Alternatives...Alternatives...

I've never considered myself to be a proponent of alternative medicine, homeopathic approaches, all-organics, "I only eat meat if it was fed green blades of grass on a spring water-fed farm," etc. However, I've come to realize that a few of these approaches may be helpful when it comes to our little Sadie.

After doing a lot of research , we've decided to trial Sadie on a blended diet. She will continue on her ketogenic diet for seizures, but we're going to try it with blended "real" foods as opposed to formula. In order for it to remain ketogenic, the recipes will still be high fat, consisting of some heavy cream and oil. But, we'll also be able to add in real meat (chicken, turkey, pork, beef) as well as a variety of fruits and vegetables.



A wonderful "must read" for
any parent of a tube-fed child.

There are a few reasons we're making this switch. As I mentioned in previous blog posts, Sadie's GI motility issues have been getting progressively worse. (Or, in layman's terms, she simply doesn't poo on her own). With the exception of one miraculous day last week, it's been eight months since she's pooped without the assistance of a suppository.  She's been to numerous GI doctors, has had a variety of laxative treatments, and recently underwent an anorectal manametry study - which came back completely normal. Our hope is that these GI issues improve with the introduction of real food. Additionally, it will be quite nice to feed her similar things to what we ourselves are eating. For example, this past weekend, we had chicken salad and Sadie "ate" a blend of chicken, celery, cream and oil.

Our new Blendtec blender for
blending Sadie's food

This decision was guided, in part, by a fabulous book called Complete Tubefeeding, which I initially heard of from a few other parents. I now consider it a 'must-read" for any parent of a tube-fed child. While undergoing this research, I learned that the best way to deliver a blended diet through a G-Tube is by using a commercial-grade blender. Commercial grade blenders are able to blend almost any food into a thin, chunk-free consistency that is able to easily be pushed through the opening for the g-tube. We are loving our new Blendtec blender - which I hear is also fabulous for making smoothies (send your recipes my way :).

In addition to the ongoing GI issues, Sadie still has a few days where she fails to urinate on her own and requires catheterization. Another Aicardi parent (and nurse) mentioned the use of Peppermint Spirits to aid urination. Apparently it can aid in the relaxation of the GI muscles...who knew? So, we have been putting a drop of this oil in her diaper and it does seem to produce results!

We are also excited to start Cranial Sacral Therapy for Sadie in the next few weeks. We have heard anecdotally from other parents that while it may seem a bit like hocus-pocus, their children come out of therapy so much more relaxed. Whatever helps Sadie relax, I'm all for! So, we're giving it a try - and I'll be sure to report results as she gets further along.

Another alternative medicine technique we have been trying is the use of frankincense oil for her seizures. Seizure control has been an ongoing problem with Sadie. She is still not in a great place after trying 13+ seizure meds. The few nights I've put a drop on her big toe before bedtime, I didn't see any change in seizures, but I figure it can't hurt!

As for the seizures, we've been trying to hold steady with any changes in her seizure meds, as we await a second MRI to check the functioning of her shunt. When she was undergoing her GI test mentioned above, the hospital took the opportunity to get a full MRI of her brain while she was under anesthesia.



A shunt-series x-ray

We received a call at home the evening after her MRI. (You know its not good news when a neurosurgeon calls you after-hours.) The MRI showed her left ventricle was enlarged. This could be an indication that her shunt is not working properly. We went back to the hospital the very next day to get a shunt series x-ray (where they xray down the shunt line). While the x-ray looked normal, the neurosurgeon noticed a lot of gas in her belly. This could have been caused by the intubation during the procedures, or she could just be an abnormally gassy child.

Either way, the neurosurgeon suspects that perhaps the shunt is not draining properly due to the increased pressure in her belly, and thus is causing the enlarged ventricle. It's crazy how all of the processes in your body are connected. So, tomorrow, Sadie goes in for another MRI to check the ventricle size. Please say some prayers that the ventricle size is decreasing. The poor girl has had enough surgeries in the past few months.  Besides, we are hoping to spend Easter with family and not in the hospital.

