Wednesday, December 30, 2009

Our Favorite (Dual Purpose) Toys

Christmas is over, and we are having a great time playing with the new toys and relaxing after all the business of the season. The boys loved all of their toys this year, and I especially loved the toys that are "dual purpose"- great for both play and therapy. While the boys inevitably play with each others' toys, I will separate the toys out by the child (and thus, age) they are intended for.

Here is my list of our favorite toys for Nolan (age 2):

  • GloDoodle: A drawing toy, which has the obvious fine-motor and creativity benefits. I also use it for several language activities. With the GloDoodle turned off, I draw a picture and have Nolan guess what it might be. Then I turn it on and we can see if the guess was correct. It glows, so we can use it on night drives as an in-car entertainment toy, too.
  • Blocks: We got a great set of unit blocks made by Melissa and Doug years ago. This year, we received the architectural blocks add-on set. Blocks might be the greatest language toy ever created. The great set of zoo Duplos we got also falls into this category- the language opportunities are simply endless.
  • Doctor kit: The ability to role play and set up a pretend animal hospital has endless language opportunities. Hopefully, this will also help alleviate his anxiety about going to the ENT's office and our pediatrician's office.
  • Shake and Go Race Cars: These cars are great. They're easy enough for Nolan to operate on his own, they go really fast, and are really fun. We can also count the number of shakes needed to make the car go, set up an obstacle course with our blocks, and race the cars side by side to get the concepts of "first, second, and third."
The best toys for Matthew (age 4) are:

  • Automoblox: These things are simply great. We got a three-pack of the "Automoblox Minis." To be honest, Nolan plays with these as much as Matthew. They're great for fine motor skills, spatial relationships, and that unending need for boys to take things apart. Matt doesn't have a language delay (articulation issues only), but we never pass up the opportunity to discuss positional words and to emphasize the /s/ sound on "wheels." I love these things. Simply love them.
  • Marble run: Another building toy- one that requires a lot of planning, fine motor, and spatial skills. As with any open ended building toy, there is a lot of talking going on while building the run. We pretend it is a roller coaster, we try to copy the patterns from the box, we come up with our own inventions. Nolan likes to drop the marbles in and watch them swirl around, but due to the obvious choking hazard, this toy is really designed for those in the 4-and-up category. We do get some frustration, as Nolan likes to play Godzilla and destroy Matt's intricate creations.
  • Tag reader: Matthew received the Tag system made by Leapfrog for Christmas. I love it, and he loves it. The computer-pen can read individual words scanned, or can read the story page-by-page. The books have games, and the pen records the child's skill progression. Currently, the books have placed Matt into the kindergarten (for reading) and first grade (for vocabulary) levels. There is an associated website that tracks your child's "learning path"- currently Matt's' vocab is off the charts (perfect scores on the games) and his decoding skills need a little work (considering that he just turned four last week, I'm not surprised). The only difficulty with this system is keeping Nolan's hands off of it. He's quite interested in it, but the system is really meant for the 4-8 year old set (meaning that 2 year olds won't quite "get it"). There is a Tag Junior system out there, but we figured we'd just wait another year and get Nolan the regular Tag system when he's old enough for it.

Wednesday, December 16, 2009

The Not-A-Hearing-Test Event

We got the kids bundled up and headed out to Buffalo Hearing and Speech Center, for a repeat hearing test. With the wax clear, we wanted to finally get a complete audiogram and confirm that Nolan's hearing levels have returned to their June 2009 levels.

This sounds like a good plan, but when the critical player is a two-and-a-half year old boy, the following scenario ensues:

"Nolan, point to the baseball."

Nolan points to the baseball (so far, so good)!

"Nolan, point to the ice cream."

Nolan throws a peg across the room.

"Nolan, point to the popcorn."

Nolan crawls under the table and pretends to take a nap.

Oh, goodness. I tried giving him a couple of raisins to get him back on track, but then he simply wanted to eat more raisins, or crawl on my lap, or do anything but point to flashcards.

We tried to shift over to getting some pure-tone results for his audiogram, and he could have cared less about the lit-up koala in the box. Normally, he loves those puppets. Yesterday afternoon, he wouldn't condition to looking at them at all. He stared at his hands, dropped toys on the floor, and became "noodle boy," where his limbs flailed around and he sank to the floor in a most dramatic way.

