12 Month Well Check

We scrambled to get everyone dressed and in the van by 7:30 so we could be unloaded and checked in at the pediatrician's office by 8 a.m. This is how the kids ate their breakfast:

The appointment took nearly two hours, though I guess that's to be expected when you combine three kids well-checks. The biggest news is that Maddie is on the growth chart for the first time since birth! I am so excited! Granted, she's only in the 5th percentile for weight, but she's on there.

Here are their measurements from the last year. Keep in mind we did not have a pediatrician from 2-4 months so I have no stats during that time.

	James	Amelia	Maddie
Birth	6 lbs 12 oz 20.5 in	6 lbs 2 oz 20 in	5 lbs 9 oz 18 in
4 Months	13 lbs 5 oz 2 ft 1 in	12 lbs 2 ft	9 lbs 23.75 in
6 Months	15 lbs, 7 oz	14 lbs, 9 oz	11 lbs
9 Months	17 lbs 6 oz 2 ft 5 in	16 lbs 11 oz 2 ft 3 in	13 lbs 5 oz 2 ft 2 in
12 Months	21 lb 15 oz 2 ft  6 in	20 lb 9 oz 2 ft 5 in	17 lb 4 oz 2 ft 4 in

Quick summary of each baby:

James

• Pediatrician recommended we switch to soy milk because cow's milk has caused James' to have 4-6 poopy diapers a day. 
• She told us his upper gums were swollen and we should expect the top teeth to cut soon. 
• She was also impressed with James' balance when standing and ability to pull up on the wall and door. 

Amelia

• All is easy and well with our once challenging girl. None of us have any concerns. 
• The doctor did comment that she didn't have any teeth, but said that wasn't uncommon until 15 months.

Maddie

• The ped was especially happy about Maddie's weight gain since most babies' weight gain slows down between 9-12 months due to increased activity. 
• We were told to reintroduce cow's milk and yogurt every six months to see how Maddie tolerates it. The pediatrician believes Maddie might outgrow her milk allergy since she does well with cheese. 
• We briefly discussed notes from the neurologist and observations from the PT. Overall, everyone is happy with Maddie's progress. 

They had three shots (Prevnar 12, Proquad, Hep A) each and a finger prick to check iron levels (all were in normal range). All three left crying and covered in band-aids.

3 Year Well Check

We took Jackson to his 3 year well-check yesterday. I was surprised at how much he was asked to do by the nurse and doctor. He completed the following requests:

• stood on the scale barefoot for height and weight checks
• provided a urine sample in a cup (good thing he's potty trained!)
• stood still while the nurse took his blood pressure
• brushed fluoride on his teeth
• attempted to identify shapes on a vision test (When asked "What do you see?" he replied "Nothing" and "Shape")
• drew a circle and an x
• jumped up and down
• bent at the waist and touched his toes
• walked on his tip toes and on the heels of his feet

He also had to answer the following questions:

• Do you know your name? (refused to answer)
• Can you tell me some fruits and vegetables you eat? ("bananas and apples")
• Do you sleep in your bed? ("yes")
• Do you use the potty? ("yes")
• Do you put your clothes on by yourself? ("yes")
• Do you brush your teeth? ("yes")
• What is the name of one of your friends? (He named his BFF from school and Geo from UmiZoomi)
• Are you a girl or a boy? Is Mommy a girl or a boy? Is Daddy a girl or a boy?

I expressed concerns about social/separation anxiety because Jackson will NOT play in an enclosed area where there are multiple people he does not know. He still gets upset when we leave him at the church nursery. He doesn't transition well. The pediatrician told me to keep taking him places and exposing him to different people. The behavior was common among three year olds, but it would not be typical if he refused to go to the places (i.e. park, church, rec center) for fear of other people being there.

Our other concern was allergies and frequent complaints from Jackson that his eyes are burning. She gave us a prescription for liquid Claritin that is covered by Medicaid.

We were asked if we wanted Jackson to receive the flu vaccine. We declined since we had repeatedly promised Jackson he would not receive any shots. We'll just wait until next flu season begins.

