Dr. Grayson said Emily’s columella was 4 mm on one side and 3 mm on another and the goal is to stretch it to 5 mm. Her palate hasn’t begun to come together so he adjusted the NAM by flattening the top. He didn’t put the nasal bridge on yet – hopefully we won’t need that – it’s a piece of plastic that connects the stents just beneath the tip of her nose. It would apply a lot of pressure to the columella and the reason I don’t want to deal with it is because I’m afraid it will cause blisters, hurt her and generally complicate things. She was so good today. She hardly cried at all until it got later and I know she was tired. She fell asleep at 6 pm in the car and is still asleep as of 7:30. It means she’ll be up early.

Emily’s appointment went really well today. Dr. Grayson took lots of pictures of her nostrils because they were taking the shape of the stents. He rounded the stents to make them more natural. Emily cried the entire time the NAM was out which felt like forever, but was only about 10 minutes. She fell asleep sucking on Dr. Grayson’s finger when he put it back in. Dr. G. said her columella was 3 mm and it was stretching so well he didn’t need to put the nasal bridge on. She weights 10 lbs. 13 oz with her clothes and diaper on.

Emily’s appointment went very well today. Dr. Grayson (the orthodontist who does her adjustments) said she her premaxilla (the segment of her gums that juts out just under her nose where her first four teeth will come in) is moving into place. The columella is already stretching and because her premaxilla has moved so much we can ease up on the tension of her cheek tapes. Jim (Emily’s papa and my husband) came up with a novel way to tape up Emily’s prolabium (that’s the tape just beneath her nose that’s meant to stretch her columella). Dr. Grayson said it was cool and very simple. He thinks if it works that they will start showing other parents the technique!!

Amy, Emily’s Aunt and my sister-in-law, met me at the hospital today. The appointment was about two hours – we got a new piece of tape on the NAM. This one is to pull the columella (that piece of skin in between her nostrils) down so that it stretches. The longer the columella, the better result we’ll get with the surgery. The taping is very complicated, or rather difficult to do and you need to glue it to the space below her nose (called the “prolabium”). WhenI got home, Jim took one look at it and figured out a much simpler way to do it. I took pictures of it and emailed it to Dr. Grayson and he thinks it’s fine to do it our way.

Fourth week at NYU and third week with the NAM. Emily got her nasal stents in today – we were at NYU for over four hours. It sucked because I was so tired, but it was actually kind of relaxing otherwise. I went in by myself (Jim stayed home with Ana). Emily was really good. She didn’t cry much at all except when one nurse held her arms above her head – she hates that! There were two students, one clincial fellow and a nurse plus Dr. Grayson all hovering around her and she did just fine.

Second trip to NYU – Dr. Grayson, the team orthodontist, met with us today and showed us how to put the NAM in (NAM is an acronym for nasoalveolar molding device, which is a fancy way of saying orthodontic plate – similar to a retainer). Dr. Grayson is a quiet guy who seemed really focused on his work. Emily screamed a few times mostly because we had to hold her head still, then when the NAM was initially in she sort of made weird gag faces with her tongue. She seems to eat well and hasn’t cried a lot (yet). She’s slept the entire way home on the train – almost two hours.

Here’s a picture of Emily the first week she had the NAM in – it looks so huge on her little face.