Playing It By Ear

It wasn't a good week for appointments.

After riding high off our Sick Kids news, I guess we got a little too ahead of ourselves.  We only had two appointments last week and they were both local (which made it seem like they weren't any big deal somehow).  Only one of them was for Wyatt and other than some anticipated possible friction with his ENT, it was all supposed to be a breeze.  Sadly, it didn't turn out that way.

Thursday morning, I finished off my last night shift and came home, only to turn around again and go to the dentist.  As I've mentioned a few times before, I'm having a lot of restorative dentistry done;  after my pregnancy with the twins I basically had the teeth of a bulimic.  We've also been delinquent in taking Quinn lately, so we both went.  I brushed and flossed and we loaded up the Whaaambulance to go.

Quinn was in the hygienists capable hands, so the coast was clear for my dentist to bring out the scary needles.  Since we were working on a few things on the bottom right side, she explained where and when the freezing had to go in.  I felt the shock in the tip of my tongue as she put the needle into the back of my mouth;  I started to laugh as I felt it zap again on the way out.  I was about to comment on how cool that was when my chuckle quickly turned into a cough.  As I was being sat up in the chair, I felt my heart start to pound, my chest became heavy and my vision began to blur and go grey.  I guess a little of the epi had snuck through into my bloodstream or my sugar had dropped dramatically (or both) and I felt awful.  I could barely articulate what was happening and half-mumbled in agreement that they should bring me some juice.  My hands were shaking so badly that I couldn't open the juice once it got there, or the straw that they handed me.  I quickly drained two small bottles and was relieved to see my vision start to clear up.  A few moments later, the crushing feeling passed and we got on with the task at hand.

We were 3/4 of the way through the work when all that juice decided to make it's presence known again.  I tried not to wiggle and squirm for a while, but had to let them know that I had to go now.  We got to a point where we could pause for a moment and I dashed off to the washroom.  Once finished, I ran back and sat down, slightly out of breath.  The hygienist put her hand on my shoulder.  "How are you feeling now?" she asked.

"Whew!  Much better!" I answered, thinking she was referring to my bladder.

"Oh." she answered, her hand still on my shoulder, her face all concerned. 

"Why?" I asked.

"Because your lips are blue", she answered.

Shit!

A warm blanket and twenty minutes later, my lips were no longer blue and my teeth were finished. Quinn was quietly reading a book in a chair at my feet (after entertaining half the office with his knowledge of the human body).  I swore to myself and my dentist that there were to be no more appointments after night shifts.   I'm getting older and they just mess with your body too much.  Also, I promised I would eat breakfast next time (my last intake had been 5:30 am).  Quinn and I settled accounts, bundled up and we walked outside.

Into a blizzard.

I had seen the first flakes start to fall from my seat in the dentist chair, yet they had been forgotten in the ensuing shenanigans.  This was a bit of a surprise as it hadn't been mentioned on any of the weather reports I had heard that morning.  Quinn and I stumbled through the swirl towards our white van and Sean drove very carefully home, as we couldn't see 5 feet in front of the vehicle.   I was in my own little blizzard as by this point I was completely exhausted and sore.  I took some Robax once we got in the door and I truly don't remember my head hitting the pillow.  Next thing I knew, it was dinner time and the mad scramble that is bedtime in my house.

Friday was an even earlier morning as Wyatt had an appointment with his ENT at 8:30.  With the twins, we make a point of getting the first appointment of the day as it is less busy, less stimulating and generally goes a heck of a lot faster.  We got everyone up, fed, changed and dressed, Wyatt and I were dropped off right at 8:30, Sean continued on to drop Quinn at school and then the plan was to meet us there with Zoe afterwards. 

It would have been easier for Sean and Wyatt to go, while Zoe and I took Quinn to the bus stop, but Sean did not have a very good experience the last visit and I thought I'd intervene and check things out.  It's a scary feeling when the expert may not have your best interests in mind (or in this case my son's) and I wanted to make sure that was not what was happening here.

