Well it has been a very tough couple of days for me. A was taken off of the vent on Sunday and did okay until about 5pm. He then started with his morphine withdrawals AND blue spells. I was just beside myself.
Anyhow, the one stitch has come out of the right side of the trach. This is of course the side that is a bit wider open than the other. We had to change his trach tie Monday night and he did NOT like it. He was crying his eyes out and was very very off colour. I don’t even want to see this kid when we have to do trach changes!
There is a chart at his bedside where the nurses are to record all blue spells/desats so the doctors can try and figure out WHY he is still having them with the trach.
Monday I probably cried for three hours straight. I just am SO tired and just want things to be fixed and go home. There have been alot of tears shed this week!
On a positive note, he is sleeping BEAUTIFUL. I don’t want to jinx things, but so far so good in that area. The only exception was last night which he was up from about 12am until 6am. I was finally able to see his sleep study that he had done almost two years ago while we spent 88 days in Sick Kids. He had a total of 58 obstructive episodes which came down to one every five or six minutes. Those are obviously gone now with the trach.
Why on Earth I was told by his team at Sick Kids that his sleep study was not that bad is beyond me. His RT here said that his sleep study was “scary.” To me this is something that should have been dealt with almost two years ago.
He is breathing better in the day and does not have the nasal flaring that he has always had and the hard work of breathing.
We had a team meeting Tuesday and the issue now is his feeds. He is aspirating (we got formula out of his trach Monday-not 100% sure but pretty sure it was) and we are trying to figure out what to do. I was told by the docs that I am NOT allowed to have any say in feeds right now and they are trying to work them out. This is VERY hard for me as I am a 24/7 hands on mom. So they want to feed him straight peptamen 1.5 at a rate of 20mls/hour from 8am-10pm. Today he is up to 40mls/hour for the same amount of time. This makes me ANGRY. He has to sit in his chair this whole time. I know it is only temporary, but I am stressed out after watching him in his chair for ten minutes with the trach.
The doctors said that I am probably emotionally, mentally and physically exhausted and therefore they are taking some “burden” off of me. However I did say that I am the one sitting there all day with him, not the dietician. I am the one watching him reflux. I am the one dealing with him being upset because he is NOT comfortable in his chair.
Yesterday and today from about 12pm until 2pm he is just CONSTANTLY turning blue and just not happy. I really don’t know what to think of it but I just hope that this stops.
Just another day…..I really need to start seeing a light because I am already stressed to the max! Here is a picture I took last night myself of my little man and I.
Well, as I sit here and write this post so much goes through my head. We headed to the hospital yesterday to see A’s respirologist. As I have said in previous posts, I truly wish we had met this man sooner. He is amazing in every single way and really knows his stuff. And he is the ONLY doctor that has taken what A does VERY VERY seriously and is very confused as to why his issues have not already been dealt with.
So, as it sits right now we are waiting for “the call”. A is going to be admitted to the PICU for a period of time and will not be able to come home until he has some sort of ventilation.
His issues at night have continued and this use of oxygen has been very concerning to me as this is not something that he *needed* in the past. Yes, he has always had issues with desats, but not like it has been lately. I have been saying that I feel like he is going downhill and that is the same thing that his resp. doctor thinks. He told me that kids with issues that A has get worse, not better.
So the plan is going to be to try to get A used to wearing Bi-PAP at night while he sleeps. “Bi-level Positive Airway Pressure; Used to treat sleep apnea, and other sleep related breathing disorders; Delivers alternating levels of inspiratory pressure (IPAP), or higher pressure, to keep the airway open as a patient breathes in, and the expiratory pressure (EPAP) is lower to reduce the work of exhaling; the BiPAP can be set to drop the level at specific intervals, or upon demand.”
Children usually take some time to get used to this, so depending on how well A does with it will depend on the length of our stay. The good thing is that he has not had his soother since he was ill in October. This would definitely be an issue as the Bi-PAP mask goes around his nose and over his head. And with him only taking his soother upside down and sleeping on his belly, it would have been next to impossible.
The other added bonus is that he really really wants to sleep on his back now, however I have not been able to allow him as his saturations are always lower and he just doesn’t breathe well. Bi-PAP will be MUCH easier if he is sleeping on his back.
