Authorizations and Appointments

This has been a week when we've truly realized that having a special needs child is a full-time job. I feel like I've been pinging from meeting to appointment to meeting to phone call.

On Monday morning we were joined at our PT/OT session by the medical director of the managed care company that authorizes Abbie's therapies, along with a care coordinator. I was very nervous about this visit, and the meeting that would follow therapy, because I worried that Abbie's access to therapy would be cut off. After all, she is over five years out from her injury, and I didn't know what kind of progress they would be looking for to justify continued therapy.

I was encouraged to find out that the medical director is a physiatrist, and had a long history of working with brain-injured patients. She was very observant, and gave Abbie time to respond to requests. Abbie did her part by having a very "on" day, thank goodness. She did well in the sit-to-stand practice, and then she activated the power chair when was she asked to do so. All the while, though, during her brilliant performance, I was dreading the post-therapy meeting.

It turned out that all the chatting we'd been doing during the therapy sufficed as the meeting. As the session drew to a close the Dr. turned to me and said, "So what I am thinking is one OT/PT session and one PT/Speech session per week, and then we'll reevaluate in three months because she is changing so quickly." I almost cried.

I told her how very grateful I was to not have her put the "fill in the blank" (e.g. "one year out, "two years out") limit on Abbie's recovery. She answered "Oh no..not with an injury this diffuse in a child, you just never know, you never can tell. Let's just she what she does."

We got home just in time to prepare for the next meeting, with the folks who authorize Abbie's nursing hours. Back in July we were told that her hours would be cut from 30 to 2-4 per week. We were trying to prepare ourselves for this axe to drop on Monday afternoon. We were told that while cuts are on the way, they cannot be implemented until a new policy is written, which could be December or January. So, we have a reprieve for now. After two hours in that meeting, my head was spinning, but I was relieved to be through it.

Yesterday morning we received a call from our neighborhood school, who determined they could not care for Abbie, to tell us what school had been selected for her, Ali'iolani Elementary.

We've set up an appointment for their staff to meet Abbie, and are trying to set one for Ray and I to visit the school. We will also have to have more IEP meetings, especially since Abbie has now met many of the goals we set for her just last month.

Yesterday afternoon I took Abbie to see our fantastic orthopedic surgeon, Dr. B. We started out with Xrays of her spine, hips and femurs, which were fine. We discussed the timing of taking out the hardware in her hips and femurs. I was hoping it wasn't a strict one-year timeline, because that would mean an OR trip next month. Nope - no time pressure on that front, we could wait up to a year.

But, there was discussion about the possibility of a completely surgery. Abbie's thumbs are contracted are pretty glued to the palm of her hands. In addition, her forearms always roll to the outside. Dr. B. can do a procedure to release those stubborn thumbs, and can reroute tendons to rotate her arms to a normal position. I wouldn't consider this surgery, save for the fact that there is now a huge upside. Abbie's communication and expression has been exploding lately, and with open thumbs and properly-rotated arms, her ability to access communication devices (and the power chair) would be greatly increased.

I was thinking about pushing this procedure off quite a while when Dr. B. made a very compelling point, "Remember that her hand is her communication tool. So, think carefully about how far down this track of new communication devices and methods you want to let her progress before you knock her back with a surgery and then have to adapt to new positioning." Hmmmmm, he is so right. We are going to schedule a meeting with him and all of Abbie's therapists so we can decide what (and when) is best. Please pray for wisdom for us in this matter.

Abbie continues to change and progress in amazing ways. Today, as we did our morning "dancing" session, a new, very foreign thought came to my mind. As she shows us how quickly she learns, how ardent a learner she is, and as college for Abbie has crept into my mind, that lead to "what then?" Today, I imagined her life as an adult, and for the first time since the day she was injured I considered that Abbie may live apart from us as an adult. Perhaps not independently, but "on her own". I didn't know how to feel about that at first, as I've grown to assume she'll be my forever daughter, always with me. I now suspect she has much bigger plans than that!