Archives for January 2010

Milestone Cerezyme treatment day

Cerezyme treatment #26

Cerezyme treatment #26, a milestone

Today was Hannah’s 26th Cerezyme treatment.  Every two weeks for the past year, we have made the drive down to Texas Children’s Hospital’s Infusion Center.   For 2-1/2 hours, Hannah is cuddled up against me (usually asleep) while she gets her life-prolonging enzyme replacement therapy treatment via an IV in her hand.

We have been lucky that she has not needed a surgical port placed yet.  We, along with her doctors, have all agreed that a one-minute cry during the input of an IV far outweighs the risks of having to deal with an surgically placed infusion port inside her chest.  The nurses at TCH have been able to master her IV placement, and it literally takes less than a minute to get it done.  Even Dr. Schiffmann, her Gaucher specialist, was incredibly impressed by this feat.

Cerezyme treatment #1, February 9, 2009

In my heart, I truly believe the Cerezyme treatments have kept Hannah alive longer than if she had not had the treatment.  I look back at how large her spleen and liver where when we started at 6 months old, and she would have probably suffocated because they were already shrinking her lung capacity by their size.

I know they say that Cerezyme does not cross the blood-brain barrier.   But making her more comfortable by dealing with the other physical symptoms of type 1 Gaucher’s (bone pain, spleen and liver enlargement, etc) has made Hannah much more comfortable and happy.

Hannah is not in any pain.  She does not live in pain.  For that I am incredibly thankful.

One year of treatments down.  A lifetime to go.

Failed attempt #2

We didn’t make it again to the nursing home, but this time it had nothing to do with Hannah.

Abigail seems to have caught a 24-hour stomach bug of some sort and had been vomiting every-hour-on-the-hour for almost 12 hours straight!    She seems a bit better today, but there just was no way that we were going to make a drive dealing with both her and Hannah.  Abigail was so upset that we had to postpone our “vacation” (even though we told her it wasn’t a fun vacation).

The nursing home coordinator is also not so pleased.  We rescheduled for next weekend, but I got the impression from her that “3 strikes and you are out.”

Great, no pressure there!

Nursing Home Visit – attempt #2

After a horrible attempt for a road trip last month to try and get our nursing home overnight stay requirement filled so that Hannah can be approved for the medically depedent children’s program (and medicaid), we are going to try again this weekend.

Last time, we only made it about 45 miles of a 200 mile drive before we had to return home.  She had 3 beginnings of a hypervenilation episode (as a result of a tantrum of not liking behind confined) and one actual hyperventilation episode, all requiring us to pull over for about 10 minutes, get her out of the car, give her some fresh air and cuddles, and then move on.  Also last time, she was teething horribly and completely congested, so in hindsight, it probably was not a good move to go that weekend.

We are going to try again this weekend.  We have to check in by 11 am on Saturday, so we are actually going to leave when the kids get home on Friday afternoon.  This way, we can drive as far as we can on Friday and spend the night in whatever city we can get to.  Hopefully we can make it the entire way Friday (it would normally be a 4-hour drive, but not with our situation).  But this gives us a cushion just in case we have to stop and give her a break.

I will admit that I am incredibly nervous about this trip.  The first 40 miles is in more of a rural area, so if for some reason we needed 911, it would not be that quick.  We will definitely be taking our oxygen with us, actually a couple of tanks “just in case.”   We have the DVDs ready to go, but even those only taking her mind off things for a period of time.

I don’t know what it is about her and driving.   She tends to do it when she is more on the tired side (not nap tired, but just up for a while), and when she is not feeling well.  We were able to make it to Katy last weekend (45-minute drive) without a problem, but on the way home, she had another episode, and we had to pull off the freeway and give her fresh air.

I hope, hope, hope this works.  I don’t know what we will do if it doesn’t.  We thought about flying closer to the nursing home, but there would still be an hour+ drive from the airport, but then we have to pay for airline tickets.  We thought about renting a small RV (which the kids would love), but even that is a few hundred dollars.

Just keeping my fingers crossed…

Liver and Nutrition Woes

We met with Hannah’s liver doctor today, Dr. Carter at TCH.  We actually had not seen her since before Hannah was diagnosed.  I brought her up to date on everything that has been going on, including how Dr. V was concerned about some of her elevated liver function levels from as far back as Sept of 2008, which were still a bit high at the NIH.   What they mean, we don’t know yet, but Hannah had another set of blood work today so she can review it.

