Post-adoption Medical Examinations - The Bad, the Worse, and the "We can live with that"

When you adopt in Russia, you are supposed to be given the child's medical records, their "diagnosis" and you actually sign paperwork in Russia on your first trip that says you have been given these things, that you understand them completely, and that you agree to pursue the adoption anyway. On your second trip, the judge asks you about the medical records and diagnosis and asks if you understand them and if you are prepared to deal with the medical conditions. You had better say "Yes" if you want to be given custody. Our local adoption clinic does "pre-adoption visits" where they will go through these records with you and explain them from the view of Western Medicine (which is VERY different from the view of Russian medicine).

We had one problem... we NEVER received ANY of the medical records of our kids until AFTER the second and final day of court. On our first trip, the orphanage director called the doctor into her office and she explained (or at least our translator told us) that the kids were healthy, that they had physicals on such and such a date, and that they had cognitive and social delays that are typical of orphanage kids. We received this verbal explanation and the chance to ask questions, but we received NO ACTUAL PAPERWORK about their medical history (even though russian law requires it.).

On the second trip to Russia, we again met with the director and the doctor before court. Again we heard about recent physicals, about cognitive and social delays (but the director told us how smart Kim was and that she was no longer delayed and had "perfect memory"). This time we were given more specific diagnoses... "cerebral asthenic syndrome" for Kim. They also explained that Peter has a "problem" with his mitral valve in his heart, but that it is common for children and not an issue. This was the first time we had heard of this one. Had I known of this, I would have brought my stethescope and listened to the murmur myself. They told us nothing else.

AFTER the adoption was final and we had the kids, we received their paperwork to take to the doctor in Moscow who would do the physicals for their immigration visas. I read through the translations and learned a few "interesting" things that were NEVER discussed with us. They had orthopedic concerns about Peter's knees. He is VERY knock-kneed (genu valgum for my students who are reading this)... I wonder if he might have had rickets given his tooth issues and the knee deformity. The kids tell us that they never had milk in the orphanage. We also learned that both Kim and Peter's previous TWO Mantoux tests were 15 and 12 mm respectively. I recognized this one immediately. The Mantoux test (aka PPD or tuberculin test) is the skin test for Tuberculosis and readings of the size that the kids had means that the tests were positive. This was NEVER mentioned to us at any time before the adoption. Oh crap. Now what? Were they even going to be able to enter the United States? They had chest X-rays at the Moscow medical exam and were cleared to enter the U.S. I have these X-rays and they both look pretty much fine. Unlike X-rays in the U.S., the patients' names are written on the printed X-ray with a Sharpie instead of included in a label in the X-ray itself. If you wanted to, you could take an old X-ray image, print it, and write someone else's name on it. We were not able to accompany the kids for the X-ray and I'm not entirely positive that the X-rays I have are actually of my kids. I'll just say that they are certainly not as clear as the X-ray we had at the adoption clinic in the U.S. We absolutely feel that we have been done a major injustice by not giving us medicals or disclosing their contents. I don't know that our decision to adopt would have changed, but we would have been in a position to do some research and to be prepared... just as the court required us to be.

In the U.S. our local children's hospital runs an international adoption clinic. We had our appointment pre-scheduled for less than a week after we returned. It is a two step process. Day 1 (Friday) the kids have a physical exam, a developmental exam, and we spoke to a nutritionist. The kids had blood drawn for a battery of tests (vaccination immunity, common genetic diseases), given stool sample jars, and the kids were given (another) skin TB test. The nurse did not do a very good job of explaining WHY the kids needed this when we already had positive tests on them in Russia. All she could explain was that we can't trust the Russian tests. This was hard for us, but not too hard (emotionally) for the kids. They are used to suffering through this test and it was almost as if it was no big deal to them. (and what is one more set of scares?)

Over the weekend, the kids had VERY POSITIVE result to this test. At one point, Kim's little arm had swelling from the test that was wider than her arm had been before. Both kids' swollen red, itchy patches from the test blistered... not just swollen, red and hard... they actually blistered... a lot. They both said it did not hurt (they are very Russian), but it did itch. This was nothing new to them, but it was REALLY hard on us, particularly on Lisa who felt like she allowed someone to hurt her kids for no good reason.

On Monday, we had the second part of the clinic process... this time at the hospital in downtown Columbus. The kids' arms were looked at to read the TB test (both were clearly positive for TB... Although that long after the test they didn't look bad at all, compared to the previous two days.) We had brief hearing tests, and we spoke to a developmental psychologist about the kids transition so far. Because both kids had positive skin tests for TB, they both had to have chest X-rays.

