Amy took one Harmony, hooked it up to the computer and then it was time to begin with Melody's first mapping. Because Melody is so young (only 12 months) she is not able to tell us much information. Amy took the headpiece and processor and gently placed it on Melody's ear. Melody turned and kind of looked at her funny. We held our breath, Melody promptly swatted it off her head. Amy tried again and asked my husband to make funny faces at her so that she would be distracted a bit. This did the trick! With the headpiece in place we were on our way!

Amy told us that she was going start off by doing some “objective measurements" -  this means that she would be presenting some sounds through the implant and the computer and hardware would measure the responses to give them a starting point of where to set her M-levels. How cool is that?!? Kind of like the testing they do on newborns during the hearing screening - obviously, they won't be raising their little hands to say, “Oh! I heard the beep!” LOL

After she did the measurements on the right side, she repeated the procedure on the left side. Working quickly as Melody was getting tired. Our job was just to keep her distracted and relatively quiet. We were prepared for this and brought a couple of Melody's favorite toys. We also had lots of books and even a blanket for peek-a-boo.

Now that measurements were made on both sides Amy indicated that she was going to turn on her processors and our little girl would hear for the first time with her cochlear implants. Up to this point all Melody had heard was “beeps” and funny noises – nothing meaningful. Amy also reminded us that there was no way to predict how Melody will respond and she may not respond at all to sound or she may not like the sound and cry. The important thing was for us to make sure that the sound was comfortable for her.

This was the moment of truth and it was like her short little life flashing before my eyes…her birth, her diagnosis, her first pair of hearing aids, her first/second/third set of earmolds (ha!), her CI evaluation, surgery, time without hearing aids…and here we were. Amy said that because Melody is so young, she was going to start out at a very low level and SLOWLY turn it up until we saw her first response…

Amy did a few more things on her laptop and said, “Here we go!” Amy asked me to talk to Melody while she turned up the sound. Melody, oblivious to what was going on around her, was happily chewing on the corner of her blanket and looking down at it.

The next moment, I'll never forget.

As Amy was hitting some keys, I said, “Melody, Melody…it's mommy…can you hear me?…I love you!”…and Melody blinked. Then she blinked again. She also stopped chewing on her blanket. MY BABY COULD HEAR!!!!!! Amy turned off the computer for a minute then turned it back on and I said the same thing again and Melody reached up to one of her headpieces and pulled it off.

Tears of joy streamed down our cheeks! She could hear! I remember hugging my husband and kissing Melody all over – she had NO idea why Mom was getting so excited! I think I may have scared her!

Amy let us have a moment and then continued adjusting Melody's levels. As Amy had said earlier everyone's first reactions at initial stimulation are a bit different…some kids start frantically looking around, some cry, some just get really quiet. Melody never full out cried but all of a sudden she got kinda clingy. I was happy to oblige her by giving her a big hug but then also encouraged her to sit up so that we could continue with the testing.

After a few more measurements, Amy declared that we had a pretty good first map and that she would turn off the processors for a little while she did some further programming. When she turned them off, it was interesting to me that Melody had the same reaction. She got somewhat quiet and started looking around – it's like she realized that she couldn't hear again. We played some more and distracted her while Amy added some different maps to her other program slots. It's typical for new implantees to start needing more sound as their brains start to make sense of the new sounds around them. So, program #1 was her starting level, Program #2 was a little bit louder meaning her M-levels were increased slightly and Program #3 provided the biggest increase in her M-levels – giving her the most sound. This would allow us to gradually switch to louder programs as Melody needed over the next 2 weeks until we returned for more programming.

Before leaving, Amy went through all of the paperwork and accessories with us.  We sat down at the desk and filled out the requisite forms and registration. Amy also showed us what was in “the kit”…now, I understand that I'm pretty well-versed in this stuff since we already have a child with a CI and so, it wasn't a big deal. For you new parents out there, I imagine that getting all of these pieces and parts is a bit overwhelming at first.  I totally remember going through that with Buddy…after that first appointment, all I wanted to do was make sure that I got the battery on right and that the headpiece stayed on! A lot of that other stuff was a blur and this is completely NORMAL. The audiologists understand that there is a lot to digest and that it may take some time and repetition before you understand it all. I've heard of some clinics being able to give you some of your equipment ahead of time (like batteries and user guides and such) – be sure to check with your clinic about their procedures. Another great thing to do is check out the Advanced Bionics website – they have an awesome section called “Getting” that talks about what to expect on this first day of sound and even has links to User Guides and some videos

I was talking to a parent the other day that was going through this process for the first time and she was in shellshock. Luckily, she remembered that AB has an Audiologist on Call through the BEA Support Center to help them walk through what to do. What a great service! It's so important to be able to reach out to parents in different ways because everyone reacts to this journey in a different way…there's also a DVD and instruction booklet, information on www.bionicear.com and of course, getting information straight from the experts (i.e., recipients) at www.hearingjourney.com

Because Melody is so young, our job was to keep the device on her all waking hours – and her little hands are quick; watch and record her reactions to sound – either positive or negative; and remember to point out sounds around her and make a big deal about them so that she could begin to learn and make sense of her new “hearing world”.  I commented on how I was totally hooked on the Listening Room and Amy agreed that they had great tips and resources on there, especially for the parents of new implantees.

