Post Op Update

Wow, what a whirlwind the last 7 days have been! Annelisa is doing beautifully post eye muscle surgery! Dr. Stager, Jr. was thrilled this morning with her progress since surgery, last Wednesday. Her eyes are doing everything he could hope them to be doing. He is a man of few words, so when he excitedly began to tell me about his observations today, I knew that everything I had been observing was on target and that God was answering all of our prayers in a BIG way!

His goal in surgery was to correct both eye muscles to the "ball park" of straight with hopes and research pointing to her brain taking over and treating her eyes like a magnet and pulling them to straight. Thus helping her vision development over time to be binocular and appropriate. As of today that is happening! Praise God!

As a mom, I've been thrilled to observe Annelisa look at her toys, the house, her father, the dog, and me with a new found sense of detail and desire. We have enjoyed her tracking us with BOTH eyes together as we move around the kitchen. We love seeing her see us clearly and respond with a bright eyed smile! I now know that her vision was impacting her development in minor ways and having her surgery sooner rather than later is proving to be an awesome decision.

Some of the significant changes in Annelisa POST OP:

• pulling hair and glasses deliberately
• wiggling everywhere
• starring at toys for long periods studying them
• starring at details around the house
• rolling around her crib 
• desire to stand up and look around
• tracking dad, Farley, and mom around the house
• reaching for toys out of reach
• successfully feeding herself puffs

Finally, a before and after photo comparison. 

Taken Saturday, December 1. Notice how each eye is turned slightly towards the outside. 

Her eyes are now straight and working together. 

Surgery is a GO!

Annelisa's corrective surgery is a GO! Wednesday, December 5th, she will have corrective surgery on both eyes for Exotropia.

At her appointment this morning, Dr. Stager, Jr. measured about 30 degrees of wandering in each eye; as a point of reference, at her initial appointment in October he measured between 20 and 25 degrees. He is very optimistic about the results of surgery in a week.

A couple of things about the surgery, it is outpatient surgery...so there is no intention of staying overnight and we expect for Christopher to be back at work that afternoon. We will be one of the first appointments that day due to Annelisa being only 8 months old. Due to being put under general anesthesia, she will have restrictions about when and what she can eat.

Her surgery will be at the Cook Children's Pediatric Surgery Center in Plano.

Some specific things to pray for:

• Annelisa's ability to handle the physical  mental, and emotional stresses of the procedure and alterations to her "normal" schedule, especially feedings! 
• Dr. Stager, Jr. and his assistants in surgery...that all would go according to plan.
• The pediatric anesthesiologist to quickly and effectively take care of our little lady. 
• The staff at Cook Children's to be efficient, patient, and helpful. 
• Annelisa's medical chart to be free of errors (our last name has been misspelled on some documents!).
• Christopher and I to know how to best take care of Annelisa and to be kind, loving, and slow to anger with each other throughout the stresses of this procedure.
• Annelisa will heal quickly and properly after the procedure. 

I'll post again post surgery to update on how things went! 

You can read more about our journey in Exotropia here and here. 

Exotropia Update

Yesterday, we saw Dr. Stager, Jr. again for a second appointment to check Annelisa's eyes. Basically, her eyes have maintained (or even slightly worsened) the level of exotropia he saw four weeks ago at our initial appointment. (You can read more about that here.)

Dr. Stager, Jr.  wanted to see us three weeks later, December 6th, for the next follow up to begin to discuss surgery options. At the conclusion of this appointment, his nurse told me she'd call the next day to pencil in surgery for Annelisa before the end of the year. This surgery will be to correct the muscle tension on one of her eyes, likely the right eye. Dr. Stager, Jr. feels like doing both eyes could overwhelm her at this stage of vision development. He will continue to watch her over the next several months and years. We could eventually have surgery on the other eye. Or we might not...depending on how her vision develops after surgery.

Fast forward to today...Dr. Stager, Jr.'s nurse calls to arrange a potential surgery date, depending on how the next appointment goes...and low and behold the only option for surgery at the Cook's Children Pediatric Outpatient facility in Plano is December 5....so we have moved up our next appointment to Tuesday, November 27.

There is the potential that the surgery won't happen on the 5th, but we are planning on it. I need to complete all the surgery center's online paperwork for Annelisa to be all set up in their system. I suspect that the next couple of weeks will be busy with appointments for pre-op and post-op and such.

