Cochlear implant

A Relatively Quiet Week

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There isn’t much going on in the way of news, but I felt like writing something out and keeping momentum. We don’t have any appointments this week! I was telling Shannon that I both like that and feel anxious about it. It’s nice to get a little bit of a break, but I also want to keep things moving. We’ve just about maxed out what we can do at this point, though – the genetics appointment is next week, early intervention is probably tearing through all sorts of paperwork and getting our therapy team lined up, and our ENT doesn’t have much for us until Alex can get his MRI done in March.

Despite the lack of appointments, we’ve been busy working with Alex on the minor issues that the physical therapist identified – neck strength and favoring his right side. Shannon and I have been very diligent on giving Alex plenty of tummy time, which has paid off well. Only a week later and he’s clearly MUCH better at getting his neck up nice and high, even if he’s still a little bit wobbly. We’ve also done a lot of work to encourage Alex to move his head to the left. That typically involves putting him on his side a bit so that gravity helps to push his head to the left (especially when sleeping) and putting him on the floor such that whatever action is occurring (Taylor playing with toys, the TV, mommy / daddy) is to his left. This has also paid off. He may still be favoring his right side, but at the very least it’s less noticeable at this point. Shannon and I hope to keep at it and see how much improvement we can get out of Alex before his PT appointment. Shannon has done some great research on head bobbling, and she’s identified that as an area we’ll still want to work on. According to what she’s seen, most kids’ heads generally stop bobbling by four months, so we only have a few weeks to get Alex to that point. I think that overall, we’re making great progress with working on Alex to address the issues the physical therapist brought up. It’s nice to see results!

A cool thing that I forgot to mention out of the audiology appointment we had last week was that part of the oral school’s “curriculum” includes a music class. I LOVED hearing about that. Shannon and I are both relatively musical people. Our favorite game of all time is probably Rock Band, we both like musicals, and we commonly have music playing in the background when we’re home. Taylor’s also quite the little singer.

Among the many things that hit me hard with Alex’s diagnosis was that he wouldn’t be able to appreciate that as much with us because he’d either be unassisted-deaf or be using cochlear implants (which currently aren’t known for being great with music). To hear that the school does any element of music therapy was wonderful, because it will be catered toward kids like Alex and it implies that, contrary to a lot of older stuff you’ll read on the internet, music isn’t useless noise to some of these kids. I can’t end this paragraph without also mentioning that there’s good stuff coming down the pipe for music comprehension through cochlear implants, too. I’m excited to know that Alex might be able to join his family of music appreciators. Shannon and I both want so much for him to enjoy Christmas music with the family next year.

On the topic of implants, I’ve still been doing a lot of research on implants so that if we’re eligible, we’ll know which direction we want to go and not feel rushed. At this point, I think we’d lean toward the Cochlear Nucleus 6 system. There are lots of good reviews from both adult users as well as parents of kids who use them that indicate that they sound “fuller” than previous models and that they also do wonderfully in noise compared to previous models. They’re also splash-proof! We like what we’re reading about them so far, and it helps that Cochlear owns something like 65% of the market. Technogeek note – they’re also the company who are known to be testing the fully-internal implant that I really, really want Alex to eventually get.

Despite all of the optimism and hope I think I’ve been showing here, it’s still really sad to know that our hopes, at least for the interim, will still involve Alex having a very obvious apparatus on his head. We’ll often read posts from parents on the boards discussing their strategies for dealing with when people ask about what the implants are (with varying degrees of politeness), and it just sucks to know that Alex will have to deal with that for an appreciable amount of time. The term “it’s just not fair” has been used quite a bit in our household. We’re still very grateful that the opportunity to experience sound and speech will be available to Alex, of course, but it sometimes pains me to look down at his perfect little head and know that, in some way, it’s going to be “spoiled.” When Alex gets his hearing aids, I’m sure that those shallow concerns will fade into the background if we know that he’s getting sound, but it’s sad to contemplate in the present.

What else… I think Shannon and I have found that it’s becoming much easier to talk about Alex’s hearing loss in a more matter-of-fact sort of manner without getting emotional about it. We went to a family party and Shannon brought the topic up very smoothly (everyone was probably wondering about it but afraid to ask), and we gave a general update regarding what we were hoping was going to be coming down the road. Being able to do this without getting measurably sad might not sound like much, but it’s a small victory and one that we’ll take.

Last interesting thing of note – Shannon has been visiting Alex at daycare during her lunch hours at work. It works out pretty well because her office is only a few minutes away from Alex’s daycare, it gets her some extra time with him that includes a little bit of physical therapy, and it also shows the good ladies who work there what sort of things we’re working on with Alex. During conversation with the teachers in Alex’s room, one of the teachers revealed that she has a daughter with hearing loss as well. Though hers was not enough to qualify for cochlear implants, she DID say that she has all kinds of experience dealing with hearing aids that have fallen out or are squealing, and so she can certainly help out when Alex gets his as well as be the go-to person for other teachers if Alex has any problems. Since we still haven’t found a nanny yet, that’s significantly comforting! One of our fears with leaving Alex in daycare is that we won’t be able to emphasize enough to the teachers how important it will be to keep his hearing aids / speech processors on or that they won’t know how to do it, so knowing that there’s a pro in the school really helps to alleviate that concern.

I think that about wraps it up for now – happy holidays!

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On the Topic of ASL

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I was going to write about how yesterday’s Early Intervention meeting went, but that can wait for another day or two.

