Four-year Check-up

Sarah had her four-year-old wellness exam Thursday.  She is such a different girl than she was three years ago.  She strolled into the office confidently and seemed to enjoy every procedure and evaluation the nurse and doctor threw at her.  This was her first "big kid" appointment, where she had her blood pressure taken and was given eye and ear exams.  The doctor had her draw a circle, an "x," and a person; sing her ABCs; write her name; touch her toes; and stand on one foot.  Sarah loved performing and passed with flying colors.

She is now a little over 41" tall (78th percentile) and 36 lbs., 6 oz. (61st).  As we could tell, she has stretched out over the last year. 

The only concern the doctor had was her articulation of some words.  Her language skills (sentence structure and vocabulary) are excellent, but her speech is a little unclear at times.  The doctor said that the school will evaluate her and do some therapy, if necessary.  I'm not worried about that, because she has been working on saying things more clearly, and I think it will come naturally once she's with other people more often. 

Before the appointment, she was a little worried about getting shots, but when the doctor said she needed them, she seemed unfazed.  She chose to sit on the exam table instead of my lap and watched with interest as the nurse poked her three times.  She caught her breath each time, but there were no tears.  She's one cool customer and tough cookie these days, as you can tell from the photo, where she's showing off her bandages.

Sarah's Machine

Sarah started the new year with a cold and nasty nighttime cough.  The cold lasted a few days, and the cough subsided after a couple of weeks, but it never went away.  For weeks after, she would wake multiple times a night coughing and choking.  I'd give her honey, and a few times, I took her into the bathroom and ran the shower to soothe her throat.  After six weeks of interrupted sleep for all, I called the pediatrician's office.  The nurse said it was a common afliction this year and to give it some more time. 

Finally, in mid-March, when she was still having at least one spell a night, I took her in.  Her regular doctor was on vacation, so we saw a physician's assistant.  Her lungs and ears were clear, but he could see some irritation in her nose that looked like a sign of allergies. 

Two days later, we saw a pediatric allergist.  He couldn't see distinct signs of allergies and thought that the cough might be caused by some residual spasming in her upper respiratory tract.  He suggested testing for allergies, just to be sure.

Luckily, Sarah has conquered her fear of doctors, for the most part.  She's reached the point where she's more interested in the process of being examined than frightened of the caregivers.  When the technician arrived with a marker and a rack of tiny vials, she was intrigued.  She sat calmly as the woman marked the places on her arm then innoculated her with various allergens.  A few minutes later, she looked as though she'd been the victim of some S*tanic ritual.

The testing showed she is allergic to grasses, but that wouldn't be a problem during the winter.  The allergist said he could prescribe a short course of steroids to calm the cough but he thought it would go away in a couple of weeks.  I chose to wait.

A couple of weeks later, the cough was still around, so we tried Pr*dnisone for five days.  The house was quiet on the second night, for the first time in months.  Third and fourth nights, same story.  On the fifth night, however, it returned.  The next day, Sarah had a runny nose and a cough, and the following night, she awoke with a 103.5 degree fever.  She has had a fever only a couple times since she's come home.  Decreased immunity is a side effect of being on oral steroids, however, so perhaps they allowed a virus into her system.

I brought Sarah to her regular pediatrician, who said her lungs still sounded clear.  The doctor had seen a lot of high fevers in kids lately, however, so she wanted to check for flu, even though Sarah had a flu shot.  She said she'd like to do a nose swab to test for flu.  It sounded harmless to me, so I agreed. 

I became concerned when two somber nurses arrived.  One told me to lay Sarah on her back and hold her hands.  "She's not going to like this," she said.  The other held Sarah's head while the first stuck a tiny-but-way-too-long Q-tip up her nose.  It was quick, but obviously very uncomfortable.  Sarah winced and squeezed her eyes shut to keep the tears in.  I did my best to console her, while the nurse did the other nostril quickly.  Sarah lunged into my arms and melted into tears.  I felt like a traitor.  How I hate being a party to causing her pain.  (The test result was negative.)

