New Home, Fresh Beginnings

We moved into our new home this weekend.  My husband, father-in-law, and brother-in-law moved all the heavy furniture themselves.  My in-laws and my hubby must have made dozens of trips back and forth between the two houses to bring more and more things over.   Tonight we celebrated with them with a BBQ in our new backyard.

I LOVE this new house.  It is a combination of a fantastic layout, a massive purge of stuff, and getting my ocean blue painted bedroom again.  It is weird because the house is quite a bit smaller (700 sq feet smaller), yet it still feels big, open, and very comfortable.  The backyard is also great (and even has a built-in space for a jacuzzi at some point), and we love sitting out there with Hannah while the kids are playing.  Even better, the way the house is situated, we get shade in the backyard in the afternoons, which definitely makes it cooler and more comfortable!

My first priority was getting Hannah’s area created and her supplies organized.   It was incredibly important to me that we make the living room look less like a hospital and more like a living space (in the old house, there were med supplies everywhere in the living area).  We gave her the big linen closet for the med supplies, and that still is just not enough so I will have to redo that at some point, but at least it is all hidden.  The only things left in the main living area are her oxygen, her chest percussion vest, suction, and a small basket of go-to supplies under the coffee table.

Another big change is that Hannah is now sleeping in a big girl bed by herself and not sleeping with me!   For the past few months, Daddy has been sleeping in the spare bed in the office and Hannah was sleeping with me.  In this new house, we have our king-size bed AND her twin bed in our master bedroom (and it fits great).  It is going to take an adjustment because I used to doze off at night holding her hand or leg so that if she woke up, I would know it (since she doesn’t have a vocal cry).   But I miss having my hubby sleeping next to me.  Now I have my hubby in bed with me, and Hannah just two feet away in her own bed.  She still has her toddler bed in the living room for daytime naps.

Our nursing situation is still a big question mark.   Today, our normal Monday nurse was supposed to work 7 to 5 today because she couldn’t work on Monday.  Yet, she ended up leaving at 11:30 am because of a family crisis and was too upset to finish the day.  She says she will make up the hours tomorrow (Monday, on the day she originally needed off), so I’m keeping my fingers crossed.  We have a backup nurse for Tuesday, but I don’t know what the rest of the week holds for us.  Our Monday nurse (that left early today) is supposed to take 4 days a week starting the week after next, but I don’t know what the nursing agency is going to do for those extra two days.

My hope is to get our house completely unpacked by Hannah’s birthday, July 25th.   There are so many possibilities with this house, and over time, as we have the money and time, we will make it perfect.  I am really, really loving this house!

Another one is gone

Our Tuesday thru Thursday nurse was fired today.   I got the call 5 minutes before the end of her shift from the nursing supervisors to let me know that she wasn’t going to be back.  They couldn’t give me a tangible reason why, but obviously it was something serious enough that it had to be done at that moment.

Hannah LOVED her.  She was absolutely wonderful with Hannah.  I could honestly say she was the best nurse we have had since we started with nursing.  You could tell that she just adored Hannah as well.  She would sing to her many times during the day, and Hannah would have a huge grin on her face every single time.   She always was right on top of all our “daily goals” in terms of feedings, therapies, etc.

Most of all, I felt like I could totally trust her to take care of Hannah’s needs when I had to go out of the house.

It sucks.  I can’t blame the nursing company because obviously there were circumstances that warranted this termination because they know how much we liked her and how we are still in need of a normal nursing team.  I could also tell in the nursing supervisor’s voice that there was a sincere disappointment that it had to be done.

But it still sucks.   The timing is absolutely horrible.  Tomorrow I am supposed to get the sutures removed from oral surgery I had done last week.  We move the furniture to the new house on Friday and Saturday.   There will be weeks of unpacking, I’m sure.  Maybe even more.   Ethan and especially Abby are needing more and more attention these days as Hannah’s disease progression is becoming more obvious.