A commenter named Suzanna left a thoughtful message on my last big update and as I was thinking about I was going to respond to it, it seemed that the content of that response might be worth its own post because it’s a big piece of our early strategy and goals for Alex, so here goes.

Our overriding objective for Alex is to give him every opportunity in life possible. To us, that includes doing everything we can to help Alex overcome his disability. Yes, we look at his deafness as a disability. We live in a hearing world and there are obvious detriments to living in that world without the ability to hear. We worry about him not being able to hear danger closing in. We worry about him not being able to communicate with hearing people as easily as possible. We worry about him being at a statistical disadvantage when looking for employment (even though 20 years from now this might not be an issue). We want him to be able to appreciate music. To us, each of those things represents opportunities that, at the very least, become more difficult as a person who can’t hear. That isn’t to say that the deaf community should be pitied or that they need to be fixed. But at the end of the day, if modern technology / therapy gives us the ability to grant Alex any opportunity to hear, we’re going to take it for him, not because we want him to be “normal” and without regard to contributing to perceived ethnocide (yes, it gets that intense). With his level of hearing loss, this basically means very powerful hearing aids that would have limited functionality, cochlear implants, or auditory brainstem implants. I’ve written this before, but if I’m fixating on technology and implants, it’s because those basically represent what Shannon and I think are the best gateway to opening those opportunities up for Alex.

We’ve spent hours upon hours researching from many different angles. Our research has shown us how successful kids can be with these implants, the relatively low dangers associated with what’s an outpatient and NON-BRAIN surgical procedures, and we know what the many challenges and limitations are going to be. Most importantly, a very well-known aspect of developing a brain geared toward using hearing is that that hearing must be present and exercised within the first three years of a child’s life – the earlier, the better.  Knowing that, we are absolutely of the “TIME IS OF THE ESSENCE!” mentality.

So – this post is about ASL, but I wanted to give that above background to explain why we’re not going on about ASL quite as much. Primarily, it’s because ASL isn’t much of a variable for us. We plan on using it with Alex and learning ourselves.  To what extent is dependent on Alex’s needs and his therapy. Our objective for Alex at this point is to have him use speech primarily IF it’s possible (i.e., he takes to the implants well and therapy results are obvious). There are various schools of thought regarding the usage of ASL if attempting to teach speech as the primary mechanism of communication. One side believes that it hinders speech, the other doesn’t. I haven’t found anything decisive, but I do know this – in the sunniest of scenarios, if Alex gets his implants and does well with them, they still won’t be on all the time, and it’s unacceptable to us that he’ll simply be out of luck during those points. If nothing else, we (and the family) are going to make sure we know some of the basic signs. I’d like us all to know as much as possible without hindering Alex’s speech / hearing development, however.

So if I don’t talk about ASL that much, it’s for a few reasons.

  1. Barring Alex’s eligibility for cochlear implants, it’s simply not our first choice for Alex’s primary means of communication.
  2. We’re planning on learning ASL regardless, though only to the extent that it doesn’t interfere with his speech development. We’re still learning about how that works, but unbiased literature on this is relatively sparse
  3. I’m a technogeek and am still amazed at what these implants are accomplishing in the real world, and my true belief is that if Alex does well with the implants NOW, when it’s key, then his disability will present less and less barriers to opportunities as the technology improves. He only needs to get his foot into the door now and enjoy the advances (obviously assuming he wants to!).
  4. If it becomes evident that Alex isn’t doing as well with the implants or can’t get them in the first place, we will immediately switch to ASL. It is absolutely NOT off the table or something we’re trying to avoid.
  5. The chance that Alex won’t be able to take advantage of ASL is far lower than the chance that he won’t be able to go the oral route, so that’s more of a concern that’s on our minds.

A little story: one of the first things Shannon and I did when we learned of Alex’s hearing loss was to discuss how important it was to us that the family be able to communicate with one another and to jump on that early, so we added a few signs to our repertoire (Taylor learned some signs at daycare, so we already knew a few).  They included “dad,” “mom,” “sister,” “brother,” “please,” “more,” “food,” and “enough.” Though we’ve admittedly slipped on this in the past few weeks, we have been showing those signs to Alex where appropriate and working on them with Taylor (“Can you say ‘please’ with your hands, Taylor?”).

Honestly, as I write this, I’m excited to learn ASL. I love learning new stuff, and deafness will always be a part of my son’s life, even if the medical suddenly developed a shot to give him his biological hearing back next week. Though I don’t want him to be limited to only ASL when the vast majority of us don’t use it and don’t value it enough to get in the way of getting him his best chance of access to speech, I still want him to have that link, and I want us to have it, too.

A Sliver of News on the AN Diagnosis and other Thoughts

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For the first time in what seemed like forever, we actually had a pretty nice weekend.  None of our evenings were complete Google-fests that got us worked up, and we were able to really enjoy our kids and the family dynamic in general.  Good for the soul.

On Saturday we went to Shannon’s workplace.  They’re a relatively family-oriented company, so they offer a breakfast where Santa shows up on a firetruck, kids get to ask for presents on his lap, etc.  There are various activities for the kids to participate in as well.  It blew my mind when I thought of the fact that this was actually the third time our daughter had participated in it, even though she’s only two.  Crazy how time flies.

