Sunday, May 31, 2009
Seriously... what is with Fridays lately?
I will preface this post by saying that Gracie is just fine... but what happened on Friday morning was quite alarming and for a few, brief moments (that didn't feel so brief) quite unnerving.
Fridays are not Gracie's typical school day, but since there was an event on Wednesday in which she couldn't have actively participated, we planned to swap Wednesday for Friday. (Next week she starts Monday thru Thursday!)
Fridays are also Preston's TOTnastics day... he loves this! He gets to see his little friends, jump, run, somersault, sing and play for an hour straight. No interruptions for anything - - it's all about him.
So, Friday rolls around and it's business as usual in the morning... waking up both kids, getting them dressed, teeth brushed, hair combed, load the car with equipment, backpacks, snacks, sippy cup and, of course, kids. We make our way out of our neighborhood and head toward Gracie's school, which is about 8 miles from our house - - and takes about 30 minutes if you hit the lights wrong... and I almost always do! Anyway, through the whole car ride, Preston and I are discussing what we are doing after we drop off "Neener." (Don't ask... she's got a million nicknames... many courtesy of Daddy. Preston doesn't miss a beat, so he now calls her all of the names that both John and I do! Maybe that's a silver lining to the fact that she can't hear us... she'd never learn her name if she could hear all the different terms of endearment she has!)
As we approach the street her school is on, Gracie coughed... very typical. I looked in my rear view mirror at her just as about a tablespoon of thick, blood-tinged secretions poured out her trach. At that point I wasn't too alarmed. People with trachs can get an irritated airway which can easily cause bleeding. This has happened to Gracie several times over the years... especially when really sick, or dry (like in the winter from the heater running without enough humidification), or when in the hospital because the air is so dry. She had been fairly dry the day before and she'd had surgery last week (the ENT removed some granulation tissue as well) so I thought perhaps her airway was irritated due to the surgery and the dryness the day before.
I pulled into the drop-off area and she coughed again... and it was worse. It wasn't blood-tinged secretions... it was just blood... a lot of it. I jumped out of the car and let her health aid and the school nurse (who were waiting curbside for her) that I didn't think she'd be getting out of the car. For the next five minutes or so, I just kept suctioning blood from her trach while trying to remain calm. The nurse, Cathy, and I were talking about the fact that this has happened before, but as every second was passing and I kept suctioning, I also told her that this looked different.
Gracie was none the wiser to what was happening... she was signing "up" and starting to get really upset that we hadn't gotten her out of the car. Preston was talking about "nastics" and getting a little impatient. That's when I noticed a tiny speck of blood in the right corner of her mouth... and as I wiped it I could see her teeth were now blood-tinged. At first we thought she was coughing so hard that the blood was coming up into her mouth. I suctioned her mouth and got an enormous amount of thick blood and that's when I told Cathy that it might actually be coming from her mouth.
It was hard to see because Gracie won't just open her mouth for you. I pried the Yankauer (an oral suctioning attachment, very similar to the one a dentist uses) into the back of her right cheek and could see blood pooling back there. I was relieved on the one hand (because with the amount of blood, I knew we were headed to the ER if it was coming from her airway) but, then again, not so relieved because I couldn't tell why she was bleeding. More prying into her mouth revealed that her gums in the center of the bottom-right 6-year molar she's been cutting (she's been working on all four of these teeth for almost a year) was the source. But why, you ask? Well, because my little girl, who is also cutting the top-right 6-year molar, was grinding her teeth so hard during the drive, that she sliced the daylights out of the bottom gum with the very sharp edge of the top molar. (She often grinds - - for so many reasons - - in fact her other molars are ground even to her gum line.)
I didn't actually confirm what had happened until I was able to get in there and look when we returned home... which was pretty much the exact moment the bleeding finally stopped... doesn't it figure? The ride home included two pull-overs for suctioning. And, sadly, the shirt she was wearing doesn't appear to have survived the drama.
