Wednesday, October 26, 2016

Rory's Battle With the Unknown

Preface: We're going through a rough time right now with Rory. I wanted to wait to publish this and another post I've been working on until we got a diagnoses. But it looks like that isn't even a possibility for at least 4 / 6 months. So here's what we've been going through.  
October 4th: Well we took Rory for his 18 month "Well Child Check". It didn't go as planned. He's the height of a 2 year old but the weight of a 1 year old (22.5 pounds). Tall and thin. No problem. 

But his communication skills were discovered to be sub-par (both in verbal and comprehension abilities). He knows a few words but he should know 15-20. His problem solving skills are also below what they should be. (Charlie noticed these issues at his 12 month appointment but we were told to "Just give him time".) 

I don't know what it is, but Rory is now in a struggle. Early intervention and detection is key, but I don't want to alarm anyone until we know what we're dealing with. This post is mostly for my piece of mind and something to confide in. 

October 5th: We started the referral and insurance prior authorization process to get help from Early Intervention and a Speech Therapist. It can take up to 5 days alone to go through the insurance prior authorization.

October 6th: I called the doctor to see if we could throw in an audiologist appointment as well. Just to be sure there isn't something wrong with his hearing. Once I found out our insurance doesn't require a referral to see an audiologist I went ahead and scheduled an appointment on the 17th. 

I feel like I should be moving mountains for him. Char reminds me these things take time and I'm doing the best I can for Rory. That's all we can do. Wait on the insurance so we can proceed on this new journey. 

I tell myself we named him after the Rowan tree. A tree that thrives where other life struggles. A tree believed to guide weary travelers on their way. I must say I could use some guidance right now, along with answers on what's going on with my little boy. 

October 7th: I went ahead and called Early Intervention services. They set up an appointment without the referral. They said they'll get it before the appointment, so why delay? Sadly, their soonest appointment isn't until November 4th. So the 4th it is. They will screen his gross and fine motor skills, problem solving abilities, his hearing, and his speech. The whole gambit. It'll be more in depth then the questionnaire at the pediatrician's office. If something's wrong they're bound to find it. 

I just keep telling myself I'm doing the best I can as fast as humanly possible. 

October 10th: Insurance approved Early Intervention screening for Rory. Char called the Early Intervention people and they suddenly had an opening for this Wednesday at 12:00 pm.  (Apparently, Charlie is more terrifying then I am). Anastasia got her new helmet today. 

October 11th: I am so nervous for tomorrow. I'm praying for a miracle and that some questions get answered. My biggest fear is that we'll just end up with more questions than we started out with. The main question being, what is this? What are we dealing with? Is it a simple speech delay, autism or something else?  

October 12: Well, that went about how my friend, Valerie, and Char said it would. 

The Early Intervention lady came at the same time as Anastasia's new physical therapist. Which made for a crazy time as 2 people were asking me questions about 2 different children. Luckily, Char was there with me and took point on Rory. 

They checked both babies' vision for us. Unfortunately, the vision test showed that both of them need to see an eye doctor because they have vision problems. Which could explain some of Rory's issues. 

We just filled out a more in depth questionnaire about Rory's habits, abilities, and behaviors. Then she scored it while we waited, just to give us a preview of what her report will be like (which she'll have done in a few weeks). The results were all in the black, which means he qualifies for Early Intervention, Speech therapy, occupational therapy and for further testing. 

Next we see the audiologist to determine if he has any hearing impairments. We're also waiting to meet with the Mental Health Coordinator who can shed some light on what, if any, mental disabilities he could have (like autism or it's sister disorders).   

The early intervention lady said that regardless of his diagnoses his treatment is the same. The goals maybe slightly different. But I need a name to what is plaguing my happy little boy. That's what seems to get most people, is he's so pleasant. Shouldn't he be upset and frustrated at this mad, confusing world he doesn't understand? Instead, he's just happily going along, perplexed, but in a good mood. 

I worry that we won't find out what this is. I worry he won't have a normal life I looked forward to for him. Simple things like soccer games or swimming lessons in summer to Boy Scouts when he's older. 

I fear that people will treat him as less than a person just because he's different or delayed. I fear that life will never be normal. I worry he'll  fell like he's always trying to catch up to some ghost of himself.  

