Thursday, November 17, 2011
In years past on November 17th I have attempted to recreate the horror that was our lives as we supported Amanda through the NICU and the challenges we faced once she came home. This year, instead of going back there, I thought we should have a "Where are they now?" sort of update. Everyone likes those don't they?
To Recap: Amanda was born at 24-weeks via spontaneous vaginal birth. She was on a ventilator for about a month, had heart surgery, suffered a collapsed lung and a bowel obstruction before coming home from the hospital the week of her original due date on an apnea monitor. It was the longest three months of my life. FEAR ruled every waking and sleeping moment. At the ripe old age of two she was diagnosed with hepatoblastoma, a tumor in her liver. We participated in a study investigating whether some of the treatments she received in the NICU may have increased her likelihood of contracting this particular cancer. Was it due to her low birth weight or was it because she was given oxygen? We don't really know.
Skipping Ahead: Last spring it was suggested that Amanda's toe walking was more than just a delayed maturity of physical skill. Many kids will walk on their toes as toddlers and then eventually settle down into the more stable flat footed gait. At five, our girl was still up on those toes more often than not. She could walk with "flat feet" if we asked her to, but preferred to be up rather than down. We went to see a Neorologist who gave us the diagnosis of Spastic Diplegia, a form of Cerebral Palsy which effects the legs in this manner. She just didn't have a good range of motion in the area of dorsiflexion. Oh, and she also has ADHD-C which means she is both attention deficient AND hyperactive (the C stands for combined).
Over the summer we started preparing for her to start Young-5s Kindergarten. (This was a source of stress on us as parents considering as she grows up she will be older than her classmates by a year or possibly two. Not so bad now, but wait until puberty hits!) We started her on medication for the ADHD. We chose a long acting 12-hour pill so she would not need to re-dose during the day. Honestly, we've been through so much with her already we tend to be a wee bit over protective. Shocking, yes, I know. But, we just didn't trust the school or even our beloved daycare to remember every single day at a given time to provide the right meds in the right amounts. No offense to anyone but even if one staff member does it everyday, what if they are sick one day or they have a staffing change? No thanks, we'll just take care of this at home in the morning and she's good to go. (Do you see the level of over-thinking that has to go with every decision?) The good news is, the meds seem to be working. We increased the dose once school started and her teacher said she's doing very well in class and is able to attend and follow directions fairly well. She is not out of the norm for the other kids in her class.
She also started physical and occupational therapy at a local rehabilitation hospital. The physical therapy was to stretch out her legs so that she would easily and naturally put her heels down when she walked. It has been decided that while she does have tightness there (which later we found was not limited to her heels but rather tightness in the fascia (connective tissue between skin, muscles, organs, etc.) all the way up to her neck. By doing a myofascial release massage the therapist was able to get the full range of motion in her ankles. She gave us homework to do stretches twice a day and we ordered orthotic shoe inserts to prevent her from going up on her toes. The inserts in theory will retrain her brain and body how to walk so she doesn't want to go up on her toes anymore. She fought and fought the stretches to the point where the therapist had to teach me how to manually stretch her myself. Twice a day I need to coax and bribe and plea to get her to let me stretch those legs. It doesn't hurt her, it just *feels* better when she points her toes rather than flexes them.
This leads to our next topic, Sensory Processing Disorder. She is sensory seeking, she wants to FEEL the pull of her muscles as she hangs from the trapeze on her playset, the wind in her face and hair as she swings or goes down the slide, the tightness of her calves as she walks on her toes. Hey, what was that last thing? Yeah. Everyone pretty much agrees while her ankles are a bit tight and the stretching will help with that, she's up there teetering around due to her sensory integration issues. She just prefers to be on he toes. *slaps palm to forehead* We knew about the SPD when she started occupational therapy and were hoping they could work in as much sensory therapy as possible given the fact that such things are not covered by insurance...anywhere. It is still a "theory" made up by occupational therapists trying to explain certain behaviors which the medical community, or at least the insurance companies, have yet to recognize. There are three very good private therapy offices in our area where we could go and feel confident she was getting the appropriate sensory therapy for her needs, yet it will be 100% out of pocket so we started with the hospital since we had the referral from the doctor who diagnosed the Cerebral Palsy. We thought we would see just how far the insurance would let us go. Just far enough to start seeing a slight improvement and then drop therapy for a month before going back to the doctor for a re-assessment which will be after the first of the year so our deductible will zero out again. *ARGH!*
Oh yes, and she also went through an extensive neuro-psych evaluation which did nothing to make us feel better about our situation. Amanda is a sweet kid, very charming and fun loving. She is also a bit delayed in the processing and returning of information. Remember how Forrest Gump was just 5 little points away from attending public school and Missuz Gump had to ...persuade, shall we say. the principal to let him go to the mainstream class? Yeah, I see I may need to do some persuading in my future.
