Gifted and Struggling

I mentioned recently that Mira was evaluated for gifted identification. She’s a bright kid, and her abilities in class – when she’s focused – made her teacher think it was worth the time to check.

We received the results this weekend. In the letter, it explained the testing methods used and provided her scores. Based on her scores, she’s not identified as gifted in math, which I thought would be her strongest skill. However, she did score high in reading, and has been identified as gifted in reading. Surprise, surprise! The girl who refused to read for SO long, saying that she wasn’t good in reading and Cordy was the “reader” among them is actually a very good reader.

She was also given a cognitive abilities test, and while she didn’t score high enough to meet the cutoff for “superior cognitive,” she was only a few points away. It’s possible she’ll be re-tested in a couple of years.

Overall, I’m proud of Mira, even if I am somewhat pleasantly surprised by the results of her evaluation.

Here’s what confuses me, though: how can a child who reads so well have so much trouble with spelling?

She reads out loud to me, and while she stumbles on some of the harder words, she still makes a good attempt at reading them the way it looks like they should sound. But have her read a word several times, then ask her to spell that word without looking at it? She can’t.

I know she’s reading at too fast of a speed to still be sounding out each word. She automatically recognizes the order of the letters and knows the word. So why is she unable to rely on that recognition for spelling?

This was her most recent spelling test. While this one was particularly bad, because she told us she liked to study on the bus and not with us (and wasn’t studying), even the spelling tests she studies for have several missed words.

Spelling testOuch.

She has fantastic ideas she wants to get down on paper, but is often held back by writing unintelligible sentences. Can you decode this one?

What does this say?This was from the start of 1st grade. “I will take care of my bunny, like feed it.”

Or this one?

What team?From Friday – the team name is “Zeus’ Thunder”

It’s like some kind of spelling-only dyslexia. Or possibly a remnant left over from when she had speech apraxia as a toddler and preschooler. Her speech is still a little hard to understand at times, so maybe when she sounds out a word, she’s writing it using the sounds she still substitutes for the correct sounds?

I was never the world’s best speller, either, but I don’t remember struggling this much. I’m not sure how to help her, other than drilling her spelling words over and over again, which she finds utterly boring. (And I understand – it is boring!) Mira seems frustrated with it, but she also prefers to act like it’s no big deal and hide her frustration. I’m planning to ask her teacher for advice on how to better handle spelling when we meet for parent-teacher conferences later this week.

Does anyone else have experience with a good reader who has a difficult time with spelling? Is it just something that will eventually “click” for her, or will it at least get better?



Mira, the Daisy Scout (and Cookie Seller)

Earlier this year, interest forms were sent out about forming a Daisy scout troop in our area. Mira had been wanting to join Girl Scouts since last year, and we nearly joined at the start of summer, but the troop we were matched up with abruptly dissolved before she could attend her first meeting. When this second chance presented itself, she begged me to sign her up for it.

Mira's Daisy Scout vestMira’s Daisy Scout vest (I still need to iron on 2 more petals that she’s earned – oops!)

I was excited that she wanted to join Girl Scouts. I was a Brownie scout when I was in elementary school. (I don’t think they had Daisy scouts back then?) It was a fairly large troop, and I remember making crafts and going to day camp in the summer. I probably would have been in Girl Scouts longer had our troop leader not moved away. It was the only troop in my small town, so when she left, our Girl Scout troop dissolved, just as many of us were bridging to Juniors.

When Mira had first expressed interest, I dug through some boxes and pulled out my old Girl Scout Handbook. She didn’t believe I was once a Girl Scout, too, so I proved it with my circa 1977 edition of the handbook:

Girl Scout Handbook, 1977 editionI didn’t notice it as a kid, but I love the diversity in this book’s images. Pretty awesome for a 1977 printing!

This troop did get started in the fall, and Mira is now a proud Daisy scout. She’s competitive, so she is determined to earn as many badges as she can. Daisy scouts are kindergarteners and first graders, so she’s one of the older girls in her group.