*IF* the Bi-PAP does not work then we will have to talk deeper about a tracheostomy. When he mentioned it to me yesterday I said that I didn’t know if I could do a trach to A. His exact words were “well here is the question to answer it for you. Do you want your son to live or die?” I started to cry. Of course I want A to live, but a trach is a HUGE deal. It is a major surgery. It would change his life completely and ours. It is not something I take lightly.
Now with all that has been going on, he is very concerned about A having issues with his heart because of how much harder it has to work for him with all of his breathing issues. So they will doing another echo to check on things. One of the big issues that can happen with severe sleep apnea and the apnea that A has daily is right heart failure.
Another thing that was talked about was these big “spells” that A has. He thinks that they *could* be sudden pulmonary hypertension spells where the vessels all clamp down which cause him to go very blue and not breathe. I sit here wondering why on earth no other doctor has even suggested this could be the problem????
So it looks like we are in for another hospital stay. I feel more comfort in the fact that this is being done in the ICU but I am still very scared of what the future holds yet again.
The other issue that we have to deal with is A’s night feeds. His respirologist wants him off night feeds, no ifs ands or buts. This is proving to be VERY difficult and for now I just can’t make it happen. I didn’t do a feed last night but today just did not work out to give him more feed. He was refluxing like crazy with his second feed and that was only at noon. I will be lowering the night feed by 10mls/hour but that is the best I can do for now.
A’s x-ray from our last appointment did show that he does have interstitial lung disease. I specifically asked A’s chest team at Sick Kids *if* he could have this and they said no. Yet again, another question in my mind.
This is day two of no beds being available. I just pray that we get one soon because I am so afraid that my little man is going to be spending Christmas in the PICU.
So the issues with A continue as usual at this household. We are having problems with feeding and sleeping and of course along with that comes the awful desats that go on ALL night.
For about the past week the nurses have had to use oxygen at some point with A during the night. I didn’t really think much of it because they have to administer oxygen if his saturations go below 90 for greater than two minutes. Well anyone who knows A knows that this happens A LOT. Anyhow, two nights ago, Friday night was HORRID. It brought me right back to the days when we brought A home from the NICU. I would never want to relive those days, and honestly sometimes I wonder how I even did survive back then.
When I put A down on Friday night and hooked him up to his monitor, he was sitting about mid 70s. He was sound asleep. I tipped his head back a little and he came and hovered around 84. This is NOT good enough. For about twenty minutes I just stood there watching him wondering what the heck was going on. I still don’t know what to think.
I came downstairs and grabbed some nasal prongs, tape and an oxygen tank. Once I got up to his room he went to 91 and stayed there. This is still not really good enough for me because it isn’t the norm when he is sound asleep.
Basically from 1am until 5:30am I was in there about every five minutes to place oxygen in front of his face or to try and move him to a position where his oxygen saturations would be better.
Feeds. I am having so much trouble getting the required amount into him in a 24 hour period. I really wish sometimes that we didn’t need food to survive! As you all know, he has been off of blended food since getting sick in October and gaining weight. I talked to his dietician on Thursday again and she said to maybe try adding just avocados in with the formula to make it a little thicker and maybe that would help go down easier. Well within thirty seconds of receiving only 30mls of food he threw up. He was gagging constantly and I had to pull all of the food back out of his tummy. This is very strange as well because he had avocado every single day in his blend of food.
So in the day time I have to give him a total of 750mls and at night he gets 500mls. This just does not work! I am so afraid that he is aspirating which in turn is causing his lungs to get worse-which we really CANNOT let happen. This would explain the crappy oxygen saturations. Thankfully we are seeing his respirologist in a weeks time and hopefully he will have some insight into what we should do. I know he did speak last time about admitting A into ICU for a couple of days to trial CPAP and BI PAP but I just didn’t think that would work because A has a soother. However he has not had his soother now in about six weeks! Something really needs to be done though because he cannot go on the way he has been.
A weighed in at 27.6lbs last night. Seems like he has stabalized there for a bit so that is good. Much better than 25lbs!
We just got home today from getting his second dose of the H1N1 vaccine. So the continuation of our hibernating will happen for about three more weeks. And even then we have to be careful as he has not had his regular season flu shot! Ugh neverending worry I’ll tell you!