Which leads me to my next point, ADVOCACY! As parents we have spent Amanda's whole life advocating for her best interest. The staff in the NICU would put off providing this or that because "she hasn't declared herself yet" to which we would respond, "We are declaring FOR her". During her cancer treatments when they thought she needed iron and we couldn't get her to take it orally (Seriously, have you tasted that stuff? Who in their right mind would take it willingly?) we told them they needed to find a new way to get it into her because force feeding her made her throw up (the only time in 9 months of chemo she was ever sick was when we forced meds on her.)We have been fighting for our daughter since before she was born. We are used to fighting for her. Not in a Momma-Bear don't-threaten-my-cub way, but rather in a Missuz Gump way, my child will have the best opportunities I can provide for her because it is not her fault she has the issues she has!
Finally, the fighting. Fighting for her, fighting for her, fighting for her. We are now fighting HER. Late summer brought about the perfect storm of our house in a bit of disarray as we had guests for a couple of weeks, she started PT and OT, she started meds, she started school and switched to a new class at the daycare. HOLY CRAP that is a lot to load on a sensitive kid all at once. She started "declaring" herself through tantrums. Not just stomping her foot on the floor, though she does that too, but violently kicking us, the doors, the walls, hitting, scratching, spitting, screaming, crying tantrums that literally shake the house and can be heard from the street out front. "Luckily" she reserves these for home, not once has she done this at school and only occasionally at Grammy's house. She is declaring she needs help and we as her parents need to provide it. BUT HOLY HELL I DON'T KNOW WHAT SHE WANTS! She needs more sleep as she has trouble sleeping through the night and with the new school schedule cannot get a nap anymore but still. *Ack!*
Today she will meet our newest specialist...the behavioral therapist! (I hear horns playing and a glowing light shining from behind this woman's smiling face.) She has to be our savior because, DAMN, we cannot keep living this way. I think the sleep, sensory integration therapy (wherever that ends up coming from in the long run) and continued support for the ADHD and rigid schedule at home will help her calm down and return to the sweet loving dramatic funny girl she really is. Right now I have Dr. Jekyll and Mr. Hyde without the need for that pesky potion.
What does all of this have to do with World Prematurity Day? Everything. I'm not saying that people who have full-term babies don't ever have to deal with these issues but time after time when we meet new therapists, new doctors, new specialists and we describe her developmental skills, quirks or challenges they nod their heads and say, "Yep, that's a preemie thing." This preemie thing will follow us the rest of Amanda's life. It is truly the unseen birth defect. Cerebral Palsy, ADHD, Sensory Processing Disorder and Learning Disabilities are all MORE COMMON in kids born prematurely. The March of Dimes has worked tirelessly to provide the treatments that help more and more babies survive, however, these kids will more than likely require more services throughout their lives than their full-term counterparts. The March of Dimes has shifted their focus now to PREVENTION. If fewer babies are born premature, we can help resolve this issue. The way to prevent prematurity is to support expectant mothers even before they conceive. Help the moms, help the babies. Fairly simple. If I had been properly educated on the signs and symptoms of premature labor maybe we could have stopped it before she was born, or at least bought enough time to get the steroids for her lungs.
They say Amanda is a "Former Micro-Preemie" but I think that is something that will be with her all her days.
Tuesday, April 26, 2011
Well, maybe it isn't THAT good, but things are looking up. Amanda has been accepted into the Young-5s class at the school we were hoping for, which means we can stay at our current daycare. This is a MONUMENTAL load off of my shoulders. The thought of moving her daycare and then having her start school within a couple of months is just too many big changes too close together for my girl to handle. I know she would get used to the new routine but the behavioral backlash during the transitions would not be pretty.
SO, good school and continued care from the people who already know and love her and will drive her to and from school means the world is a better place today. We'll be writing the new IEP in May and I believe the OT is now convinced she could use some classroom accommodations rather than an exit IEP. (Note that my word wasn't good enough, but a copy of the neurologist's report which said the same thing I said made an impression.)
