Today was Xander's first day of PreSchool!

Xander is now signed up for morning preschool; a major change to the daily weekday routine.

He was nervous for about 30 seconds this morning before heading into the classroom.  There he had a great time and was praised by the teacher for being a big help.  She also noted that Xander got 'quiet' when Mom came to pick him up.  Hmmm, doesn't sound like the Xander we know...

Yesterday was actually supposed to be Xander's first day but we had his Dental Surgery appointment that was a long time coming.

We enrolled him specifically to help give him a small educational boost after being warned, several times, about the possibility of cognitive problems in the future stemming from the use of radiation at a young age.  Any small thing we can do to advance him before future problems will hopefully be of some use.

Not to mention all of the great social aspects he will be exposed to.  In doing some recent reading the parents noted that at three and a half years the preschooler may be more easily guided by non parental figures.  Considering some of the things we have observed lately this seems to be spot on advice.

Plus this gives Mom a small break and Willem some more one on one time with Mom.  We think it will be a win-win all around.

We did not think that Xander would have too much trouble acclimating considering he made quite a scene in leaving the Preschool Open House last week.  Just mentioning going to school was greeted with shouts of, "Oh Boy! Oh Boy!!!". 

What started out as a small observed speck on Xander's molar in the spring has culminated in some major dental surgery today.

After all this time we finally have Xander's Dentist appointment set up to take care of fillings for his known cavities.  Progress.  Since Xander had to go under for all the work that was required we actually were back at Children's proper going through much the same procedure as early MRIs.  We went to admitting, but they chased us down to surgery admitting - odd.  So we registered there and waited, then waited a bit more, then finally waited a tad more.   Definitiely a step back from the streamlined MRI appointments we've been having.  It was a little more compilcated too in the Xander's younger brother came along.  So he wanted to eat and was starting to fuss, but we didn't want him to eat in front of Xander, who could not even have water before going under so it was catch-22 time until Xander went in to anesthesiology.  He did well and did not even mind when they put the mask over his face and asked him to breath it all in.  The one thing different about this aesthesia as opposed to the others was that he was getting a nose tube put in rather than the mouth tube he usually had.  We were warned about possible small weeping from his nose afterwards.

Since we were unable to get full X-rays of Xander's teeth previously nobody quite knew what all would be done.  We wanted someone to notify us of what was going to be done before they did anything which brought up some resistance from the dentist since he did not want to be leaving Xander on the table while searching for us.  We indicated that we did not necessarily need him to notify us, just to have somebody tell us what was to be done.

So Mom, Dad & Willem wandered around the hospital while Xander was getting checked out.  Finally we got beeped and headed down to Surgery to see what the tally would be.  A resident informed us that the X-rays showed cavities in the two rearmost left-hand bottom teeth and in each of the upper backmost teeth.  After that we headed up to the family area and hung out until we got beeped again.; a surprisingly short time later.

Xander finally showed up in the recovery area after a nice snooze - again he was nice and calm and was not too concerned about what was going on.  Getting too used to the procedures??  The boys had some popsicles while we talked over the procedure with the Dentist.

The final list made us glad that Xander had slept though it all.  First, the cavity we noticed in the spring had gone down to the nerve, so they had to do a baby root canal.  They then filled it and then put a cap on it.  The tooth just before it also got capped.  The upper two molars got enamel fillings.  One of the other molars had shown a bit of its enamel being worn away, but was still in fairly good shape so it was just noted.  They Dentist also noted white spots along the gum line indicating area of the teeth that were weakening.  These received a fluoride polish to strengthen them and then received a sealant to help reduce further damage.  Enough stuff that an adult would have been squirming in his chair.  The Dentist did say Xander was keeping up this dental hygiene pretty well now considering the shape of the gums.  The Dentist also explained that the white spots and the number of cavities probably resulted from the chemotherapy and the radiation.  Radiation in particular slows down the saliva glands and saliva is the primary cleansing agent in the mouth.  Considering Xander eats very little sweets and brushes regularly this seems to make sense.