On our way out of the mall where his doctor is we stopped at the one store. I was looking at the Toronto Maple Leaf stuff and a lady was trying to get around me and A. Once she got down the aisle she wanted she turned to me and asked me if I was his mom. I said yes. She held her hands to her chest and with tears in her eyes told me that she admired me. I said thank you. She told me she thought he was a gorgeous boy-ha we all know that!-I again said thank you. And she told me, no thank you for doing what you do. To give him life. I told her he gave himself life. He fought to be here. She gave me a hug and again said she admired me. I said thank you again and told her that it is nice to hear such kind comments from people. Totally made my day. It is not too often that a complete stranger says anything like this to you. Why can’t the world have more people like her in it???
Well I should have known not to say anything about A having such a great day! The desatting started again last night and he had a pretty unstable night. This morning it was constant desats to the point where I took him out of his chair, put him in his stroller and took him for a walk. I am just SO tired of hearing the beeping and seeing him drop SO much. It is getting SO frustrating!!!
The chest team and complex care doctor came in around noon and wanted to try out the NPT tube (nasal trumpet). I said no at the time but as the day went I thought it would be worth a try. I knew it was pretty far feteched and too easy a cure but I said okay. I could feel my heart pounding and my eyes filling with tears just thinking of it. I cannot stand feeling like I AM the one putting him through all of this nasty shit.
The NPT tube is NOT nice to look at and I cannot even imagine having it put through my nasal cavity and into my airway. I told the RT when he came in that it looked big but he said it was the right size. I asked about how well it is handled and he told me that once it is in you don’t know it is there. Hmmm really? I then asked if he has put one in and knows this or is this just what they think? This is what they think. I then said that I had to leave because I just cannot handle hearing A scream and cry. Then I feel like a worse mother for not being able to comfort him at times like this. It really breaks my heart though to look at him and he just has NO IDEA what is coming.
So I left and came back about ten minutes later. The RT said that he tried both sides of his nose and the tube was too big so they were waiting for a smaller one. WTF!??! When are they going to learn that mothers know best?!
Anyhow the tube is now in and he is doing okay with it in but it definitely isn’t changing much. He is still desatting and doing all the things he was doing without it. It has also made him more junky sounding and is needing the odd suctioning. Poor guy SEES the suction tube and he will drop to the 40s.
I am giving it the night but there is no way that I am going to be keeping it in with it not helping. The RT came by tonight with another one and said there has to be a spare at the bedside. LOL I told her that if this one came out then that was it. She asked me if the docs know this and I laughed and told her they probably would.
I am at a loss really for thinking we are going to find the answers to what is going on. I just don’t know what they could be missing, but they ARE missing something.
Well I have to say (without jinxing anything!) that A has been VERY good the past two days, including today. I went home on Friday night (only the third time in almost 7 weeks) as I had to go and get my wedding dress! I could not keep putting it off as it can take up to 8 months to get in and I only have under 6 months left! The owner of the store though said she would work miracles for me. So before heading home for the night I had requested a certain nurse for the night and then the one for the day yesterday. This was the ONLY way that I was leaving as I knew that they would take great care of him.
Friday night Aunt K and Grandma S came up so that they were able to come along with Aunt Shorty, Grandma C and I. I did end up getting the same dress that I had first tried on in October. I absolutely know that it is MY dress and can’t wait for the day that I get to wear it and walk down the aisle.
Saturday my heart went to my feet because I got a call from the hospital in the morning. It was the doctor that is on for the weekend for complex care. He was asking me about the NPT tube (nasal trumpet) that we had discussed on Friday. Before I left Friday night I told them that I wanted to be here if they were to do it because I felt that I would be the best judge on whether or not it was working. Anyhow he wanted to know if it was okay to put one in if he felt A needed it. So I told him exactly what I told them Friday night. Well he then said “well you aren’t here 24/7 to judge it anyways.” Now I have to say that I wish I had of responded, however I think I was so shocked by what he said that by the time I would have he was already talking again. I should have said, “listen buddy, I AM there 24/7…this is the third time that I have been home in almost 7 weeks. How many weekends have A and I spent just hanging out and then the ONE weekend that you guys want to move your asses and do something I am at home?!?!??!” Oh I was just so angry!
Anyways, A never had to have the nasal trumpet placed and he had a wonderful day yesterday while I was out. Daddy and I got here last night about 10pm and gave him a bath before he went to bed. We then headed over to the hotel for the night. Today was a GREAT day for him and he was VERY happy and seemed like he was back to his old self. I just don’t want to get to excited as we all know how A doesn’t play by the rules. He also came off oxygen today at noon and is STILL off. This past hour he has been desatting quite a bit so we will see, but so far so good. I am MUCH better with seeing 70-80s then I am seeing single digits or 20s! He only had two big desats today and those were both with crying.
