Tuesday, November 27, 2012

Bumps in the road

So November was a busy month for us. Audrey continued to have oozing from her PICC line so her team of doctors decided placing a new, more permenat line would be best for her. Due to her glucose/ fluid issues she had to go into the hospital the day before surgery to stop her feeds. Her surgery was done on November 7th. This was the 8th time she had been under anesthesia this year. Since she's 3 now she's more verbal and knows what she does and more importantly what she does not want. So per op scared her until she got her happy medicine (versed makes her chuckle). Once she woke up in recovery she was not happy! She wouldn't look at or talk to anyone. She was also vey pale and drowsy. She ended up needing another blood transfusion and was eventually sent home on half strength feeds again. We thought we were in the clear now. Then, not even a week later her new line starts bleeding! Not again! After a quick trip to visit the surgeon it's determined the line is fine so it must be Audrey. We are waiting to hear back from her pediatrician about her work up for bleeding problems.

Audrey had her post tonsillectomy sleep study. The good news is she has no more obstruction! Yay! Unfortunately she still had some desats during sleep so she will stay on her 1/4L. She is also still needing her o2 during the day. We can't wait to get rid of oxygen!

This month Audrey added a new GI doctor to her team. We have high hopes we will get her to a better place and off TPN. Since her broviac surgery, Audrey has not yet been able to tolerate full strength formula. while meeting with her new doc we discussed changing out her GJ tube. GJ's are usually good for 3-6 months. Since we don't want her without it, the plan is to change it every 3 months though it's already been 4. So plans were made to change it out which is done in interventional radiology. Low and behold, the very next day her tube broke!! Some girls have all the luck! With some finagling, she was able to get it changed the next day. Unfortunately, anytime we touch her tummy it freezes in terror. So she slept through thanksgiving and black Friday barely tolerating a low rate of pedialyte. Now we are back to her normal rate but still half strength formula. Right now we are very thankful for TPN!

So this is where we are. She is once again sleeping a lot. Most days she is only able to go up the stairs halfway and then struggles to crawl the rest. Today I noticed her leg muscles are getting weaker. She was barely able to lift her leg up for me to put her sock on. Is this disease progression? Is this just a result of excessive sleep and muscle loss? Is it from her decrease in feeding tolerance? I'm not sure what the answer is or what we do for now. For now I'm just loving my girl and her brother, trying to take advantage of her fun and spunky self.

Driving into work today I was listening to a Talor Swift/BOB song. The chorus she sings really caught me: "I wish I was strong enough to lift not one but both of us. Someday I will be strong enough to lift not one but both of us." This is my hope for my girl. Some day Miss
Audrey, we will beat this awful disease!

Here are some pictures of November in a nutshell...grouchy post op, pink sleepy head after blood, new big girl bed, bleeding and bruising, sleep study, g-tube turkey and post thanksgiving laziness

Tuesday, October 23, 2012

An update

It's been awhile since I've done an update because things have been status quo. Audrey started preschool the day after her birthday. She goes for 2 hours a day 5 days a week. While she's there she gets her PT, OT and speech therapy. She's with 5 other kids who have various delays from muscular dystrophy to speech delay. She also has an RN with her at all times. She loves going to school now! It wears her out, she usually sleeps most of the day after school, but she's learning to interact with other kids and many other things. Her speech has improved dramatically which is great for everyone. We hope she will continue to build up endurance. Out of the last eight weeks she has only been able to go to school for 5 days once. Well, it's good to have goals!

Medically there has not been many changes. She is still on her TPN and still only getting 17mls/hr of feeding. Each time we try going up to 18 her gut completely stops but we keep trying hoping one day it will work. She was seen by surgery today to discuss getting a new, more permanent central line placed. I have been avoiding this as the thought scares me but here we are. Central lines have a higher risk of more serious infections. However, Audrey has had continuous problems with her current line which has lead to a high risk of an infection as it is. So November 6th she'll be admitted with surgery planned on the 7th. She stay overnight after surgery because of her pulmonary stuff and if all goes as planned home on the 8th. Fingers crossed we don't get trapped :)

Aside from the line and feeding stuff things are mostly going well. She is growing and getting stronger all the time. She is sweet and sassy and so full of life that we are great full for all the medical advances letting her thrive with us at home. We hope that this line placement will be the last procedure she will need for a long time. She hasn't been inpatient since July so maybe we are finally on the right track with her! Also her pediatrician brought up she hasn't had any new symptoms from her mitochondrial disease since May so maybe she has reached a plateau with her disease. That being said we are starting cold a flu season and with every cold and sickness she gets she is a risk for disease progression. Needless to say, I am very nervous about how this winter will go.