I worry that people will say I'm a failure as a mom because he has speech delays or because we're now in Early Intervention therapies. But I read to him as much as possible, cuddled him as time allowed, spoke to him every moment I could. It's easy to ignore the truth, or to make excuses for him, it's hard to face the fact that life will never be the same as you thought it would be.

October 14: I got an eye appointment set up for the 25th for Rory. Now we'll see what's going on with his vision.
October 17: Today we had Rory's audiologist appointment. HAD is the key word. They called just as we loaded up the car to tell me their machine broke. She asked if Rory could point or raise his hand to indicate noise. I told her no he can't. She let out an Ooooo sound. Then put me on hold. She came back and said they were booked for the next few weeks BUT that the doctor decided to skip lunch on the 24th for Rory to have an appointment. The reason it isn't sooner is to make sure the machine they need is operational by then. 

Yeah, they're squeezing us in as soon as possible. Which is super kind of them. It's just I wanted to know today what, (if any) hearing issues he has. I just hate having to wait another week in uncertainty. At least he's a happy child. 

He did do an odd thing this evening. Anastasia and Rory were both crying and wanted to be held by me. I picked up Anastasia to comfort her, which frustrated Rory, who rarely gets upset like that. Then he started spinning in circles. He wasn't smiling either, the way most children spin and giggle. No, he just went in circles until I put Anastasia down and picked him up. 

October 18: I just watched a friend's video of her boy who's 8 weeks older than Rory. He could say I love you to his mommy. I want that so badly. I cried as I watched the sweet nightly interaction between mother and baby son. I felt envious of her. She gets to hear those many words from her boy. Meanwhile, I don't know when or if I'll hear those from my only son. Oh, I wouldn't wish this fate upon anyone! I need a Kleenex. 

October 19: Today 2 ladies from the Early Intervention came to do a further assessment of Rory, at the same time as Anastasia's physical therapist. Which meant there were 5 adults discussing the 2 children. 

Char answered 1 women's questionnaire which was assessing his fine and gross motor skills, watched how Rory played and interacted with us. Meanwhile I took point with the other lady discussing Rory's daily routine, ways he reacts if we deviate from it, how he acts around other people or the world at large. 

After an hour of the 2 of us answering their questions is draining. It's disheartening to answer no to so many of their questions. It just makes me realize how far behind he is or just how much he lives in his own world. 

Today I had to admit that my little handsome boy has never given me a kiss, a squeeze, nor a hug. Sometimes he tolerates me hugging and kissing him, but never reciprocates. 

I hated bringing up his "Lost words". Words he could say around 12 / 14 months that are just lost to him. Words like "ball", "momma", or even "shut up" (which would be told to the dog when she barked to much). With him you never know what word will go away next. If it's the last time you'll hear his little voice say a certain word. It's heart-wrenching. At an age when most toddlers are learning to say a new word a week or understanding a new word a day, he's stagnate. My friend Val recommended a book called "Let Me Hear Your Voice" about a mother with 2 autistic children. It's how I feel, just let me hear him speak real words. 

Now I wait for another week to bring me closer to an answer. Next week we have a hearing appointment, the next day an eye exam, then the report from the Early Intervention gals on what they can do for Rory and what steps we need to take next. 

This is such a lonely path. We informed Heidi tonight that, while we don't know what Rory suffers from, he's different. She cried and cried. She just wants her baby brother to be healthy and happy.

I dread having to tell others about his delays. I don't want my boy to be treated unfairly or like he's an idiot. I want him accepted for who he is, regardless of what the testing reveals. In a perfect world, people would try to understand what his worldview is, and adapt to him. Instead, we have to somehow bring him out into the great unknown. 

When people say they just want their child to be happy, it's a lie. They want them; "normal", healthy, and happy. 

October 22: Today had some ups and downs. We went on a family adventure to a pumpkin patch and hay maze. Towards the end we noticed he started to stress out. He did the hand flapping thing and added a new behavior. He'd open up his mouth in a O shape, it looked like a silent scream now that I think about it. But he was good apart from that.  
He discovered these toy dump trucks and became fixated on them. He also cleared off a pumpkin display table because Nothing can be on a table. 
Then he had a melt down when Char put a mask on. He loves his daddy so much. He says Bye Bye only to Daddy. After Char left for work Rory began spinning in circles. I'm starting to think it's a sign that he doesn't feel in control and can't quite handle it. 