And then earlier this month, the Girl Scout cookie drive started. I don’t know why I thought that Mira might not care all that much about selling cookies, because I was utterly wrong. She carefully looked over the materials, especially studying the prizes earned at each level, and then announced she was going to sell 1,000 boxes of cookies.

Um…that’s the spirit, kid? How do you tell your child to aim lower with her goals?

Girl Scout cookiesI didn’t want to tell her that her goal was too high, but I also didn’t want her to be disappointed if/when she didn’t reach that goal. Because selling that many boxes of cookies is not an easy task. Aaron and I have plenty of friends, but not THAT many people we can hit up for cookie orders.

So I gently tried to explain just how many boxes that was, and how many people would have to order to reach that goal. I encouraged her to keep that goal in her mind, but to also set a lower goal that she’d still feel proud about reaching. Basically, a minimum goal. She settled on 300 boxes. Still awfully high, but not nearly as impossible.

For the past two weeks, she’s brought up selling cookies everywhere she’s been. She’s tried to sell cookies to cashiers in stores, to people in waiting rooms, and of course to friends and family. She’s had the best luck with friends and family, of course.

She sat next to me while I posted cookie order announcements on Facebook, checking in with me later to see who placed orders. She’s asked Aaron at least every other day if he gathered any new orders for her at his office. Mira is determined to be the World’s Best Cookie Seller, and I am the mom who is required to have the order form with me everywhere we go. Really, Aaron and I are her unpaid interns, I think.

She’s not going to make her big goal, but she has a shot at making her smaller goal. I’ll give her credit for having drive and persistence. The order forms are due later today, and she’s at just over 200 boxes ordered. Hopefully she’ll have the chance to participate in some booth sales in March to supplement her total and reach that goal of 300.

This is my first time on the mom side of Girl Scout cookie sales, and I have a new appreciation for my mom, for her efforts helping me sell cookies as a kid. So far it hasn’t been too hard, although I realize the real work begins when we have to pack the SUV full of cookies to deliver. But it’s worth it if Mira is happy and hopefully learning something from the experience.

(Side note: I’m turning in the forms today at 3pm. If you’d like to order cookies, let me know before then and I can get your order in. $4/box, and we can mail them out to long-distance friends if they cover shipping. The things we do for our kids…)



An Update on My Shoulder

Sorry folks, I’m being whiny today. You’ve been warned.

Last week I told you all about the shoulder pain I was experiencing after I got my flu shot. My doctor diagnosed it as bursitis, resulting from a poorly administered shot, and reassured me that it would likely go away within a week. I wanted to believe her. I hoped she was absolutely right. I even foolishly decided not to seek out additional treatment yet beyond the heat and ibuprofen she recommended, thinking that it would quickly heal.

The update? Her prediction didn’t come true. While most of the sharp pain is now gone, I’m dealing with a constant dull ache that I can generally ignore most of the day if I don’t move my shoulder too much. But it often swells to a more noticeable pain in the evenings that shoots down into my left arm and occasionally makes my fingers numb.

Some arm movements remain difficult, and I’ve discovered I really can’t use that arm to carry anything more than a few pounds without it hurting. The popping in the joint has continued, too, and ewww that’s a horrible feeling.

In short: this sucks, and I want to go to bed and hide from it.

Hiding from the world

After I had reached a week without significant improvement, I emailed my doctor and described what I was experiencing. I asked if we should consider the oral steroids that she had recommended we try if it didn’t get better. I wasn’t thrilled with the idea of steroids, but willing to give them a go if they’d reduce the inflammation to heal my shoulder faster.

Her reply the next morning was not what I was expecting to read: based on what I described, she thought we should skip the steroids and go straight to physical therapy.

Yep, physical therapy. Forget the small stuff, we’ve moved on to considering this a major injury in need of intervention.

Because of a flu shot.

That didn’t even immunize me from the flu.