Needless to say, when seizures are not good, sleep is not good. We've tried the aromatherapy approach by hanging a bag of lavender on the side of her crib to help with sleep, with minimal results. So, we were excited to learn a few weeks ago that we got initial approval from the state to employ a CNA (Certified Nursing Aide) to watch Sadie overnight four nights a week. After three years of interrupted sleep, I could just cry with delight. 

Finally, we are in the home stretch of deciding between two alternatives for Sadie's schooling. We have toured both schools and think either would be a good fit and equally equipped to handle Sadie's complex needs. For children with special needs, home therapies end at age three and therapy and education continue through the school system. So, Sadie will begin school on her 3rd birthday (April 29th) - yikes! I can't even think too much about it without getting emotional.

So these are the alternatives we are trying so far for Sadie. We hope they'll work as advertised...just stop me when I pull out the crystals.

An Eventful Few Weeks

A lot has happened in Sadie-Land in the past month. A few weeks back, Sadie had a series of sleepy days. As you know, sleepy days are few and far between for Miss Sadie. She is lucky if she gets a 30 minute nap each day. So, on a Sunday when she had slept 5-6 hours and barely woken up when roused, we were naturally concerned.

The following day, I mentioned this sleepy behavior to her Epileptologist during our routine visit. She shot me a concerned look and immediately sent Sadie to medical imaging to check if the fluid in her brain had started to build up again. At this point, we were only 2 1/2 weeks out from her cyst fenestration surgery.

Thankfully, the results came back fine. At this early stage, the fluid didn't look like it had started to accumulate again, but we wouldn't know for sure until Sadie's 6-week post-op CT scan. However, the doctor did express some concern about the tumor on the left side of her brain.

Chillin' in her stroller during a walk.

You see, Sadie has a tumor in her left hemisphere called a choroid plexus papilloma. We've known for some time that it was close to the third ventricle in her brain and had the potential to cause hydrocephalus (fluid buildup) should it shift or grow. Prior to her recent brain surgeries, she had been undergoing MRIs every 6 months to check for tumor growth and to ensure it doesn't block the ventricle. The doctor mentioned that THIS imaging showed the tumor to be partially obstructing the third ventricle.

So, now it seems we have two things to be concerned about - first, that the scar tissues doesn't re-form and cause blockage, and second, that the tumor doesn't get in the way and cause blockage. If either of these occur, then it appears that the only way to fix the problem is by placement of a shunt. We will know for sure if either of these things is occurring after her CT scan scheduled for this Thursday.

In other news, Mommy and Daddy were able to get away for vacation for a few days. But, despite a long talk with Sadie about NOT getting sick, she decided to do the opposite - just like a toddler! 

On Saturday night, her oxygen dropped and she developed a fever. When her temperature increased a few hours later, Grandma and Aunt Megan decided to take Sadie to the ER for assessment. Turns out, she had a mild pneumonia which was likely caused by aspiration from vomiting a few days earlier.


Sadie looking lovingly at Aunt Megan (Goo).

Another issue Sadie has been dealing with lately is slow motility. Or, in layman's terms - she can't poop. In the four weeks since her brain surgery, she has not been able to have a bowel movement without assistance of a suppository. We visited the GI doc this week who gave us some tips on how to get her to go...yes, it's a glamorous life we lead.

We did receive a bit of good news last week. After a visit with a doctor at the Chicago Lighthouse for the Blind and Visually Impaired we received confirmation that Sadie has normal vision in her left eye. Yay! We had heard this from her regular opthomologist, but I've become a bit of a sceptic when it comes to doctors, so it is always a relief to get confirmation from another source!

Please keep Sadie in your thoughts and prayers as we hope for good news out of Thursday's CT scan.



Where to Begin...

