Kate's Bone Graft, Part 1

Kate's bone graft really wasn't on our radar last year. It was something that the doctors said she would need when she was about eight, so although we knew it was out there in the future, we didn't spend too much time pondering it.  However, that changed when we saw Dr. N. at the Commission back in November. He wanted to go ahead and get X-rays of her mouth, so that he could track the growth of her mouth and determine when the surgery would be.  Dr. N. is an oral surgeon who has worked with Kate's (now retired) plastic surgeon for 30 years.  I asked him once what the likelihood of a bone graft failure was, and he told me that he had one fail once.  Once.  OK, you get the job. 

Kate is missing her left lateral incisor - aka, the tooth that doctors sometimes use to decide when to do this surgery. Because of this, there was a wider window of time to get it done.  Dr. N. said that either the summer of 2013 or 2014 would be fine, or even later if we needed to wait for whatever reason.  We went home that day thinking 2014 sounded fine with us. Or later.

Then in the spring a couple different things happened that caused us to start reconsidering.  First, the central incisor started coming in at a weird angle.  And when I say weird, I mean it was pointing straight out and the bottom edge was vertical and pressing on her lip.  Thankfully it has now started to rotate itself down into a better position, but it still has a way to go, and it irritates her upper lip.

Second, the other three lateral incisors started to erupt, meaning that her jaw was close to the right stage of growth for the bone graft to happen now.  This was surprising since Will still has one of his baby lateral incisors, and at the time this happened, he had two or three.

Third, one day at a visit to Jack's plastic surgeon, Dr. L. was making small talk with Kate and got this look on his face that meant he noticed something.  He asked her to start making faces (lip puckers, etc.), and according to him, all of Kate's upper lip muscles aren't properly connected.  That was news to us, since her (now retired) surgeon never mentioned it.  So I started making appointments and asking questions.  Within a very short amount of time we saw the other members of Kate's plastic surgery team (who thought there was no muscle issue but wanted to do some work to minimize the scar - I said no; they also said that they would work with either Dr. N for the bone graft, or their ENT for an ear drum repair, but not our ENT), an orthodontist (who said he would normally do a palate expansion on a child getting ready for a bone graft, but wasn't going to touch that front tooth with a ten foot pole because it could fall out if we start shifting things around), her ENT (yes, we can do her ear drum repair when we do a lip revision; no, we can't do an ear drum repair when we do a bone graft), and three different speech therapists (who all agreed with Dr. L., something was amiss with that front lip).

By this time it was May of 2013, and honestly it was too late for a summer 2013 bone graft, what with vacations and all (ours and Dr. N's).  Plus, was had to make decisions about which surgeries to do and which ones could/should be combined.  I consulted with Dr. L through all of this too, even though he has never seen Kate as a patient.  I decided to wait until summer 2014 so that she would have time to heal, and I would have time to mull over the choices.  There was no reason to rush.

As we considered, the decision was made to have Dr. N. do the bone graft, and then later, after she was healed we would have Dr. L do a major lip revision while Dr. M (ENT) do a ear drum repair at the same time.  Three birds with two stones.  

As summer rolled by, I became more and more thankful that I hadn't scheduled a bone graft.  Talk about busy!  We didn't slow down at all, and as per usual, we barely saw Tim except on vacation.  Also as the summer rolled by, I realized that there was no way I could schedule a bone graft for next summer either.  It wasn't going to be any better!  I knew he was suggesting summer because it is when lots of people's lives slow down, but let's face it, we aren't "lots of people."

I called Dr. N's surgical coordinator in August to discuss the possibility of doing it over fall break instead.  She suggested the Thursday before break, and then Kate would have eleven days to recover before school resumed.  Mimi could come up and care for the boys, then they could be farmed out when we got home from the hospital on Friday.

And that is what we did. 

(Stay tuned for Part 2.)

Smarty Pants

Jack continues to blow us away with that sharp-as-a-tack brain of his. He doesn't miss much.

He has this Leap Frog toy called a Text and Learn that Aunt Sally gave to Kate years ago.  When we brought Jack home we pulled it out for him.  He loves to play with phones, ipads, and anything electronic, so we needed a toy to occupy him in the car and at times when his brothers and sisters want him to stay away from their stuff.  It is a simple little thing with a small screen.  Nothing fancy.  The best game on it has bubbles that rise up with letters on the inside.  The game says the letter, and when you type it in, the bubble pops. 

So we were at the Olive Garden the other night, and they always give kids those menus with pictures and games on them.  One of the games had a series of random letters.  Jack points to the A and says, "A". 

Whoa.  Yes.  That is an A.  And then he does it with the L, M, and O.  That was as far as he could go, so I asked him where the T was, and he pointed to it.  And then the same thing again with the N, I, and a couple more.  He knew every letter on that thing.  Pretty good for a kid who has only heard the English language for eleven months.  And is only 2 1/2.