We found out the EEG came back "normal" with no signs of epilepsy. I have asked our pediatrician for a referral to the Pediatric Cerebral Palsy Therapy program at a local hospital. I have not heard back about this which I am taking to be good news. If she didn't agree with my asking for the referral (I called the referral desk, didn't speak to her directly about it) she would have called me to clarify what it is that I am looking for. The therapy program will encompass physical therapy, occupational therapy and speech with sensory integration inclusive in these other therapies. I am hoping the SPD therapy will provide a noticeable result in her behaviors and ADHD-C symptoms before school starts in the fall.
I have been attempting to find a fish oil supplement that she would be willing to take. She is not able to take pills at this point so a liquid is my best bet as she would need to have 4-8 gummies at a time in order to get the recommended dose of fish oil. She is very picky about flavors and not great at brushing her teeth yet (another sensory issue at play) and the dentist recommended staying away from gummies as they tend to get stuck in and between teeth. This leaves the option of a liquid which we can mix into a drink or yogurt as the strong flavor will probably not win us a straight shooter. I did find Barleans brand has a Peach Mango Smoothie flavor which sounds perfect ...except I can't get it in town. I've read that the fish oils need to be continuously refrigerated in order to NOT taste like fish. I can order it from Amazon but that means it will not be refrigerated during shipping (and to be honest, I don't know that they are refrigerated at the warehouse either). The local health store said they have been trying to get it for a couple of weeks and can't get it. If only my daughter would tolerate lemon, orange or strawberry I would be perfectly set. Since she exists in order to make my life more difficult, she will not touch any of these flavors. There is one more local place I can try and then I may need to just cross my fingers, order it online and hope for the best in covering up the taste.
Now that I have my brain half-way working again I have started jogging in an effort to train for my first 5K in a matter of three weeks. Not just my first race mind you, I have never run before with the exception of high school PE class. Not pretty. My legs are screaming at me and my lungs are launching major protests. But I declared I would do this for Make-A-Wish and I will follow through on that promise if it kills me...which it might. According to the Couch-to-5K program I should be able to run a full 2-1/4 miles at this point. I didn't get in 1/4 mile on Saturday before I gasped, "What the F*ck did I get myself into?" Then promptly stopped talking as it required too much oxygen.
Wish me luck!
Thursday, April 14, 2011
• Two New Diagnoses
1) Spastic Diplegia - A sub-classification of the most common form of
2) ADHD-Combined type - Both inattention and hyperactivity/impulsivity
• Mere FREAKS out
• Mere slowly starts collecting herself again
The Long Version
I've been wanting...needing to write for a while but felt like I had to hold back now that I am no longer anon. However, Julie mentioned something the other day which opened my floodgates. I typed up a huge purging comment on her blog and then deleted it because that wasn't where it belonged. It belongs here, where it all began anyway.
I took Amanda to the orthopedist back in October to follow up on her knock knees which are no longer knocked. I asked at that time about her toe walking which her school physical therapist had recommended we check into. She has tight heel cords, she doesn't get full range of motion when she walks however she is able to walk, stand, sit, climb ride a bike and do what is physically necessary for school so PT through the special ed services at school has been discontinued. She is able to walk with "flat feet" if we remind her to concentrate on it, but her natural gate is on her toes. The orthopedist said she probably has a mild form of Cerebral Palsy and if we took her to the neurologist for a formal diagnosis we may be able to get more services for her, either insurance covered physical therapy or through the school again.
We had the neuro appointment at the end of March. The neurologist was a friendly bright engaging young woman (loved her!) who talked to Amanda, not just me. She said it is quite common for micro-preemies to have some scarring in the frontal lobe area of the brain. Seizures are not uncommon so she ordered an EEG (still awaiting those results). She agreed we should definitely follow up with the child psychologist on the ADHD but that the seizure issues could mimic ADHD. The EEG will determine whether we pursue anti-seizure meds or ADHD meds as treatment. She decided not to do an MRI at this time which could conclusively diagnose these issues for us but would severely traumatize my poor girl who is acting out like CRAZY right now from the two visits to the neurologist's office within a week (initial visit then EEG). The doctor had enough information from the circumstantial evidence to give the diagnoses.
She has Spastic Diplegia, which means both of her legs are affected, she may have normal intelligence (also to be checked by psychologist) but learning disabilities and issues with fine motor skills can be a problem for many patients.
The neurologist agreed the sensory processing issues seemed apparent as well however, Sensory Processing Disorder (SPD) is not considered a medical diagnosis in and of itself and therefore insurance will not pay for therapy. Let me explain how CRUSHING this feels. What I feel would do her the most good is sensory integration therapy. This will not be covered by insurance. Insurance will pay for "rehabilitative" therapy not habilitative. Meaning, they will cover her to regain a lost skill, but not to gain a skill she didn't have before. Our best bet may be a local hospital that specializes in rehabilitation which has a special program for Pediatric Cerebral Palsy Therapy which includes sensory integration therapy along with PT, OT and Speech.
