We are almost there...

Shaylins birthday was wonderful! Agh, I cannot believe that she’s 9 now!! I don’t know about other families with medically fragile children, but I know for us it has truly affected every member of this house. While Shaylins birthday was a success it also showed us something we suspected was going on with Shaylin; she won’t rock the boat, she won’t speak up about things that she should. What I mean is she is all about trying to please us, trying to please Alana by giving into whatever Alana might be complaining about. Shaylins birthday was a surprise party a day later then her actual birthday was. We noticed that she didn’t even mention anything about not getting a gift or having a party. She was sad, trying to not cry, but just would not tell us what was wrong (even though we knew). Just trying to please everyone and not make a fuss, my little Shaylin.

Things do continue to change around here with everyone. We have been on the search for a counselor to work with us and the girls in regards to Alanas fascination with death, Shaylins inability to speak up and trust her voice, Noelanis unwillingness to acknowledge that she has a sick sister and all those other issues that have come with having not only a chronically ill child, but a child with no diagnosis and more testing then you can imagine. Things due work out finally though and we find not only 1, but 2 counselors who will work with us separately, and then as a whole unit.

In the meantime Alana needs to have another surgery. This one is to remove an enlarged lymph node from her neck that has been enlarged for years. I remember the first time we noticed it, it was actually my mom who did while she was rubbing Alanas neck trying to calm her down from a fit. We took her into the doctors right away but in the end they said it was just from an illness. After a few years and it getting larger with illnesses, larger than a grape, but no smaller then a blueberry it is decided that it needs to come out and be sent for pathology.

After meeting with the ENT, same one who did her tonsils, adenoids, and PE tubes, he asks us about the ear infections she still is having and the chronic fluid behind her drums. He tells me that when she comes back for pre-op in 3 weeks, if she still has fluid behind the ears she will need to have a second set of PE tubes put in. Okay, well wasn’t expecting that but not a big deal. I am more worried about her neck and the fact that she has such a hard time with general anesthesia. Dr. P goes over how this should be an outpatient procedure, she will spend about 2-3 hours in recovery and then should be well enough to go home right after that.

The day of surgery arrives and at least things are going along smoothly. We’ve been there done that so to speak and as long as the anesthesiologist will read her chart and band and see that she’s allergic to A LOT of tapes and stop trying to stick them to her for her IV we should be good to go!

Once the surgery is over they take me back to recovery to see her and she looks good. She’s still sleeping and they’ve got her O2 going. Right before the surgery Dr. P decided that he wanted her to go upstairs to sleep of the anesthesia and make sure she isn’t having any unexpected breathing problems and due to the fact that it's been hours and she is still sleeping.

Once we are upstairs, it again is only suppose to be for a few more hours, things do change. Sigh. She was sleeping and facing away from me so first I notice her SATs drop a bit, not drastic, but enough that I took notice. After a bit of this I go to move her and as soon as I see her face I see a red, swollen, patchy tomato lying where Alana once was. I don’t even move her but open the door and get the nurse in there within 30 seconds. They give her a push of Benadryl and call the doctor. Now we are in for the night for sure. Long story short, this happens all through the night, her SATs drop, her face swells and she has a pale ring around her nose and her mouth, and they shoot her up with Benadryl. By morning when it’s still happening they are starting to wonder if this is a G.A. or tape reaction or is this something else.

We spend 2 days in the hospital and have no idea what happened. She has done this before, the red face and pale ring around the mouth and nose, and it was after surgery. Hmmm another fish in the sea, symptom to wonder about. Once she is home it still happens over the next day and a half. We stop giving her Benadryl because it’s not helping it, what is helping is getting her up and moving around. It really seems to make at least the red and white patchiness go away. Again…hmmm.

Alana continues with PT and OT and as is now par for the course, things keep changing. After about 2 months of PT once a week the decision comes up to move her PT to twice a week in the hopes that we will see a better improvement? Stability in where she’s at? Something? Well the first session of the new sessions (say that 3 times fast!) ends up telling us a lot. Backing up a bit here, after each PT & OT session she’s falling asleep within 10 minutes of leaving each respective session and sleeping for 2-3 hours. Well after 30 minutes in her second PT of the week, Tuesday and Thursday, she was falling asleep in the pool. Well gee, that’s not good. After that PT she slept for almost 4 hours straight, was asleep even before we left the parking lot.

After that it was thought that we should move the PT down to 30 minutes for each session and see how she does; does she sleep less or is she able to stay awake longer? How is she through the session; is she able to function better both physically and cognitively? Well what we see is that she’s just back to where she was with the original 1 hour session in regards to sleep but…she is able to function through the session itself a bit better. What ends up happening is we stick with the 2, 30 minute sessions. It takes 1 1/2 L of O2 for her to be able to keep her SATs up (95%) enough while she’s in the pool but that’s alright, small steps.

Going back to the lymph node biopsy; the results finally come in from pathology and the cultures grew nothing. Go figure. On top of that the path results are the same, benign lymphatic tissue mass. It depends on the day on how I look at this, some days; we put her through another surgery, that didn’t go great, for no good reason. Other days, we ruled out 3 more things that were slight possibilities.