Something I’ve found myself doing A LOT now when I’m in a semi-crowded area is searching for people with hearing aids.  I’m not sure why, exactly.  Maybe it’s to comfort myself that Alex won’t be alone in wearing assistive hearing devices (should he be lucky enough).  Maybe it’s because I’m interested in seeing how those people “do” in louder environments.  Regardless, one thing that particularly caught my attention at the event was the amount of people who were wearing glasses, kids included.  And though this analogy is obviously flawed, it made me think that if Alex is wearing assistive tech, is it really THAT fundamentally different than all of these people with glasses or braces?  Now, of course there ARE real differences.  Glasses are practically a fix.  You put them on and you’re ready to go.  With hearing aids / implants, therapy is basically required to teach children like Alex who weren’t born with hearing to learn how to use their sense and get them “caught up” with the hearing children who did.  Glasses are also very common on little kids, whereas hearing aids (let alone cochlear implants) aren’t.  Still, it lends a lot of credence to a common experience I’ve read from many different parents, and that’s that though their children’s peers are often curious about the implants, a simple “these help me hear” explanation suffices and that’s that.

It’s probably a coping mechanism and reach in general to say that an implant is similar to a pair of glasses, but it still brings me some comfort because there ARE some parallels there, the biggest of which is that a person with glasses who’s practically blind without them isn’t defined by them.

Anyhow, it was a nice little family event.  I was telling Shannon that it’s going to be very interesting to see what’s going on with the family at this point next year.  Maybe Alex will be a few months into his hearing journey by that point?  We’ll see.

Later that day I ran out to grab a pizza (our appetites have officially returned, which feels good) and grabbed our mail on the way out of the driveway.  In it was a letter from the hospital containing the official ABR report from Alex’s last test (this was the test where the audiologist doubted the auditory neuropathy diagnosis from a prior test).  I anxiously opened it to see if there was any new information – she may have collaborated with the other audiologist to compare notes, as I know that what gets sent to doctors / professionals is much more detailed information than the write-up that they send to patients.  But there wasn’t!  The write-up indicated that no signs of auditory neuropathy were observed in EITHER ear.  Again, this isn’t really news, but it was somewhat comforting to see that written out on the official report.  A little bit of hope.

We have another meeting coming up with Buffalo Hearing and Speech which we’re assuming will consist of yet another ABR, so maybe at that appointment it can be hammered out either way. We’re still really hoping it isn’t AN because that would mean that Alex might get some benefit from the hearing aids he should receive within a month and, more importantly, give Alex a better chance of not having any other associated health issues.

Speaking of appointments, Alex has a pediatrician appointment tomorrow.  I’m looking forward to asking a few questions to our awesome doctor and hoping to walk out with a clean bill of health that I can then report to the Early Intervention evaluator that’s coming over on Friday.

Emotionally, it’s still a roller coaster.  It’s easy to get caught up in both the lows as well as the highs (though a “high” is just feeling relatively normal).  The Facebook group I mentioned has been a great source of information, comfort, and realism.  What’s great about it is that there are tons of great uplifting and happy stories, but at the same time there are also real stories about the occasional sadnesses involved.  A great example was a mother asking the board about what they said to their kids when they got to the point where they’d ask why the other kids didn’t have to wear “ears” or when they’d be able to take theirs off.  Leaving my techno-phile hat off and ignoring my belief that that’s all going to go away given time, I appreciate those stories because it gives us a hint as to what we MIGHT be in for and it also makes the happier stories all the more real and graspable.  Needless to say, I’m now a big believer in the power of support groups.

Alex is also helping us to keep our heads up by being a good little guy in general.  We’ve gotten a few laughs out of him and he definitely likes to smile at us, which I like to interpret as his faith that we’re going to do everything we can to help him kick as much ass as possible in this world.  There’s always just a little bit of sadness with each of these moments, though, because you can’t help but wonder WHY any of this is happening to such an innocent and happy little dude.  I often feel bitter that Alex is our last child and we can’t even enjoy him and the completion of our family as much as we would be in the alternate universe where he was completely fine.  That isn’t to say we don’t love him as he is now, obviously, but there are very few moments when we’re not thinking about the whole thing and worrying about what’s coming up and if we’re doing everything that we can for him.  It pisses me off that we can’t enjoy this time to its fullest.

All of that said, we’re definitely doing better.  We’re smiling a little bit more and depressed a bit less, though there’s always that underlying sadness present.  I think we’ve come a long way in a few weeks.  Getting rolling with Early Intervention this Friday could go either way.  I’d like to think it will make us feel better because it’ll feel like now we’re actively doing something for Alex, but it could also be a reminder of the long road ahead of us that we didn’t choose.  We should hopefully get closure on which way Alex is going to go within a few months (hearing and mainstreaming or visual / ASL / deaf school) which should also be a big help in getting us moving down the path of what’s best for Alex.

Just keep swimming.

Putting my Money where My Mouth is

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I’ve always loved technology.  I still have very fond memories of playing with the family’s TI-99 console back in the day with my dad and how much excitement I got out of going to the local Big Lots with my mom and sisters where she’d let me pick out a game for our Atari (and maybe a model airplane, if I was lucky), and endlessly fiddling with our various home PCs.  Way back when, we had a monochromatic monitor with a simple, cursor-based word processor.  I didn’t love writing, but I loved playing with the thing.  The power of these devices, of course,  is a complete joke compared to what most of us now carry around every day in out pockets.