The physician did a much better job of explaining why the kids had to have the skin test despite their history of a previous positive. We weren't crazy about the explanation, but at least we understood a little better. In Russia, they often give kids an immunization (BCG) for tuberculosis to try to prevent it (TB is rampant in Russia). This immunization DOES NOT actually prevent TB infection, but it seems to limit the spread of the disease in your body once you have been infected. Once you have this immunization, your TB test will always produce a positive swollen spot. They had to re-do the test to 1) know what strength of TB test is done to make sure it was correct and 2) read the size of the spot to know if it is really TB or just the reaction to the previous immunization. Both kids were positive for TB. The X-rays showed Kim to have no active infection. Peter's X-ray showed a couple spots that were not clear enough to rule out active infection... so he had to have a chest CT (CAT Scan)... and he had to wear a mask in the hospital until he was cleared. The mask absolutely terrified him and we had his biggest meltdown ever.

The CT was scheduled for later in the afternoon, so we were able to take the kids out of the hospital and bring them back. We had lunch and then Kim stayed home with Beth and Luke while Lisa and I took Peter back for the CT. Peter decided that he could wear his mask if Dad wore one too. So, with us both donning our masks, we went to radiology, where we had to stay in the special isolation waiting room (they have to buzz you into the room). We had the CT and were able to have a head CT also (it was to look for anything that might explain Peter's small size and was already scheduled for another week away anway... killed two birds with one stone). Peter's CT was fine... no active TB. Because both kids have had previous exposure / infection, both Kim and Peter will have to take a daily antibiotic for the next 9 months... no fun. They are not contagious and are not at any risk, but the treatment will reduce their risk for a future recurrance of TB (happens in up to 10% of folks who have been previously infected).

As I am writing this, the phone just rang.... it was the health department... you remember the "Ya Hachoo Kaka" post?... the samples were positive for Giardia. Looks like maybe another antiobiotic for a few days. They wanted to follow up to find out where our kids came up with this... the fact that it was an adoption solved their concerns. I wonder what the blood tests will have to say when they come back...

Merry Christmas

Merry Christmas to everyone. You should have seen the kids faces for their first American Christmas. Even seeing that Santa was over Greenland (Norad Santa Tracker) on Christmas Eve sent them scurrying to get to bed so he could come. It was all pretty wonderful.

Ya hachoo kaka!

Do you remember, back when you were a kid, when you thought "I'll never say that when I'm the parent"? You probably had in mind something like "Because I said so" or "Because I'm the Dad, that's why". I had a few of those in mind, but this weekend I came across a phrase that I never imagined that I would say. "Ya hachoo kaka!" I spent much of the weekend saying it, saying it in funny cartoon voices, singing it, singing and dancing it, etc... all to roaring laughter from everyone in my family. You see, "Ya hachoo kaka!" translates as "I want poop!". How very dignified of the tenured college associate professor in me. My students would be proud.

At Kim and Peter's preliminary visit at the International Adoption Clinic on Friday we were given four little bottles for each of them for stool samples to check for intestinal parasites, etc that we were to bring to our next appointment on Monday. We were to collect two stool samples from each child and put some into two bottles for each sample. We were given little trays to catch the "precious material" and the lids of the bottles have built in little spoons to... well... you get the idea. The nurse explained what we were to do and the translator told the kids. Boy did their eyes get BIG at that one. The nurse commented that don't be surprized if they try to hold it in all weekend now that they know you have to collect it.

So, we went home and I asked if they needed to use the bathroom and I held up one of the little trays. I received, in unison, a scared little "Nee Hachoo" (I don't want to). So we waited. I asked again later... again a very small "Nee Hachoo". OK... this isn't going to be all that easy. To break the seriousness and fear, I spent the rest of the weekend asking in VERY humorous and animated ways so that they laughed instead of panicked. Who needs dignity?... I needed poop. They really laughed at my chardes attempt at explaining that they didn't want the doctor to have to take it out of them. Eventually, my efforts paid off (I can't believe that I'm actually proud of this). It took a couple rounds of "back on the toilet" to get an adequate volume for Peter's first sample, but we succeeded. I've never seen a kid so proud and so paralyzed with laughter at poop. Good boy! After we dropped the samples off on Monday, Kim asked if I wanted any more poop. We both giggled and I told her "maybe later but not today".

Happy 10th Birthday...again!

We've been a little behind in putting up a few posts, so bear with us. Saturday was Kim's 10th birthday... again.

As we mentioned in a previous post, she was 10 when we arrived in Russia for court and we thought her birthday was in May. The morning of our first court hearing they had located her birthrecord and her birthday was not in May, it was December 20th. She was officially 9 again.

