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As a result, glucosylceramideaccumulates in the mononuclear phagocyte system, primarily within macrophages.This accumulation leads to macrophages loaded with lipid-engorged lysosomes[ 13].

There should be atleast one intervention for every objective.

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In the series ofRoss and Hu [45], 24/76 (32%) of the pelvic radiographs were normal at the time of thefirst examination. While some arelocated in cytosol and the endoplasmic reticulum, AlDH2,the major form responsible for the metabolism of simplealdehydes, such as acetaldehyde, is localized to the mito-chondria. Also recorded was a meanincrease of 60.6 meters in the group who received 120 mg compared to amean increase of 107 meters in those who took 240 mg. Anticholinergic Dry mouth, blurring ofvision, constipation, urinary hesitancy in elderlymales (thioridazine has the highest propensity);absent in high potency agents. The nasal resistance PTP buy modafinil china respectively, ?49 and ?56 % (Essouri et al.is already high in children, and additional 2008).

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Happy Mother’s Day a week late to all the moms and moms-to-be out there! Our Mother’s Day was a bit different than planned, but still very nice. The original plan was to go up to my Grandma’s house and spend the day with family. We had to alter this when Max got sick Saturday night. He didn’t have much appetite on Saturday but was otherwise okay. Then when Jeff and I went in to check on him before we went to bed, the poor kid had thrown up and then gone back to sleep! We got him all cleaned up, the sheets changed, got him back to bed, and about 15 minutes later we heard some odd noises…and he had thrown up again. Repeat the cleaning, and then I slept in his room because we were afraid we’d miss it if he threw up again, since he didn’t make any fuss. Thankfully he slept the rest of the night and there was no further throwing up. So Sunday we took it easy, he seemed to be doing pretty well so we ventured out to Taco del Mar for lunch, took a couple walks, and hung out at home.

This week marks another growing-up milestone in our boy’s life. I’ve written before about how Max loves to suck his right thumb while pulling his left cuff over his hand and holding onto it. With the warmer weather, we decided it was time to transition him to sleeping in short sleeves…which of course means no cuff. Overall he’s done really well, there is a bit of crying when he goes to bed at night and when he wakes up in the morning, but not as bad as we thought it might be. The thumb without the cuff just doesn’t seem to be as comforting. We put a small blanket in the crib with him in the hopes that he’d use it in place of the cuff, but so far no such luck.

On Friday Max’s physical therapist will come to our house and do an additional evaluation. Then at the next visit we will make a plan for his treatment. I will be sure to update as we know more!

A mother-son moment on Mother’s Day:

Eating chips like a big boy:

One of Max’s birthday gifts was a small ride-on car. He loves to sit on it and have us push him around, and he’s starting to get the hang out of moving himself on it, though he’s more successful going backwards than forwards. Here is cruising in the kitchen:

Have a good week!

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I promised an update on Max’s medical appointments this week, so here you go! On Wednesday we had Maxwell’s physical therapy evaluation. They evaluated both his fine and his gross motor skills. He did great on the fine motor assessment, which involved doing things like putting Cheerios in a small container (of course some went in his mouth), “coloring” with a crayon, and turning the pages of a book. He was 13.5 months on the day of testing and his fine motor skills were at a 15 month level. Gross motor was a different story, as we expected. The physical therapist warned me before she scored the test that his gross motor would be really low, just because he isn’t doing any crawling. Sure enough, he scored at a 7 month level, or a 40% delay. This qualifies him for Early Intervention services, so a physical therapist will be coming to our home and working with Max probably once a week, and also coaching us on things to work on with him. The good news was the therapist said she didn’t see any red flags that this would be a long-term problem. She said she could see that Max knew what he needed to do, he just doesn’t have the strength to do it. He has low muscle tone, so he starts to do something, it feels unstable, and then he stops and relies on his charm to get us to reach whatever he wants. So we need to work on encouraging him to get things on his own and helping him to get to what he wants. She also showed me a few things to do with him to work on building his strength. After the appointment my mom took Max home again and I went back to work. Mom called me shortly and said that Max was in his crib for naptime, repeatedly pulling himself to a stand and flopping down, which he hadn’t done yet. So I guess the eval gave him a little motivation!

Yesterday was our pediatric ophthamology appointment to assess Max’s slight bit of lazy eye. This runs in my family so we wanted to be extra cautious about getting it checked out. We had to drive almost an hour to and from the office and then were there for almost two hours, and Max was a champ. He was examined by the nurse, then examined by the doctor, then the nurse came back and put drops in to dilate his eyes, then we waited for the drops to take effect, then he had another exam from the doctor. Quite the afternoon! We got good news; the eye doctor said that Max’s eyes are very healthy, look great, and he does not need glasses. He thinks that the condition will most likely correct itself. Max will go back in a couple of months to have the nurse check him, and they will continue to monitor him for the next year. If it gets worse, then we will need to intervene, but otherwise it should just get better and better. That was great to hear. Max also got lots of admiration for his cuteness while we were there, which is always fun.

Here’s a few random pictures from the last month that I haven’t shared yet. In honor of Mother’s Day coming up, a couple of Max with Grandma. This was out to lunch at a local spot that has a train that runs around above the tables, a definite hit.

Here’s Grandma saying “Choo choo!” as the train comes around the corner:

On the way home that day Max was reading one of his all-time favorite books, “Hippos Go Berserk” in the car. First upside-down, then right-side up:

Getting ready to do some Costco shopping and tasting of free samples:

For his birthday, Max’s Oma and Opa got him a little table and chairs. Here he is checking it out and demonstrating his “scrunchy face:”

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I don’t have a lot to write about this week, but I wanted to get a couple new pictures up for Max’s adoring fans. We’ve had a very nice weekend. On Saturday I co-hosted a baby shower for a friend at our house. Max slept through most of it but enjoyed hanging out with us towards the end of the afternoon. Then Saturday night our friends Laura and Dave came over and brought dinner (their delicious shrimp pizzas). Max was in fine form and performed all his tricks for them…blinking, nose beeps, the “more, ” “all done” and “milk” signs, lots of waving and of course plenty of general cuteness. He also showed off his latest development on the mobility front: He stands by the side of his toy shopping cart, pushes it and takes steps! It happened by accident a few days ago, and then we figured out that it works better for him than pushing it from the back or front, because the wheels just slide sideways across the carpet and the cart doesn’t move as fast. He’ll do (guided) laps of the living room that way now.

Today we got to babysit for a friend’s little girl who is just a couple months older than Max. It is always fun to see what things she is doing and she liked checking out the toys at our house. Her favorite part of visiting us is crawling up the stairs (closely supervised, of course!). All in all, a great weekend!

This week we have Max’s physical therapy evaluation on Wednesday and then his pediatric opthamologist appointment on Thursday, so it will be a busy week! Here are a few pictures: