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March 02, 2008

Candle light and Cholla

Just before dusk yesterday evening Jonah climbed down out of the junipers he's been spending time in (a lot of time) and ran and hopped a few happy steps back towards the trailer, then stopped and started screaming. He'd stepped on a cholla fragment. Barefoot.

Last year at this site he embedded an inch of yucca spine into his lower calf, and it was a trip to the local clinic and full-pay for the uninsured for the local anesthetic, the excision and extraction, the sutures, the topical antibiotic, and the follow-up for suture removal.

We spent several minutes pulling cholla hairs out of the sole of his foot, and a half-inch long spine fully embedded into his big toe.

It was just a moment of joy turned to bleeding and tears, not particularly difficult, a day in the life of many kids, and for an autistic kid who kicks off his shoes on every occasion, and jumps and hops erratically in the joy of life, not too common -- we watch out for hazards.

But Jonah had MaineCare, which is to say, Jonah had MediCare, as did Sam, and their siblings, and their parents, a year ago, as I still had no long-term work, just some about to end consulting work. The only reason we paid was the hassle of dealing with paperwork when we have to have everything forwarded to us, sometimes several times.

Jonah and Sam may have lost their right to MaineCare, which is to say, MediCare, even though they are still residents of Maine (away on educational travel), because I am now eligible for employer-provided health insurance (provided I move them to Switzerland), and of course every private insurance provider is only too happy to insure people with pre-existing conditions, like a complete disability determination by the Social Security Administration, for Autism ... in something other than real life.

So I'm relieved that health care is now off-the-table for Dems, according to the leading organs of the "netroots", and that Single Payer is no longer an issue for that demographic.

January 09, 2008

Continuing Increases in Autism Reported to California's Developmental Services System: Mercury in Retrograde.

Continuing Increases in Autism Reported to California's Developmental Services System: Mercury in Retrograde.

Schechter R, Grether JK.

Immunization Branch, California Department of Public Health, 850 Marina Bay Pkwy, Richmond, CA 94804. R.Schechter@cdph.ca.gov.

CONTEXT: Previous analyses of autism client data reported to the California Department of Developmental Services (DDS) have been interpreted as supporting the hypothesis that autism is caused by exposure to the preservative thimerosal, which contains ethylmercury. The exclusion of thimerosal from childhood vaccines in the United States was accelerated from 1999 to 2001. The Immunization Safety Review Committee of the Institute of Medicine has recommended surveillance of trends in autism as exposure to thimerosal during early childhood has decreased. OBJECTIVE: To determine whether trends in DDS autism client data support the hypothesis that thimerosal exposure is a primary cause of autism. Design, Setting, and Patients Study of time trends in the prevalence by age and birth cohort of children with autism who were active status clients of the DDS from January 1, 1995, through March 31, 2007. Main Outcome Measure Prevalence of autism among children with active status in the DDS. RESULTS: The estimated prevalence of autism for children at each year of age from 3 to 12 years increased throughout the study period. The estimated prevalence of DDS clients aged 3 to 5 years with autism increased for each quarter from January 1995 through March 2007. Since 2004, the absolute increase and the rate of increase in DDS clients aged 3 to 5 years with autism were higher than those in DDS clients of the same ages with any eligible condition including autism. CONCLUSIONS: The DDS data do not show any recent decrease in autism in California despite the exclusion of more than trace levels of thimerosal from nearly all childhood vaccines. The DDS data do not support the hypothesis that exposure to thimerosal during childhood is a primary cause of autism.

PMID: 18180424 [PubMed - in process]

December 30, 2007

Jonah is eight

Eight years ago today, the birth and then the sudden change of plan -- to the NICU, where we learned how to change a shirt and diaper through the ports of an incubator without dislodging the distal oxygen monitor (foot) or the electro-cardiogram leads (chest), watched the millennium bug (Y2K bug) fail to crash the world while sipping sparkling non-alcoholic cider, and moved each day from the attention-hot center of high-risk babies towards the calm wall of safe babies and the car seat home.

A year and a month later and he and MB were back at Maine Med for a week that turned into five weeks and several near misses with death.

Jonah didn't want his cheeseburger yesterday as much as he wanted some of his sister's chicken tenders.


Jonah: Chicken tenders.

Gracie: You have to ask a question.

Jonah: I want a chicken tender for me please Gracie-wah with a fish on my head.


It was about three years ago that Sam's language really took off. He's still a dinosaur except when he's an elephant or anything else that might make a noise as large as a boy, but he is completely conversational and in the present, though no matter what the Singapore maths page reads (he's at 2A), he does every problem as addition -- correctly.

If Jonah gets to where Sam is today in three years, or more, we shall be very happy, but we've many, many big wins already -- still alive (rinse and repeat), self-{feeding, bathing, dressing, toileting, ...}, fine and gross motor, reading, writing, counting, rudimentary arithmetic, singing, place memory, thousand word vocabulary ... and we're working on expressing disapointment as an alternative to howling. Transitions are still a bitch.

November 22, 2006

A Special Gift

Today is my older son's thirteenth birthday. "Beware, there is a teenager in the house," my wife warned me this morning. Happy Birthday, J.D. You are a great son and we are very proud of you.

In addition to being his birthday, today also marks the 4,748th consecutive day that either my wife or I (or both) have been on diaper-changing duty. That streak is intact because my younger son, Bobby, now eleven, is autistic and is not yet toilet trained. With the kids nineteen months apart, we never got a break from the diapers.

