July Updates - Orthotist, IEP, Orthodontist, Botox, Neuro Psychologist

Another busy month!  And although I hoped for a very lazy August to wrap up summer, we now have seven more appointments I'm trying to get on the calendar...

Orthotist
We met with the orthotist to have the cast made to mold the orthotic brace.  Reagan hasn't had a brace in over two years and although I'm not looking forward to the nightly fight, I am hopeful it could reduce the tripping.  Luckily she is really good about sitting still and doesn't get scared getting it cut off anymore.  Her favorite part is picking out the straps and plastics.  Although pink was her go-to when she was younger, this time around she picked turquoise with horses.  We need to wait about a month for the brace to come in and then we will go pick it up.

IEP Meeting
We met with the school team to write the goals and discuss services for Reagan for the next year.  I was nervous going into the meeting, but felt confident knowing I have an advocate who understands Dyslexia and the accommodations that may be needed.  We had a pre-meeting to review the document and consolidate our feedback.  Overall the meeting went very well.  We were happy with the recommended services, but wanted to refine the language on the goals and add a few accommodations.  Given the volume of changes and research needed to determine appropriate encoding and decoding metrics from FastBridge (information not accessible in the meeting), the school will be making updates and distributing another draft for us to approve.  I am very thankful for the ideas the advocate brought to this meeting and I am very hopeful this sets us in the right direction for 5th grade!

Orthodontist
Although I've had a lot of updates about Reagan lately, Cole also had a follow up appointment with the orthodontist. Thus far the ortho has only recommended the extraction of four teeth back in February and luckily that is behind us.  And I'm definitely not in a hurry to have another regular appointment on our books.  His appointment went well and he asked us to come back in 6 months.  They did say that we may need to remove permanent teeth down the road in order to make room because an expander will not make enough room for the amount of space needed for the teeth that still need to come in.  Luckily no decisions need to be made at this point so we will revisit in this in January.

Neuro Psychologist
I've been waiting for this meeting with Dr. VanVeelan at Domion Center for Behavior Health Services since I started searching for a neuropsychologist back in February.  I was very nervous I was putting too much hope in this appointment, but I left completely overwhelmed with the volume of information and data that supports the concerns we've had for the last year.  There is a lot to share, so I've broken it out into the main areas of concern.

Attention versus Inattentiveness
The first category of concern is Reagan's tendency to often "check out" or stare off into space.  Overall the psychologist feels we still haven't uncovered a reason for this.  She doesn't feel it is manifesting as traditional ADD symptoms and believes some of the other testing she is recommending may help identify the cause.  We will need to follow up with the neurologist on this.  We did rule out absence seizures with the EEG so we're hoping some of this additional testing could identify a reason.

Cognitive Efficiency - Corpus Callosum
One possible cause for the inattentiveness could be a disconnect in the left and ride sides of her brain.  The psychologist has recommended a repeat MRI to determine if it is functioning properly.  The corpus callosum is the nerve tract beneath the cerebral cortex that connects the left and right hemispheres enabling communication between them.  I spoke with Dr. Lavenstein's nurse and have requested an order for the MRI.  They need to process it through their Finance department for authorization and will call next week to get it scheduled.  She hasn't had one since her seizures started again in 2012 so a lot has likely changed.

Visual Processing Disorder
One of the larger concerns the neuropsychologist has is a deficiency in visual processing.  The theory is that the eyes receive the message, but the brain is not effectively processing the image. An example of this is shown below in the Rey Visual Design Learning Test, the image on left is presented and Reagan was asked to draw it while looking at the image.  The concerns with her drawing was the first, she started with the smallest diamond not the largest component of the image.  Second, she started from the right and worked left. After viewing the image for 306 seconds, it was then taken away and she was asked to draw it from memory.  The third image represents her memory of the drawing.  Not only did she again focus on that small diamond, it's not even in the correct orientation.  This indicates that she cannot effectively process the images she is seeing (which impacts EVERYTHING she sees whether it is word in reading, math or drawings).

The recommendation is to have an evaluation for a visual processing disorder and determine if there are occulamotor issues.  I made the first available appointment with Dr. Smithson at Northern Va Doctors of Optometry for the end of August.  Prior to that evaluation, she also has to have a traditional eye exam which I was able to schedule for mid August.  He will conduct visual and perceptual testing to help us further understand the root of these issues.  I'm guessing this will be much like the visual testing Cole had done in Ohio three years ago.

