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Thursday, March 19, 2015

Calvin's Speech Therapy and Upcoming Surgery

Calvin has delayed speech related to his chromosome disorder, 22q deletion syndrome. He used sign language almost exclusively (and very successfully!) from the time he was 18 months old until he was about 30 months old and in that time he learned well over 100 signs. His receptive language has always been on target for his age.

He started speech therapy a couple of months after he turned two. At first he saw his therapist for an hour once a week, then later we added a second therapist to do a second hour per week on a different day, and recently he's been having a third therapy session (only 20 minutes long) with his doctor at Stanford who is a part of the Craniofacial Clinic team that follows Calvin's case because of his submucous cleft palate (also related to 22q).

It took a couple of months of speech therapy before Calvin really started trying to talk. One of his therapists, Holly, thinks it might have actually been the experience of having his arm in a sling (after fracturing his collarbone in September of last year) that motivated him to start using his voice because it was hard to sign one-handed. He still uses sign language along with speaking to communicate, but he is now saying single words, and sometimes 2- or even 3- word phrases. Yaaay!

Here's the Bean with Holly back in January. You can see here that he's not always a cooperative little student!

Here he is with one of his animal books in February.

But now that he is talking we can see and hear that he has a lot of problems with his articulation. He's not using his lips and tongue the way he needs to in order to produce sounds, so when he talks it usually comes out as all vowel sounds, no consonants. His speech therapists (and his dad and I) have been working with him for the past several months trying to help him get the hang of putting his lips together to go "b-" "mm-" "p-." It can be really frustrating for us and for him :/ We try not to push too hard because we don't want to make talking stressful for him.

Calvin's speech development is also affected by his submucous cleft palate. His palate looks intact, no hole when you look into his mouth, but the muscles underneath his soft palate (back of the mouth/throat) are not connected as they should be. Those muscles are supposed to connect in kind of an arch that moves the soft palate up and down and helps control air flow when talking or eating. Those muscles in Calvin's mouth are not connected, so they can't do their job properly.

Calvin is going to have a surgery to repair his submucosal cleft. This means his plastic surgeon will go in and connect the muscles of his soft palate. We don't know how much this will help his speech development, but we hope that it will make things a little easier for him. It should help with the air flow when he is speaking. Of course, it won't solve the problem of getting him to use his lips correctly, and we know he will need continued speech therapy no matter what.

Unrelated to his speech and palate, Calvin also has a hernia in his abdomen that needs repairing. (It's not the result of an injury. When babies have hernias it's because they were born with a little hole where there shouldn't be one. It doesn't hurt him, but it could hurt him one day if part of his intestine were to get stuck in the little hole that shouldn't be there.) To repair the hernia, it's a really quick procedure and it's usually an outpatient surgery. They make a tiny cut and a tiny stitch. We know this because Calvin has already had hernia repair surgery before. But he still has to be put under general anesthesia for the hernia procedure. So, to reduce the number of times he needs to be under anesthesia, we are opting to do the two procedures - the palate repair and the hernia repair - together in one surgery.

Two different surgeons are needed for the two different procedures: a plastic surgeon for the palate repair, and a general pediatric surgeon for the hernia repair. To make his case even more complex, Calvin also has to be cleared for surgery by his cardiologist because of his heart defect (a tiny VSD that gives him a heart murmur, but is otherwise non-symptomatic). His cardiologist will likely recommend that he have a special team of cardio-anesthesiologists do his anesthesia for the surgery.

We've got a surgery date set for March 31. So soon!! But it's pending an appointment with his cardiologist to get the all clear that his heart can tolerate surgery. (We're not worried. He hasn't had any problems related to his VSD - Thank God.) He will also have to have pre-op appointments with his plastic surgeon, his general surgeon, and the cardio-anesthesiologists. All between now and March 31! And, as we learned from Henry's surgery last fall, there's always the chance that his surgery will end up getting rescheduled, particularly because there are three different departments involved: plastic surgery, general surgery, and cardiology.

I'll post updates on Facebook, and, assuming the surgery actually does happen on the 31st, I'll wait until after it's over to write another blog update on Calvin.

The closer we get to surgery, the more the whole ordeal feels pragmatic and logistical instead of hairy and scary. I've definitely spent wakeful nights and tearful moments worrying about Calvin going through another surgery, but at the moment I'm not feeling fearful as much as I am feeling determined. I hate that he needs surgery. It feels awful and unfair. But we're eager to do anything that could help his speech development, and it will be a relief to have that last hernia taken care of. We know he will be in good hands. We are so lucky to have access to the great medical care we get from Stanford for both boys. We love our little Bean and we'll keep doing everything we can to help him grow and thrive.

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