Heidi Anne wants to become a doctor to find a cure for autism. That or a vet, she's a sweet girl. 

October 23: Tonight I told Heidi she could ask any questions or fears about Rory, with no worries of coming across as rude. And I'd answer to the best of my abilities. She wanted to know how Rory views the world? What is his life like? It turned into the follow conversation:

Heidi, you know some Spanish words right? 
You know how grandma speaks in Spanish sometimes?
Yeah, it's really hard to understand her, I can pick out a few words, but I don't know what she's really saying.
That's how Rory views the world. It's like he's living in a different country. He understands some of what we're saying but not everything. He knows a few words but not enough to tell us what he needs, wants, or is thinking. 
Why doesn't he hug me? 
You're learning about different cultures in school, right? 
Yeah, so...?
Well, he has his own culture. In his culture people don't hug or give kisses.
So he doesn't love me? (With eyes filling up with tears). But I love him so much! He's my only brother!
He shows he loves you in other ways. In his culture people don't really touch. But he'll cuddle up next to you. Or sit on your lap. That's his way of saying I love you. He's going to learn with Early Intervention and Speech therapy ways to interact with our culture. At the same time, we need to understand more about his culture. What he likes, hates, how he wants people to act around him. It's just going to take time. 

So now when she goes for a hug and he doesn't hug her back she says "Oh, right. Different culture." Also, when he cuddles up next to her to watch her play a game she happily states "Mom! He's saying "I love you" to me! I'm in his country right now!" Or if she gets frustrated with him I remind her "He's in a different country" or "Different culture".  

It's got to be hard on her, just as it is for me when we see other kids his age doing "average" things. But we're getting there. 

October 24: Rory's hearing appointment was today at noon. It was a long car ride down to Ogden, raining off and on all the way. We arrived the customary 15 minutes early, but since we were a fit in appointment, we didn't get seen until 12:30 pm. Rory kept busy by playing with a toy truck while we waiting. 

The doctor asked some questions about why we needed an hearing appointment so young. Not in a mean way, just trying to understand if this was an appointment to rule out a hearing disorder for something like autism or if there were concerns about him being hearing impaired. I told him it was a little bit of both.  

He waited until Rory got okay with him even in the room before he did any testing. Which was nice because Rory was spinning in circles doing his stressed out thing when we first came to the patients' room. 

The doctor performed an ear drum test. It tested to see if there was fluid build up in Rory's ears. He passed that test. Meaning he's got a clear and functioning ear drum. 

The next test was more of a struggle. I had to hold Rory down for nearly a minute per ear so he'd be perfectly still. He had to be perfectly still for this test, which just indicated wither or not he had perfect hearing. It was a pass / fail test. He failed it. The doctor said something as simple as his ears not adjusting to the change in altitude could cause a "fail". 

IF Rory could point to his ears, nose, mouth (point to anything), then the doctor would administer a last hearing test. Do you remember them from school. (Right, blog? Back in elementary school? Where you'd sit with those 70's / 80's fantastic huge headphones. Then raise your hand on the side of the ear you heard the various "beep" sounds.) But Rory can't do that. So now he needs a special test done only at, you guessed it, Primary Children's. Man you're on a roll today!

The doctor heard Rory's babbling and told me some of his observations as to why we'll find out his hearing is perfect or near perfect:

1. Rory babbles and "talks" in a normal tone of voice. IF he were hearing impaired he'd speak much louder. Loud enough so he could hear himself speak.

2. The words he does say sound fairly accurate. IF he couldn't hear well, the words would come out as Rory hears them. Also, he'd probably speak more words than he does.  

3. He never picked up sign language. Which means he's not connecting with us. Even hearing impaired and deaf children pick up on sign language. But autistic children tend not to. 

Now we wait for a new referral to get a new appointment with a new doctor at Primary Children's. I'm hoping to get into see them by the end of the year. Fingers crossed!!

October 25: We had his eye appointment today. It was a difficult appointment. Not only did Rory struggle though out it, but it removed any doubts I had that this isn't autism. 

First a MA came and tried to do some basic eye tests. Like use a flashlight across his eyes. Or cover one eye to see the other eye. He didn't like it very much, Char had to hold him down. Then she tired to put special glasses on him and have him point to pictures. We told her he wasn't able to do that. After which she left the room.