Can you believe we are almost to the present? As I’ve typed this over this past, well almost a year, there seems like so much but yet so little. It might seem like that’s an awfully long time to recount something but think about this--we’ve been on this journey for over 5 years now. There have been so many labs, 100’s and 100’s, CTs, surgeries, months of long illnesses. So, so, many tears, smiles, sleepless nights, and days of "are we going to make it through this"? There is more to come, we are almost there, to the present, but we are not there yet. Next we meet with Seattle Genetics to go over the “new” Alana. The Alana that we are at today.

PT & OT here we come...

Things do continue in the same fashion as they have been, unfortunately. Her baseline is officially changed now from mediocre to crappy. On top of that she is having a harder time with shortness of breath, fatigue, and eating. Even at this point she has not gained back the weight that she lost over this last illness and she’s coughing more. Something new that does come up is a physical therapy evaluation. This is done for a few reasons, her fatigue, the evidence of muscle weakness and/or wasting, and her overall wellness level. We meet with a wonderful PT, Mrs. J, and after a few sessions with Alana she requests that another gal, an OT who works with children who have lung/breathing/heart issues sit in and give her input as well in regards to some issues Mrs. J is seeing in regards to Alana and her breathing issues. I am fine with this because heck, maybe she will notice something that can help.
Here is what they had to say in their report to the doctors:

“Alana is a bright and engaging 5 year old little girl” (okay, had to put that in here that that was the first thing they said =)

“Alana had difficulties coordinating co-contraction of her trunk for stability when attempts were made by therapist to elicit. Endurance is quite poor as a 5 year old child should be able to participate in an hour of sub-aerobic physical activity without immediately falling asleep upon cessation. However this lack of endurance doesn’t appear to be simply due to de-conditioning as Alana tries to be an active child. Alana appears to be a very busy active child with endless energy. However, it seems to this therapist that it is easier for Alana to remain in motion then to do stationary tasks that require core stability and subtle grading of muscle control.”

“Alana does demonstrate difficulties with coordination of her body following several minutes of sustained activity. At today’s evaluation Alana was propelling herself around the pool wearing floatation with nice coordinated movements of her upper and lower extremities initially. However, following 2.5 minutes of sustained activity Alana was no longer able to coordinate her movements and resorted to flailing type movements of her arms and legs to attempt to continue the activity because she wanted to”

“Alana demonstrates 85% open mouthed breathing but with increased demands she closes her mouth and creates a valsalva to increase intrathoracic pressure thereby increase her strength and stability. Her cough is non-productive with limited intra-abdominal pressure. Her mother reports that she will cough so long that she turns cyanotic. When asked to take deep breathes or after breathing increased for activity demands Alana demonstrated paradoxical breathing, this means that she activates her diaphragm on expiration not inspiration, limiting the volume of air she can inspire.”

Summary

Alana demonstrates:
1. Significant low tone especially abdominal muscles, also indicated by mild rib flares.
2. Mild to moderate dysregulated autonomic nervous system: indicated by inconsistent pulse, oxygen saturation levels not tied into activity needs, erratic temperature regulation and breathing pattern (several quick/shallow breathes and then large breath).
3. Inefficient breathing patterns. The diaphragm, intercostals, external/internal obliques, rectus abdominis are the predominant muscle in efficient breathing patterns doing approximately 60% of the work, while accessory muscles such as the paraspinals, pectoralis muscles, serratus anterior, scalenes, SCM, and trapezius are recruited for increased oxygen needs. Alana also demonstrates paradoxical breathing.
4. Possible undiagnosed venous return disorder. Red flags include constant movement without sensory seeking quality, desaturation without movement, and sitting down/flailing limbs with fatigue.

They did her SATs before and after PT and before (without O2) she was at 94%, after she was 86% and stayed that way for awhile. This was a very clear indication to us that she needed to be on O2 more than we had been putting her on it. This report went to her doctors not only here, but in Cincinnati as well. Within a day we heard from the pulmonologist in Cincy to discuss this “significant change in her status” in regards to her O2, muscles, and fatigue. Well HELLO! We’ve only been telling you she’s been having these issues for almost a year now!

Things do come of this though; Alana is put on O2 with activity and during PT and OT (OT was recommended as well due to her sensory issues—screaming, hands over ears, fight or flight reactions to car washes, some restaurants, music class, etc. and tactile issues to clothing and other), she is now going to PT once a week and OT once a week for an hour. The plan is that once her strength is increased that we will start working with the other OT in regards to her breathing issues to try and get her to utilize her lungs better, maybe in about 3-4 months is the goal.

I’d like to say I was surprised with what the OT & PT tell us, that she has the emotional maturity of a 2-3 year old, that she is hypotonic (low-tone), her O2 needs were greater than we appreciated, and that she needs long term, 12 months or more, of PT services. I would like to say that I didn’t see any of those things but I did. I just couldn’t seem to make them better for her—again.

