My Journey To Bilateral Cochlear Implants

The New Tests

2009-07-28T03:59:00.000-07:00

There are some new tests that are being put through studies with Med-El to determine reliability, and all of that fancy stuff they need to do before releasing for use across the country. A couple of you asked what they are like and here is your answer. They are challenging...very challenging compared the the CUNY or HINT.

The first test (easiest) is two different people talking in quiet. You never know which person is going to talk but at least it is quiet.

The second test (middle) is two different people talking in noise. The noise on this test is not just the static white noise that we are used to. The background noise is other people talking. It is kind of like being in a fairly loud restaurant trying to follow two different people.

The third test (hardest) is four different people talking in noise just like I described above. This test is challenging.

All of the tests involve both males and females and no two tests are the same. However I will say that it is not the voices that trip me up as much as what they are saying.

In the HINT (the current hardest test) you might bet something like "the mother baked a cake." Not very difficult to interpret out of context like we do in a sound booth. The new test....the sentences are like this (this is one from the first test that I never forget) "He was an ordinary man who did extraordinary things." All of the sentences are like that and some are more difficult and longer than this one. I think the sentence structure and vocabulary make these tests more difficult.

Anyways...to answer the question about my current audiogram. Both ears are hovering at 20 decibels right now. They were a little higher in places...but this past visit I had the audiologist turn me down. I had too much power going through my head. It was funny that I actually told an audiologist to turn me down because I have always fought with audiologists to get more power than they would give me.

Anyways...I am off to class.

Three month update--Eight month update

2009-07-23T04:35:00.000-07:00

Okay so I went to Chapel Hill last week. Everything was fabulous. Of course I had a minor panic attack on the way there. As I was driving the long miserable drive I noticed that my right cochlear implant was cutting in and out. I started to panic. Well as I got closer to the hospital...it completely cut out. I was freaking out at this point. I got to the ENT office and checked in, then it was time to try to figure out what was happening. I started by switching out the cable connecting the coil and the processor, and voila....no more problems. I knew the cable would go bad and need to be replaced at some point but I did not know what would happen when it did need to be replaced. Well now I do and it was not fun!

When I got back to audiology with Marcia I had her check my residual hearing in both ears to see how it was doing. I still have all of my residual hearing in my right ear, which I am pleased with. My left ear is gone, I knew it was but it was nice to have this confirmation. The loss of residual in my left ear is probably due to the multiple insertions that took place when trying to get the electrode in that did not want to go in. My residual hearing is not important to me, rather I have found it interesting that it has stuck around this long.

Marcia put me in the booth for testing. She of course had to administer the more difficult tests that are being used as a part of the research where I get to be a guinea pig. Whoo! Anyways...remarkable improvement since the first time I took these tests.

The first time testing...May ----and now

Easiest of the three tests...68% (may).....now 96%

Middle of the tests...40s (May)....now upper 80s.

Hardest of the tests....60s (May)....now 92%

I was not expecting this type of gain for the tests...but I am pleased that I am continuing to make progress daily. The implants do sound better with each day, surprisingly. The brain is remarkable.

I will be traveling to UNC for some research (I get paid) regarding to the new tests they are trying to develop in the clinic.

But for now I don't have to go back until November unless they tell me otherwise.

Hope all the others that read this are doing well with their new ears!

Lauren

I hate moving!!!

2009-05-31T18:24:00.000-07:00

This weekend has been miserably strenuous. We moved this weekend and I could just about pull my hair out from trying to get everything done. I have decided....whether we like it or not....we are staying here for at least two years. I am not packing all of our stuff up again.

Anyways....the CIs are still awesome. I am looking forward to my appointment in July to see how things have progressed over the past month or so. The new place we are in makes some annoying noises....the dryer in particular at the moment. The darn thing squeaks and it is driving me CRAZY!!

Anyways....I am exhausted and hoping I can make it through the week alive as I start summer school classes for my Master's this week.

Yipee!