Sadie post surgery

I've been procrastinating writing this post because so much has occurred in the past few weeks. Where to begin...

I suppose I'll start with the biggest piece of news. In case you hadn't heard, Sadie had a second brain surgery a few weeks ago. During her 6 month post-surgery follow up appointments at Cleveland Clinic, her MRI showed water in her brain cavity that was unable to drain. This fluid-filled pocket (or cyst) was causing pressure to build up and press against her brain stem and other structures in her brain. We saw this clearly on the MRI.

The doctor was not 100% sure why this occured, he said that it is possible that scar tissue from her first surgery formed a membrane over the brain's natural drain causing a buildup of fluid. Apparently this can happen in 5-10% of patients who receive brain surgery.

The doctor spoke about a few symptoms that we might have seen. Headaches, sleepiness, loss of head control, etc. Obviously, Sadie can't tell us if she has a headache, but we hadn't noticed a change in her behavior. We did, however, notice that her head control hasn't been quite as good and she has been excessively sleepy lately - both things that we had been attributing to a recent change in seizure medicines. 

Our pager that provided updates
during Sadie's surgery.

The doctor layed out a few options for treatment. First, we could choose a cyst fenestration - which essentially is a procedure where they go into the brain to lance the cyst and create a natural hole for the brain to begin to naturally regulate the pressure. The second option he offered was a cyst fenestration and shunt. A shunt is an artificial drain which is implanted in the head and drains the spinal fluid into the belly where it is reabsorbed. The drawbacks of a shunt is the probability that it could malfunction, get infected, etc. This occurs quite often. Lastly, he mentioned that some parents may choose NOT to treat the condition and hope for the best. The obvious drawback to this choice is that this condition can be fatal.

Adin and I decided that we were not willing to give up fighting for Sadie, and we would obviously choose to treat this condition. Which left us with surgery or surgery as options - not a great choice. So, we chose to do the cyst fenestration and hope that it works to drain the fluid and create the natural circulation of fluid in her brain. Here are some articles we read which describes the procedure in more detail:

http://cornellneurosurgery.org/pedneuro/endo_cyst.html

http://www.ncbi.nlm.nih.gov/pubmed/3226511

The drawback of the cyst fenestration without a shunt is there is a possibility that it might not work. The doctor told us that it has a 50% chance of working. Sadie will have a CT scan of her brain in six weeks which will show whether the surgery was a success. If the fenestration alone isn't effective, we'll have to consider a shunt.

Doors to the PICU.
I've seen these much too often.

Surgery was performed at Cleveland Clinic by Dr. Bingamin, the surgeon who performed her first surgery. Although this is not what we expected when traveling to Cleveland for follow up appointments, we knew she would be in good hands.

Unlike Sadie's first surgery, this inpatient recovery stay was relatively short. She was discharged in three days. She is now recovering at home and is doing quite well.

Please keep her in your thoughts and prayers throughout the next six weeks as we pray this surgery is successful and she will not need a shunt.

P.S. In our next blog post, I'll fill you in on all the FUN and exciting things Sadie has been doing this summer (trips to the Museum, the bienniel Aicardi Family Conference, etc.)

The Beat Goes On

At this week's 18 month appointment with Sadie's pediatrician, I saw that her file had been upgraded. Most of the other kids' records are held in file folders. Sadie's records are now held in a large 5-inch three-ring binder. Luckily, we've made only a few additions to that binder recently, as the past few weeks have been relatively stable for Sadie. So we thought we'd take this opportunity to update you on what is going on with certain aspects of her life and general health.

Seizures - Seems like the logical place to start, since they (unfortunately) are such a big part of her life. Sadie is still having between 5-10 clusters of seizures a day. Mostly occurring when she is waking up. The clusters can last up to 10 minutes and vary in intensity. Relatively speaking, this is a better place than where she has been previously. We've now tried nine seizure meds (yes, nine), and have come to the conclusion that it is unlikely that we'll see significant improvement with medication changes alone. So we have been exploring surgical options. More on that to come.

