Archives for October 2011

We have been on the new regimen with the addition of the increased Klonopin and Tegretol for a couple of days now, and we have definitely seen some improvement in her movement disorder and agitation.  I would say we are about 50% better than we were just a week or so ago.

We are using the chloral hydrate less, maybe 3 times a day or so.  Today we went 8 hours and 13 hours in between needing the chloral.  When we do use it now, it isn’t so much the brainstem agitation, it is the agitation because she is just so exhausted and wants to try and sleep.  We have been using Benadryl a bit more often to help with this, but it has been hit and miss with its effectiveness.

On a positive note, she has fallen asleep on her own three of four times now.  Granted, the sleep only lasts between 30 minutes to an hour, but it must be a good step.

She is a bit more comfortable, her movement disorder still bothers her.  It is not anywhere near as violent as it had been, but hopefully there is still room for improvement.

Even so, she is still not really aware.  The only smile I have seen in the last 48 hours is one single group of smiles she had while she was sleeping.  It only lasted a few seconds, but I wish I could have captured it.  But other than that, not much interaction with us.

I think I am going to see if we can get her eye doctor to make a house call.  I just need to know if she really can’t see us anymore or if her muscles controlling her eye movements are basically shot.  It kills me when she just stares straight out without any purpose.

Also, I’m going to talk to the doctors about perhaps decreasing one of the earlier sedatives (phenobarb perhaps) to see if we can get more awareness out of her without sacrificing the comfort we have achieved so far.  We still have a way to go for full comfort, but it is less stressful for us now that she is not as stress out all the time.

Hannah still is not comfortable.  It sucks.

It is painful to watch when she gets really uncomfortable and agitated,  Our hospice team is trying so hard to get her comfort manageable, but it seems none of the normal avenues work for her.   Usually they use a lot of narcotics like Ativan, Versed, etc., but these have no effect on her.  They have been reworking her regimen daily, and we have enough meds here to start our own pharmacy even though we only are using about 20% of them now!

Yesterday afternoon, out of desperation, I sent an email to Dr. Sanger at CHLA (the movement disorder specialist we saw in August) begging him for help in trying to get Hannah’s movements under control because they seem to be getting worse now.  Yes, I begged.  That is how desperate I was feeling.

Within 3 minutes, yes THREE minutes, I had an email response back from him saying he would contact Hannah’s hospice doc immediately to try and help.  He also asked me to take some videos of Hannah’s movements so he could get an idea of what was going on.   I was SO dang relieved!

This morning I got a text from Hannah’s hospice doc saying that she had discussions with both Dr. Sanger and Dr. Goker-Alpan from the NIH (who has been available 24/7 since Hannah has been hospitalized), and they came up with a brand new regimen of meds to try.

Apparently, one of the meds that we were using (Haldol) actually may increase her movement disorder even though it did seem to help cut down the agitation but made her more uncomfortable.   They discontinued that and added Tegretol in place of the Haldol and increased her Klonopin.  They also increased the morphine because we have yet to see any effect with it on her.

Hannah is on adult doses of everything.  We are talking major doses here that could wipe you and me out.  Her body is just sucking up all the meds and getting very little effect from it.

Since removing the Haldol today, Hannah actually slept 10 hours straight — she hasn’t done that in days!  But when she did wake up, she was completely agitated and miserable.  Daddy, who was up with her, said that there wasn’t even a moment of calm and he had to use the chloral within about 30 minutes of her waking up.

The pharmacy didn’t drop off the Tegretol until 10:30 pm tonight, so we will have to wait until tomorrow to see how this new regimen affects her.

There has got to be a way to give her some peace.  There just has to be.

Thank goodness we have Ethan and Abby.  Seriously, if Hannah was an only child, I think I would have fallen into a major depression by now and would never leave our house.

But Ethan and Abby force us to continue to live our lives, even if it is not at full throttle.  Because we have about 70 of our 80 nursing hours covered (51 by our favorite nurse – 5 days a week), we have felt comfortable leaving Hannah at home while we allow the kids to continue their extracurricular activities.