As for the cough, the doctor suggested we try a nebulizer with Alb*terol and a corticost*roid for 30 days to try to calm down Sarah's upper respiratory tract.  She sent us home with a mini air compressor connected to a medicine cup by rubber tubing.  For the last two weeks, Sarah has had four 10-to-15-minute sessions a day on "her machine," as we call it.  Although she's pretty good about sitting and listening to me read books, and sometimes just looks at books by herself, it's a real pain.  My heart goes out to parents of small children with chronic health conditions who need frequent treatments.  Getting a three-year-old to sit still and cooperate is no picnic.

Fortunately, the regimen seems to be working.  The cough is gone, and we're all snoozing through the night.  I'm sleeping more soundly than I have in years, I swear.  I'd forgotten how it felt to wake out of a deep sleep in the morning.  But enough about me.  Sarah's got two more weeks of treatments, and I pray the cough doesn't return when she stops.  I'd hate to have her machine take up permanent residence in our house.

Doctors to Presidents, Kings, Sheiks...and Sarah

We drove to the M*yo Clinic in R*chester, MN, the day before Thanksgiving so that a pediatric opthalmologist could examine Sarah's eyes.  She was diagnosed by my eye doctor with intermittent bilateral exotropia in January.  Her pediatrician wanted her to see the opthalmologist in our regular health care system, but he happens to be the one with whom she had a terrible experience back in Fall '09.  (Since her dark eyes are hard to dilate, they had to do drops twice, and she was completely traumatized.  When the tech wanted to go a third time and said they might have to strap her to "the papoose board" to examine her, we said we were leaving.  The doctor took a quick look into her eyes and said they looked fine, and we high-tailed it home.  I felt HORRIBLE for doing that to my daughter, especially when it was totally precautionary.)

Fortunately, I learned last spring that one of the girls in our neighborhood has the same condition, and her mom connected me with the doctor she sees at M*yo.  Since he is in our Pr*ferred Provider Network, I was able to just make an appointment.  M*yo is only about an hour and a half from our house.  As you would expect, the M*yo Clinic is an impressive place.  It dominates the small city of R*chester, both physically and culturally.  The brochure I was sent said that it employs almost 2,000 doctors there.

We started in a large waiting room that reminded me of the DMV but were quickly escorted to an examining room by a technician named Bobbie.  Sarah was leery right away.  When Bobbie tried to put a patch over her eye for the examination, she absolutely refused.  She wasn't crazy about Bobbie holding a paddle to cover her eye, either, so I had to do it.  She did well on the eye chart, which had simplified graphics instead of letters.

We were then brought to another exam room and introduced to a young Asian woman who is a fellow in the opthalmology department.  I thought maybe Sarah would feel more comfortable with her, but she was still very nervous.  She wasn't wooed by the mechanical stuffed animals on the wall that lit up and moved or the wooden marionette-like toys that collapsed when the doctor pushed the button.  I had to hold the paddle again, this time while the doctor moved my hand from side to side to watch how Sarah's eyes responded.

Then it was time for drops -- three in each eye, no less.  Another technician came in to administer them while I did my best to hold Sarah still in my lap.  "Time for some raindrops in your eyes," the tech chirped.  After the first two went in, Sarah freaked and put up quite a struggle.  I was wavering and trying to figure out a way around the situation, but the tech just forged ahead and got the drops in before Sarah or I could react (smart move).

We were ushered into a tiny waiting room for the drops to take effect (and hope that there wouldn't be need for more).  Another family was watching 101 Dalmations (the original animated version I loved as a child) on the TV, which offered a welcome distraction.  The other mom did her best to convince Sarah that the doctor she was going to see was wonderful and lots of fun, but Sarah was unconvinced.

