Arriving Somewhere...: January 2012

Tuesday, January 24, 2012

Mixed Results With A Bias To The Upside

Ethan had a plethora of regularly scheduled followups at Children's yesterday. The bottom line coming out of all the appointments is that Ethan is doing well; nothing to see here - move along, move along!

He was evaluated by a speech pathologist/therapist and the recommendation was that Ethan continue with speech therapy. He has made tremendous progress since he began, but there is still work to be done (he still does a lot of consonant substitution) and he is probably not ready yet to be discharged from his therapists' services.

Ethan also met with his plastic surgeon. His post-surgical scars are coming along very nicely. It was felt that he is on track for his next major surgery (the jaw distraction) at about age 8 (but see note below). There is the outside possibility that he may not have it until age 18, but that seems pretty improbable. Basically, the road map is as follows: if, as he grows, the mandibular hypoplasia is really not that bad at all when he reaches age 8, then they will postpone any further surgical intervention until age 18 when the jaw is almost fully grown and they can at that time not only do the jaw distraction, but all the orthodontic work that may need to be done to correct any jaw/teeth misalignment. If he needs the surgery at age 8, there will be a followup surgery to do the final corrections at age 18. Between ages 8-ish and 18, they prefer to do nothing if it at all possible. So age 8-ish is crucial as it is really a fork in the road. So while it is possible that he may not need the surgery at age 8, it seems unlikely as his mandibular hypoplasia would have to be quite minimal. But there is always hope... He will have a followup with his plastic surgeon in about one year.

We also went over the results of his sleep study. While the results are hugely improved over the results of his pre-op sleep study, on their own, they are not great results. Before his tonsillectomy and adenoidectomy, he had up to 24 sleep apnea occurrences per hour peaking with up to 48 per hour during REM sleep. Post surgery, this fell down to about 6-8 per hour. This is a vast improvement. However, 'normal' is considered to be about 1.5 per hour. The general consensus was to just watch him and to have a followup sleep study in 6 months. If the results are very poor (as in much worse than current), then early jaw surgery will be reconsidered. However, if the results are better or the same (or even marginally worse) the course of action could be varied: resume oxygen at night, CPAP, or possibly nothing at all. So again, we shall see...

Ethan also had a followup hearing test. This was actually his best test to date as he actually seemed interested and engaged and gave good results (as opposed to in the past where he seemed to get bored and then simply ignored the test after giving initially good responses). The results seemed to indicate he possibly does have some hearing loss in his right ear but over all, his hearing loss is not enough to be of any developmental hindrance. There will be yet another followup test in about 6 months or so when he will be about 3 years old and he will be old enough that they can administer a different type of hearing screen.

So overall the results were mixed. He is doing much better, but the results were not stellar. His sleep quality is still not considered 'normal' but it much, much improved. His speech is likewise greatly improved, but there is still work yet to be done. The common theme running through all the appointments today was, "see you in six months!".

- bob

Monday, January 23, 2012

Ethan's Post Surgery Appointment and Check Up

These were pictures of Ethan at his check up in January 2011 getting his ears checking by his Craniofacial Otolaryngologist Dr. Sie. He was not too thrilled with the experience since he had to get his ears cleaned, but she tried to make him feel better by cleaning penguin's ears first.

Below you can see the screen on the right side of the picture where her scope machine projects an image. On the screen is penguin's ear and Ethan can be seen behind the scope looking at the big screen. It was pretty cool that she could do that. Unfortunately when it was Ethan's turn, I had to comfort him and didn't get to see his ears on the screen.

Ethan just had his ears cleaned while he was in surgery in September, but because his ear canals are so small, he might need to get his ears cleaned pretty regularly. Too bad we didn't get the hearing screen done before he had his ears cleaned.

The overall outcome of his check up with the hearing pathologist was actually great. It was the first hearing screen he's had so far that the pathologist feels confident that he can actually hear at least somewhat in both ears.

Dr. Sie thought Ethan looked great and was happy to see that it appears his tonsil and adenoid removal worked to open up more space in his airway and improve his sleeping patterns.

Sara Kinter his speech pathologist at Children's evaluated him and thought he was doing great and has made great improvements, but was glad to hear that Ethan is still in speech therapy because he is missing a few sounds he should have. She said he also speaks with a resonance that other children like him have.