So... we had her first American birthday only 1 week after arriving home. We were planning on having more time (and more English) before birthdays. Only having a week and having very limited language and socialization made it clear that we were not yet ready for the big, invite all neighborhood kids, party.
We had a small, family only celebration instead... then we took the kids to Chuck-E-Cheese's... talk about insanity... it's crazy enough when you speak the same language. The kids all had a great time and played forever. The Russian kids are not very used to making choices, so at first, Kim could not decide which games to play. She used maybe 3 tokens in the first 25 - 30 minutes. After that, she settled in and was on pace with her American siblings before long. Note: If you are going to Chuck-E-Cheese's, sign-up for their mailing list. The coupons are TWICE as good as you will find in the newspaper or online.

The "big" gift that she wanted was an MP3 player. These were a VERY BIG status symbol in the orphanage. The kids who had them mostly had old cell phones (no phone service) that doubled as players. We bought Kim an inexpensive player (not ready to invest in an iPod for her quite yet). She spent several days listening to the sample music on it and to the radio before she realized that I could download songs to it. She hasn't learned how yet, so I get to choose her music options... if only that could last. The kids watched A LOT of music videos in Russia and they have both been known to burst out singing things like Brittney Spears "Womanizer"... not exactly what we approve of as music for elementary school children. Kim enjoyed her cake. She wanted Lisa to make one instead of buying one. We put those "self re-lighting" candles on it and the gag was a huge success.

Cedar Point Needs a Ride Called "Newly Adopted Kids"

I always thought that I loved rollercoasters. I loved them as a kid. They are pretty much the only ride I'm willing to stand in line for at the amusement park. We even like playing "Rollercoaster Tycoon" on the computer. After the rollercoaster highs, lows, and quick blind-turns of the first week of having the kids home, I now have a different appreciation for rollercoasters.

Today marks one week at home and it is Kim's 10th birthday. This week has seen a lot of very good moments and a few that have been, well, less than very good. On Thursday night we were ready to pull our hair out in frustration with two kids who seemingly had no interest in communicating, no interest in respecting others, and absolutely no interest in helping with even the most miniscule tasks that we would ask of them. They were beligerent, disrespectful, stubborn, and impossible. After Lisa put them to bed even before Luke and I got home from Upward Basketball, she and I sat down and wrote them a letter (using a free online translator... it takes a while at 500 characters per translation). We explained that we were being unfair to Beth and Luke by having a double standard for what we are willing to accept in terms of behavior. It was unfair that we sit and watch Luke trying to communicate with the new kids in his very rudimentary broken Russian but they never seem to try to communicate with any of us using the few English words that they have learned. We were pretty much ready to cancel Kim's birthday and withdraw as many priveledges as it would take to get them to start moving in the right direction. We were going to give the letter to Kim after we returned from the doctor on Friday. We felt at our wit's end... then there was Friday.

On Friday, Kim and Peter had their appointment at the international adoption clinic through Nationwide Childrens' Hospital in Columbus. It was held at their Westerville "Close to Home" location on Cleveland Avenue. We had a Russian translator provided by the clinic. The kids were examined by a physician who is very familiar with the medical issues of internationally adopted kids. We spoke to a nutritionist who gave suggestions for the kids who are both pretty small. We had some time with a physical therapist who did a developmental assessment to let us know if and where the kids were behind. The kids also had to have new TB tests (even though we know their test results from the autumn in Russia) and blood tests. The kids were really good about the TB tests (which are kind of painful and burn a lot when you are getting them)... no tears. They were scared about the blood tests, but then realized that they hurt less than the TB test and we were fine. The kids think that it is hillarious that we were given trays to take home to catch their poop and little bottles to put it in for more tests.

The kids absolutely could not have been much better for their medical exams and Peter was not even shy or withdrawn at meeting new people... we were shocked. Afterward, we stopped by the library to pick up 4 of the 48 Columbus Metropolitan Library's book that are in Russian. We were ready for an all out battle after Lisa's previous experience. Instead, they were eager and cooperative. They even volunteered to carry books that were for someone else. Again, we were shocked. We had to stop for gas ($1.48 per gallon, woohoo!) and they would have to sit patiently in the car. They don't do patient very well... but they were happy and we had no problems. We had to stop by the grocery store for more milk. We have had a battle EVERY time we have gone to a grocery store because they want toys and candy and have thrown a fit. No battles this time. They accepted our gentle "no toys" or "we have that at home" without ANY resistance. Again... shocked. We were so pleased, we even went to McDonalds for lunch with them. It's the first time since we had custody to have no issues at a restaurant. At home, they eagerly jumped into their schoolwork and we learned that Kim was excited to have books to read. They actually helped, A LOT, with finishing up the Christmas decorations. Peter was very proud to help me with the lights. Afterward, we introduced them to playing Wii. Peter loves Wii boxing (I wonder if it's the first time he's ever fought without getting the crap kicked out of him... he has lots of scars and old bruises). The boys rooted for the boys and the girls for the girls. It was great. We absolutely could not have had a better day with them. We never showed Kim or Peter the letter. Welcome to the Rollercoaster.