We had already scheduled our follow-up visits and remembered how it was like putting pieces of a puzzle together at every appointment. Buddy was a bit older but with Melody being so much younger, we know that it's impossible to get all of the information that we need in one sitting. As Melody gets older and matures, she'll be able to do more things behaviorally – like respond to the beeps in the booth and eventually even tell us information like if a certain sound is too loud. Everything comes in time and I must remember to be patient J.

I was carrying Melody and walking somewhat slowly through the corridor. Oh yes – she was definitely hearing things! I tried to take notice of all the sounds around me that I take for granted everyday; there was the sound of a paper shredder going, an announcement on the PA system and just general conversations going on all around her. I could feel her little body tense up when there was a sudden sound and her head would kind of jerk around. She didn't cry though. She didn't try to pull off her headpieces either. That's my girl!

When we came through the doorway, I thought the boys were going to tackle us. They were so excited! I looked at them and nodded. Yes, Melody could hear.

In the middle of this waiting area, there was a small table with some blocks. I put Melody down on the floor and she promptly pulled herself up to a stand so that she could reach for the blocks. She got a hold of one but then she lost her grasp and it hit the table. She picked up another one and let that one fall, too. Oh! I could almost see the wheels turning in her head – “if something hits another thing, then it makes a noise”. Now, who knows what TRULY goes on in the mind of a one-year old but it's fun to guess, right?

Melody started to wiggle in my arms so I put her down by the table. Then the most precious thing happened that I will never forget – Melody let go of the small table and took her first steps towards Buddy without any help.

A day of firsts. Indeed!

She recovered very well and was back to her crawling, creeping and climbing ways in just a couple of days. I asked the boys to tone down the rough-housing a notch (those kids love to wrestle and tickle each other!) and be mindful of her incisions. Luckily, she didn't try to grab at them too much. We went back for our one-week check and our surgeon said everything looked great. Woo hoo!

The kids have been very supportive during this interim period with Melody not able to hear anything. I don't think I've seen so many different facial expressions in my life! LOL Buddy and JoJo even made some drawings of themselves making these crazy faces. They're all plastered above Melody's bed. I love it.

It's amazing how much you can still communicate with your toddler even without words…must be what she feels like! She's observing and taking everything in and yet doesn't have the actual words or a way to communicate. That's what touches, smiles, tears and gestures are for, right?

I'm also noticing how visual Melody is and it still astonishes me! I've even tested her by tip-toeing into a room (so she doesn't feel my elephant steps on the hardwood floors) and her keen eyes don't miss a thing. Buddy is the same way. When his implant is off, he is very aware of movements and vibrations. Definitely good skills to have!

- It's got this great earhook called the T-mic™ that sits at the level of her ear canal. Melody can look just like JoJo when she's old enough to wear headphones and hold the phone up to her ear. Amy explained that because it uses this natural placement, the T-mic is also great for hearing better in noise and also for helping to figure out where sounds are.

- The battery life is awesome with the Harmony – most people only need one battery to last them the whole day!

- This is a very child and parent-friendly processor with dials that are easy to access and use and there is evenan audible alarm that lets us know if the battery needs to be changed or if the headpiece fell off.

- This processor is rugged! It takes a lickin' and keeps on tickin'…

The boys helped me give her a bath today and all looks good! Melody seemed relieved to have that bandage come off and celebrated by an EXTRA big splash in the bathtub!

It's only been a couple of days and Melody is doing great. She's back to crawling around, standing up, playing with her toys and is even eating just fine. Buddy is just giddy in anticipation of her hook-up. It must be so interesting for him to kind of go through this whole experience again but from a whole different perspective!

Oh yeah – we started another countdown calendar. This one is for her hook-up! Yay!

We started yesterday by saying good-bye to the boys as we left them in the very capable hands of their grandparents. As usual, the boys doted over their little sister and gave her lots of hugs and kisses and were rewarded by a two-toothed smile and giggle. As we drove to the hospital, she sat in her carseat watching the trees and buildings whiz by, pointing and babbling as she often does. As she squirmed in her seat trying to reach a toy, I heard that unmistakable high-pitched “eeeeeeeeeeee” - also known as the tell-tale squeal of her hearing aids. It occurred to me that this would be the last time she would be wearing them.

We got to the hospital and for the hospital staff, it was business as usual, taking our paperwork, showing us to the waiting area and then eventually the room where we would change Melody into her hospital gown. We held our little girl tight, also showering her with kisses and lots of hugs. After a little while, our surgeon came in to say, “Hi!” and let us know that they would soon be taking her in for surgery. The staff, at the hospital as well as our cochlear implant center, is so wonderful, caring and kind. When it was time, I remember gently taking out Melody's hearing aids, holding them in my hand and placing them in my purse. All of a sudden it was déjà vu back to Buddy's surgery but instead of looking down at a young Buddy, I was looking down at my baby girl, Melody. But I knew that she was in very capable and skilled hands. We carried her out of the room and waved and blew kisses as we handed her to the OR nurse. Then, it was time to wait.

As with any surgery, that time in the OR is the most anxious. No doubt about it. It seems even more so when it is your child. I passed the time away chatting with Hubby and calling the boys to let them know that Melody was fine and that she was in surgery.