As I got older, most of the money that I earned working at the local pizza joint was piped into upgrading the family computer to soup-up my video games, then later into buying my own computer that I pieced together.  I went to college and majored in Computer Science, and today my profession is that of a software engineer / architect.  Buying a new piece of tech still brings me that childlike joy.

Because of my love and experience with tech, I feel like I have a pretty good pulse on how quickly it moves and what’s coming down the pipe.  There’s a guy out there by the name of Ray Kurzweil.  He wrote a fantastic book called The Singularity is Near.  The basic premise of this book is that technology is advancing at such a rate that computers will eventually be able to build faster and smarter versions of themselves, which will then go on to build faster and smarter versions of themselves, etc.  Basically, there’s a tipping point where computers will flat-out be smarter than humanity, at which point we’ll generally see some serious shit as every complex problem that exists in the world gets solved by rapidly-improving AI.  I think the projection was that this will all go down in 2040 or so.  I happen to think that the premise is inevitable, though the timeline feels either too aggressive or too incredible to accept.  Pick one.

I bring all of this up because it colors my perception of Alex’s hearing loss and what the future will hold in the context (AND THIS IS IMPORTANT) of what sort of opportunities he will have to be able to hear this world if he wants.

At this point, we’re not sure if Alex is even going to be eligible for any sort of cochlear implant (which would be necessary given his 90db hearing loss).  It seems pretty sad to us that our biggest hope for him at this point is a pair of relatively invasive surgeries that, if successful, will still require him to wear a very conspicuous apparatus on both sides of his head, but I find it amazing that this technology exists and has helped as many people as it has who want to hear or restore some of their hearing NOW.  In five years or ten years… these things will not look the same, or sound the same.

I have little doubt that within ten years a fully-implantable implant will be available for Alex that will perform better than whatever he might be implanted with today (if we’re lucky enough to be eligible for that option).  I actually brought this up to the ENT at our first meeting, who rightly said “But if it’s working, why go through another surgery?”  A perfectly valid point.  My mind at that point, though, gravitated toward “He’s right.  At that point, we’d wait until he’s 17 or 18 years old to get the best out there prior to college and take advantage of less traumatic / invasive operation methods and make sure that he’s the driver of that choice.”

Before I get off the topic, a cool note that the ENT brought up – Cochlear (one of the big three manufacturers of cochlear implants) implanted a few users with a very interesting design.  The internal portion of the implant includes microphones, which means that even when the user takes off the external piece of the apparatus, they still have some trace hearing through the internal part.  Essentially, it’s completely invisible hearing.  This implant also allows the external apparatus (the part that looks like the hearing aid and wire that leads up to the head) to be used, which allows the user to hear much better than using the invisible hearing mode.  Though the invisible hearing isn’t nearly as good, it’s still amazing to me that users would have the option of being able to do things with SOME hearing such as sleep, go swimming, etc, all without the clunky visible pieces.  Even cooler –  these folks were implanted eight years ago.  God knows what they’re testing behind closed doors today.

A like-minded friend of mine made an astute observation that I hadn’t considered, and that’s that the baby boomer generation is greatly helping to push money and resources into development of hearing aids / implants as they age.  Alex’s condition is clearly not a blessing (at least to us, no offense to the Deaf community intended!), but the fact that it affects as many people as it does makes it a high-visibility issue that researchers from different fields as well as assistive-technology companies are racing to address in increasingly innovative ways.

My dad was recently over at the house – he’s worn hearing aids for years.  I appreciate the hell out of the man, and I love getting his perspective as a guy who’s worn hearing aids for years and is generally well-researched.  He’s re-iterated many times that his hearing aids have VASTLY improved since he first began with them.  It’s great to hear that reinforced from a guy who lives in that world and has actually seen (heard) the benefits.  It makes it all more real.

Getting my feet back on the ground – all of this could of course be a moot point for Alex’s immediate future.  We probably won’t know if Alex can take cochlear implants for months, and even if he can, we don’t know how well his body will react.  Even if his body reacts well to them, the implants are only part of the equation.  Therapy and hard work is the other, larger part.

Overall point… it’s been wonderful and comforting to see what these technology-driven implants are capable of affording the young and old alike and to think of how much they’ll improve in the coming years.

Shannon and I recently joined a Facebook group of about 2000 parents of children with implants.  The stories and videos they put up are mind-blowing.  Kids singing in tune.  Stories of mainstreaming children with little to no issues.  Playing in the school’s orchestra.  Speaking with no sort of affect.  Videos of kids saying their first words only a few months after implantation.  Stories of honor roll, wonderful social lives, sports, music… the list goes on.  It’s been great to look at the results as well as the support system that’s in place in that group, as well as the sheer number of folks posting within.  These aren’t isolated superstars, they’re a large segment of kids with loving parents who fought through the surgery, dealt with the processors falling off, and got through the therapy to get their kids over the mountain that Shannon and I are staring in the face right now.

It’s all both inspirational as well as terrifying.  If the tech gives us an opportunity, Shannon and I will do whatever it takes to get Alex the therapy he needs to get the best results possible for his brain to wire itself up for hearing / speaking.  If we get the miraculous results that some of these folks are getting, then as time goes, the implants will get smaller and better, perhaps to the point that they’re always on, invisible, don’t need to be charged, and are either as good or better than normal hearing one day.  Perhaps the enormous amount of stem cell therapy being researched for hearing loss will give Alex a purely-biological option.  It’s terrifying because this is all building up a great amount of hope that could be squashed and send us down the path of devastation again.

