A Little Update

In the next few weeks, Audrena will be evaluated as part of the transition from Birth to 3 to the school district for services. I am interested to see what the evaluation brings. She is putting 3-4 words together. However, I feel like her vocabulary is still lagging behind a bit, and she is still leaving out the beginning and ending consonants more often than not. For example, one time she might pronounce "puppies" crystal clear, and the next time it might be "uppies." "On" and "off" both lack the endings more times than not. We are working on it, and we've seen some improvement. Our current SLP through Birth to 3 has done a great job with Audrena, and we are seeing some really nice progress.

We have been using the Naida processors nearly exclusively now. It's new technology, and there have been some bugs. We kept losing mic protectors from one of her processors almost daily, and before long we noticed that the mic just wasn't crisp and clear like the other. So we switched back to the Neptunes and sent the Naida in for replacement. The replacement had issues of its own, giving random red lights or orange lights. The orange light would ordinarily mean the battery was low, but we found that it didn't matter what battery we put in, it would still show that the battery was low. So again we had it replaced. Audrena is hard on cords, so we have had to replace those a few times as well. We went through that with the Neptune cords, too. She is just rough with them. That's why it is SO important to be very conscious of your child's cochlear implant equipment. We constantly monitor things because if she is not getting good quality sound, she can't catch up as quickly with her speech and language.

The Naida processors can use the T-mic 2. We have heard they are generally not recommended for small children because there is no good way to monitor whether they are working. However, our Audiologist wanted us to use the T-mic 2 because it delivers the sound into the opening of the ear, where it naturally would be heard. Also, studies show better outcomes with T-mic usage than without. As closely as we monitor Audrena's equipment, that concerned us because we couldn't really check the T-mic's function, yet we wanted her to have the best possible listening opportunity. Dr. M. explained that she would be programming it to use 50% T-mic and 50% processor mic. That would really function as a 100%/100% arrangement because if the T-mic were to fail, Audrena would still get the sound through the processor mic. She could monitor the T-mic via booth testing outcomes by switching off the processor mic during testing and then testing again with it on. So we agreed to try it. We also think we have figured out on our own how to test the T-mic with it being programmed this way. When we do listening checks, we simply tightly cover the processor mic with our fingertip, and we can hear the sound only through the T-mic. We know the sound is coming into the T-mic because if you get close enough and the air from your mouth hits the mic, you can hear it just like wind. I'm not sure if that's in any way reliable, but it seems to be working for us.

We feel like Audrena is getting better sound with the Naidas. It may or may not be coincidence, but she has had a speech & language explosion since we have started using them. One thing we haven't quite figured out is how to keep them on without using toupe tape. Her glasses get in the way, so they don't sit perfectly on her ear. Tape seems to be the only solution, and it works well, although we sort of hate it. Her hair seems to get stuck in it no matter how careful we are. If anyone has a solution, I would love to hear it!

Time to Give Thanks

As Thanksgiving approaches, I am always thankful for the gift of cochlear implants. This hearing journey is certainly not something we ever expected to endure, and I say "endure" because it has not been easy. However, it has been rewarding in the most awe-inspiring ways. It has taken us places we never dreamed and tested our family and even our marriage a bit at times. But we have come out stronger and happier. Audrena has come so far in the past 15 months, much farther than we expected in some ways.

We are thankful for Advanced Bionics. We are thankful for Boys Town National Research Hospital and every single person who works there. We are thankful for the University of South Dakota Scottish Rite Speech and Hearing Clinic staff, for our top notch Audiologist and Speech-Language Pathologists, and for the enthusiastic students. We are thankful for South Dakota School for the Deaf. We are thankful for a fantastic Physical Therapist. And we are thankful for the many friends we have made along the way, the families that we have connected with, and the mentors we have found.

We can't forget to be thankful for our two older kids, Reyana and Kelton. They have always been loving to their little sister and really watch out for her. They are the best language models for her, and she would not have come so far if it were not for them. I am sure of it. Our family, friends, and coworkers have also been huge supporters throughout the past couple of years.