A few hours later, we were paged in the waiting area to come to recovery. I'm so thankful that there are resources on the Internet for sharing things like pictures and videos. We'd been through this with Buddy so we had our own experience, but we also got to see some recovery pictures of some of our friends' children and so had some reasonable idea of what to expect from a bilateral surgery. We're the kind of family that likes to do research and prepare and so, for us, knowing what to expect helps us cope. Finally, we saw our little girl with the big bandage wrapped around her head in the big hospital bed and just held her hand until she woke up. As expected, she was a little groggy from the anesthesia and whimpered a little bit as she was probably wondering, “Where am I?” They put those braces around her elbows to keep her arms straight so that she wouldn't immediately started tugging on the bandage. That was a little disconcerting for her and so we comforted her by pulling out her favorite blanket and playing peekaboo. Pretty soon, the surgeon came in and told us that the surgery went very well. Both of the internal devices were in and the incisions looked good. We talked about the normal care for the incision sites and how to deal with the possible effects of the anesthesia and how it would be about 3-4 weeks before the initial stimulation. As with Buddy, we knew that we had to wait for the incisions to heal and for the swelling to go down before we connected the external processor to the internal device (or in this case, processors to the devices!).

In a few hours, Melody started to move around more and wanted to be held. She was a little teary-eyed sometimes and so we distracted her with books and toys that we had brought. Funny – as we played with these things, I found myself back in my mode of making sound effects and narrating everything that I was doing. It then struck me that Melody could not hear any of this. No hearing aids! Doing these things are such a part of our lives that we don't even think twice about it. That's a good thing, right? LOL.

Then it was time to go home. Melody was still pretty tired from the effects of surgery and continued to sleep on and off for the rest of the evening and into the morning. We slowly introduced some fluids and crackers until we knew that she was able to keep them down. This morning, “Merry Melody” as we sometimes call her, showed signs of a quick recovery (Hurray!) and soon was back to some of her old ways. We focused on quieter activities today like books and toys and tried to keep moving around to a minimum. Melody isn't walking yet but definitely loves her saucer so it was great to be able to put her in that and let her play. As expected, she took a few more naps today than normal but by dinnertime was really more like her old self. If not for the pressure bandage around her head, you might not even realize she had just had surgery.

Now, I know that every child is different and so for you parents out there reading this, please know that this is just one possible scenario for how a child recovers from the surgery. Everyone heals at their own pace. My only word of advice is that if you have any concerns about your child's recovery, please contact your pediatrician, cochlear implant center or whatever contact your surgeon provided you. They're the experts!

Phew! It's getting late and I'm pooped. More to come…

You can also network with other families and professionals. I've found that these networking opportunities are so important for my own peace of mind. I have met so many of these parents online or through e-mails and it's so great to put a face with a name!

If you want to turn this into a family trip, they have childcare in the hotel that you can pay for so that you can leave your child(ren) with trained caregivers and attend workshops on your own. After the last conference we attended, we took a couple of days to take in the local sights and even visited some extended family.

They also have this great exhibit hall where you can see the latest and greatest gadgets and products. All of this under one roof! This bigger national conference happens every two years. There are also state chapters of AG Bell, so if you have an opportunity to go to one that is more local to you, I completely recommend it! For more information on this conference as well as local resources for you, go to http://www.agbell.org/.

We're especially excited because this will be right after Melody's initial stimulation. We'll get to look at all of this with fresh eyes again. We'll be hanging out some at the Advanced Bionics booth in the exhibit hall so please do stop by! We'd love to meet you!!!

Kids are such sponges and I love to see how much Buddy has picked up and uses everyday. As we go through this process with Melody, all I have to do is look at Buddy to know that we have absolutely made the right decision for our family. We KNOW first-hand the opportunities a cochlear implant can provide for our deaf children and we are so grateful. The other day when I went to pick Buddy up from school, I was just watching him from the doorway as he was gathering his backpack. Without missing a beat, I heard him respond to his teacher with his back turned and no visual cues. “You have a great day, too!” was all he said…so simple and everyday for him but for me, it was such a special moment because I know how far he has come – and can go…

The whole family is getting really excited for Melody's upcoming surgery date. We have a countdown calendar on our refrigerator…Buddy and JoJo are really getting into it – it's so cute! Every morning after breakfast, we make a big production of giving Melody a crayon and helping her make a big “X” on the calendar and crossing out the days until May 25. I don't know who's more excited – us, the boys or Melody! Buddy even made the cutest little birthday card for Melody's ears and can't wait to celebrate. He asked if we would have presents, a cake and candles - the whole shebang. LOL

Hubby and I were talking the other night and were just commenting on how different this experience is compared to when Buddy got his cochlear implant. Of course we have jitters and butterflies, which is totally NORMAL. It's just that this time around, we have hindsight on our side and know what to expect. For you parents out there who are new to this whole journey back to hearing, I really encourage you to get your hands on everything that you can to read about what to expect and also to talk to other parents about what they went through.

Advanced Bionics has a really great resource on their website that talks about what to expect for surgery and initial stimulation – you can find it by clicking here. Did you know that they even have a coloring book with accompanying cartoon that you can watch together as a family? You can click here to download the coloring book or contact Advanced Bionics Customer Service at 800 678-2575 to order your copy.

