A Day in the Life

Perfect day for me to write this one, will also kill two birds with one stone - that, is a horrible expression, by the way -  as it will also cover going to the dentist.

Today, he was scheduled to see the dentist for a check up, he goes every 6 months.  Between his diet, my reliance on candy to keep him happy in some difficult situations and his constant need to have "things" in his mouth at all times, I figure it's necessary.  Though as I'm sure you can imagine, taking an autistic child to the dentist can have its challenges - sometimes taking non-autistic children and even some adults can be difficult, so yes, it is that much harder with Josh. 

My little son, who won't let you near him with a Band Aid, whose finger and toe nails I have to clip while he is in his deepest stages of sleep (and even then it can still be tricky), for whom a nose bleed and someone holding tissue to his nose is like Armageddon, is not about to let a dentist in his mouth willingly.  So this is a challenge. 

The first and frankly most important thing was to find a dentist that was good with and well equipped/prepared for special needs kids.  This was the easiest part - Josh's dad, being a pediatrician, knew of a great dentist in the area to whom he referred most of his special needs patients.  Not only are they patient, understanding, well equipped, and experienced with kids who have all sorts of issues, they are also collectively the nicest bunch of people, from the reception staff, to the hygienists, to the docs themselves.  This was a godsend.  They have special private rooms for the kids who need extra care, every chair in the place has its own video screen in the ceiling, and you can choose from one of their movies or bring your own DVD's.  There is a working model train that runs on tracks suspended from the ceiling so that the kids can watch the train going by as they are lying in the chairs.  The kids can have sunglasses if the lights bother them.  There is always nitrous oxide available for those who want/need it, and, they have a Pediatric Anaesthesiologist who works with them when they need it.  I wish they took adult patients, I'd totally go there myself!

SO, we've had Josh seen there for years.  They know him pretty well.  Most of the time we go in, Dr Kenny gets a very brief look at Josh's teeth but not much else can be done.  About 5 years ago, he had an appointment where he received general anaesthesia, so that they could get a set of x-rays, pull a few teeth that needed to come out, and give him a really good cleaning/fluoride treatment.  It went well, though I was so nervous for him.  Poor little toadie woke up with 5 teeth missing!  But it was really the only way to do it.  The idea is to try to keep the amount of dental work he might need to an absolute minimum, I mean, there's no way we could even contemplate braces for him.  So they want to try to do what they can to keep his mouth healthy and spacing etc reasonable, to avoid serious problems while not having to go too far work-wise. 

Last year his dentist suggested we try oral sedation for his regular appointments, to see if we could optimize what he is able to do.  The first time we did this, it worked amazingly well.  Josh got really loopy and tired and even though he wasn't completely out, he was sleepy enough that they were able to get a good look in his mouth and get his teeth brushed and fluorided.  Sweet!  Or, so I thought.  Next time we went in, we tried it again, only that time he had a paradoxical reaction to the sedation - instead of getting calm and really tired, he became extremely hyper and loud.  He was jumping around all over the room.  Also, no way on the dental exam.  Hmmmm.  So, we came back in a few months to try again.  Nope.  Another paradoxical reaction.  This morning, we were set to try one more time.

For the last couple of weeks, Josh has been in one of his not sleeping at night modes.  It hasn't been every night, but probably more than half the nights of the last couple weeks he's been up.  His being up means I'm up.  Last night was no exception.  Josh woke up at 2am and was up until 7:30am.  He fell asleep 1 hour before we had to leave for the dentist.  I decided that this was actually a good thing... maybe this time he'd be so tired from not sleeping the night before that the sedation would knock him right out.  I am forever an optimist!  So I was obsessing a bit about not messing with him too much, he was also not allowed to eat or drink anything so if he woke, he'd be asking for things I couldn't give him, leading to the usual tantrums.  So I did something this morning I have always judged others for - I left him in his pj's.  Granted, there is a huge difference between my leaving my autistic son in his jammies for a morning appt where he was likely going to go to sleep anyway, and people who take their kids to Target in their pj's... which I can't stand... but still, I felt the sting of hypocrisy just a little.