Sensory Integration Therapy is my main goal which is not covered by insurance. There are a few very good private therapists in town and I will just have to figure out a way to pay for them because the sooner she gets help the better chance she'll have in school these first early years. I need her to like school and to continue to LOVE books and learning new things. She is going to need this resolve as I fear school in later years will be a huge challenge for her organizationally and just trying to keep up and fit in and feel equal.
It is my belief that the SPD is her main issue right now. She definitely has auditory processing differences, is sensory seeking, inattentive/distractible has multisensory processing issues...the list goes on. So, let's look at this. Trouble processing what her senses are telling her, inattention and highly distractible/impulsive. Sensory seeking means she is constantly trying to FEEL movement/touch/SOMETHING. Put these things together and they sound like a kid with ADHD, no?
I am not saying she doesn't have ADHD, but all the meds in the world will not fix her sensory processing disorders. We need to start with those first, I think if we can get those under better control the ADHD will be easier to manage and symptoms will be much less than they appear right now.
I went looking for these diagnoses believing they would help me get her the support she needs to continue to achieve and succeed in school. They recommended last year that she go to a special ed preschool. That did not work out logistically for our family and I chose to keep her in a private preschool/daycare class with itinerant (30-mins/wk) occupational therapy through our local school system. She has met 3 out of the 4 goals on her IEP and has made progress on the fourth. She is doing well. Next week is parent teacher conferences with her preschool teacher to be followed by two rounds of kindergarten screening. We will determine in the next month whether she will attend Young-5s or Kindergarten next fall. I don't really know what to wish for. I think she would do well in the Young-5s class and be more equal to the kids in that class but she will be almost 6 when the school year begins. Not so bad now, but down the road the difference in age will become more apparent.
Also, her occupational therapist said she is doing so well she doesn't need special ed help anymore. She can exit from the program. All fine and good, I am glad she's doing so well, but that means in order to get help again she has to show signs of not being able to keep up. Why make her fail in order to offer the support she needs to succeed? I want an IEP with accommodations for ADHD at the very least. Keep her in the system and under the watchful eye of her teacher and the school social worker. She will need the extra help, I am sure of it.
I learned to advocate for my daughter in the NICU five V-E-R-Y long years ago. I strengthened that skill in the pediatric oncology unit three V-E-R-Y long years ago. I continue to struggle with that on a daily basis only this time it is with medical and school environs.
Here's the thing. This whole business has been hard on me. I went into a depression over the past few weeks. Figuring out school for next year plus the fact that due to our school choice she will most likely have to change daycares and I LOVE our current daycare and do not want to leave. Not knowing whether she'll be best suited for Young-5s or Kindergarten and whether IEP accommodations would make a difference in that decision. I need to make all of these decisions final in the next month or so because if we move to the new daycare I want her to spend the summer there getting used to the new environment before school starts in the fall. Hoping she makes these transitions more smoothly than is her customary way. Looking ahead to our next cancer check which will send her off the deep end again behaviorally when we haven't quite pulled her back to "normal" from the neurology appointments yet. I need to find out what type of therapy she can/will get into and when that will happen so that I can determine what my own work schedule will be and hope like hell my company is Ok with it. As you can imagine, I have used the "I need to be gone because my daughter..." excuse a few times in the last five years and that might be wearing thin. I need to keep my job since our family uses my company's health insurance.
What therapy does she need? Where can she get it? When can she get it? Will the time and place of this therapy threaten my job? How are we going to pay for the therapy ? It cannot take place during school hours as that needs to be a priority.
I want to cry.
Why me? Why her? Hasn't she been through enough? Haven't we all been through enough? Just as Julie asked, having been through everything we have been through, aren't we deserving of an easy path now?
Yes...But...this is the path we are on, so we need to keep going. Can't really turn back now can we?
Next week should bring at least a couple of answers. We will have the parent-teacher conference with her Pre-K teacher and get her recommendations for next year. She will go through her first of two kindergarten screenings. Hopefully we will get the results of the EEG so we can begin looking at treatment options. I will feel better when we have a plan in place. Right now I feel like I am drifting and don't know which way to turn.
This is all a very verbal outpouring of what has been going through my head lately. Pictorially it would look like this. I am done stressing/depressing about it. I will get answers as they come, make decisions from there and hope for the best possible outcome. *crossing fingers*