Another great place to go (that we didn't have when Buddy was first implanted) is www.hearingjourney.com. I go there pretty regularly and get to talk to parents, adults, recipients, and professionals about all types of issues. I also feel like I am “paying it forward” by sharing some of our experiences with new parents as well. It makes me feel so good to know that others can learn from what we went through. How empowering!

Preparing for surgery

I've already shared above what I think are two great resources for preparing for the big day (www.bionicear.com and www.hearingjourney.com) . Here are some of my favorite tidbits of advice:

• Your child will really look to you to be his or her rock. If you are calm and confident, then your child can emulate that. It's always amazing to me to realize how much a child picks up!
• Talk to your kiddo (as much as is possible developmentally), read books, look at pictures and maybe even do some role-playing. Pretend to go to the hospital, talk to a nurse and maybe even pretend what it is like to have the pressure bandage around their head.
• Do you have all of your ducks in a row when it comes to paperwork and insurance? If you're not sure, talk to your cochlear implant center and confirm that all is in order.
• As a parent, I know how hard it is to see your child uncomfortable or scared. The hospital staff will walk you through how to deal with the effects of anesthesia and the recovery.
• Make sure to take time for YOURSELF with plenty of sleep, some snacks to keep up your energy and something to occupy your time such as reading materials or someone else to talk to. For us, playing with JoJo in the waiting room was soothing and helped us focus all of our nervous energy. He was so cute…he kept saying, “It's ok Mommy and Daddy. It's almost over. Buddy will be back soon and then we can all play together!”
• Bring a button-down shirt and easy slip-on shoes for your child. No need to wrestle with putting a shirt over their head or tying shoe laces.
• Don't forget whatever comfort object they have – stuffed animal, blanket, picture, favorite book. These familiar things will help them feel more at ease. They will help you, too!

Buddy asked if Melody was going to have three birthdays also. What?!?! He said, “You know, Mom! Birthday for when you're born, birthday for when you get a cochlear implant, and birthday for when your cochlear implant is turned on.” All of sudden he got this very curious look on his face…”Mom, how many birthdays will she have if she gets two implants??” I have no idea. LOL

For the first couple of days, we didn't get any action on the feeder. Then today it happened! Buddy has been almost obsessed with watching the feeder and waiting for the hummingbirds to come. He's made a little station for himself by the windowsill – complete with peanut butter crackers, raisins and some apple juice. I was in the living room dusting and Buddy was at his station. The windows were wide open as we were airing out the house and enjoying the fresh air. All of a sudden, out of the corner of my eye, I saw a peanut butter cracker come flying through the air. I looked over and Buddy was absolutely giddy. He threw that cracker to get our attention without making noise! He was pointing frantically out the window – outside were 3 hummingbirds! Yay! I put my finger to my lips to show him that I would be quiet, lest we scare them off. I also pointed to my ear to tell Buddy to listen. The wind must have been blowing just right to carry the sound into our house and those guys must have been really happy with their sugar water because their wings were definitely creating that characteristic “whirrrrrr” of hummingbirds. It was so cool seeing Buddy take it all in! And then, they were gone. I asked Buddy what he thought and he said, “I was reading my book, heard a buzzing noise and thought it was one of the bumblebees looking for the flowers. I looked up and it was the hummingbirds!” It then occurred to me that my son, my deaf son, could hear the buzz of a bumblebee and the whirr of a hummingbird's wings.

I was talking with Amy, the audiologist, today about how therapeutic it was for me to blog. She has been following my blog closely, as have many of her colleagues. She's even recommended it to some of her patients! We got to chatting and she asked if it would be helpful to get another perspective into the whole cochlear implant process. It sure would! I asked her if she would be willing to tell “her side of the story” and she very graciously accepted. So, here is Amy, the audiologist, and Melody's cochlear implant evaluation…

Melody came in with her parents for the first part of her cochlear implant candidacy evaluation earlier today. Buddy came along too. He felt like he knew a lot about cochlear implants so he wanted to help. Melody has been wearing hearing aids so she is already well along in the process. Mom also brought copies of the ABR test that Melody had at birth and copies of all Melody's hearing tests. It's always better to have too much rather than too little so try to bring all of your records if you have them!

We started by testing Melody's hearing. Although she has had several hearing tests, she has not had one in a few months. We needed to be sure that Melody has the degree of hearing loss that is appropriate for receiving a cochlear implant. When we test little kids we use two audiologists. One goes into the test booth with the child and a parent. The other goes into the control booth and presents the test signals from the audiometer. Melody came into the test room with Mom. Buddy and Dad watched from the other side of the test booth. Megan, the audiologist who was going to work with Melody picked her up and put her into the highchair so that she would be sitting in the right place and be seated comfortably. Mom sat in a chair right behind Melody so she could watch and be able to provide support to Melody if needed.

We tested using visual reinforcement audiometry which is the test we use for kids between 6 months and 36 months of age. Megan kept Melody's attention focused to the front using some colorful blocks. Dr. Jane made sounds through the audiometer and when Melody heard the sound, she turned on a mechanical toy (an elephant playing the drums) and Megan drew Melody's attention to the toy. After she looked at the toy, Megan got Melody interested in the blocks again while Dr. Jane made another noise. Soon Melody understood that the toy will light up when she hears a sound and we were on the way. As soon as Melody was comfortable in the test booth Megan put small earphones into Melody's ears so we could test each ear separately. Using this method we got a complete hearing test which was printed out on an audiogram. An audiogram is a graph that shows how much a person responds to either beeps or speech sounds. Today's test indicated that Melody has a profound hearing loss in both ears, which means that she is a good candidate for a cochlear implant.

