More on PharmaNAC

PharmaNAC has been wonderful for Ayden Jane in many ways.  I KNOW that our results are not typical.  That seems to be a recurring theme for AJ...

Here are the good results.  Clear upper respiratory system.  Ayden Jane did get a bit of a cold, like Mckenna, but it was cleared out in a couple of days.  No extended goo, no infection.  Nothing short of miraculous.

The big surprise, however, is that it is causing her brain and mouth to be much more connected.  Basically, AJ has great verbal skills, but when trying to express complex ideas or when a lot is going on around her or she is just surrounded by new people/places she struggles to get those ideas out.  It is not a true stutter, but that is generally what we call it.  Basically she repeats the first few words of the sentence a few times while her brain is working on the second part.  Then throw in some basic pauses and the end result is that it requires a LOT of patience from the listener and determination from Ayden Jane.   After about a week of taking the NAC, I realized that she hadn't "stuttered."  I am not really sure when it stopped because it was noticing something was NOT happening...  I asked Gary and he said he could not think of one time either...

It is like the thoughts in her head now just come flowing out with ease.  Here is an example over breakfast.  Just imagine that there is only a split second pause after each question where you cannot possibly get in an answer!

Was Santa born? If he was who are his parents? If he wasn't born does that mean he was made? Did God make Santa? Why did God make Santa? So we could get presents? How old is Santa? What about the elves? Did God make them or did Santa make them? How old are they? Do Santa and the elves ever die? If they die what will happen to Christmas? Can the elves talk? If they can talk, why does Fiddlesticks (our elf on the shelf) not talk to us? Is it that he can't or because Santa told him not to? Why doesn't Santa want him to talk to us? Is Santa afraid Fiddlesticks will accidentally tell us his secrets? You know, Santa lives at the North Pole. So do polar bears. How do polar bears keep warm when they swim in the cold ocean? That's just crazy! We have a bear cave at school. How many types of bears are there in the world? How come bears look so different but are all bears? ...

And it goes on forever....  It is amazing.

Now the down side (why does there always have to be a downside?).  PharmaNAC was tearing up her belly.  Ayden Jane did not complain, but you could see that her belly was bloated and, pardon the bathroom discussion, but her poop turned to pudding.  I thought that the side effect may diminish over time but it continued to gradually get worse and I was beginning to worry she was going to have problems at school.  I told her teacher of the problem and assured her that it was the result of something we were giving her to help her.  The teacher's response shocked me.  "Is that why she is so much quicker to answer and is able to transition so much easier now?"  Ummm.  I guess so!

Well, with no hope for improvement in sight I decided to try giving her PharmaNAC every other day.  The evening after skipping a dose we were at horses.  Ayden Jane was trying to retell a story and she just got so stuck.  It kept wanting to come out backwards and she kept repeating parts of sentences.  I was getting frustrated and then it hit me.  This was our normal just a few weeks ago!  I just couldn't go back!!!

Faced with the choice of torn up gut or dis fluency in speaking I had to find a different solution.  (By the way, the break took care of the gut)  Dr. Miller was concerned that if I opened the package and used half a tab that the other half may not be useful the next day.  I just was not up for throwing away half a dose a day.  This stuff is expensive!!  She gave me the mission of contacting the company.

Victory!!  The effervescent tab that they make is more stable than powders or powder in capsules.  It was suggested that I snap it in half and save the other 1/2 in the packaging and/or saran wrap.  Basically, they said that it may lose some of it's potency to oxidation but it should be minimal in 12-24 hours.

So, we are currently using 1/2 a tab daily and things are flowing at appropriate rates from both ends :)  (I just couldn't resist)

Speech Therapy and Letters

We decided at the end of the school year to take the summer off of speech therapy. I was curious how it would go, but confident that we would not lose too much ground even if it proved that the benefits of therapy have been bigger than we thought!

So how has the experiment gone? We can positively say that the speech therapy is a necessary part of Ayden Jane's life. We are lucky in that, for Ayden Jane, ST is for articulation only. I don't believe a break in therapy is possible for those who are dealing with apraxia or other more whole language delays.

