Showing posts with label surgery. Show all posts
Showing posts with label surgery. Show all posts

Thursday, April 20, 2017

You'll get used to it

"You'll get used to it"

The words I heard at 3am a little over 2 years and a month ago when I first brought Sonzee into the ER.  I remember how angry that phrase made me and how badly I wanted to punch the nurse who said them.  While it wasn't the most ideal time for her to say those words aloud, it turned out she was right.

Sonzee is back in surgery.  They called about 5 minutes ago to say that her doctor began the procedure.  It should be approximately 90 minutes until she is done and we get to see her.  I am sitting in my comfort spot with my "usual" PCH breakfast, a salted caramel oatmeal and a coffee, and I am blogging. This is my normal and I am used to it.  There shouldn't be anything routine about your child going under anesthesia but then again a life with CDKL5 shouldn't be either, yet this is life.

I am not even phased anymore about these types of procedures, they carry risks I don't even listen to because if I entertained them I wouldn't be able to breathe.  I don't even ask to hear statistics and if they are mentioned I honestly don't listen, because let's face it, when you become a statistic, what does it matter anymore?  I prefer to just ride out this journey without being fogged by the "chances are" because Sonzee's odds are completely her own, and I have learned if there is a small chance of nothing, with her it can become something; and if there is a small chance of something it can become nothing.

So here I am 2 years later and I want to go back to that nurse and tell her that her delivery was a smidgen off, but she was right, I will get used to it.



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Sunday, March 6, 2016

Sonzee becomes a "Tubie"

Lately I have been throwing out names of feeding tubes as if they are common household appliances.  It is pretty amazing how only a year ago none of these terms were part of my typical every day speech and now they have become part of my "professional jargon".  Sometimes I forget how little I used to know and how different life used to be.  I honestly do not think I ever saw a feeding tube in a person's stomach until Sonzee's birthday party when a friend of ours brought her daughter.  I honestly had not even google imaged what they looked like after Sonzee's initial consultation with the surgeon and I do not even know why.  

There are so many types of feeding tubes and various reasons why families might choose one over another, so for the sake of this post, I will explain the type of tube we are doing for Sonzee and explain our rationale for the choice.  Please know there is no right or wrong choice when it comes to choosing the type of tube a person uses, it is all about what works for the family and the situation.  The most important thing to remember is that any way you can get your child to meet his/her nutritional requirements is the BEST way.

From the start, I was very clear that I did not want something that would potentially interfere with Sonzee's desire to eat.  An NG tube goes up the nose and down the back of the throat and ends up in the stomach.  Many families may choose this route if the feeding tube is assumed temporary, if they just want to give a tube a "trial run" so to speak, or because they do not want their child to undergo a surgery.  I personally was against this option because the tube being placed against the back of Sonzee's throat could be such a nuisance to her that she may decide she would rather not eat by mouth.  The reason we are doing a feeding tube for Sonzee is not that her swallowing muscles are weak, nor is she on any food restrictions as far as thickness of liquids or textures of food.  It is because of these reasons; we immediately ruled out the NG tube and settled on a tube that goes directly into the stomach (gtube).  

Originally, Sonzee was scheduled to have a MIC-KEY button.  After speaking with many families, we settled on the MIC-KEY button due to its ease of use as well as the fact that it was inserted directly into her stomach.  The MIC-KEY button does not have any extensions hanging out of the stomach that can be pulled on, and it is easy to clean and easy to change at home.  The problem in Sonzee's case with the MIC-KEY button is that this procedure requires interior staples that with her high dosage of steroids could potentially have problems healing, and she would have a higher risk of developing a post-operative infection.  While her neurologist felt the steroids were not worth putting off until after we rescheduled her surgery we all agreed an NG tube would be our temporary fix.  I was not ecstatic over this decision, but whatever is best for Sonze.  

After multiple back and forth phone calls between the interventional radiology team and Sonzee's AMAZING pediatrician, we were advised that a PEG tube could be our temporary solution.  The PEG tube is similar to the MIC-KEY button in that it is directly placed into the stomach, but there is an extension that hangs out a couple of inches.  This procedure does not require staples, and will give the insertion site ample time to heal before changing to the MIC-KEY button.  We feel this will be a great solution, and we have been advised by multiple medical doctors that the high dose of steroids she is currently taking should not pose a problem for this surgery.  


Her surgery will be Thursday, March 10 at 8am.  I am a little nervous due to our last experience, but March 10 is an auspicious day as Sonzee's Bubbie celebrates her birthday, so it is already looking to be a positive experience.  Please keep the bear and the rest of us in your prayers this week and especially on Thursday morning.


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Sunday, February 28, 2016

What nightmares are made of

On Friday we arrived at the hospital at 9am to check-in for the bear’s surgery.  Sonzee was visibly upset due to not eating, so Sam was walking around with her while I took care of her admission.  We went up the fourth floor and by 10:30, we were back in the pre-op room.  They took her vitals; she received Osito a tiny red beanie baby bear.  Things were going smoothly and we were just waiting around.  Sonzee had a little stint of spasms around 10:45, and then again around 11:20.  We were told around 11:30 that the surgeon was running behind and it would be at least another hour, so we asked if it would be possible to get some food into her.  After speaking with the anesthesiologist, it was decided we could start her on IV fluids.