In the past 15 months, Audrena went from hearing nothing to hearing whispers, hearing at 20 decibels with her implants. She went from saying only mamamamama to putting 3-4 word sentences together. Thanks to her physical therapist, she now walks good, runs, navigates uneven surfaces, and is even beginning to go down steps without constantly holding on to the railing. She did 4 steps the other night while holding a sippy cup and a treat, and with me hovering over her like a Nervous Nelly. Hey, in my defense there was concrete at the bottom!

I was a very shy child, and it has taken me a long time to come out of my shell. I'm not a very outgoing person, and neither is Randy. But this journey has put us in places we never thought we would be. We are finding ourselves filling the role of advocate as Audrena gets ready to transition out of Birth to 3 and into the school system. We have been mentors of sorts for other families, while in turn being mentored by other families further along this journey. Most recently we were asked to be involved in a PSA (which I think will just involve Audrena's picture being part of the announcement) and to be parent advocates for hearing screening legislation that is currently being drafted.

This hearing journey is certainly not something we would have chosen. Given the choice of Audrena with normal hearing, or Audrena with cochlear implants, I think I can safely say we would choose Audrena with normal hearing simply because normal hearing would be just easier for her. However, we love Audrena as she is, and if this is the path God has chosen for her, then maybe her purpose is to make a difference in the world of hearing loss. I have no doubt that she will go far in life. Who knows, maybe she will be a cochlear implant surgeon. Or maybe she will be the first deaf woman president. The moon and the stars are the limit. We are just thankful for great people and great technology to help her along the way.

Our Naida review.

We have been waiting for the FDA to approve the new Advanced Bionics Naida processor since Audrena had her second CI surgery in May. Approval came a few weeks ago, and Audrena had her processors programmed about a week ago.

What we love:

• The smaller size. We felt like the Harmony was just too big for a kid. Audrena is 2 1/2, and the Naida fits her ear nicely with the 110 battery. We also got the 170 battery, and it hangs just slightly below her ear, so it's a reasonable size as well.
• The shorter cord. We really love the Neptunes, and they have served Audrena well, but the shorter cord is so much easier for her when the headpiece gets knocked off. She can reach it better to put the headpiece back on.
• The program button is easily accessible. We never kept the Neptune Connect on her Neptunes. Instead, we used the cap so that the settings wouldn't be accidentally bumped. The program button on the Naida is easily accessible, but it doesn't really seem to be easily bumped, either. It makes changing the program to Clearvoice so easy when we need it!

What we don't love:

• The Naida, like the Harmony, does not have an external audible beep when the battery is low, or when the headpiece gets knocked off. This is a must for small kids! It was so helpful to us when Audrena was smaller and her Neptune headpieces would fall off because we knew immediately. (She couldn't put them back on by herself when she was younger. Fortunately for us, now Audrena is getting pretty good at putting the headpiece back on when it falls off.) I realize that mostly adults and older, more self-sufficient children will use the Naida. But they did make it smaller, and it fits younger children better now, so why not build it with the capability of having that alarm?
• The indicator light is hidden by Audrena's hair. Going back to my rant about the lack of an audible alarm, if they didn't give the Naida an external beep, then it would be nice to have the indicator light in the front like *gasp* Cochlear so that it's more visible to parents. I know, I know...it's more discreet this way.
• We're back to using toupee tape to hold her processor in place like we did with her hearing aids.

Overall, we are very pleased with the Naida! Audrena wears it without complaint. It frees her up from wearing the special pocket cami under her shirt every day. We are excited to have the behind-the-ear option for her. The t-mic technology (which places sound input in the most natural place, in the ear opening) should improve her speech understanding in noise. The Naida was definitely worth the wait!

This was taken just after her programming appointment. She does not have the t-mic on the processor in this photo.

Nothing Stops Her

It's camping season, and we've been spending as much time as we can at the campground. We stay close to home because of all the therapy appointments and our work schedules. While it's still soaking in that Audrena really doesn't have Usher Syndrome, we still realize that things would have been ok. We are overjoyed that she will not lose her vision, but Audrena proves to us daily that nothing will stop her. She is determined and feisty. Take, for example, the following photo. Audrena mastered climbing this ladder. Then she moved on to the BIG one. Thankfully Daddy was there to catch her when she fell at the top rung! But she just does what she pleases, no matter that her balance is not good, or that she is only two! Nothing stops her.