Basically, we find that we are asking Ayden Jane to repeat herself more and more these days. That is something that we, as those who spend a lot of time with her, did not have to do last spring. I can't put my finger on what sounds are getting left out or replaced or 'mushy' but I find myself asking her to say it again... and again. Luckily Ayden Jane is not getting frustrated by this and I get a kick out of how, on the second or third 'say it again' she usually get louder. Like she thinks we just can't hear her or something.

Her word order is often strange and she still uses pronouns incorrectly more often that correctly. (or maybe I just notice cause it sounds so cute) For example: Sadie not give me she ball. or Her want me to give she a drink.

The poor articulation does not, however, deter AJ from increasing her vocabulary. She is good at using big words (if you can understand them). Some off the top of my head are: supplements, eventually, frustrated, patiently, annoying, actually, determination.... She is just a parrot and understands words and loves to use them.

Ayden Jane is also getting very interested in letters and books and reading. She is constantly on the look out for the letters in her name. She is good with recognizing them and is interested in how the letters make words. As for writing them? Wow is that an area that we will have to really work on. I will leave that for a future post.

Ramblings

First off, the big bloated belly has resolved. It did so over a couple of days where all Ayden Jane wanted to do was drink and she pottied more in 48 hrs. than she does in a normal week! I have no idea why it came or why it went. I guess I will leave it as an unsolved PWS mystery for now and worry about it if it continues to randomly occur.

Next up, PT today. Jen is happy with how back to symmetrical Ayden Jane is but she definitely has some work to do on the hanging belly. Ayden Jane hangs her belly on the ligaments in the front and has managed to stretch them out pretty well. She has enough trouble with this problem and then went through the massive belly thing and wow. It is always fascinating to watch Jen work with her on this stuff. She started by having her stand with her heels up on a notebook. (elevated her heels). At first AJ could not even balance properly, but once she figured it out, she was standing beautifully with her back straight instead of swayed. It is another way to approach getting her to stop locking/hyper-extending her knees. They they moved on to lots of belly work and Ayden Jane looked much better. I am guessing that new orthotics in the fall when we go back to school (and actually wear shoes) will be necessary.

On other fronts, Ayden Jane's swimming is getting amazing. Today for the first time she was jumping in the water (slightly over her head) and coordinated getting a breath. She has jumped in the past but just held her breath the whole time and could not figure out how to breath when she came up. I am really hoping this will translate into being able to take a breath while swimming. (Hoping to get some help getting pictures soon!!)

Speech. This summer is our first ever break in ST since Ayden Jane started at 15 months. Last fall we transitioned to the school district for speech and Ayden Jane was doing great. We talked about whether to continue services over the summer and we agreed that we should take the summer off. Now, I don't know that taking a summer off of speech is an option for a lot of families because the speech is working on language/communication skills like vocabulary and expression. For Ayden Jane speech is just for articulation. I was really wondering myself how she would do without it. Let's just say, we (the family and extended family) all agree that AJ has lost some articulation skills. It is not horrible and I am not ready to call Mrs. R, but I will be glad to get her started again. I think AJ will be glad to get things going again so she doesn't have to repeat things so many times! I am sure she will quickly get back on track so I am not really worried, but I can say I am glad to know that it is a totally worthwhile hour a week!

Speech Therapy and Horses

Ayden Jane has been involved in Speech therapy since she was 15 months old. It is a little hard to tell with ST just how it is helping. Our original ST was great with AJ and helped get her going. Since AJ turned 3 she has been going to ST at our local school and seems to love the switch. It has been a change for me too as it is our first therapy where I drop her off and pick her up. Nope, I don't even stay. (Of course, it helps that I have worked with Mrs. R before and am completely confident in her.)

So, is it helping? Today we did ST at 8:30 before we headed over to AJ's preschool. As AJ climbed into the car after school her teacher said, "she was sure chatty today and I could understand most everything she was talking about." I guess we will keep ST! (As if there was any doubt.)

Now it will be interesting to tell over time whether these new language skills are from the speech therapy this morning or if they are a grand result of our latest sensory spurt.

We did not have horses last Tue. so it feels like it has been a really long time since we have been there. A couple of days ago AJ decided it was time to go see Zip. We spent about 15 min. in a 'discussion' about how it was not our day to go ride Zip and that Mrs. Rona was not at the barn and how Zip was sleeping... anything and everything I could think of. Of course, that simply made AJ inform me that I should call Mrs. Rona, wake up Zip, get my keys to unlock the barn... I think her little body just knows sometimes what it needs and that is a great thing. She is also tenacious and is willing to work incredibly hard to satisfy that need which is a quality that has helped bring her so far. It does not mean, however that I can always accommodate her! It is hard to be 3 and know you are right and not be able to get anyone to listen.