We sat there, in his office waiting room for a very long time.  For your average person, this doesn't pose a problem.  If it was me alone, it would have been annoying, but still do-able.   Wyatt was now raring for his morning of fun and was in no mood to sit in a stroller.  He wanted to practice his standing and roll about on the floor and I couldn't let him do that.  We played patty cake, we sang songs, we watched Elmo and baby signs until my phone battery threatened to die.  We tickled, we giggled.  Even the receptionist got into the game and peeked around the counter at him (and he peeked back once she had returned to her work).  At 9:15, a full 45 minutes after my appointment time, the doc sauntered in and did a quick scan of the waiting room on the way by.  Before Wyatt's name was called, I leaned around and asked the receptionist if it was always like this and at her nod, I informed her that I would make the next appointment for 8:30 but I would be arriving at 9:00.  She nodded sympathetically and said something about "having to check in" to which I responded "I can do that by phone".  Wyatt's name was called and I hauled him into the office where we plunked down in the chair.  Already this morning was not off to a good start.

After the first attempt to visualize Wyatt's eardrums failed, I had to hold him sideways and secure his hands and head so the ENT could pick at his ears with a slender instrument.  What he brought out was minimal, but he still could not see Wyatt's eardrums.  Already wailing, we had to 'extract' my poor boy's ears and then hopefully see things better with the microscopic lenses.  It went without saying that he was going to hate it.

We took him into the next room where I laid my crying son on a table.  He has not had very good experiences on tables covered with paper lately, so this new place made him howl a little more.  The receptionist/nurse came in and held his face while I held his hands so the ENT could basically rotor-rooter out both of his ear canals.  Wyatt screamed as I nuzzled and blew on his tummy to try and distract him a tiny bit (while trying not to lose it myself). The nurse murmured sweet things into his face as we did first the one ear, then rolled him over for the other.  Once the Doc had a look at both ears with the microscope, he shut the array down with a pissed off snap and declared that we were going back to the other room.

On the way back, I looked at my son's tearstreaked face.  He had miniscule red dots, petechiae, on both cheeks that went up over his eyes to his forehead.   They were on the tips of his ears where the doctor had held them to do the extraction.  I wasn't happy and neither was Wyatt who continued to howl loudly into my shoulder throughout the delivery of the results.  It turns out that there appears to be fluid in at least the left ear.
Probably.
Possibly.
Maybe.
He wasn't sure, but that's what it suggested.  At my look of shock, he mentioned the colds and flus that Wyatt had recently had.  I explained that we had sought medical help, he had his ears examined several times and been on antibiotics at least twice.

I'm not sure what happened, perhaps it was my rapidly reddening face or the tone I was using, but he suddenly changed his approach a bit and explained that "Down's kids" (UGH!) are notorious for small ear canals, but Wyatt's are extra hard to see as they are not easy to straighten out, due to some extra twists and turns.  The only person who could see his eardrums would be him, with his specialized equipment.  [Read:  walk-in doctor who pronounced his ears as "fine" is a liar].  I asked if due to the nature of his ear canals was there a problem with them self cleaning, to which he responded no, but a miniscule flake of skin or a tiny bit of wax would mean the difference between visualizing the ear drums or not.  I nodded, still trying to soothe the crying toddler snuffling in my ear.

What he said next, for some reason, shocked the hell out of me.  Due to the potential...
probable,
maybe,
possible ...presence of fluid behind the ear, it would be best to put Wyatt on the waiting list to put tubes in his ears and have a pre-op appointment 4 weeks before.  If at that appointment, there was no evidence of fluid, we could take him off the list.  I nodded, knowingly, but it was evident that I wasn't happy at all about this.  He had the nurse/secretary call the audiologist upstairs for Wyatt to have a non invasive wave test on the spot and we were sent to the waiting room.

By this time, Sean and Zoe had arrived.  Zoe was busily charming the waiting room, yet became very upset when she saw the state of her twin.  She would not be comforted or calmed either and Sean and I traded kids to see if we could do any better with the other.  The audiologist came upstairs, I took Wyatt back and held him on an angle while she placed what looked like a thermometer in his ear.  Then we repeated it for the other side, him screaming again all the while.  We tried to collect ourselves in the waiting room once more --- as Zoe ran around screaming and Wyatt cried --- and I started to fill Sean in on what had transpired so far.  I hadn't gotten two very far when we were called back in.  Everybody went in this time, a fact that seemed to take the Doc aback when he saw my large husband and the not so happy look on his face.