I had called our dentist in route, but he is off until the 15th of June. Should this happen again, I will be calling the on-call dentist to see if there is anything we can do to stop the bleeding or help with removing the excess gum tissue. The big concern here is the fact that she can't swallow at all, so even though she has the trach for suctioning access, some of that blood was certainly aspirated into her lungs. Hopefully, with all the extra breathing treatments I did (and am doing), we will avoid any big issues. It's taking her so long to cut these teeth because she's not an oral eater. Those molars have a lot of tissue to break through without the help of constant stimulation from chewing.
So, she missed school, Preston missed his class, we waited for our Friday nurse to arrive, then took Gracie to her (previously scheduled) post-op ENT appointment, raced back home for the nursing company to do their monthly supervisory visit and then took the kids on a WELL DESERVED two hour park outing. I needed that mindless running-around, sliding, swinging, fresh-air time just as much as they did!
Oh... and Preston... well he handled the disappointment of not having his "planned day" so very well. He knows that blood equals an owie, so he was concerned about Gracie and quietly accepted that we were going straight back to the house without going to his TOTnastics class. I, on the other hand, felt so disappointed for both of them. Gracie was so sad to be sitting at the school and not able to go in - - and not understanding why. It was heartbreaking. She handled it well though and was no longer upset once she realized we turned into our neighborhood.
And although Preston handled it all so well (and completely forgot about it, I think, by the time we headed out the door for the doctor's appointment), I often wonder what effect all of the extra waiting and changed plans will have on him. I constantly feel like I am telling him, "Wait a second, Bubba... I need to suction Gracie first." Or, "I need to help sissy, first." It's a delicate balance and I really do try to even it out, but the bottom line is that she requires so much more immediate, hands-on care. It's just one more reason that her successful transition to school is so important... it's good for Preston to have more frequent individual attention - - no matter how tolerant he is and no matter how much he loves his sister - - he needs to be "first fiddle" a little more often.
Friday, May 29, 2009
Foto Friday vol. 14




Thursday, May 28, 2009
LONG Catch-Up: Potty Patrol, Birthday Boy, Humbled Thumbs, IEP, Outpatient Surgery
I had been letting myself feel guilty about not posting on our blog, but since it's my blog and our life dictates how I spend my time, I decided to let that piece of guilt go! I did, however, miss so much that was going on with my blogger friends and 'family' - - some of it not so good and some of it so joyous and wonderful - - and am definitely feeling guilty about that.
Besides being a way for me to "journal" our life and keep a virtual scrapbook, my blogger network has become a wonderful support system and lifeline. Thanks to everyone who emailed, texted and called to check on the Flock... your concern is so sweet and really touched our hearts.
Now... on to business! I last posted on Preston's birthday... nearly three weeks ago. The day before his birthday was a pretty dramatic and somewhat traumatic day...
Needless to say, the park plans were scrapped and the moment we got back to the house after picking Gracie up, I started calling carpet cleaning companies to see who could come out on a Friday afternoon. Preston, thankfully, had fallen asleep in the car and once in his room, was oblivious to the whole situation for a couple of hours. Nicole kept Gracie busy while I spent two hours in her room trying to get a jumpstart on the massive clean-up. I found a company that could come out, but not knowing what time they'd actually arrive, I just couldn't let it all sit.
Back to Sophie... poor doggie. She's our "firstborn" and we were quite concerned... it was a lot of diarrhea... A LOT. Something was obviously very wrong. The only thing that gave us a bit of comfort was that she still wanted to eat and drink. This, however, was not good for me. That meant she got sick... over and over. I spent the next SIX nights with her sleeping in the kitchen and me "sleeping" on the couch (in between running back and forth to suction Gracie) so I could let her out every 45 minutes. ARE YOU KIDDING ME? THAT is dog love. (She's 12 years old... it's too cold for her old joints to sleep outside and regardless of the temperature, she's always slept inside... outside at night would certainly have caused neighborhood disturbance in the way of howling or barking.) If I didn't hear her quiet pleas in the wee hours of the night (which at one point every night for six nights, I didn't) then she'd go all over my kitchen. I spent every morning for six mornings mopping, scrubbing grout and disinfecting my kitchen floor. Every morning... for six mornings. Because of the bout with doggie dysentery, I couldn't let the kids in the backyard... there's no way to protect them from that mess. And as luck would have it, this started on day three of John's 8-day stretch at work. So, I couldn't even get her into the vet with both kids in tow, it was impossible. Because she was eating and drinking, we decided to wait it out and hope that she had a bug of some sort. Those first few days, though, we were incredibly worried and even had to start having "the talk" about how much is too much for her to go through. Thankfully, she is fully recovered. But that was just the start of our potty drama...