Lauren

Elk River Falls--fun sounds

2009-05-02T15:16:00.001-07:00

Kevin and I were bored this morning so we went out for an adventure. We went for a hike to the Elk River Falls. It was fun, no one was around, and the weather was perfect. The sound of the falls was amazing...it was a lot louder than I expected. I loved every moment of it though. The only thing I was wary of was the water. We climbed out on the rocks to sit in front of the falls and I was paranoid about falling and my implants going in the water, or better yet, them falling off my head and never being found again. Either way...I had a blast and I still have two implants! I know I am weird, don't bother telling me that. We noticed one thing at the falls that would take a brave soul...I would never do it. At the top of the falls there was a rope tied into a tree. We assume that it is used for people to jump off the falls, however I personally don't think that would be a great idea.

It was a great morning and we had a blast...we are very fortunate to live so close to beautiful things in nature. These falls are about 20 minutes from our house.

Anyways here is a picture of the main fall. The others are just small falls that flow into this one, and a few that go out.

This is me and Kevin being silly. I was trying to take a picture of us sitting on the rocks at the bottom of the falls.

A fun morning....now back to writing a paper!

Have a great weekend!

First Official Bilateral Mapping

2009-04-27T14:02:00.000-07:00

Today has been a long day, but well worth it in the end. Today was my first mapping since I went bilateral three weeks ago. The results were awesome and unexpected...especially by me.

I have been activated for two weeks today with the new ear. I was pleasantly surprised with the results.

On the tests (new ear only)....
Hint in Quiet 96%
Hint in Noise with SNR of 10dB 97%

They did not do the CNC test on the new ear. However they did do a new test with both implants. I am one person involved in the initial use of the new assessment. It was very interesting and much more difficult than the HINT or the CNC. I did well on that assessment as well. We did not go into great depths with that assessment today, just one list from each category.

I am just glad that I don't have to drive back to Chapel Hill until July....YAY!!! I have been up and down the road a lot lately, it is tiring.

Also best wishes to Sara as she has her first CI surgery this Wednesday!!

This is an answer to some of my visitors' questions. First of all THANK YOU for all of your well wishes and excitement for me. To answer one of your questions about things I am hearing now. I am hearing the same things I heard before, only better and clearer. There is one thing though that I did not hear until I received the new implant. I heard crickets for the first time. They were amazing. I just stood out onthe back porch and listened to them.

Have a GREAT week!!

2009-04-21T03:21:00.001-07:00

Things are continuing to get better...matter of fact they are AWESOME!!! I never thought I would say that I am actually looking forward to an audiologist appointment at UNC next week to test my ears, but I am! Things are sounding marvelous, but some times a tad too loud. We will have to play with my thresholds next week. We had my right ear up to 15-25dB across the frequencies. When we activated the new ear last week we did not check thresholds, but I think between the two that maybe they are just a tad loud. OR it could be the people around me. I know everyone is used to talking louder for me and now they don't have to, but they still are out of habit. I am trying to find "nice" ways to tell people to speak normal!

Anyways...all is well and I LOVE having two ears. After five months with only one ear I am thrilled to have two ears. I never thought I would say this...but I am actually looking forward to my graduate class tonight....I want to see how much better I can hear!

Have a great day!

The First Couple of Days with 2 CIs

2009-04-16T16:02:00.000-07:00

Well the first few days of both CIs have been very interesting. Things have dramatically improved. The bells that I was hearing the first day are gone. I am not hearing those anymore, which I love. I do still occasionally hear a bell if something drops or anything like that. The "voices" in my head have started to merge into one central voice. By voices...I am talking about how my ears sound. One ear sounds like Darth Vader. The other ear sounds like chipmunks. They have started merging together in my brain...I am now for the most part only hearing one voice.

Things are a lot easier to hear. I am able to hear conversation entirely without speechreading at all. This is a huge benefit, and I love it. I was able to talk on the phone with my new ear. I was talking to mom, so it was a familiar voice but I was not expecting to be able to do this. I am doing well with the new ear...I have been doing some therapy. I am able to use the new ear alone and understand about 95% of conversation without speechreading right now. I am hoping this will continue to improve as time goes on....I know it will.

But for now I am extremely satisfied with both implants...I do not regret having the second ear implanted by any means, even though they were not able to achieve deep insertion with the electrode. It has drastically changed what I can hear. I am actually looking forward to my first graduate class since the second implant to see how things are different in class....I am not looking forward to class on other terms because I have yet to complete all of the work from when I was out for surgery...that will be my weekend.

ACTIVATION DAY for CI #2

2009-04-14T15:45:00.000-07:00

Well yesterday was my activation for my bilateral CI. I knew it would be interesting as the electrode positioning was not the same as the first CI due to the ossification in my ear. However...it was dramtically different.