This wave test was also inconclusive.  So, without further ado, Wyatt was put on the wait list for tubes for the...
probable,
maybe,
possible ...fluid behind at least one of his eardrums.  I signed all the surgical papers and we headed out.  They will call us 4 weeks before his name comes up.  The wait list (as it is considered elective) is currently sitting at 6 months, so that will buy us some time.

I stomped down the hall towards the elevator, simply furious. Sean gave me a questioning look and all I could get out was some nonsense about breaking in my new winter boots on the walk-in doc's genitalia.  It's hard to totally grasp what I was so angry with at the time, but I was completely inconsolable.  I was angry with the one MD who lied to me and said his ears were fine. (Malpractice or just plain prejudice?) I was angry that my baby had to be restrained for something that obviously hurt and scared the living daylights out of him (and emotionally hurt me).  I was angry with the ENT for his bitchy, prima-donna attitude and angry that Wyatt's ears were probably going to need surgery.  I was angry with the medical profession in general, for dismissing people with DS out-of-hand and not seeing them as individuals with individual challenges.   I know there is a high predisposition for certain illnesses that come with the extra chromosome, trust me.  I've explored and written about it ad nauseum.  That doesn't mean that the Walk-in clinic Doc's negligence or even the (generally well meaning) ENT's less offensive attitude of "Well, he's a Down's kid, so what do you expect..." should be allowed to continue.  [You will also note the lack of person first language]. 

Most conditions have a higher incidence in one population or another, but you don't hear a lot of: "Mrs. Jones, you've got breast cancer.  You're Caucasian, so it's to be expected."
Or: "I'm sorry Mr. Smith, it's diverticulitis.  You're an older man, so these things happen."
Even better, how about: "...it's Schizophrenia, sir and since you are new to this country and poor, you're son's chances of maintaining his medication regimen are slim.  He will probably end up on the street, in jail or dead within the next five years.  Whether it is by his own hand or not, it is hard to say, but he's a schizophrenic.  He won't amount to much."
Those conversations don't happen.
But, if your kid has Down syndrome it's: "what do you expect?" or some rationalization about life span (which, as a side note has gone from 25 to 65 years in one generation alone and is steadily climbing).   One mother on our Down syndrome Uprising page was told by a resident after her daughters stroke at age 13, that because she has Down syndrome "she has lived half her life already" (that was a scant 5 years ago; her daughter has flourished since then).  Kari at a typical son was told that her son was being referred for osteopathic treatment thusly:  "Since he is retarded it isn't like it will help or hurt him so I will make the referral." Shannon at Love life and be gentle was asked by the audiologist when her son was getting earplugs (exactly like Wyatt will need to for swimming) if she was sure if she wanted to "waste" the money "on a kid like him".  It's shocking to hear, but it happens all the damn time.  Sometimes it's overt like this and other times it comes out as "what do you expect?"


Our ENT isn't so bad, all things considered.  He has also gotten George-Clooney-in-ER bitchy in the past when he believed, for an ill-informed brief second, that we were not putting the mineral oil drops in Wy's ears.  What we thought was prejudicial behaviour turns out not to be, as he's just really arrogant. He does however, need to understand how disrespectful his choice of not using person first language is.  That walk-in Doc can DIAF as far as I am concerned, however.  Team Logan has had it pretty good so far with it's medical encounters;  many families I have come across cannot say the same thing.   The underlying prejudices are still out there and I am saddened to hear that they outweigh the positive encounters.  Many people are predisposed to a multitude of conditions due to their racial, cultural or socioeconomic backgrounds.  That doesn't mean it is automatically going to happen, just statistically the odds are higher.  It doesn't mean you can discriminate.  The same goes for our friends with an extra chromosome. 