Gracie has some "habits" that are a little less than ladylike... and one of them is to strip naked at the drop of a hat when she is ready for a bath. Thankfully, she only does this at home because she knows that is where bathtime occurs. Thank goodness for small favors! It doesn't matter what the time of day is... if she feels that it's bathtime, then she will get naked. You can put her clothes back on and tell her "no" but she will cry and kick and fight... and take them off again. (She also strips naked in the morning if she's awake for more than a minute or two... to0 long for Princess Gracie to be waiting to get dressed!) Inevitably, the moment she's naked, she feels the need to "go." I don't know if it's the fresh air hitting her nether region that gives her the urge, or if it's intentional. It's never much, so I'd like to think it's not intentional, but any amount is too much to have to deal with when she's begging for a bath and Preston is thinking it's pretty funny that she's naked and decides to strip his diaper off and go, too.
I've pretty much curbed his behavior. He gets that his sister does things that he's not supposed to do. He knows that what she's doing is naughty and I think he even understands the fact that his naughty behavior has far different consequences than hers. Nevertheless, this all started in the days that Sophie was in the midst of her illness and I was at my wits end. It was not pretty... on so many levels! For six days, no matter how much I scrubbed my house or myself, I never felt clean. As Preston would say, "Ewww, yuck!"








So... the IEP - - Nana to the rescue. Turned out that John, while he did get the day off, had court for a ticket he'd issued and couldn't attend the meeting... not really a day off. Just our luck. It went well... her services won't change from what was established in the initial IEP 30 days ago, but for the assessment and recommendation that's pending from the Adaptive PE Coach. Her goals have been completely re-written and while I feel that the goals themselves are good, I am still waiting to talk to her teacher a bit more for some clarification on measurements of success and for correction to the document itself regarding present levels. I will explain more about this once I am able to have a conversation with her teacher. I can't mention the IEP without shouting a very public, loud and heartfelt "Thank You" to Leslie, Katie's mom, for providing me with so much valuable and helpful information from Katie's IEPs and evaluations. Gracie and Katie are so similar - - CHARGE Sisters, if you will - - and Leslie's willingness to share information has been of phenomenal help to me. Thank you! :-)
The day was mixed... good and bad results. The bad was not a surprise, just confirmation to the doctors that I am not crazy and that what I have been telling them about her (because some doctors STILL haven't gotten records down here... unacceptable) is, in fact, the reality.
The ENT did her tubes and the bronchoscopy. The bronch showed (by our estimation in comparing our photos of previous bronchs) a fairly happy airway - - the least red we've ever seen, actually. This is excellent news. There are structural anomalies, some that are quite interesting, but none that are compromising her airway and none that require surgical intervention - - aside from the granulation tissue he removed during the bronch. It's a beautiful airway that would work perfectly without the trach... but for the fact that she doesn't swallow at all.
There is a picture from the procedure that is looking down at her carina (the top of the area that "bridges" where the lungs start) and sitting on top of the carina and rolling into her lungs was a giant pool of bubbly saliva. Without the trach, Gracie would drown. Period. If we can't rehab her swallow enough to manage her secretions, she'll never get it out. Not surprising news... not new news, but still so sobering each time it's said.
