Wednesday, July 01, 2015

Happy Happy Joy Joy

We received the letter from the twins' school yesterday:  the twins will be held back for Kindergarten.  I know I must be 1 in a million to be so happy and relieved about this news.  It was our first real fight for our children's future, but as Dave's cousin says, it won't be our last.  We have to pace ourselves.  Thank you all for your support on this big issue, which most of you probably wouldn't do.
It is true that we don't have to agree on anything to be kind to one another.  We appreciate your kindness and support.  Also, we kindly suggest you keep your summer babies out of kindergarten for an extra year.  Forgive me:  you know I'm a professor and I have to profess what I think I know.

Speaking of "kind," let's do the Christopher update, which is kind of working.  I say "Kind Of" because it is SO MUCH BETTER, but it is not perfect. Yesterday, in particular, sucked mightily.  You know why?  Guess which child refused to eat anything but fruit and carbohydrates all day long? No protein knowingly passed through his lips yesterday.  Can you say Blood Sugar Drop?  Dave suggests we live in a Snickers commercial.  Pretty much, this is a dramatic re-enactment of our house on carbohydrate days.

Um, yeah.

The good news is that Christopher willingly accepts going to his room for a minute or two to calm down.  Kazdin's big thing is that time outs should not be long.  Longer is not more effective.  For Christopher, honestly, just walking into his room and getting on his bed means he has accepted that he accepts our authority.  Dudes, that is a huge step forward.

Christopher no longer completely loses it multiple times a day. We have gotten better and quicker at "If you do this positive thing, you immediately earn that positive reward."  That's a good thing altogether. It really is just when he is tired and hungry.  And we don't run a short order kitchen, so what's to eat is what's to eat.

Also, Baby No (as he was referred to as soon as he could speak) will suddenly dislike his favorite food to "punish us," I assume for cooking it.  He once threatened to leave us to move in with a family that cooks food that he likes.  Had he been older, not at all sensitive, and I in any way didn't care about the repercussions,  I would have replied, "Be my guest."

So, all in all, we're doing better. I have to better at sneaking in protein, of which homemade yogurt shakes and peanut butter have tons and Baby No still likes them.

What I hate is that he is not getting pleasure out of these episodes.  He doesn't like himself when he is bad.  No kid does.  We all have to remember that.  He's not losing it because he likes it.  He's losing it because he's lost control and somehow we have learned to reward that behavior.

OH!  OH!  OHHHHHH!!!!  I forgot THE MOST important thing we've learned during this process.  It IS rewarding for him, even though it's negative attention.  The most powerful thing we can do is leave the room (or have him leave the room) for a few minutes.

The most impressive event was one night when he, Bridget and I were going to sleep and he had moved from his normal place, drawn a line in bed, and was kicking Bridget every time she got near it.  This was the end of  a 15 minute episode of bad behavior.  I remembered to leave.  So Bridget and I got up and went to her room so he could have the whole bed to himself. YOU WOULD THINK that he was thrilled we were gone.

But 5 to 10 minutes later, we heard a plaintive, "Mommy, would you please come back?!"

"Why, sure, honey!!" You *cannot* hold grudges with this method.

We came back, the bed was cleaned, he was in his right place, and he snuggled up hard to me as we all went to sleep.

It's the last time we've had that particular problem.

Happy happy joy joy, indeed.

Tuesday, June 23, 2015

Knowing for real vs. conservative guessing

So everything is fine.

In fact, everything is so fine, we've stopped Bridget's antibiotics.

Based on worries and suggestions, we did call her pulminologist who ordered a chest x-ray.  At the same time, Bridget's temp went back down to normal, even though she said her ribs still hurt.  She isn't coughing.

This morning:  normal temp, no coughs, pain in throat only, and chest x-rays showed no pneumonia and only some chest wall thickening possibly due to a virus and her asthma reactions.

So, again, we stopped antibiotics.

So the summary:
*Pain in ribs and shoulder
*Low grade fever that disappeared and came back strong then left again
*Junky cough for only a few days
*Very good oxygen numbers.

It seems like a normal virus (except for the spike on Monday morning).  I know atelectasis can sometimes cause fever, but it's only done so once for us and that was in the worst hospital event.