After about 15 minutes, we returned to the exam room.  Sarah squirmed nervously in my lap.  The door opened, and a man in a suit and brightly striped tie strode in.  He greeted Sarah and said, "So, who are these people you brought with you today -- your cousins?"  Sarah gave him a half-smile and her characteristic, "Nooooooo," which she uses to answer ridiculous questions.  "Oh, is this your brother?" he asked, pointing to Don.  He went on to ask if she had come to have her ankles checked.  When she shook her head, he said, "Oh, your knees."  His silly questions broke down her defenses, and she warmed to him quickly.  "This," I thought, "is why we came to Mayo." 

Sarah let the doctor do a few quick tests (although the others had done most of the technical work) and was rewarded with a lollipop.  The doctor said on a scale of 1 to 10, with 10 being the worst, her exotropia is about a 3.  It is not affecting her acuity.  He said patching and eye exercises haven't been proven to help and recommended monitoring until either one eye remains out constantly or kids start to tease her about her eyes (break my heart!).  At that point, we should consider surgery to correct it.  Surgery successfully treats the condition in 85% of patients; 12% have to have it done again; and 3% become worse.  He wants to see her again in six months, then once a year.

After he'd answered all of our questions, the doctor turned to Sarah and said, "Well, should we call it a day, or do you want to do a few more things?"  Without missing a beat, she said, "Call it a day," and we were out the door.

As I tucked Sarah into bed that night, she said, "Mom, the woman said she was putting raindrops in my eyes -- those weren't raindrops; raindrops are outside."  "I know," I said, "She was trying to be funny and make you feel better."  I remember thinking when the tech said it, "Does she think Sarah is stupid?  She knows they're not raindrops."  Don't try to put one over on this little girl....

I feel very lucky to have access to some of the best medical care in the world.  It's such a relief to not worry every time I see Sarah's eyes move outward.  Since the last doctor told us we should do something when it was happening a third of the time, I've been obsessed with trying to estimate the frequency.  I asked the doctor at Mayo how I should go about that, and he said, "You don't need to do anything; it doesn't matter.  We can learn everything we need to know when we see her here."  Whew! 

Three-year Checkup

Last week, Sarah had her three-year checkup.  I'm happy to report that doctor's visits have become fairly routine and even somewhat enjoyable for her (there's a potty book in the examination room that she loves).  It helps that she no longer has to get undressed and lie on the baby scale.  She happily steps onto the floor scale and obediently backs up to the wall to be measured.  She is now 38" tall (72nd percentile) and 34 lbs., 6 oz. (81st percentile).  I found it interesting that they also calculated her body mass index (BMI), which is 17 (80th percentile).  The doctor declared her healthy and height-weight proportional.

I asked the pediatrician about having Sarah see a specialist for her exotropia (the optometrist we saw in January suggested we come back in 6-9 months).  She recommended seeing an opthalmologist and scheduled an appointment in September with the same one Sarah saw in late 2009 (a nightmarish visit involving two rounds of drops, each of which sent Sarah into hysterics, and our refusing a third).  As you can imagine, I'm anxious about this, but I guess we'll see how it goes.  She's come a long way from the scared little girl she was almost two years ago, so maybe it will be fine.

Two Steps Forward, One Step Back

Sarah is now two-and-a-half, and she is noticeably more mature than just a couple of months ago.  She's progressed in all areas but still hits speed bumps.  The last couple of weeks have been full of new developments but also included some set-backs.

Sarah and I have had a couple of unexpected separations over the last few weeks, and I was surprised and pleased at how well they went.  She came with me to give blood at our church.   I thought she could stand near me the whole time, but after I checked in, the attendant asked if there was anyone who could watch her, because she wasn't allowed in the donation area.  When I said "no," he suggested she sit at the refreshment table with the volunteers.  I was skeptical but figured it was worth a try. 

I put her in a chair and showed her where I'd be.  I'm not sure she even heard me.  She caught sight of the tray of cookies, and three grandmotherly women swooped in to dote on her, and she was sold.  During my check-in, I kept nervously popping up from behind the privacy screen to see if she was searching for me.  All I ever saw was the back of her head and three smiling seniors chatting with her.  She was eating it up.  By the time I finished and joined her, she was charming the minister. 