Here is Jacskson's growth since birth and some pictures from his doctor visit:

	Weight	Height
Birth	8 lb, 15 oz	21.75 in
1 Month	11 lb, 1 oz	23.25 in
2 Month	12 lbs, 15 oz	25 in
4 Month	14 lbs, 4 oz	25.75 in
6 Month	16 lbs	27 in
9 Month	19 lbs	29 in
12 Month	21 lbs, 5 oz	30 in
15 Month	23.2 lbs	31.5 in
18 Month	24 lbs, 15 oz	33 in
2 Years	27 lb	34.5 in
3 Years	31 lb, 8 oz	37.5 in

Nurse asked if she could "hug his arm". BP was 72/40

Waiting for the doctor, showing Geo around

Getting to pick out a sticker at the end

9 Month Well Check

The trio had their 9 month well check. The entire family went since Jesse is on spring break. Jackson was especially grumpy and ended up falling asleep in the van. We knew waking him up would cause more difficulties, so Jesse stayed with him in the van while I took the babies inside. 

Their "6 month check" was a few days shy of 7 months. We're back on track now since the babies just turned 9 months old yesterday. In just over two months, each baby has gained over two pounds. James and Amelia weighed less than they did at their sick visit the other week, but that is because they were weighed wearing clothes and full diapers. They are always weighed completely naked for well checks.

James-17 lb, 6 oz and 2'5" 

The only concern I had with James is that he frequently coughs while eating. He mostly seems to shovel down food and eat so quickly, but there have been a few times where we've had to do a finger sweep and smack his back because he seems to be choking. She said she wasn't concerned yet since he wasn't aspirating on liquids. If it is a regular occurrence at 12 months, she will refer to a SLP.

Amelia-16 lb, 11 oz and 2'3"

My concern with Amelia is that when she is sitting up unassisted she does great for a few minutes, then suddenly falls over with no warning. She never seems to correct herself or try to catch herself. The pediatrician had Amelia sit up on her own until she began to fall over. She assured us that was normal for a beginning sitter and not to worry.

Madeline-13 lb, 5 oz and 2'2"

My questions regarding Maddie now extend to the neurologist and physical therapist. Nothing new was addressed. We were happy with her weight gain. Her reflux is manageable, though she continues to take Prevacid twice a day. The pediatrician did try to get Maddie to pull up to a standing position, which was ridiculous. We're aware that Maddie is on a different time frame, but the gap is smaller than it was two months ago. 

The trio had two vaccines (Prevnar 13 and Pediarix). They are now up-to-date on all vaccinations. 

6 Month Well Check and Cardiologist

The trio had their 6 month well check last Thursday (though they're really closer to 7 months old).  Here are the highlights for each child:

James-He weighed in at 15 lbs, 7 oz.  Neither the doctor or Jesse and I had any concerns.  James prefers putting weight on his legs and jumping than he does sitting or rolling over.  While looking in his mouth she said, "Those teeth are right there." James was especially silly and talkative throughout the appointment.

Amelia-Her weight was 14 lbs, 9 oz. At her last check we had expressed concern over a mildly flat head.  It has corrected itself now that she spends more time on her tummy or in a exersaucer or bumbo.

Maddie-She weighed 11 pounds even.  While she is clearly still the runt, she's holding her own.  All three babies gained around two pounds in the last two months.  The doctor was pleased that Maddie was putting on weight and has made excellent progress with trunk control.  She was concerned that Maddie is continuing to keep her fists closed and doesn't cross the midline.  For example, if Maddie has a toy in her left hand, she never puts it in her right hand.  People always comment on how sweet and dainty Maddie is because she always keeps her hands clasped together in front of her.  However, this is not developmentally appropriate for a six month old.  Our pediatrician referred us to get her evaluated and receive OT at home through early intervention services.

The babies had four vaccines each: DTaP, Hib, PCV, flu.  They go back in one month for the second dose of the flu vaccine.  At 9 months they will be caught up with all their vaccines.  (There aren't typically shots at the 9 month check, but we had a delayed scheduled.)  It took longer to sign permission the forms than it did to administer the shots, thanks to two very efficient nurses.

Unfortunately, the shots had an ill effect and all three babies were crying and ran fevers the following day.  At least one baby was up fussing every half hour throughout the night.  Amelia wouldn't keep any food down until mid-afternoon. It took until Saturday evening for the trio to return to their predictable moods and schedule.

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Maddie had her cardiologist appointment scheduled for Monday afternoon.  Scheduling the follow up was a headache in and of itself because the cardiologist was adamant that Amelia was the one with the heart murmur.  I assured the office that it was Madeline who had the echocardiogram in the hospital when she was three days old.  We finally tracked it back to original paperwork for"Baby C", which was indeed Madeline, not Amelia.

The cardiologist's office is located one floor above my MFM's office.  I felt all kinds of nostalgic navigating the parking deck, elevators, and corridors.  I was excited to listen to Maddie's heartbeat and watch the blood flow on the machine, just like when she was in utero.

