3#

August has been a busy month for Audra so far with lots of follow up doctor appointments.

The most exciting of which was her GI appointment...

From April 2013 (when we brought her home) until June 2014 (when she got her feeding tube) she gained a mere 3 pounds, taking her from 22lbs to 25lbs.  Despite her voracious appetite and consuming enough calories to satisfy a grown man...she just didn't gain the weight she needed to.

In the seven weeks that she had been receiving supplemental overnight feedings of the specialized formula that is easier for her GI system to absorb...she has gained THREE pounds!!!

In only seven weeks she had gained the same amount of weight that it took her 14 months to gain!

At 28lbs she is still a feather weight...but 3# in 7 weeks is truly amazing.

For perspective here are my soon-to-be 7 year old's measurements:
28lb which is the 50th percentile for 2 year old
38in which is the 50th percentile for a 3 year old
(both are very far below the 3rd% for her actual age)

Audra has been taking pancreatic enzymes before every meal since early June and we have seen a dramatic improvement...she has had zero episodes of diarrhea!  This leads the doctor to believe that Audra has pancreatic insufficiency which resulted in her malabsorption...which is most likely the cause of her chronic malnutrition.  We will investigate this a little further with an ultrasound of her pancreas.

General Surgery (g-tube surgery follow up)
~ everything looks good with her G-tube and we are now able to change the tube ourselves at home (either for a routine change or if it accidentally becomes dislodged)

ENT (tympanoplasty surgery follow up)
~ she still has packing in her left ear from the surgery, so we will do more ear drops and go back for another follow up in 4 weeks

Audiology (hearing aid check)
~ could not test the hearing in Audra's left ear because of the packing, but she had her right ear tested and this was the first time the audiologist felt like she got a reliable behavioral hearing test on Audra
~ Audra was very consistent with moderate hearing loss in her right ear
~ the audiologist and I are very anxious to test her left ear and see if there is improvement after the surgery.  The left ear has previously tested in the moderate-severe hearing loss range.

International Adoption Clinic
~ there was the usual review of Audra's attachment and emotional well-being, followed by the nitty-gritty review of all her medical concerns and the treatment plan/follow up required with each specialist.  Each specialist tends to function in a silo, and so the Adoption clinic has been helpful in coordinating/overseeing Audra's medical care.
~ the truth is, though...we are no longer dealing with attachment or adoption related concerns, and her medical issues are not specifically orphanage or China related.  Her still somewhat mysterious medical and developmental concerns are just that...medical and developmental...regardless of her history of international adoption.
~ So, Audra has "graduated" from the adoption clinic.  We were gifted with a CHOP care binder in an effort to help us organize ourselves for the road ahead.

We are still waiting on a few appointments for Audra...
~ Neurology in September
~ Developmental Pediatrician in October
~ Genetic testing:  pending insurance approval, but if it is denied by the insurance company there is currently a research study at CHOP that Audra is eligible to participate in which will include the same genetic testing