When the first CI was activated everything sounded like Darth Vader as I have much deeper stimulation in that ear. This CI sounded like the three chipmunks singing on helium. In other words it was atrocious. When she first turned it on...I heard the sound, looked at the audiologist and said "turn it off." We turned it off and made some adjustments. After we got everything adjusted and some more power in my lower frequencies and less in the high frequencies we turned it back on to live mode. This time it was better but everything was still high pitched. Although this time I started hearing the bells that most people with other implant companies talk about but this is not something I had experienced with my first CI. At the end of every word I would hear this little high pitched bell ring. I found it rather annoying.

Anyways...we got both CIs up and running together...everything sounded really weird, but I was able to understand speech without lipreading which was promising.

Today was my first full day using both CIs and the sound became better as the day went on. The bell sound is still there but I am not noticing it now like I did yesterday. I am ready to adjust my old ear though...I want some more power in the low frequencies to see if that will help balance out the highs on the new ear.

Overall...all is well. I love both of the CIs and it is amazing how much more I can already hear with the two CIs as opposed to the one CI and even the one CI and HA that I was using sometimes.

Now I am off of here for the night....it is time for the new ear therapy and then therapy with both ears. I go back to the audiologist on the 27th for my first official bilateral mapping.

More later!!

Pictures

2009-04-10T06:17:00.000-07:00

I said I would post some pictures. There is nothing graphic here...just pictures of me and mom hanging out in my room. I was bored, there was nothing to do with the exception of watching t.v. and nothing good was on.

So this is a picture of me and mom....

This is a picture of me indicating that this is implant number 2....aka bilateral time.

If I remember to take my camera I will have mom record part of my 2nd implant activation on Monday.

2nd CI Surgery Update

2009-04-09T06:28:00.000-07:00

Well I guess I should post about recovery and all that is going to follow. This was an interesting and long surgery. To start off my surgery lasted an hour and a half longer than expected. The surgeon found an unexpected surprise when he got inside my head that will affect some things, but makes me glad that I did go ahead with the second surgery.

When the surgeon was inserting the electrode into my cochlea (he was using the S array, long electrode array manufactured by Med-El) he ran into a slight problem. The electrode would not go all the way into the cochlea. He tried several times but it turns out that I have some ossification in my left cochlea (bony growth) that prevented full insertion. So eventually he switched out and used the M electrode (shorter array but still has 12 electrodes on it). He was able to get 11 out of the 12 electrodes on this array inserted in my cochlea. So overall the effects on me....well I will not have access to all the frequencies that I have with my other implant...but that is okay because I have them with the other implant.

The benefits...well primarily I am glad I did not "SAVE THE EAR" for later technology because chances are I would not have been able to be implanted in 10-15 years as the ossification would have continued. So I am glad I decided to get this done now.

In the meantime....recovery is going well...no pain. I have only had to take tylenol for any discomfort. The nurses were shocked in the hospital. I had the same nurses this time as last time, and last time I was not a pretty sight. After the first surgery I was on a morphine drip, demirol, and percocet. This time I was just taking tylenol. I was up walking around the unit...I was bored and tired of being trapped in the bed. I even asked the resident if the doctor did anything to my head...she laughed and said "oh he did something...I watched." I responded with okay...well it doesn't hurt this time and she just laughed.

Anyways I am passing the time until Monday when I get this bandage cut off my head and I am activated. I am curious to see how activation goes this time since the electrode array is inserted differently than the other one. I am just glad I have a doctor who was able to change things up during surgery and use the shorter array giving me more electrodes instead of staying with the longer one and having fewer electrodes firing off.

The surgeon brought my audiologist in while I was still on the table and had her test the newly inserted implant to determine the response. My brain did fire off a positive response, which is good. Both my surgeon and audiologist feel that I will do well with this implant as I have done extremely well with the first one.

Well I am off of here for now...but when I get the chance later today I will post some pictures from the hospital.

Lauren

2ND CI SURGERY TIME!!

2009-04-06T04:03:00.000-07:00

Well tomorrow is the lucky day for me. I go in for my second CI surgery tomorrow. Right now I am hoping that my surgery is in the morning so I can get it over with and not have to wait all day for it.

