Thursday, April 17, 2008
Kyle was in the Newspaper!
Thursday, Apr. 10, 2008
Health & Fitness
Targeting autism early
Richland's CADET specialists take team approach to diagnosing, treating disorder
By Laura Kate Zaichkin, Herald staff writer
Kyle Long spent the first half of his life meeting normal developmental milestones.
The Richland toddler had a vocabulary of about two dozen words, played with his brother and was "spot on with everything," said his father, Nate Long.
Then his vocabulary began to disappear, and Kyle retreated into himself. "He was in his own world," Long said. "Other kids would be engaging with us, but he'd rather play with his trucks.
"He was a really happy kid so we didn't see anything wrong with it."
Kyle, now 3, was the first child diagnosed by Richland's Children's Developmental Center's Comprehensive Autistic Disorders Evaluation Team, or CADET, which started last month.
CADET is the only Tri-City team that uses specialists in many disciplines to diagnose autism. And they review the largest age range of children in the area, explained Christine Beck, the program's autism specialist.
Most physicians won't diagnosis autism before children are 3, while CADET's team of Beck, a pediatric neuropsychologist, physical therapist and speech therapist will diagnose those who are 15 months to 7 years old.
"We're all about early diagnosis," Beck said. "We want to push the importance of the early identification."
The disorder that affects one in every 150 children affects the development of social and communication skills. Autism affects nearly 1.5 million Americans.
Beck says early diagnosis generally leads to a better prognosis for the child. Once diagnosed, both the child and family can learn more about dealing with autism, including information on communication and adaptive and social skills.
Kyle was officially diagnosed with late-onset autism only about a month ago, though he has been at the developmental center since last summer with suspected autism. Already "he's made phenomenal progress," Beck said.
CADET is accepting referrals, and the evaluation process begins with a referral to Dr. Scott Grewe, the team's pediatric neuropsychologist. From there, the team does a series of interviews with the family as well as standardized tests that cater to the respective age group.
"They're pretty thorough," Long said. "They're things that parents wouldn't really think about.
"There's a lot of things that parents think are cute when their kids are young," he added. "But they're really flags."
For instance, Nate and Jana Long noticed Kyle laughed hysterically at things that children wouldn't normally find funny, like a child sliding down a slide. He also used repetitive motions with his toys.
Early diagnosis is just as important for parents and families of autistic children as it is for the children themselves, Beck said. Once diagnosed, families are provided with knowledge and resources to help them cope.
"Autism, no matter what, is awful and hard," Beck said. But education, "makes autism a little bit less scary. It helps parents feel less helpless."
Wednesday, April 2, 2008
Global Autism Awareness Day
Hi Everyone
Today is global autism awareness day (apparently as declared by NATO) and CNN made a bunch of great videos available on their website which focus on different aspects of autism from therapies to adults living with autism, even triplets with autism. If you have a few minutes you should check it out and view what might interest you. www.Cnn.com
Also, I ordered a 90 min. movie from an autistic filmmaker adult who created a documentary on adults living with autism. He is interviewed on Cnn. If anybody wants to check it out let me know and I'll get it to you.
Nate.
Sunday, March 30, 2008
Saturday, March 8, 2008
Kyle's Therapy at School with Teacher Karen
We're lucky to get video from Kyle's classroom! I hope you enjoy...
Monday, March 3, 2008
Update from Kyle's New Teacher
As you may or may not know, Kyle has been attending Richland School District for a little over a month now. Here is a progress report from his teacher:
Cognitive Skills: Kyle has been learning the routine and structure of our class. He is doing very well. When he started in our program, he didn't seem to understand the concept of matching. Kyle can now match object to object and object to picture. We have just started matching picture to picture. Kyle can now sort 5 colors of bears into 5 matching color cups. He is working on color identification "red." Kyle is working on "touch" or "give me" to receptively identify objects such as apple, banana, and shoe. When asked, "What's this?" he tends to repeat the question instead of saying, "apple, banana, or shoe." He is working on receptive and expressive identification of objects before he can move to picture identification. Kyle will come when his name is called. He is working on listening for just his name. He tends to want to come whenever anyone's name is called. Kyle is working on the command, "go play." He tends to sit and want a physical prompt before he will move (like a touch on his back). Kyle is working on following 1-step nonverbal commands (imitations) such as "Do this" and teacher touches table and wants Kyle to do the same. It has taken a while for him to learn what is wanted and is now starting to get the idea. Kyle can take off and put rings on a ring stand and will self correct to get the rings to fit. Kyle can put shapes in an 8-piece shape sorter.
