An Unexpected Turn

All tuckered out from opening birthday gifts.

Raising a special needs child is often compared to a roller coaster ride. Along with the many ups and downs are unexpected twists and turns. We experienced an unexpected turn last week during Sadie's swallow study. This was Sadie's third exam to look at her swallow. Her first swallow study showed she aspirated thin liquids, and we've since been thickening her bottles using a gel called "Simply Thick."

During the swallow study, a substance called barium is added to her food. The barium lights up on the x-ray showing where the liquid is going during the swallow. (You can see a pretty cool video here.) Her therapist and doctor at the Rehabilitation Institute of Chicago ordered the swallow study to check her post-surgery swallow. We went in assuming a routine appointment - after all, she had a post-surgery bedside swallow examination in Cleveland which she passed with flying colors. She had not been getting sick and her lungs have always sounded clear (two red flags for aspirating).

However, the results showed otherwise. While drinking her bottle, even thickened, a small amount of the liquid was making it's way into her lungs during each swallow. Even at it's thickest consistency (honey thick), it was still going into her lungs.

Sadie eating her breakfast via NG tube.

Sadie was sent directly to Children's Memorial Hospital for an immediate admission and NG tube placement. (Standard protocol when a child fails a swallow study.) We were told by the pulminology team at Children's that if we had not found the aspiration, Sadie could have come down with a horrible life-threatening pneumonia. And, if she were to continue to drink, the aspiration could cause lung disease. The pulminology docs said that there are over 70 different mechanisms that must occur in the throat to ensure a safe swallow. Seems amazing that all of us aren't aspirating all the time, right?

This is what a G-Tube looks like.

So...you may ask, where does that leave Sadie? Well, there are few options for a child who aspirates. The most common being a G-Tube. Many girls with Aicardi Syndrome also have G-Tubes. In fact, one of Sadie's good Chicago Aicardi friends, Olivia, just got her G-Tube a few months ago.

In order to mentally prepare for this possible next step, we met with the surgeon this week who would perform the G-Tube operation. He provided us with pros and cons of G-Tubes. The pros being ease of medication administration, hydration, and most importantly - no aspiration. We have spoken to Sadie's team at Children's Memorial who have advised us to take our time with making this decision. They have offered to repeat a swallow study in 3-6 months to see if her swallow has improved. By that point, we can do more research and become more comfortable should the G-tube be the path she must go down.

Luckily, she is still able to eat pureed food (baby foods), so we've been feeding her her favorite keto-friendly food - mashed banana with butter. While we are disheartened and saddened by another "normal" being taken away from Sadie for the time being, we are grateful that it didn't develop into something even worse.

It Gets Better?

When Sadie was a newborn, she and I would take daily walks around our neighborhood. There was a local park we'd circle every day with a playground, pool, and softball fields. After Sadie's diagnosis, there were some days when making that loop was just too painful. Every child jumping off monkey bars, running by the pool, pitching a ball - was a vivid reminder of my own child's limitations.

As Sadie is our first baby, Adin and I have no previous experience in typical child development. We only have the children of friends and family with which to compare. Now that summer is into full swing, we find ourselves at friends' barbecues, pool parties, and family gatherings. As I mentioned in a previous blog post, it's quite difficult NOT to compare your own child to others.

Friends of ours, parents of another Aicardi girl, compare it to "the bends." A feeling you get when resurfacing from a deep sea dive. You are thrown into an alternate reality, then just as quickly, you're catapulted back into your own reality. Psychologists call it "chronic sorrow," a pervasive grief experienced by parents of children with special needs. There is no "It Gets Better" campaign for parents of children with special needs. You're simply handed a copy of a poem about Holland and sent on your way.

Don't get me wrong, I LOVE seeing our nieces, nephews and friends' children, and am fascinated with how quickly they grow and develop. But will there always be a twinge of pain when seeing a child do something that Sadie might never do? Does this mean our friends and family should feel guilty for having healthy children? No - absolutely not. We simply hope they cherish every healthy, typically-developing moment.

And while I hate hanging out in the land of "I feel sorry for myself", perhaps I've been thinking more about this lately because Sadie has been experiencing one of the most rocky seizure periods she's ever had. Her Dilantin levels have been all out of sorts - high one week, low the next. We also started a new medicine, Ospolot, a few weeks ago. Since then, she's been having periods of time where all she does is twitch. Sometimes it's mild - just the foot and hand twitching in a synchronized pattern, other times, her whole body twitches. This can go on for over an hour. We tend to err on the conservative side when it comes to administering Diastat (her emergency med), otherwise, we'd be giving it every day. We have given it three times in the past two weeks.

Just when we thought things were starting to calm down, the seizures spiked again for no apparent reason. We also noticed that Sadie's heart rate was extremely high and she was running a temperature. Come to find out, Sadie had a urinary tract infection (UTI). We started her on antibiotics, but the fevers continued to spike. Back to the pediatrician a few days later and they gave her an antibiotic shot - to which she had an allergic reaction. Hives all over her arms and legs.

