fills in the area with what our brain thinks should be there, the background pattern. The thought with Ava right now is that she has some blind spots and she is changing her direction of focus to try to see around the visual deficits that she currently has. As you can imagine this can be quite difficult. Your central area of vision is responsible for almost all of your visual acuity. Try looking at this “X” but read the words just two or three lines away from it. It is nearly impossible. Your central vision is critical, especially in a child that has all of her education ahead of her. Fortunately, she is young and her brain has a chance rewire and fix itself, better than ours would.

All in all, the ophthalmology appointment was reassuring. Ava still has a good chance of recovering what visual deficits that she has now. Weeks 4-6 after the injury tend to be the critical times for such recovery/injury. Last week was week 4. She will have another Ophthalmology exam this week and again next. This will give us more information.One of the more incredible developments has been the rapid improvement in muscle control of her head and neck. One week ago she had essentially no muscular neck tone. Today she went through a one hour long Physical Therapy session without needing any head or neck support. This is great for her and those caring for her and is one more box to check on her road to recovery.
Another box to check on our list is “eating.” Ava passed her swallow study earlier today. Yeah!!! Manny tells me that she went to town chowing on some pears, applesauce, mashed potatoes, peas and green beans earlier today. You would think that this girl hasn’t eaten in a month, the way she munched on those pears. Like Manny’s nose wouldn’t be enough to hold over the hungriest of babies. All kidding aside, I can only imagine how succulent pears would taste after not having eaten in a month.

She still has the feeding tube (which was switched to her left nostril to try to encourage her to grasp at it with her left hand) which will stay in place for the next several days to ensure that she will continue to tolerate solid foods well. She still has some difficulty swallowing thin liquids but this should improve as her tone increases.

So what is left?

Ava still has very little body tone and cannot sit up on her own, but 4 weeks ago she couldn’t breathe on her own. Three weeks ago she couldn’t move. Two weeks ago she couldn’t speak. One week ago she couldn’t hold her head up. Just imagine what amazing things she will be doing a month from now.

Please keep up the prayers and the Lopez encouragement. You all are doing a phenomenal job of helping this little girl recover.

Beatrice, your baby misses you… and so does Ava.

Ava, the party waits for you.fw.Tomorrow, I have a special favor to ask.

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