Auditory Processing Disorder
Another significant area of concern is auditory processing as it relates to speech and language.  Reagan struggles significantly with recall despite no issues with intelligence or memory.  Similar to the visual processing, the question is whether her ears are effectively communicating with her brain.  For example, when given an image of a canoe and asked what it was she said boat.  When shown an escalator she called it stairs.  But if given several images and asked to point the escalator she could correctly identify the image (which means she knows the word).  So her brain KNOWS the information, but she is unable to RECALL the information.  Closely connected to hearing is the speech and language component.  So in addition to the auditory evaluation, she is recommending a speech and language evaluation.  The area of the brain that coordinates all this activity is the left side.  So that could be impacted by the seizure medication, by language issues, or by issues with the corpus callosum.  These evaluations would help us identify which is causing them and therefore drive the correct solution.  In addition to private evaluation, I will be requesting a speech and language evaluation from the school.  Prior to either the auditory processing disorder evaluation or speech and language evaluation she needs to have a standard hearing test.  That has been scheduled for next week.

Anxiety Disorder
Last but certainly not least, she also mentioned the anxiety related to testing and "separation".  We both believe this will lessen as she is given the appropriate "tools" to learn, but it comes from feelings of not being able to do things independently.  Much of this likely started with her left sided weakness - she worked very hard to learn to tie shoes and she can, but she is unable to pull them tight enough to stay tied all day.  In second grade, it wouldn't bother a child to ask her teacher for help with a task like this.  But entering 5th grade, some of these task that normally developing children can do independently are still challenging. Combine those feelings with similar feelings for the cognitive tasks, and it has compounded the issue.  The suggestion is to have her meet regularly with a psychologist to work through those feelings and see that she is very independent.  We will do some research to find a good fit since she didn't have a person in her office that would be a good fit at this time.

Botox
Reagan has a form of cerebral palsy that causes spasticity, or muscle tightness that can interfere with motor activities.  Botox is an injection that works by blocking the chemical signal between the nerves and muscles that make the muscle contract or tighten.  It causes relief from the spasticity within 2-3 days, but unfortunately only lasts about 3 months. We have been cautious in using it because we have to put Reagan under anesthesia to locate the exact injection site.  The physiatrist uses a large needle to get into the deep tissue area that is impacted.   Last time we treated her wrist and ankle, but this time we treated her wrist and shoulder.  It will be important to ramp up the amount of time we spend on left hand rotation activities in the coming weeks to try to strengthen those muscles and try to increase how much mobility she retains as the Botox wears off.  We plan to do a lot of lacrosse and use the NeoFect games she uses for occupational therapy.

Braille Camp
I believe I mentioned earlier that we were going to have Cole go to Braille camp because he was not found eligible for Extended School Year through Loudoun County.  This decision was made because there is "no evidence that he will regress".  We planned to place Cole in a one week sleep away braille camp in Harrisonburg this summer to help build independence but it was cancelled due to low registration. Apparently nation-wide braille enrollment has dropped with the increase in technologies available for the visually impaired.  As a backup we enrolled him in a program in Tacoma, MD.  Unfortunately, after much debate, we chose to pull him.  It was 9-3pm and about 1.5 hour drive without traffic EACH WAY.  Complicating our schedule is the neuro psych eval and Botox appointment for Reagan, neither of which we felt we could reschedule.  We plan to request a Braille evaluation immediately upon returning to school to determine if he had any regression in the hope that we'll have data to support summer services through Loudoun County next year.

As we wrap up July, I reflect on the hope I had to get lots of answers, with the realization we enter August with more questions.  And although I'm thankful for more insight, I'm slightly overwhelmed by having 7 more appointments.  That includes intake paperwork for each, adjusting schedules and taking time out from work.

As with everything, we take Dori's advice from Finding Nemo and we "just keep swimming...just keep swimming" and I try to remind myself to enjoy the little things like time with the kids.  After Reagan's Botox appointment we decided to stop by the new dinosaur exhibit at the Natural History Museum in DC.  This exhibit was closed for 5 years so we were excited to check out the new displays.