I know. That's a plastic slide. But sometimes you have to let a kid be a kid. Plus, this one wasn't full of static like most others. We just didn't let her on the tube slide since those seem to be really bad for static.

On the subject of Audrena's balance, I am happy to say that she has made great progress over the past few months! She is walking better on uneven surfaces, running, jumping, and even sets up her own physical therapy style obstacle courses at home! It's wonderful to see her improving so much, and others have noticed the progress as well.

As for her speech, she is in a period where she is not learning as many new words, but she is figuring out how to put them together. She is using mostly single words or simple phrases at this point, but one night last week she surprised me. Kelton opened the door to go outside and play. Audrena, being the bossy little sister, yelled at him, "Hey! Kelton! Get back here!" She is also getting better at pronouncing words that she has known for months. The old words are coming out more clearly, and she is becoming more comfortable with trying to repeat new words.

One day a few weeks ago, she was in her car seat, and from the driver's seat I could her her talking to herself. She was saying what sounded like, "Bit**, Bit**, Bit**." I was thinking, "WHAT?!? Where did you learn that?!?" So I turned to look at her in time to see her trying very hard to form the /f/. She was really practicing, "Fish, fish, fish."

I haven't reviewed the First 100 Words checklist for awhile, but I would venture to say we're somewhere in that next 100 words by now. But here are some of the more recent things Audrena has said:

Flower
Oh! It's you!
Who's that?
What's that?
Where go?
Get back down!
Get back here!
What?
Hey!
Pizza
Beach
Butterfly
Nigh night
Fish

We are losing our speech therapist again. She is moving on to bigger and better opportunities for her family. We respect that, but we will sure miss her! It sounds like our Birth to 3 team may have found someone to replace her. I'm not sure what kind of experience the new person has with children who have hearing loss, but I'm confident the team will continue to pull together to make sure Audrena is getting exactly what she needs. Her last speech therapist told me that no matter what happens, Audrena will be just fine. As a parent, I will always worry that we are missing a piece of the puzzle, but also as a parent I know my baby girl. And I take comfort in knowing that nothing stops her!

What a Difference a Year Makes!

Last year on the 4th of July, Audrena had hearing aids and couldn't yet walk. The hearing aids weren't doing much good, but we thought she could hear the fireworks. She would react to the boom before the explosion of color. We will never know for sure if she was feeling the vibration, or if she was actually hearing it.

This year, Daddy threw a fun snap down on the ground behind Audrena. She was facing the other direction, and when it popped, she turned to look the ground behind her. She threw her own fun snaps down. If one didn't pop, she stomped on it to make sure it did. She ran and played with the big kids.

When it came time for the big fireworks, she heard the boom, and then she localized the direction of the echo. She yelled things like, "oh," "pretty," "more," and "look at that!"

About 11 months, 4 surgeries, and countless programming and speech therapy sessions later, Audrena is hearing fun snaps, localizing sound, listening to what we say, talking in response, and putting together phrases! What a difference a year makes! On Independence Day we couldn't help but reflect on the difference cochlear implants have already made in Audrena's life and what kind of independence they will continue to give Audrena throughout life.

2C or Not 2C? That was the question.

We had our much-anticipated appointment at University of Iowa Hospital & Clinics last week. Our stomachs were in knots as we hoped for "no change." With Usher Syndrome, it's a waiting game where the Retinitis Pigmentosa is concerned. It happens at different ages for different people. Generally, people with Type 2 would have a later development than those with Type 1. However, we were still feeling really nervous.

Audrena was a champ for Dr. D., the Pediatric Ophthalmologist, and her associates. She completed the exam, went through some medical questions, and then looked at the genetics report. That's where things got interesting. She explained it to us, and she said things just were not adding up for her. But she reserved judgement until we had talked to Dr. S. after lunch. Dr. S. is an ENT and is in charge of the OTOScope testing lab. So far, though, Audrena's eyes looked good, although she does have some features that were a little interesting to Dr. D. However, it was nothing to be concerned about.