Attending Skills: Kyle loves to work with the teacher. he seems to love to learn. He also sits well participates in the ending circle time. This is just a quick 5-minute time when we sing songs before going home. Kyle smiles and is starting to do the motions to the songs.
Social/Emotional Skills: Kyle will often respond to teacher "hi," but hasn't yet initiated saying, "hi." Kyle loves trains and vehicles. He prefers to play with these toys in the play area. Kyle will play next to his peers, but gets very upset if a child messes up the things he is playing with or takes a toy he thinks is his, even if he is not directly playing with it. We are working on sharing and taking turns. Kyle does have nice eye contact. He loves to play silly games with teacher and will have a back and forth interaction (looking at teacher and laughing).
Self-help Skills: Kyle is doing great with the routine of class. He walks in with his peers and with no assistance will go to his cubby and take off his backpack and coat. He will hang them up in his cubby. Kyle needs assistance to put on his coat. Kyle will sit at snack table and touch or say what he wants for snack (when given a choice of two things). He needs some assistance to clear his place at the end of snack, but will follow the direction of "push in your chair and go get your carpet" in order to be ready for ending circle. At the end of circle, Kyle will pick up his carpet and put it away.
Fine Motor Skills: Kyle is working on holding his crayon correctly. He can imitate a horizontal and vertical line. He loves to draw a circle, though he goes around and around and keeps going around. Kyle can complete a 9-piece knob puzzle. This seemed to be new to him, but he can now do a couple of these type puzzles unassisted. Kyle can take apart and put together pop beads. He likes to put them together and move them in a line like they are a train. he will say, "Thomas, choo choo."
Gross Motor Skills: Kyle loves recess. He loves to climb up and go down the slide. He will say, "come" to teacher to get teacher to go with him. We are working on Kyle asking other peers to go down the slide with him. Kyle has also just started in a language/OT enrichment group. This is 30 minutes a week and gives him the opportunity to practice gross motor skills plus following directions and using language.
Favorite Activity: Kyle seems to love school. He loves to "work" and seems to enjoy learning new things. We enjoy having Kyle in our class. He is making nice progress.
--Karen
Cognitive Skills: Kyle has been learning the routine and structure of our class. He is doing very well. When he started in our program, he didn't seem to understand the concept of matching. Kyle can now match object to object and object to picture. We have just started matching picture to picture. Kyle can now sort 5 colors of bears into 5 matching color cups. He is working on color identification "red." Kyle is working on "touch" or "give me" to receptively identify objects such as apple, banana, and shoe. When asked, "What's this?" he tends to repeat the question instead of saying, "apple, banana, or shoe." He is working on receptive and expressive identification of objects before he can move to picture identification. Kyle will come when his name is called. He is working on listening for just his name. He tends to want to come whenever anyone's name is called. Kyle is working on the command, "go play." He tends to sit and want a physical prompt before he will move (like a touch on his back). Kyle is working on following 1-step nonverbal commands (imitations) such as "Do this" and teacher touches table and wants Kyle to do the same. It has taken a while for him to learn what is wanted and is now starting to get the idea. Kyle can take off and put rings on a ring stand and will self correct to get the rings to fit. Kyle can put shapes in an 8-piece shape sorter.
Attending Skills: Kyle loves to work with the teacher. he seems to love to learn. He also sits well participates in the ending circle time. This is just a quick 5-minute time when we sing songs before going home. Kyle smiles and is starting to do the motions to the songs.
Social/Emotional Skills: Kyle will often respond to teacher "hi," but hasn't yet initiated saying, "hi." Kyle loves trains and vehicles. He prefers to play with these toys in the play area. Kyle will play next to his peers, but gets very upset if a child messes up the things he is playing with or takes a toy he thinks is his, even if he is not directly playing with it. We are working on sharing and taking turns. Kyle does have nice eye contact. He loves to play silly games with teacher and will have a back and forth interaction (looking at teacher and laughing).