We are planning on going to Disneyland for Mickey's Halloween this week so pictures to follow. Audrey will be dressed as Rapunzel, surprise surprise ;) I will update after her survey in 2 weeks...

Tuesday, September 18, 2012

Mitochondrial Disease Awareness week

If you haven't heard already, it is mitochondrial disease awareness week. What does that mean? It's the week where families all over the world talk non-stop about the disease that has affected their lives so much. Have you heard of it? Are you tired of me posting about it? I hope so! How is it possible that so many people have never heard about a disease that takes more children's lives than cancer?? This disease affects 1 in 3000 children by age 10 and yet no one can even tell you what a mitochondria is. Well let me tell you again what we deal with every day...

Mitochondria are the power houses to all the cells of your body. They take the food that you eat and turn it into the energy for your body to use. Try to think back to 9th grade biology when you learned about the Krebs cycle and ATP. There you go, that where the problems start. Imagine a remote control car. When the batteries are fully charged you can zoom it up and down the street over and over. The remote control works well and it's lots of fun. When the battery is almost empty it starts to slow down. It's slow to respond to the remote control until it doesn't work at all. That is mitochondrial disease. The mitochondria power up your cells. Make them zoom around and perform their programmed task. But when they have mitochondrial disease some cells only make half the energy they are supposed to, some don't make any at all. So the body moves slow and is slow to respond to the brain or remote control. Each cell has different amounts of mitochondria. The skin cells have very few, so mitochondrial disease doesn't really affect the skin. The brain cells have thousands of mitochondria so mitochondrial disease REALLY affects the brain. So if you think of the hardest working organs and parts of your body you can see where mito can do the most damage.  Everyone with mitochondrial disease has different symptoms. This is because the number of affected mitochondrial in each cell is unknown. So you can have mito where your cells only make 10% of the energy they are supposed to but it only affects 2% of your cells so you have mild symptoms. Then you can have someone else whose mitochondria make only 40% of the energy they are supposed to but 80% of their cells are affected so they have very severe symptoms. To add more confusion, symptoms can vary everyday. On good days, the mitochondria can function well and the unaffected mitochondria can step it up. Add something like a minor cold or a little over exertion and affected mitochondria can stop working completely and leave only the few unaffected mitochondria to run the show. These can be very bad mito disease. Sometimes you can recover to baseline and sometimes the changes are permanent or at least long lasting. These challenges make diagnosis mitochondrial disease very tricky.

Just in time for mitochondrial disease awareness week we finally got back the type and confirmation of Audrey's disease. This was a mixed blessing. It is a relief to know for sure this is what is wrong with her. We haven't missed some rare disease that we could have been treating. Obviously though, she definitely has a horrible disease which not only cannot be cured but does not even have a treatment. It's a disease that we don't know what will bring to her in the future. She could get better, she could stay the same or she could deteriorate before our eyes and there is nothing that will tell us what will happen or when. We will live in fear of every cold or stress she goes through that maybe this will be the time she has a mito crash she can't recover from.

Audrey's muscle biopsy results show she is affected in complex I. There are 5 complexes in the mitochondrial energy cycle. The defective part of her mitochondria affect 2 parts of the cycle. This enzyme in Audrey functions at 7% of what it should be functioning. What does this mean? We don't know. No one knows how this will affect her or what her outcome will be. In the meantime though she is thriving and that is what we can focus on today.

Audrey is doing better right now, then she has since she was diagnosed. She has good energy and is only sleeping 15 hours a day. Her speech is improving every day and she is making 4-5 word sentences finally. She is slowly getting stronger and is definitely getting bigger. She is silly and happy and playful.These are the things we focus on. Yes, she still needs oxygen and IV nutrition. Yes, she has not been able to tolerate any more formula through her feeding tube. But all of her interventions are helping her grow and become strong again, and for now that is the only treatment we have for her.

Below are some links for mitochondrial disease awareness week. The first is a video made about Audrey's journey the past year. The second is a link to a photographer friend who took beautiful pictures of Audrey. It is awful and amazing to look back and think one year ago we were just starting this journey. Audrey was still eating and drinking food by mouth. She had never had an IV or surgery. She had no scars on her little body. Now, 12 months later, it's been 6 months since she's eaten anything by mouth. She's had several IV's and 2 central lines. She has 4 scars on her beautiful body. Our consolation is that we know what the problem is. Our hope is that we can find a cure for her before its too late. So help us and spread awareness. Tell everyone you know about mitochondrial disease. Ask questions, google, investigate and donate. Our mito warriors need all the help they can get.