We get to come back on January 12 and try this again. Sounds like fun!

We are going to modify a few things on this next try. We are going to do the test at 10:00am rather than in the afternoon, to see if that improves his attention span. We're also going to do the test sans Mommy. The hope is that without my presence, Nolan will focus and listen to the audiologists a bit better. Our ENT really wants a full audiogram, so hopefully we'll be able to get one.

We were able to determine that his speech reception thresholds (SRT) were 45dB for both the right and left ear. This is good for the right ear, because that is only 5dB away from his June 2009 level (within test-to-test variability). So the loss in that ear was probably from the wax and nothing more. The left ear, however, used to have an SRT of 30dB, so this is a 15dB drop. With Nolan's lack of cooperation, we can't tell if it is a "real" drop or not. Without the pure-tone results, we don't really know what is going on with the little guy. His tympanogram also looked good: the right ear had a "Type A" and the left ear shows an open perforation (the hole from the PE tube hasn't sealed up yet).

Wish us luck for the January 12 repeat!

Monday, December 14, 2009

The Importance of the Middle Ear

We go to Buffalo tomorrow for Nolan's repeat hearing test. Hopefully the most recent loss of hearing was due to the wax in his ears. Kids with hearing aids for a sensorineural loss rely on a healthy middle ear to maintain reasonable aided hearing levels. Nolan has a relatively mild loss, but middle ear problems can cause his hearing to drop into the severe range across all frequencies. This is the primary reason our ENT wants to get those adenoids and tonsils out.

With every hearing test, our audiologist runs a tympanogram. This measures the mobility of the eardrum and can give an indicator of middle ear health. A nice, healthy middle ear gives a "Type A" tympanogram, with a nice peak to indicate the eardrum is functioning properly. I actually only have one tympanogram with this configuration- this example is from Nolan's right ear during a relatively fluid-free period of time. This was also shortly after his second PE tube fell out of the right ear.

Nolan's right ear: possibly the only normal tymp. he's had.

The second type of Tympanogram is a "Type B," and is flat. This can mean fluid, or a perforation. When Nolan's right ear dropped to a hearing level of 80dB in December 2008, his tympanogram looked like this:

Type B tympanogram in a very fluid filled ear

You can't see a peak, and the line is very flat. With no PE tube in place, this was bad news. This is what earned Nolan his second set of Pressure Equalization (PE) tubes.

Not all "Type B" tympanograms are bad. Nolan's healthy left ear always displays a "Type B" tympanogram, because it has an intact PE tube. A child with a PE tube will display a flat tymp. with a large Ear Volume. The volume lets us know that the tube is in place and functioning as it should. The tympanogram is a good way of checking up on the status of his tubes:

Type B tympanogram with a patent PE tube.

There is also a "Type C" tympanogram, which is what Nolan's right ear is currently displaying. This means there is negative pressure in the middle ear space, causing the eardrum to retract. I don't have a picture of this tympanogram, because it was done as a quick check-up at our most recent ENT appointment. Type C tympanograms can be caused by congestion, and sometimes mean the middle ear space will soon fill with fluid.

Hopefully our hearing test tomorrow will show a return to our June 2009 hearing levels. If we see a decline in hearing ability, a tympanogram will be run again to verify a healthy middle ear.

I have my fingers crossed for good hearing levels and a nice "Type A" tympanogram!

Tuesday, December 8, 2009

Buffalo: Round 2 (GI)

Completely unrelated to the post- just a gratuitous Nolan-cat picture

We went to the GI doctor today and took their scale for a spin- Nolan weighs a little heavier on the GI doc's scale, placing him on the charts! A heavily full diaper and thick, heavy clothes definitely make those weight numbers increase. The DuoCal is obviously doing its job, even if Nolan is back to eating almost no solid food. The GI doc agrees with our ENT that the reflux symptoms are definitely making a comeback, so she increased his Nexium to twice per day (still at the 10mg dosage). We get to go through the insurance battle all over again to get the dosage increased, of course.

Otherwise, he's looking good from a GI point of view. She wants to see him in two months to make sure the increase in medication level is helping. She also thought that his tonsils might be inflamed from a viral illness rather than reflux (I tend to agree, since he had a cold a few weeks ago). I mentioned the sleep study and she thought that was a good idea. I told her I wanted to avoid a tonsillectomy, but she said that a tonsillectomy/adenoidectomy might really help with the fluid-in-the-ears problem that Nolan frequently has. I was a little disheartened by this- I was kind of hoping she would say, "Oh, he's gaining weight and just fine! Don't worry about the tonsillectomy."