And have I been working with him on letters?  Nope.  Well, maybe the M because he has a race care with M&Ms on it, and I often point that out, but other than that, nope.  I didn't even know he knew how to play the Text and Learn game. I thought he was just pushing buttons for fun. 

Further, Jack said his first complete sentence today.  I asked him who poured him his milk.  He said, "Dat Nang oo it."  Translation: "That Dad do it."  Yes, I am aware that it isn't the most grammatically correct sentence ever, but I give him big time points for putting four whole words together.  This boy will do anything he puts his mind to.  Just watch him. 

Jack and the Hearing Saga

When we first saw Jack's file over a year ago, it was noted that he had severe/moderate hearing loss.  At the time we had two thoughts concerning this.  First, it was probably conductive loss related to his cleft palate.  If so, a good set of tubes might go a long way in helping him hear. (As one of Kate's doctors told me once, it is hard to hear with tapioca pudding in your ears.)  Second, even if the loss is permanent we have lots of resources to help a child with partial hearing loss.

So, we started the process and honestly did not give a lot more thought to his hearing loss. It was one of those We Will Cross That Bridge When We Come To It kinds of things.

Fast forward to last April when we met him. We had some indication that there might be loss.  For example, he is really loud.  No really. He is loud. Also, (unlike Kate, who also had moderate hearing loss) he had no connection with his Chinese name, even when spoken by people at his orphanage.  Was it because he couldn't hear or was it that they just never called him by that name?

Within a few days though, we noticed he was easily turning his head towards all sorts of sounds, and he was responding to the name Jack. This confirmed - for us anyway - that his loss was moderate at worst, not severe.

Once home our regular audiologist (#1) confirmed this for us again through a series of tests.  However, everyone and their mama thought we still needed to get a sedated ABR hearing test to further nail down the type and severity of the loss.

Remember all of the rigamaroll I went through to get the ABR?  Blech.

So in August, after his tubes were placed but before Dr. L repaired his palate, an audiologist (#2) came in and performed an ABR.  I was so confident that his hearing would come back with minor or no loss that I didn't give it a lot of thought.

Except that isn't what the report said.  The audiologist (#2) (who I had never met before) told me that Jack had moderate/severe sensori-neural loss and that he needed hearing aids immediately.  That he wasn't hearing well enough that he would ever learn to speak without aids.  Honestly, it was a punch in the gut.  I cried for quite a while before I felt ready to go back into the waiting room.  In my head I knew that this was a possibility, and I thought I was prepared for it, but the reality was a lot more painful.

Tim and I together decided we weren't ready to share this news.  Keep in mind that we were still dealing with the fact that our 2 year old was in surgery.  And for my part, I knew that I needed to get to a point where I wouldn't cry every time it was mentioned.  The last thing Jack (or I) needed was pity.  We needed resources and strength.  Jack would need the confidence to know that hearing aids would not slow him down or stop him from anything he wanted to accomplish in life.  It had to be no big deal.  And honestly I wasn't there yet.

We went in to see our regular audiologist (#1) a couple of weeks later.  Immediately, she questioned these results.  She questioned the type and severity, maintaining that Jack's loss was conductive and minimal, and she tested him again.  Over the course of the next few months she repeated those tests more times than I could count.  I carried the results to pediatricians and ENTS, looking for answers to these conflicting reports.

In the meantime, Jack was starting to talk.  He said the word ball.  Daddy. Wah (water). And one night I was putting him to bed.  It was pitch black in the room, and we were whispering to each other. He would say, "Mama," and I would say, "Jack."  Back and forth we went. And then I said, "Time to sleep, Jack." And he rolled over and went to sleep.

I know some of you are marveling that he listened to me, but I was marveling that he heard me! I whispered!

I went in to see audiologist #1 and told her, and she cried. I love that woman.

Then last month Dr. T, the international adoption doc, suggested we see her friend who is an audiologist (#3).   I had been considering a third opinion from the place this woman works anyway, so I was game.  They got us right in, and audiologist #3 did a series of tests and then says, "Jack has normal or near-normal hearing.  He does not need aids." And I cried again. I asked, "How could this other, supposedly objective test have been so wrong?"  And she explained to me how the instruments can sometimes get covered in the blood and other fluids present in a surgical situation, thereby making them inaccurate.  It wasn't anyone's fault. It just happened.

And so here I am, considering all of this.  I am extremely grateful that his hearing is fine, not only because I am a normal parent who wants their child to have normal hearing (even though I was perfectly willing and able to parent a child with hearing loss), but also because now we only have to have hearing checks a couple times a year. Which is really great, considering my recent complaints about frequent doctor appointments.