I know having tubes in the ears isn't the worst thing ever;  mine is the kid that still needs his heart repaired at some point.  I've stood in the OR and seen tympanosomies first hand, taken care of the kids afterwards and known children in our extended family that have had them done (and suffered no apparent ill afterwards). I can see myself writing a post on it as we get closer to the date.  However, Wyatt's case is a little more unusual that your average run-of the mill kid prone to ear infections. Due to the size and shape of the structures of his ears, it will be more difficult to perform the surgery in the first place.  This fact the ENT stressed with an incredulous look on his face and a bit of hand waving, thereby driving the point home. Then there is the general anesthesia to consider as well, in a child with an AVSD (now ASD) and the complications that may arise from that.  As well, there is the risk of infection with the grommets in;  any swimming or submerging of his head will require ear plugs to keep water and infectious agents out of there.  Tubes are also notorious for clogging or simply falling out; it would be awful to have to do this more than once, or have him get a horrible ear infection that makes him lose his hearing anyway.  Essentially, it's a lot more "what ifs" piled on a precarious foundation of "perhaps".   Sorry, not a fan.  Not.

I will be hoping that the fluid, if any, is just residual from his recent bouts of colds/flu/bronchitis and that by the time his appointment rolls around this will be a thing of the past.  In the meantime however, I am going to make a point of talking to the ENT, about his office hours and a few other things at the next appointment.  Wyatt's petechiae are starting to fade, so hopefully my nagging fear about his platelets will do the same.  I have one more marathon appointment at the dentist coming up (that is not after a night shift) and after that, any and all decay will be dealt with and we can move on to happier things and a brighter smile.  In the meantime, we'll play it by ear as it were and try to stay as healthy as possible.

We're also hoping that this week is a lot better. The waffles helped a bit.

This was the next morning.  The spots over his eye had faded a bit.

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Teeth Suck (But They Don't Have To)

As I'm writing this, I'm in agony.  One of my back molars has caved in, there is an exposed nerve and I am waiting for an appointment with my dentist on Wednesday.  It's horrifying and yucky all at the same time.  I'm not happy with my teeth in general these days... Start with antibiotic discolouring, add vomiting every single day for 6 months when pregnant and then sucking back Cokes and sugary coffee in an effort to stay conscious (not to mention 'nurse food' like doughnuts and pizza and cookies and candies and all sorts of junk at 3 am)... Quel surprise!  Things are a mess, I'm chewing on one side of my face and stealing the kid's Orajel.

I'm not the only one in dental hell either.  If you are keeping tally with Team Logan's tooth parade, you'll know that someone is either losing or gaining teeth all the time right now.  Quinn has lost his "grey" tooth (a incisor that he damaged when he was a toddler) and we are anxiously awaiting the appearance of the secondary tooth that is to replace it.  Zoe has decided to skip her canines and premolars and go straight for molars, while Wyatt is finally deciding to give his two [razorlike!] teeth on the bottom some playmates on the top.  Slooowly you can see them coming up; as of this writing one has cautiously poked through.  I'm not the only grumpy one either;  the twins both have red cheeks, copious amounts of drool, sore bums, loose-ish stools and are generally irritable as all get out.  A few years ago when my oldest and our friends twins were teething, we had a catch phrase: "teeth suck".   This was a direct result of those early desperate acetaminophen and gripe water soaked parenting years where we would have entertained just about any idea to get them all to feel better and stop crying.  Wanna gnaw on my thumb for three solid hours? Please, go ahead, if it makes you happy! Now it's my turn with teething twins and my fridge is full of chewies of various sizes and descriptions, frozen washcloths and frozen waffles.  I should have stock in Tylenol and diaper cream and both Sean and I could use an extra arm right about now.  As far as we are concerned right now, teeth really suck!

Since we're all about les dents at the moment, I might as well prolong the agony and talk about Down syndrome and dentistry.  I have had the same dentist since I've been 11 years old (when I actually go) and that hasn't been a problem, at least for me.  However, is that practice the perfect choice for Wyatt?  When should he start going to the dentist and what should I be looking for in a dentist?  What kind of things do you have to deal with in Down syndrome that you may not have to deal with typically? Like just about everything else, there is a learning curve for me.  Which means that there is one for many other people as well;  it would only be fair to share my findings.  I'll also switch to my "medical voice", which can be a bit dry and for that I'll apologise for now.  To start, I thought I'd go over some of the more common problems. 