My main concern is that Hannah has been on the Cerezyme treatments for one year (next week), and her spleen and liver should have shrunk back to normal size by now.  They definitely aren’t.  Dr. V, her GI doc,  is actually concerned that it seems a bit bigger.  This along with the elevated numbers makes this something that needs to be looked into.

So we will be doing the liver function tests (blood work), and we are going to schedule a abdominal ultrasound downtown at TCH to get measurements to see where we are at.    Then, depending on the results of these tests along with the advise from Dr. Goker-Alpan at NIH, they may do a liver biopsy to see if there is any liver disease that may not be common with GD.  Apparently there are a few rare cases of “liver scarring” with GD type 1, so that is in the back of her mind.  The thing that sucks with the liver biopsy is that what would normally be a quick outpatient procedure would be an overnight stay downtown at the hospital to be monitored because 1] of her lower platelets and 2] because of the quality of platelets (which may not be as functionable as normal platelets).

We then talked about Hannah’s nutrition and how we have seen regressing in finger feeding.  I wanted to know “what to do” because we have been just winging it lately with milk, pediasure, and stage 2 baby foods in the bottle.   She brought in her dietician, and her dietician recommended a product called “Compleat Pediatric,” which is basically all the required food elements (proteins, fats, vitamins, etc) pureed together using natural foods.

She warned me that it is mostly used for g-tube feedings (feeding tubes), but she does have some patients that can drink it orally.  Apparently, it doesn’t taste that great, but since Hannah is used to stage 2 meats, veggies, and fruits mixed together, we would give it a shot.

We came home, and I put together her first bottle of 4 oz whole milk, 4 oz Compleat Pediatric, and one stage 2 fruit (pears and pineapple).  She downed the entire bottle!  Not only that, she drank most of her second attempt with it tonight (again 4 oz milk, 4 oz CP, and stage 2 fruit).  I’m going to email her in a couple of days and take her up on her office to get a rx for this.

Even though we have had to “give up” on feeding her normal foods, there is a sense of comfort knowing that we are a step closer into getting her the nutrition she needs.    After talking to another of her doctors, it is time to stop her feeding therapy now and just move on and accept this is where we are at this time.   I guess there is a sense of comfort knowing that we aren’t needing a feeding tube at this point, but there is such a sense of loss/grief trying to accept this.

Hannah and the kids

Hannah, 12 months old, watching her bro and sis play their DS games

Ethan and Abigail are home for a 4-day weekend.  It feels like they just had their 2-week holiday break!

Even though the chaos in the house gets a bit overwhelming when I have all the kids home for multiple days, I have really seen a huge change in Hannah when they are here.  Ethan and Abby shower her with attention, love to play with her, and make a strong play to include her near them at all times.  We never have to ask them to do that, they just do it.

During the holiday break, they spent a lot of time with Hannah.  Every day, multiple times a day.  I really think Hannah thrived on it because … well, let’s face it, they are more fun to be with than Mommy and Daddy are!

Hannah seems to thrive on the attention from them too.

With Ethan, she just lights up when he comes to her.  I never get a smile that big unless I’m carrying her bottle or she is tired and wants to cuddle.  He knows her limitations, but still tries carefully to push her and teach her things (like putting things “in” or throwing a ball, both of which she has not been able to do yet.)

With Abigail, it is different.  She is very motherly with Hannah and protective.  Making sure that Hannah’s toys are near her, making sure they are turned on.  Always wanting to be her “friend” and play her toys with her as Hannah watches and learns.

I’m thankful that Hannah is well enough these days to be able to spend time with her brother and sister like this…without machines, without significant problems, etc.  Just a baby girl and her big brother and sister.

My Vtech baby

Hannah has quite a few favorite toys.  All of them are ones that are cause/effect and make noise/music when pushing buttons.  As I am looking at them, I realized they all have one thing in common.  They are all VTech toys!   After going through their website just now, I realize I could spend a few hundred dollars more on toys I know Hannah would love and get a lot of use out of.  THANK YOU, Vtech!

Vtech Learn and Drive Discovery

Sing & Discover Story Piano

Baby's Learning Laptop

Sit-to-Stand Activity Walker