But through this process I have also thought a lot about what it would mean to have a child with something the rest of the world considers a disability.  I have given a lot of thought to parents who want their child to not be seen as a deaf child, but a child who happens to be deaf.  Do you see the distinction?  They don't want the emphasis to be on the deafness, but rather on a child who has infinite possibilities for success in his life.

This is another post without a neat bow.  I am thankful for Jack's hearing. I have twice been given the gift of a child whose hearing loss was restored.  (And twice the gift of children who have no hearing loss but severe selective hearing loss, iykwim.) I guess what I am saying is that maybe when I hear a child has a diagnosis, I will think twice before saying, "I am sorry."  Not that there isn't a time and place for I am sorry.  There is.  I just know that it wasn't something I wanted to hear. I did not want anyone pitying my son, who is one of the smartest kids I have ever met. (He is starting to recognize letters.  He is 2 and has only heard the English language for the past 8 months, 4 of which his ears were full of tapioca pudding.)  He is going to do amazing things, and it has nothing to do with how well he hears.  Next time I will be more likely to look past whatever the child has, and see the child's potential.  That is what is best for the child.  And for his mom.

Appointments, Part 6: Speech

Please forgive my lack of posting.  We have been on vacation, and I am still trying to find our new out-of-school norm.

I mentioned earlier that our state's Early Intervention folks had done an evaluation on Jack, and there was one area that he qualified for services: Speech.  He has almost caught up in every other area, but his speech is very slow in coming.  I get a lot of questions about Jack's speech, so I figured that this would be a good place to answer some basic questions.

Can he speak English?

This one gets an eye roll out of me every time.  No, he can't speak English.  Most 21 month olds that I know aren't exactly fluent, ya know?

How will you teach him English?

The same way every English-speaking parent teaches their baby English - they talk to him.  Children learn to understand new languages amazingly fast.  That's why people should learn second or third languages as small children instead of as adults or teenagers.  (But wait, that's another rant of mine.)

Can he speak Chinese?

Nope, he can't speak Chinese either.  The thing is, he doesn't speak.  He babbles.  Because of his cleft palate (the big, gaping hole in the roof of his mouth that goes up into his nasal cavity) he cannot produce most consonant sounds.  He can't make the puff of air he needs for some sounds.  Couple that with the fact that he hasn't been encouraged to babble and play with his sounds.  You know how parents copy their baby's sounds and go back and forth being silly?  This teaches the child to explore their sounds and to imitate words.  But Jack is just now experiencing that.  So, he can say, "Ah gah!" and "mamamamamamama," and "Uh-oh!" and "Ow!"  That is his current favorite repertoire.

Will he ever learn to talk?

Absolutely.  We are starting off with an hour of speech therapy a week.  Melissa comes to our house and basically plays with Jack and me.  She points out positive things he is doing and models exercises for us to do.  For example, this week she wants us to repeat the random noises he makes and get really silly so he will be encouraged to repeat the sounds that we are making.  It's actually really fun, and Jack gets crazy giggly. 

We are also working on teaching him sign language so that he will be able to start communicating his needs with words instead of tears.  Last night in the grocery store he signed milk when we walked past the milk and pizza when we walked past the pizza.  And then we both got crazy giggly.

(Have I ever mentioned that a great place to have a conversation with an infant/toddler is in the grocery store?  You can get lots of eye and skin contact and teach them tons of new stuff, while entertaining the other shoppers at the same time.  Yes, they will stare at you if play peek a boo with your baby while you pick out tomato sauce, but it will also make them smile really big, which most tired shoppers need.  Consider it your contribution to making your town a happier place to live:)

So, to sum up, Jack is right where we expect him to be right now.  He is exploring sounds.  He is trying to imitate us some.  He is starting to use signs.  He's a smart kid.  And he is awesome like that. 

Posts (so far) about Jack's cleft/developmental/IA issues:

• Let the Appointments Begin!
• Appointments, Part 2: Audiology
• Appointments, Part 3: Plastic Surgeons
• Appointments, Part 4: The Dentist  
• Appointments, Part 5: Early Intervention

Posts (yet to come) about Jack's cleft/developmental/IA issues:

• ENT (and probably more audiology)
• Plastic Surgeons...Again (maybe)
• Surgery

Appointments, Part 5: Early Intervention

A couple of weeks after we got home from China, I took Jack to see the pediatrician at the International Adoption Clinic at the nearby university hospital.  As part of the work-up, an OT came in and did an assessment of Jack. 

At the time, she and I talked about how Jack's walking had largely improved since I met him, but how he ran with his arms extended for balance.  And how he had recently learned to put rings on the yellow cone, and go up and down stairs holding an adult's hand, but he still lacked a pincer grasp, and he couldn't lean down and pick things up without falling over.  At the time, she indicated that if evaluated for Early Intervention that day, he would qualify for both physical and occupational therapy.  We discussed how I fully expected him to continue to improve quickly over the coming weeks, but if he didn't continue then I should push for OT services with someone who is also skilled in gross motor development.  She gave me some exercises to do, and off we went.