Structural Issues:

To begin with, those with DS generally experience what is known as delayed eruption.  With this, the teeth emerge late compared with typical children.  All children are different, however it is not surprising to see "typical" children teething between 6-12 months, while children with Down syndrome generally start between 12-14 months and can possibly wait until 24 months.  Typical children have all 20 of their deciduous or primary teeth by age two or three, while children with DS may not have all their teeth until they are 4 or 5.  The permanent teeth are also delayed, with the front permanent teeth and permanent six year molars possibly not erupting until age 8 or 9.  The teeth may also arrive in a different order than expected.

The teeth may also be smaller than usual (microdentia) or missing;  in some cases malformed.  Crowns are often smaller as are the roots (which can also be conical).  Taurodentism is also common, as are 'peg teeth'. 

The tongue is also an area of concern as it can be larger.  It can also appear larger while being of average size as the upper jaw could be smaller.  Grooves and fissures are common, especially with the high incidence of mouth breathing (due to smaller than average nasal passages).  These can be severe at times, which would contribute greatly to halitosis.  Mouth breathing can also lend to an overall decrease in saliva (xerostomia) which impacts on the ability of the mouth to clean itself.

Issues with bite can also occur.  There may be gaps in the bite, due to spacing from smaller than average teeth.  Malocclusions such as an "open bite" are common, as is Prognathism or "underbite", where the bottom jaw is moved forward and the top teeth rest behind the bottom.  There also might be overcrowding of the teeth in those with a smaller than normal jaw which could lead to impaction of the secondary teeth.  These are all completely treatable with orthodontics; however orthodontic appliances can interfere with speech development so that it is recommended by many sources to delay such treatment.

Tooth grinding or Bruxism is a common here and throughout the neuro-typical community as well.  Children often grind their teeth and many stop as they grow older; if this does not cease, however, severe damage to the teeth can occur over time.  If this is the case, a dentist may prescribe a mouth guard.  DS, can affect ligaments around the teeth.  As a side note, Atlantioaxial Instability can cause some positioning challenges whilst in the dentist's chair and possibly interfere with navigating throughout the office safely.

Sleep apnea should also be assessed when positioning and seriously assessed when considering sedation and sleep dentistry.  

Disease-Related Issues

Peridontal disease, or  issues with the gums is very common in those individuals with Trisomy 21.  This is due largely to a predisposition based on an diminished immune defense (see below).  Also, there is an overall increased amount of plaque.  Onset is rapid and often results in the loss of adult teeth by the teenage years.  Frequent brushing (targeting the gum line) and flossing are very important to prevent problems in this area.  Regular dental check ups and X-rays are also important to monitor such potential problems such as bone loss. Using specialized antimicrobial mouth rinses such as chlorhexidine might also be helpful.   

Dental caries or 'cavities' as they are more commonly known, are also common.  In years past, it was assumed that individuals with DS had a natural resistance to caries as they had a lower incidence.  Sadly, this research was done in an era where most people with learning disabilities were institutionalized and therefore, had a restricted diet.  In this more forward thinking time, everyone is exposed to the same abundance of carbohydrates and therefore, the same risk of forming cavities.  Reducing carbohydrate intake, frequent flossing and brushing (with a fluoridated toothpaste) will significantly reduce the formation of caries.

There is a distinct link between oral disease and heart disease.  People who have heart conditions are usually recommended to take antibiotics before any invasive dental procedure, including cleaning or scaling (tartar removal).  Due to the high incidence of heart problems associated with Down syndrome (specifically, mitral valve prolapse), it is not surprising that many individuals with DS are prescribed antibiotics before a trip to the dentist to prevent bacterial endocarditis. 

