Four years ago this month, I wrote a three part blog series on the cost of homeschooling. It makes sense that I wrote that series in January. January is when I start to think about the next school year.

For almost two decades now, we've deposited that spring (IRS) check in a special savings account earmarked for school costs.  Some years we haven't needed all of it, some years we have. Many years, the doldrums of winter were chased away by browsing curriculum catalogs, comparing programs, making wish lists, and dreaming of next year's fun.  The Cost of Homeschooling, Part 1

Nathaniel's airway surgery is about a month away. Now that Christmas and New Year's is over, it seems close. We wanted to share our plans and the needs our family has as the date approaches.

Both Rich and I will go to Cincinnati for the surgery. We have been told to expect a five hour surgery and for Nathaniel to spend a week in the Critical Airway ICU afterwards. Nathaniel will have a new stoma and possibly medical new care routines that we will learn before his discharge. We have been asked to stay in the Cincinnati area for a second week to be close to the surgeon and hospital in the event of complications.  There are three different ways you can help our family now.

A friend sent me this photo on Christmas Eve. "Baby Jesus has a trach this year," her text said.

Doll baby Jesus' mother is six-year old Maggie. Maggie's mother is a medic who spends her days training first responders in tracheostomy emergencies.  Maggie's grandmother is a Sunday School director. Maggie's grandfather had a trach. Blend it all together and it is logical that when a baby was needed for the Family Service nativity at church that Maggie's trached baby doll was cast for the leading role.

The baby wrapped in swaddling clothes and lying in the feeding trough had a tracheostomy.

About a month ago, I offered my layman's understanding on the functions of the larynx - it provides a passageway for breathing, it protects the lungs, it contains the vocal cords aiding in sound production, and it helps with eating. I mentioned in that post that having all four functions is not possible for Nathaniel. Tests during our last trip to Cincinnati Children's showed that Nathaniel still aspirates - his airway is unprotected - and that condition is unlikely to change with more time. The news we received in November was more brutal than hearing all four functions of the larynx could not be saved. Because Nathaniel's airway is not protected, it is not in his best interest to restore any larynx function.

Yesterday I visited my own blog to find a link for someone and realized it has been two weeks since I posted last. It takes our family at least a week to recuperate after one of Nathaniel's hospitalizations. Thanksgiving, recuperating, and now preparing for Christmas have all tumbled into each other and filled the empty crevices in each day.

Rich took off a couple hours early one Friday evening so we could go cut down our Christmas tree. With two of our older boys working retail, finding times for this traditional family outing was tricky. We can't remember the year we started going to this tree lot, but we think it has been around twenty-years. It is one of my favorite Christmas moments.

PrAACtical AAC, a popular blog for speech therapists working in augmented communication, shared a post this morning that hit me hard. "No matter what the age or type of disability," it said, "almost all AAC learners face the challenge of communicating effectively during encounters with healthcare professionals. People with AAC needs are among those who are considered to be communication vulnerable and do best when there are planned supports in place."

Communication vulnerable.

I had hoped to post some photos for Nathaniel's third birthday last week, but a sudden hospitalization reorganized all plans. He had a runny nose and sneezes on Friday, November 21st, and I assumed it was a virus. Nathaniel has had a handful of viruses that come and go like they do for most children. He woke up coughing Friday night and threw up. The night nurse needed to put him on oxygen -  often our first indicator that he aspirated.  

Three years ago tonight another woman held Nathaniel warm and secure in her body sheltered from the encroaching world. I don't know when her labor pains started or who drove her to the hospital. I don't know how many needle sticks it took to start her IV or what type of pain reliever she had. I do know that three years ago tomorrow morning, the doctors delivered a baby boy from her womb and she heard no cry.

The larynx does a number of things for the human body. Its most important role is providing a passageway for breathing. Second and almost equal in importance, the larynx protects. The coordination of nerves, muscles, and cartilage work together to prevent foreign objects, including spit, from entering the lungs. We are all familiar with this process. Something starts to go down "the wrong pipe" and we cough it out. That is your larynx doing its job. Another function of the larynx is to produce sound or our audible voice. A fourth function is to help move food and drink toward our esophagus and stomach. Four things: breathing passageway, protection, sound production, and aid in the eating process. We learned last week that having all four is not an attainable goal for Nathaniel.