A while after she left, the doctor's assistant came into the room. He performed more tests on Rory, which took both Char and me to hold him still so the assistant could complete his tasks. Next, he dilated Rory's eyes, which almost made him cry. Then we had to wait 20 minutes for the eyes to dilate for the doctor to do his examination.
I went into the kids waiting room and brought back a toy dump truck and a puzzle box. He'd take the little puzzle pieces, put them in the dump truck and dump them out. Or put them back in the puzzle box. He's also play with the truck wheels. It kept him entertained while we waited for the doctor.

Finally, the doctor came in. This time I held Rory down, while a nurse and Char helped keep him still. Again, this doctor looked at his eyes. (What do you expect from an ophthalmologist office?). 

He finally came to a conclusion. Rory has a barely detectable right lazy eye. They only caught it because three people examined his eyes. Apart from that he has perfect vision. (The doctor also called him a very handsome boy). So the plan is to get him glasses in January, which should help align his eye within 3 months. IF that fails then we'll use an eye patch for a few months.

But the overall conciseness is his inability to look at us or point to things is a "behavioral issue" (AKA Autism). I'm sad because this was the remaining non-autistic problem there could have been. On the way home I made the statement out loud that my boy has autism. That is the remaining option. 

October 26- Today we got the official report and what type of therapy he'll be getting for at least the next 4-6 months. 
He'll be getting "Language Therapy" which is different then speech therapy. According to the language therapist, a speech therapist fixes incorrect speech and patterns. A language therapist just teaches you the words. So speech therapy could still be in the cards. 
He'll also be receiving Occupational Therapy, to help with his fine motor skills.  

His goals for the next 6 months are:

  • To learn 10 new "functional" words. (Words like; up, cup, food. Words that serve a purpose in every day life. So 1.6 words per month.)
  • To learn the word and meaning of "No" without the angry tone.
  • To be able to drink sitting up
  • To be able to use a spoon and fork properly.

We also got his skills results back as well, it gave an age equivalent, too: 
Cognitive:      11 Months 
Adaptive:       12 Months
Gross Motor:  15 Months
Fine Motor:    14 Months
Social Skills:   13 Months
Personal Skills:  8 Months
Communication:5 Months

We called around and discovered that psychologist won't see Rory until he's age 2. That's when they no longer "grow out of it", before then I guess there's hope? They said call back in a few months to set up the appointment. Which bites because I want to know now what's going on. I also want to get him into ABA Therapy but they won't accept you until you have an official diagnosis. Now we're just in a holding pattern.

Worried about Rory

Preface: We're going through a rough time right now with Rory. I wanted to wait to publish this and another post I've been working on until we got a diagnoses. But it looks like that isn't even a possibility for at least 4 / 6 months. So here's what we've been going through.

I may never publish this, it could be for nothing, just a mom overreacting. But I need to talk to someone, besides Char. So you're it blog. Aren't you lucky? I'll only publish this if there is something going on. Otherwise, it's just a mom who hasn't had a baby boy before and every kid is different. 

Rory at 9 months:

He doesn't respond to his name. You can call "Rory" till the cows come home, but he won't turn around. He responds to tone, he'll turn around. But you can call him "Sally", "Bobby", or "Sue" and he turns around. I could swear that by the time Heidi Anne was his age she was responding to her name. Maybe he just doesn't know it yet? 
Also, he'll only drink laying down. Perhaps, it's just a "Rory" thing. Just enjoy it while it lasts.

Rory at 10 months:

Rory has started this clicking sound. He does it when he's happy but also when he's upset, too. It's kind of cute. He still won't respond to his name. But with all the stress right now, well, maybe he's just reacting to it. Look at this cute guy!

Rory at 11 months:

Well, Anastasia was born. I'm keeping a separate update on her. He's become a crawling machine! So close to walking I'm sure!! He says "Momma"! and "Dadda", and "Ball. Maybe this worry is all for nothing. 

Rory at 12 months:
Well his birthday didn't go as planned. He REFUSED to do the smash cake. He hates getting messy, like he physically can't stand it. This is as messy as it got. My concerns are growing. He won't wave "Bye" or "Hello". He can only drink laying down. We've tried different sippy cups, but he will go without drinking. It's like he can't learn to drink sitting up.He still isn't walking. But he can stand and cruise around just fine. 
Char is starting to worry about him now as well. But his doctor said "He was premature. Let's compare him to an 11 month old. Give him more time. Don't worry so much." Then asked and talked about Anastasia."Take care of the new baby, she needs you." Which made me feel better. Anastasia needs me more right now, and apparently all he needs is time. He says "Heidi" and "Uh-Oh" now, too. 