The next step in the evaluation process was to see how Melody was doing with her hearing aids. It is really important that Melody wear her hearing aids from the time her hearing loss is identified until she receives an implant. Even if she is not hearing a lot with her hearing aids, she is hearing something, and her brain is getting some auditory stimulation. That increases the probability that she will do better with the cochlear implant. We tested Melody with her hearing aids and used the same test methods that we used when we tested her hearing. We found that when Melody was wearing hearing aids, she was hearing at moderate hearing loss levels in the low and mid pitches. That means that she was not hearing soft speech. In addition, she was not hearing any high pitches. (High pitches are important – that is where sounds like “s”, “sh”, and “f” are.) We tried to change the settings of her hearing aid, but we were not able to make her hear any better.

By now Melody was really tired. She had worked very hard and needed a rest. We all went back to Dr. Jane's office and Melody and Buddy played with some toys while Jane and Megan talked with Mom and Dad. Even though Buddy has a cochlear implant and we knew that Mom and Dad already had a lot of knowledge about implants, we decided that we should explain everything to them just the way we would if they did not know anything about cochlear implants. That would give them the opportunity to ask questions and use their experience with Buddy to learn even more.

We talked about Melody's hearing loss. Even though Mom and Dad knew that Melody had a profound hearing loss it was hard for them to look at the audiogram. They were really happy that they knew that cochlear implants work well so they could be optimistic that Melody would do well but they would have preferred it if they didn't need to talk about cochlear implants at all.

We talked about the rest of the steps in the evaluation process. Melody has an appointment with Liz, for a speech-language-listening evaluation to find out what Melody's current skills are and to help make a plan for therapy. She and her parents have an appointment with Susan, the Deaf and Hard of Hearing Education Specialist, to talk about Early Intervention, pre-school programs and any other education questions Mom and Dad may have. They have an appointment to meet with Dr Ron, the ear surgeon. They already know him since he did Buddy's surgery but he needs to talk to them about Melody's surgery and help answer their questions. They have an appointment with Stacy, the social worker, to talk about their feelings. Then they will see Dr. Jane and Megan again to confirm Melody's test results and to answer questions.

Thanks to Melody's Mom for letting me give you all an audiologist's point-of-view!

Since we're pursuing bilateral cochlear implants for Melody, we want to make sure we have our ducks in a row as we approach the surgery date. In addition to communicating with our health insurance contact, we have also tapped into the expertise of the AB Reimbursement Services team. http://www.bionicear.com/Support_Center/Customer_Support/Insurance_Reimbursement/Professionals.cfm?langid=1 They are very seasoned in navigating through the Insurance Jungle in terms of things like pre-authorization, approval for bilateral cochlear implants and things l didn't even know about. This is definitely a resource I would suggest using! I'll keep you posted…

At the resort, we got to enjoy all of the amenities – our cabin was beautiful and well-stocked (we only went out for dinner twice!), the kids loved the planned activities with other kids, we had a great time at the pool but perhaps our favorite activity was “the family hike”. We found arrowheads and leaves and flowers and mushrooms and even a couple of caves. It's a good thing that hubby is a nature buff because he was like our private tour guide. The kids learned so much. Melody was especially cute in the traveling backpack that we used during our hikes. She was looking everywhere and just taking it all in. She was also doing a lot more babbling this week. She's at that point that most babies reach – hearing or deaf/hard of hearing – where they are figuring out how to interact with their environment. For babies that are hearing, they babble or coo and then they hear their caregiver babble or coo back to them. This back-and-forth interaction is the precursor to the normal turn-taking of conversations. Now, with babies that are deaf or hard of hearing, they also babble and coo and unless the caregiver responds in a visual way (like facial expressions) or in a tactile way (like touching the baby's arm or face), the baby starts babbling and cooing less and less because it's not reciprocated. When I first learned that, I was absolutely fascinated! Just goes to show that HOW you communicate may not always be as important as THAT you communicate!

This year, we've decided we're going to go up to my uncle's “cabin” up in the mountains. Actually, it's more like a resort with a rustic feeling. HAHA We'll stay in a cabin with all of the amenities – washer/dryer, kitchen and even dishes and cookware! There's also scheduled activities for the kids as well as an indoor pool. JoJo and Buddy are so excited!!! We've been looking forward to this for a year. They are especially ready to show Melody the indoor pool – she loves the water. She loves to splash in it in the tub, throw stuff in the water and is just now experimenting with pouring water out of her toys. Of course, everything ends up in her mouth, too! JoJo is eager to practice some new cannonball dives and Buddy can't wait to hit the water slide. Hubby and I are looking forward to hanging out in the kiddie pool with Melody and/or catching up on some leisurely reading. Yay!