Saturday, Daddy and I were out of the house for about 4 hours (my first time getting out in over a month for an activity other than a quick meal).  Because Abby was at a harvest festival with one of the girls on her volleyball team, Daddy and I took Ethan out to lunch.  I can’t remember the last time it was just the three of us for a meal!

After that, we went directly to Ethan’s flag football game.   It was the first game I was able to go to, and it was really exciting to watch my baby boy so intently passionate and into a sport that he loved.   Immediately after, we rushed over to where Abby’s volleyball game was.  I was clapping and cheering so loudly for them, especially Abby when she scored a point on her serve!   When the game was over, we all went back to our house (including my in-law family, nieces, and nephew) and had a BBQ.  Even though Hannah was out most of the time, she was still right in the room with us (we have her twin bed in the living room now).

We had kind of forced the kids to take a year off of sports since we moved here from Texas, so we had promised to let them do it this year — not realizing that we would be in this position so soon.   But it is so good for them.  So Daddy and I promised ourselves that we would work hard to make sure they made all their practices and games if they were up for it.  Fortunately, some wonderful moms on Abby’s volleyball team have offered to take Abby to practices so if we don’t have a nurse that evening, Abby can still get there.

Sunday, Daddy and I decided to take Abby out for a few hours.  Ethan spent the night at his grandparents house (Abby is in this “need to be near mommy phase” and didn’t go), so the three of us headed to our local mall.  I can’t remember the last time we actually went shopping in the mall!

After lunch there, Abby asked if she could get her ears pierced.  She has wanted to do it for over a year, but we were going to wait until she was 10 or so.  You know, a right of passage like I went through when I was younger.   But Daddy and I both felt that she needed this now, and if she wanted to do it, let’s do it.    And she did.  She did great!   She got a Hello Kitty starter earring set (she is in love with Hello Kitty stuff now — if they had American Girl doll earrings, it would have been a toss up!), and she is just so proud!   She shows them off to everyone.

Then yesterday evening, after Daddy got home from his conference, I took Abby and Ethan to her Brownie Halloween party.  At first I didn’t really wanted to go because I was just so tired and not in the mood to socialize, but I am so glad I went.  Both kids had a fantastic time, and I really enjoyed just hanging out with other families.  Even though many of them knew what was going on with Hannah, I was able to keep my composure and share what was going on with her when I was asked.

But the good thing was that it wasn’t the main topic of conversation, which I appreciated.   It’s like I want people to ask about Hannah, care about how she is doing.  But I also want people to realize that we can talk about other stuff as well.

Even though it was just a few hours a day for the past few days, I really needed it.  There were many times during these past few days that I went through major guilt pangs, thinking that I should be at home with her, but I was also brought back to reality because Ethan and Abby needed me too.

I had to remind myself on MANY occasions that Hannah was being cared for and loved at home (which is why we aren’t training any new nurses), so it was almost like I had to give myself permission to laugh, enjoy myself, and cheer on my kids.

For the past year, Hannah has had strabismus (her eyes turned inward).   We see it in all her pictures, and I got used to looking into the beautiful brown eyes and seeing them crossed, but she still would be able to gaze back into my eyes.  Classic Gaucher symptom that you just eventually learn to overlook and assume as normal.

Hannah and I would cuddle for hours and just look at each other.  We always said that for a nonverbal child, she is incredible expressive and you know what she is feeling because of her eyes.

That is completely gone now.  All of it.

The strabismus is gone.  Not even a sign of it anymore.  Hannah’s eyes are now both straight ahead in the middle.  She can’t move them left to right anymore or even up and down.   The nurses say they still react to light, but what does that really mean in terms of what is going on?

We also wonder if she can still see us.   Could she have lost part of her vision or even all of it?

Even if I put my face strategically right in front of hers so she can make eye contact, it just doesn’t happen.  She has the actions of how a blind person uses their eyes, but whether or not that is the case, we just don’t know.   But then there are those rare times where we will lay on her side and let her watch her iPad (Wiggles or Elmo) for about 5 to 10 minutes (before it is obvious she isn’t interested) – but unlike two weeks ago, she really doesn’t seem to pay attention to the screen and just seems to listen to it for a few minutes.