To say I’m frustrated with this series of events would be an understatement. I now have no idea when, or if, my shoulder will be back to normal and pain-free. I had never heard of SIRVA (Shoulder Injury Related to Vaccine Administration) before this, or ever considered filling out VAERS paperwork to document an injury.

So now I need to schedule physical therapy. Because I have so much time (and money) available for that, right?

Again, please forgive the whining. I’m not used to being anything other than physically healthy, with occasional lower back pain that isn’t a chronic issue. Having reduced function for one of my arms is difficult for me to cope with. The constant ache makes me grouchy, too, and I don’t like taking a lot of pain meds for it. This wouldn’t be so bad if I knew there was an end point, but not knowing when that end point will be (tomorrow? a week? a month? a year?) makes it overwhelming.

Alright, I know I need to get over myself and make the calls to get things started. No more stalling, hoping it’ll go away on its own.

 Time to workTime to get to work.

I’m calling for the physical therapy referral today. I’m calling to set up a chiropractic consultation, too. And I’ll accept that my schedule is going to be mad for a little while and I’ll likely hit my health insurance deductible early in the year. If it results in having full function of my left shoulder again, it’ll all be worth it.

—–

UPDATE: When I contacted my doctor to ask for the referral for the physical therapist, she heard the current state of my shoulder and decided to switch courses again. She’s certain I should have seen more improvement by now, so the new (new) plan is a referral to an orthopedic doctor who specializes in shoulders before anyone has a chance to manipulate my shoulder. Yay?



Let The Label Game Begin

First grade has been an interesting experience for Mira and for us. I’ve found that despite already having an older child, we’ve been prepared for practically nothing with a second child. Mira’s first grade experience has been entirely different from Cordy’s first grade experience.

When Cordy was in first grade, it was her first year of being fully mainstreamed, so we were intensely focused on making sure she could handle the classroom experience and start to enter the social world of the other students. Adapting to the classroom routine and nightly homework were the topics we spent the most time on.

Mira has had no trouble at all with adapting to classroom routine or navigating the social world. Rather, she seems to think the primary purpose of school is social time. Instead of wondering if she ever interacts with other kids in her class (which Cordy didn’t much), I get a long tale at least once a week of who her new best friend is, or who doesn’t like who in her class, or tears over one of her friends choosing another friend to play with over her.

This? Not my strength. I don’t have a lot of good advice for her about navigating the social network at school. Don’t be a bully, don’t hang out with bullies, and don’t waste your time with those who aren’t nice to you are the extent of my parenting advice about friendships.

Her social nature has resulted in some classroom woes as well. Not following the class rules will result in a student being required to move the card with their name on it down the wall to a warning. A second offense in the same week results in moving it again and losing five minutes of recess. A third offense results in ten minutes of recess lost. (The consequences get worse from there.) The cards are reset at the start of each week, so everyone has another chance at a fresh start.

Mira’s card is moved at least once most weeks, and it’s generally for the same reason: speaking out of turn. Those who know her are aware of what a chatterbox she is. The toddler with the speech delay took her speech therapy to heart and never stopped talking. At school, she forgets to not talk until she’s called on in class (she’ll raise her hand sometimes, but talks as she raises it), talks in the hallway when they’re supposed to be quiet, talks to those around her during quiet activities…it never ends.

In some ways, I’m not worried. I know it’s frustrating to the teacher, but if talking is her greatest offense, she’s not doing too bad. She’s impulsive, especially with her speech, and as long as her impulsive nature isn’t hurting anyone, it probably doesn’t need any intervention, other than reminders to not be disruptive. The consequences for talking when she shouldn’t have been beneficial. She makes an effort to remember when it’s OK to talk and when it isn’t. I don’t want to stifle her freedom of expression, but there are times in life when you need to be quiet, so I see no problem with reinforcing that lesson.