If there’s a greater power steering any of this, I’ve considered that perhaps it decided to put my faith and interest in technology to the test by taking Alex’s hearing from him.  Granted, that’s a bit jerk-y of said power to do, but the thought has crossed my mind.  Hence the title of this entry.  Though it’s true that if we’re lucky enough to be able to go down this road (and yes, I know how odd it is to call it “lucky”) that our family’s dedication to our new addition and elbow grease will be more important to his success than the implant, it can’t be denied that the implant is still necessary to allow Alex to hear our voices in the first place, and it WILL improve, just as braces lead to invisiline and thick coke glasses lead to lasik.  It’s a huge component of Alex’s potential hearing future.

If… IF we can get the implant early on, when language development is key, I see a future for Alex where his disability melts into the background of his life in all ways and that the combination of hard work, technology, and familial dedication will overcome that mountain that was put in front of him.

We just need the chance.

Some Clarification

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I’ve gotten a few notes from my past few posts, and just wanted to take a stab at clearing the air quickly.

At this point, what I’m writing is very emotionally charged.  I know that I’m saying dark things, but the reason I’m doing this is to document the journey I’m on and being real about it.  I mean no offense to anyone involved in the Deaf community, and I understand their perspective that there’s nothing wrong with them that needs to be fixed, they’re just different.  I find that perspective to be very reassuring.  I apologize to anyone who takes offense at my visceral reactions to what’s going on with Alex and would hope that they would understand that all rationale is generally out the door when you’re talking about your children, but again – my goal is to document the journey, and that will almost certainly involve change.  I want it all here as an honest representation of that journey.  I initially thought I would write just a private journal, but decided to publish it in the hopes that, along the way, it might help someone else in some capacity or let our friends and family know what’s going on and how we’re doing.

On another note, if I seem gung-ho on cochlear implants at this point, it’s because they represent the ability for myself and Shannon, as parents, to give our child all that we can.  We know that it might not work.  We know that if it does, it’s not a “cure” for his hearing loss.   We’re not squarely on that path yet.  Alex’s viability as well as the testing that can be performed to see how well he might take to them will absolutely be major considerations, and we’ve been very happy with what we’ve heard about the Total Communication / ASL Early Intervention route as well.  Our happiness or love for our child doesn’t hinge on him getting cochlear implants, just as we know that his love for life and identity aren’t dependent on them (or any other medical device) either.

I hope this gives some clarification on where I’m coming from.  So far, the story has been written in a pretty bleak way, but that’s because this is all still very fresh for me.  Believe me when I say that Shannon and I have had many conversations about how we can’t wait to look back on this period and roll our eyes at ourselves for worrying so much about our beautiful son.

Introduction, Part Three

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Continuing…

After the ABR where we discovered that Alex was functionally deaf, Shannon and I were obviously distraught to the core.  His “out of the box” hearing was practically non-existent.

One of the last kindnesses the audiologist gave us was to refer us to a new ENT whom she referred to as “THE guy for cochlear implants around here.”  She even called their office for us on the spot and arranged an appointment; she got us in something like four days later, which is apparently miraculous because this doctor is very sought after.

She also gave us a quick background on our two basic options that we’d have at this point – we could try for a listening / speech approach, or we could go the ASL route.  No decisions were or have been made at this point because we don’t have enough information to make an informed choice, but I’d be lying if I said that we didn’t ask more questions about the hearing / speech approach.  Apparently most of the kids that go through that program have great success in mainstreaming (that is, going to typical schools and basically being brought up to be a part of the hearing world), which was good to know.

Our nights were awful.  One thing that was particularly difficult was falling asleep, because the silence beforehand gives plenty of room for the mind to race.  To make things worse, Alex was still waking up once or twice a night to feed, so we had to go through the process multiple times per night.  Each time we woke up we realized that it still wasn’t just a nightmare that we were waking up from; our child was still deaf.

During the days, much research was done around cochlear implants, including how well they work, how they do with music, what sort of future-tech was coming up, etc.  Again, it was all a compromise, so it was all very difficult to feel positive about.

The day of our appointment with the ENT rolled around.  Our new doctor was definitely an improvement from the last guy – our audiologist had given us a heads-up that this would just be a very quick and cursory check, but our doctor answered almost every question we had accumulated at that point.  It was nice to be able to ask an actual professional questions and get real-world answers rather than reading clinical statistics from Google Scholar.  He seemed rather matter-of-fact about going with cochlears at that point, and most importantly, he said that if that’s the approach we were to take, he’d want to do so as early as possible.  The earliest he had implanted was eight months, but typically he could get them done by nine months.  The FDA currently recommends waiting until one year despite all of the studies that scream “THE EARLIER THE BETTER!”, but the doctor ensured us that he could petition and we’d have a decent chance of pushing it through.

Throughout the discussion, the doctor brought up the term “auditory neuropathy.”  I didn’t think anything of it at the time because it basically sounded like the medical term for “deaf” or “hearing damage brought on by damaged nerves.”  On our way out, the doctor mentioned that he wanted to line up an MRI if possible so he could get a better idea of what was going on with Alex’s ears.  A challenge with this is that it takes something to the order of 40 minutes to complete and requires the subject to stay very still.  No easy task with a squirming infant.  Typically, children are anesthetized, but he wasn’t sure if we could do it with Alex being this young.  Nevertheless, they would follow up and see what the MRI folks would recommend (we haven’t heard back from them yet, but I’ll share that info here when we do).