It always takes a minimum of three attempts to get into Sonzee’s veins; it is just how it goes.  After multiple attempts, and two nurses, she was finally set up at 12pm.  I made sure multiple times that they were going to administer straight sodium chloride vs the dextrose 5 bag, as she is on the ketogenic diet.  Our neurology team made it clear that even if I tell the nurses about the ketogenic diet, and they act like they understand,  I shouldn’t trust anyone’s word, and so I peaked at the bag myself to ensure it was the correct one.  Around 12:05, they began to administer the fluids.  I was holding Sonzee at this point to attempt to calm her down because she was clearly uncomfortable, but we decided shortly after I took her that it would be better if Sam held her since I just stopped pumping and she could probably still smell breastmilk.

At 12:10pm, she started to cough.  She looked panicked, she was clearly having problems breathing, but I was assured it was nothing, and it was because she was upset.  (She was not that upset to cause this type of coughing).  Another 2 minutes of her coughing goes by and she is now having large amounts of secretions come out of her mouth.  She suctioned her mouth.  I am visibly upset, the nurse is staying right next to us, and she tells Sam to place her on the bed.  He does.  I ask her if we can turn off the IV, and she reassures me it is just water and that this is not due to the IV.  I was doing my best not to be combative, but I made it clear this was not normal behavior, and while I was not arguing to the fact that it was straight water, clearly something was wrong with Sonzee.

Thankfully, an air pocket was found in the IV tube, so the pump began to ring and the nurse was forced to work out the kink.  Over a couple of minutes, the IV was turned off, and she started to calm down, and had less coughing.  Sam decided it was a good time to run downstairs to grab a quick snack as we had not eaten and were waiting for her to be taken back.  He left, the kink was fixed, and the nurse turned the IV pump back on.  Within a couple of seconds her coughing began, I was repeatedly telling the nurse this is not normal, she continued to reassure me, and as a peace offering, decided to put a pulse ox on Sonzee’s foot so we could see the amount of oxygen in her body as well as her heart rate.  After a couple of minutes her oxygen dropped to the 70s, there was foam coming out of Sonzee’s mouth and I am pretty sure I screamed to the nurse, "this is not normal, you need to do something".  I ended up walking out of the room as the oxygen bag was taken out and I am pretty sure the “code blue pre-op room 1” alarm must have sounded because within 1 second there were 20 people standing in and outside her room.  I tried to text Sam and give him a warning that they were taking the oxygen out, but he did not read the text and when he walked through the pre-op doors, all he saw was the chaos.

Everyone was trying to blame her current state on a seizure.  I was adamant this was not a seizure.  I was continuously telling everyone that I was not trying to argue, but while they might be new to Sonya and seizures, I knew this was NOT at all seizure related.  Her stomach was distended, her lungs sounded tight, they rushed in a chest x-ray, and shoved an NG tube down her nose into her stomach to release the air/pressure that was inside.  That was an immediate help, but at this point, she was just lying there.  There was no movement.

Her surgeon was the only person willing to listen to me that this was not due to any seizure activity.  I had spoken with my dad who is a doctor and he asked how many cc’s of fluid were given, I was not sure at the time, but he told me if it was less than 100cc then it would be fine.  I went back to the nurse and asked, and they said it was 150cc’s.  I said, I think that is the problem, and I was met with all 20 people telling me this was appropriate for a baby Sonzee’s size based on a calculation (which I will find out which calculation they used because it makes zero sense with what I know her weight is and what my dad says is the recommended dosage).  No one listened to me.

We were transferred to the ER, and she just laid still on the gurney.  Her body was beyond pale, and her lips were a greyish/blue tinged color.  I get it now what people are referring to when they ask if lip color has changed.  She looked so awful; I took a picture and could not bear to look at it.  It made me sick.  We got into the ER and the ER doctor comes in and talks to me as if this is my first go around with seizures.  He starts to tell me that it is possible Sonzee is having sub-clinical seizures that we might not be able to see, I retort back with “You mean status?”  I think he was taken back when I said those words.  He said, “Yes”.  He then continued to tell me that he just spoke with neuro and they want to give her Ativan to take her out of the seizure.  At this point, Sam almost punched him in the face, I told him to sit down and be quiet or get out.  I told the doctor, we were not doing that, but I would be more than happy for her to have an EEG and if it showed she was actually in status, he could give it to her.  He said, “Why are you against the Ativan”, I said, “Because she isn’t having subclinical seizures”.  He said, “Well I can’t just order an EEG, she would need to go to the ICU for constant monitoring”.  To which I replied, “Okay, then put her in the ICU”.  He goes onto to explain that usually Ativan is just administered so as not to waste the time it would take to get her hooked up to the EEG.  I said, “Well until you show me she is having a seizure, you aren’t giving her anything.”  I am pretty sure he did not realize I know a thing or two about seizures; he walked away, I am sure to make a phone call. 


When he came back, he listed all of the tests he would need to perform since I was not willing to give her the Ativan.  I am pretty sure he was not so excited her blood work indicated she was sick, not saying he wanted her to be sick, but it was not helping his case.  He had them do urine cultures with catheters, he had them drawing blood out of her arms, they put in another IV, she continued to lay there.  We were adamant this was related to the IV and the fluid administration; everyone else was blaming it on a seizure, or they would simply say, “Well, we just don’t know what happened, it’s hard to say”.  I know they have to do that to protect themselves, but it can be quite frustrating to deal with.  We wanted to try to feed her; the poor girl still had not eaten.  I kept asking for an NG tube if they were not going to let me feed her by mouth.  We were told for that they would need to do more x-rays of her stomach and lungs in order to make sure we could place the NG tube.  Neither of those tests was ever done.  Finally, around 3:15pm after all of the poking and prodding, the bear began to come back to life.  We begged to give her a bottle, by 3:30pm, she was finally taking one.

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