One year with mito

Kevin Amick photography

Friday, September 7, 2012

Catching up

I apologize for the long space between postings, life is crazy as usual! So what is new with our journey with mito...

Audrey continues on her PN and lipids through her PICC line 24 hours a day. It has been 4.5 months and she has not made any progress with her feedings. The good news is she is growing well. Her height is up to the 65% and her weight went from the 8% to the 80%!!! So she is on a little TPN diet right now :) She looks great right now so that is what is important. Her feeding intolerance continues to be a source of frustration. She receives 17mls an hour and her goal is 40mls per hour. So she is not quite at half her rate. Any attempt to increase has been met with disaster within a few days, her gut just stops working. She pours out huge amounts of bile from her g-tube and nothing comes out the other end. Oh well, I guess the PN is what she needs right now.

Aside from her nutrition, since I wrote last Audrey has had 2 hospital stays, 3 procedures, 3 x-rays and 2 blood transfusions. Not to mention her countless doctors appointments. Yep, she keeps me busy. This week has been a big week for change for her. She had her last sessions with her therapists from regional center. This was very sad as she's been working with them for a year now. Especially Anne, her physical therapist. They really bonded and she will be greatly missed. Since Audrey turned three, she started with the school district. She goes 5 days a week for 2 hours and they work her PT, OT and speech therapy into those 2 hours and "normal" preschool stuff like A, B, C's. She's gone 2 days so far and loves it! Yay! For all you who remember my blogs about the horror of dropping her off at daycare, I was understandably nervous about how this drop off would go, but so far so good!

So that is pretty much all that is going on right now. There are definitely changes coming up that I will write more about later and Mitochondrial Disease Awareness Week starts September 16th so be prepared to hear alot more about mito!

Big girl is three!

Last day with Anne :(


A lollipop for Audrey

A happy birthday button


Tuesday, June 26, 2012

She's doing well!

We've been home over a month now and all I can say is she's doing well! People are always asking "how is she?" And as I respond, "She's doing well" I know they are thinking of a healthy almost 3 year old girl with big brown eyes. Unfortunately doing well for Audrey means, she's thriving on IV nutrition given through her arm. She's still not up to even half of her j-tube feeds, her g-tube is continuously draining and she still goes through 18 syringes of medications per day. But she is doing better than she has in almost a year and for that we are thankful and able to enjoy her even more.

We have been fortunate to take some time out for the zoo and a trip to Sea World. Audrey and her brother love animals and little did we know how much Audrey would love Sea World! She asks to go back every single day! We learned somethings on our short trip. First, we cannot get a smaller car. The amount of things she requires just for two nights away, is staggering. Second, the nurses who work in the first aid station at Sea World are great! They were willing to keep her TPN and refrigerated meds for us so we had less to lag around all day. Thrid, we can do this! Yes, she was exhausted and didn't even get out of her stroller once all day. But, her new stroller lays down almost completely flat so she was able to take a 2 hour nap! It was also tricky making sure to keep her pick dry with so much water around, thank you glad press'n'seal!! That, being said it was a great time for us all, and so important to remind us we can do "normal" things with a twist.

I have gone back to my weekend, night shift job which has worked out well. I'm able to be home with Audrey and her brother all week and work during the weekend. It limits our family time some but it is definitely better for the kids right now. Audrey is thriving being at home and not exposed to other kids. She hasn't been sick since the last week of May! This is the first time she has gone a whole month without being ill since November!

With all this goodness going on, we have a big hurdle leaning over us. Audrey needs her tonsils out. Surgery is rough on her and will undoubtably set her back. Right now she is the strongest she's been in awhile so hopefully she will bounce right back. Surgery is already complicated because she needs a blood transfusion before surgery. Her blood count never recovered from her last hospital stay and has started dropping down again. This gives her a high heart rate and she has need her oxygen more in the past few days. She will also need her clotting factors checked since they were low with her last admission and tonsillectomies are notoriously bloody surgeries. So for now the plan is admission the night before for transfusion and lab check and then one night after to monitor oxygen and bleeding. We may also have to tag a g/j tube change on since we've been having some trouble with flushing. Hopefully it will just be the planed 2 day stay and not turn into something longer!