We have no idea what caused her truly severe pain.  I'm taking it as a data point.  If she never has pain in her ribs again, then this was some weird funky thing.  But if she does, perhaps it is some new manifestation of her funky problems

I know in comparing risks of x-ray to the risks of un-needed antibiotics, people have differing opinions.  We know kids are way over-prescribed antibiotics and it has long term effects.  We don't hear of kids being over-prescribed x-rays and it's been over 2 years since her last one.  I have a feeling she'll end up back in the hospital at some point, and I'd rather save her sensitivity for antibiotics when she needs it.  Not just to be conservative because she has funky lungs.

So there.

Of course, Conor started running a low grade fever this morning.  Kit had it last week.  Apparently, it's going through our house.

And no one is seriously ill.  Thank the god(desse)s.

Monday, June 22, 2015

Same? Different? Squirrel-o-rama

So back from the second doctor's visit in two days.  Bridget has some pain in her "waist" (really, her ribs) when she breathes.  That's been going on for about 5 days, and it keeps switching sides. Also, she says when it's on  her right side, it also hurts her shoulder.

She had a low grade fever for about 24 hours, Friday to Saturday.  It went away and came back at 102.1* this morning.

First doc said she'd pulled a muscle and that's why her ribs hurt.  :-/

Second doc said today we could hear some depressed breathing in her lower right lung lobe.  (I'm sure "lung lobe" is not a correct phrase.  It sounds really odd to say:  Lung lobe.  Lung lobe. Lung lobe.  So I shall say it repeatedly) To be fair, yesterday Bridget said her left side hurt and today, she said her right.  First doc didn't spend any time at all on her right side because Bridget didn't say it hurt.

We're starting her on antibiotics in case the depressed lower lung lobe is antibiotics. LOWER LUNG LOBE, FTW!

I have to be honest with you:  Dave and I really feel like we've been here before.  Diagnosis of pneumonia that really is atelectasis and, well, things happen.  However, Dave and I are no longer novices with Bridget's lung lobes.

We've got a pulse oximeter and we know how to use it.  We have a top notch pulminologist who will be our next step, should her oxygen numbers start to go down. We have a pediatric team that knows she's funky.

The crummy part is that neither option is great here:  Bacterial pneumonia or virus-causing atelectasis. Yeah, at this point, pneumonia is the better choice.  I guess??


No one is naive here.  This may be the end of the diagnosis and we're done.  Or, we may be at the start of something.

Blergh again.

Thursday, June 18, 2015

Mondor's Disease: A Punny


I forgot the funniest part of spraining my boob, I mean, self-diagnosing with Mondor's disease.

When I first started searching google and explaining it to Dave, I kept saying Mordor's disease.  That will only make sense to you if you are a JRR Tolkein fan.

Mordor's Disease.




That means my boob is the Eye of Sauron!


Wednesday, June 17, 2015

A Shitty Couple of Weeks

It has been tough here in the Mother Thing household.  As I was telling a friend yesterday, Conor is the only one who doesn't have something big and possibly bad going on.  Four out of five is not good.

So humorous deconstruction of reality.  Let's go!

First up:  Dave!  Dave had outpatient surgery last week.  In the interest of HIPAA, I'll let Dave share the reasons why, but it was NOT elective surgery.  And while it was outpatient, he has had some significant down time.  We expected that.  Sort of.  I must admit that when I came back to the recovery room, his state coming out general anesthesia was pretty pitiful.  It's the first time I thought:  How am I going to walk this 6'4" dude into our home and onto a bed.  He went back to work on Monday.  But Tuesday came home early with a similar look of pain and fatigue.  He's working from home today.  It's supposed to be a 2 week recovery and we're hoping we're about halfway through it.

Next: Me!!  I had a bit of a breast cancer scare, although probably not as much as I thought it was. It started about 3 weeks ago with some serious pain in my breast.  YES!  You are correct!!  99% of the time, breast pain is NOT cancer!  Breast cancer doesn't hurt!  But the 1% of the time that it *is* cancer, it's very bad.  I waited two weeks for my annual GYN visit and the doc scheduled me for a diagnostic mammogram which was a week later.  I *really* wanted one ASAP and they moved it up to two days later.  YAY!!  Nothing on the mammogram and the radiologist was not amused by my coming in so quickly.  I really don't care.  Really.  No one lost out on my getting in quicker.  Doctor's advice?  Stop poking your boob.