First Observations...

We've now been home for just over 3 days and we're starting to settle into routines. Beth and Luke go to school and Kim and Peter have "schkola" in the morning. We are home schooling the adopted kids at least until they have passable English language proficiency. I'm still on vacation this week, although I did go into the office anyway yesterday for the afternoon to attend an important meeting and to put out a few fires.

A few observations so far. DISCLAIMER: I will not acknowledge any of these observations in a few weeks or months when it becomes clear that I am completely wrong and must have been an idiot to think any of this...

... Kim and Peter love their new home and all of its treasures. They think their bedrooms are awesome... but they both want a light left on at bedtime. Neither had any problems with the dark during our time in Russia... but then again, they were sharing beds with others and may have found comfort in this. Their cool new bedrooms are still a little foreign and scary at night.

... Bandit and Peter are becoming fast friends. In the morning when I get up to wake Luke for school, Bandit wants out of our bedroom. He immediately pushes Peter's door open and jumps on the bed and starts licking his face. Peter giggles and yells at him in Russian. Bandit (sometimes called Banchick or Bandeek) doesn't know Russian... so he just keeps on licking until I rescue poor Peter.

... Kim is going to be Queen of the Neighborhood kids in no time. She likes to direct them already... even though they don't know any Russian, she seems to communicate her wishes to them fairly easily.

... Both Kim and Peter have a lot of socialization to learn. In this regard, they often function like toddlers. The things that we normally teach our kids at age 3 or 4 about how to treat others and how to react in social situations are completely foreign to them. They do not handle introductions to new people very well at all. They look stern, act pouty and what we would consider to be disrespectful. They turn away, won't speak, and resist all attempts to get them to say hello. They do warm up in a few minutes once you become familiar, but until then don't be offended. They are still overwhelmed in such situations. We've been debating about whether and how much to venture out during the holidays to see friends and family. My folks have a big family gathering next weekend and we've also been invited to join some friends for a trip to Roscoe Village for some of the festivities. There is also Kim's birthday coming up on Saturday. All of these pose socialization challenges that we aren't sure how to handle yet. I'm not sure the kids are quite ready for functioning with others yet... we'll see how it goes.

... the kids seem to have this notion that once you are in America all you have to do is play games and enjoy toys all day. It's been a bit of an eye-opener for them that we expect to have school time, "help Mom and Dad with house duties" time, and then have playtime.

... We're starting to figure out roughly where the kids schooling has left off for Math. Kim is fine with addition and subtraction of single digits, not sure yet about multiple digits. She has some basic notions about multiplication, but is not yet proficient in it. Peter on the other hand had just started school this fall in Russia (at age 8). He is not able to do single digit addition unless you have pictures showing how many things are there so he can count them all. In terms of language, Kim is able to retain the vocabulary we are working on with her, but she is hesitant to use very many English words in conversation yet. Peter can point out things when we say the Engish word, but he can't yet come up with the English word when we point to things. We also wonder about his hearing a little bit. He wants everything very loud and seems to struggle to hear the sounds in English words (hence it's Bandeek instead of Bandit). We have their medical exams on Friday so we'll know more then.

... Both Kim and Peter are small, but Peter moreso than his sister. Luke (age 9) wears size 12 (but he's always been a big kid). Peter is just over 6 months younger and wears size 6. Size 6 slim pants fit him in length, but are about 4 inches too wide in the waist. It's interesting to see Luke and Peter side by side.

... Beth and Luke are trying to get back into the swing of things at school. Beth had a choir concert last night and did a great job despite missing the past three weeks of practice. She also a little slower and less accurate with playing her clarinet. Luke is loving the fact that he can go back to school... especially to Math class...he loves Math.

... Kim and Peter seem to have more struggles with Lisa and than with me... especially Kim. We all have our share of communication and culture frustrations, but Kim gets much more defiant with Lisa. When she's "testing", she won't even let Lisa finish saying her name before she pulls out the trusty "Nee Pahneemahyoo" (I don't understand... said with a lot of attitude to heighten the full effect). We have a couple of battles per day... nothing excessive mind you, but enough to be frustrating. We are using the translator on the computer, but that only works when Kim is willing to meet us half-way... there are times when she is not. I don't know if her battles with Lisa are a function of Lisa having less Russian language proficiency than I do (not that I have much) or it's more likely that she sees herself in competition with Lisa for serving in the mother role for Peter.