Rory at 14 Months:

Sorry I haven't written, life has been hectic. Anastasia just got home this month. Something finally clicked with Rory and he's started walking. I'm so proud of my handsome little man. He does this adorable thing with he's hands as he walks. He opens and closes them in time to his steps.

Rory at 16 Months:

I'm using gray for a reason. Something is not right. My mommy-tution is telling me this. Here's some things worrying us.  
  • He's stopped saying "Momma", he only will say it if he's super upset and crying. 
  • He's stopped saying "ball". I can't get him to say it for the life of me.
  • He doesn't look at you, more like he looks through you. 
  • We went to a family reunion and he didn't do well. He freaked out when he normally just goes to sleep right away. But, no, he had a meltdown.
  • He'll only eat in a high chair, like he'll nibble if he's on your lap, but he won't eat unless he's in that high chair. 
  • He still doesn't respond to his name. (I know you're not supposed to compare kids but his cousin responds to their name and he's 7 weeks younger than Rory). 
  • He will only drink on the floor like he did at 9 months old. We've tried many different types of cups, sippy cups, straw cups, the whole gambit. 
  • He gets super obsessed over certain toys. 
  • He won't give hugs or kisses. He'll take them but won't give them.
  • He doesn't wave "Hi" or "Bye".
  • He won't play the "Where's your eyes, nose, mouth, ect." game. 
I can't wait for his 18 month check up. I'm sure this isn't normal behavior. Char is really worried, which makes me more worried. But he's so happy. Just my happy boy. 

Rory at 18 months:
Well, the Well Child check didn't go as planned. The doctor agreed with me something is off. He's delayed in speech, and the phrase "autistic like behaviors" came up. I'm going to keep a better detailed log of this new journey we're going through. 

2016 has been one HELL of a year. A 3 month premature baby isn't enough? Now something is wrong with my only happy little boy? I keep asking myself, WHY?? But I know no answer will be coming any time soon. 

Sunday, October 23, 2016

This is (Almost) Halloween!!

All Together!!
When we lived in Logan we had three fun Halloween activities we'd do every year: 
1. We'd go to a pumpkin patch and pick our own pumpkins. 
2. We'd go through a corn maze, during the day to be more Heidi Anne friendly.
3. We'd go to the Logan Pumpkin Walk. 
4. We'd paint our pumpkins. Because Me+Knives= Bad News

Well, we haven't done any of those things since we moved from Logan. Mainly, Char was back in school, then we had a 9 month old baby and I was having a rough pregnancy. I decided we'd try to bring back the traditions since Heidi Anne misses them and I want to continue them for the babies. 
Sadly, there are no corn mazes or pumpkin walks here in this part of Wyoming. I did find a pick your pumpkin that had a hay maze. While not a corn maze, it's a start. I'm easing back into adventures now that Anastasia can participate, with in reason. (We promised Heidi Anne and the babies that next year we'll go to a real corn maze). 
Regardless of what grain the maze was constructed from the kids were excited. We went at around 1 PM, after naps had been taken and the kids were feed. The weather was beautiful, sunny and in the low 60's. I pushed Anastasia in 1 stroller while Char pushed Rory in the other. Heidi Anne would walk between the strollers. Thus, making a family caravan through the hay maze. 
We decided to take our time, get lost, and get pictures of the different "scares". The babies seemed to enjoy the walk/ They were content, if nothing else, through the maze.We completed the maze in like 10/15 minutes even with meandering. 
Since the maze wasn't busy (only one other group of people were there at the same time as us). The maze people let Heidi Anne go through it again. She started out by herself but quickly turned back around to us. So Char watched the babies while I took her through the maze for some 1 on 1 time. After we finished, she promptly went through it again, but alone this time. My brave girl.
While Heidi Anne and I were in the maze Char played with Rory in the pumpkin patch. Char also saved some pumpkins on a display table. You see, Rory has this viewpoint that NOTHING should be on a table or table like surface. He will knock everything down until the table is cleared. 
After Rory "cleared" the display table of their pumpkins he found 2 toy dump trucks. They promptly became his new favorite thing. Yeap, more fun then clearing a pumpkin display. (Note to self: Dump Trucks = Christmas idea?) 
Once Heidi Anne completed the maze on her own we picked out our pumpkin. In Logan we'd go to a field and pull the pumpkin right from the vine. Today they were just in a little area for you to grab. I even got into the spirit and had my picture taken in the patch.
Then we ran to the store because Heidi wanted window clings to decorate our house for Halloween and I wanted a pumpkin pie for some unknown reason. Char put on a "Jason" / hockey mask at the store. Rory freaked out poor guy. It took some time to console him. 