Most of all, Hannah needs someone she can feel comfortable with and trust.  We have had a parade of nurses since the end of March when we lost our two regular nurses.  I hate doing this to Hannah…all these new faces, new people, and we just leave her alone with them for hours on end (even if we are in the same house).

I have a tremendous, tremendous amount of guilt every time a new nurse starts with Hannah.   It kills me to just leave her alone with a stranger after just sitting with them for about 30 to 45 minutes or so.  They don’t know her cues, they don’t know her wants, they don’t know what makes her happy and comfortable.    And what is worse is that I am usually sleeping the first half of that shift because I was up the night before doing the night nursing stuff.

Right now, we only have one regular nurse, and she works on Mondays.  Thankfully one of our backup nurses was able to cover tomorrow’s shift so I can get my sutures out, do carpool, and get to the new house to pay the painters (I really didn’t want to bring Hannah to the new house with the smell of fresh paint fumes).  Friday and Saturday are covered for this week, but who knows what next week holds.

There is an emotional side of nursing that I don’t think outsiders get.   Yes, we need it to help us try to keep our heads above water each day.  But there is also the guilt and frustration because we are leaving our child to be cared for by someone else, which is a constant reminder that I, as a mom, am not able to get my crap together enough to be able to take care of her and do everything else.

What makes things worse, every single time I leave the house and leave a newer nurse home alone with Hannah, I am scared to death that something is going to happen to Hannah — her trach comes out and the nurse can’t get it back in, she has a tantrum that leads to breath-holding, etc.   It takes me many weeks before I feel comfortable just leaving her with the nurse without feeling that way.

But yet, it isn’t reasonable to be at the house every single minute the nurse is, but I do try.  I just feel like I need to be there for her.

Right now, with the loss of this latest nurse, I feel completely overwhelmed, stressed out, and just very sad.   Sad that Hannah has to deal with the loss of another person that she came to like and trust, and now the roller coaster of new faces, being left alone with strangers, and separation anxiety begins again.

Physical therapy changes

We made it to physical therapy today.   We haven’t been there in 3 weeks because of the Disney trip and then the subsequent trachiitis that knocked her out.

When we got there, Hannah’s PT brought us into a side room and told us that their corporate office is becoming more strict on missed sessions.  Reality is that we only go to PT when Hannah is awake and up for it.  There is no reason to wake her up or go when she isn’t feeling well because she won’t do anything except cry and get upset.

Our PT’s office has been really understanding since day 1, understanding the fragile nature of Hannah’s condition and the reasons why she can’t always make it.   But apparently their corporate office is not so understanding.

Her PT suggested strongly that we go to “on call” status.   Basically, I call on Monday mornings and see what cancellations they have (which seems to be quite a few) and pick a time that would work for Hannah.  This actually would work well for us because it gives us the opportunity to get her speech, OT, and PT if there is availability instead of just PT.

It isn’t the most ideal situation because she doesn’t get a set therapy time, but the reality is that she can’t keep a set therapy time no matter how hard we try.  She will only do well in therapy when she is feeling well.  We can’t tell her to suck it up or make her do anything she doesn’t want to because she just can’t comprehend that.

We still have our twice monthly PT with early intervention which has been wonderful and we are hopefully going to get twice monthly OT through early intervention (now that they have hired more OTs).

It isn’t enough therapy for her.  But we only have so many options because of Hannah’s tolerance.

We have our school district evaluation next week which will include PT, OT, and speech.  It will help the school district, Daddy, and I come up with a good IEP plan for Hannah when the school district takes over her care in August.

Not thrilled with not being able to get her regular therapy services, but we are having an incredibly difficult time finding home therapists who will work with Hannah here.   Because we have primary private insurance and only secondary medicaid, we can’t find anyone who will take private insurance.   If she had primary medicaid, we would have quite a few possibilities.  But for now, it really is up to Daddy, Hannah’s nurses, and I to therapeutically work with her for the most part.