And, while we thought we had gotten rid of the nasal cannula, she's needed to be on oxygen for the past week. According to her pulminologist, this can happen when kiddos get sick. Grrrrr...the girl simply can't catch a break.

So, I'm patiently waiting for things to get better. Patiently.

Sadie Time

We always joke that Sadie works on her own schedule - "Sadie Time." I have to laugh when people ask me questions like "When does she typically nap?" "What's her schedule?" The girl does what she wants, when she wants. We do our best to have her awake and alert during the day, and keep her sleeping at night - but most of the time, even this proves to be a challenge.

Case in point, we've now had to reschedule her swallow study twice. The first time around, she came down with a cold, so we cancelled and rescheduled for a week later. The second attempt proved beyond a doubt that Sadie is in charge. Despite sleeping relatively well the night before and getting in a good morning nap, she simply refused to wake up for the 1 pm swallow study. We tried taking off her shirt, putting a wet washcloth on her face, turning the lights up high, playing music, etc. The more we tried, the more she slept.

So frustrating when there are three technicians, a speech therapist and doctor in the room all asking why she's not waking up? Isn't she hungry? Did she not get a good nap? I wanted to scream at them and tell them that she does things on her schedule - and four seizure medications doesn't help either. Arrrghhh...

We attempt the swallow study again on Tuesday. I'm fearful because she hasn't taken anything by mouth for the past month, that she's lost some of her swallowing ability. I guess we'll know for sure on Tuesday (if Sadie cooperates.)

Sadie has been having a hard time keeping her oxygen levels up on her own. This week will mark one month on oxygen and the NG feeding tube. We had been slowly weaning her off the O2 when she came down with a slight cold and we had to boost her up again. After speaking with her pulminologist last week, she suspects that Sadie's low O2 levels may be the result of her having a difficult time coughing stuff up. Apparently this is a problem for many kids with low muscle tone. I have an appointment with a respiratory therapist next week to learn how to do chest PT, which will help with this. My nursing repertoire expands.

The pulminologist also suspects that Sadie may have sleep apnea. So, they will conduct a sleep study in the next few weeks where they will observe her overnight. Perhaps this will finally answer our question about her horrible sleep patterns.

If that wasn't enough, this past month her seizure activity has been up and down. She'll go for a few days having very low seizure activity (2-3 is a good day for Sadie.) Then, out of nowhere, she'll have a day where she'll be seizing every 3 minutes. We've had to give diastat (her emergency medication) twice in the past month. The seizures have been looking a little different lately as well. Instead of her typical infantile spasm "crunches," she's been having seizures that look more like your standard seizure (some shaking/trembling, eyes rolling). These look a little more frightening than her old seizures.

I was a little (OK, a lot) disappointed that Sadie had all of her cords attached for her first birthday party. But as you can see in the photo above, she looked adorable and had a wonderful time with friends and family.

We forge ahead, hopeful that we can get her off of oxygen and the feeding tube very very soon. Which, Sadie will do when SHE is good and ready.

P.S. Sadie's Journey now has an option to "Follow by E-mail." To receive e-mail updates with new blog posts, enter your e-mail address in the field to the right.

The Wrong Side of the Crib. Team Sadie.

Since Sadie's been home from the hospital she's been a little crabby. Adin likes to say that she woke up "on the wrong side of the crib."

She is still attached to three cords - one for her oxygen, another in her nose (NG tube) for feeding, and a third attached to her foot (her pulse oximeter which monitors her O2 levels) Most likely, she is mad about all the darn cords attached to her. Although she may also be pi*&?ed that she can't wear her cute outfits. Her current attire is old sleepers with one foot cut off. You see, she currently can't wear clothes that go over her head due to her oxygen tube, and she needs one foot free for her O2 sensor. Thus, our one-footed sleeper invention. Adin says we should market it and make millions ;)

Our days have become exponentially busier as Sadie is always cycling between feeding time, oxygen monitoring, breathing treatments, and medication administration. Nursing was never a career I considered, and I'll admit, it's a little stressful. Good thing I love my patient. We are hopeful that we can wean her off of the oxygen soon, and the NG tube will go away once she shows no aspiration in her swallow study.

Our hospital experiences with various medical professionals have made us extremely grateful for the team we have in place to oversee Sadie's care.

Dr. Lori Walsh, Pediatrician - I knew Dr. Walsh was a keeper from the moment I met her in our prenatal visit. She was truly interested in Adin's PKU (Phenylketonuria). She even called at 8 pm one evening to discuss what she learned about the genetics of PKU. Dr. Walsh has been the key player in coordinating all of Sadie's care. She truly understands Sadie and her condition and has been the ultimate partner throughout Sadie's journey.

Dr. Srishti Nangia, Epileptologist (a long word for "seizure doctor") - Both times Sadie was inpatient at Children's Memorial, Dr. Nangia visited us every single day - including weekends. We've been on the roller coaster with Dr. Nangia since the very beginning. She helps us through ups and downs, listens carefully, and knows Sadie quite well. She is a wonderfully compassionate, thoughtful, and caring doctor.