Tonight we have horses. The interesting thing is that Mrs. Rona switched Ayden Jane from riding Zip to riding Tamara last time. I have tried to tell AJ that she is riding Tamara tonight but she just 'informs' me otherwise. I told her that it is up to Mrs. Rona so she will have to talk to her about it. She says she will tell Mrs. Rona she is riding Zip. Let's just say, Mrs. Rona has a huge heart, but even the horses know better than to take her on head to head. I am almost looking forward to it.

Here Goes

I guess I will go in reverse order in time. That means I start with today. Ayden Jane and I went to visit Dr. Clark. It is about a 2 hour drive so it shoots the day, but Dr. Clark is great. She looked over some labs that had been taken as part of an NIH study. We are a little concerned about Ayden Jane's cholesterol. It is not too high, but with the healthy diet she eats it is hard to understand how it could be elevated at all. I am going to drop one egg yolk from her morning eggs and see what that does. Her IGF 1 level has a bit of room so we are also going to go up to 0.6 gh. Ayden Jane grew like crazy over the past month. It was definitely not my imagination that all her clothes seem to have shrunk. She shot up from the 50th to the 70th percentile in height. That puts her at a bit over 37 5/8 inches and weighing 32 pounds. Those numbers keep her just slightly lean for her height. PERFECT.

We also had horseback riding today. Starting last week Ayden Jane got a new horse to ride. Her name is Zip (although AJ calls her rip). She is much bigger than Mindy was and Ayden Jane LOVES her. I made the mistake of telling her at our appointment this morning that it she would see Zip later... Over and over and over, that is all we talked about for 2 hours home! Anyway, here are some really poor quality pictures to show you how little AJ looks on Zip.

Before we left for endo (remember, reverse time order) we had speech. It was just the second time with her new speech therapist and Ayden Jane loves it. She worked hard and is starting to come up with some sounds I have not heard her make before. She asked for blueberries this evening with supper and instead of the usual 'bu bu bu's' we heard something resembling balooberries. I'd say that's a pretty big jump. Another one is that she is making a sound something like the sh. Up until last week we wore hoos and took hower's. (shoes and showers)

While I was putting in the horse pictures I remembered to check for random pictures taken by Mckenna on my phone. These were taken at Kayla's volleyball tournament.

Say cheese!

Silly face!

This one shows the lovely scar on her chin from the stitches. It doesn't look too great, but as long as she doesn't sit around like this no one ever sees it anyway!

So much more to say, but so many dishes, clothes... to take care of. I will get back on track soon.

IEP

Now these 3 letters strike fear into the hearts of many parents of special needs kids. Not so much for me. First of all, I spent years on the other side as the special needs teacher and secondly because I just do not need to ask for too much. That said, here is how it went for us today.

Ayden Jane officially does not meet the criteria as developmentally delayed from her testing. Yep. Never been so excited to be average in my life! She does qualify for speech services with a language delay from the testing Nicole did in August. (Jen has thankfully agreed to keep AJ on her case load for PT so they did not even evaluate PT or OT) So, we know that cognitive ability falls in the average range, receptive speech is at least average and expressive speech has made great gains. Actually, she does not qualify for a language delay for expressive speech accept for articulation. She has a number of omissions and substitutions which make her speech unintelligible to those who are unfamiliar with her. In simple terms, she has the vocabulary and complex sentence structure but needs a translator. Ayden Jane will have speech therapy weekly at the elementary school. Perfect.

I asked Ayden Jane's preschool teachers to give a summary of how she is doing to help at the meeting. I thought I would include all the great things she is doing as I am amazed at my little one. This is a preschool without special needs students. Her peers are typically developing kids in her age group. Ayden Jane turns 3 tomorrow and I could not think of a better way to celebrate.

Ayden Jane is doing great in school. She has adjusted very well and has recently started to come out of her shell and communicate a lot more. She understands directions very well and is usually engaged in classroom activities. She is communicating more and more, not only with her teachers, but with her fellow students as well.

