Wednesday, April 13, 2011

Micah's Neurologist Appointment

So way back when Micah was in the NICU they scheduled him an appointment with a neurologist for April---back then it seemed like forever away. Well forever is here so today was his appointment. I was kind of dreading it--nobody wants to go to a neurologist for their own kid. I was afraid of what they might say, especially since Micah seems so normal, I just didn't want to be hit with a surprise bomb if you know what I mean.

As always, I will back track a little.  You might be wondering why he even has an appointment. When they are in NICU they do head ultrasounds on the babies frequently to check for brain bleeds, which is generally pretty common among early preemies because their brains are still immature. Micah had a Grade 1 brain bleed on the right side, which was basically the most minimal version of brain bleed you can have and I was told by the doctors that for his gestational age at birth it was basically like never even having a brain bleed. That was a relief. He had another ultrasound about 3-4 weeks later to see how the brain bleed was doing, and it had gone away. Another relief. What was very unsettling was the new news: he had cystic "PVL" and if I quote the NICU doctor "not what you want to see." I was sick to my stomach. They told me it could mean anything from Micah having no issues, minor learning disabilities to cerebral palsy and total mental retardation. One of the worst things about it was there was no way to know then, only time would tell. We were told things like the brain is "plastic" meaning it can rewire itself. I saw the scans and to me, a very much non-expert, it seemed like his cysts were pretty tiny so I hoped it was just a mild case giving him a better prognosis.

I educated myself and did the google-until-you-have-a-nervous-breakdown thing. It was horrible. I was always worried. I hyper analyzed anything about him. Some things happened to ease my fears, a) Developmental Eval came to see him around his due date and said he was advanced in many things b) he smiled around 7 weeks old (adjusted) and has been super smiley ever since c) he has reached nearly all of his developmental milestone nearly on time or fact he is advanced in many areas. Not to mention he has ALWAYS been described as "alert", even when he was so very tiny in the NICU. Those things have reassured me so much. I was just afraid that maybe I was missing something major by being so optimistic.

Back to today's appointment. We showed up to a nice little waiting room, all decked out for kids and pretty cool actually. The nurse brought us in, weighed him, measured his head etc and got a few details from us about him. I knew I was in the right place because when she saw his purple Gentian Violet tongue she said "He's got a Chow tongue." Ah, a fellow dog person. ;) The doc came in and she was happy and friendly and totally fell in love with how adorable Micah is (how could you not).

She checked him out played with him a little and did all the little testy things evaluaters do to babies. Checked his reflexes, watch his eyes track, pulled him up by his hands, checked his grip, got him to smile, bear weight on his legs...stuff like that. She was very happy with him. He did not have high reflexes which is good since high reflexes can be a sign of high tone (if you are a preemie parent you know all this kind of stuff).  The only issue we talked about, and we already knew, was that his left thumb tends to want to tuck in to his hand.  The physical therapist saw that and told us to just massage his thumb. I had been doing that and he has been opening it easily, grabbing stuff, keeping his thumb out and holding his thumb outside of his fist like he does with his other hand. She said it's great that he is doing that. She called it a "soft sign" meaning it's nothing major, and that it is mild, as opposed to never wanting to open his hand and only going back to the same fisted position once you let go. Overall she was very pleased and said that she believes that he will be completely normal.

We also discussed his actual brain. We talked about the brain bleed and such and how she wasn't sure why he would have bilateral PVL (meaning he had small cysts on each side) if he had the brain bleed on just the one side. I brought up that he had an APGAR of 1/7 (Isaac was a 9/9) and that probably had to do with it. PVL is caused by a lack of oxyen to the brain...and since he was not born screaming and breathing, and had to be intubated I'm pretty sure that is when he would have had any damage done. I don't think the NICU doctors wanted to bring that up because it might make it look like it was their fault (I don't think it is). She agreed that the APGAR was probably why he had Bilateral PVL. Regardless, she says that it's apparent that he is very intelligent and doing well and normal which is the best you can hope for. He even has a higher head to body ratio, meaning he has a big noggin for his little body. She said that neurologists tend to make a big deal out of head to body ratio and head circumference because it usually predicts intellegence. She said it's not necessarily that a huge kid with a huge head, just the head size compared to body size. That was also reassuring.

She was so comforting, personable, and knowledgable. I wish she could be my pediatrician. Not only that but she spent over an hour with us, which was nice to not be rushed in and out of there. Oh, and she showed me a picture of her dog! Man I REALLY wish she could be our pedi.

Praise God for answering my many heartfelt prayers---and those from all of you around the world who were praying for Micah. He really is doing amazing and every day is such a blessing.


  1. I'm so glad all went well.. and I LOVE that picture!!!!!!!!!! He is a handsome little man. ♥

  2. Yay for Micah doing so well! I am elated that he had such a good appointment. I will continue to keep your family in my prayers!

    ~Jamie (September from TMP)

  3. Woohoo for Micah! I'm so proud of him and he is so cute! I'm glad the appointment so well and I'm sure your fears have eased greatly.

  4. It really is a relief. Thanks again for all your prayers!

  5. So glad everything went well, Maddie! He's doing so well! =)