In the meantime, I had been trying to get Jack enrolled in Early Intervention.  At first, they qualified him based on his severe hearing loss.  Except, after we saw the audiologist we realized that he didn't actually have severe hearing loss, and therefore no longer qualified based on that.  And so we had to start over with a thorough evaluation of several different developmental areas.  When I filled out the questionnaire, he failed every single area. 

Two weeks ago, Ms. Teresa came out to do the evaluation.  This was 10 days after the questionnaire.  Two weeks after we saw the OT.  And he did totally awesome.  His walking - while still not developmentally at 21 months - had improved even further, and we have no reason to think it won't continue.  His grasp has gone from a full hand grasp to a fingertip grasp.  Still no two finger pincer, but it will come. 

He did things that I had tried to teach him only days before, but at the time he hadn't figured out.  He could put long pegs into the tiny holes on the first try.  He could put wooden shapes into the puzzle.  He could drive the Little People car.  He could sit on a riding toy and push with his legs. 

In other words, he is learning even faster than I thought. 

But of course, there is one area in which he did qualify for Early Intervention - speech.  But that is a post for another day:)

Posts (so far) about Jack's cleft/developmental/IA issues:

• Let the Appointments Begin!
• Appointments, Part 2: Audiology
• Appointments, Part 3: Plastic Surgeons
• Appointments, Part 4: The Dentist 

Posts (yet to come) about Jack's cleft/developmental/IA issues:

• ENT (and probably more audiology)
• Speech (even though this is part of EI, it will get it's own post)

Appointments, Part 2: Audiology

This post started out as a full description of all the the specialists we have seen so far, but I quickly realized that it would take a couple of hours to read it all, so I better break it up a little:)

We spent yesterday morning at the Commission's cleft clinic.  We have done this more times than we can count with Kate, but for Jack it was a new experience.  Thankfully it went very well.  And so there is good news, and there is bad news. 

First, the good news.

We saw Kate' regular audiologist (who is now Jack's audiologist), and she did an evaluation, even though Jack's ears are full of fluid and infected.  She told us that she feels like with tubes, Jack has a great chance at completely normal hearing.  We are absolutely thrilled with this news.  She said his loss is probably mild/moderate and told us to come back when his ears are infection-free for a more accurate test.  She also requested a sedated ABR to be done during the palate repair. 

And now for the bad news. 

Jack's enrollment in early intervention was based on his hearing loss being severe in his left ear.  A diagnosis of mild/moderate hearing loss means that he no longer qualifies for services based on his hearing loss.  When Kate was enrolled, cleft palate was considered a significant enough issue to get her in the program, but it no longer does.  (I would love to know how many cleft kids don't need speech services, for Pete's sake.)  And so now I have to start from scratch and get him qualified another way.  Basically it has to be proven that he has significant development delays to get the speech therapy that he will obviously need, even though he is very young and the delays aren't that serious yet.  Should be fun. I am eagerly awaiting the paperwork to get the ball rolling on that. Hopefully his expressive/receptive speech delays will be considered significant enough, because I don't think his motor delays alone will be.

The OT we saw on Wednesday had warned me about this.  Unfortunately, budget cuts mean that they have to find ways to cut services for kids who need them.  She said that I will have to fight for services that they automatically would've offered to Kate.  That's ok.  I am pretty good at that.  Y'all remember how much I love arguing with navigating insurance companies, state-run red tape services, and healthcare providers? Actually I take a sick pleasure in conquering it, but that is probably a post for another day.

School's Out, School's Out

Yes, I know I should have posted this like three weeks ago or something, but for some reason, I can't get any writing done with 3+ kids in the house. Of course, it could've had something to do with some new books I was reading (ok, obsessed with). And the one week that the kids were at the grandparents' and I could write? My computer crashed. So, yeah, my writing took a back seat. It happens.

But back to my topic: School's Out!

I know I am supposed to say, "I can't believe another school year has come and gone," but that would be a lie. Because I think this was the longest school year ever. Between my babysitting schedule, the homework assignments that never seemed to change, and a desire for warm weather in all of our hearts, we would have to say that summer was way over-due.


It would, however, be true to say that I can't believe how much my children have grown and learned this year.

Kate NaNa has now decided she is Kate. Not Kathryn. Not Katie. Not NaNa. Not any combination of the above. Just Kate. I am sure it is a phase, but if I use anything else she asks, "Why are you calling me that?"

Her end of the year program was a on a day that I was working, so Tim, Will, and I took Mr. O, Mr. A, and Miss O (ages 1,2,&3) to hear Kate sing. You can tell by the photo how thrilled she was to stand up in front of a crowd of strangers and sing about jungle animals.