Later that night, we had our first social dinner outing since having Alex with Shannon’s best friend and her fiancee.  Though we weren’t sure if we would really be able to enjoy ourselves, it proved to be extremely therapeutic.  They asked questions about it.  They offered encouraging words.  They didn’t try changing the subject.  They obviously were interested in what was going on with Alex as well as our well-being.  Basically, it was fantastic, and it’s yet another reason that I appreciate that we have the two of them in our lives.  Yes, some alcohol might have helped as well, but it was great to feel somewhat normal for a few hours.

Again, this good feeling would be unfortunately short-lived.

Shannon brought up that the term “auditory neuropathy” sounded strange when the doctor had brought it up.  I told her my initial thought on it, which was that it was just a fancy term for “deaf.”  We went to sleep for the night.  Alex woke up at around 3:00 in the morning to be fed.  During that time, Shannon and I started looking up the actual term “auditory neuropathy,” which was also present on the ABR report we had received that day.

Our third drop straight into deep depression commenced.

Auditory neuropathy, as it turns out, is a SPECIAL type of deafness (you have to win the lottery to get this, it’s something like 1 in every 100,000 children will have it) with a few terrifying characteristics.

  1. Cochlear implants don’t always work with it, or they don’t work as well.
  2. Hearing aids flat-out won’t do anything for it except for rare cases.  Therefore, putting hearing aids on Alex prior to getting cochlear implants (if we were to go that route) would likely do absolutely nothing for him.
  3. It’s something that’s relatively “new” in terms of being diagnosed, so there isn’t a dearth of experience in treating it.
  4. Worst of all – auditory neuropathy is often accompanied with other issues.

That was the end of our sleep for that night.  We had gone from adjusting to a perfectly healthy baby to a baby with moderate hearing loss to a baby with profound hearing loss to, now, a baby who would potentially not even benefit from cochlear implants AND who was more at risk for having additional health issues.

The latest bit hit us the hardest.  This might be because we’d already endured the previous two hits, so we were already raw.  There was a lot of pleading for the evil to cease.  “Please stop.  That’s enough.  We can’t take any more.”  We began to make peace and accept that we could have a child who would simply not have hearing, and potentially have worse things coming on the horizon.  We’re still trying to make peace with this possibility.

Two days later, we went to Shannon’s mom’s house to spend the day.  It’s always been a boost to the soul to visit for a few hours – Taylor and Alex’s grammy and grampa love taking care of them and spoiling us.  It’s also nice to get out of the house occasionally, especially when you’re sending so many hours writhing in depression within it.  Shannon and I had a good discussion on the way over (as we usually do) about what sort of GOOD things the future might hold, and how that rational thought that we’d deal with whatever came our way and adjust our lives accordingly was worth holding on to even as we were bottoming out.

Upon arriving at the house, the kids were immediately spoiled.  The TV was tuned to Disney Junior, which contains most of Taylor’s favorite TV shows.  At one point, there was a show called “Little Einsteins” on.  It’s basically an educational cartoon that places a lot of emphasis on a few bits of classical music every episode.  While it was on, I was holding Alex, who was resting in my arms, looking innocent and beautiful.  Every time they played a little musical hook was like taking a knife to the heart.  He couldn’t hear this.  Even if he had cochlear implants, he probably wouldn’t hear it with the same fidelity that we could.  I broke down and cried silently on the couch.  I even received the added bonus of feeling guilty about doing it because I know that Shannon’s mom could probably see me, and I highly doubt that made her feel any better.  Certainly one of the lowest emotional moments I had had so far.  In my life.

I think that by this point I had lost something to the tune of 15 pounds in just over a week.

The following day we had another ABR with the hospital we had performed the first one with.  The main objective of this particular ABR was to get a good measurement of Alex’s left ear now that Buffalo Hearing and Speech had gotten a solid reading out of Alex’s right.  I held Alex again while Shannon waited in the hospital waiting room.  Before the audiologist began the test, I gave her an update (suspected auditory neuropathy, profound hearing loss), mostly to encourage her to tell me what she was doing as she went along without worrying that she was going to casually deliver horrific news to a dad who thought everything was AOK.

After about an hour’s worth of testing, we received some interesting news – she didn’t see any sign of auditory neuropathy in Alex’s left ear.  That was somewhat unbelievable, considering that auditory neuropathy is almost ALWAYS present in both ears.  She explained something about a wave V (I’ll try to get more detail on this as it unfolds in case it helps anyone else) and how it wasn’t exhibiting signs of neuropathy.  It might’ve been because it was smooth?  I’ll clarify later.  My hope didn’t skyrocket (or, at least, I won’t let myself admit it), but it was a potential win.  I eagerly asked her if she could re-test Alex’s right ear to scan solely for auditory neuropathy.  She agreed.  Flipping Alex over woke him up, but luckily I was able to get him back down again after about twenty minutes.

She couldn’t find any signs of neuropathy again.

The testing concluded and Shannon was brought into the room to discuss the results (I specifically asked for this to make sure she could hear everything the audiologist had to say as well as have the opportunity to ask questions).  She re-iterated that she couldn’t find any signs of AN, but she also didn’t have the report from Buffalo Hearing and Speech that might’ve shed some more light on what THEY had seen.  Again, I tried not to get my hopes up too much.  We had been told that Buffalo Hearing and Speech had the latest and greatest equipment, so maybe they were looking for something different than the hospital was.  Our souls had already been squashed three times in the past two weeks, so this the prospect of any hope just felt like a cruel setup.