Cole was able to find his favorite dino, the Ankylosaurus and feed him with a new interactive exhibit.  Although he was very disappointed the dino gift shop didn't have any REAL fossils.  We also got to see our favorite statue of the Dum Dum who wanted Gum Gum (Night at the Museum movie reference).  And of course, we visited the Butterfly conservatory which always tugs at my heart....

June Updates - Eligibility, Brain Injury Services, Pediatrician, EEG, Physiatrist, Dental Surgeon

Wow, it has been a busy few weeks.  Just a few updates about everything going on.

Eligibility Meeting

We had a meeting at the school June 18th to discuss the testing done to help identify why Reagan is struggling at school.  Honestly it was very hard to see four years of testing and the results of the psychological and education testing that was done over the last two months.  Although we knew she was having to retake a lot of tests and reading below level, but it was very powerful to see all the data in combination.  She took a very large battery of tests which confirmed that she doesn't have an issue with IQ or memory, but she has been identified as having Dyslexia.  Although glad to have some answers, it comes with mixed emotions because it doesn't explain why she struggles to memorize new content.  We are hopeful the neuro psych eval sheds more light on that aspect.  She was also identified as having significant attention issues, but was not identified as having ADD.  Again, we're hoping to get more information from the neuro psych about what could cause these lapses in attention and "staring spells" if it's not ADD.  The other issue that was uncovered was anxiety.  Our hope is that by getting her help in learning, that perhaps this concern will resolve itself.  But it is something that we will be monitoring and I will be curious if it shows in the neuro psych results as well.

I did hire an advocate to attend the meeting with us who is very knowledgeable about Dyslexia.  The good news is that Reagan was found eligible for services and we will meet July 16th to draft her Individual Education Plan (IEP), set goals and determine the support and accommodations she will need moving forward.  I look forward to having the advocate's support in understanding what accommodations and services could help her progress more smoothly through 5th grade.

Orton Gillingham Tutor
One suggestion to help her immediately is to provide specialized tutoring called Orton Gillingham. The approach is "a direct, explicit, multi sensory, structured, sequential, diagnostic, and prescriptive way to teach literacy when reading, writing, and spelling."  We've schedule a Special Education teacher from the school to help Reagan twice a week starting next week.  Although I'm sure it will come with some resistance, we chose not to send her to summer school so she can focus on this more customized approach.

Brain Injury Services
Along the journey in finding a neuro psychologist, we also made a connection with an organization called Brain Injury Services.  They are a non profit who supports people who have experienced a traumatic brain injury.  We met with them a few times and provided the intake paperwork and were finally accepted on their caseload! I met with the intake coordinator last week and we built a Care Plan to identify areas where they may be able to help us. More to come on this as we learn more about what they do.

Pediatrician
In addition to the other appointments, Reagan had her regular annual appointment with the pediatrician.  Luckily this was somewhat anticlimactic.  However, we did discuss ADD medications and whether those would be difficult to administer in combination with the epilepsy medication.  We also discussed the possibility of needing to switch her epilepsy medication if ADD is ruled out and the meds are causing the "staring spells".  Although this is a decision that would be made by the neurologist, I like having this conversation with the pediatrician as well to get multiple perspectives.  Luckily we are not seeing significant increases in the symptoms of precocious puberty so we think she is following the normally developing timeframe for girls her age.

EEG

We were able to have the EEG and as usual, Reagan was a rockstar patient.  She was "the easiest all week" according to the tech!  Although we don't meet with the neurologist until the end of July, I did call to get results.  Unfortunately our neurologist is out of town, but I got a call back from the nurse.  The preliminary results do not show any changes from last year.  So while that's somewhat good news, I was still holding out hope that maybe they were better.  The fact that they aren't worse, however, is not a missed blessing.  One concern I've had after speaking with the testers and her teacher at the Eligibility Meeting is that the "staring spells" could be something called absence seizures.  It's essentially where the seizures is very short and you often don't even notice it.  Although this is not ruled out, the nurse said it is not likely she's having absence seizures since those are usually generalized (come from all over the brain) and Reagan's seizures are focal (originating from scar tissue in the area of the brain that was removed).  So not bad news, but not really good news either.