Self-help Skills: Kyle is doing great with the routine of class. He walks in with his peers and with no assistance will go to his cubby and take off his backpack and coat. He will hang them up in his cubby. Kyle needs assistance to put on his coat. Kyle will sit at snack table and touch or say what he wants for snack (when given a choice of two things). He needs some assistance to clear his place at the end of snack, but will follow the direction of "push in your chair and go get your carpet" in order to be ready for ending circle. At the end of circle, Kyle will pick up his carpet and put it away.
Fine Motor Skills: Kyle is working on holding his crayon correctly. He can imitate a horizontal and vertical line. He loves to draw a circle, though he goes around and around and keeps going around. Kyle can complete a 9-piece knob puzzle. This seemed to be new to him, but he can now do a couple of these type puzzles unassisted. Kyle can take apart and put together pop beads. He likes to put them together and move them in a line like they are a train. he will say, "Thomas, choo choo."
Gross Motor Skills: Kyle loves recess. He loves to climb up and go down the slide. He will say, "come" to teacher to get teacher to go with him. We are working on Kyle asking other peers to go down the slide with him. Kyle has also just started in a language/OT enrichment group. This is 30 minutes a week and gives him the opportunity to practice gross motor skills plus following directions and using language.
Favorite Activity: Kyle seems to love school. He loves to "work" and seems to enjoy learning new things. We enjoy having Kyle in our class. He is making nice progress.
--Karen
Walk Around the Block
My boys love to walk around the block...they always find a way to spice it up!
Wednesday, February 27, 2008
Friday, February 15, 2008
HEEEELP!
THIS IS A NOTE I WROTE TO KYLE'S FORMER TEACHER TODAY
Hi Christine!
Well I decided to try some new things with Kyle and I'm having a tough time. So is he! I put all of his Thomas train stuff in a big tub and put it up. He seems to be fine with the change. However, I intended to let him play with it once a day, supervised. So later today he guided me to the tub and so I thought it was a good time to play. We took the tub down and set up his circle track. All he wanted to do was lay on the floor and push the train back and forth on the track. I wouldn't let him lay down and said "sit up" everytime he tried to lay down. He didn't like this whatsoever and threw a big tantrum everytime I did it. So I kinda ignored his tantrum and pushed the train by myself and made sounds and stuff. We tried this same thing yesterday and didn't get to play more than 5 minutes. Same thing today....I was tired of all the tantrums so I just put it away and he threw one big one.
So we went straight to the legos and started building stuff and he did okay. He was real upset and was trying to lick things and put things in his mouth. This is something he's never really done before. I think it's from the overwhelming stress of not getting to play with his trains anymore. He focused on the legos for probably 15 minutes...stacking them as I handed them to him. These are the real small legos so he was doing quite well actually.
I don't know what to do about the train stuff though. He gets so upset....I'm not sure if I should just get rid of EVERYTHING we own with wheels...b/c he's been trying to find anything with a wheel on it....I've been keeping it all up. We went outside to play and he found a dumb little truck and was constantly moving it back and forth on his belly so I threw it over the fence hehehe.
Got any advice? I'm trying!! The last two days I've been by his side almost non-stop, playing with him and making sure he's not stimming with anything. It's real hard to do. The only time he's by himself is when he's watching his 2 hours of movies. That goes by real quick. I haven't been able to get much done around the house because I've been right there with him all day. I suppose that's a good thing...hopefully Kyle will make some big improvements. Just tell me if I'm doing the right thing, please!
Nate.
------------
Teacher's Response:
I think your on the right track (no pun intended) by putting up the trains for awhile. I would advise you to put them up somewhere that Kyle does not know about for about 2 weeks. While the trains are obsessive for him and he really stems off them, they are also very motivating. So - put the trains up to let him release his obsession a little bit. you don't have to remove everything with wheels in your home. The thing is to find a replacement for the action. Since Kyle enjoys the wheels and turning or pushing them, look for something that is appropriate for that action. A wind spinner, connects, ummmm something that is meant to spin. Let him play with it for 10-15 minutes throughout the day, getting the sensory need met. Pair the activity with words such as "Do you want to spin Kyle? Tell me you want to spin." Require an amount of requesting from him and then allow him to do for a short while. By teaching him to request it with functional communication it helps teach him self regulation. Your right about the licking and putting things in his mouth. He is trying to regulate himself in a different way then spinning. The behavior cannot be stopped right now, but directed to a more appropriate way. If he finds a truck and begins to over it back and forth on his belly then use that as a teaching moment. You could work on things such as " prepositions, Kyle you have the truck on your stomach! Lets put it on your leg! OR you could take turns pushing the truck on your stomach. "My turn Kyle!" Then you lay down like Kyle and put the truck on your stomach and make vroom vroom or beep sounds. Do that for a minute or two and then"Kyle's turn!" Has you imitate Kyle, he will begin to imitate you adding the sounds or different subtle actions. It may take a few times of pairing the activity, but you will be amazed at the result.