I load the sleeping toad in to the car along with big brother, and we head out.  Josh woke up just before we got there.  We got Josh to stand on the scale so they could calculate how much of the sedation he would get and took us to our room.  First thing Josh says, since he's familiar with the place, was "Blue's Birthday!"  Meaning he wanted his DVD loaded so he could watch on the screen in the ceiling.  Before he'd even finished the word "birthday" my heart sank and I wanted to die.  Zach was just looking at me, his eyes huge with the sudden realization of why I looked like I was about to cry.  "I forgot his DVD's.... "  Extreme fail.  I had been so pre-occupied by his being asleep and trying to keep him that way, I totally spaced and didn't bring his DVD collection.  Honestly, I may have to blame the lack of sleep for this one, it's normally just part of the going anywhere with Josh routine, I can't figure out why I left them this time.  Needless to say, Josh was not pleased.  I was beside myself, I felt terrible, I knew I'd probably mucked this up.  Did my best to keep him from losing it completely, but it was a real fight to get him to take the medicine this time, when usually he takes things quite well. 

He did calm down once the medication started to take effect though, thank goodness.  He was clearly tired.  I convinced him to climb off of my lap and in to the chair where he just kinda chilled.  They brought him a very snuggly blanket - I so wanted to curl up under that bad boy myself! As tired as he was though, he's no dummy and his "people are going to try to do things I don't like" senses were on high alert.  As soon as the dentist or hygienist tried to do anything he went in to full-on ninja-defence mode.  I swear he could fight off a grizzly if he thought it was going to try to look in his mouth or *cue suspense music* floss him. 

Ultimately it took me getting on the chair behind him and wrapping him in a bear hug, the amazingly wonderful Dr Kenny holding and squeezing Josh's head (he really likes deep pressure, especially on his head when he is upset) and the hygienist patiently cleaning his teeth a couple at a time when she could coax him in to opening up for a couple of seconds.  Also, big brother Zach was there by his brother the whole time, doing what he could to make Josh feel better. 

It sounds horrible, and it's not easy and obviously I would prefer not to have to hold him and struggle, but, better this than having cavities that need to be filled (not a single cavity in his mouth, if you can believe it) or other issues that are preventable with the proper care.  And I don't mind holding him, that way I know he's not getting hurt and I whisper in his ear the whole time which, even if it doesn't help him, I like to think it does. Zach was given the task of watching Josh in the car on the way home in case he fell asleep, to watch his positioning so that he wouldn't compromise his airway.  I know the post-sedation drill, though as you can see, Josh is a beast, he should totally have been sleeping the rest of the day... but wasn't. 

We got home and he was like a stumbling drunk.  Thought he could just run around like he usually does but kept falling over.  So Zach and I managed to steer him toward the couch till he got his legs back.  You have to be careful after the sedation as far as eating and drinking, just water at first, then soft foods.  Water was no problem but you know Josh and his diet... he would cough a lot every time he tried to drink so he didn't have much water the rest of the afternoon.  He was asking for things to eat, but he wasn't really eating them.  At 4:15  we took Zach to karate class.  Josh had asked for fries - he seemed fine and the sedation had been at 9:15am so I figured he'd probably be ok by that point.  Just as we were pulling away from the dojo, Josh started coughing and threw-up, all over himself and his seat.  Then he did it again.  Aw, toadie... but, ugggggghh... I didn't have anything in the car with me to clean him or anything else up.  Luckily the dojo is only about 8 minutes from our house, so I made for home, Josh yelling at me for fries when we did not stop at the McD's.  Yes, even after throwing up all over himself and the back seat, he still wanted fries.

We got home and I cleaned him and the car and his seat up best I could, loaded us back in to go pick up Zach - class is only an hour.  This time I brought a couple of towels.  We get to the dojo again, Zach jumps in, and Josh throws up.  Again.  I was ready this time though, I had pulled in to a parking spot, jumped out, opened his door so I could hold the towel for him.  FUN!  Poor toadie. 

Yes, he asked for fries again on the way home that time too.

He's a little on edge tonight because I was unable to give him his Celexa and Lamictal this morning since he wasn't allowed to have anything before his appointment.  I'm hoping he'll actually sleep tonight, the whole night, and not be too unhappy by the time tomorrow morning comes when I can give him his meds again.

No, we don't go to the dentist with him every day.  But, it's just an example of how something as routine as a dental appointment for your child can turn in to a fairly major ordeal when that child is autistic.

Also, I'm tired.  I kept dozing off writing the first part of this, hope it makes sense !


On the business end of things here at the blog, I have a new little Facebook "like" button in the sidebar, just below the Archives list.  I am highly resistant to most of the usual things we have to do in the blog-o-sphere to build our readership, but this is more about creating a credible platform - it has always been my intent to write a book, and you can't get a publisher's attention for non-fiction material unless you can show an established audience for what you're writing.  Believe it or not, they actually look at how many followers you have on Twitter and how many Facebook fans you have as part of the whole deal. As Zach would say right about now, "GET ON WITH IT, MOM"... so, yeah, if you could hit that little "like" button for me, I would appreciate it, thank you :)