It’s been mentioned, by others and myself, that she likely has ADHD. No attention span, constantly on the go like she’s driven by a motor, fidgety, impulsive – I’ve completed the questionnaire at her pediatrician’s office, but have yet to schedule the follow up for the results. If she does have ADHD, we’ll manage. (Says the mom with ADD.) At her age, she’s not going on medication, especially when she’s doing fine in school and, other than being a distraction at times, she’s not bothering anyone else.

And it’s true that she is doing well in school. Her reading is slightly above grade level, her math skills are excellent, and she’s a pro at solving puzzles. When she had her pre-kindergarten evaluation in preschool, she was identified as likely gifted. The psychologist was impressed with her cognitive skills, even though she wouldn’t sit still for a moment of the test. (That was our first clue into ADHD, too.)

We discussed the possibility of giftedness with her teacher in the fall, and she thought it was worth requesting the individual evaluation. I’ll be honest – I wasn’t sure it was needed. Yes, I want to believe my kid is smart, but I also don’t want to be That Parent who assumes her kids must be geniuses. Cordy being gifted was fairly obvious, and she needed the intervention, but the signs are more subtle in Mira. It’s possible she’s just on the better side of average and I’m trying to interpret that into something far grander. There’s nothing wrong with average, and if she doesn’t need anything beyond her regular classroom, that’s fine.

Because her teacher thought Mira should have the evaluation, we agreed and signed the paperwork, and so one day last week Mira spent the morning with the gifted education coordinator. I’m not sure when we’ll get the results, but I’m curious to know if she gets the school’s label of gifted or not. Either way, she’s a bright student and it’s heartening to know that her teacher considers her smart, despite the behavior issues she has to endure.

The only benefit to the label is that she’ll qualify for some additional instruction, which often includes fun logic puzzles and games. Honestly, I wish they included that material with all kids in the school. Logic is a valuable skill that all kids should spend additional time developing at all levels.

Whether she’s labeled or not, Mira will take it in stride. Her endless enthusiasm and energy, along with her ability to roll with most situations, gives me assurance that she’ll do fine in whatever she’s up against. School is one big stage for her, and she’s happy to play whatever role she’s given.

Mira and her dollLife ambition at 6yrs old: be the first female Doctor Who. Or maybe a vet.



Went For A Flu Shot, Got A Shoulder Injury Instead

I’ve had a flu shot many times. No one really wants to get a flu shot, but many people generally consider it worthwhile if it keeps you from getting the flu. I have no time to be sick, so I usually get vaccinated each fall.

While the girls were already vaccinated, I had yet to get my flu shot this year. I meant to do it at my doctor’s office visit last month, but then forgot to ask about it. So a little over a week ago, when I heard of more flu cases creeping into our area, I decided to get my flu shot at Walgreens while I was picking up a few other items. Cordy was with me, too, and I thought it might be good for her to see me getting a shot, to reinforce that it’s not a big deal.

I answered the pharmacist’s questions and paid my $28 for the vaccine, then waited in the little cubicle they had set up for vaccinations. The pharmacist walked in and asked which arm I preferred. Seeing how I was already seated with my right arm to the wall, I said I preferred my left. It was my non-dominant arm, and I know from experience that the muscle is sore for a couple of days after the shot.

He opened an alcohol pad and cleaned off an area on my arm. Or rather, my shoulder. I noticed the area he chose seemed awfully far up on my arm. As an RN, I never gave shots that high up on the deltoid. But I’ve also been out of clinical practice for a few years, so maybe there was a new technique I wasn’t familiar with? I didn’t say anything, because I didn’t want to sound bossy and tell this young pharmacist how to do what he was surely well-trained to do.

The pharmacist stood beside my chair and quickly gave the shot, right at the area he had swabbed on my shoulder. I felt the initial poke of the needle through my skin, and then felt nothing else. “All done,” he said. I blinked. There was no pain, not even a slight burning sensation that has always accompanied a shot. I didn’t feel anything from the injection. Weird.