So, three days later....I SWEAR I WAS NOT POKING MY BOOB!!  Instead, I was going "OW! This bra really hurts; let me pull it off the sore spot!!" and felt something.  It wasn't/isn't a lump.  Instead, it's more like a cord or a tendon or ligament.  I haven't had biology since high school, so honestly, I don't know if one's boobage has ligaments.  It doesn't.  I did not sprain my boob.

Instead, Dr. Google suggests that I have "Mondor's Disease."  Basically, a superficial vein in my boob has a blood clot in it and has caused the rest of the vein to swell up and harden. It is believed to be benign, sometimes painful, and rare.  It is seen less than 1% of the time in breast clinics.  There is really no treatment except waiting for it to heal itself.

So I called my OB/GYN to tell him about the cord I'd found in my boob, who gave me the same advice as when I saw him in the office:  take ipuprofen and if it still hurts, he'll recommend biopsy surgery in 2 months.


That's not what is going on.  I am annoyed.  I potentially have this rare but still benign problem and his advice is take two aspirin and call me in the morning?  Ok.  Fine.  It's rare, it's benign, and he clearly doesn't believe me.  Whatevs.

So then the Twinnies.  This is the part that has been keeping me up at night and making me so anxious that just typing that caused my stomach to drop out.  It is possible they could still be be promoted to 1st grade.  Despite our wishes and their poor performance on standardized tests, their scores are low but within normal range.  So they *could* go forward.  Further, I feel like my emails about our comfort with them being retained got their care team in trouble, something I had no intention of doing. I'll be honest with you.  Seeing all the other kindergartners graduate to first grade makes me sad.  But they are not ready to go up.  And I still believe holding them back is a good idea. We are anxiously awaiting the final word.

Also, don't email anyone in the public sphere.  Just don't.  Call.  Unless you want your email to be part of a permanent record that could bite you or someone else in the butt, DO NOT EMAIL.  DON'T DO IT.  Unless you *do* want it in the permanent, public record, then feel free.


Summer school is over at the end of this week.  I'm teaching two classes, one of which is a new prep.  With all this other stuff going on!!!  YIKES!!!

I hope the rest of the summer is boring and fun.

Friday, April 24, 2015

Week #3 on Parental Reboot

So we've gone through three weeks of our Kazdin's Positive Parenting Reboot to keep Christopher from throwing a tantrum.  We have learned a couple of important lessons thus far.

1)  We're not done yet.  We've made significant progress.  In fact, I would have been shocked three weeks ago how much better things are now than they were then. But we're still dealing with a hair trigger temper and a quick devolution to 5 year old hell.

2) OH MY GOSH.  If there any indication that positive parenting works and punishment focused parenting does not, it was our own N=1 design last Friday. For some reason, Christopher started off on the wrong foot stealing Bridget's bagel at breakfast.  I told him he would only have one opportunity to earn points that day instead of two.  He screeched and screamed and I took the second opportunity away too.  ((This is a good example of how I had been parenting before))  I realized I had just experienced a brain fart and gave him one opportunity back.  That afternoon, he demanded two opportunities and I said No.  That night, he got mad at us and would only sleep on the ottoman at the end of the bed.  I should have ignored him ((MORE LATER ON THIS)) and instead I tried to engage him.  He gently (but  it still happened) slapped me on the face.  I grabbed his arm and forcefully told him not to ever do that again.  He screamed that I could never be a mother with that tone of voice.  He then became hysterical, screaming and kicking and throwing and sobbing.


I'm giving you that example to show What Not To Do and What We Have Been Dealing with.

He and Dave went to bed elsewhere and I slept with Conor and Bridget.  About an hour later, I couldn't stand it and switched places with Dave.  ((It's a commune around here on weekends))  In the middle of the night, Christopher and I woke up and kissed and made up.  In the morning, he told me that he had been very, very sad the night before.  I had re-read Kardin's book and realized that my approach to take away his opportunity to be good was probably not going to win me mother of the year.  Not doing that again.

3.  Who the heck knew IGNORING was so freaking effective?!?!?!?!?!  He was doing his "No, I'm Not!!!" where he basically refuses to do anything we ask the other night.  So we all left the room.  He was refusing to go to bed and Bridget, Conor, and I just left.  Dave came in about 15 minutes later and told him it was time to brush his teeth and go to bed, and he hopped up and did it.  I SHIT YOU NOT!!!    Right?????  Afterwards, Dave and I just looked at each other and went, "How positively reinforcing is THAT?!"  For us, yes!!  Ignoring is a good thing.  Christopher told me "No, I'm Not!!!" the other day and then immediately backed down.  I will freaking take it.

