Life with Luke (and his doctors!)

It has been so long since I last updated about Luke.  So much has transpired since.  First an update on all of his medical "stuff":

After Luke's appointment with his eye Dr. in January we decreased the patching of the right eye down to one hour a week.  At that appointment it was also noticed that he was in need of a new prescription.  Thankfully, our vision insurance has been wonderful through all of this, and they expedited our eligibility for new lenses, so Luke got those right away.  More recently we re-visited the eye doctor in April and received the good news that with his new glasses, Luke's vision is now 20/20 in both eyes!  She also decreased the patching even further, to just a few times a month for one hour and pushed out his next check-up to 10 weeks.

I found a new ENT specialist who will now handle all of his ear care (if needed).  She came highly recommended from Dr. Dugoni and is also at Lucile Packard Children's Hospital.  We met with her back in January and she had a good look at Luke's ears.  She thought that the ear drums looked healthy and as though they were healing well after the tube removal.  She also did not note any fluid behind the ear drums at that time, so suggested that we handle ear infections normally through Dr. Dugoni and come to see her only if they start to become recurrent again.  VERY good news!  A huge relief.  That being said, Luke had a great winter and managed to escape ear infections almost entirely.  The day after we returned from NJ, he did start to run a fever and complain of ear pain, but when I took him in his right ear was completely full of fluid, but did not appear to be infected.  He started on Claritin in the hopes that it would allow the ear canal to drain and would dry up any fluid.  Since then I have noticed Luke asking me to repeat what I say quite often, so I am concerned that that ear continues to be filled with fluid.  Although thankful that it isn't infected, I am concerned about his compromised hearing, so we may need to pay another visit to Dr. Dugoni and/or the ENT Dr. in the near future.

Now for the most exciting news:  Since the end of January, Luke has been participating in twice-weekly, one-on-one speech therapy with a wonderful (really, wonderful) speech therapist out of Lucile Packard, Miss Amy.  After Luke's initial assessment, she noted quite a few two-letter blends that he was substituting other sounds for that she determined necessary to work on.  So, Luke and I made the trek up to Menlo Park (NOT fun in rush hour traffic) twice a week to visit Miss Amy.  Despite the drive, I have to say that it was really worth our time and effort.  I can't imagine Luke loving his sessions or his therapist any more, and we were able to start seeing (hearing) results relatively quickly.  We practiced at home and Luke worked very hard ... and I am thrilled to say that after about 10 weeks of therapy, Luke was released on April 19th!   After taking a few weeks off, we went back for one last appointment to be sure that what he had worked on was being retained and generalized throughout his speech ... it was, and so we said goodbye and a very heartfelt thank you to Miss Amy (Luke was actually very sad to part with her ... I was not sad to part with the hours in the car two mornings a week).  We are incredibly proud of Luke and the progress he has made.
With all that aside, here's a bit about Luke and what he's like at 4 years, 9 months old:

He has gained some weight in recent months and is weighing in at almost exactly 40lbs.  Not sure on his height, but believe it is nearing 43".  He is now wearing mostly size 5 in clothing and size 11 shoe.  His food intake has increased drastically over the past few months - I suppose he was feeding that growth spurt.  However, he continues to be be the pickiest eater EVER. :(

Luke is very full of energy these days.  His brain is going about a bazillion miles a minute and he has a TON of information to share and questions to ask.  All. The. Time.  If he isn't talking, he can often be found singing, humming, or making other random sounds (whistling, squeaking, drumming, etc.)  Basically, unless he's involved with a task, he is not quiet!

He loves, loves, LOVES school (yay!).  He is always happy to go and gets excited when it's a school day.  He spends much of his time there playing with his best friend, Christopher (who he now refers to as "Chris").  Apparently they spend a good portion of their choice time at school in the sandbox, judging from the amount of sand that comes home in his shoes and pockets each day.  Luke has had the pleasure of being in Miss Sharada's small group this year and she was such a wonderful match for Luke.  She has worked quite a lot with him on his social skills, as well as really encouraging him to explore things that interest him.  As a result, we've seen his mathematical skills skyrocket (he's a whiz at addition, is starting subtraction, and has an amazing start at understanding the concept of multiplication - we can now see very clearly that he is very mathematical minded), and his reading skills begin to blossom (he is reading very simple rhyming words and sentences made up of such words).  Luke's end of year report card was very, very impressive - we were so happy to see the progress he has made throughout his years at Mandala (more on that in the coming weeks as our preschool boy "graduates!")