"You want me to do motions? You have got to be kidding me."

Her certificate stated that she wants to be a firefighter when she grows up. I assumed that she picked that career because it was the first one she thought of, but I could be wrong. In the past few weeks she has told me no less than a dozen times how she and her friend, Vanessa, are both going to be firefighters and live at the fire house. I suppose we shall see.

Her teacher and SLP both raved about how far she has come in terms of her ability to communicate with adults and peers. Plus, on her report card she scored "Mastery" in every single preschool skill. She asked if that meant she could go ahead and go to kindergarten next year since she already knows everything. It's a wonder she Will don't share genetic code.

Speaking of Will, he wrapped up his kindergarten year, receiving the "Loving to Write" award. He is reading easy reader books, and carries around a stack of Wimpy Kid books everywhere he goes, just like his brother.

He is still a huge help to me with the small children. When they are sad, he cheers them up. When they are thirsty, he finds their sippy cup. They adore him.

Ben didn't have an end-of-year program, so I don't have any photos, but he is still reading and writing and drawing comics like crazy. He got the "Whoppers Award" for his class. That means he loves to make up and tell stories. And no, in this case that is not a euphemism for big fat lies. He still wants to be an author when he grows up. He will be a third grader in the fall, and is obsessed with Transformers and Star Wars, as he should be.

And now is the part where I am supposed to talk about how we have two whole months to relax and do nothing, except for the fact that we are down to about six weeks of vacation. But I plan on squeezing in as much relaxing and doing nothing as is humanly possible. Wish me luck.

Two and a Half Years Ago

It amazes me that this is how long I have known my daughter.

Some days it feels like she has been here much longer. She is so intertwined with my heart that surely she has been here forever. Other days, it feels like the time has flown. Wasn't it only yesterday that I held this little toddler who cried until I gave her back to Baba? Surely it was only a few months ago (years?) that we turned onto our street and heard that sweet deep voice say "home" for the first time.

I have gotten out of the habit of posting updates because there is very little "adoption" or "special needs" stuff to post about anymore. She is my normal, four-year-old daughter, who still goes to speech therapy and still says, "Rock, Mama," before bed. But I still feel the need to record her progress, if for no other reason than to say - Look how amazing my girl is! School/Speech Issues:
Kate is now attending preschool three mornings a week. She even rides the bus home every now and then, which she thought she would totally love, but it turns out it is only ok. She is unbelievably smart. She can write her name with amazing penmanship, holding her pencil better than her brothers do now.

Her class has several other kids with speech issues, and so the speech and language pathologist spends a lot of her time in the classroom working/playing with groups. This works out well for us, because it means the speech teacher interacts with Kate NaNa more often than she would if Kate was just getting her 30 minutes a week required by law. I can see (and hear) the progress - I am with her so much that sometimes I would be oblivious if I didn't intentionally slow down and listen for it. But it is definitely there.

Cleft Issues:
At our last visit with the plastic surgeon (December?) he was very pleased with how much Kate's cleft had healed. The lip was repaired in China, and he did the palate in January 2009. There is still a good-sized hole in the gum line that won't be repaired until she is about seven years old. It is an impediment to some speech sounds, but mostly it just bothers her when she has a runny nose. (Guess where the snot goes.) She has totally conquered the straw, which I had worried would never happen. It turns out chocolate milk at school is a wonderful motivation.

Hearing/Ears:
She is on her third set of ear tubes. Hearing-wise, I noticed a couple of months ago that she wasn't hearing 100% (she has some very minor hearing loss, but this was something more), but I also knew that there was so much wax in those little ears that she couldn't hear a mac truck. The ENT cleaned out her ears at the last visit (which was very tear-filled), and I have seen some improvement, although I think it may be time for another visit to the audiologist. Amazingly, she only had one ear infection this winter. Her left tube fell out back in the fall, and the right ear got a little infected a few weeks ago, but I was able to treat it with some drops.

*Update 4/16/11 - She was diagnosed with an ear infection in the left ear today. Last night she spiked a fever, so that's how I figured out there was something going on. The doc said it was "bulging really bad." I have a feeling that she had it two weeks ago when we treated the right ear, but she doesn't feel any ear pain, so we didn't know the left ear was affected. I'm frustrated with myself for missing it.
Attachment/Adoption Issues:
Currently we are having no attachment issues. (Can I get an amen?) She has appropriate separation behaviors (she is ok with me dropping her somewhere and happy to see me come back), when something is wrong she comes to me for help, she has learned to trust me, etc. I think I am creating an environment where she feels comfortable talking about her story and asking questions.

