Friday, September 18, 2009

Surgeries scheduled for 8 October & communication options

After postponing his dual surgeries in June following a tracheal infection, we're set for surgeries again on 8 October.

1. Cryptorchidism - this will be the 3rd and hopefully final stage of the urology surgery.

2. Ear tubes - replacing of Reuben's right ear tube which help remove excess drainage and prohibit ear infections.

3. Laryngoscopy & bronchoscopy (L&B) - Reuben was trached 2 years ago due to subglottic stenosis (a narrowing in his airway) and scar tissue acquired from the trauma of being on a ventilator. Whilst the endotracheal tube (ET tube) placed in his airway for mechanical ventilation saved his life, the inevitable damage resulted in the need for a trach to bypass this damaged area. The purpose of this procedure to be undertaken whilst Reuben's under anaesthesia for the above surgeries is to determine how his airway has healed 2 years on. Can we believe it? Two years on next week? How far you've come my beautiful boy from these early days of
1. discussing the trach,
2. accepting the trach would be a reality and the
3. trach surgery itself.

So what can I say on this front? Well, the miracle of Reuben finding his voice after 2 years cannot be underestimated. Too many posts have gone before about how we just didn't bank on it and instead, we scenario planned for a life of signing and that (which continues to this day), even in the event that Reuben had a voice, that he would choose to use it for expressive communication.

So I have a few questions now to pose:
- Reuben wears his PMV (speaking valve) all waking hours unless he needs a trach suction to clear accumulated secretions. On occasion, I can hear vocalisation without his speech valve. Does this indicate anything?
- If the L&B continues to show an obstruction, Reuben may need further throat surgeries (he's had many). In some cases, I've read about LTP to reconstruct an airway as a means to decannulation. I must be patient for the results (like Victoria though, we're none too pleased with a particular surgeon's bedside manner, receiving the results of the surgery from the ENT nurse), but would also prefer to get my research in place prior to the surgery.

And then I have questions about Reuben's pre-schooling. UCLA is an option but as previously said, it will be private and currently, outside my photography, we have no income with Jason losing his job. Kristi I know will have thoughts on this and I know Hannah's thinking about the future too for Vivian. I guess time will tell where Reuben's expressive communication skills lie, but the progress he's making is remarkable, not in terms of the number of words, we're not there yet, but in terms of him speaking gibberish, like a foreign language he's creating himself, a combination of new vowels and consonants with an increasing number of syllables.

One of the speech therapist's techniques (she comes to the house for 2 sessions a week each of an hour), is to work on imitation. She'll leaf through a book and ask "Is this the baby?". Reuben will nod yes or no, with the intention that we'll eventually have him say yes or no. The funny thing is that when he's by himself or thinks noone's looking, I'll catch him pointing to imaginery pictures in turn, nodding "no" and eventually nodding "yes". It's adorable imitation and I wonder what's filtering through his head at the time. Is he hearing my voice or that of the speech therapist's asking "Is this the baby?" and then answering to himself? I wonder...

1 comment:

hannah m said...

I will be thinking of you as you approach these surgeries and procedures for Sweet Reu.

I think schooling choices and communication options have been one of the most heavy of decisions for me in the past year. I've come to the conclusion that there's no perfect choice, just the best choice for Vivian where we are right now. What's best may change. I think it's also important to be in a place where I am learning and inspired, too, since this very early education is as much about helping Viv as it is about helping me help Viv. For now, we've found that place, and I'm so thankful...but who knows what the future will hold.

You know your son so well, Catherine - he's so blessed to have a mom who will make hard decisions in his very best interest!