Today I am heading down to Chapel Hill to stay overnight so we don't have a long drive. I will update when I get home from surgery.

4 MORE DAYS!!!

2009-04-02T17:16:00.000-07:00

Well I am four days away from surgery. I go in on Tuesday. I am hoping that this surgery is in the morning. Last time I did not go in until about 2pm and I was starving when I woke up, but I was unable to eat. Right now they have me in at 7:30am for surgery and I hope it stays that way.

Otherwise...one more day at work this week. I have to finish up some things for the boys tomorrow and get them squared away for the next week, as I won't be there.

Then I have to get things packed for the hospital and go get my second cochlear implant. I am excited...although right now I have either allergies or a cold that is aggravating me. I hope it clears up by Tuesday.

10 Days and Counting!!

2009-03-28T08:51:00.000-07:00

Well I have 10 days to go until my bilateral surgery. I am definitely counting down the days. This next week is going to be a crazy, hectic, and EXCITING week. I am thrilled that I have the opportunity to go bilateral with implants. I have had the first implant for about 3 1/2 months now and I love it. I do not regret the decision of getting an implant at all. Matter of fact I am thrilled with that decision.

Anyways....I am spending this weekend getting ahead on some of my graduate work since I will be missing class the week of my surgery.

10 MORE DAYS!!!

Two Weeks to GO!!!

2009-03-22T06:23:00.000-07:00

Well I am down to two weeks until surgery and the days cannot go by fast enough. I liked the first time better, because I only had to wait four days between my evaluation and surgery. This time is killing my because I am so excited and all I can think about is my surgery.

Anyways....I am getting things in place for my students as I will be out of work for at least a week, maybe longer, depending on how I am feeling. I am trying to get lesson plans and all of that ready.

16 days and counting....this is so exciting.

CI Number 2 Pre-op and First CI 3 Month results

2009-03-10T17:25:00.000-07:00

Well yesterday was exciting in more ways than not. I had a visit to UNC for my three month mapping and testing as well as my pre-op for my second implant. I will start with my first implant testing results.

The audiologists are going to have to try and find a new test for me as I have done extremely well. They mentioned this new test they want me to try the next time I am in the office. It uses real human voices and is more real-life than the current HINT and CNC tests that are used.

My scores at 3 months post activation:

HINT in Quiet-100%
HINT in Noise-97%
CNC-78%

Otherwise I had my pre-op and all is well. Apparently my surgeon thought my surgery was today instead of a couple more weeks. I say this because he initialed the side of my head, this is required at UNC or they will not take you into the OR. He also gave me a great big hug. Anyways, I still have four weeks until surgery....APRIL 7th. That day can not get here fast enough!!

Until next time....

Exciting News

2009-02-18T03:33:00.000-08:00

On Friday the 13th....of February I received awesome news. I was approved for my bilateral cochlear implant. So everything is full speed ahead with my surgery on my left ear. I have pre-op on March 9, and surgery is on April 7. I am so excited I can't stand it anymore.

48 days to go!!

Something Interesting

2009-02-18T03:32:00.001-08:00

This is something my principal sent to me a couple of weeks ago.

http://home.att.net/~hideaway_today/t130/frog.htm

Things to Hear

2009-01-21T10:56:00.000-08:00

Well a little over a week has passed and things are still going great.

Over the past few days I have been able to hear a person tapping a pencil on the table in my graduate class. I was able to understand the professor when he was talking with his back turned to me.

My favorite has been the sound of the snow squishing under my feet, or the sound the snow makes when you compact it into a snow ball. The sound of the ice cracking as you open the frozen car door.

All of the sounds are great to hear and I continue to look forward to every day and the new sounds that day will bring. I am becoming even more excited about counting down the days until my surgery. A couple more months and I will hopefully be bilateral!!!

Random update

2009-01-13T03:46:00.000-08:00

So over the past weekend I was doing some housework and I realized things that made sound...it was interesting and exciting.

I was mixing up the water and soap to mop the kitchen when all the sudden I heard this noise....I could not figure out for the life of me what it was. I was probably hilarious to watch as I roamed around the kitchen trying to find the sound. Well I found it....It was the popping of the bubbles in my mop water. I did not even know that bubbles made a sound. I loved it....I just put my head over the bucket and listened for a few minutes.