Dr. Hopper the plastic surgeon gave him a look over and thought Ethan looked great although he wants Ethan to repeat his sleep study in July, which will make it 6 months since his last study to re-evaluate where his sleep is at that time.

Dr. Kifle the sleep doctor told us that Ethan still has sleep apnea, but it is much improved from the last study he did. She would normally want Ethan to use a C PAP machine, but agreed that if the other doctors are okay with him having another sleep study to evaluate, she would be okay with it too.

-Dina

Gong Hay Fat Choy!

Happy Year Of The Dragon!

- bob

Friday, January 20, 2012

Snow Week

Today was the first day since last Saturday night (which would be 1/14/12) that it *hasn't* snowed here in Kirkland, WA. Consequently, we had about a total accumulation of about a foot. This translated to me working from home all week (as the campus was actually closed all week) and that translated to taking the kids out back to play in the snow pretty much every day.

One thing they both *loved* to do was some downhill sledding. Because of the tiered nature of our backyard, it basically meant there were two slopes steep enough to do any sledding of any consequence (or at least, of consequence to a 2 and a 5 year old).

There were of course snow angels made, a snow fort built, many snowmen (and a snow Foster) built, and 'snow ball fights' - though not in the traditional sense - more of a snowball fight adapted to suit a 2 and a 5 year old. But the main attraction was, of course, the sledding.

And, yes - I actually did accomplish work during this whole week as well!

One interesting side note: Jonathan's actual birthday was last Tuesday (1/10/12) so we held his birthday party at Jump Planet for him and his friends last Friday, and his family party on Saturday. The snow held off exactly long enough for him to have both parties. Right after the family party, it began to dump snow incessantly.

(Pictures of the kids playing in the snow and Jonathan's birthday parties will be forthcoming in a followup post(s). Yes, I know we have been negligent in that area on this blog lately. )

- bob

Thursday, January 19, 2012

Gymboree Play and Learn Class

I finally took Ethan to try out a Gymboree Play and Music class this week. Auntie Elaine and Uncle Rob gave Ethan a gift card for a Gymboree class last year. Recently, there was a Groupon for a discounted rate at the Redmond Town Center and Bellevue locations. I couldn't pass up the deal because it also waved the $50 lifetime membership fee. Saving money all around!!!

I took Ethan to the Play and Learn #6 class for children 28-36 months. Unfortuntely, there is no class for his age group Mon-Thurs while Jonathan is in school, which would be perfect, so we went on Friday. The theme was "Firefighters". The equipment was set up so the kids could climb up and save a kitty, sleep in the firehouse, slide down the hatch, and drive the truck with a small hula hoop. They also got to pop bubbles with clackers, play with the parachute, sing songs, and read a story about a fire truck. The kids are encouraged to participate, but are not forced to and can go off and play on their own. Ethan participated in about half of the scheduled activities, which the instructor said was really good for a first visit.

Trying out the equipment.

Driving the truck.

Stairs. What balance!

Running across the bridge.

Take my picture mommie!

Sliding with a ball.

Riding the horse.

Popping bubbles with the clackers on a giant parachute.

I think Ethan really enjoyed himself. He didn't want to leave when the time was up, but after a time warning, he let me wash his hands and get a stamp. I signed him up for a month using my Groupon which gave us a huge discount and waived the $50 membership fee. Next month, we will use the gift card towards a second month if he continues to enjoy himself. Thanks Auntie Elaine and Uncle Rob!

-Dina

Wednesday, January 18, 2012

Another Snow Day

The week after Jonathan' birthday, we had the snowstorm of the century. The snow-pocolypse closed most school districts for the whole week including Jonathan's school and we were stuck in our house for a week. The morning after Jonathan's family party, we woke up to snow. Some days it snowed all day long, which is unusual here. The fun thing about this snowstorm was that both boys were really into playing in it and we played outside almost everyday, finally using the sled we bought in Canada last year. Our backyard is sloped and made for a great sledding experience. We also built snowmen, a snow Foster, and a fort. We even had an ice storm mixed in. When all was said and done, we had over a foot of snow. That much accumulation is extremely unusual for Kirkland.