Physiatrist - Botox and leg brace

When we started talking about doing electrical stimulation, our neurologist asked us to start seeing a physiatrist.  This specialist is a physical medicine and rehabilitation physician who treats medical conditions affecting the brain, nerves, joints, ligaments, muscles and tendons.  We met with Dr. Morozova Tuesday for the first time in 3 years.  Reagan has complained a lot lately about tripping due to her toe drop so we wanted to discuss using a night leg brace again.  Also, we haven't done Botox since 2013 and Reagan has shown an interest in trying it again.  I'm hopeful if she sees that she CAN rotate her hand over that perhaps it will encourage her to continue to use the NeoFect application to work on hand control.  The appointment went well and we left with a script to meet with the orthotist to have a brace made and an appointment for a Botox treatment.  As you can see in this photo, Dr. Morozova asked Reagan to turn over both palms.  She was happy to see that Reagan does have the range of motion in both her wrist and ankle, but agreed that she isn't able to use it and that Botox could help.  Some children are so tight that you cannot physically rotate their hand over.

Dentist - Dental Surgeon

Reagan's orthodontist recommended she have three teeth extracted to make room in her mouth for the teeth that need to come in still.  She was very nervous despite the encouragement from her younger brother about it not hurting at all (he had four extracted in February).  But overall she did really well.  She picked strawberry for her scented "calm me down" gas and as always, Slush came along to share in the fun.  She wasn't quite as chatty as Cole was under gas, but she kept poking her lip and nose and laughing hysterically saying she couldn't feel her face.  And of course she was very excited to see if the tooth fairy would recognize the extra effort put forth with the extraction.  She didn't disappoint!

Swim Team
We are on year three with the Cascades Rapids and the kids are having a lot more fun this year.  They both have friends they are swimming with and it really helps !  There are about 250 kids on our neighborhood team so it is very competitive.  Many of the swimmers are on year round teams.  Reagan's neurosurgeon told us early on that swimming is an excellent sport to help increase her range of motion.  And we know that swimming is a good choice for Cole since eye/hand coordination is not as critical.  They've had a lot of fun with their friends and I'm hoping to convince them to do it again next year.  They both struggle but our goal at practice is to have fun and their goal at every meet is not to come in last.  This week Reagan even shaved 3 seconds off her free style time!  I am very lucky to have my niece, Allison, staying with us again this summer to watch the kids which makes getting them to and from swim team much easier.  Reagan swims from 8-9am and Cole swims 8:45-9:45am.  Definitely tough if you work full time in an office and rely on camps.  We're glad we can make the schedule work.

Summer Box Lacrosse
In addition to swim team, Reagan started playing on a summer box lacrosse league last week.  It will only run for 6 weeks but it keeps the stick in her hand and keeps her practicing.  We all love how fast the game is when there aren't any out of bounds!  Lots more play time for sure and it's much more laid back so the kids have fun.  It has been super hot the last few weeks so they get tired out pretty quickly, but she's having fun playing.

Up next in July...meeting with the neuro psychologist, casting appointment with the orthotist, follow up with the neurologist, the Botox appointment and Braille camp!

The Raw Truth

I haven't blogged since last year and we're already half way through 2019 (that last post I found in drafts and just hit Publish). And although some of that is because life has been very "normal", it is also because what I need to blog about is too raw.  I have searched for the right way to share updates, but it has just been too hard.  So I apologize this post may be long, but I feel like it needs explanation...

For years, I've found blogging as an outlet to work through what we're facing, sharing our story with others to help them not feel alone in their journey, and documenting the journey for Reagan and Cole so they can one day go back and see how hard they've worked to get where they are.  But I find it interesting that sharing has become so difficult for me.  I've been blogging since Reagan's brain surgery and have been very open and honest about everything.  The good, the bad, and the ugly.  The celebrations and the tears.  For some reason, I'm finding it much harder to share the behavioral and cognitive struggles than it has been the physical ones.  But as I struggle through this, I feel drawn to write.  Drawn to share.  Drawn to help others better understand the raw and ugly side of learning disabilities.  So much of social media today is sharing the happy times.  And they should be! Parents should be proud of the awards their children are getting, amazing grades, championship trophies for sports or performances.  But this time of year especially, I am drawn inward to wallow in the struggles of my children with other special needs parents. Feeling sadness for how our children sit in these ceremonies not feeling adequate to reach for any of the awards being given.  Forced to question self worth and value amongst the overachievement that is so common in Loudoun County with many valedictorians having over a 4.7 GPA.  And while I tend to get caught in the rat race, I remind myself that truly what is important in life is being HAPPY.  Because what is all that success worth, if you aren't happy?  But even happiness is about perspective...