Oxygen - Sadie has been off oxygen for about 2 months. (Yay!) She receives chest physical therapy (CPT) as well as an inhaled steroid (Flovent) twice a day. Chest PT is administered by tapping on her lungs with a little oxygen mask. It works to keep her lungs open and air moving freely. It's such a relief not to cart around oxygen tanks everywhere we go! We've even weaned ourselves off the pulse oximeter monitor (during the day, at least, she's still on it at night).

Eyes - Sadie's last MRI showed a growing cyst behind her right eye (the smaller eye). Her opthomologist will monitor the cyst by viewing her MRIs every 6 months. He is not terribly concerned and advised us that if it does create a problem, he can easily drain it. We did discover some good news recently with the help of Sadie's vision therapist. We now suspect that she does have some light perception in her right eye. Her therapist patched the eye with good vision and waved a light stick in front of Sadie. She promptly reached out and grabbed at it - much to our astonishment. Go Sadie!

Therapy - Sadie's therapy schedule is still going well. She is making strides with her therapies, and we've continued music therapy, and even added a massage therapist once a month! (Too bad massage therapy isn't also for mommy!) Sadie has also been using her stander during physical therapy. The stander is equipment that keeps her upright in a standing position. She stands for about two hours total every day. Because she isn't bearing weight on her own, the weight-bearing position helps for better development of her bones and joints. (The photos above show some of Sadie's activities during physical therapy (standing, sans stander) and swinging in the gym at the therapy center.)

Ketogenic Diet- Sadie has now been on the Ketogenic Diet for the past 15 months. We continue to measure out her food to the precise gram. She is taking her bottle pretty well, and we'll start to transition her onto a sippy cup soon. We've hit a stumbling block trying to get her from pureed foods to foods with a bit more texture. The high fat ratio of the Ketogenic diet has provided some challenges with transitioning to foods with more texture - there are only a few things that have such a high fat content. We're using a few recipes (such as a pancake made with her KetoCal powder, or a little bit of chicken mixed with mayo and avocado). She'll hold the chicken or pancake in her mouth, but won't chew or swallow. We're seeking out some supplemental feeding therapy from Children's Memorial to see if we can overcome this hurdle.

Sleep - Sleep is still a major challenge with Sadie. Her naps during the day rarely last longer than 20 minutes, then she is awakened with a seizure. After 18 months of not sleeping through the night, we put her on a medicine called Neurontin, which has helped slightly. She is still awakening at night with seizures, but will typically go back to sleep. Unfortunately, she rarely sleeps past 6 am. The past few nights, she's been up for the day at 4:45 am and 5:30 am respectively. We are considering hiring a night nurse to monitor her seizures at night so we can get some rest.

Surgery Update - We're still waiting on some test results requested by the doctors at Cleveland Clinic. We're planning another visit to Cleveland in the next month for a consultation with the doctors. If everything goes well, we'll likely schedule Sadie's brain surgery for the beginning of next year.

We're hoping that the upcoming Holiday season continues to proceed smoothly for Sadie. Please pray for no hospital visits or unexpected illnesses. We want to keep that medical record binder as thin as possible!

Home Sweet Home. Sleep Sweet Sleep.

Sadie has been home from the hospital for about a week. She is still struggling with kicking this recent respiratory virus. At her pediatrician's request, she is now the proud owner of a pulse oximeter and a nebulizer machine. We will use the pulse-ox at home to monitor her O2 levels should she get sick again. We've been using the nebulizer machine to give her albuterol breathing treatments three times a day. We'll continue with the treatments until the virus works its way out and her breathing returns to normal.