Could one of the meds be causing this?  Is it progression of her disease?  Why two weeks ago, even in the hospice, she was able to make eye contact with us but now it is almost if she looks right through us, never making that connection.  I think it is time to send off an email to her NIH pediatrician and see if she has any insight.

I feel like my only way of having two-way communication with my baby girl is gone.  We couldn’t have conversations with words or signs.  Losing that bond with her now, not being able to have her really see in my eyes how much I love her and how much I hurt for her…just so mean.  This disease is so damn mean and cruel.

“Challenging” is a word I have heard used to describe Hannah more times throughout her life than I can count.  Just once, I wish she could just not be so challenging.

We are still trying to find the right combination of meds to balance her agitation and movement disorder in order to give her body peace yet give her some awake time so she can feel love from all of us.

Saturday was pretty bad, but Sunday was progressively worse.  She would sleep for only a couple of hours (from the chloral hydrate), and then wake up really agitated.  We would then have to watch the clock until that 4-hour mark just so we could knock her down again.  That went on all…day…long.  It was hell.   Finally, I called our nurse coordinator that night begging for help.

She talked to Hannah’s hospice doc, and they agreed to give her an extra shot of phenobarb as well as increasing the haldol from 0.1 mL to 0.25 mL and see how she responded.

What a difference!  She woke up at 8 am (after getting her last chloral at 4:30 am), and she was not agitated!  It was almost bizarre because we were expecting it.  What is even crazier is that she stayed awake until 2 pm – 2 PM!  We gave her benadryl to see if she could sleep around noon because she was really tired, but we don’t know if it took a while to kick in (or just didn’t work), but she actually fell asleep on her own around 1:00 pm!   She slept for about an hour, and then at 2 PM she woke up agitated again, so we had to resort to the chloral.

It was so nice to see her somewhat comfortable for a few hours.  She really doesn’t react to us much anymore, but she seems to respond to our voices on some occasions but trying to turn her head to us.  Sadly, there were no smiles during this time, no matter how hard I tried to get them.  Fortunately, our Monday  nurse (who we had to fight to keep on Mondays) was so loving with her and basically spend the afternoon rocking her and cuddling her (while I slept).

She slept for a few hours, and then she woke up again in a pretty less-agitated state.  Daddy got to spend time with her, holding her, and then she fell asleep on her own (with the help of benadryl) at 7 pm.   Again, ON HER OWN!

She just woke up around 11:15 pm when I am “on duty,” and she was horribly agitated within minutes of waking up.  I gave her midnight meds at 11:30 pm, and I waited desperately for them to go into affect so she could calm down.   She was just too miserable.  Hearing her squirm (the only time we hear sounds from her mouth are when she is upset), I just had to give her the chloral again at 12:30 am.

It seems like she is really getting agitated when she wakes up within a couple of hours of her three-times-a-day meds (8 am, 4 pm, and midnight).  Maybe I’m just trying to find a pattern, and it was just a fluke?

I would give anything for her just to be comfortable and not experience this intense agitation again.  I hope her body lets us comes up with a plan of care that will let us do that.

Hannah was a few days overdue on her Cerezyme treatment.   It was important to us to continue treatments because Hannah’s comfort is always our priority.

Our hospice coordinator had been working to get Hannah’s treatments done at home now that she has the broviac catheter (and doesn’t need an IV anymore).

We just assumed that an RN from our nursing agency would come to our house and do it.

But then I got a call from Dr. Bernstein, Hannah’s specialist, whose office we have been going to every 2 weeks for the past 16 months.   He was sending our favorite nurse, the one who has done Hannah’s IV and taken care of her 90% of our visits, to our house on Friday to administer the Cerezyme herself.

How wonderful was that?  We were so touched that their office cared so much about Hannah to send her out to us — on a work day!   These infusions take 2 to 3 hours, and they were willing to let her come to us.

It was nice being able to sit and chat with her.  We, along with Hannah’s regular nurse, were able to talk about what was going on, joke about ridiculous things, and just hang out.

Really meant so much to us.   Now I don’t know if this was a one-time visit (and then our nursing agency would take over treatments), but I hope not.  Whatever happens, I am just so grateful that she was able to come out for this.