There are two ways to go bilateral: simultaneous or sequential. Simultaneous means getting them both at the same time, so just one surgery. Sequential means getting them during two separate surgeries – you do one side first and then do the other side at some predetermined time later. I found quite a bit of information on the www.bionicear.com when I typed “bilateral” in the “Enter Search keywords” window. I found the Tools for Schools issue “The Buzz on Bilaterals” especially helpful! http://www.bionicear.com/userfiles/File/Issue_3_Fall_2006.pdf

I've talked to other families about some of the benefits they have experienced with their child being bilateral. Some were simultaneous and some were sequential. I found the sequential family's comments very interesting since they got to see the difference both ways.

Here's what they have experienced:

- Improved listening in noise

o Someone told me that the brain needs a signal from both sides to hear better when there's background noise. I definitely notice Buddy struggling more when we're at a restaurant as compared to being at home where it's quieter.

- Improved ability in localization

o What's localization? It means being able to figure out where a sound source is, like speech or environmental sounds. In our house, we've figured out that in order get Buddy's attention, not only do you call out his name, but you also have to wave your arms or flash the light in the room where you're located otherwise he has a more difficult time trying to figure our your location. I remember when he was very little, he looked like a little top spinning around trying to figure out who was calling him and where they were.

- Ability to hear from both sides without having to turn their head

o With Buddy, we definitely are aware of which side is his “good” side and which side is the “poor” side. Sometimes I feel like we're doing the square dance do-si-do as we maneuver ourselves in the right position.

- Can hear softer sounds (this was a comment that many of the sequential bilateral families had)

o They gave me examples like “It only took me 1 time for me to call his name.”, “She heard the clock ticking in the bathroom for the first time.” and “Johnny heard his teacher calling him on the playground.”

- Some of the kids tell me they like the quality of sound better with two compared to just one – they really notice a difference when one of their CIs is off (like when changing batteries)

o This is what my friend who is a sequential bilateral recipient told me…she had normal hearing then lost it suddenly. Having hearing with one vs. two is no comparison, according to her - music sounds better and more natural, and people's speech seems to be easier to understand.

- Some families told me that their child seems less fatiqued at the end of the day because they don't have to turn their heads so much to figure out who's talking and because listening in noise is easier

o For the sequential families, they have noticed that their child doesn't feel like they need a nap after school anymore. Can you imagine? All of that stuff that happens in school and it can be so noisy…of course they're tired!

- Can still hear when one of the batteries is depleted

o I was talking to a bilateral kiddo the other day when I picked up Buddy at school and I noticed that her battery needed to be changed. Without skipping a beat, she continued to look at me and talk to me, pulled out a new battery, changed it and went on with the conversation. No deer-in-headlights look! LOL That's what we call Buddy's look when his battery is done and he hears nothing.

- Access to the newest technology

o I know some families that went bilateral and the technologies are of two different generations. How does THAT work? Well, in my mind, I see it working the same way that it did when my friend who is a CI recipient wore a hearing aid on one side and a cochlear implant on the other. The brain is truly amazing and can make sense out of the two signals!

When I asked them, “If you had to do it all over again, would you still do it sequentially or would you do it simultaneously?”, more of the families said they would have done it simultaneously. One surgery, one healing period and they were hearing from both sides from the beginning. Anecdotally, I have also heard about a “dominant” side when done sequentially – that is, their first side seems to be preferred over the second. It makes sense…they've heard and bonded with the first side for a longer time compared to the second. However, most of the time and with focused attention on the second side, it could potentially catch up to the first side. For those who did it simultaneously, there seemed to fewer instances of a “dominant” side – they just worked together right away, very similarly to how normal hearing children develop their auditory skills.

OK – so I've typed this all out and now I'm re-reading it. This should be a no-brainer? Why do I hesitate? Probably because I'm like every other parent out there who has had to make this decision! But in looking at this list, the benefits of bilateral implants far outweigh the risks – we're gonna go for it and we're going to do it simultaneously!

So, last week one of Buddy's bottom teeth got wiggly. Last night while he was lying in bed, I hear, “Mom! Mom! I think it's going to come out! Oh m'gosh – it did!” Sure enough, my little one lost his first tooth! We got to go through the whole routine of putting it under the pillow and discussing what the Tooth Fairy might leave him. I'd been planning for this event and have a stash of $2 bills thanks to my father-in-law who is a banker (luckily, Buddy is a frugal guy and immediately put it in his piggy bank). I even made up a cute little certificate “from the Tooth Fairy” talking about the importance of continuing to brush. LOL

Well, Melody has been awfully fussy lately, has had a runny nose, not so hungry but still wants to put everything in her mouth and has been drooling like crazy! On a hunch, this morning I bravely (!) stuck my finger in her mouth and ran it along her bottom gums. Budding through was her first tooth! Well, the location of this first tooth is the same place as where Buddy lost his tooth last night. As we were cheering and clapping this morning about these two wonderful firsts, Buddy asked, “Mom, does the tooth fairy recycle?”

These two taglines that I have read from Advanced Bionics literature really sum up how much this technology has touched our family. As we begin the evaluation process for Melody, I can't help but think about all that Buddy has accomplished. I know that cochlear implant technology has come a long way from the first devices a couple of decades ago – back then, clinicians were happy if the patient was able to simply *hear* conversational speech…it was seen more as an aid to lipreading. Now, technology has elevated to the point where we, as parents, are asking for our children to hear BETTER (we know that Buddy can hear) in noisy situations, connect (and discover!) to phones and to go “beyond words” to music! This goes way past an aid to lipreading. Did you know that the cochlear implant is the only medical device to replace a “sense” (i.e., hearing)?