4.  Three weeks in, we're already starting to taper out the points and rewards system.  He received his fancy new Lego set for being good for 2 1/2 weeks and earning enough points.  Since then, we've run out of treats for the goody bag and we're just sort of doing the practice and points as we need to.  I need to read up what is next.  I don't know, but he's not All Done yet.

So, yeah.  Big steps forward here.  We haven't changed any underlying cognitive processes here. I am suspecting that Christopher is extremely sensitive and instead of directing his pain inward, he directs it outward. I think it means that for most of our parenting, we're going to have to focus on helping him do right instead of punishing him for doing wrong.  That doesn't mean punishments are out.  But it means focusing more on rewarding what we want to do than relying on threats of punishments to stop what we don't  like.

I'd love to hear how you all are doing on your parenting challenges.

Wednesday, April 08, 2015

Parenting Intervention(s)

So, last Friday we started our first "Parenting Intervention" with one of the children.  Specifically, Christopher, aka Kit (mainly because that's a boatload easier to type, write and text).  So our little moose, Christopher/Kit, is a very sensitive boy.  And he experiences pretty big feelings:  high highs and lowwwww lows.

And when he gets angry (frequently because I tell him no, he can't have a homemade yogurt "milkshake" and instead he can have a banana), he turns into a holy terror.  He screams, he hits, he spits, he bites, he says he hates us, he says we hate him, he goes right up to but does not cross the line of destroying important toys/plates/knick knacks.

We have been using time outs as punishment.  And really, it's also been a strategy for him to get ahold of himself when he is truly losing it. Here's the thing though:  as the time outs become more frequent and longer, at some point you have to note that the behavior is not changing.  Our parenting strategy is not working.  ((And for spanking/hitting advocates, the results would likely be the same with just more anger on his part and then more force on ours.  Not a road we're going to travel down))

So I wish we had been the ones to recognize that more times outs, longer timeouts, or more/longer/extreme timeouts (or any punishment)  without a change in behavior means that the parenting strategy is becoming less effective.  But we did not.  Instead this was an observation in the first chapter of our new parenting guru, Dr. Alan Kazdin, developmental psychologist, Yale professor, and author of The Kazdin method for Parenting the Defiant Child.

I have to be honest with you.  While I appreciate pediatrician's parenting advice, as a psychologist, I sometimes think they should stay in their own lane.  So when I find a psychologist who offers applied advice based on 30 years of published, peer reviewed research, who was also APA president (less impressive to me, but there it is), I'm going to listen.

Also, WHOOPSIE DAISY!!!  Although I spend a good portion of my reinforcement theory lectures talking about how punishment only stops a behavior and only positive reinforcement CHANGES a behavior...I FORGOT!!!  Yeah, we professors do that sometimes.

So, what have we been doing?  We have focused on the Positive Opposite of the tantrums ("To ask nicely and to remain calm no matter the answer").  We have ENTHUSIASTICALLY!!!!!!!!! praised every positive practice and every actual "asking" episode.  We have immediately given check marks on his scorecard.  We have provided goodies and rewards for both low level points (one good episode and he gets to go to the regular goody bag) and higher level accumulated points (2 1/2 days of good episodes and delaying reward lets him go to the BIG goody bag).  We have provided goodies for the other kids to get when he does well, which allows him to be the family hero.

In 5 days, he's moved from frequent goat to frequent goody.  He still gets mad and he's still making poor choices.  But he is SO MUCH BETTER.  When he gets ready to lose it, he can handle himself a little better.  When he loses a point or I tell him he only gets to earn 2 points instead of 4 for the day, he agrees with it.

We're only 1 week into this and it apparently takes about 2 months to get the new behavior to become a habit and phase out the rewards, but we are really happy.  It's truly a family intervention.  We are all trying hard to help Kit do well. And he loves the attention he is getting for doing well.  Positive reinforcement is SO MUCH MORE POWERFUL than punishment.

It's exciting to see this in action.  And it's exciting that this is based on both strong theory and a great deal of good research.  This is one of those blog posts I hope can help others make effective changes in their child's behavior.  Leave a message or email if you have more questions.  We'll be updating more about this as we go through the 8 weeks of intervention.