Kyle will not play functionally with toys very much right now because he sees them in a different way. Typical kids see the car or truck as a mini representation of daddy's truck, but Kyle sees the working of the wheels, the doors, etc. We can't change his way of looking at it very quickly without rocking his world. so we have to teach him subtle different functions of the toy. Unfortunately children don't always want us to "teach" them so we have to kind of trick them into learning.
I am not saying you should let Kyle lay down and push a car for hours, but start small with the demands. Sitting up might be too big of a step at first. Maybe lay down with him with another car and push the car up and down a small ramp or make sounds, crash them, hop them, etc. Once Kyle begins to imitate that then push to another level and have him push them on a table.
When Kyle comes up to you and gets close to your face to "twitter" his eye lashes on you then kiss his nose and say "kiss nose!" Turn his stems and obsessions into a learning experience pushing the envelope a little each time.
It is great that your ignoring the tantrums, we don't want him to think that is a functional way to communicate. Tell him No ___! Count to 10 out loud with your fingers visually seen by him. When you get to 10 then see if he has stopped. If not then say No ____! and repeat. As soon as after 10 he has stopped give him the item or activity. This will take a few times (like 20) but it will again help with self regulation. Letting Kyle know he needs to calm himself down - then he can request correctly to get the item.
Hi Christine!
Well I decided to try some new things with Kyle and I'm having a tough time. So is he! I put all of his Thomas train stuff in a big tub and put it up. He seems to be fine with the change. However, I intended to let him play with it once a day, supervised. So later today he guided me to the tub and so I thought it was a good time to play. We took the tub down and set up his circle track. All he wanted to do was lay on the floor and push the train back and forth on the track. I wouldn't let him lay down and said "sit up" everytime he tried to lay down. He didn't like this whatsoever and threw a big tantrum everytime I did it. So I kinda ignored his tantrum and pushed the train by myself and made sounds and stuff. We tried this same thing yesterday and didn't get to play more than 5 minutes. Same thing today....I was tired of all the tantrums so I just put it away and he threw one big one.
So we went straight to the legos and started building stuff and he did okay. He was real upset and was trying to lick things and put things in his mouth. This is something he's never really done before. I think it's from the overwhelming stress of not getting to play with his trains anymore. He focused on the legos for probably 15 minutes...stacking them as I handed them to him. These are the real small legos so he was doing quite well actually.
I don't know what to do about the train stuff though. He gets so upset....I'm not sure if I should just get rid of EVERYTHING we own with wheels...b/c he's been trying to find anything with a wheel on it....I've been keeping it all up. We went outside to play and he found a dumb little truck and was constantly moving it back and forth on his belly so I threw it over the fence hehehe.
Got any advice? I'm trying!! The last two days I've been by his side almost non-stop, playing with him and making sure he's not stimming with anything. It's real hard to do. The only time he's by himself is when he's watching his 2 hours of movies. That goes by real quick. I haven't been able to get much done around the house because I've been right there with him all day. I suppose that's a good thing...hopefully Kyle will make some big improvements. Just tell me if I'm doing the right thing, please!
Nate.