I was boiling water the other day to make tea, and I was in the other room. Once again I heard something that I couldn't identify. Well this one was easier to figure out. I heard the water boiling in the kitchen.

When I was in Chapel Hill for my mapping I heard one thing that I never thought I would hear. I was looking forward to spring just to hear this....birds. Where I live it is too cold and the birds are long gone for the winter. In Chapel Hill I was walking to the car and I heard the birds singing. It was gorgeous. I just stopped and stood there listening to the music of the birds....there is nothing better at this point.

That's all for now.

CI One Month Update

2009-01-07T15:35:00.000-08:00

Well it has been sometime since I updated. Everything is going great. I went back to Chapel Hill for my first mapping and testing since activation. My mapping session went great and things are sounding better.

When they put me in the booth to do my testing...the audiologists were surprised with my overall results.

HINT
6% Pre-implant
100% 1 month post activation

CNC
0% Pre-implant
62% 1 month post activation

They also administered the HINT in noise and I scored 82%.

So overall to have only been activated for one month, I would say that I am doing awesome with the CI. So much that my surgeon agreed to go ahead and implant my left ear.

My bilateral surgery date is scheduled for April 7, 2009. We are now waiting for insurance approval.

CI Day 11

2008-12-20T16:06:00.000-08:00

Well it has been 11 days since my activation and everything is going great. I am looking forward to my next mapping on January 5th. Hopefully I will come out hearing even better than I am now. I can talk on the phone with the CI, which is awesome. I can even listen to talk shows on the radio which is phenomonal. I don't ever remember having this ability.

Over the past week communication with my husband has improved greatly. Even he has made comments that he does not have to repeat things as much for me. Work has even improved. I can understand my students better every day. I am still only using the CI in order to force my brain to learn to hear with it. I have tried my hearing aid once, and it took me awhile of playing with the CI and HA settings to get the sounds semi close to where I could understand. The results with both the CI and HA were marvelous, I could hear so much. I will eventually wear the HA but right now it is important to rely on the CI. I am still working on my therapy daily.

I am looking forward to the Holidays coming up....partly because I spent Thanksgiving out of it on pain medications as my surgery was two days before Thanksgiving. I am also looking forward to the holidays because I will be around family and mainly my neices, nephews and cousins. I can't wait to hear my three year old nephew tomorrow.

All is well, and it gets better with everyday. I love my CI and look forward to the other. Hopefully it will happen in the spring of 2009.

CI Day 4

2008-12-12T17:42:00.001-08:00

Well today has gone fairly well. I am continuing to use the CI on the phone, which is going remarkably well.

I watched some television this afternoon and I was able to understand parts of what I was hearing without the captions. I dont know that I will ever completely give up captions but I will certainly start trying to watch tv without them to see what I can understand.

I have been doing some listening exercises and those are going well....everything is getting better.

CI Day 3

2008-12-11T18:06:00.000-08:00

Well today has certainly been awesome.

Things went great at school today, much better than yesterday.

This afternoon I met with a professor in a coffee shop and was able to communicate despite other customers as well as the background noise being produced by the coffee grinder, etc.

Tonight I was able to have an entire conversation on the phone with my mom using the CI only. This was awesome. This has been one thing that has worried and scared me about the CI since I received it. I was not sure if I would be able to adequately communicate on the phone as I never was able to using my hearing aids. I always had to take the hearing aids out. So for today being my third day since activation I am thrilled that I can hear on the telephone.

More and more joyful days to come. What a great Christmas present this is working out to be!!!!

Day 2 with the CI

2008-12-11T18:01:00.000-08:00

Today was interesting. It was my first day back at work with the CI. I am a school teacher, I also teach children with hearing losses. I did have a little trouble understanding my students but it did improve as the day went on.

The worst part of today was by all means the cafeteria during lunch. It was loud, almost painfully. For the most part I have just been playing with my programs and trying to figure out what it is that I like. Right now I am leaning towards program 2 for the majority of situations.

One of the best parts of the day was the evening. I was in the kitchen cooking dinner and I had my back to my husband. He asked me a question and I was able to understand and respond with my back turned. He was so excited. That was the first time I have ever been able to do this.