Xander's left side of his mouth looked a little swollen but it went away by the evening.  His nose did show what almost looked like a very slow nose bleed that needed dabbing every few hours.

After the popsicles we headed home a mere 6 hours later.

So before Xander can be cleared for his dentist visit in the next few weeks he needs a physical first to show he's fit!

Yes, amazing as it seems we needed a physical so that Xander could go to the Dentist.  Even though Children's Dentist office is a part of the Children's Hospital, it is off-site and does not have a doctor present.  Only the anesthesiologist will be there to put Xander under and watch his condition.  So the dentists need the physical to make sure he is not sick and can be put under safely.

He got checked out and was good.  He still has his stuffed nose.  We have been using saline every evening as well as a mister in his room when he sleeps, but he still has a runny nose.  The Pediatrician recommended some Claritin, but that does not seem to be helping either.  Basically we're thinking it is just allergies, which Mom has as well.

So he checked out fine so next stop the dentist for some sweet dreams and lots of work on the mouth.

Xander went in today for a Psychiatric Evaluation to see how his mental development is coming along.  It was a pretty benign test, but getting there was amazingly difficult.

We have met the most dysfunctional organisation we have met anywhere in our journey and it is the Psychiatric department at Children's.  It even ranks above dealing with the insurance company!

It all started months ago when Mom called in to make an appointment.  She called a few times, left messages, but no one called back.  Finally she got to talk to a receptionist and she referred Mom to the Psychiatrist.  Lisa left a message, and called again and called again.  When she finally caught the Psychiatrist in the office she was told to talk to the receptionist.  We were finally at Children's for an appointment so went down there in person to make the appointment.

We had to make two appointments, one for us (the parents) and one for Xander.  We were told the day and time of the first appointment so we all came in.  The Doctor came out after about a half an hour after the appointment was supposed to start and told us this was supposed to be a phone interview.  No one told us that, plus we thought it was a little too important to leave to talking over the phone.  It was a good thing too since we had a good conversation with the Psychiatrist and she got to see how Xander operates first hand, instead of trying to evaluate him cold during the second appointment.  Then she sent us home with a bunch of homework to have done by the next appointment.

The homework was a bunch of questionaires about Xander's development and such.  So we sharpened our pencils and poured over the 600 questions.  It took over two hours to answer everything. Of course there were multiple questions that were the same to determine consistency and such, but it was fairly grueling.

So finally we arrived for Xander's actual evaluation and guess what - they were late again, another half hour.  At least they're consistent.  So Xander and Mom went into the room with the Psychiatrist and Dad and Willem went into the observation room.  It took about a hour and Mom and Dad learned a few things along the way.   It was mostly play type tests.  What comes next; build a structure like this, what is that, etc...  The interaction between the Psychiatrist and Xander was pretty interesting.  Xander was getting to the point where he wanted the 'Big Bang', to have the praise for doing something right so he would become increasingly silly at times to get the effect. Shades of pre-school to come?

After that Mom, Xander and Willem dropped Dad off at work.

Hopefully we'll get the results soon - should be interesting.

This should be a yearly occurrence from now on.

Well, we received another 3 month pass from the fine staff at Children's.

Xander, Mom and Dad headed into Children's bright and early, leaving Willem with a friend.

We checked in at 8:00 (even though Radiology insisted on 7:30) and there was minimal waiting throughout the process.  We breezed right through vitals and had Xander on the Anesthesiology cart in no time.  He was great at the cart he didn't want to be there but there was minimal fuss and he was out in no time.  He did not have a repeat of the oxygen level dip like the previous time showing that all the saline and vapouring worked.

It was interesting in how you could tell Xander was getting anxious.  He would ask to go to the bathroom every 5 minutes or so and go just a little bit, then 5 minutes after that, and so on.

He had a nice sleep after the M.R.I., after he woke up had some Graham crackers and some juice and then headed to U Village.