The nurse, pediatric cardiologist, and ultrasound technician were completely smitten with Maddie's smiles and coos.  I don't think any of them ever made eye contact with me because they were so enamored by our sweet girl.  Before the appointment, my main concern was how Maddie's hands and feet turn purple.  Just like the pediatrician, the cardiologist also assured me that it was still typical for infants and was not a result of anything related to her heart.

The cardiologist could no longer hear the murmur and the ultrasound confirmed that the larger of the two holes has closed.  She does, however, have a PFO, which is a pinhole size heart defect.  Apparently, 1 in 5 adults has a PFO and most people with PFOs don't know they have one because they are harmless and have no symptoms.  He told me the only time it would be an issue is if she wants to go deep sea diving.  He also let me know that there are current studies about the correlation between PFOs and strokes, but there is nothing preventative or treatment for it. I'd rather not dwell on that possibility.

Maddie was very cooperative during the ultrasound.  I held her hand, not because she needed comfort, but because she kept trying to grab the cords.  The tech printed a picture for me and said, "Here's your first Valentine from her."

Four (Almost Five) Month Well-Check

We FINALLY had an appointment with a pediatrician!  I can't tell you what a weight off my chest this is!  After exhausting all our resources with pediatricians in our county, Jesse found a children's clinic in the neighboring county that accepts new Medicaid patients.  We filled out the paperwork on Tuesday, made the appointment on Wednesday, and went to the doctor this morning.  When calling to make the appointment, I kept repeating, "Now our insurance cards do not have you listed as the Primary Care Physician.  Are you sure that's okay?"  The receptionist asked for the phone number listed on our cards, put me on hold, and called them directly while I was on the phone.  She clicked back over two minutes later and said, "They gave us authorization to treat.  You're good to go."  Seriously???  Why the hell couldn't our former pediatrician have done that three months ago?  This whole thing has been a disaster, but praise God that we have proper medical care for our children once again.  Here are the stats:

	Weight	Height	Head Circumference
James	13 lbs 5 oz	25.75 in	16.3 in
Amelia	12 lbs	24.75 in	15.4 in
Madeline	9 lbs	23.75 in	15.2 in

I really appreciated the fact that the doctor made it feel like three separate appointments.  She treated each baby individually and reminded me not to compare the three.  She had read their files beforehand and was familiar with their brief history.  Here's a quick recap: 

James-no concerns, all is well.  We were given Vitamin D drops to give all three babies since they are breastfed. 

Amelia-I mentioned I was worried about her diaper rash and possible flat head.  The doctor told us that Amelia did have a mild flat head, but there was no asymmetry and it was not pronounced enough to require a helmet.  As far as the diaper rash, she just told us to use the lowest dose steroid cream when needed, but that her skin was likely just sensitive.

Maddie-Our obvious concerns were weight gain and reflux.  It has been nearly three weeks since Maddie has taken her Prevacid because the previous doctor would not refill her prescription without an appointment.  Our new doctor called in a prescription and we've already been able to give Maddie a dose this evening.  We were given samples of Similac Alimentum to supplement with that should be easy for Maddie to digest.  She is supposed to drink breastmilk as usual, but then we are to offer 1-2 oz of Alimentum after each feeding.  We go back in two weeks for a weight check.  If Maddie has not gained "adequate weight" despite medication and supplementing, she will be referred to a GI doctor. 

I also expressed concern that Maddie wasn't lifting her upper body during tummy time.  The doctor said she was delayed but exhibited great tone and neck control so she wasn't concerned at this point.

She also wrote a prescription for creams for Maddie's eczema, gave us prescription shampoo samples for stubborn cradle cap, and checked her heart murmur. 

The appointment was long and thorough.  Thank God Jesse accompanied me.  He kept Jackson occupied by walking around with him and playing in the lobby.  After 90 minutes, James was over it.  Mind you, this was before shots!

I had been concerned about delayed vaccination schedule.  The babies aged out of the Rotovirus, which I'm indifferent to anyway.  They had DTaP, Hib, and PCV vaccines.  They will have vaccines at 6 months and again at 9 months, and then be caught up.  Thanks to an efficient nurse, we had quite the assembly line going.

I think that's everything.  Now we just need prayers that Maddie gains weight and James and Amelia continue to thrive.  Hooray for healthy children.