For example, I talk to her about China and adoption, and I bring up her first mother and foster mom occasionally. She doesn't usually have a lot to say when I do, except to get really excited about China, but she has started figuring things out. And she asks questions, like, "Mama, when did Mimi go to China to adopt you?" which led to an explanation of birth and adoption. Another question she asked recently was, "Mama, how did you carry two boys in your tummy?" which of course led to an explanation of what twins are and how her brothers aren't twins and what happens when babies are born. (Thankfully she hasn't asked how babies get into tummies yet.) These are all normal questions for a four-year-old, so I am glad she feels good about asking them.

Sleep Issues:
I used to roll this over into adoption issues, and I suppose I still could, technically. But now the issues seem to be age-appropriate rather than clingy/needy/grief-filled behaviors. She now goes to sleep in her own bed without us in the room. This is huge, people. However, about 2am, she gets out of bed, creeps into our room, and crawls into her pallet. We find her there the next morning. Will used to do the same at this age, but he decided his bed was much better than a quilt on the floor. She would rather be near us, and that is ok. She told me a couple weeks ago that, "It's not fair, because Ben gets to sleep next to Will, and Daddy gets you, and I don't have nobody!"

Siblings:
Well, they are siblings. I probably wouldn't feel the need to even address it here, except for the fact that I still get asked if they get along or not. I don't know--do your kids get along every waking moment? They fight and make up and pick at each other and love each other stick up for each other and tattle and all of the things that all brothers and sisters do. Regardless, they just love each other fiercely.

She is bossy and sassy and shy and hilarious and cuddly, and she calls me out for being mean on a regular basis. Mostly I am just amazed at how resilient and brave and creative and amazing my Kate NaNa is. I am so thankful for you, baby girl!

Biking

Kate has been asking to "go biking" for months. And for months I have said, "Honey, it is just too cold for biking today." But today it was about 60 degrees out, and again, "Mama? Can we go biking?" (And every. single. time. she says it I am amazed at how perfectly she says it. Wow.) I asked if it was ok for us to wait until half-time (it is March Madness, after all), and then we went out.

She rides on a big trike, kind of like a Big Wheel. I've let her try out her brother's bike with training wheels, but frankly, it doesn't go fast enough for her. She can really move on her trike.

We went to a street in the back of our neighborhood where there are only a few houses and about three blocks of wide open street. Will and Ben also came along on their bikes. My brother Jacob started teaching Ben to ride without training wheels last spring, but then he went home, and honestly, I am a terrible teacher. And what with me working and Tim being gone most of the summer, Ben never really figured it out. But he was this close.

So today we practiced his riding. Within about two minutes he was off and riding by himself. He made great progress with his balance and steering. I was so pleased, because there is a strong possibility he has my sense of coordination, which is ridiculously lacking. I plan on teaching Will this spring/summer too, and I have the same fears with him.
At one point I was holding the back of Ben's seat and giving a little push, when Kate went flying by on her trike.

As she passed, she shouted, "See ya later, chumps!"
I have no idea where she gets this stuff.

Kate's First Day of School

Just to prove to you all that I haven't dropped off of the face of the earth, I thought I would share about Kate's first day of school. As you know, she had been eagerly waiting for September to get here so that she could be a big kid too. So last Wednesday the day finally arrived.

She picked out her own clothes, with matching orange socks and orange bow.

And she and her Daddy headed out on their annual First Day of School Breakfast, where she happily feasted on pancakes and chocolate milk.

When I picked her up, it was obvious that she had had a great morning and was really happy to see her friends and teachers again. She was grinning ear to ear and ran to meet me.

But when I got her in the van and asked her how it went, she put on her pouty face and said, "I didn't get any homework!" Yes, my daughter loves homework. She asks me every night when she will have homework, and doesn't understand why the teacher only assigns it (usually a story book to read together) on Mondays. My mom says I have to remind her of this in about 5 or 6 years.

A few days later I got a call from the special ed coordinator at her school. She didn't personally know Kate, but she was making rounds with Miss Julie, the speech and language pathologist who does know Kate. She said that Miss Julie's reaction to Kate's progress this summer was, "Wow!" You better believe wow! Learning to raise her tongue has only improved her ability to make sounds and words, and we are very excited about her progress.

And another plus of preschool, Kate is finding new ways to practice her sounds. Apparently one of Kate's new classmates is named Vanessa. So she spent most of Wednesday afternoon singing, "Banessa Banessa Banessa Banessa..." You get the idea. I asked her if she liked that name, and she giggled and said she did. Then she went back to her song. And the best part is that occasionally you can hear the V sound on the front of Banessa. Because of her under bite, that's a tough one!

Ahh, I love back-to-school time.

How about a little joy for a change?

