Dear Noah....Jan. 4, 2010 - dentist and cardiology day........

Well we made it through the holidays. You had a wonderful Christmas and birthday. You got many nice presents......including a new HO scale train set from Santa and books, movies, gift certificates, and games. You got movies on Twisters and books on space and tornadoes. You got a Magic 8 Ball and Monopoly City, Diamond Scrabble and Yahtzee. You also got enough money on your birthday to order yourself a Wii!! That should be coming this week.

You did so well when it came time for everyone to sing to you on your birthday. IN fact....you have done well overall with all gatherings recently.

Today you had to go back to the dentist for a followup and cleaning. ZERO cavities and they look so nice again! However....you do have one baby tooth that came out partway and got jammed between the new tooth and the gum that we cannot get out. The dentist said it would have to be surgically removed and knowing you..laughing gas would not help you as you would still be awake and get too worked up probably to handle a shot in the gum to numb it. SO....he suggested sending you to the OR (operating room) to be put under and they can do everything to your mouth at one time. I guess there are also 2 upper teeth trying to do the same thing. He thinks and I agree, that those will probably come out on their own with your help. BUT so far we cannot budge that other tooth. SO you may be facing surgery for all that if we cannot get them out ourselves in the next few months. I would like to avoid any surgery for you if possible....so I am going to try to work on that bottom tooth and you are already working on the upper teeth.

Cardiology visit went better than last time as far as you handling the ultrasound of your heart. However, the doctor this time actually HEARD the aortic valve regurgitation and stenosis and is concerned if it continues on without any intervention....your left ventricle will eventually be affected as the back flow of blood goes there..so blood comes out from there but also some leaks back. Your aortic valve has narrowed a bit so she can hear things there now she could not before. Anyway....to make a long story short..the goal is to try to postpone any surgery for you as long as possible. SOME cardiologists do nothing for kids born with a bicuspid aortic valve and even if you develop aortic stenosis and aortic regurgitation if not too bad, they just let it take its course. Some live normal lives and never have problems...most eventually one day face some sort of surgery to try to repair the valve or replace it. SINCE this is all open heart surgery so far to in most cases.....we are trying to postpone this as long as possible.

ONE way (if things slowly worsen) is to place you on an ACE inhibitor to lower the blood pressure (yours is NOT high)....which in turn reduces how hard your heart has to work to make up for the leaky valve....and the rate of pressure your blood is being pumped through the heart. SOMEtimes kids on ACE inhibitors ventricles improve and almost normalize..sometimes it appears it really does nothing. So some docs say to try something like medicine to see if you can HELP postpone the inevitable..some say it makes no difference. We are going to wait another 6 months...have you go back again for another ultrasound of the heart.....and then see how things are at that point. Each time things have changed a bit.....and she hears more or they see more leaking and things on the ultrasound images. She said in 6 months if things have again worsened even a little bit....she would recommend trying some sort of medicine. SO we will see. The problem with putting you on an ACE inhibitor when you don't really need it.....is we would have to monitor your blood pressure really closely until we got it regulated....since you are normal already....we would not want it to drop too low. I also want to do my own research on this and see if it really makes much difference in the inevitable outcome. If not......we may just let nature take its course and only act if things got really bad over time.

Regardless you made it through the day. I took you to Hallmark to buy you the newest Diary of a Wimpy Kid you had seen there before Christmas for a present for being so good today. You are still in your room reading.

I love you Noah. God will help us get through all these things together!

Mommy
XOXOXOX