I tried to rationalize my confusion, and settled on believing this young pharmacist was a master at flu shots and somehow found a way to make them completely painless. I called to Cordy, who was standing nearby, scared at the idea of me getting a shot and unable to watch, and told her, “See? I’m done. And it didn’t hurt at all.” My smile to reassure her was genuine.

Later that night, my arm felt a little sore, which I knew was common with the flu shot, and I didn’t think anything of it. The next morning (Monday), my arm was significantly more achy when I moved it in certain directions. The ache felt different from how I remembered the muscle pain from a shot before. I attributed it to faulty memory. Monday night, I noticed that sleeping on my left side was uncomfortable.

Tuesday morning, the pain was worse. I was unable to move my arm in certain directions without a sharp shock of pain. I could lift my arm directly ahead of me, but couldn’t cross it over my body, and I couldn’t lift it out to the side by more than 45 degrees without the pain keeping me from going further. I had noticed the ache occasionally traveling down my upper arm into my elbow, too. And I was starting to develop some occasional tingling and numbness in my left hand and fingers, too. Tuesday night I had to sleep on my right side or back – the left side hurt far too much, and woke me up several times when I shifted in my sleep.

At that point I started to be concerned. Muscle soreness is typical with a flu shot, but this went beyond soreness. It was now the third day after the shot, and I should have been feeling better by now. Instead, I was counting the hours between ibuprofen doses and trying to search online for why my shoulder and upper arm were reacting in this manner.

By Thursday, the sharp pain had lessened quite a bit, but the intermittent numbness and a constant low-level ache had set in. I was also starting to develop some “popping” in my shoulder when I moved it. Prodded by conversations with a few people, and by some scary information from Dr. Google, I made an appointment with my doctor for Friday.

My doctor listened to the whole story with concern, then carefully examined my shoulder and arm, trying different motions to see which movements were uncomfortable and which didn’t cause any problems. She knows I’ve never had a shoulder injury, too. (Knees are another story.) Surprisingly, she agreed with Dr. Google: I have bursitis in my shoulder, with an outside possibility of a small rotator cuff tear, too.

When the pharmacist gave the injection, he was too high on the deltoid muscle. My doctor said that a lot of women don’t have a significant amount of muscle mass at that spot on the deltoid, and directly under it is the subdeltoid bursa, a pocket of fluid that is part of the shoulder joint, designed to reduce friction in the joint.

Deltoid muscleThe deltoid muscle, in red. (Source)

So when he administered the injection too high on my arm, he went through the deltoid completely and punctured the bursa, injecting the flu antigen into the bursa. That would be why I didn’t feel any pain or burning when it was injected, and it’s also why I’m experiencing all of my shoulder pain symptoms.

Shoulder joint anatomyThe bursa is located just above the rotator cuff tendons, with the deltoid over all of it. (Source)

The bursa fluid isn’t meant to have a flu virus antigen mixed in with it. So it reacted with inflammation, pain, and stiffness in the joint. The numbness and pain into my elbow that I’m feeling is likely caused by the inflamed bursa putting pressure on the nerve.

My doctor thinks the symptoms should go away within a week or so. She recommended a conservative approach for now, and that we treat it with heat and ibuprofen. If it doesn’t get better within a week, then we may try a round of oral steroids to help it along. If that doesn’t fix it, then we’ll consider an MRI to see if the rotator cuff was damaged, physical therapy and begin thinking about long-term treatment plans.

That last sentence scares me. Long-term treatment. Long-lasting shoulder pain. I’m really hoping my doctor is right and it’ll resolve within a week. In doing research on this, I discovered that the government already has a name for this type of vaccine injury: shoulder injury related to vaccine administration, or SIRVA.

As of 2010, it’s a known type of vaccine injury, and a study on it found several identifying characteristics. In most cases, those affected were women, the person administering the injection was standing while the patient was seated, and the injection was placed too high on the arm, resulting in the injection being delivered into the bursa.