Later that night Heidi Anne had hives up and down her legs. We believe she's developed and allergy to hay. Poor girl, to say she was uncomfortable barely describes it. 
Here is Heidi Anne's pumpkin painting creation:
Side 1
Side 2 

Saturday, October 15, 2016

Star Valley Temple Adventure

Side Note - I know this post is a bit delayed, I honestly thought I had already posted it. Ooopps. 

On Tuesday, September 27th we went to the Star Valley Temple in Afton, Wyoming with Grandma and Grandpa. We took Heidi Anne out of school early for this special occasion. 

The goal was to be there by 4:00 pm. It took us 2 hours to drive to Afton. Once we were there the babies needed changing and feed. We ended up with the 4:30 group. The tour started at a church, I think it was the stake center. We went into a room that gave an overview of what temples are and what they mean to us Mormons. 

Then we got onto a bus to tour the temple. You can only do this during an "Open House". We arrived at the temple only to be told no strollers were allowed. We meet at least 20 people (ushers and tour guides during our 30 minute wait) and no one said a thing about strollers not being allowed in the temple. 

Anyways, the tour started at the entrance, with a lovely stain glass piece of Christ. Then to the baptism fount, the sealing room, the instructional room, and the celestial room. It's a rather small temple. 
The Baptism Fount 
The Sealing Room
The Instructional Room
The Celestial Room
In a hallway of the temple Grandma caught a glimpse of a painting. Apparently, her grandfather had painted it. Which is nice to know many people will enjoy the artwork. Now we have a personal connection to the Star Valley Temple. 

Anastasia and Rory were miraculously quite and well behaved for the whole tour, which was about 40 minutes. As soon as we got outside, they became fussy. I planned on getting a nice family photo but the little ones wouldn't have it. (We really need to get a family photo sometime with all of us). 

Tuesday, October 11, 2016

Anastasia's Helmet Head

On Monday Anastasia finally received her new helmet. Char calls it a hat because it sounds more lady like. She'll be wearing it 23 hours a day, every day, for 3-4 months. (Until her asymmetry changes from 19.5 degrees down to at least 3 degrees.) That'll take some time. 

It's a lovely helmet covered in little pink, green, and purple hearts with a light yellow background, I think it shows off her sweet nature. It's certainly an improvement from the utilitarian clear helmet Heidi Anne had as a baby. 
Heidi Anne's Helmet as a Baby
The day started out with a physical therapy appointment where she is showing some improvement. We just need to go down to Ogden every other week now. We could really use the good news, things have been a bit gloomy lately. 

Later in the afternoon, she had her helmet appointment, which took over an hour to fit her helmet! That's a lifetime with a cranky eight month old. 

The helmet was molded based off what her perfect skull shape would be. (We got a copy of the 3-D mold which is cool and a perfect place to keep her helmet when not in use.) 
The doctor placed the helmet on her head, which she didn't like, and began making marks along the top of her head. When he was finished he went and cut a huge hole in the top of the helmet to provide air flow.  

We put it back on her again, making new markings along the sides and bottom of the helmet. Then proceeded to cut and buffer along the markings to provide comfort, expand her field of vision, and more space for her little ears so they don't rub the helmet all the time. 

We put it on her a 3rd time. He thought he could give her more space for her ears and raised the back of the helmet to help with her torticollis. The doctor was finally happy with the look and fit of the helmet after fitting number 4!

We started the helmet therapy with 2 hours on 1 hour off. Just to get her used to the feeling of it. It'll increase to 23 hours on 1 hour off in a few days. In that 1 hour I have to change her clothes, bathe her, and do her physical therapy. So it'll be a spaced out 60 minutes.