Buddy just peeked over my shoulder and asked what I was doing. I told him I was just writing out my thoughts about his cochlear implant and he said he wanted to help. I love it! His new favorite phrase is “I can do that!” and his new favorite toy is “borrowing” JoJo's iPod so we have combined the two to create Buddy's “iCan” list:

With my cochlear implant, iCan:

- hear and talk to my family, teacher and classmates at school

- learn all that “stuff” I need to in school

- hear the pages turn while I read

- know to stay in my hiding place during hide-and-go-seek because “it” is right around the corner

- laugh with my friends at the pizza place after T-ball practice

- listen to my sister make funny noises like “toots” and “burps” and tell EVERYONE about it

- play “Twinkle Twinkle” on our piano

- play “Go Fish” and “Chutes and Ladders” with my big brother

- pretend not to hear Mom when she tells me to clean my room (Mom comment: I knew he was ignoring me!!!!)

- sit on the boat with Dad, let him put the worm on the hook and hear it plop in the water. Yuck!

- be whatever I want to be when I grow up!

Mom comment: ok, I'm gonna get some tissues now…

People often ask us how we came to the decision to choose the device we did. Two reasons for us: We believe in the company and we believe in the technology.

When we first started investigating a cochlear implant for Buddy, we wanted to talk not only to adult recipients but also to other parents who had gone through a similar process. The Bionic Ear Association (BEA) was fantastic in hooking us up with a mentor couple, James and Jen. I felt completely at ease asking tough questions and if they didn't always have the answer, they were more than happy to refer us to a good resource like one of the AB audiologists. They live in California about 3 hours from where Advanced Bionics' manufacturing plant is and told me that they got to take a tour of the facilities. How cool is that?!? They saw how some of the intricate pieces were assembled by hand and then put together to make this wonderful device. Advanced Bionics is the only cochlear implant company based in the U.S. This is very important to us. We also got to meet an adult recipient who was able to articulate for us how much a cochlear implant has benefited her. You can really get a sense of this also by going to www.hearingjourney.com

Another great quality of the company is how they try their hardest to minimize any time “off-the-air”. When we were on vacation once, Buddy dropped his one and only headpiece and then it got run over by a bicycle ridden by none other than JoJo. We called Customer Care and a new, replacement headpiece was sent overnight! Buddy barely missed a beat. And this is pretty standard for their Customer Care – super fast service. We love it. Advanced Bionics also has this great resource where you can contact them for troubleshooting help or just general information – this can be done via telephone (800/678-2575) or e-mail (hear@advancedbionics.com). I know our school audiologist has used this service as well when Buddy got a new FM system.

Yawn! It's getting late…I wanna make sure I can clearly tell you how great the technology is. Stay tuned!

Kids crack me up. Plain and simple. Even with something as seemingly mundane as the English language, kids can find a way to make it fun. Yesterday JoJo, Buddy, Melody and I were sitting around the table making Valentine's Day cards for their classmates. The school rule is that EVERYBODY gets a card, not just certain people – this way no one feels left out. I really like that. Unfortunately, there are 22 students in JoJo's class and Buddy has 20. That's a lot of valentine cards! We came up with a plan – we were going to do this assembly line style. Luckily, I have plenty of tools from my scrapbooking days (who has time to scrapbook anymore? ) so it was easy to get a bunch of die cut hearts and I even have some fun Valentine's Day stamps. I started by cutting out a heart-shaped card, handed it to JoJo who used the glue stick to paste on shapes of little hearts and cupids, next Buddy enthusiastically (!) stamped “Happy Valentine's Day!” or “You're my friend!” on each card. After each of the 42 cards were assembled, the boys took their respective pile and signed, “From, JoJo” or “From, Buddy”. After we were finished Buddy said that he wanted to make a special card for Melody because she so patiently ate Cheerio after Cheerio, watching intently as the cards were passed around (though she did try to put a glue stick in her mouth). With tongue sticking out of his mouth, deep in concentration, Buddy made her a card. I peeked over his shoulder and he had drawn a picture of him and Melody looking at each other face-to-face and under the picture, he had also drawn an eye, then a heart, and then the letter “u”. He looked up at me and said (as if I didn't understand), “That means ‘I love you'! Since Melody can't read yet, I drew her pictures.” Who would have thought that a little boy who is completely deaf would ever get to the point that he enjoyed a play on words?!? Happy Valentine's Day all!

For those of you new to the cochlear implant world, I thought I would do a quick review of candidacy for your benefit. Some of you may be following along and wondering, “Does my child qualify for a cochlear implant?”

(1) First things first – talk to your audiology team about a cochlear implant evaluation. They know your child's hearing history the best. If your audiology department does not do cochlear implants, click on the “Find a Clinic” link at the top of the Advanced Bionics webpage (http://www.bionicear.com/), select your state and voila! You will get a listing of clinics, staff, contact information and even a link for directions.