Luke continues to take weekly swimming lessons.  He is a "Sea Turtle" and is working on arm strokes while maintaining strong kicks (a bit difficult still to coordinate those for Luke), as well as roll-overs.  Luke is taking a break from soccer for a few months while we are neck-deep in tball, which he seems to really enjoy also.

Favorite things right now:
-swinging on the swings in the backyard (he's become an excellent "pumper" and is content to be out there and swing for 20 or 30 minutes alone).
-playing educational apps on the ipad
-Care Bears (that *might* be Mommy's fault)
-Building with legos or Daddy's old Construx (he can often be found doing this early in the morning before the rest of the house is awake)
-Helping cook in the kitchen or water plants in the yard
-Playing board or card games

Luke is still such a sweet, loving, affectionate little boy.  We are so, so lucky.  Aside from the difficulties he occasionally has with his sister, he is a very easy kid.  We love him to the moon ... and back.

Eyes, Ears, Mouth, and Nose...

I have been meaning to update on this for quite a while, but it never seems like we've reached the "end."  I guess I was trying to wait until we closed the book on some of these issues, but it seems like they are still ongoing.

So, here's Luke's update on all of his "stuff:"

EYES

Luke continues to do great with his glasses.  Really, he couldn't be easier or more relaxed about them.  He happily puts them on the in the morning, and wears them all day long.  Throughout the summer and fall we patched his right eye daily for 1.5-2 hours in an effort to strengthen that left eye.  At our most recent appointment last month (November 1st) we received the good news that the patching has continued to make a positive impact and that when wearing his glasses, both eyes are very close in visual strength.  This is exactly what we were hoping to have happen.  So, as of November 1st, we are only patching 3-4 days per week, and will likely be finished with patching completely at Luke's next appointment in January.  At that time he will also be re-examined for a new prescription.  All in all, wonderful progress.

EARS

Unfortunately, this is the thing that I was hoping we could close the door on, but it appears that we can't.  Luke had an ear infection just before we left for Cabo - his first of the season.  When I took him in because of drainage from his left ear, we walked out with both oral antibiotics and ear drops.  Poor guy - apparently it looked pretty bad.  The good news:  the tubes seemed to be working since he didn't have a ton of pain and there was drainage.  He took the full round of antibiotics, but I continued to notice blood in his ear for weeks afterwards.  I took him back in only to find out that the ear was still very infected and was referred to the ENT.  After then paying a visit to Luke's ENT, we now know that the actual tube (which was still in the eardrum) was infected, causing the continued bleeding.  The Dr. immediately removed the tubes from both ears (NOT comfortable for Luke on the side that was infected ... poor guy), and we will be visiting the ENT again for a re-examination of that eardrum once the inflammation is down.  Of course, we're hoping for the news that it is healing normally now that the tube is out.  In the meantime, I'm on the hunt for a new ENT.  I've never been super impressed with Luke's and now I'm noticing that he seems to have issues hearing me (now, whether that's a HEARING problem, or a LISTENING problem ... one can't be too sure!), so want to take him to have his hearing re-checked.  Ahhh ... the ear drama continues.  I'm keeping my fingers crossed for no more ear infections this winter.  Without the tubes in, he will definitely feel them again.

MOUTH .... well, SPEECH
The update on Luke's speech is that he was re-screened by the local school district in October.  The speech pathologist thought without scoring the test that he would end up being "borderline" on whether or not he would qualify for services.  So, as one option we were offered an interim 4 week small group class to work on specific sounds for kids with similar articulation issues to Luke.  I took him on the first day, and he completely blew us all out of the water.  Answered and clearly articulated every single word correctly.  Every. Single. One.  It was laughable.  SO ... apparently, he is able to articulate with some support, but it just has not yet become habit.  Needless to say, he did not qualify for any special services through the district and we didn't go back to their class.  In the meantime, Mandala (Luke's preschool) offered a speech screening through an outside company and I requested that he be tested.  Of course, their results indicate that Luke may benefit from speech therapy, so I may be looking into that further after the first of the year.  As a side note, Luke's scores for language skills overall (comprehension, vocabulary, expressive language, etc.) on the assessment administered by the school district placed him in the 97th percentile :).  No issues there!

Three and a half

Our little guy is three and a half. Time is flying. He is growing like a weed. His imagination and vocabulary are out of control. His naps are sparse. And we're more and more in love with him and feel so grateful to be able to watch him grow. Here's the mid-year recap on Luke:

The first half of 3 was "challenging," as many told me it would be. Several mommy friends warned me. I wasn't sure that I needed to worry ... I did. I can't put my finger on exactly what was the challenge. I guess because it was just EVERYTHING. Luke spent several months testing all of the limits and just being difficult in general. The good news is that we seem to have come through it and for the past few weeks he has been the most pleasant, agreeable, patient, kind boy. I hope that boy hangs around for a while :)!