While in the hospital, we finally weaned Sadie off of one seizure medicine. While Clobazam looked promising at first, it seemed to be having an adverse affect, as Sadie's seizures went up with each increase in dosage. Once we backed off the dosage, her seizure activity went down. We also started Sadie on Dilantin when she was having a rough time with seizures at the hospital. I hesitate to say that her current seizure medication cocktail (dilantin, vigabatrin, topomax and clonazapam) seems to be showing some improvement. The seizures are at their lowest level. She still has episodes daily, but we've gone from 20+ seizures a day down to 3-5. Our next step is to slowly wean a few of these meds that we're not entirely sure are working, something we've been wanting to do for quite some time.

We also received some troubling news a few months ago that I didn't feel comfortable blogging about at the time. The doctor noticed some new brain abnormalities in Sadie's recent MRI. According to the doctor, there were a few areas that showed some "disbursed white matter." She said the changes looked consistent with a mitochondrial or metabolic disorder. "Instead of her Aicardi diagnosis?" I asked. "In addition to her Aicardi diagnosis," she responded. Wonderful.

This time around, I did no googling, no researching...I simply just ignored the fact that our daughter was being tested for an additional disease and kept on living. As a friend so wisely stated, "no point in going down paths that aren't yours."

I've come to the conclusion that we are the big losers when it comes to the battle of the odds. If a medication has a extremely rare side effect, Sadie is bound to get it. As it turns out, that's what the doctors think is happening with these MRI abnormalities. So far, all the mitochondrial and metabolic tests have come back within normal ranges. So that leaves the medicine. Apparently, one of Sadie's seizure medications, Vigabatrin, can cause MRI abnormalities that are similar to those shown in Sadie's MRI. The problem occurs with high doses and when children are very young (check, check). The good news is these abnormalities often revert back to normal once the medication is weaned. So, the plan is to slowly get her off vigabatrin and hope it is a transient finding and the MRI goes back to its original state.

We are overjoyed to be home after our 7-day stay at Children's Memorial. Sadie has been delightful this week. Smiling, chatting, happier than we've ever seen her. She dove headfirst into her therapies this week and did a great job. The picture above was taken during one of her monthly music therapy sessions. She liked the rain stick toy, but she liked her therapist's diamond ring even more. Smart girl.

The only trouble we've had with her is sleep. The girl simply doesn't sleep. And when I say that, I mean she is up about every hour at night. I found that one side effect of dilantin is insomnia. However, I'm not willing to give up seizure control for sleep. Insomnia combined with the coughing make for long nights for the McCann clan. We've been encouraged by her doctors to explore melatonin, which is a mild, naturally-occurring sleep aid for children. With all the medicine that she's on, we've been hesitant to add one more thing...but give us a few more nights and we may be there. For now, we thank God for espresso.

A New Set of Problems.

Sadie was finally released from the hospital on Saturday, eight days after first arriving - well, nine if you count the day she was there for her MRI.

I'll start where I left off. On Day 5, we were moved from the PICU to the 9th floor. I have to say, while we have always been impressed with the personnel at Children's Memorial Hospital, there is a level of care and attentiveness that Sadie received in the ER and PICU that we didn't see once we were moved to a floor. Our stress level rose knowing that there was no longer a nurse right outside her door all night. I understand that this is to be expected as your child's health improves, but there is something comforting knowing that a trained medical professional is keeping an eye on your child while she sleeps.

It also didn't help that our trip to nine started with Sadie crying out in pain, then the seizure cycle started up again - and for the second time during our hospital stay, she was given Ativan (a seizure suppressant/sedative) to calm her down. The exploration for the acute pain began. The doctors x-rayed her belly, which was puffy with air from being on the ventilator and high-flow oxygen. Sadie also received an ultrasound to check for kidney stones. She again began her pain cry/seizure cycle the next day, and again Ativan was administered.

We wracked our brains looking for an answer. One of the nurses suggested that perhaps her tummy was upset from not having food for so long, so we started her on Zantac for acid reflux. She seemed a bit better and the pain cries went away. Mystery solved, or so we thought...