Strengths:
*Ayden Jane is very independent. She loves to do things by herself and is very capable as well. (even more so than many of her classmates)
*She is a very good listener and follows directions very well.
*Even though she may struggle with certain activities, she is a very willing participant.

Ayden Jane is a very good student. We have noticed that only in a month's time she has made marked improvements. The greatest improvement we have seen is in her ability to socialize with others. A strength of hers is that she has a wide vocabulary, however she struggles with articulation.

Weaknesses:
*Ayden Jane struggles with group activities that involve lots of physical activity. She tends to be more of an observer. (my take: too much to process too quickly to keep up with the song...)
*She sometimes needs to be asked several times to do something. She often needs eye to eye contact to communicate effectively. (my take: again, that pesky processing, can't screen out all the background noise to catch what is being asked)

Moderate Verbal Dyspraxia

As Ayden Jane was getting closer to 3 our speech therapist gave her an evaluation which was about as detailed as Ayden Jane could handle. We figured, the school district person taking over would need a clear picture of AJ but it would take a long time before AJ would cooperate sooo... Here are her results on from 2 tests. (we tested articulation because of the poor clarity of her speech even though her vocabulary has grown by leaps and bounds)

Goldman Fristoe Test of Articulation: Standard Score 66, Percentile 5 Honestly, not a shocker.

Kaufman Speech Praxis Test (KSPT): Therapist wrote - developed to assist in the diagnosis and treatment of verbal apraxia of speech. It is used to determine where the child's speech system is breaking down, and to help provide a systematic course of treatment.

Part 1 - Oral Movement. Ayden Jane scored a SS of 79 percentile of 6. Places her as mildly delayed. Considering we have not 'worked' any of this I am not too worried here.

Part 2 - Simple. Ability to produce sounds in isolation and simple word patterns. AJ scored a SS of 102 (woo hoo) percentile rank 58. This we have worked and it is obvious.

Part 3 - Complex. This evaluates the more complex word shapes. AJ scored a SS of 40 (yuck) percentile rank 2. Nicole did notice, however, that part of the poor score was that there were some sounds she was to use which she just does not yet have and she made the same mistakes (substitutions) repeatedly.

Part 4 - Spontaneous Length. This assesses the intelligibility. SS of 90, percentile rank 22. Nicole rated this using the information from part 3 somehow. I haven't had the chance to ask her about it yet, I am just reading off the report.

So to sum in all up: Based on the results of this testing, Ayden Jane is presenting with moderate Verbal Dyspraxia , which involves extensive replacements of sounds, length of utterance and complexity continue to result in motor-speech disintegration, inability to perform oral diadochokinesis, phonological processes are more consistent, and better productions of single words versus longer utterances.

In the end, it all means what I already know. Ayden Jane has a LOT to say, but cannot always get her mouth to cooperate.

Speech Therapy News

Nicole came yesterday and shared some of the results of testing she has been doing to get a good picture of where Ayden Jane's difficulties lie and to help me as I head to the school in the coming weeks to look to transition from early intervention speech to school district speech.

I do not have the test in front of me as Nicole is still using it to write up a report for the school, but I can't wait it out. I have to talk about it the best I can. The first section had some oral motor things. Moving tongue... Ayden Jane scored a 79 on that portion. (all scores are typical 85-115 within normal limits) I am not really concerned too much about it because I believe at least a portion of that score was the day and the 'not in the mood' attitude that was going on. Nicole is going to hit a few of those things in her last couple of months with AJ just to be safe though. On the next section Ayden Jane scored 102! This section she needed to identify things... Woo Hoo. On the next section, however, we find our problem. I cannot remember if she scored 40 or 60, but either way it was very low. Now the good news is that helps me get her qualified... It also revealed some things that make Ayden Jane hard to understand sometimes. Nicole described some things AJ was doing that she found very interesting and that she also feels are 'very therapy friendly'. Finally, she definitely is still missing some sounds that are supposed to come developmentally later and we expect will be delayed a bit.

All in all, I think it is good news in that the majority of her speech issues are articulation related. It seems that the hypotonia that comes with pws is at least part of the trouble, but I my gut tells me that the motor planning portion is giving her the most trouble. Definitely a little bit of the mouth coordination not able to keep up with the brain. As she tries to say more complicated things I see some frustration down the road if we don't keep working hard.

Potty Training Cont.