------------
Teacher's Response:
I think your on the right track (no pun intended) by putting up the trains for awhile. I would advise you to put them up somewhere that Kyle does not know about for about 2 weeks. While the trains are obsessive for him and he really stems off them, they are also very motivating. So - put the trains up to let him release his obsession a little bit. you don't have to remove everything with wheels in your home. The thing is to find a replacement for the action. Since Kyle enjoys the wheels and turning or pushing them, look for something that is appropriate for that action. A wind spinner, connects, ummmm something that is meant to spin. Let him play with it for 10-15 minutes throughout the day, getting the sensory need met. Pair the activity with words such as "Do you want to spin Kyle? Tell me you want to spin." Require an amount of requesting from him and then allow him to do for a short while. By teaching him to request it with functional communication it helps teach him self regulation. Your right about the licking and putting things in his mouth. He is trying to regulate himself in a different way then spinning. The behavior cannot be stopped right now, but directed to a more appropriate way. If he finds a truck and begins to over it back and forth on his belly then use that as a teaching moment. You could work on things such as " prepositions, Kyle you have the truck on your stomach! Lets put it on your leg! OR you could take turns pushing the truck on your stomach. "My turn Kyle!" Then you lay down like Kyle and put the truck on your stomach and make vroom vroom or beep sounds. Do that for a minute or two and then"Kyle's turn!" Has you imitate Kyle, he will begin to imitate you adding the sounds or different subtle actions. It may take a few times of pairing the activity, but you will be amazed at the result.
Kyle will not play functionally with toys very much right now because he sees them in a different way. Typical kids see the car or truck as a mini representation of daddy's truck, but Kyle sees the working of the wheels, the doors, etc. We can't change his way of looking at it very quickly without rocking his world. so we have to teach him subtle different functions of the toy. Unfortunately children don't always want us to "teach" them so we have to kind of trick them into learning.
I am not saying you should let Kyle lay down and push a car for hours, but start small with the demands. Sitting up might be too big of a step at first. Maybe lay down with him with another car and push the car up and down a small ramp or make sounds, crash them, hop them, etc. Once Kyle begins to imitate that then push to another level and have him push them on a table.
When Kyle comes up to you and gets close to your face to "twitter" his eye lashes on you then kiss his nose and say "kiss nose!" Turn his stems and obsessions into a learning experience pushing the envelope a little each time.
It is great that your ignoring the tantrums, we don't want him to think that is a functional way to communicate. Tell him No ___! Count to 10 out loud with your fingers visually seen by him. When you get to 10 then see if he has stopped. If not then say No ____! and repeat. As soon as after 10 he has stopped give him the item or activity. This will take a few times (like 20) but it will again help with self regulation. Letting Kyle know he needs to calm himself down - then he can request correctly to get the item.
Wednesday, February 13, 2008
Here you can see Kyle eating his gluten free, dairy free pizza. It was the first time we made something like this--it turned out very good! Jana used rice/sorghum flour and rice cheese (which doesn't taste too bad--but not really like cheese). My dad liked it better than Papa Murphy's haha! I think he was just being nice. Oh, can you see my new floor, trim and paint in the living room?? We just got all that done two weeks ago!! It's fancy schmancy.
SSSKOOL bus
Jana makes another birthday cake! She makes one for every birthday, based on whatever theme or interest one of our sons is into. She has lots of fun with it. I think it's cute. :)
Kyle Education
Kyle has now advanced to public education after turning 3 years old last Sunday. He has been attending Richland School District at Jefferson Elementary for about two weeks now. He attends 2.5 hours per day for 5 days per week. His transition went very smoothly. He just put up a short fuss on his first day, but quickly adapted to their plethora of toys and play-based style of teaching. His teacher's name is Karen King and came highly recommended to us by Kyle's former teacher. I didn't even have to ask for her--Kyle just ended up assigned to her. So I think God is definitely watching out for Kyle. Thank you all for your prayers.
I haven't had much reported on Kyle's progress there at the school, as things are still pretty fresh. But, we plan to get some kind of commitment from them to keep us up to date at least on a weekly basis.
Kyle rides the school bus to and from school--he just loves it! When he's dropped off at home, he says "byebye school bus."
Jana and I are starting to address the finer issues of Kyle's behavior. We are going to focus on minor and major problems that Kyle struggles with everyday. Some of those include:
--Escaping while eating (i.e. running around)
--Wiping his hands on his clothes during eating
--Attachment to specific toys--More specifically, his inappropriate use of those toys (laying on the floor "stimming" with them). An example of this would be pushing his trains back and forth while staring at the wheels while they turn. This may seem innocent but it's very obsessive for Kyle.
A big one we will take on soon: POTTY TRAINING!! AAAAAAAAAAAGH!
I haven't had much reported on Kyle's progress there at the school, as things are still pretty fresh. But, we plan to get some kind of commitment from them to keep us up to date at least on a weekly basis.
Kyle rides the school bus to and from school--he just loves it! When he's dropped off at home, he says "byebye school bus."