Imagination and make-believe are the main parts of Luke's days. He LOVES to pretend. He has all sorts of scenarios playing out at all hours of the day. Some involve real people and real things, others involve things and characters that are most definitely not real (the pack of 10 dogs and 10 cats, for instance, who apparently live in our storage loft). Sam, Luke's pillow pet, is also a main player in all of the make believe. It is pretty cute and amazing to hear some of the stories that he comes up with ... then again, I don't find it quite so "cute" when he blames the shove that he just gave his sister on Sam.

After meeting with the social worker at Luke's school in November, we have completely figured out the potty situation. We basically gave the potty power back to Luke (since he had it all the time anyways) and it essentially "fixed" the accidents that he was still having. So, I can now say with complete confidence that he is potty trained and hasn't had an accident in 2 months! Woo hoo!

He's still the pickiest eater I know. In fact, things that he used to like have started to fall of the list - leaving an even shorter list of Luke-approved foods than before. I've decided that I'm giving Luke the power back on this one also (after all, he's in control - I can't force him to eat anything). So, I cater most meals to his tastes, adding in a non-approved food from time to time just to expose him to it. I sneak vegetables into fruit dishes and juices. Whatever ... hopefully he'll grow out of it. In the meantime, his growth is right on track....

Speaking of which, he seems to have grown a tremendous amount in the past month or two. I have no idea how tall he is, but I took one look at him a few weeks back and was shocked to notice that his 3T shirts are no longer fitting. They are all too short in the torso and arms. Amazing! 3T pants still seem to fit well. As of this month Luke weighs 34lbs.

Napping has been slowly dwindling down. For a while he was "resting" and falling asleep on most days, but we're down to a real nap about 1-2 days a week now. He takes a "rest" everyday from about 2/2:30 - 4:00, which means he's in his bed during that time with some books. The nice part of him not actually sleeping is that (after a short period of complete insanity before bedtime) he is 100% ready for bed at 7pm. He doesn't complain and there are no late-night antics. He just passes out immediately. :)

In terms of health - he's been relatively healthy this winter. Only one ear infection! One tube is out (right ear) and the other is still in. We'll just see how he does, but we are optimistic. Luke's speech sounds to us like it has improved dramatically. Most people seem to understand what he says the majority of the time. We'll double check with his teachers next month during our conference, but I'm hoping that he has made some progress and will continue to do so until he has caught up with his peers. He's at no loss for vocabulary! Some of the stuff to comes out of his mouth amazes me. This month his teachers at school did notice Luke having some trouble focusing his eyes and one of them wandering a bit, so he will be seeing a pediatric opthamologist in a few weeks to have them looked at.

At 3 and a 1/2 Luke has a full schedule - school 3 mornings a week, a pre-soccer class/program on Tuesday evenings, and swimming lessons on Thursdays. Although there are times when he tells me that he doesn't want to go (his favorite thing to do is to stay in his pjs all day long!), he really loves all of his activities once we get there. He's becoming more social at school, but overall is still pretty quiet in a group setting and takes a while to warm up. I say he saves all of his talking for Mommy and Daddys' ears!!!

What a sweet, sensitive, energetic, curious, loving, imaginative, silly, cute boy we have ... so lucky!

Luke's speech follow up

Just a quick update post our IEP meeting with the local school district regarding Luke's speech/articulation issues...

In short, he does not qualify for services as of now. Apparently, in order to qualify, children need to test about 6 months or more delayed, and Luke does not at this time. That being said, their requirements at age 3 are pretty minimal, so it is likely that if his difficulties with articulation continue, he will qualify at 4 years old.

We also have a lovely neighbor who is a speech pathologist and who screened Luke when he was 2.5 and offered to screen him again in about 6 months. Based on her findings, we may pursue some private speech therapy.

What ALL of the "experts" who have met with Luke have said is that he has an amazing vocabulary, advanced sentence structure and phrasing, and an above average attention span for a boy his age. They all seem to agree that his articulation issues stem from that period of time when he essentially lost a good portion of his hearing due to ear infections (from about 15-21 months) until he had the tubes placed in his ears. That time frame is essential for the language and speech development in kids, and Luke missed out on that due to the fluid behind his eardrums. :(

Our hope (and the hope of the speech therapists who worked with Luke recently) is that his speech will continue to develop and catch up over the next 6-12 months.