Medicaid Migraine

Here's the goose chase we've been on over the last six months:

June 10-We mailed the completed application for Medicaid (for myself and Jackson).  Even though I had Blue Cross Blue Shield through the end of maternity leave, I wanted to get us approved and in the system. The theory was that we could simply add the names of the children once they were born and it would go into effect ASAP. 

July 15-Happy birthday James, Amelia, and Madeline!

July 19-Babies had their first appointment with the pediatrician for weight checks.  Because they weren't expected to have insurance as newborns, the receptionist assumed they'd be added to my insurance. 

Late July-We still hadn't heard from Medicaid.  FYI, the phone system is ridiculous and there is no option to leave a voicemail.  Jesse went to DSS office, only to be told they never received our application.

August 1-Babies had two week check up with pediatrician.  Maddie was back up to birth weight and all three were healthy.  We were told we didn't need to schedule another appointment until two months old.

August 15-I receive a call from a social worker through the hospital.  She informed us that insurance claims must be made within 45 days of birth.  We only had two weeks from that phone call to make sure everything was processed. 

Late August-I spent every morning on the phone with hospital social workers, DSS, and case managers to try and check on the status of our Medicaid.

August 30-Medicaid cards were issued for all four children (with one day to spare).  Praise God!

September 18-We took babies to the pediatrician for their two month well-check (which included four immunizations per child).  The receptionist told us we would either need to pay upfront (almost $700) or reschedule because our Primary Care Physician was incorrect.  They would not accept our insurance until the PCP listed their provider number.

Mid September to Early October-I tried to call the customer service number dozens of times.  You have to listen to about 10 minutes of automated prompts and menus before being directed to the actual Medicaid office.  Again, there is no voicemail so if you don't get through you hear, "We're sorry.  We are currently assisting another client.  Please try again." before you are automatically disconnected.

October 16-Maddie and I went to DSS after her chiropractor appointment.  We waited in line for over an hour and finally got to talk to a kind social worker.  She inputed the correct information into the system and assured me the change would be updated within 7-10 business days.

November 5-We still had not received updated insurance cards.  After dropping Jackson off at preschool, the babies and I waited in line for almost two hours at DSS.  Another social worker looked up our information, confirmed that the PCP had been changed, but informed me that insurance cards were never issued to be mailed.  She requested that the cards be mailed and told me to call (what a joke!) if I didn't receive them within a week.

November 10-When we came back from the beach, we found four new insurance cards in the mail!  Unfortunately, they STILL had the wrong PCP listed!!!

November 12-After dropping Jackson off at preschool, the babies and I went to the pediatrician's office to try to resolve the issue.  The receptionist informed me that they cannot accept our insurance until their provider number is listed.  I happened to glance up and see a letter on the glass door that announced our beloved pediatrician had left the practice.  We still cannot schedule an appointment until our insurance cards are correct.  I was given a list of pediatricians in the area to contact.

Mid-November-I called all local pediatrics offices, only to be told that they are not accepting new Medicaid patients.  I continued to call DSS, only to be disconnected after sitting through the automated prompts.

November 27-Since Jesse had the day off, I was able to go to DSS by myself this time.  The line was rather short, and the social worker assured me that even though their electronic system was down, I would leave with an answer today.  I was given a number and directed towards another waiting area.  When my number was finally called, I went back to speak to a case worker directly.  Here was our conversation:
(I swear I'm not making this up!)

CW: How can I help you today?
Me: I need to update the PCP on my insurance cards.
CW: Did they not tell you that the system is down?
Me: Yes, but I...
CW (interrupted): Yet you chose to wait anyway?  What did you think I could do?
Me: Well, I've been up here four times before and...
CW (interrupted again): Oh, you don't have to explain.  I've heard it all.
I received a text, which caused my phone to vibrate in my purse.
CW: What is that?  Is that your phone?  My God that's annoying.  Turn that off.
Me: Okay.  So what am I supposed to do about the PCP?
CW: Well you can fill out the change of request form and I'll enter it in the system on Monday.  (Hands me the form.)
Me:  But I've already done that multiple times.
CW (rolls eyes): So you don't want me to change your PCP?  That's why you came in here.
Me: I just want to know what the problem is.  I've received new insurance cards but they still have...
CW (interrupted AGAIN): Right.  Well, the only other thing I can do is give you your personal case manager's phone number.
Me: Will that be a direct number?
CW: Yes.  We're closed until Monday.
Me: Fine.

At least I have something new to try on Monday.  The babies have not seen a doctor or had any immunizations in the last four months.  I feel angry and helpless, but I cannot afford the thousands of dollars in medical expenses.