Jana and I are starting to address the finer issues of Kyle's behavior. We are going to focus on minor and major problems that Kyle struggles with everyday. Some of those include:
--Escaping while eating (i.e. running around)
--Wiping his hands on his clothes during eating
--Attachment to specific toys--More specifically, his inappropriate use of those toys (laying on the floor "stimming" with them). An example of this would be pushing his trains back and forth while staring at the wheels while they turn. This may seem innocent but it's very obsessive for Kyle.
A big one we will take on soon: POTTY TRAINING!! AAAAAAAAAAAGH!
Sunday, December 9, 2007
Tuesday, November 27, 2007
More Blessings!
Great news from Dr. Grewe.....
He and several other doctors in the area with different specialties, including Kyle's teacher at the development center, are going to start doing assessments of kids as a team.
After seeing us for the initial consultation (Kyle was not there), the doctor said that Kyle would be a perfect patient to practice the new "team assessing" on, so that they can get a feel for working all together. So basically, Kyle will be able to get a very good assessment, buy a whole group of doctors, much sooner than expected, for Free! That will satisfy the school district, so that he will get all the services he needs. It's a real blessing.
Kyle keeps on doing terrific. It has been really exciting to see him start to initiate talking more. He's been saying short two or three word sentences, and definitely recognizes the meaning of most words he says. Just yesterday, he walked up to me with a teddy bear and showed it to me and said "Bear!" Not only did he say it without prompting, but he also wanted to show it to me, which is a great step in the social interacting and relationship building stuff. Sharing interests with others does not come naturally for him, but it's really important. After all, we don't just want him to be able to talk, we want him to be able to have relationships with people.
And another big step for Kyle.....he no longer sleeps in a crib! Isaac and Kyle got bunk beds for Christmas (and birthday :) ). He used to always roll around a lot at night and end up with his feet on his pillow and his head under his bead, or some other odd position, but he has been more normal lately, and last night he slept with his head on his pillow, under his blanket, in the middle of his new bed. It was pretty cute (I just had to peek in and see!).
He and several other doctors in the area with different specialties, including Kyle's teacher at the development center, are going to start doing assessments of kids as a team.
After seeing us for the initial consultation (Kyle was not there), the doctor said that Kyle would be a perfect patient to practice the new "team assessing" on, so that they can get a feel for working all together. So basically, Kyle will be able to get a very good assessment, buy a whole group of doctors, much sooner than expected, for Free! That will satisfy the school district, so that he will get all the services he needs. It's a real blessing.
Kyle keeps on doing terrific. It has been really exciting to see him start to initiate talking more. He's been saying short two or three word sentences, and definitely recognizes the meaning of most words he says. Just yesterday, he walked up to me with a teddy bear and showed it to me and said "Bear!" Not only did he say it without prompting, but he also wanted to show it to me, which is a great step in the social interacting and relationship building stuff. Sharing interests with others does not come naturally for him, but it's really important. After all, we don't just want him to be able to talk, we want him to be able to have relationships with people.
And another big step for Kyle.....he no longer sleeps in a crib! Isaac and Kyle got bunk beds for Christmas (and birthday :) ). He used to always roll around a lot at night and end up with his feet on his pillow and his head under his bead, or some other odd position, but he has been more normal lately, and last night he slept with his head on his pillow, under his blanket, in the middle of his new bed. It was pretty cute (I just had to peek in and see!).
Thursday, November 15, 2007
Jason McElwain (a must see)
This video tells a lot about the love of a community for their kids...especially their autistic ones.
Saturday, November 3, 2007
The Good Doctor
Jana and I have an appt. with Dr. Scott Grewe this November 19th. He will have an initial consultation with us regarding Kyle and make a determination of whether he needs to evaluate Kyle in order to obtain an "official" diagnosis. This first appt. is more or less a screening, to make sure we aren't wasting $1500 on an evaluation. Yes, he is expensive!! But, he's the best there is. And the school district needs a diagnosis from a neuropsychologist. I was going to take Kyle to Spokane, but I'm working out a deal with my insurance company to see Dr. Grewe.
However, things are going to get tricky. Jana is most likely going to take a new job next week. That means different insurance companies...yadda yadda..so we'll see.
However, things are going to get tricky. Jana is most likely going to take a new job next week. That means different insurance companies...yadda yadda..so we'll see.
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