Wednesday, December 5, 2012

The IAC visit

Today we finally made it to Brennan's IAC (International Adoption Clinic) appointment at MUSC.  We had an appointment scheduled a couple weeks back, but we had to reschedule due to some urgent dental issues that came up for Brennan and needed to be seen about the same day as his original appointment.   We feel very blessed to have an IAC just 20 minuted from our home.  It really is nice to have these types of medical resources right in your own town!  I headed out with Brennan about midday, and we met Scott at the clinic.  I did not tell Brennan what we were doing; simply that he and momma were going for a ride.  Well, he is a pretty smart little guy, and as we got downtown and parked he started asking me if we were going for another visit for his teeth.  Our dental appointment had also been at MUSC, so he recognized the buildings.  I assured him we were not going back to the dental clinic, rather we were going to see a doctor who needed to look at this ear, listen to his heart, look at his arm etc.  He seemed to be OK with that.  When we got to the IAC they checked us in and pretty promptly began to get to "business".  They weighed, measured height, took Brennan's temperature, and then they ushered us to the exam room.  The nurse and the translator were the only ones with us at that point, but within a few minutes we had a crowd of people in the room.  There were 2 doctors, 1 resident, and an OT person that came in to perform assessments.  They spread out a sheet on the floor, pulled out some blocks and some pictures and got to work assessing.  I was on the other side of the room with one of the doctors answering her assessment questions.  I really appreciated that they asked us what we wanted to accomplish with our visit today.  They wanted to know what our major concerns were so they could address them and order proper testing.  At this point, our "biggies" are of course his ear and having his renal status checked to rule out oto-brachial-renal syndrome, particularly since he has an affected ear and arm.
Of course I was trying to answer the doctors' questions about health history and so forth, but at the same time I wanted to see what they were doing with Brennan in the floor.  I could see some little wooden blocks.  He was stacking those.  I also saw them begin to ask him questions about some pictures.  I think they were trying to get him to identify the pictures.  The translator was helping, but I could see that Brennan wasn't responding very well to the translator who was a man.  At that point I switched my focus from answering questions to the assessment that was taking place.  I think Scott took over answering questions because I really became engrossed in the activity on the floor.  The doctors also had Brennan go out in the hallway to walk and run for them.  We rolled up his pants so they could see his legs, but he did not like that at all!  He got all modest and rolled his pants legs right back down.  They also proceeded with a physical assessment when we went back into the room; very smart to save that part until the end!
So at this point in the visit, we began getting feedback from their assessments.  The OT informed us that she was very encouraged by his ability to use the right hand with the two residual fingers.  She also said his gross and fine motor skills are lacking.  This of course was no surprise to us.  I am trying to work with Brennan on his fine motor skills while keeping him safe and accident free.  It's a balancing act...no pun intended (especially with little brother and sister)!  He has made improvement with walking stairs since we've been home, but I still hold my breath as I watch him running around.  My neighbor can attest to the wipe out he had at the end of her driveway last week; and the subsequent dramatic meltdown that ensued.  All in all, though, the OT was highly complementary of his abilities given his background and disabilities and said he had scored at the level of a 33.5 month old child.  This fairly well coincides with the 17 month delay we expected from his time spent in an orphanage.  She gave us some activities and games to play to foster the motor skills.  I am particularly looking forward to learning how to play some game called "Sneaky Snacky Squirrel" :)
The next part of the assessment that was discussed with us was his cognitive and language assessment.  The doctor let us know that she felt cognitively he was doing great.  She actually said "he is amazing!"  However, she felt his language/communication skills are lacking.  She is afraid that with the differences between the two abilities (cognitive/language) he is going to become frustrated and begin to show behavior problems if we don't intervene to help with language development.  I am not sure I fully agree with this assessment of his language.  He was absolutely not responding well to the translator, so I don't think it was a completely accurate assessment.  I also realize that I am NOT an un-biased opinion, though.  The doctor wants to start him in speech and language therapy right away.  I have always said that I would not be surprised if speech therapy was in Brennan's future, so I am not surprised.  I am just not completely convinced, based upon what I see from him at home, that his skills are as lacking as the doctor thinks they are.
Lastly, we talked through his physical concerns.  Brennan is a pipsqueak for his age...and it isn't all related to being Asian.  Our boy is way below the growth curve.  He currently wears 2T clothes and weighs 29 pounds at 4.5 years old.  He also has not gained the first pound since we've been home, and he is certainly eating more and a more balanced diet than he was in the orphanage.  There is some concern about genetic and/or endocrine disorders, so we will be following up with a geneticist as well as drawing several labs for testing.  Again, none of this is a surprise really.  We knew before we went to get him that he was small and could possibly have a condition causing this.
Before we left the clinic today, the doctors also wanted a hearing test performed on Brennan.  So we walked down to the children's auditory testing area for the test.  The lady performing the testing was super-nice and very willing to talk about what she was seeing result-wise.  Basically she did a regular hearing test on the normal ear which tested out with great hearing.  She then did a bone conduction hearing test on the left ear.  As he started responding to the sounds on the left side, my eyes filled with tears.  I knew what his response meant!  Our boy would have an opportunity to gain hearing from that left ear.  I am really happy for him!!!  It is truly going to be life-changing for him to have hearing in both ears.  We see an ENT on January 17th to get the ball rolling in that regard.  We are praying for wisdom as far as what will be best for Brennan; BAHA (bone anchored hearing aid) vs. ear canal construction or perhaps a combo of both?
I am so thankful that Brennan is now in a situation where he can have good medical care.  He is going to have a great team of doctors and a momma and baba advocating on his behalf.  I feel like he is this little flower getting ready to really bloom!  I am so excited to watch his potential unfold.  I am so humbled and thankful that I will have a front row seat to the redemptive work that God is doing in this little boy's life.
             

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