We went to lunch feeling relieved, but we had more questions and were pretty confused at Dr. D.'s opinion of the genetics report. After we checked back in, we waited for Dr. S. And we waited. And we waited. He walked by once. And then he left. We waited, and Randy walked the halls with Audrena to keep her occupied. Dr. D. came out to get a cup of coffee. She explained that she and Dr. S. had been talking, and things were looking good. But she would wait until he called us back to explain. More questions. By that time, I was seriously puzzled.

Finally, Dr. S. returned, and we were called back. He came in and sat down with his report...the one signed by him...the one we had received from the geneticist we originally saw who gave us the Usher 2C diagnosis. He explained that Audrena has two unknown mutations along the Usher 2C gene. However, when tested against all the different databases, only one gene had the potential to be disease-causing. If we understood correctly, it takes two. Then he moved on to review Audrena's anatomy, or her clinical findings. She has an abnormal vestibular system. Usher Type 2 patients have normal vestibular function. She has abnormal cochleas, also generally not consistent with Usher Syndrome. She has profound hearing loss. Usher Type 2 patients typically do not have profound losses. She met some of her milestones later. Usher Type 2 patients meet their milestones on time. He explained that the genetics and clinical findings just do not match up with Usher.

At that point, Randy asked, "Are you telling us that she does not have Usher Syndrome?" I am a little foggy on what Dr. S. actually said because it was such a shock, but he said something like, with today's knowledge, he can say that Audrena does not have Usher Syndrome. In the future, who knows if they will find a new type of Usher Syndrome, or who knows if they will find some other gene. But right now, today, his report will be amended to clarify that Audrena's hearing loss is a recessive, unknown, non-syndromic hearing loss.

Whoa! That took a bit to sink in. We must have questioned him five different times, five different ways. It was just so hard to have gone through the grieving process and then have someone tell us in an instant that it's all ok. I questioned how so many doctors could have misinterpreted the genetics report. He and Dr. D. didn't really know. They were surprised, too, that no one caught it.

Randy and I did give blood because Dr. S. wanted to do a more complete genetic analysis on the three of us to see what he could find, although he expected it to take a year or more. He also mentioned other patients with the same inner ear structure issues and thought there might be potential for a research study.


Dr. D. left us with, "Isn't it nice to ONLY have to worry about her hearing?" Yes, yes it is. But we still couldn't quite believe it. So after the doctors left, the nurse smiled and said, "Would you like me to tell you again? She does not have Usher Syndrome. I can tell you as many times as you would like to hear it!" We kind of laughed, and then we cried. Thankfully she was quick to find a tissue for me!

We spent the long ride home in disbelief. I called Dr. L.'s nurse to give her the news. She was in the same skeptical state as we were. Is he sure? Is he really, really sure? She said Dr. L. would be calling me the next day because he would want to talk to us about it.

Sure enough, the next day Dr. L. called me on my lunch hour. He said, "Well, this is certainly a surprise!" I agreed and said we were not sure what to believe. In a nutshell, he told me that Dr. S.'s lab is one of the best in the country, and maybe one of the best in the world. If Dr. S. said Audrena does not have Usher Syndrome, then he believes Audrena does not have Usher Syndrome. If Dr. S. said her hearing loss is unknown, then there is no one else who will know what caused it. He is just that good. Actually, Dr. L. called Dr. S. "the man" for this type of genetic testing. If there is one person we have been able trust, through this journey, it's been Dr. L. He has never led us astray. So I ended the phone conversation thinking, "If he believes it, then I guess it's safe for me to allow myself to believe it, too."

However, we have spent so much time trying to convince ourselves things would be ok if Audrena had Usher Syndrome that now we find ourselves still trying to protect her eyes. Dr. D. changed her prescription, and when we ordered new glasses we ordered Transitions lenses. I suppose it's ok be cautious no matter what. It's just going to take awhile to work ourselves back to the idea that our baby girl is not going to go blind after all.

Dr. L. had said to me, "If I had to choose between 'unknown' and Usher Syndrome, I would choose 'unknown.'" I agree. We'll take it!

Time for an update.

UPDATE: I felt the need to come back and update this post as we have learned that Audrena's Usher Syndrome diagnosis was a mistake. Here is the post where we learned she does not have Usher Syndrome.