So, we've been back at home for a few days now. Sadie seems to have kicked RSV, but with one resolution comes a new set of problems. Her seizures are again on the rise - occurring every 30 minutes or so. She's also been quite irritable lately and has been crying out for no reason. We suspect it's her new medicine, which can cause irritability. We see her neurologist this week and hope to have some resolutions.

P.S. Last week, another Aicardi Family, the Verdecchia's, were profiled on The Today Show about their daughter's brain surgery. Here is the link to the story. We were planning to write a post about this, but our friend Neil Pasher beat us to it. His question is one that resonates with us as we make difficult decisions about Sadie's care. Read his eloquent blog post.

Another year, another hospital visit

Just as soon as things got better, they got worse. Sadie was at Children's Memorial Hospital for an MRI last Thursday. Despite receiving a bit of oxygen following the procedure, she was fine. We were home on Thursday night and she went right to sleep.

Friday morning, Sadie arose with horrible breathing, coughing, and irritation in her throat. She had received a tube in her throat during the procedure, so we thought it was irritation from the tube. As her breathing progressively worsened, we decide to take her into the ER.

We again found ourselves at CMH. After a quick assessment by the triage nurse, they rushed her into one of the larger operating rooms. Doctors and nurses quickly started working on Sadie. In the time it took for Adin to park the car, about 20 medical professionals had filed into the room. It was quite scary. They first put her on a mask with a breathing treatment, which seemed to clear her airway. They also gave her a steroid to stop the swelling in her throat.

She seemed fine for a few hours, then the seizures started. One cluster, the two, then three...they progressively got worse until she was almost status epilepticus (a state of nonstop seizure). She was given a sedative to stop the seizure, but it was not terribly effective. The doctor decided to give her a dose of fosphenytoin, a paralytic, to stop the seizing. In order to administer the med, the had to intubate to protect her airway. That procedure was even scarier, at least 5 doctors and 20 other medical professionals raced into the room for the intubation.

So began our hospital stay. They determined that Sadie had a virus called RSV, which most likely was the cause of the raspy breathing. RSV is a cold-like virus that can be very serious in infants. The breathing tube stayed in for a few days, we were very relieved when it was removed without incident a few days later.

We write this from the bedside at Children's Memorial and hope to have Sadie back at home very soon.

Trying Times. A Christmas miracle.

We've been delaying our Christmas update, as were waiting to see if there would be good news to report. Unfortunately, that is not the case. Sadie had a pretty rough holiday season. Her seizure activity began to increase a few days before Christmas. We've been slowly tapering one of her seizure meds, Topomax, in the hopes that we could get her off of one of the three medications and increase her alertness. She's been on Topomax since she was first diagnosed with Aicardi Syndrome, and we haven't been entirely convinced that it is working. Additionally Topomax is not an ideal medication in combination with the ketogenic diet as it can cause kidney stones. So, a few days before Christmas, we started to decrease her dosage. A few days later, her seizures increased 7-10 clusters of a day to 10-15 clusters a day.

We didn't want to jump to the conclusion that Topomax was working. Unfortunately in children with seizure disorders, so many other factors can play a role with seizure increases. For Sadie, it could be the change of routine with traveling, the fact that she was running a low-grade fever around Christmas, coming down with a slight cold around New Years, etc. Our New Years Eve was spent on the phone with her neurologist, and we're working on tweaking the Depakote dosage to see if we can get more seizure control while keeping Topomax at the same level for the time being. Needless to say, we're frustrated and continue to hope that someday soon we'll see an improvement in Sadie's seizures.

While experiencing trying days and nights over the past few weeks, our holidays were also interspersed with a few moments of pure Sadie happiness and joy. She had many moments where she would talk, squeal, giggle, smile...were it not for these moments, we'd be having a much harder time. Of course, our little girl was also showered with love and affection from a host of friends and family. It will take three trips to get all of her gifts and clothes back to our house! Her closet continues to expand.