Prayers for:

• Annelisa to handle the physical and mental stresses of the appointments and surgery. 
• Wisdom for Christopher and I as we make decisions for her health care and best development. 
• Patience with all the medical staff we will work with. 
• Financially for all the claims to be filed appropriately with our health insurance company so we can maximize the benefits we have been blessed with. 

I'll update again after our appointment on the 27th. We appreciate all of your prayers as we walk through this process! 

The Diagnosis is Exotropia!

We finally had our first appointment for Annelisa's eyes on Tuesday, October 16. Back at her four month update, I talked about our initial concerns with her vision. Shortly after that blog post, I began noticing Annelisa's eyes not working or focusing together more frequently throughout the day and decided to push ahead with the referral process. Dr. Starnes, Annelisa's pediatrician, recommended we see Dr. Stager, Jr. at Medical Center of Plano. I promptly called their office in early August, to make an appointment, and this was the first available!

We were very impressed with him and his awesome bedside manor! You can read his impressive bio here.

We had initially thought that her eyes were going cross eyed, but over the last 6 to 8 weeks we've changed our thinking, she tends to have one eye at a time drift to the outside. It is intermittent during the day, but it shows itself in almost every picture I take of her shifting between both eyes.

When Dr. Stager first walked into our exam room, he noticed one of her eyes was turned out. We went over our family history, specifically how Christopher had corrective surgery for Strabismus as a 2 1/2 year old, and how he has prisms in his glasses today to continue correction. These genetics likely have an impact on Annelisa and her eye muscle development. Dr. Stager proceeded to examine her eyes by using various toys and a series of movie clips down a narrow hallway to catch her attention. Christopher said that this part of the appointment was very reminiscent of his childhood appointments with his ophthalmologist.  At this point, her diagnosis was determined as Exotropia. (An information page can be found here.) He wanted to dilate her eyes in order to measure more specifically...so Annelisa experienced her first refraction. She didn't cry when the drops were put in, but there was a lot of eye rubbing and hiding her face while we waited the twenty minutes for the drops to work. We were taken to a different room for the conclusion of her exam. She had been a really good trooper to this point, but that changed. Dr. Stager needed for her lay down so he could hold her eyes open and get a good look at each eye. I had to hold her arms and feet. She cried, pushed, and kicked at me trying to break free....for which I don't blame her! She isn't old enough to understand what is going on, and why her eyes feel funny.

Dr. Stager, Jr. then discussed with us his approach at this point and the severity he sees. On a scale of 1 to 10, 10 being most severe, he would rank Annelisa's eyes a 6...he performs surgery at 7. She will likely have surgery to correct both eyes before age one...that's less than 5 months from now. He went on to say that she has 25 to 30 degrees of refractive prism...or muscle deviation from center. The surgery will involve general anesthesia and surgically altering the muscles on each eye to cause her eyes to straighten.

It is so important for this to happen...as the information sheet he gave us explains:

The natural history is one of deterioration as evidenced by drifting occurring more frequently, to greater degrees ("further out"), and "staying out" for greater amounts of time. In the earliest stages the child may experience diplopia (double vision) but quickly the visual brain suppresses ("turns off") the image from the deviating eye resulting in the child's seeing with only one eye. ...Since precise simultaneous use of the eyes is necessary for good depth perception, there also occurs a corresponding reduction in this visual skill.  

The timing of the surgery is important. As the early years are important and critical to normal vision development. The longer a child goes with this pattern of strabismus, the more difficult it is to completely cure. The immature visual brain "adapts" to this abnormal relationship between the two eyes and restoration of good binocular (use of the eyes together) skills become harder to restore. Untreated eyes drift farther and farther apart and are never "straight". Binocular depth perception is virtually lost and the abnormal appearance of the eyes becomes an increasing cosmetic and social problem for most. 

We will have a follow-up appointment on November 15 to measure her eyes again. This may happen two more times, a month apart, before surgery is scheduled. He wants to monitor the rate at which she progresses and attempt to only have surgery once. At the same time, we have met our out of pocket maximum for the year with our insurance, so if he is comfortable doing the surgery before the end of the year, it would be helpful to us financially. 

As in all things, I am thankful for having the opportunity to see such a skilled doctor and provide what Annelisa needs. We are praying for wisdom as we navigate these waters and to the timing of her surgery. Ultimately, the financial aspects of this process are not most important! Instead helping Annelisa develop into a healthy, strong little lady is the most important part!