Orthodontia begins!

Iver just got braces! After a couple of consults with local office (Century), it was recommended that he undergo an 18-month (ish) treatment to correct some overbite and rotation of his teeth. I thought age 11 seemed early for braces, but Iver informed me that several kids in elementary school last year (and even a couple of second graders!) had started their orthodontic journeys. As long as he is reliable with a retainer, this should be a *one and done,* treatment, not requiring future courses braces, like I had! (I had braces for the second time when I was college aged. Kelvin never did. He says that in Vietnam, no one can afford orthodontic treatment so Asians just use their tongues to push out their teeth to straighten them :)).

Iver was offered either braces or Invisalign (at the same cost/treatment duration estimate). Invisalign requires faithful wearing of the aligners up to 22 hours per day, and to keep track of them, and brush frequently including at school, which seemed hard to me!  Braces seem to have less user error and the more conventional approach, although Iver knew friends with both. 

He and Kelvin queried AI about the benefits and risks of both approaches. It also provided a photo :))  

For fun, Niall's AI-generated photos with braces on!

Iver (wisely, in my opinion), chose braces but opted to wait until after our travels to get them on.  Early on Monday, we went to the orthodontist and here is the result (he chose blue rings for the brackets).

Before/after

He's definitely had some soreness adjusting to the treatment, managed with tylenol, and is getting used to the careful brushing/flossing process with the brackets on. We go back every 6-8 weeks for adjustments and hope for a good result in about a year and a half!

Ailing tummies and paws

It's been a rough health week this week in these parts!

Pepper (almost 13.5) woke up on Sunday unable to put weight on her left hind leg. There was no obvious injury or skin findings and we were really concerned about her. We've heard of dogs tearing ligaments and (not being inclined to have her have any major surgery) worried if that would be... it for her.  She has all kinds of "old lady problems," including being deaf and partially blind, and doesn't walk very far at baseline due to arthritis. She also needs a fiber supplement to keep her regular!  She is on prednisone, which can cause all kinds of problems including bone fragility as well as infections.  We feared the worst and having to carry her up/down steps to go potty outside or across the house to eat/drink didn't seem to be a good set-up or sustainable long-term solution for decent quality of life (both eating and going to the bathroom are hard with only three limbs). We were thinking about if we'd have to track down the urn I bought a couple of years ago when she was really sick. (Kelvin recently learned that the mean lifespan of her breed is about 13.2 years).  We hugged and kissed her a lot and took a bunch of photos. 

Eating, where it's hard to balance

However, Kelvin was lucky to get a Monday squeeze vet appointment in the afternoon and we were relieved to find out that she seems to have developed cellulitis and an abscess in her paw, which was making it painful for her to walk. It wasn't very apparent on Sunday through her fur. However, the vet techs shaved her hair, and treatment with warm soaks and oral antibiotics has helped immensely in just two days. 

Niall was also ailing a bit, complaining of belly pain on Sunday and Monday but was acting normally. Nevertheless, on Tuesday, he woke up unable to move and holding his stomach. Since starting kinder, he is in charge of his own bathroom tasks, so I actually don't know how regularly he poops (or if he poops at school?) but he, not a huge lover of vegetables and liking "white" food, has struggled a bit with constipation over the years. We kept him home from school Tuesday (although he perked up midday) and I tried to get as much fiber and fluids in him as was possible. He didn't love the taste of fiber chews I got, ate some fruit, and didn't like the juice-Miralax cocktail I mixed. Even a glycerin suppository didn't solve his problem.

                                                          check out our counter-pharmacy situation! 

He woke up multiple times crying in the night, but still no other symptoms (no vomiting) despite the acute pain. Kelvin was more worried than I was (because he remembers how I minimized his symptoms in 2022 when he had acute appendicitis-- not uncommon for me!) and pushed to get N seen at the acute care clinic and a prompt ultrasound, which saved us so much time, waiting, and an ER visit, which we have always avoided because our feeling is that you actually have to be dying or need surgery to go to a hospital (in any circumstance outside of childbirth). We're thankful for our medical knowledge (which allows us to mostly diagnose our kids/selves without having to go to doctors' appointments), as well as community connections, even thought the knowledge doesn't always serve us that well due to my "normalcy" bias and tendency to not freak out about health things (any other parent would probably have brought their kid to the ER based on how Niall was acting on Tuesday night). 

Thankfully, the ultrasound did not suggest intraabdominal fluid nor appendicitis, and showed some stool and prominent lymph nodes... but Niall is back to his feisty, happy self this morning.   I still don't know if and when he poops, but "FOS" as we call it in the medical world is not the worst ailment to have. And I was right this time. Childhood constipation is far more likely that acute surgical emergencies, after all.  Sigh. If only vegetables tasted like cheese. But we're glad everyone is on the mend.

Senior Dog Eye Saga

Our dear senior dog Pepper continues to struggle with health problems. We forked out some big bucks for sight-restoring bilateral cataract surgery in January via Bliss Eye Care, a veterinary ophthalmologist in Medford, Oregon. It was totally worth it.   And luckily we have had a wonderful experience with patient care and follow-up with this office.

A little over a week ago, we noticed a white spot developing in Pepper's right eye. Kelvin sent photos to the ophthalmologist in Medford and she responded promptly with suggestions about treatment of a corneal ulcer and hypopyon (liquid pus level) in coordination with our local vet. Pepper had two local visits with fluorescein staining and intra-ocular pressure checks as well as a complicated medication regimen beyond her maintenance ketorolac eye drops including 6-8x per day ofloxacin, 4x/day terramycin ointment, twice-a day doxycycline orally (I can see how patients struggle with compliance with multiple-daily dosed meds).  We thought the eye looked a little better (less dense whiteness) this week but, despite it being pretty inconvenient on short-notice, we arranged a bit of on-call coverage at the tail end off my Monday call and Kelvin agreed to take Pepper up to Oregon on Tuesday for a squeeze- direct in-person exam at their request. Her right eye looks perfect and she seems to still be able to see well out of it. 

The ophthalmologist diagnosed Pepper with "large temporal paraxial keratomalacia," described as a severe, melting corneal ulcer.  She said that this was unrelated to her cataract surgery but just due to her breed and age (her being on prednisone probably also had a immunosuppressive role). Treatment options were reviewed with Kelvin and included continuing medical therapy (~60% success), Corneal Collagen Crosslinking (CXL) intervention (~80% success in 21d), or surgery (conjunctival graft, curative, but leaving vision compromised).  The CXL was not cheap but, due to our limited time with capability of trips, we opted to proceed and the doctor was able to complete it the same day.

Pepper is now on even more medications than she was before, including atropine eye drops every 48 hours, EyeQ amniotic eye drops 4x per day,  Moxifloxacin eye drops 6x per day,  Terramycin eye ointment 4x per day, toradol to the left eye daily, meloxicam (a non-steroidal) orally daily, and twice-daily oral doxycycline. She was asked to continue her liver supplement Denamarin but hold her chronic prednisone for the time being. The topical meds are supposed to be separated by 5 minutes which is tricky to juggle (and remember! This is up to eighteen med administrations daily unless I miscounted!). She is supposed to stay in a cone and Kelvin has a return trip in two weeks, after two other back-to-back out-of-town trips he had planned (one for Danny's wedding and another for a conference). 

Prayers for healing for her are appreciated!  We obviously love our fur child a lot and wish she didn't have so many seemingly acute-but-severe conditions! With hope, she doesn't end up losing her eye (enucleation) but one working/seeing eye is still better than none!