In addition to the seizures, we've also been battling with some bowel movement issues with Sadie. Warning to readers who may get squirmy when hearing about poo, you may want to skip this paragraph. I feel like the topic of poop has come up way too much in our household lately. It's been about 2 months since Sadie has pooped on her own...that is, without the help of a glycerin suppository. We actually had to give her an enema last week to get her to go, after three suppositories didn't work. Talk about stress. We're not sure what to attribute it to - the ketogenic diet, which can be constipating or the fact that she is taking three sedating seizure medicines, or a combination of both. We've tried everything - miralax, milk of magnesia, prunes, senna, baby massage, reflexology. Day four after reducing her Topomax doseage, Sadie had a bm without help of a suppository. Adin called it a "Christmas Miracle."

Because of these issues, we've added yet another doctor into the mix. Sadie had her first appointment with a GI specialist at Children's Memorial. This month will be a busy one for little Sadie. She'll have another MRI to monitor her choriod plexus papilloma tumor. We also have an appointment at Easter Seals to get her fitted for a specialized stroller and potentially a special car seat.

So, we'll stay hopeful that 2011 will bring Sadie better seizure control, more moments of pure joy and happiness, and the knowledge that she is loved and adored by many people.

A week of firsts. Good days and bad days.

It's been a whirlwind past couple weeks. Many firsts have happened since our last post.

We spent the first night in our new home. After a lot of stress with coordinating move logistics and closing paperwork, we have officially moved in to our new house. I can't tell you how excited we are to finally be settled.

Sadie spent her first full night in her crib. Up until now, she had just been taking naps there. Call me a paranoid parent, but I had her sleeping overnight next to us in her pack and play for the first five months of her life. With all the changes in seizure meds, etc., I wanted her next to me should anything happen overnight.

Developmentally, Sadie has seen some very good progress. She is reaching for toys with both hands. She had previously only been using her right hand, as her left side of her body is weaker due to the more extensive damage on the right side of her brain. Sadie transferred a toy from her left hand to her right - a task her therapists said may be difficult given her missing corpus callosum (the part of the brain that connects the left and right hemispheres). She is also grasping her bottle with both hands!

Sadie also discovered that she loves to play peek-a-boo, and on rare occasions, she will giggle, which makes her mommy extremely happy. Although, every time I try to capture it on video, she becomes decidedly quiet.

We had our first meeting the neurosurgeon this week to discuss Sadie's MRI results. Overall, he said there is nothing to be concerned about at this point. She will have another MRI in January to continue to monitor the brain tumor, called a choroid plexus papilloma.

Later this month, Sadie will go in for another overnight EEG to monitor her brain activity. We are hopeful that this EEG will show some improvement in the seizure activity in her brain. Sometimes, seizures can occur in the brain, but show very little in terms of outward characteristics.

Sadie will also have her first ERG (Electroretinogram), a test designed to test the visual function of the eye. We hope that we will finally get a definitive answer on whether or not she has any vision in her right eye. The test will also give us information about her peripheral vision, as peripheral vision loss is a potential side effect of one her seizure medications.

There are also a number of "firsts" that we're anxiously awaiting.

Sadie is still working on her head and neck control. We, along with her therapists, continue to give her a lot of tummy time to help strengthen her neck and back muscles. We look forward to the day when she can hold her head up independently.

Personally, we are working on how to respond to questions we get about Sadie, something we've struggled with since Sadie's diagnosis. How do you respond to innocent comments from strangers like...."Is she sleeping thru the night?" "Is she sitting upright?" or "Just wait until she's running around." While I'd rather not lie, the truthful answers or responses seem too heavy for this light conversation. The honest answer would be..."No, she doesn't sleep well because her seizures wake her up every 3 hours." So, in the meantime, we put a fake smile on our face and give our generic reply - "She has good days and bad days."

Overall, the "first" we most look forward to is Sadie's first seizure-free day.