Bobby, attends a public school for autistic kids. There are 118 students at his school ranging in age from five to twenty-one. We recently learned that the school, originally built in the 1920's and expanded in the 1950's, contains lead-based paint. Much of that paint is in poor condition. It is a health hazard.

The intersection of autism and heavy metals is a location with intense emotional and neurological content. With studies showing that exposure to even small amounts of lead can result in substantial reduction in IQ, and other studies suggesting that heavy metals may have some involvement in the etiology of autism, parents of autistics take the presence of lead paint in their kids' school very seriously indeed.

After learning that Bobby may have been exposed to lead at school, we made an appointment at the doctor's office for a lead test. That test was also today.

I felt reasonably confident as Bobby and I entered the Doctor's office. I had carefully explained the situation over the phone and they have dealt with Bobby before. During my phone call, I was assured that the test could be done with blood taken by finger prick. Bobby has had finger pricks before and we know how to do them.

When we were called back to the lab for the test, I noticed that the technician did not have a lancet for a finger prick but, rather, had the equipment needed to draw blood from a vein. I inquired and was informed that the test did, in fact, require that blood be drawn.

The technician asked if that was a problem and I responded that we would need reinforcements if we planned to put a needle in Bobby's arm. The technician told me that he was very experienced and was sure that it would be no problem.

Ten minutes later, no blood having been drawn, we were having a powwow about how to draw the blood. I noted that we usually employ elements of the Powell Doctrine in similar situations. That is, we clearly define our objective and then apply overwhelming force to accomplish it.

With Bobby sitting on my lap with my legs around his ankles (to immobilize his lower body) and my arms around his torso, one nurse holding his right hand and arm, and a second nurse holding the arm from which blood was to be drawn, the technician was able to locate a vein, draw the blood on the first try, and apply alcohol and a band-aid. That was accomplished with a minimum of disruption and no injuries to Bobby or others. I was very pleased. We should have the results of the test in a few weeks.

As we were leaving, one of the nurses asked, "if he is autistic, what is his special gift?"

Clearly, she thought Rainman was a documentary of the average autistic. She thought Bobby must be able to calculate the square of her telephone number in his head, or count a multi-deck blackjack shoe, or play a Mozart piano concerto perfectly after one hearing, or perform some other feat of savant brilliance.

I have been asked that question many, many times and I gave her the stock answer. A fair number of savants are also autistic but very few autistics are savants. Rainman is just a movie, a good one, but just a movie. Bobby does not have a special gift, he is just a boy trying to cope with a neurological condition.

She seemed disappointed. I think she expected Bobby to calculate the area under the curve of the examining table in his head on the spot.

On the way home, I alternated between bemusement at the popular misconceptions about autism and outrage that a health care professional in whom we trust the care of our son could be so ignorant.

Suddenly, I realized that she was right and I was wrong. Bobby does have a special gift.

Bobby is a sweet, loving but vulnerable and needy child whose neurological defects make it impossible for him to have normal interactions with the world. He literally can not speak for himself. He has no judgment whatsoever concerning his own health, safety, or needs. He needs help and direction with the most basic of life skill such as brushing his teeth, bathing, donning clothing, and other aspects of personal hygiene. He can not plan or prepare for his future. He can not protect himself from people or nature. He can provide for himself none of the basic needs of life.

Caring for Bobby has become a central focus of my life. I bridled at that role for a long time, but have come to accept it. Now, I can think of no better use of my time, intellect, energy, and talents that to simply be Bobby's Dad. It is the purpose for which I have always been destined. Being Bobby's protector, advocate, helper, teacher, and Dad is a very fine thing to be.

That is Bobby's gift to me. He allowed me to find my life's purpose. It is a very special gift indeed.

November 21, 2006

Another run-down

I picked up his footprints about 2km up the beach. I stopped running and started from the water's edge, and walked towards the dryline. There. Running feet much too close and the toes slightly too long. Jonah was still ahead of me. I'd checked the ravine that lead up to the SP tracks, my greatest fear.

The Bell UH-1 that landed an hour earlier with mechanical problems earlier was airborn and coming up the beach. I'd asked a crewman to look out for Jonah, in the off-chance that he crossed the creek and went through the wire and onto VAFB land, because helicopters might interest a person. I looked back up the beach to where the second Ranger was visible coming back towards me from the second rocky point that ended the beach to the north, and the form seperated into two persons, one tall, one small.

I cried out without thought and ran to my boy. Naturally, the Ranger had something to say. They always do. They're the real protagonists, distracted from their real work by ... careless parents. We sat to let me catch my breath and let the angry man leave, watching the sun crawl towards the sea on the huge expanse of the minus tide. I sang Bear's Song and Jonah joined in on the fourth recital. Then we walked home. First, leashed, then Jonah kissed me to ask to be off-leash and cooperatively hand-in-hand, and so we walked along a wide beautiful beach next to the sunset sky until dusk when MB met us near the camps at Jalama Beach. We sat down again and sang again. Its calming, and the story is of a boy in a cave brought into the light by a bear. Its wicked old.

This morning the Ranger came by to inform us that if they were distracted from their real work again by ... that we'd be evicted. Just as we were in Monterey. I'm underwhelmed by the County response to a safety needs of a handicapped child. This isn't how local government should respond.

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