Well, I think we are trained ... as long as we are nakey. It seems that the next big step is to 'remember' to use the potty even when we have 'big girl pants' on. Something about the feeling of having even the little bit of something on makes her not really notice until it is too late. I guess practice is the only way that will improve? At least we have a good start.

On to other news. Communication is definitely improving. I don't mean that her vocabulary is growing by leaps or even that her articulation is getting better. She just combines things in new ways and is funny. It is hard to explain because the difference is subtle. Just that I don't feel like we have the same conversations or even the same 'root'. You know, those favorite repetitive phrases that, although we are thankful for, we have heard enough of.

All these new things just make her seem more like 3 than 2. I know we are approaching 3, but it still surprises me sometimes when she sounds and act 3. Definitely bitter sweet. We have worked so hard to be ready to be 3 and we are so proud of her, but as with all little ones, we will miss the tiny age. (Especially since it is our last).

Fun Busy

This week, like most of this summer, was overflowing with business. It was truly fun busy though. Not pre planned for the most part, just non stop action. The last 2 days were highlights for Ayden Jane. We had 2 wonderful little boys stay with us over night on Friday night. They are 7 and 5. (I will stick with numbers for their names since I don't even think their parents know I have a blog let alone having asked them if I could name the boys.) Mckenna was great with them and they all played and played. Ayden Jane totally just tagged along and did her best to keep up. We went to the pool and AJ was very excited that, "(7) and (5) ride in my car." After they came back AJ just couldn't take any more and fell asleep on the sofa watching them play the wii. The next morning she was beyond thrilled that they were still here and continued to ask where they were after I took them home. I am pretty sure Ayden Jane thought she was going to get to 'keep' them.

We also finished a speech eval. Friday afternoon before they came. Ayden Jane did a great job talking to Nicole and I feel like we got results that truly show the best she is capable of. Nicole is going to write a report with the scoring to help me get the right speech services for Ayden Jane next fall as she ages out of early intervention and into the school systems programs. I know that the schools are limited as to what they are financially able to provide right now, but I am definitely interested in fighting for speech. I just think it is so important for her. She is doing well, but it definitely comes and goes and only comes with hard work. It is also hard to measure, but there is just something still a bit off in how she just gets over whelmed with 'newness' and the speech just shuts down.

Nicole mentioned a couple things quickly in explaining what the eval was measuring for articulation and it was amazing how true it was. Ex. Ayden Jane cannot do any blends. If two consonants come together in a word, she just uses whichever is easier to say. Instead of plan we get pan, sleep is seep, truck is tuck, brick is bick, snow is no, swim is wim... The good news is that she is hitting some of her endings much better. Now in the grand scheme of language development is this a really surprising result? No. I just know that over time, we have seen it in both motor development and language, that things don't just happen with Ayden Jane. Don't get me wrong. I know we are incredibly blessed because Ayden Jane responds so well to therapies that she is doing amazing. Sort of like she learns with ease and retains much of what she is taught, but she definitely still needs the professional instruction to break the skills down and keep her progress moving. I should have the scores and report in a couple weeks.

Abs looking better, but what about those hips?

I am heading out of town tomorrow morning for my brother's wedding and I haven't even started to pack but I just had to do a quick update.

PT this week was great. Jen definitely feels that Ayden Jane is getting stronger and is very impressed with the ab work. The belly does not poke out so much and AJ is getting pretty good at sit ups on the exercise ball. I am not sure I could do them! I think the bump in gh has really settled in. I did ask her though about the way that AJ is bringing her knees together when she is bending ready to jump, and even some when running. Looks like a bit of hip weakness is back and she is slightly rotating when she does these things. It just looks to me like a 'less athletic' stance. You know, running a bit like your legs aren't quite under control. Now, to just maintain the abs and strengthen the hips at the same time. We shall see.

On the speech front, I think there have been some noteworthy changes. One example was in the car the other day. Ayden Jane saw a scrape on Mckenna's chin and said, "Mckenna have a owy on you chin. Does it hurt?" That second sentence is the one that is new. AJ has become conversational and asks questions... Of course, only when she is in the mood, but it is wonderful to know she CAN...