(2) The current FDA guidelines say that your child needs to be at least 12 months old, have profound hearing loss in both ears and/or have minimal benefit from their hearing aid(s). For children, hearing aid benefit is measured looking at auditory development milestones and progress with oral speech and language development. Evaluating benefit may be done by testing in the booth or sometimes they use questionnaires and checklists. If your child has lost hearing or has had progressive loss since birth, your doctor will compare his or her developmental course with that of a typically developing child... looking for gaps, plateaus in development, and rates of progress. Since Melody has profound hearing loss in both ears and we know she is getting very little benefit from her hearing aids, we think she is probably a candidate for a cochlear implant…or even two!

Pretty soon here we'll be going for our cochlear implant evaluation. I'll be sure to let y'all know what tests we had done and how Melody did.

I completely forgot how important it is to child-proof your house with a wee one! Not only is there the obvious need to cover outlets and get gates for the stairs, but I forgot about locks for cabinets and even getting the dog food and water dish out of her reach. Poor Huckleberry, his bowls have been relegated to the laundry room. One time is too many for Melody to have “dog food breath”. Blech! Another of her favorite pastimes is getting into whatever her brothers are doing. The boys were making a Lego tower today and left it to get a snack. The next thing we know, we hear a loud crash! Grinning mischievously from ear to ear is little Miss Melody with a tell-tale Lego still clutched in her pudgy little hand. What's not to love?

Melody has a new game. Find the Hearing Aid! She's at that discovery stage where anything in her grasp is something to put in her mouth, drop on the floor or stick in any crevice that she can find. Those critter clips are definitely getting a workout!

We're also wondering how much she is actually getting out of her hearing aids...we like to call her "consistently inconsistent". LOL Sometimes she puts them on and starts babbling right away but most of the time, we put them on and she just stares at you or tries to take them off. We learned with Buddy that keeping them distracted is the best way to go. Movies, books, making funny faces - anything goes!

We also came to the realization that we did with Buddy. Melody is probably not getting access to the speech sounds that she needs and we should start thinking about the cochlear implant route. Hindsight is definitely 20/20 and after all of the research we've read and people we've talked to (parents and professionals alike), we know how important it is to get language to our little one as early as possible. We didn't have this opportunity with Buddy because he was identified a little later but with Melody, we knew right from the start, we started hearing aids as soon as possible and we have continued talking and communicating with her. Don't get me wrong, Buddy is doing FANTASTIC with his cochlear implant but we just wonder where he would be right now if we started with him where we're starting with Melody. Time will tell. We have scheduled a formal cochlear implant evaluation with the cochlear implant team for next week when they will do the battery of tests that they do. One issue that was brought up that has really got our family thinking is the possibility of bilateral cochlear implants - this would mean getting an implant in each ear at the same time. Hmmmm...

I am so grateful to the people at AB and knowing that having an implant is part of a journey. It's not just about the cochlear implant itself but they also have an amazing support program for children and adults. I was on HearingJourney.com last night just catching up on some topics and I decided to go over to The Listening Room. Oh wow! It is their free resource for aural rehabilitation ideas and there is so much stuff on there that I can use for Buddy AND Melody and our therapists really like it, too. They have new activities posted each week so we don't get bored. Obviously, with Buddy's history, we know a lot about language and listening milestones but for parents going through this for the first time, there is tons of helpful information on there. If you haven't been there yet, go now!

I'm realizing how much we integrate good communication strategies for our deaf children into our lifestyles everyday. Buddy is such a great role model by telling others to please face Melody or get her visual attention before they start talking to her. Buddy and JoJo are also really quick to try and get Melody's hearing aids in before she gets them in her mouth. JoJo can usually do it on his own but sometimes Buddy needs my help. “THANK YOU!” to whoever created the concept of critter clips – this invention is basically a lightweight string or lanyard that attaches to the earhook/tubing portion of the hearing aid and then there is a clip that you attach to the back of Melody's shirt. Not only does this prevent her (sometimes!) from getting her hearing aids in her mouth but it also prevents her from taking her hearing aids off and throwing them or dropping them somewhere.

I found an awesome website! Advanced Bionics has an online community called HearingJourney.com. It's basically a place where people can ask questions about a variety of topics, and many different people will respond. I've found a few families on there that I met at a cochlear implant picnic. There are also some adult recipients on there. I even saw people who are just thinking about cochlear implants for themselves or for their child. People talk not only about cochlear implants and the benefits, but there's also information on education, insurance, bilaterals, music and lots more!

An interesting discussion I followed was the one on communication methodologies. Every family is so different in their wants, needs, and abilities; it was so great to be able to read what other people are doing as well as learning what's out there. Whether it's something like auditory verbal therapy (AVT), auditory oral, cued speech, total communication, or American Sign Language (ASL), all families have to figure out what fits their lifestyle best. It's also so important to have realistic expectations that having a cochlear implant does not CURE the deafness, it is a tool to access sounds and speech. Our job is to nurture and encourage our children to use their hearing aids or cochlear implants to their highest potential—whatever that may be.

I also spoke to her about how she has set up her children's therapy appointments. Our wonderful, extremely gifted specialist who works with Buddy will now work with both Buddy and Melody. She has even offered to schedule them together so I won't have to drive back and forth each day, plus she will even come to our home to work with Melody. That will allow me time for day-to-day chores and routines. Plus, JoJo is at an age where sports and friends are important. I do not want to take away from JoJo either. What a juggling act this all can be!