Is hope realistic?

I have been emailing with a few families over the past couple of weeks who have children that have been newly diagnosed with neuronopathic Gaucher’s disease.

One mom asked me if she should “hold out for hope for a treatment to save” her child diagnosed with type 2.    Another dad I emailed with described one of the top experts he had seen as a supposed “savior” for his child when that person said there was really nothing that could be done.

As I watch Hannah’s condition deteriorate over the past few months, I am losing the idea of hope.  I am very realistic to know that it is very unlikely that there will be a treatment found to save Hannah.  As much as I wish I could change that, reality is that there is so little money going into neuronopathic Gaucher research and so few researchers working on this form of Gaucher’s.

What can I say?   How do I try to provide support for a family grasping for hope when I am watching this disease take away my daughter’s mobility, agility, and ability to do even the most basic of infant skills?  I don’t want to take away what hope any family may have but I also feel that families need to be realistic with the diagnosis, especially those with type 2.

This is a cruel disease.   We have to squeeze quality time out every moment that it becomes available because each month that passes we realize that this disease is taking more and more control over Hannah.    She is losing her ability to have fun, to play with her favorite toys, and even to interact with her iPad on special apps (thank goodness she can still watch her Wiggles).

I will not give up on trying to find something, anything to help Hannah and the other nGD kids.  But with the very real possibility that Hannah is going to need supplemental oxygen in the very near future, I honestly feel like we are losing this battle and are heading into even more complicated territory.

I find my heart breaking more and more these days.

Neuro changes

We met with Hannah’s neuro yesterday.

Even he noticed that Hannah seemed more “lethargic and loopy” compared to her last visit with him a couple of months ago.   So the plan is we are going to reduce the Klonopin back to where we were at a couple of months ago which is 2 mL, 2mL, and 3 mL daily instead of 3 mL three times a day.   Hopefully in a few weeks, we will see Hannah get back some of her independent spirit and drive to crawl and play with her toys instead of just wanting to be held all day.

We are going to hold off on the sleep study at this point because I don’t feel her seizure activity is very active while she sleeps these days and because we really want to optimize her Klonopin to a stable level before we start playing around with other meds.   I feel comfortable with that decision, although once we move to the new house in a couple of weeks, we are going to start charting her O2 sats overnight to see if perhaps she needs to be on oxygen at night and let the pulmonologist know when we see him in a few weeks.   (It is difficult to do it now because the equipment is downstairs, and the oxygen concentrator is not portable enough to bring up and down the stairs safely).

She was definitely a bit more alert and happier today.   The Cipro has definitely started working to help with that and also her secretions which are already going back to being white and clear instead of yellow/greenish and thick.

We will meet up with her neuro again in a couple of months to see where to go from here.   In the meantime, I’m still going to work to try and get Hannah an appointment with Dr. Sanger, the pediatric movement disorder specialist from Children’s Hospital Los Angeles.   We also have appointments with her pulmonology and GI doc within the next month so we can also work on the O2 sats and reflux issues to help make her more comfortable.

Hannah also has her big evaluation with the school district in a few weeks so we can get her ready for transition from Early Intervention in a few months when she turns 3.   On a very sad note, we lost our EI service coordinator to a new job just recently – Hannah really bonded with her, and I hope that she can come visit with Hannah once we get settled as a “playdate” and not for “work.”

Lastly, Hannah’s stander came in today.   Metal blue (although I could have sworn I ordered a different color, but oh well).   After meeting with her orthotist today to do a followup on her leg braces, I think working with the stander over the next few months will also help strengthen her core as long as the decrease in Klonopin does as wel hope — give her more alertness, balance, and less of a drunk feeling!

From Bad to Worse to Sleep

Shortly after I posted my blog last night, we went into crisis mode with Hannah.

