Wednesday, October 29, 2008

Reactive vs. Proactive Medicine

Pictures first and then if you want to read about how his appointment went and my little rant on the standard care of medicine you can continue. If not, then enjoy the pics. :)

Close-up 4 weeks post op. Gotta love the drool. Like a 24/7 faucet that we can't turn off.

Notice the different sizes in his nostril. Is that normal? Who knows. The scar looks great but is starting to get more pink and noticable to me.
Non cleft note - Aiden is enjoying his first big boy bath. Up until now we had been bathing him in the sink still. He LOVES the bath and all the room he has to splash around. He even attempted to crawl around in the water and wanted to float on his tummy. Alexis helped me wash his hair. She is such a little mommy at times and can be very helpful.
*Warning here starts the update from his appointment and my rant*

Ok, so I am slowly learning that Aiden's PS is a reactive kind of doctor, whereas his peditrician is proactive. At his post op appointment yesterday we talked about his adversion (by adversion I mean that he NEVER lets me put it in there and when I try to he throws himself backwards, arches his back and screams) to having the nipple put in his mouth. I told him that we had talked to Aiden's peditrician and that she has arranged for an OT consultation so we don't have any long term feeding/speech issues. He said he didn't feel that was neccessary and that if it were up to him he would just wait longer until it became an issue. Then when asked about the scar and how we should take care of it he said that he would just leave it alone and only if the scar starts 'roping' or pulling then he would recommend massage. Some PS have their patients start massaging once it is healed to prevent roping and pulling instead of waiting for the problem to start and then having to work harder to fix it. I think it would be easier to deal with it all before it is a real problem (proactive) then to wait and then have to work harder to undo what has already happened (reactive). Sometimes I wonder if he doesn't want to do anything because that then means another surgery for him to 'fix' it cosmetically. (sorry for being pessimistic, just frustrated).

As far as the stitches that are still hanging in his palate - he isn't going to do anything about them (shocker - NOT). The stitches that are hanging from his nose, making him look like he has black/purple nose hairs - he will clip them at his next appointment in two weeks if they are still there.

I love his pediatrician for lots of reasons, but her proactive medicine is one of the things that draws me to her. She has been on the ball with getting him the care he needs and making sure he doesn't fall behind. She is the one that saved Andrew's life when he was little, litterally. Andrew's previous pediatrician kept treating Andrew for a cold and told us to not worry about it, even though this type of practicing medicine ended us up in the ER multiple times for breathing treatments and even a hosptial stay for RSV. She never wanted to get to the bottom of what was causing his breathing issues and just blamed it on a cold. One constant cold that lasted 2 1/2 years!! Mailander (the current pediatrician) recommended allergy testing on our first visit and life as we knew it changed from that moment on. We eliminated the things he is allergic to, wheat, soy, cats, and other environment things and started him on maintenance medicine. We have been able to control his asthma issues and have not ended up back in the hospital. Why not take care of business before it becomes an emergency?

Can proactive medicine go overboard? YES! Don't even get me started on the whole unnecessary c-section rate in our country and the way the OB world treats pregnancy as if it is an illness and something they need to cure us of. But, at times it is necessary to treat first and then ask questions second instead of waiting around for there to be further complications.

So, that is the low down on his appointment yesterday, plus a little rant from me about the practice of medicine as we know it. He did very well and even smiled for some post op pictures that Dr. Martin took. And, we didn't have to wait the usual hour wait. They got us in within 10 mins and we were out of there by 3:00 when we had a 2:30 appointment!!! Trust me, THAT is amazing!
Question of the day: (got this idea from Heather and love it!)
Do you prefer proactive or reactive medicine? Have you ever had a negative experience with one or the other? And, for my cleft mommies: How do you feel about lip massage to prevent tugging/pulling up of the lip and roping of the scar?? Leave me a comment and let me know.


  1. First thing, yes, the variance in size of the nostrils is completely normal. Take a look at Abby's.

    Second thing, lip massage, I say go for it. Our PS prefers the silicone taping, which didn't work for us, and I always wonder how Abby's scar might differ if we had massaged. Also, this is about the time Abby's scar started to tighten and pull up, but over time it has relaxed. Every kiddo heals differently, so I say try everything you feel necessary.

    BTW, his scar is looking amazing! Such a cutie!

  2. I feel like our plastic surgeon is leaning on the reactive side now, which I didn't think before. Like Allison said, our hospital prefers the silicone. They say it's better than massage/Vitamin E. But I couldn't really get the silicone to work, so I didn't end up doing anything. Well, now Aidan's scar is totally roping and pulling his lip up (much more than the PS would've liked), and NOW he's saying to massage! Well, should I have been doing that from the beginning? I thought you said it didn't work!! Ugh. I don't know what to tell you. I say, do the massage. Right now, we're using a medicated tape with steroids (can't remember the name - Caldran or something?), and that's supposed to help. But when Aidan's asleep and I can, I'm massaging it. I hope it relaxes someday soon.

    As far as his nostrils, Aidan's are very uneven right now. And he had the nose stents! Grrr. Oh well. At least from front appearances, he looks good. And it's funny but his "normal" nostril looks like the bad one, because it's so much bigger than the other!