We went to the Toy store there to pick up a gift for a little girl at Children's who was diagnosed with a Rhabdoid brain tumour a few months ago.  Another family burdened with the unthinkable.  Hopefully she can get some small comfort from the gift.

We were also saddened to hear to Alexandra Scott's passing.  She is an amazing little girl from Philadelphia who was diagnosed just before her one year birthday with a neuroblastoma.  At age 4 she started her first Lemonade stand which later blossomed into a national phenomenon.  Her goal this year was to raise $1,000,000.00 for pediatric cancer research.  She was almost there when she passed away.  Hopefully we can all help to make her dream come true, check out http://www.alexslemonade.com/ Xander will be making his contribution to their cause.

After goofing around U Village we had some lunch and headed back to Children's for a chat with Corrine and Dr. Geyer. Corrine gave us a call with the radiologist's report and it was all good.  Even the sinus infection was gone.

Everyone in the Oncology Clinic was amazed with Xander.  They could not get over all the hair and how well he is looking.

It was a nice visit with Corrine and Dr. Geyer.  We talked about the results from the Occupational Therapy appointment we had earlier.  We disagree with some of their conclusions since we believe their testing methodology is flawed because of the setting of the test and the direct nature of the interaction with the subject.  If they performed the tests more like the hearing tests where there is an unseen observer we believe they would get more realistic results with younger children.

Mostly we talked about all the upcoming tests and such we will be scheduling:  Psychiatrict next week, then actual Occupational Therapy, a Hearing Test, Endocrinology Test and an evaluation by Speech Therapy.  Not to mention he is going to be starting pre-school in September.  It's going to be a busy few months.

Plus Baba and Gege are moving closer to their Grandchildren next month!  It's going to be fun.

Mom, Xander and Willem headed back to the pediatricians again since Xander's nose started running again and the discharge was green again.

The pediatrician recommended using saline three times a day and running a cold vaporiser during the night to help Xander's body fight the infection.

Now if there is one thing I do not think anybody likes, it is getting saline sprayed up their nose, Xander is no exception.  However he is getting used to it a bit and now consents to getting it done rather than holding his arm over his nose when he sees the bottle coming.

Plus Mom had to go out and get another vaporiser since Willem is teething with his molars and his nose is running as well.

So far so good.  The pediatrician also gave us a prescription for antibiotics is the saline/vaporiser did not work since we are so close to the MRI date.  We do not want to miss the MRI because of a technicality, but so far have not had to use the prescription.

Although adding humidity into some of the warm evenings we have been having has not been too comfortable.

Wait a minute why is Xander's brother muscling in on his territory?  Well, because Xander was piggy backing on Willem's appointment to get a follow up on the sinus issue.

The results we great the sinus infection was all gone, now to keep him that way for the MRI.

Xander, Willem and Mom all headed in to Xander's first appointment with the fine dentists at Children's.

But wait, it wasn't actually at Children's since their office is just off campus (but still in the area).

Once settled, they got down to work, the assistant did a great job of assisting and kept Xander cool and Willem entertained while the Dentist and Mom worked to get the dentist a good view of Xander's mouth with minimal theatrics. 

The dentist found not one but two cavities that need to be repaired.  She made out a treatment plan and sent that home with Mom, and the kids' home with some cool Killer Whale toothbrushes.

Dad called the insurance company again to check on the treatment plan which again included anesthesiology.  This time the answer was slightly different in that even in children under 3 it is on a case by case basis, so the dentist had to submit the treatment plan for pre-approval.  But the sealant woudl be covered at 100% and the cavities being filled or capped would be at the regular rates.  We called the dentist back and asked them to take care of that.  Once we get the OK then we can get going and close this chapter.

Interestingly the dentist indicated that since Children's would be doing the anesthesiology that it would be covered under medical while the dentistry would be covered by the dentist office so there is no real need for the approval, although they are doing it anyway just to be complete.