After yesterday's post, I felt the need to write about something more positive. Last night as I was going to bed, I considered. What is something that is really great right now, something amazing? And I realized that I can't remember the last time we had any "steps back" with Kate NaNa. You know, two steps forward, one step back? Well, we have had a lot of steps forward here lately, but I can't remember the last backwards one.

That's not to say that parenting her is without issues. She seems to have skipped over the terrible twos in favor of the sassy threes. She gives me attitude, and lots of it. Sometimes I hear words coming out of her mouth, but they sound like something Will would say (who spent about 3 years in the terrible twos/sassy threes, and still likes to visit there occasionally). But she usually responds very quickly to requests for appropriate behavior, and behaves a whole lot like my other two.

She is becoming more and more cuddly, coming up and giving me unexpected hugs. She tells me several times a day, "I love you, Mommy," without my prompting. She is even making huge strides with her Daddy. She still doesn't like it when he goes to work (she wants all of us together, all the time), but she greets him happily when he gets home. And last night when I told her Daddy was putting her to bed, she smiled and said, "I love him." Only a month ago that would've gotten a grumpy face and crossed arms, if not a full out cry-fest. She has settled in to our family so beautifully.

Kate NaNa is pure joy to parent. She really is.

And as for medical/speech issues, they continue to be less and less of an issue in our daily lives. He speech is now clear enough that most people can understand her, as long as they pay attention. She continues to receive speech at the local preschool. Her hearing fluctuates depending on how much fluid is in her ears at a time. Her previous tubes are not in place anymore, and so she has some fluid build-up at the moment, but it doesn't appear to be slowing her down. Her vocabulary and pronunciation have continued to develop, despite any mild hearing loss that it creates. She continues to have ear infections, thus the other reason for the tubes. But even that is just normal life at this point, not any big disruption.


She is really just a happy, normal, amazing, resilient, wonderful child. I can't imagine my life without her.

Kate NaNa

There isn't a whole lot of big news to report on the Kate front, but at the same time, she seems to change and grow every day. She is nearly as big as Will, and she thinks she is 5 like he is. She can now mostly get dressed and undressed by herself, including her socks and shoes. Part of the motivation for this is that we have been potty training. I tried back in May/June, and she had a couple of days without accidents, but then one day I asked her if she needed to potty, she shouted, "NO!", and then proceeded to pee on the floor. (My mother says it is payback.) I decided to take a step back, her being 2 1/2 and all.

She has worn pull-ups, and consistently gone potty about 2-3 times a day since then. Recently I sensed that maybe we were ready to try again. She has done beautifully this time around. In the past week, she has only had 3 accidents, and honestly, two of those times weren't even her fault. We are very proud of our big girl. She is very proud of her big girl panties that we bought on our girls only trip to Target:) (As I type this, I am hoping that I am not jinxing this by declaring that she is potty-trained. Lord, help us if I am wrong.)

The other fun news is on the speech front. She continues to make progress every week, and in the past month or so, friends and family have begun understanding her more. Her favorite topics of conversation are still Di's houseboat and Hot Dog House. She has also been telling people that she went to the circus, where her favorite thing was the popcorn. Yesterday I was telling the kids the stories of their names (where they came from, etc.). I said, "Katherine Xuna has a very special name." She replied, "Yes, my name NaNa." And then she started telling me something about a peanut butter sandwich, and I got lost:)

She continues to amaze me and be a complete joy. We are very blessed!

Kate's Speech, Part 2

Oh, my goodness! Kate just said, "Kay-Kay"! Big stinkin' deal because she doesn't do the 'k' sound!

I said, "Are you Kay-Kay?" She nodded and said, "Uh." (Translation: yes.)

Of course, just now I tried to get her to repeat it for her Da. Did she do it? Nope. This girl's got a mind of her own:)

Kate's Speech

This girl continues to amaze me as her speech progresses. Recently her speech was evaluated and compared to her evaluation six months ago. Both her receptive language (what she understands) and her expressive language (basically what she is trying to express) has risen in leaps and bounds. In her receptive skills she is even above her age level now, which is awesome. I actually attribute a lot of that to her sign language skills. I don't think she would've picked up on language so quickly if we weren't all signing with her. I am kind of sad that we aren't learning as many new signs anymore, but we just don't need them as much, which is awesome. As she learns to say a new word, she drops the sign, usually.

Of course, we are still working hard at producing individual sounds and making them into words. Just because I understand that "ma ha ah how" means Mickey Mouse Club House doesn't mean that the rest of the world does. (And actually the literal translation of that would be Mickey Hot Dog House, because that's what she calls the show.) So we still have weekly ST appointments where she and Jennifer play lots of fun games, which she enjoys.

This past two weeks we have seen lots of new words and phrases, such as - beach, pizza, I wanna see, me too, baby pool, and my turn (can you tell that she did not want to be left out of what the big kids were doing on vacation?). And today she said 'ocean' for Jennifer. Now, she isn't saying every sound for all of these words, but we heard the "ch" sound for the first time, and lots of "s" sounds, which are really tough for a two year old even if there isn't a cleft involved.

