Goldilocks Visits the Dentist

I took GL to the dentist yesterday. Today I'm recovering. Actually, the dental checkup itself wasn't as bad as I'd feared. Our dentist is the gentlest, kindest, most engaging man I’ve ever met. He reminds me of Mr. Rogers. Goldilocks absolutely loves him. When he knows he has an appointment, he says, “I get to visit Dr. N., my dentist? Hooray!” and runs to the car.

But it wasn’t always this way. At first, Dr. N. was not sure he could handle a patient with autism. He referred him to a “pediatric/special needs” dentist who he said would give him a sedative. He teaches at the state university dental school, but he didn’t feel comfortable prescribing a sedative, because he felt that was outside his area of expertise.

The “pediatric/special needs” dentist was horrible. She refused to give the sedative she had promised, and instead, put her knee on his chest and told Mama to hold his legs, all the while scolding him for being “naughty”. He was so terrified, she couldn’t even do a basic exam. Mama Bear promised Goldilocks he would never have to go see that mean lady again.

When we reported this to Dr. N., he was shocked, and said he would never refer anyone to her again. He also agreed to give Goldilocks a chance. He scheduled him for a slow time of day with his gentlest, most patient hygienist. At the end, he came in, introduced himself, shook hands, and sent GL home with a big bag of trinkets. With each visit, he did a little more of his usual exam, eventually working up to a cleaning, complete exam, and x-rays.

But Dr. N is retiring. For the last several months, he's been gradually turning his practice over to Dr. G. She's been seeing more and more of his patients, and he's been gradually reducing his hours. He's down to 1-2 days a week. And GL doesn't like change. So at the end of his last visit, we scheduled this visit on a day both dentists would be in. On the way to the dentist office, I told him that Dr. N had a friend, Dr G, who is also a dentist. She is very nice, and she works on my teeth. Would he like to meet her? He thought he would. Alerting him to upcoming changes is a delicate balance. His anxiety is increased by both too little notice and too much.

GL giggled during his cleaning. He said it tickled. But he held my left hand so tight, I had to switch to my right, because my wedding ring was cutting into my finger. Then he started moaning. The hygienist was worried, until we figured out that he was singing.  Occasionally he'd forget to keep his mouth open, so I'd say "Ahh" to remind him. So he started singing "Ahh-ah-ah-ah!" I said he sounded like Tarzan. He started beating on his chest. The hygienist laughed, and asked him if he liked swinging on vines. He laughed, and said he did.

After his cleaning, Dr. G came in to meet him. He wouldn't make eye contact, or even look in her direction, but he shook her hand and talked to her, which is a step. Then Dr. N came in and did the exam. He and GL joked about Tarzan. Dr. N keeps bird feeders outside his exam room windows. It gives patients something to look at, and helps them relax. GL looked at the birds and said, "Hey, birds! Here are some cookies!"  I explained that he was quoting Frog and Toad. Dr. N said, "That's one of my favorite books. My wife says I'm a little like Toad."

He shook our hands and left, and the hygienist came back to give GL a fluoride treatment. He handled it pretty well, despite being tired of having so many hands and tools in his mouth. At one point, he yelled, "Hey, birds!" Come get your fluoride treatment!"

All the way home, he kept asking if we could go to the library for DVDs. We did have to make one other stop first, but that boy cannot take yes for an answer! At the library, he followed his usual routine: As soon as he was in the door, he yelled, "Hey, librarian, do you have anything in for me?" Then he threw his returns on the counter and ran back to to the children's DVDs without waiting for an answer. Sigh. We're working on it. Really.

Last several visits, he's had a new problem. He grabs three or four DVDs and runs back to the circulation desk to see if he has anything in. If he does, he leaves me to check out, and goes back to grab a few more books or DVDs. If he doesn't, he yells at the librarian, and then runs back and grabs as many DVDs as he can carry. He'll keep running back and grabbing more if I don't stop him. It's not like he watches all the DVDs he checks out. Every day, he insists the discs he checked out the day before are old, (even if he hasn't watched them) and he needs new ones. Since we only live two blocks from the library, and walking to the library is the only way I can get him to exercise, we go every day it's open. Even though he checks out the same DVDs over and over, they are "new" each time, and he is satisfied for the rest of that day.

Even the most patient and understanding librarian, who doesn't mind scanning ten DVDs every day, even though she knows he doesn't watch them all, wants him to leave enough DVDs for others to check out. So I've been making him choose some, and put the rest back. This time, he started screaming at me. And the librarian. About how we were taking all his DVDs away. About how we would never let him go to the library, ever, ever again. We were done checking out, so I hustled him toward the door, while he screamed all the way. As we were going out, we met the head librarian coming in. She reminded GL to zip his coat, because it was cold outside. He yelled at her, too. Outside, he kept screaming at me. About how I took all his DVDs. (Never mind the two bags he was carrying.) About how I would never let him go back to the library. About how he needed to go back right now, and apologize to the librarians. He usually "apologizes" by screaming at people. Not today, Zurg! Once I got him across the highway, I walked away. He can cross the less busy intersections on his own. He chased me, but even chasing someone, he doesn't walk very fast. He continued screaming at the whole world, but it was easier to tolerate from ten yards away. I did watch for traffic when he crossed. There wasn't any. Once we got home, he asked me to put on a DVD, and eventually calmed down.

Treading Water

I feel like I've been treading water the last few weeks, and I'm only halfway through. I will only be home one weekend in August and one in September. Like Jonathan Bing, "home's the best place for all people like me." During the week, I'm trying to re-establish some semblance of routine and illusion of order. BB is driving me to distraction. He's not uncooperative, his mind's just not on his work. It's been a constant struggle, but it seems to be worse lately.