I remember as a child having a friend Amanda whose brother had seizures.  Until I experienced a seizure with Reagan, my perspective was, "no big deal, just make sure they don't hurt themselves while having one."  I never stepped inside the shoes of that boy or that mother.  What if Reagan is at the top of the playground equipment?  What if she's driving? What if she's in middle school and wets her pants?  How do I help her understand and prepare for that?  Or do I not tell her and wait until it happens so she doesn't build anxiety for something we don't know when or if it will happen?  Many times in the last ten years I have faced other people's issues very differently than before Reagan started having seizures because I quickly realized you really don't understand until you've faced something yourself or have been close to someone who has.  Which makes me hesitate to share stories and struggles because I fear they will not be understood by all.  And judgements are often quick to come...I know, I was there too before my eyes became wide open.  But as I'm drawn to share, it requires me to share the raw side and therefore the gates are opened...

We just finished one of the hardest school years yet.  We made the decision last summer to start Cole on medication to help regulate his behavior, stay on task, and most importantly, stop being bullied.  He is so often misunderstood.  In the quiet of our home, I get the sweetest kisses.  He snuggles and reminds me how special I am to him.  Yet he is pushed off his seat on the bus.  Told he is annoying.  Told to shut up.  Regulating the medication has been so challenging.  We started out slow, ramped up, and it still didn't work well. Then we moved to a long acting medication so he could make it home and get his homework done before it wears off.  Then he became hyper focused on something unrelated to instruction and missed the lecture.  So we switched again.  All I have to say is that this juggle ain't no joke.  Again, I always just thought, "so you have ADHD and move around a lot...big deal."  Wow, I had no idea how it would affect every facet of our lives.  His relationship with his friends, teachers, and even his own sister.

On top of these struggles is the big decision of how Cole should access his curriculum.  Braille is coming very slowly.  He's trying hard and doing well, but he doesn't see the value in this language yet.  Statistically, the National Federation of the Blind states that  63% of adults with vision disabilities are unemployed.  That's huge!
 
We requested another technology assessment and it was determined that the CCTV no longer works well for him and that he should have an iPad to access the curriculum.  Although hesitant about how this will be integrated, I have to trust that we will figure it out.  Unfortunately the rest of the children at our school are given Google Chromebooks but the applications he needs are not compatible on that device so he will need to learn to use both.  I pray daily that we are making the right choices.  That we are leading him down the right path.  That one day he is accepted by others who understand Cole for the amazing, sweet child that he is.  He has so much potential, it's just finding a way to help him while maintaining his self-esteem.

That brings us to Reagan.  I've known the 4th grade curriculum would get harder, but I had no idea how intense it would be.  Reagan worked SO hard this year and we are SO proud of her.  Just as she has faced her physical challenges, she has really tried to keep up cognitively.  She studied a LOT more than most kids in her class.  What has saved her this year is that her classwork and participation are solid.  But for any given test we studied every night for a least a week.  Unfortunately she struggled to grasp the concepts and dropped further behind throughout the year both in public school and in church school.  I had her retake tests when she got a 1 or 2 (on a 4 point scale).  And in my defense, she always brought her score up from failing to passing.  On most weeks she had a spelling test on Friday plus unit quizzes, a test (either math, science or history) and a re-test.  Unfortunately, the rigorous studying caused her to get very frustrated and feeling depleted.  She started asking why she should bother studying when she's just going to fail.  If you remember correctly, she lost her IEP last April because she no longer needed physical support (OT/PT) to access her education and had an Orthopedic Impairment diagnosis.  To keep her cognitive goals she would have to go through re-eligibility to find her eligible under a different diagnosis such as Other Health Impairment.  At the time, I was told she "wasn't failing enough" to be found eligible.  So she has spent the last year "failing enough" which justified my request February 7th for a Child Study Meeting to determine whether assessments should be done to find the cause for these learning issues.  In our meeting March 25th everyone on the team agreed testing should be done.  I am still waiting for the final results from the school's testing which is due 48 hours before her eligibility meeting June 18th.  In addition to the public school testing, we decided to have her independently tested by a neuropsychologist due to her complicated medical history.  After spending several weeks trying to find a neuropsychologist, she had her evaluation June 3rd.  Most places I called either had over a year wait for an appointment or charged over $3500 out of pocket.  Even the place we chose wasn't willing to commit to how much we would pay after insurance because the number of tests they run is dependent on how she tested and how much more time would need to be spent writing the report.  Unfortunately they now need 4-6 weeks to write the report findings and then we will schedule a call to review them...so it won't be completed before the June Eligibility meeting.  I plan to request at the meeting that we postpone it a month and hopefully have the results for a late July meeting.  If not, there are no eligibility meetings in August so it would have to wait until September.  That would mean the IEP would not be in place until November...which is halfway through 5th grade...and the process started February 7th.