This led to the recommendation that “the upper third of the deltoid muscle should not be used for vaccine injections, and the diagnosis of vaccination-related shoulder dysfunction should be considered in patients presenting with shoulder pain following a vaccination.” (The Dept. of Health & Human Services accepted this recommendation, along with also recommending that the person administering the vaccine be seated if the patient is seated to reduce error.)

A report on this injury was given during a 2010 Advisory Commission on Childhood Vaccines meeting (pages 15-28 or so), where it was revealed that among those without prior shoulder injuries, only a third who developed SIRVA ever fully recovered. Meaning there’s a chance that an improper injection can lead to life-long joint pain in that shoulder.

And here’s the kicker: I still don’t have any immunity to the flu. My doctor said it’s unlikely that I gained any immunity from that shot, since it went into the bursa and not the muscle. I paid $28 to be given subdeltoid/subacromial bursitis, that has a chance of causing chronic shoulder pain. Lovely.

I don’t want anyone else to have to go through this, so here are a few tips for you the next time you have to have a flu shot (or any vaccine injected into your arm):

SIRVA: shoulder injury related to vaccine administration

1. If it seems too high of a position, say something! I wish I had followed my own advice here. A shot should not be given just under your acromion process (the knobby end of your shoulder), but should be given at least two finger widths down. Needle size should be carefully considered, too. Better to say something rather than be injured. Not sure how to bring it up? Try this as a starter when the alcohol pad is rubbed on the spot: “Huh, that seems really high on my arm. I don’t remember getting any other shots that high.”

2. Ask if you can stand while the shot is given. If the provider would prefer that you sit, ask that person to sit as well, so that you’re both at the same level. Injecting from above tends to result in the injection being given higher on the deltoid, which increases your risks. Trying to estimate two finger widths down while standing provides a skewed view of the site and means your shot will likely be placed too high.

3. For the flu shot, ask if you’re eligible for Flumist. The Flumist version of the vaccine is sprayed into your nose – no needles! Not everyone is a good candidate for this version of the vaccine, since it’s a live vaccine, but if you’re eligible you’ll prevent any needle injury by avoiding it altogether.

4. Consider who administers your shot. Pharmacies are convenient for flu shots, but how well do you know your pharmacist? Many may not have the experience of your doctor’s office nurse. On the other hand, you may have a better relationship with your pharmacist than your doctor’s nurse. Ideally, you want someone who has a good amount of experience in giving shots, and who gives them with some regularity.

However, one point regarding this: sometimes, you get a bad shot, no matter the person giving it. I’ve had my flu shot at Walgreens in the past, by one of their pharmacists, and didn’t have any issues. Nearly any medical professional has a risk of giving a bad shot, even if they’ve been involved in your care since you were a baby. That’s why it’s important to pay attention and ask questions if something seems wrong, even if the professional is someone you trust.

I’m not going to say that the solution is to never get another shot. But I do think we should all consider each shot as a careful medical procedure. Any medical procedure has the ability to help, but most also have the ability to harm if done improperly. We should be cautious in who we choose to give us a shot, and we shouldn’t feel dumb or bossy to speak up and ask questions if we’re uncertain.

As of today (1 week, 2 days after the shot), my shoulder has almost a full range of motion again, although a few movements continue to be painful. A low-level ache is present nearly all the time (I’m told this is what arthritis feels like?) and I still can’t sleep on that side. I have occasional numbness/tingling in my fingers, but it’s less and less each day.

I have noticed a significant weakness in that joint now, so I’m taking it slow and easy with lifting anything or too much movement. And the “popping” in my shoulder has continued – with certain movements you can hear the pop across the room. I had a chiropractor recommended to me, and I will likely give him a visit to see if he can help. Hopefully it’ll be resolved soon and the only popping and ache will be the standard ones in my knees.

UPDATES

To see more about how I’ve been dealing with SIRVA, I’ve provided links to my update posts below:

An Update on My Shoulder – one week later

The Ongoing Shoulder Saga, Episode IV (A New Hope?) – one month later

Flu-Shot Shoulder Update – nine months later