The audiologist went on to answer all of our myriad questions.  She had previously been involved with the early intervention program, so we got to find out a lot of great information about the two tracks – one for auditory / verbal, one for ASL.  We discovered that the ASL track was actually more based on total communication (so ASL, speech, hearing, lip-reading, everything available) which made us feel better about that program.  It was pretty informative.  She was also kind enough to give us the opportunity to email her the ABR report stating that Alex had auditory neuropathy so that she could take a look, and she promised to get back to us with her input.  She did so a few days later and stated that she didn’t read anything on the report that would make her back her opinion out that Alex was free and clear of AN.

At this point, I think we’re basically caught up in terms of diagnosis.  We don’t know if Alex has AN or not.  Over the past few days I’ll admit that I have some hope that he doesn’t have AN on the basis of the latest ABR as well as a few things that we thought were odd that the audiologist agreed with – namely, that his OAE test was always coming back as negative.  With AN, an OAE typically shows as normal for a period of time and then goes to abnormal, but that takes a lot longer than the ten weeks that Alex had been around for.  Typing this, I can feel the letdown that I’m already setting myself for, but I guess we’ll just call it cautious optimism.

We haven’t heard back from our doctor yet regarding Alex getting an MRI (step one in determining whether cochlear implants would work for him).  We have our first early intervention meeting scheduled this week, but that’s just going to be boilerplate.

At least we’re moving.

Introduction, Part Two

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I’ve struggled a bit to figure out how to keep this from just becoming a babbling stream of consciousness for the sake of keeping things organized and helpful.  I literally have four other posts that I’ve started and not finished for various reasons; regardless, it’s probably best to keep catching up with Alex’s story.

Where we last left off, Shannon and I had found out that Alex had some degree of hearing loss.  We had no idea what the extent of it was at this point.  When we got home, we immediately took to Google and started investigating hearing aids and feeling awful.  Some hearing loss might not sound bad, but understand – our child would now depend on hearing aids for the rest of his life.  And if you know anything about hearing aids, then you know that they’re far from perfect.  Unfortunately, hearing issues can’t be boiled down to “just amplify it!”  It doesn’t work that way.  They contain speech processors, noise reducers, different programs for different sound environments, etc.  Basically – Alex’s hearing would not be able to fixed or brought back up to 100%, at least using today’s hearing aids.  Everything from here out would be a compromise for our boy.

Then, of course, there’s the visual.  He would always be wearing these.  As a guy, he doesn’t have the same benefit as most ladies do in terms of being able to grow his hair out.  Well, of course he COULD, but let’s be real.  Only a select few guys can do that.  Dark thought – he would never be able to approach a girl at a bar and stand on the same footing as another guy who doesn’t have hearing aids.  There’s nothing cruel about that in itself; we’re biologically wired to look for attractive partners who don’t have any potential issues that could be passed to their children.  But as a parent?  It’s a fucked up thought to have.  And I knew it was a fucked up thought to have, so I felt guilty about it.  The dark thought -> guilt -> depression cycle has been a common theme through much of this.

We felt terrible, had trouble sleeping, felt victimized.  It might have been the day after we took the test that we decided to immediately get moving as quickly as possible and call up an ENT specialist.  I’ve worked in the healthcare system.  I know how inefficient and slow it is.  We also scheduled a follow-up ABR with the hospital to get a better diagnosis of what sort of loss we were actually dealing with.  The closest we could get was something like three weeks away.

And just a quick note on those three weeks.  Three weeks is a very.  Long.  Time.  Especially when you’re talking about something as emotionally charged about this.  It’s three weeks of pure uncertainty.  Gives the mind plenty of time to conjure up stressful visions.

Getting back on track – shortly after the initial news, we hosted Halloween at our house with my parents, some of my friends, and Shannon’s family.  I asked my dad (who wears hearing aids) many questions, to which he had many rationally reassuring things to say.  I qualify that with “rationally” because at this stage of grief, nothing rational really helps.  At the end of the day, it’s still a compromise regarding something you would NEVER, EVER, want to do so on – the welfare of your kids.  Speaking with my dad, though, was very helpful.  He’s someone who’s living in the world of less-than-perfect hearing, so to hear his perspective was real, and hopeful.  Much was said about how far the technology has come along since he started wearing hearing aids.

After many tears and heartaches, Shannon and I came to a base form of acceptance regarding Alex’s hearing loss.  Hearing aids wouldn’t be too bad.  There’s some pretty crazy stuff out there for hearing aids, including aids that fit directly into the ear canal.  No one would have to see them down the road, so Alex wouldn’t have to deal with any sort of obvious social stigma from looking slightly different.

Just as long as it isn’t something like, oh, say, cochlear implants… we’ll be alright.

Shortly after Halloween, we had our appointment with the ENT.  Nice building, but the guy sucked.  He wouldn’t look us in the eye.  He didn’t introduce himself when he walked in.  He talked over my questions (Shannon later told me that she knew that I was getting increasingly angry).  He spent much of our time together talking about late night hearing aid infomercials.  Worst of all, though, is that he thought we had come to him a little bit too early, and that typically they don’t engage until the patient is about six months old.  Nope.  Everything we had read up to this point was that getting your baby as much hearing help as possible, as early as possible, is paramount.  As if that didn’t seal the deal that this was going to be a one-appointment thing, his detached manner really drove it home.  It’s amazing to me that someone can get their doctorate and have such a shitty bedside manner.  I didn’t need the guy to give me some hugely compassionate speech or anything and I get that not all doctors are psychiatrists, but this guy was just completely disinterested.  We weren’t there to talk about subjects that interested his whim, we were there to do the best thing that we could for OUR CHILD, which most parents would probably agree is probably the most important part of their lives.  Before we had left the room I was relatively certain that Shannon and I had already telepathically agreed to never see this guy again.