As if that isn't enough, we're noticing an increase in the tone of her muscles on the left side.  She was in tears over Spring Break because she keeps tripping from her toe drop and she gets scabs on her toes when she wears flip flops.  So I've made an appointment with the physiatrist to talk about trying Botox again and possibly getting a night brace.  We also saw the neurologist and talked about the challenges at school and he has requested an EEG to rule out subclinical seizures that could be causing the attention issues and increased tone.  On top of the EEG this week, she also has her annual appointment with the pediatrician and will be having three teeth extracted.

It's hard to explain the feeling of lack of control when it comes to the behavioral and cognitive issues.  I feel like the physical issues have clear solutions.  Regular therapy. Constraint therapy. Cranial helmet. Leg brace. Eye surgery. Medicine. But when it comes to cognitive and behavioral, the answers are so much more fuzzy.  They are more based on perspective and the direction is not clean cut.  And yet the need to solve them seems so much more intense.  Perhaps that's because the kids are getting older and can verbalize how it makes them feel.  Or because you notice their perception of self in a different way.  Having a background in psychology I've studied how you are affected by the world around you and I know all too well how that shapes who you become.  Does it encourage you to be understanding or cynical? Does it help you be more accepting or bitter? Do you blame others?Does it turn into self loathing?  We all know these people.  We can all become these people. But how we feel about ourselves is the core element of being happy....which truly, if all things are equal, happiness should be our focus.  And yet I find myself pulled into the abyss of tutors, advocates and new theories and programs to solve each of these learning disabilities.  Everyone you talk to has a different answer for how to solve it.  If only it was as easy as just being happy....

Maybe, just maybe, happiness is in the every day when you stop thinking and you just enjoy life.  Happiness is in the smile, the laugh, and the memories that you build every day.  Yes, I will hang my hat on that!  Happiness is my feet in the sand, a sun kissed cheek and a head full of sand !

Neurosurgeon Visit and Indoor Skiing

Just found this post in "draft" that I apparently forgot to post.  Hate to miss it so here it is...

Well I truly haven't had much to post this year (2018), but I will add an update from our appointment with Dr. Myseros in November.  Both kids had a visit with the neurosurgeon.  Cole's appointment was of most concern given we were getting feedback on the FAST MRI that was done a few months ago.  The good news is that the results look stable from the last scan five years ago so everything is working well.  The other amazing news is that he doesn't want to see us back for TWO YEARS!  Wow, what AM I going to do with all this newly found time?!  He also said he would like to wait for any additional brain imaging for five years unless he is symptomatic.  Also great news!

Reagan also sees Dr. Myseros and also had a great check-up.  No symptoms, but still good to keep that relationship in case she starts to show any additional signs of seizures.  As she moves into puberty we expect to have some challenges with medication levels due to varying hormones.  But she will also wait to go back for two years.

So now on to the fun updates.  In anticipation of ski season, we decided to sign the kids up for lessons at the new Indoor Ski Training Center in Leesburg.  We have already requested lessons with the Wintergreen Adaptive Ski School and are waiting to hear back.  We bought the kids their first skis last year and unfortunately Reagan already grew out of hers.  However, Alpine Ski shop has a GREAT buy-back program so we traded in her old ones and got some that fit her a little better.  We were hoping to give them to Cole, but he isn't quite ready for hers.  Looking forward to some snow this year so we can get them out more!

Until then, we will enjoy the holiday season and dwell on all our blessings.  There was a day that I had trouble finding time to post updates between appointments....now I find I don't really have anything of value to post as updates.  And although we still have many challenges that we face with both children, I am eternally grateful to focus a lot less on doctors appointments and more time on fun....and I pray that continues!