Last week, I took her to a local school for a developmental screening.  We were ushered into the kindergarten classroom, and a nice young woman asked Sarah what she'd like to play with.  Another woman then said I needed to fill out some paperwork down the hall.  I had a moment of panic but decided to give it a shot.  I kissed Sarah and told her I'd be back in a few minutes.  Down the hall, I rushed through the forms and strained my ears for cries of distress but heard none.  When I returned 15 minutes later, she was happily playing kitchen with the speech therapist.  She immediately said, "Mama play."  They said she had asked for me a couple of times but was satisfied when they told her where I was and that I'd be back soon.  Huh....

She had her two-and-half-year Well Child Check-up last week, and you never would have known she was the same child who used to scream in terror at contact with medical personnel.  It may have helped that she got to stand on the big scale to be weighed and was measured against the wall, instead of being stripped and put on her back.  She walked confidently into the exam room and seemed more interested in what the nurse was doing than scared.  She actually wore a hospital gown for the exam, which I think she rather enjoyed, even though it was way too big.  She was terribly brave while getting her shot, grimacing but fighting back the tears.

Once we got home, it was a different story, though.  She limped around and whined about how much her leg hurt.  I gave her some Tylenol, but she still carried on.  I don't know if it really hurt that much or if she was just being dramatic, but she gave quite a performance.  She ended up in tears at dinner and had a meltdown afterward.  I'm sure it didn't help that she refused to nap that day, but she still tells me it hurts every now and then.

She officially weighed 32 lbs. 14 oz. (87th percentile) at the doctor's, but she had a heavy sweater on, so I think that's a bit high.  She is 37" tall (69th percentile).  I'm glad to see that she's come down a bit in comparison to kids her age, while remaining incredibly healthy.  The doctor estimates that she'll be about 5'6" in adulthood.

Sarah has had two developmental evaluations in the last month -- one through the county's Birth-to-3 program and one through the school system.  Both showed her to be age-appropriate for the most part, with some of her personal-social skills a bit behind (speech) and some advanced (counting to 10, knowing her letters, spelling her name).  Overall, she has caught up nicely and is on-target.  She talks a lot now, including some three-word strings, and seems to pick up new words every day.

Despite all of these strides (or maybe because of them?), the last couple of weeks haven't been all that rosy.  She's been irritable and controlling and sleeping poorly.  She seems to have nightmares a lot and cries and yells in her sleep.  She's refused to take naps six out of the last 12 days.  She has angry meltdowns and has started hitting us.  Although she had a great stretch of potty training (dry for 12 days), she's had a few accidents lately.  I'm not sure what's going on.  Did I jinx us by saying we were on our way out of the Terrible 2s?  Are all of the new skills and experiences she's acquiring stressing her out?  Is she processing some residual grief?

I get the sense that she's anxious and feels as though she has to do and control everything (I know that sounds like a typical toddler, but an adopted child can take it to the extreme, because of the losses she's suffered).  She is a rather serious little girl.  A couple of weeks ago, we had two toddlers who are a little younger than she is over to play.  One is from the same province as Sarah.  While they ran around and played with her toys, Sarah stood by me shaking her head, pointing, and saying ruefully, "Mess, mess...." 

Although I'm thankful that both Don and I have been home with her all the time, I'm starting to think Sarah could benefit from some time away from us with other kids.  On the way to church this morning, I mentioned to Don that, given how well she did when I left her recently, maybe we should try putting her in the nursery again.  She immediately yelled from the back seat, "No nursery!" 

On second thought, I don't think the nursery would work, anyway.  During the two recent incidents, adults played with Sarah and kept her focused on what she was doing.  That doesn't necessarily happen in the nursery, and I don't think she can overcome the bad memories she has of the place.  I'm hopeful that next fall, when she's old enough for Sunday School, the structured activities will distract her enough to keep her happy while away from us.

I've decided to try pushing back on her a bit to show her that she doesn't have to control everything.  I wonder if we've complied too frequently with her unreasonable demands, for example, allowing her to decide whether Mama or Dada puts her in her highchair and letting her put the cover on her sippy cup.  I've started insisting on helping her more with little things and telling her that it's Mama's job to take care of her, while still letting her do age-appropriate tasks.  This has led to more tears, but I hope things will improve over time.