So, you will have to forgive me for bragging, but this kid works so hard, even her brothers notice. Today I heard Ben today saying, "Say 'socks', Kate. Lemme hear the 'ks' sound." I had to laugh. He was being so sweet:)

Update #5 - Other Stuff

When we first got home, Kate was evaluated at the International Adoption Clinic. She was evaluated for gross and fine motor skills, speech delays, and general health, including extensive lab work. Speech was really the only issue that was identified as being problematic. When we entered the early intervention program, she was evaluated again. Speech was identified as an issue, which we expected, and she was borderline for something they called developmental intervention. This is kind of a general term for her social interaction with others. Specifically, there was concern over whether her play was age appropriate. At the time, she looked at toys as if she had never seen one before. (In fact, we know that her orphanage did not have toys except the play yard outside, but we have no information about her foster care.) She didn't push cars around, hold baby dolls, color, or any of the things that 2 year olds should be doing. We were concerned, but the person evaluating Kate told us that if she wasn't doing these things in 6 months, we would re-evaluate her and she could receive intervention.

Thankfully (Praise God), her play is right on target now. She plays cars. She rocks her babies and feeds them and puts them to bed. She has pretend conversations between her toys, which is way too cute. No one can understand them, but she has a blast. We owe much of this progress to the boys, specifically Will. She spends a lot of time with Will, and one day I mentioned to Will that Kate didn't know how to play. I went and got into the shower, and when I came back to check on them, they were sitting on her bed together. Will was showing her how to hold and feed the baby doll. Shortly after this, she got some kitchen toys for Christmas. She started fixing me food with her pots and pans and serving it up on plates. And she has grown by leaps and bounds since then. She even pretends that random household objects can talk to each other now. Her imagination is in full swing. Who knew I would be so thrilled with such everyday blessings?

She still loves to help me in the kitchen. I have always thought that she must have spent time helping her foster mom in the kitchen, because she has always loved to play in the dishwater, set the table, mix things in a bowl, etc. She loves to have a job.

Finally, a speech update... I mentioned that we were working on 2 word signing combinations, but she wasn't interested. Today she started speaking in 2 word combinations. She said things like, "Hello, Mama. Mama eye. Mame woe (nose). Mama mow (mouth)." She was pointing to my eyes, nose, and mouth. She is soooo much fun!

Update #4: Speech

Since we have been home, Kate has been receiving speech services through our state's early intervention program. We are doubly blessed because our SLP is my cousin, Jennifer. She services our county, so when we were applying I specifically requested her. Growing up I always followed around my big cousin, begging for attention. "Jennifer, do my hair, play Barbies with me, come swimming with me!" I would do anything! She even found an old picture of us where I am holding her by the face and she has an expression that says,"Make her leave me alone!!!" It is really amazing that she still speaks to me:)

Anyway, Kate thinks that she is the coolest thing since sliced bread. When she sees her coming up the driveway, Kate starts doing her happy dance. She thinks that Jennifer just comes to play with her, and loves to sit in her lap. And I am pretty sure that Jennifer was the first person that she said, "I love you" to. She was leaving one day and told Kate bye-bye. Kate replied, "Mye-mye. Wah woh wuh." Doesn't that sound like an I love you to you?* Jennifer can get her to do things that she won't do for me. For example, last week she got her to make a "K" sound and an "L" sound. Has she done that for me since then? Of course not.

Progress-wise, I have to admit I get frustrated sometimes. We are all working so hard! But Kate's lip and tongue muscles seem fairly underdeveloped. We now do exercises to strengthen them, and we are seeing some progress. I just have to accept that this is a process, and it may be years before she is able to discontinue the ST. I think that even though I knew this going into the surgery, I had this naive expectation that Kate would be the exception to the rule. I hoped that she would start making all kinds of new sounds immediately, but it has been much slower.

As far as new words, she learns them all the time, but I am pretty sure I am the only one who understands her. And sometimes she just chatters on and on to me and then will laugh like she just told a funny joke. So I laugh like I understood her. But, I can now tell the difference between "ABCs" and "Twinkle Twinkle", which I think is impressive.

We continue to teach her sign language. She can now use about 100 signs independently (of course, she made up about 5 of them). We are also trying to teach her to put the signs into multiple word phrases, which is an important part of language development.

Pray for us as we continue. She is worth every ounce of work we put into this. And she is dying to talk to us. I can't wait until she talks so much I want to tell her to hush!


*Just have to say that after she told Jennifer, she signed "I love you" to me a few weeks later, and then to Aunt Sally's cat, and now she is signing it to the rest of the family...sometimes.