... part of Peter's delays are explained by (or are at least magnified by) Kim's attempts to do everything for him. Her motivations are good... except when she pushes him aside because there is something fun or desirable and she wants it (like the computer). Anytime there is anything that is not very easy, she tries to intervein for him. She tells us (and him) that he's too small, or that it's too hard for him. I think this has become a self-fulfilling prophecy in that he quickly gives up. We have to work very hard to keep her out of the way and to show him that he CAN do things for himself. He is not going to progress and grow until he believes that this is true.

... Overall things are pretty good and the kids are doing well, these are just the common hurdles that adoptive kids face and that frustrate adoptive parents. At least we have not seen any signs of reactive attachment disorder (Thank Goodness), nor have we had any stealing or hording. Mostly we are progressing just fine... especially for just being together for just over a week. Hopefully next week we'll even see some progress on these... and discover lots more things to work on.

Home Again, Home Again

We thoroughly enjoyed taking yesterday off from blogging and off from everything else too!

We arrived back in Columbus around 8:30pm on Saturday night... exhausted. Our trip from Moscow included a 12 hour flight to Atlanta where we had a 2 hour layover before our flight to Columbus. I spent half of the Moscow - Atlanta flight with my pants soaking wet after Peter accidentally dumped his Koka-Kola in my lap... oh well, I guess I'll have plenty of time to dry out now. In Atlanta, we needed every second of the layover. Once we made it through passport control (using the US citizens line), we had to claim our luggage and go through immigration and customs. The flight back from Moscow might as well be called the adoption shuttle because there are always so many newly adopted children on it. We spent time speaking with quite a few families while waiting to board. Mostly people are adopting young toddlers, but there were a few families with older children like ourselves. There were probably 25 adoptive families on that plane, maybe more. With so many children to process through immigration, it is not the fastest of processes. We BARELY made it through in time for our connecting flight. We had to take the tram in the Atlanta airport from terminal E to terminal B and then run for it. Of course you could guess that our gate was literally the last gate. Picture us trying to run through the airport with four kids... two of whom don't speak English. Lisa had Peter and I had Kim. I'm not entirely sure that Peter's feet actually hit the ground in terminal B. He mostly flew behind Lisa like a kite. The agent at the gate knew who we were as we sprinted up, out of breath, to ask if we made it. He asked how we had liked Russia and that they were holding the plane for us guessing that we were delayed in immigration. Once on the plane, the stewardesses brought out bottles of water for us as we were still breathing pretty hard at that point.

The kids were asleep almost before we were off the runway. It was less than 90 minutes and we were on the ground in Columbus. At the baggage claim, we were warmly greeted by our dear friends the Canary's who had made a banner (in Russian) welcoming Kim and Peter. They brought our van to the airport for us as well and, God bless them, they had stocked our kitchen so we wouldn't have to go out right away. We were also greeted by another family from our church who have adopted three children from Ethiopia and have a really great blog about their experience. It was really great to see everyone and have such a nice welcoming, but you can see in the photo that Kim and Peter were pretty tired, scared, and overwhelmed. They warmed up pretty quickly however and were smiling and laughing in no time.

When we got home, the kids were in awe. They have seen many photos of the house and they knew that they each had their own bedrooms. The immediately had to run to their room and examine everything about them. After that, they had to tour the rest of the house. It was a lifetime of Christmas mornings all happening at one time. It was a little bit tough to get them to go to bed after a quick dinner of Soup (Thanks Sheri). They were back up at 3:00am turning on lights and trying to get the other kids up to play. It will take a few days to get their internal clocks adjusted.

Sunday was quiet. Grandma and Grandpa came down from Akron and brought our dog, Bandit, back home. It was cute that Peter spent most of the day calling him "Banchick". Kim also rode her bike. She was so excited about having a bike that was her own. She rides better than I would have guessed. Today, Beth and Luke went back to school and Peter and Kim started homeschooling with Lisa to learn English. We also took them to the grocery store... a little overwhelming, but kind of fun for them too. I installed a Russian/English keyboard on our computer and set up the Russian language support in Windows so Kim can type into the online translator. It is a big help... but we are limited by her ability to spell in Russian... this is a real limitation for a 9 year old. Once the neighborhood kids came home from school, Kim had to go ride her bike with them. Welcome to our new normal.