All-told, I'd still say Sarah is a happy child.  She has four stuffed animals (two dogs, two bears) who are her constant companions.  She hauls them all out of bed each morning and positions them around the dining room table, each with a little bowl of Cheerios.  She hugs and snuggles them and laughs as if they've just done the cutest thing in the world.  She loves it when Don gives both of us a big bear hug and now asks for a "goop" (or group) hug.  A couple of weeks ago, she woke up, took a look around her room, and said, "Happy, home."  You can't ask for better than that.

Sarah when she's 6...

in the flower towel that Grammy gave her...

and trying out her new snowshoes

A Trip to the Eye Doctor

A few months ago, we started seeing Sarah's eyes go out of alignment at times.  I first noticed it when she played peek-a-boo around a door frame.  When she moved her head out to see, the last eye to appear would be pointing out.  It's happening more frequently, and in other situations, lately, so we brought her in for a check-up (even though Don was convinced she just had a special talent).  Since I was born with a lazy eye and have suffered with poor vision in that eye despite surgery at age 2 and wearing a patch, I wasn't going to take any chances.

I was dreading the visit, after the nightmare we experienced more than a year ago.  That time, they put drops in her eyes twice, sending her into hysteria both times.  When they wanted to do it a third time because her eyes are so dark and hard to dilate, we said, "No."  The doctor was able to get a quick look into her pupils, enough to rule out any disease, and that was it.  We were out of there.

To my immense surprise and relief, this time was completely different.  Sarah was slightly nervous about being there, but she didn't even flinch when the drops went in (as we learned on the day we became a family, she can be very brave).  We had a different doctor, who obviously is more in tune with kids than the last one, and she seemed intrigued by what he was doing.  He showed her a short video of a mechanical chicken, dog, and elephant, and she kept requesting to see it again.  She even gamely looked into the machine that measures your prescription and, with much coaxing, was able to look at the balloon long enough to get accurate readings.

While she was a model patient, the results of her exam were less than stellar.  She has intermittent exotropia, which means the muscles controlling her eyes are unequal in strength, causing them to turn out if she doesn't work at holding them straight.  If she's tired or not concentrating, they slip to the outside.  As she gets older and does more focused work with her eyes, she won't be able to override the muscles as easily, and it will happen more often.  At that point, she'll need surgery on the muscles.

The good news is that this condition doesn't usually affect the vision in the eyes, so she won't have a weak one the way I do.  The thought of surgery scares me, but, after doing some research on the Internet, I'm not as worried.  It should be outpatient and done through a small slit in the eyeball, so it's not too invasive.  Thank goodness Sarah has gotten over most of her fear of doctors.  By the time the surgery takes place, she should be even more calm.  We need to watch her, and when we notice her eyes turning one-third of the time or more, it's time to take action.

The other disappointing news is that Sarah will likely be near-sighted when she's older.  It has something to do with the depth of her eyeball.  I guess it's a certain depth now, and it will deepen as she grows, which will cause near-sightedness.  I'm almost more saddened by this news than the prospect of surgery.  I had hoped she'd avoid having to wear glasses.  I always hated mine.  It's only been in the last few years that I've felt comfortable with how I look in them.  She's such a beautiful girl that I dread seeing her face hidden behind frames.  Obviously, these are my own issues, and I won't share them with Sarah.  I also know that there are some very cute frames available these days, and she will be adorable regardless.  This is a small thing.

It's ironic that Sarah has a condition similar to one I was born with (they're two types of strabismus) and will likely be near-sighted like her father.  Because she lacks our genes, it's natural to expect her to be free from our physical imperfections.  The fact that she shares some of our weaknesses, while unfortunate, tends to reinforce our sense of family, however.  It's evidence of the invisible red thread that the Chinese believe connects those who belong together.  We were meant to be a family, flaws and all.