Some of the sounds I have heard today:
the trash can rolling down the hall at the end of the day as they clean up
the car window rolling down
the keyboard clicking as I type
the heat or lights in my classroom (not sure which)

Activation Day

2008-12-11T17:50:00.000-08:00

Well activation was three days ago on Tuesday December 9, 2008. I was excited going into activation because I was not really sure what to expect, but I was trying to be somewhat pessimistic about everything. I did not want to get my hopes dashed.

When they first connected the implant I had to listen to a series of beeps to judge my comfort level. This was somewhat difficult for me as the pitches increased in frequency. By the time we got to the last electrode the pitch was so high it was hard to judge comfort level. Anyways we got everything figured out and it was time to go live.

When I first went live with the CI, I was upset emotionally. The sounds I heard were horrible. They were atrocious and I just wanted to take the implant off and never put it back on. However, with my experience with implants and hearing aids I knew that it would get better with time so I tried to be patient. In the beginning there was a lot of static and voices had a Darth Vader quality to them.

One of the first sounds I heard was an annoying tapping sound. We finally figured out that I was hearing the clock ticking above my head. We continued on with the session consisting of the audiologist explaining all the equipment and how to operate everything. With every passing minute I was able to understand better and my hearing improved.

The audiologist had me put my other hearing aid on with the CI as well. I did not like that initially so I took the hearing aid off. I am not wearing the hearing aid and I do not plan to for several months in order to train my ear to hear with the CI.

Towards the end of my session the audiologist put me in the booth to see where my map was at this point. I came out at 30dB across the spectrum. My speech reception was at 35dB. I was pleased as I was hoping to be around 45-50dB.

Mom and I left the hospital and headed home. We stopped at the Burlington outlets to let me walk around and see what experiences I had. It was really not bad...there was still some static but it was getting better.

We stopped by my grandmothers on the way home and it was great to see my grandmother and aunt for the first time with my CI. I was able to hear my aunt laughing in the other room.

Some of the other sounds that I heard today were:

women's heels clicking as they walked
windshield wipers
rain
water splashing under my tires

Successful surgery

2008-12-11T17:47:00.000-08:00

Well it has been awhile since I have posted. So to update everyone. I had my surgery on November 25th and all went well. I stayed overnight at the hospital and went home the next morning. Thanksgiving was okay, but I was sleeping for most of it. I did have several people bringing food for me and Kevin.

The bandage was bothersome, especially having to wear it for a week. Sleeping elevated is not that great either.

All is well though, and went back to Chapel Hill on December 1st and they took my bandage off, what a relief.

Coming up next, activation on Dec. 9th.

2008-11-20T16:32:00.000-08:00

Well today was the big day. I had my appointment today at Chapel Hill to determine if I was an implant candidate. Well all went well and I am in fact a bilateral implant candidate. The most shocking part was trying to schedule a surgery date. I was thinking at least two to three weeks at the earliest. Well how is four days. My surgery is on Tuesday November 25th. My right ear will be implanted with Med-El.

I will update more later. I go for my pre-op work tomorrow.

Lauren

Starting my Journey

2008-11-10T03:31:00.000-08:00

I am a 23 year old female with a severe profound hearing loss in both ears. I was born with a hearing loss however I was not identified until I was three years old. I started wearing hearing aids at three years of age and I have worn them ever since. It has been 20 years now. My hearing loss started becoming progressive in 2000, and since then has deteriorated quickly. I struggle every day to hear anything whether it is my husband or my mom, or the students I teach.I have known for years that I would probably have to go the route of a cochlear implant at some point, but now that it is here I am terrified. I don't know why I am scared....the thought of hearing better, the thought of giving up my ear permanently.

I know I should not be scared because a CI will end many of my battles with hearing. One of my primary battles takes place everyday at my job. I am a teacher of the Deaf and Hard of Hearing in a small rural community. I have three students and they all hear better than me (2 CIs, 1 HA). On a daily basis I will think they said something they didn't or that they left off an important speech marker such as plural s and almost every time they have to tell me what they said a second or third time sometimes. These are just the struggles at work. Not to mention my struggles with family, and graduate school. My graduate classes can be a nightmare sometimes depending on the number of people and style of classroom and not to mention the professor. So one would think that after fighting all of these battles on a daily basis that I would be ready to give up one ear for a CI...I would think so to, but I am still terrified.

However, I am tired at the end of the day and I know within me that a CI would make my life better so I am going to take the first step this morning and call the University of NC and schedule my initial evaluation. We will see what happens from there.

Lauren