It has been awhile, so I thought it would be a good time to update! We have just been so busy! Audrena is really taking to being bilateral. She knows when the headpiece falls off, and she either puts it back on by herself, or she comes to us and pats her ear to let us know. We do have the alert beep as well, so we usually know before she reaches us. However, we are trying to teach her to be independent with her implants.

We did have some question as to whether she was getting much from the new implant yet since we're still on the first set of programs. Daddy took Audrena to her programming appointment yesterday, and she repeated "bird" to him after he had said it. That was with just the new implant turned on. So it's good to know things are at least starting to sound ok to her. Sometimes it does take awhile for the brain to adapt to the new implant.

They took her into the sound booth, and of course she was just not into it. Audrena rarely cooperates in the booth. She would rather be exploring. Even with that, she did cooperate just enough for them to determine that she is at least at 35-40 decibels with just the new implant on her first sort of generic MAPP, 30-40 with the first implant, and 30-40 with both. Dr. M. from USD has always said (and others have told us as well) that 30-40 decibels is sort of the best expectation for cochlear implant recipients. We do know it's possible to do better. We know plenty of implant patients who hear at 15-25 decibels, and that is our goal for Audrena once she gets old enough to give the Audiologist some verbal information about how she is hearing during programming. Also, we have gotten booth tests with her first implant that showed 20-30. That, combined with what we see at home, are enough for us to believe that she is hearing better than yesterday's test suggests. Both of our Audiologists (Boys Town and USD) have said she could very well be hearing those softer sounds, but she is just not paying enough attention to them to be motivated to turn away from her toy when she hears them.

Also, I forgot to include in some of my previous posts that Audrena heard birds (this was before the second implant)! She heard them before she saw them! We were at the police department's Bike Rodeo at the high school, and there were finches in the rafters of the lunch room. We were eating, and suddenly Audrena looked up (way up) at the birds, pointed, and said, "Tweet tweet!" She had to have heard them because she had not been looking up at all. She was eating. When we first found out that Audrena was deaf, I would take her for a walk, listen to the birds, and wallow in self-pity that my baby girl would never hear those beautiful outdoor sounds like birds chirping. Birds are generally about 15 decibels on the audiogram (although the chart below shows them even softer), so I never expected that she would hear them with implants either. That moment in the high school lunch room was a really defining moment for me, one of those WOW moments that just takes my breath away whenever I think back on it.

Here is an audiogram chart so you can see what I am talking about. The yellow area is the speech banana, or the range that speech sounds fall into.

From firstyears.org

Another little hiccup to report...we may be headed back to the operating room. Yesterday, Dr. M. couldn't find the tube in Audrena's left ear. That's the one Dr. L. inserted in March. Granted, her tools may not magnify quite as much as an ENT's tools, and those tubes are tiny. But she is good, so I trust that if it was there she would have found it. We have an ENT appointment tomorrow morning to check it out. If it's not there, then Dr. L. will need to insert another one. It's such a minor procedure, but it would be the 6th ear surgery and the 7th time under anesthesia for Audrena. And there is always the possibility that she will need a tube in her right ear in the future. So if you are the praying type, say a little prayer that the tube is in place tomorrow, although I don't have much hope that it is. Next week is also our appointment at University of Iowa with the Pediatric Ophthalmologist who will monitor her Usher Syndrome and the doctor with the genetics laboratory that conducted the genetic testing. So please keep Audrena in your prayers that everything turns out well there, too!

On a more positive note, Audrena is really on a role with her speech and language, and she is making progress with her balance! She is saying new words all the time and starting to put them together. She is beginning to understand that there are different words for the same thing, and starting to use them interchangeably. For example, "woof woof," "puppy," and "dog." She also says, "Look at that," or "Look at those." Here are a few of her favorite words/phrases lately.

Look at that/those!
What's that?
Where go? (Where Daddy go?)
Get down!
Good job!/Very good!
NO!
Stop!
Mine!
And when you call her name, she answers with, "What?"
She has also learned "Kelton, "Ana" (for Reyana), and "Zach" (my nephew).

Although we always question whether we could be doing more for her, or whether there is something we are missing, we are so pleased with Audrena's progress!