We'll take it as it comes- the sleep study will help make the decision for us. If Nolan's tonsils shrink back down in two months, we can nix the idea altogether. If everyone could send "shrinking tonsil" thoughts this way, I'd be much obliged.

The best news was when she whispered "Hey, have they gotten the H1N1 vaccine yet?" I told her that no, there was no supply in Jamestown.

Assuming the voice of what I would guess a crack dealer might sound like, she said, "I've got some vaccine. Quick, into the back office."

There is NO vaccine in the entire Jamestown area, and it is highly rationed. Being an immunologist as well as a GI doc, she just received a supply of 600 vaccine vials. This means that not only did both of my boys get the vaccine, but they will manage to get TWO doses of the vaccine. For fully effective immunity to H1N1, you need both shots- most people are only getting one. We see her in two months for a weight check and a check-up on Nolan's reflux symptoms, so we'll receive the second dose at that appointment.

The best news is that there will be no further trips to Buffalo this week. The next trip will take place on the 15th, for Nolan's repeat hearing test. Considering the huge lake effect storm set to hit us tomorrow, I am rather glad to stay at home!

Monday, December 7, 2009

Buffalo: Round 1 (ENT)

We headed up to the ENT this afternoon to determine if there was any fluid lurking behind the wax in Nolan's ears. With a flat tympanogram in the right ear, we thought some hidden fluid might be the culprit behind the latest loss of hearing.

The ENT looked in his ears, weighed him, and then took him back to clean out the wax. This is a very miserable process, involving a papoose board, a microscope, metal instruments, and some bleeding from Nolan's ears. I won't go into detail, but let's just say that it ranks pretty high on the "least favorite thing to do" list. His left PE tube had just fallen out of the eardrum, so she removed that, too.

His ears are clear, and there is no fluid. We're free to go to BHSC for the repeat hearing test on the 15th, confident that there is no cause for a conductive problem remaining in his ears. They did run a tympanogram, which showed a perforation in the left eardrum (from the recently removed PE tube- it is too small to see and should heal completely by the time of the hearing test). The right ear does show negative pressure, but they just "wait and watch" with negative pressure. Sometimes it means a fluid build-up is imminent, sometimes it just disappears on its own.

Of course, no ENT visit is complete without finding some new thing to be concerned about. Our ENT is concerned that Nolan's anti-reflux medication isn't quite handling his reflux. He's eating less, pulling at his neck more, screaming a lot. Also, he never sleeps (reflux parents, you know what I'm talking about). He's also snoring again and his tonsils are big.

The big tonsils and reflux/snoring issues worry our ENT a bit, because all of this can affect growth. We have managed to get his weight back to 24 pounds, 3 ounces with a lot of DuoCal, but we're not seeing an improvement of symptoms. Our ENT has ordered a sleep study to be done on Nolan, and if obstructive sleep apnea is found, a tonsillectomy and adenoidectomy will be recommended. I get to set up the "polysomnogram*" at my convenience, and we'll see the ENT again on March 1 for a follow-up. If his tonsils have decreased in size and his sleep study looks good, we can ditch the whole tonsillectomy idea. I really want to ditch the whole tonsillectomy idea.

She also sent a note to our GI doctor requesting a possible increase in anti-reflux medication. We see our GI doctor tomorrow, so this may happen fairly quickly. Now I'm preparing for Buffalo: Round 2 (GI). Time to charge that portable DVD player!

*I learned a new word today.

Thursday, December 3, 2009

An Open Letter to My Two Year Old

My dear, sweet Nolan,

While jumping down the stairs is entertaining to you, it is giving your mother a heart attack. Please hold onto the handrail and walk down the stairs from now on.

Also, while it sounds like the word "toy" is in toilet, I assure you this object is not meant to be played with. Trust me on this one.

The cat doesn't like playing "dinosaur chase." His tail is also not a handle. And no, the cat doesn't really want to eat your applesauce.

And, my dear boy, these precious little objects are not Legos:

And could you please tell Mommy where the other hearing aid went? Please?