Well I am off to bed…everyone keep those prayers coming!!!
Well shit finally hit the fan. Today has been absolutely crazy to say the least and I was raging since this morning. ALL DAY and I mean ALL DAY A has been fussing, crying, turning blue and satting pretty much under 90 from 9am until 2pm. NOTHING could settle him.
The complex care team came in this morning and it started off my frustration. They asked if I was willing to start the iron and I refused. I told them that I thought it was ridiculous that they thought iron would “cure” A. I told them how I was frustrated with what is going on and nothing being done. There next answer? Well how about we try him with a nasal tube that will keep his upper airway open? Hmmmmmm NO. I mean honestly is this the best that these TOP doctors can come up with?! I told them I wanted to speak to the lung doctor I first dealt with. They told me that I could talk to the fellow. I don’t want the fellow. I don’t want the resident, I want the actual doctor. So when they left I asked the nurse to try. Didn’t work. The chest team said that if I had any specific questions that I could talk to complex care and they would relay it. What a joke.
After them leaving I continued to deal with A. I was crying pretty much most of today and I have a massive headache because of it. It is just killing me inside seeing A so upset. It is at these times that I just want to run screaming through the hospital. It is times like this where I just want to pack him up and go home.
After lunch a social worker came in to see how our hotel stay went the other night. She then asked if there was anything she could do for me and I laughed and told her “ya, find me a new doctor.” After telling her who I had she said he was pretty high up there so she didn’t know what would be next. I rambled on and on and of course the tears started to come. I felt like I was going to lose it. Actually, I guess I kind of did lose it.
Anyhow, she then asked if I thought about the Ronald McDonald and I told her I didn’t because I wasn’t thinking I would be here this long. I then told her that I was ready to pack up and go home. She thought I meant by myself but no, I meant with A. Well then she seemed very interested in what was happening. I told her in a quick five minutes update what has been happening and that I wanted to see the lung doctor that admitted us. Just as we were talking about him, the nurse practitioner that is on complex care came over. I got worse.
I am confused and not getting straight answers. ENT ruled out airway but yet really they can’t because they have to do a scope while he is awake and it wasn’t done that way.
Chest ruled out lungs from an x-ray. Said his underlying BPD isn’t that bad. Hmmmm really? Because I was told that his lungs were 40% fat and this was caused by chronic aspiration. Does that not seem odd? Add in the fact that he gets ventolin and q-var twice a day?
Neurology ruled out central apnea just from reading his MRI…..don’t know how this happens.
I was also told it could be reflux. This was the bomb. Reflux?! I did the fundo because they told me it was the final last resort to stop it. So how does that in any way mean reflux is still possible?
Cardiology ruled out heart from reading one previous echo from another hospital. All the PVCs and irregularities mean nothing. The dropping of his heart rate means nothing. The surgeons who have brought up shunting are crazy too
Anyways I said all of these concerns and how I was tired of being here. Tired of feeling like no one gives two shits what is happening. Tired of hanging out day after day. She said that they are concerned. I said “oh really? How is anyone concerned when my child is turning blue and yet NOTHING is being done?” She didn’t know what to say. I told her that I wanted a chest CT done, I wanted ENT to see me again, I want to see genetics. Well next thing you know she is paging the lung doctor I wanted to see. But yet they wouldn’t do this earlier? I was ready to go on a hunt for him myself. Funny how things blow up and things start getting done. None of this changes the guilt that I feel though. I feel like all of this misery is my fault. I signed the papers for the fundo and now A is miserable. It totally sucks especially when I never wanted to do it anyways.
So I waited and waited. No doctor. He can’t come until tomorrow. They are not dismissing lungs until they show me that CT scan that I want
I asked the nurse on tonight how often they see kids come in with sats like A. She said it is very, very rare. I asked her about the ones that are there like that, what are they in for…what is wrong with them? She said “lung disease”. Funny
Anyhow, the fire is lit under their asses and this one isn’t burning out.
Well things are pretty much the same. A had two episodes yesterday. The one last night was about 45 minutes again with saturations below 30. The one earlier in the day was 25 and the nurse was able to listen to his chest while he was in the fit. There was absolutely no air exchange at all. Of course with it being the weekend it is impossible to get any answers to anything.