As mentioned previously, those with Down syndrome often have a decreased immune response due to a decreased number of T cells, a specialized white blood cell that fights infection.  As a result, there is an overall increase in oral infections including periodontal disease, acute necrotizing ulcerating gingivitis (ANUG), candida (yeast), and ulcers.  Wound healing times may also be prolonged, especially if the individual also has diabetes.  Frequent upper respiratory infections often lead to mouth breathing,  xerostomia and fissures of the lips and tongue.

Seizures are common in the DS community.  Providing your dentist with a complete medical history and list of medications will be important, as will a list of triggers, etc.  This way, the staff can be more prepared if a seizure were to occur in the office or in the chair during a procedure.

It is recommended that oral hygiene be stressed and any problems with the primary teeth to be addressed quickly.  Due to the generally late appearance of the secondary teeth it is advisable to encourage the primary teeth to stay around as long as possible.

Other Considerations

When looking for a dentist for your child, it may be worth considering a pediatric dentist who specializes in treating children.  This is especially ideal if there are sensory issues with your child or if your child is often fearful.  Speech, vision and hearing difficulties could easily hinder communication.  Due to the cognitive diversity found within Down syndrome, there could possibly be interpretation issues as well, which could hinder treatment.  At the very least, having a dental team with experience with special needs is probably a wise decision. 

Behaviour management can also be a consideration.  Suggestions to improve the overall experience include:

• Scheduling the appointment early in the day so that all parties are well rested.
• Active listening to ensure ideas and instructions are communicated and understood clearly.
• Simple, concrete speech to facilitate short-term memory.
• Whole team involvement/introductions to help acclimatise and reduce any anxiety.
• Limiting distractions
• Consistency of care
• Reward co-operative behaviour and comfort those who require it
• Avoid immobilization techniques
• Use a collaborative approach;  sharing information, positive techniques and previous experience between staff and caregivers can improve any clinical experience.

As with any child, it is recommended that professional dental care begin with the eruption of the first teeth;  this has been stressed in much of the literature concerning Down syndrome as well.  This will not only acclimatise the child to the environment, but also ensure that they have exceptional care from the very start.

---


That's a lot to think about. 

However, it is in our best interest.  Many, if not all of these conditions are present in the 'typical' population and are by no means exclusive to those with Trisomy 21. I won't know if my dentist is the best for Wyatt until I get there and start asking questions.  If not, I will move on.  However, for now, I will encourage this process by offering up the best example that I can to the kids.  That starts Wednesday when I face the drill of my DDS. 

Writing this article in spots, if you forgive the analogy, was like pulling teeth.  Hopefully the information provided here will help promote oral health for your child (and you)... and keep that very thing from happening. 


----------------------------
Debord, Dr. Jessica, DDS, Dental Issues and Down syndrome, National Down Syndrome Society (NDSS), ©2012.

Dental caries prevalence and treatment needs of Down syndrome children in Chennai, India, Indian Journal of Dental Research,  2008; 19(3); 224-229

Frydman A, Nowzari H., Down syndrome-associated periodontitis: a critical review of the literature, Compendium of  Continuing  Education in  Dentistry, 2012; 33(5): 356-361.

Pilcher ES. Dental Care for the Patient with Down Syndrome, Down Syndrome Research and Practice. 1998; 5(3); 111-116.

Practical Oral Care for People With Down Syndrome, National Institute of Dental and Craniofacial Research, National Institute of Health, #09-5193 

A Smooth Road

"A smooth road to London town

A smooth road to London town

The road goes up

The road goes down

A smooth road to London town

But...

By and by we come to a dell

Where the roads are not so swell

A bumpy road, a bumpy road

A bumpy road to London town..."

--Smooth Road to London Town (Children's Song)

Our life right now probably won't seem very interesting to most outsiders.  We're in one of the in-betweens;  waiting for the results of the last set of the appointments as we wait for the start of the next round.  It's an odd place to be, this in-between.  We're not quite anywhere, but rather on the way somewhere.  We're also not sure where this trip is taking us, but we are inside, out of the elements and content to let the sway of the carriage lull us to sleep.  There may be brigands and cut-throats and all manner of wylde beasties lurking outside, but for now we are content to curl up and have a conversation.  Occasionally one of us will look out a window and remark on one landmark or another, but for the most part we are pleased with passing the time together.