GL has had relatively few meltdowns, but they've been big ones. Yesterday, he wasn't calming down, even with medication. He went for nearly two hours. I almost took him to the hospital. That evening, I had to take him with me to Civil Air Patrol because our sitter was out of town. I couldn't miss that meeting because I was teaching a class. It was close enough to bedtime that I gave him his bedtime med as soon as we got there. He was relatively quiet, if a little goofy. I was still uneasy about bringing him, but I had no other option. Then today was Goldilocks vs. the Dentist.

On the lighter side, Understanding my son posted Coming Full Circle. Be sure to follow the link, Duh! to the earlier post, Teaching Sass. And Arby posted a children's story with a happy ending that made me laugh out loud. As Mama Bear said, "Don't read Arby when you've got to pee!"

Goldilocks vs. the Dentist

Part One: Terror in the Chair (Holy or Unholy)

The dread kids with autism feel at the thought of going to the dentist, and the dread their parents feel at the thought of taking them have been well described by Tim at Both Hands and a Flashlight. And no matter how we handle it, we're going to feel guilty.

Our dentist is the gentlest, kindest, most engaging man I’ve ever met. He reminds me of Mr. Rogers. Goldilocks absolutely loves him. When he knows he has an appointment, he says, “I get to visit Dr. N., my dentist? Hooray!” and runs to the car.

But it wasn’t always this way. At first, Dr. N. was not sure he could handle a patient with autism. He referred him to a “pediatric/special needs” dentist who he said would give him a sedative. He teaches at the university dental school, but he didn’t feel comfortable prescribing a sedative, because he felt that was outside his area of expertise.

The “pediatric/special needs” dentist was horrible. She refused to give the sedative she had promised, and instead, put her knee on his chest and told Mama to hold his legs, all the while scolding him for being “naughty”. He was so terrified, she couldn’t even do a basic exam. Mama Bear promised Goldilocks he would never have to go see that mean lady again.

When we reported this to Dr. N., he was shocked, and said he would never refer anyone to her again. He also agreed to give Goldilocks a chance. He scheduled him for a slow time of day with his gentlest, most patient hygienist. At the end, he came in, introduced himself, shook hands, and sent GL home with a big bag of trinkets. With each visit, he did a little more of his usual exam, eventually working up to a cleaning, complete exam, and x-rays.

But on his last visit, Dr. N. found a cavity. Next visit will be GL’s first filling. Dr. N. is willing to try it, but is still not ready to prescribe a sedative. GL has his daily meds, plus an extra Trazadone tablet to be given PRN, and we’re going to try it with that.

When GL had stitches, it took four men to hold him down, and he was two years old! Now he’s thirteen. Once, after surgery, he had a bad reaction to morphine. The doctor said not to give him any more morphine, but wouldn’t start a new pain med until the last dose of morphine was out of his system–and they had just given it. He got so upset, he stood on the femur that had just been sawn through that morning. Desperate, the nurses put a bolus of valium in his IV. Have you ever watched an animal be put to sleep? We had a cat once that was dying and in misery. Mom wanted to be certain he was out of his misery, but couldn’t bear to watch. She asked me to take him in, and watch to be certain he was dead. GL’s response to the valium looked exactly like that. It was frightening, disturbing even. But when he awoke, he was calm, and they were able to give him a different pain med.

All this to say, medication makes me uneasy, but compared to GL’s meltdowns, or seeing the “pediatric/special needs” dentist again, (which would bring on a meltdown, if not in her office, once we got home) temporarily drugged out of his mind doesn’t sound so bad. But I’d rather have the Versed they gave him before surgery. About an ounce of liquid in a dose cup, and it apparently didn’t taste too bad, but once it started working, although he was quite awake and alert, when they asked if they could take his Game Boy away, he didn’t care.

Part Two: In which we Hope to Avoid the loss of anyone's Teeth or Fingers

Today was filling day. Before he left the house, I gave GL his bedtime meds, plus everything else we’ve been told we could safely give him. Ever notice how it doesn’t feel as safe when it’s your kid? But I didn’t know what else I could do. Mama Bear took him to the dentist. I had to promise to take him to the library for DVDs afterward before he would get in the car. I stayed home with BB, who has been having issues of his own.

MB said that GL didn’t yell or fight, but Dr. N. seemed nervous about the whole thing. GL spent the whole time worrying aloud, which made Dr. N. more nervous. GL tolerated the needle fairly well. MB gave everything less-threatening-sounding names, which helped a lot. So the needle was only a “pinch” that would make his tooth “tingle” not “sleep”, and the drill was only a “scraper”. I know it sounds like lying to the kid, but to him, names are everything, and the wrong name can send him into a panic far worse than the procedure itself can.

Near the end of the drilling, GL hopped out of the chair and said, “I’m done!” Only those who know him very well can appreciate the finality that phrase carries. That’s when Dr. N. looked Really Panicked. You just can’t leave a tooth like that. Since they were past the point of no return, MB resorted to bribery, something we desperately try to avoid, because no matter what you offer, GL always tries to negotiate for more. She offered to take him to the store to buy a DVD. He got back in the chair, and let Dr. N. finish drilling and filling as quickly as he could, hoping GL wouldn’t change his mind again. Dr. N. was embarrassed, saying this wasn’t his best work, but it should hold.

MB found a boxed set of all three Stuart Little movies for $10. I hope he doesn’t expect three DVDs next time he needs a filling, but it was enough to keep him busy until bedtime. Still, he kept coming to me with sad, tired eyes, asking to go to the library for more DVDs. I told him I’d take him when he finished watching these, knowing that won’t be until tomorrow, when we were planning to go anyway.