Here are some pictures of the fun we've been having:

 

 

 

 

Sunday, June 3, 2012

Adapting

Pheww! We've been home for 2.5 crazy weeks now! Our life has once again changed and we are slowly adapting to a new "day" for our girl. I wish I could say the changes have been easy for us and everything has been smooth but I cannot. Our day is now centered around medications and TPN. We plan trips to the grocery store or other errands around when her g-tube is unclamped or the other parent is home. We are terrified to take her out of the house and expose her to illness. She always gets sick, but now when she has a fever we have to rule out a line infection. Our kitchen counter is sterilized everyday to make TPN. Yes, this as a nurse kills me! I am mixing TPN in my kitchen!! I hate it! I hate that my girl has to walk around with a stroller to carry all of her medical equipment. I hate that she has 3 different tubes coming out of her little body. I hate that she can't go swimming or play in the sprinklers, even a bath is major, stressful undertaking. I especially hate that once a week we have to go through the trauma of dressing change that wipes her out for the rest of the day. That being said, since starting TPN my girl is growing. She has gained weight and gotten taller for the first time since December. She hasn't need oxygen once since coming home. She is still wearing it when she sleeps but she just did her sleep study and I am hopeful we will soon be done with that. She is finally feeling better. Yesterday for the first time in 2 months, she went for a walk outside. She is getting stronger everyday. She is trying to jump again and she is almost running with her little stroller. She is still not able to go up the stairs but I know it is just a matter of time. For all these reasons I love TPN.

Our lives are getting ready to change once again. This is my last week in my current job. Starting June 15th I will once again be a nighttime-weekends only-NICU nurse. I have missed the NICU in the last 18 months. I will miss my current job also. I love working as an NP and my very special patients will always have a place in my heart. I have met amazing co-workers and have learned so much. I am looking forward to going back to NICU. I have missed my fellow nurses though they have continued to provide me with so much emotional support through our journey that I will always be thankful to them. And so we will have to once again adapt to doing things during the week with mom and dad on the weekend. No more days off together, no more weekend activities. But in doing this Audrey will be at home. We don't have to stress her body to go to daycare or be exposed to illness. We don't have to rely on other people to watch her carefully for all the subtle signs she has when things start to go wrong. This is the best decision we could make for our family right now so we will once again adapt and things will work out. Below are some pictures since we've been home...
At the hospital waiting to sign our discharge papers

Yay! After 22 days, we are leaving the hospital!!

The ride home. The excitement was too much for her little body.

After 22 days in the hospital bed, she is super weak and easily exhausted.

Thank you Dylan Gregory Hatch Fund for her giant bear!! (She had wanted this from Costco and I absolutely refused to buy it for her)

She is mobile with her doll stroller!

Yes she came home with parainfluenza 1 and rhinovirus, so it was a  week of nebulizers and and awful cough.

Her good friend Cat now has a matching GJ tube and PICC line


All hooked up for her sleep study, she's so good she didn't touch anything!

Thursday, May 17, 2012

22 days

Today is day 22 in the hospital. After much harassing, crying and hoping everything was set for her to be discharged on Monday. We waited patiently (kind of) for the TPN supplies to be delivered and teaching to be done. The expected time moved from 2 to 4 to 8pm. Finally at 6 my husband went home with all of the supplies we already had so our son wouldn't be getting to bed at 11pm. Through out the day Audrey's heart rate had been going up and up. The doctors were too concerned, "she's a little anemic" "mito kids have higher heart rates" "your PMD can follow up outpatient." Not wanting to press the issue too much, we REALLY wanted to go home, I sat and watched her heart rate get higher till it's 160-170 at rest. That can't be right. Finally at 930 pm the supplies come! Yay! But wait, that's not a TPN nurse dropping them off, that's just the delivery guy. So now it's nearly 10 o'clock and people are calling to figure out what's going on. Discharge is not looking likely. Then her nurse turns and looks at me and says, "I've taken her temperature three times, her temp is 39.8." That's 103.6 for you non-metric minded folks. Never mind about discharge, I know enough, children with central lines and high fevers don't get to go home. I knew something wasn't right with her heart rate! Though she didn't have a temp all day this is how Audrey rolls. One minute she is 99 and 10 minutes later she can be 105. She always keeps us on our toes. So our girl earned blood cultures and 48 hours of IV antibiotics until a line infection was ruled out. We also had to go down on her feeding as we watched her belly get bigger and bigger. I don't know why a fever in Audrey equals not gut motility but that's what happens.

Now it's Thursday. Last night she had her last dose of antibiotics, blood culture still negative. Her feeding went back up to her go home rate. The TPN nurse is scheduled for 10 AM this time. We are cautiously optimistic she will make it out the door! Her supplies are delivered, everything at home is ready, now it's just us learning how to do her TPN and then we are good to go. We are terrified but we are ready to go...