We've rumbled by a few milestones with Wyatt in the last little while.  He got his first tooth the other day;  after months of sore red cheeks and gums, it finally broke through.  The one next to it should be arriving in a few days.  In case you are following along:  Quinn has two adult teeth and just lost another, Zoe has seven and Wyatt has one and is working on his second.  He has been able to "chew" food for some time now;  adding teeth to the mix just ensures I can increase the texture of things a little bit more.  Thursday,  for example, I made a whole batch of toddler meatballs for the twins.  They are so very easy to make and all my kids have loved eating them.  Zoe was a little hesitant at first, looking from the meatball on her tray to her father, back to the meatball and then to her father again, as if to say "WTF is this?!".  Wy didn't hesitate and popped two into his mouth.  One thing that we really have to be careful with him with is choking;  not because his swallowing is sub-par, but because he is prone to stuffing too much food in his mouth at once.  He also tends to get a stash going in his high palate and if we're not paying attention, can still be eating/possibly choking several minutes after we think he's finished.

There has also been the first (confirmed) "Dada" out of Wyatt.  Both babies have been babbling "dadadada" and the like for months, but Zoe has been calling Sean "Dah-dih" for some time now.  We're both pretty convinced that Wyatt's "Dada" was intentional as a)  it came out singular (no repeating dadadada over and over like he usually does) and b) he reached for Sean as he said it.  I'm not sure about Dada himself, but I was a little teary eyed.  It will probably be a long time before either twin says "Mama" though... If they are anything like their older brother it will be next year some time.  Quinn's first words, in order, were "Dada", "Kitty" and "Guitar".  Shortly after that, he started calling me "Lady".  It was months down the road before he finally called me "Mommy".  Now I'm "Mom" (or "MaaaAAAWWWmmm") most of the time, which makes me a little wistful, actually.

Wyatt's reaching and overall movement has increased lately too.  We sing with all the kids, but we have played a little game with Wyatt since he was able to sit up (supported) on our knee.  One of the action songs from Mother Goose called "Smooth Road to London Town" is his favourite.  Sean has modified it slightly to emphasize the part where "the road goes up", so he can make a point of lifting Wyatt's arms up in time.  This is followed immediately by "and the road goes down" where Sean lowers his arms and leans him forward (he used to flop forward on our tummies before he could sit up).  I hadn't sung it to him for a while and was pleasantly surprised by his progress recently.  He was balancing himself nicely on my knee and was holding my two index fingers gently when we started.  When we got to "the road goes up" part, he got a big smile on his face and lifted his arms and my fingers up by himself and then started to lower them for "the road goes down"... and patiently waited for me to continue with the more bouncier parts of the song.  I was astounded.  I remember him a few months ago anticipating "the road goes down" by nodding his head forward and tugging slightly on our hands (as they held his), but this was awesome!  Zoe, by this point, was strutting around the room with her arms up over her head and shouting as if she was announcing a touchdown, but Wyatt was as pleased with himself as I was and we continued on with two more quick trips to London Town (well, in song, anyway). 

Our OT visit was cancelled this week so we found ourselves with a morning off.  By "off" I mean "slightly unscheduled", as we still had things to do.  However, we were able to take it easy and sit around for a couple hours while the babies played and we talked.  It was a rare treat, to be honest... to feel as if we didn't have to rush off or do something.  We also got to complete a whole conversation (how long has it been since that has happened?).  The time passed quickly, as all stolen time does, but it was refreshing.  It gave us a nice little pause in what would turn out to be a very busy and draining week.  Our appointment was rescheduled for Tuesday, so I am sure we will pick up there where we left off. 

This little leg of our journey together may not be the most spectacular or the most in depth, but sometimes you need to just keep going and see where you end up.  For now, we are content to count teeth and sing songs and marvel at our children as they grow and develop.  It's not a trip for everyone, but it suits us just fine.  I'm sure the scenery will eventually change and bumpier roads are indeed ahead.  For now, however, no matter how up and down, it's still a pretty smooth road to London Town.