She was so congested in her trach all of a sudden that she would wake up choking and then go into a breath-holding spell out of panic.  Even if I was able to clear out her trach, she had problems relaxing right after so she would start to turn blue because of the breath-holding.  She was incredibly junky with her trach, and very quickly the aspirate was thick, gooey, and brownish-green.   She had three episodes like this within about 2 hours.

Infection.

She would fall back to sleep but still be breathing pretty shallow.  You could tell she was working harder than normal to breathe while she was sleeping.   She had no fever, but with such a rapid onset of infection coming from her trach, I started to worry about pneumonia.

After all, it was one year ago this week that Hannah developed the pneumonia that put her in the hospital for six weeks and put our lives in hell and changed her life forever.

Daddy and I contemplated from about 12:30 am until about 2:00 am whether or not we should take her to the ER.  We brought her downstairs where the oxygen concentrator and pulse ox were, and for about an hour, we concentrated on keeping her suctioned and giving her supplemental oxygen (5 liters pushed through a mask).   Before we gave her oxygen, her O2 sats were hovering between 88 and 91.   With the oxygen, she was at about 94 to 96 and much more comfortable.

So we made the decision to ride it out until the morning (a few hours later) to see how she was doing.   Deciding to go the ER around here is a delicate balance and not an easy one.   1]   We know that she could catch something else (like how she got rotovirus and cellulitis last time), 2]  We have Ethan and Abigail at home so we don’t want to unnecessarily scare them about her condition, and 3] We go through our heads “what could they do that we can’t”.

Daddy and I switched roles at around 5 am, and she seemed to be stable.  Definitely requiring oxygen and lots of suctioning (where we usually rarely ever have to suction her), but much more comfortable and no more breath-holding panic spells.   So I took a quick nap for a few hours since I had been up all night.

Since our pediatrician’s office is not open on Sunday (which also happened to be Mother’s day), we decided to take her to the ER on a non-emergent basis.   We weren’t sure if we were dealing with pneumonia or just trachiitis or even possibly a UTI.  We wanted to get her a chest xray, blood work, and get her some antibiotics.  We didn’t want to wait until Monday, so we went to the ER.

Because we did it later that morning and in a more relaxed setting (not an emergency), we were able to explain to the kids why we were taking Hannah in (mostly that we would do it at her pediatrician’s office if they were open, but since they aren’t, we just wanted to get her checked out and get some medicine).  We don’t want them to worry unless there is something to worry about.

Even though we were taken back immediately when we got to the ER, we were there for almost 7 hours because they were so busy.   Her chest x-ray was clear, and since there was no fever, there is likely no pneumonia.   Her bloodwork came back with an elevation in her white blood cells at about 17,400 so there was definitely an infection.   Her urinalysis came back clean, no UTI or anything else worrisome.

The ER doc wanted to admit Hannah because of everything going on (we talked about the last few weeks), but we decided to bring her home and let her pediatrician follow up tomorrow and her neuro to follow up on Tuesday.   After explaining to the ER doc (who was very interested in Hannah) that we have a mini-hospital at home (oxygen, pulse ox, home nursing), she also agreed that since there isn’t anything they would do different in the hospital that it would be okay to take her home since it is presumed we are dealing with a bad trachiitis at this point.

They gave her some IV Cipro before we left, and we  have a prescription to continue with the Cipro for another 10 to 14 days.

We came home, and she has been doing much better tonight already.   She and I are downstairs tonight because we still have her on supplemental oxygen until we can get through this thick gook.   I have been doing a lot of suctioning, but not as much as last night, and no more panic-breathing attacks from her.   I really think the IV Cipro definitely kick started the recovery process because she is just so much more comfortable tonight.

So I ended up spending my mother’s day at the ER (since we left at almost 7 pm).   But you know what, that is okay.   Because at the end of the night tonight, I had all three of my babies at home with me.    That makes today a Happy Mother’s Day.