Alison had Spina Bifida clinic today. Overall, it was a good appointment. Dr. Hurvitz thinks Alison is doing great. He continues to be amazed at her function vs. her lesion level. We talked briefly about spinal cord tethering and how it will be interesting to whether or not it will be an issue for her as she continues to grow. Right now we base things on Dr. Tulipan's statement that all the kids are tethered and just keep an eye out for symptoms that would indicate surgery is necessary. So far, Alison isn't having any.

The main focus of the appointment was what we are going to do about Alison's foot. He is concerned about the fact that Alison has now sprained her ankle twice in the last year and a half. The muscle imbalance (her muscle that controls plantarflexion is hypertonic, her muscle that controls dorsiflexion is hypotonic) is causing her foot to drop and turn in. Dr. Craig had briefly mentioned a tendon transfer when we saw him April, but also said that he was hesitant to do it because he wasn't sure she had the muscle function to rehab the foot and he was concerned about leaving her worse off than she is now. What Dr. Hurvitz is proposing we do, and he will be discussing it with Dr. Craig both before and after our appointment with him in two weeks, is to do a Botox injection into the calf muscle to weaken it and see if there is any improvement in her foot. Even if there is only a 10-15% improvement, it would indicate a higher percentage of improvement is possible if we do the tendon transfer. The Botox treatment is only temporary -- it wears off after about 3 months -- so if it doesn't work, we haven't done anything that will permanently leave her with less function than she already has. It will be another few weeks before we know for sure, but if I were a betting person, I'd say Alison is probably going to have the Botox injection.