There were two good things that came out of this appointment, however.  One – he looked at the results of the wonky ABR we had taken and made some mention of how it looked like it was mild-moderate or something to that tune.  For those who haven’t done eighty hours of research on this, mild-moderate is basically “get some hearing aids to help you hear optimally, but you’ll be fine” territory.  That was reassuring.  The other positive was that he recommended that we arrange an appointment with Buffalo Hearing and Speech, who have the best equipment, etc.  On our way out of the office the helpful secretary got us an appointment with them that fell before our follow-up ABR with the hospital, so speeding that along was appreciated.

The time leading up to that next ABR was relatively peaceful.  Shannon and I still discussed Alex’s hearing loss at length, but at this point we had a doctor implying that this didn’t look like any major sort of loss.  A hugely important calming factor that was introduced here was Shannon’s best friend.  She wears hearing aids, but you truly wouldn’t know it.  It hasn’t slowed her down at all in terms of being social, intelligent, or generally awesome.  She’s been instrumental in bringing Shannon and I up from the dregs of depression, and for that I’ll always be very grateful to her.

The morning of the next ABR with Buffalo Hearing and Speech arrived.  I treated it as any other morning, so I got changed into my work clothes so I could head out afterward.  I would say that we were nervous, but shaking in our boots, encouraged by the “mild-moderate” bit from the doctor as well as the fact that we still thought that Alex was reacting to some sounds.  Shannon said that she was hoping for just that mild-moderate loss.  I thought I would be more conservative and go with expecting moderate-severe (which is at the upper end of hearing aids getting the job done well).  Something that sticks out to me now as I write this is that as we pulled up to the building and turned the car off, I had this feeling that the next time I’d walk out of the building in front of me, my life would be completely changed.

We had a wonderful and compassionate audiologist who performed the ABR.  She explained what she was about to test.  Shannon and I explained that we felt that Alex had some hearing loss at this point just so she knew she probably wouldn’t be dropping any bombs on us, we went through the family history question (we have none), and then we got started.  I held Alex this time around to take some of the load off of Shannon.  Alex was VERY sleepy at this point, so we were sure we’d get solid test results back this time.  To setup an ABR, a small tube is inserted into the ear, which is basically the speaker.  It goes into the ear rather deeply.  Electrodes are then placed at various spots of the head to measure brainwave activity.  The idea is that if you can correlate the sound coming out of the speaker to the brainwaves, you know that the person is hearing it.  Again, everything seemed to start off fine, and stayed that way for about twenty minutes.  By “fine,” I mean the audiologist wasn’t really making any notes or saying anything was up.  I couldn’t see the results of her testing from where I was sitting, though.  After those twenty minutes, though, I could hear one of the sounds that was being played into Alex’s ear.  And he didn’t move.  My stomach dropped.  Again, these tubes were placed relatively far in his ear… and I could hear what they were trying to get him to react to.  He slept like it was nothing.  I held on to some hope, though.  Maybe the speaker was firing backward and out of his ear for some strange test.  Maybe it wasn’t abnormal to be able to hear that.  Maybe his brain registered it even though I didn’t feel him move.

At some point Shannon stepped out of the room to call my dad, who was mercifully watching Taylor while we were at the test.  During that window, the audiologist wanted to test the other ear.  I asked her how everything looked.  She very gently, but directly, stated that we were in the profound hearing loss territory.  Or in layman’s terms – he’s straight-up deaf in that ear.  I went back to the feeling of grief when we first learned that Alex had hearing loss.  It wasn’t quite as shocking this time, but that was probably because we had immersed ourselves in the world of hearing loss, so this sort of diagnosis was more like a worst-case scenario vs. what had initially felt like an impossibility.  When Shannon walked back into the room, I told her, because I felt she deserved to know it immediately.  The look on her face made it apparent she was immediately back to grieving as well.

Testing on the other ear was indeterminate because Alex woke up and started wiggling.  At that point, it didn’t seem to matter, though.  We had gone from light hearing loss to DEAF.  We did learn that his hearing loss in the other ear wasn’t quite as awful, but it was still very bad.  No consolation there.  I asked the audiologist “So we’re now in cochlear implant territory, aren’t we?”  She sullenly nodded.  During the next twenty minutes, we were introduced to what was going to be our world.  Early intervention.  Special schooling.  Therapies.  Appointments.  Mercifully, the audiologist who we were dealing with was very sweet.  She told us many encouraging things, including that most of the kids that went through the program were successfully mainstreamed.  That was important, as it helped to frame early intervention as a lot of up-front work to help your child go through life otherwise “normally” afterward.

Of course, none of that helped the complete defeat that we felt again.  I called in sick to work because there was no way I would’ve been able to cope with it at that point.  More tears and mourning.  The most evil part of depression, in my mind, is that when you’re experiencing it, it truly feels like it is never going to end.  Welcome to your new existence.

Still not completely caught up, but it’s a good stopping point…