There are still new things going on with her every month. It’s all day by day and minute by minute. She is such a strong and smart little girl, totally like her sisters in those regards. Rock stars the whole lot of em! We are finally to the end of February and we have Shaylins birthday in March to look forward to and boy, are we looking forward to some normal fun times! We all need a break and if all goes well Shaylins party will just be the ticket for that.

Our Christmas angel...

So yep, she had pneumonia again for sure. Her CRP was elevated, she had an infiltrate in her right lung and she was miserable to boot. Needless to say we did not get to do the EGE testing that time; instead we went on home with ‘scrips for steroids, antibiotics, and orders to check back in with Dr. McArthur the next day or sooner if she got worse overnight. We did end up taking her in the next day to see the doctor and as expected there was the “do we admit her or not” issue to be dealt with.

I know I said that I’d just say go ahead and let’s admit but it just isn’t that easy. There is a fine line that I feel I can walk with Alana in regards to when to admit. At that point I felt that if she could just get some fluids in that she’d feel better, ergo, be able to stay home longer. For the time being the doc agreed and what we settled on was doing an IV in the office. It wasn’t going to be a magic fix by any means but it might allow her the strength that she needs to make it through this. While they are getting things ready Dr. Tapple, whom she’s seen many times when Dr. McArthur isn’t around and admitted Alana for her October stint, sees that we are there again. He inquires as to why, is told, asks if she’s going to be admitted again and shakes his head. I think that the Alana frustration is rubbing off on him as well…

Once the line is placed she promptly falls sound asleep and we just wait for the bag to run through her. It’s amazing how much it can hurt to watch her have a line placed even though you know that she desperately needs it there. I’ve seen her have so many placed I couldn’t tell you a number, I can tell you it still hurts me; not as much as it hurts her, but in a very different way. Over time the line seems to be working and she’s sleeping a bit better and has some color to her cheeks. This is all great news at this point as it means that there is hope that we can go home!! It’s right around Christmas time and she really wants to be the angel in the play at school and I really want her to be that angel.

It does end up working out and she is allowed to go home on tight orders. If she gets worse, doesn’t eat or drink in ‘x’ amount of time, or has an even harder time breathing then we have to return, not only return but return with the knowledge that she will be admitted straight away. I can handle that and I do think that she is OK enough to be at home for the moment.

The play rolls around and she’s WONDERFUL! Thank goodness for such an amazing teacher (Mrs. C) who just takes Alana in stride; she knows when to push her, how much to push her, and when to just offer her a hug without any pushing involved! I am so very blessed with some of the people that are in Alana’s life. She does her lines wonderfully and is in great spirits for the duration of the play. Lucky for us it’s not very long and she’s able to make it through without coughing to bad.
We go back the next day for another check-in and there’s been no real change in Alana. We are given the go ahead to head down to Cooper Landing to spend Christmas with everyone again, conditional; she gets no worse, the hospital in Soldotna is within a short driving distance, and nothing new pops up. This is all doable in my book so off we go to grandma’s house.

Christmas was as well as could be expected. She did have problems with eating and drinking like I’d anticipated but not to the point of dehydration. She did lose more weight, a total of 12% of her body when it was all said and done, but she enjoyed Christmas at home, with her family…not in the hospital like the previous year. It took almost 3 and a half weeks for the pneumonia to finally clear up and things never went back to the ‘old’ way again. Her baseline had officially changed, not for the better.

There are things that I don’t remember to mention in here until I am at a point like I am now. These are the little things that no one can put their finger on but are like pink elephants starting to fill up a room. Alana has had new things going on that I’ve been, for lack of a better word, ignoring. I know that sounds ignorant, foolhardy, neglectful, you name it I’ve thought it. I wasn’t ignoring them because I thought that they were not worthy to be followed, I was ignoring them because I was worried that they needed to be followed. Of course this didn’t last long at all. As Goldfinger so put it, “the first time is happenstance, the second time is coincidence, and the third time is enemy action”. None of this was really going un-noticed by me; I just didn’t know what to make of it was the problem. Here’s a partial list of what I was noticing:

Extreme redness on her face
Hot ears
Hot and red hands and soles of her feet
Raw, painful patches on her tongue
Increase work in breathing
Decrease in her SATs even with the increase in work
A lot of rashes
Sleeping 2-3 hours a day
Increase in her heart rate as well as dips in her heart rate that last longer than they should

I didn’t know what to make of those things or even what to do about them so how the heck was I going to take care of them!? I did take heart that I was not the only one noticing them, Dr. McArthur noticed them as well and agreed that this indeed seem like a new baseline even though it was lower than her crappy baseline to begin with!

Things pretty much continue in that same manner for the next few months. Alana sleeps even more than usual, she is coughing more, she’s running fevers tighter together, not gaining back the weight that she lost in October and December, having frequent rashes and tongue issues, etc., etc. Amongst all those concerns I notice that she’s just really struggling to do daily activities that she used to be able to do, swimming for instance. Granted she still had some issues with them but she still was able to pull them off. Now she can’t even do that and it frightens me to see her literally and figuratively, sink. We are now in February of 2009 and there are changes on the horizon that shake up a lot of things.