Lastly, food. Lately Ayden Jane has been putting off eating until she is completely unreasonable. I know this sounds nuts, but today she ate about 1 of her 2 scrambled eggs and the bit of applesauce I gave her to get the supplements down for breakfast. Then she did eat some almonds and tomato for snack at school about 11. She did not eat a THING until 3:30 after that and even at that I had to cave and give her a piece of dark chocolate to even get her to think about food. Finally, after I demanded she eat a hard boiled egg white if she wanted to go swimming she got into the swing of things. She followed up the egg with some chicken salad and off to the pool we went. I managed to get some avacado in her with supplements before bed. The problem with this is that she becomes a whiny, unreasonable grouch when this happens. I try really hard not to fall for the, just give her something... routine. Usually, I can get away with giving her some fruit to get her going, but recently she will just eat the blueberries and say all done. Grrrrr. I know, enjoy it now. Soon enough...

Silly AJ and Therapy

So lately, Ayden Jane thinks it is hysterical to run ahead and get into the room, house... anything with a door and close it so we can not get in. (Okay, we can get in, but we play into it a bit...) It is all a part of her growing love of hiding. She finds interesting places to hide. Anything from lying with her head under a pillow to standing so close to the wall her nose touches. Somehow she thinks this makes her invisible. She also knows how to hide under, behind and on top of things. So far she does not have the patience to hide long so all is well, and she has not transferred this game to times when we are out and about. For that I am grateful. I just love the grin and belly laugh we get as she gets 'found'. Today she extended her game and she climbed up on the bed with Gary and slipped her baby under the pillow. She asked Gary, "Dad, Dad, where baby go?" She giggled with pride as Gary 'looked all over for the baby.' I imagine she plays this game with Mckenna, but it was the first we had heard her pull this one. Very cute.

We also had PT today. Ayden Jane did well, although she was not entirely cooperative. The core is continuing to strengthen and AJ picks up new skills. She is now able to tip toe all over. Just a few weeks ago she could not even stand up on her toes. Weird. She is better standing on one foot and is throwing like a champ. We will pull the 'balance beam' back out tomorrow. I put it away as AJ was going through a bit of a sensory seeking spurt which included trying to do everything way too fast. She was tripping on it in the living room and trying to go down it so fast she was falling off a lot. It seems she is re organizing everything now so maybe she will do great on that too. She sure is back to climbing everything in sight!

Stubborn Streak

Let's see Wednesday this week we had PT. Jen thought that Ayden Jane felt great and was combining skills beautifully. Her attention span was great and she was not easily frustrated. She was goofy and fun and cooperative. Then came Friday.

Friday brought ST with Nicole. Now Ayden Jane tends to give Nicole a more difficult time in general I think partially because she just finds movement more fun than communication. I told her Nicole was coming and she was excited, but it was all down hill after that. (Of course the lack of napping - see below- was likely part of the problem) She just became completely stubborn. Nicole showed her a picture card and asked her to say the word. Ayden Jane told her, 'all done cards'. We pushed her, tried to bribe her with stickers... There was just no way she was doing it. We did give up eventually and she proceeded to play with some animals she likes, but still was not really talking to Nicole. So what do you do when your kid won't talk to the speech therapist?

Napping. Well, Ayden Jane has decided that since she is approaching 2 1/2 she no longer needs a nap. She is wrong. Unfortunately she is also very stubborn about making this point and will find ways to keep herself awake. She would not even fall asleep for a few minutes in the car this week! When tired, Ayden Jane's speech is harder to understand and her patience with us is very small. Bad combination. At least she sleeps well at night.

I have to be honest in that I do like the stubborn, independent streak in Ayden Jane. She will likely need it down the road, but there are days...

Christmas 2009

Merry Christmas. It was a great day, as all Christmas days are. There were lots of presents and Ayden Jane started to really get into it. The funniest part, however, was when she opened the play doh from her sister Mckenna and proceeded to plop down in the middle of the chaos to play with it. Every one climbed over her and she pushed boxes and wrapping paper out of the way to make a space. She still had several presents to open, but it was like she had been waiting her entire life for her own play doh so the world stopped for a moment.

The best Christmas present for us, though, was Ayden Jane is back to her old active self. Her new language skills are strong enough now that she is basically talking in complete sentences and active at the same time. She climbed right up on her new little tricycle and said, "watch, look I ride my bike." I was soo great to hear her and watch her and see it all come together with ease. I wonder if I will ever get to the point where I will not freak out every time we hit a bump in the road.