Dr. Hawke Yoon, Opthomologist - We met Dr. Yoon when Sadie was just three weeks old. Our journey to her diagnosis started with Sadie's eye exam under anesthesia. He quickly won our hearts when we asked about the procedure. Not finding a piece of paper handy, he pulled out his pen and started drawing a diagram right there on the bedsheet. The first few months of Sadie's life, we saw Dr. Yoon almost weekly. And he just has a cool name.)

Dr. Tadanori Tomita, Neurosurgeon - Dr. Tomita monitors Sadie's choroid plexus papilloma. Sadie receives an MRI every few months to check the growth of the tumor. If it gets too large, it can cause a condition called hydrocephalus, which would require a shunt and brain surgery. We know that we are in good hands with Dr. Tomita.

Roland Scott, Ocularist - Roland Scott fabricates Sadie's eye prosthetic (conformer). He fits Sadie's eye very carefully, and given how sensitive her eye is, we see him quite frequently. She gets larger conformers every few months as she grows, and he is always very careful and patient as he molds and fits each of them. Ocularists are hard to find - there are only about six of them in the Chicago area. Roland is actually the second that we've seen as we weren't entirely happy with the first. We joke that his lab resembles Dr. Frankenstein's - pots boiling over, him in a white lab coat, but overall, we've been very happy with his work.

Robyn Blackford, Ketogenic Dietician - Robyn oversees Sadie's ketogenic diet. Even though she was booked with patients, she helped us get Sadie into the hospital to start the diet on an emergent basis when her seizures were almost non-stop. She is a wonderfully knowledgeable and kind individual.

Michelle Johnson, Home Nurse - It was Michelle who ordered Sadie emergency oxygen for us to have in the home. A week later, Sadie ended up needing that oxygen to get her through until the ambulance arrived. Had we not had the oxygen, Sadie would likely be in much worse condition. Michelle was introduced to us through a great organization called Hope's Friends.

Team Sadie will be growing this week, as she has appointments with a few new specialists - a pulminologist (a doctor specializing in respiratory issues), and a urologist. We hope the pulminologist will be able to offer some insight into why these darn respiratory viruses have hit Sadie so hard. And, although she is now pee-ing more frequently (pause for knocking on wood), we initially made the urologist appointment after she was holding her urine for up to 12 hours between diapers.

I'll brag about her therapists (who are also wonderful) in a later post. Although we would change it in a heartbeat, we are grateful that we have gotten to know such wonderful medical professionals and feel confident in their care for our darling daughter.

Sadie's first ambulance ride. Prayers, prayers, prayers.

Looking at the title of the last blog post, I hope I didn't jinx poor Sadie. After battling cold symptoms for a few days, Sadie awoke early Tuesday morning with labored breathing and a "barky" cough. We hooked her up to the pulse ox to check her O2 levels. The machine read 83%...we started panicking. Luckily we had the emergency oxygen her home nurse had sent over the week prior. We started her on O2 and she quickly rose to 100%. Adin and I knew that we had to call an ambulance to transport her to the hospital, as we couldn't take her without supplemental oxygen.

The ambulance arrived at 2 am, and delivered Sadie and I to the ER at Lutheran General Hospital. Ambulance protocol is to take the patient to the nearest ER. I was a little nervous being at a different hospital than Childrens, which we know so well. Although I prefer Sadie's doctors at Childrens, we've been quite pleased with the staff and facility at Lutheran General.

We are on day 4 in the pediatric ward. What started as cold symptoms turned out to be metapneumovirus, which is similar to RSV (the virus that hospitalized Sadie in January). Sadie is also showing some cloudiness in her lungs, which could be a mild case of pneumonia. The doctors are trying to figure out why these respiratory viruses are so hard on Sadie. They suspect aspiration, which is where some of the liquid one consumes goes into the lungs instead of the stomach. She will be having a swallow study to explore this further. In the meantime, all liquids are going through an ng tube (through nose, down throat, in tummy). She REALLY did not like that ng tube going in, and actually punched the nurse with her little bandaged IV hand.

Throughout her hospital stay, her seizure activity has been quite low. And, we finally were blessed with her first seizure free day*. I always feel like I need an asterisk after that statement, as it is possible she had a twitch here or there that I didn't see, or a mild episode in her sleep. The picture above is the page from Sadie's journal showing her first day with no seizure activity. We have been keeping these journals since she was 4 weeks old (we're now on journal #3.) Each page is a different day. We track the time and duration of the seizure. I used to count every single spasm per cluster, but once they got up into the hundreds it was just too depressing.

We also track her fluid intake and diapers in the journal (since she has decided to hold her pee for hours and hours, and poo for days. More about that in a future blog post.) We have also been advised to see a pulminologist to oversee Sadie's respiratory issues. Her team of doctors grows.

The analyst in me wants to overanalyze exactly why her seizure activity has been so low. (I see a spreadsheet in our future:) But for the time being, I'll be grateful for this blessing. Maybe all of your prayers are working. Keep them up!