As for the tubes in her ears... this one was up for debate until the day of surgery. We wavered back and forth because the tubes make Gracie crazy. Her left ear drains constantly and the feeling makes her so irritable. She's so "open" structurally on that side that her saliva actually drains out her left ear... thus it's no wonder that without tubes in her ears, she constantly has fluid in them. We had the ENT put in temporary tubes thinking that if it is too unbearable for her, we will have to take them out or hope they come out on there own quickly. We wavered also because of the fact that she's consistently testing with a profound loss in both ears now. Behaviorally, we haven't seen much response to sound in a while and when we do, it's to things that are incredibly loud or could be things she's feeling rather than hearing. The tubes are there to protect her eardrums from damage... but if she's deaf, what are we really protecting? Constant ear infections haven't plagued her... constant fluid has, though. It's a true catch 22... and we chose (since she was going under no matter what) to give it one more "go round" with the tubes. The (very) unfortunate thing regarding the tubes is that because of the drainage issue, Gracie can't tolerate her BTEs (Behind the Ear Hearing Aids). We've been trying to get her to wear these instead of her BC (Bone Conduction aid) as they provide more appropriate amplification, but it's been a struggle. If she'd have taken to those aids and seemed to be getting any benefit, then we'd have skipped the tubes altogether. It's just unfortunate that we can't really work on wearing those aids now.
The endoscopy was the thing we were most concerned about... the GI team needs to get a good picture of the status of her "gut" and they did. Hearing me talk about her gastritis and her profoundly negative reactions to feedings didn't really sink in until the new GI doc got a look-see for herself. Like her airway, her tummy was not as horribly red as it's been in the past. That's not to say that it wasn't red and bleeding - - it was. But it actually looked better... until she showed us the rest of the pictures. She blew a little air onto the surface of her stomach lining, went in further to get more views and when the camera came back to the stomach, it was horribly raw and bleeding... just from the air. Thus, you can only imagine what formula and meds do to it.
She spent several minutes going over everything with us and then discussing the things we've attempted in the past. I confessed that I'd been skipping her Prevacid because she seems to be uncomfortable when she gets it... it's like the little granules irritate her very raw stomach. She agreed with me and formally discontinued it. We added Nortriptlyne to Gracie's long list of daily meds in the hopes that it would help block out the pain she associates with feeds. So far, we've not noticed a big difference. We'll be patient. If by the weekend, we've not noticed a change, we are supposed to increase to twice a day. If that doesn't work, then she wrote for another medication to be added. If that doesn't work, we will go back to the G-J tube (bypassing her stomach entirely by feeding directly into her jejunum). She's had that tube before, it wasn't any better, really. And, while we're not keen on pumping her full of meds and making her groggy or foggy, we don't have much choice in the matter... she has to eat... she has to gain weight and be able to keep it on. Period. "Failure to thrive" doesn't begin to define how dire this situation continues to be for her.
The good news is that despite being rail thin, having a raw tummy and a drainy left ear, Gracie continues to get more comfortable at school. She looks forward to getting there and the minute I get her out of the car and into her KidKart (adaptive wheelchair/stroller), she is ready to leave me and get inside! I love that! Next week, we bump her days at school from three days to four! Yay... progress!
Saturday, May 9, 2009
Happy 2nd Birthday, Preston!

My sweet, busy, insatiably inquisitive boy ~
Today you turn two and that means, regardless of my desire to hold onto your "babyhood," you are officially no longer a baby. The truth is, you reached toddlerhood a long while ago, and in your mind (especially at the playground) you have reached little-boyhood, too. I can't even begin to list your milestones and accomplishments here... there are just too many. Thus, so I don't forget (and so that someday you can look back and know what your little two year-old self was doing, especially compared to your one year-old self), I am recording some highlights.
You have an endless and ever-growing vocabulary and you're quite smart. (I say it not just because I'm your mommy - - it's just a fact). I lost count of your words and signs many months ago... you surely are at well over a thousand now with both languages and it is simply amazing. Granted, some of your words need translation because even though your brain has the capacity to grasp the vocabulary, you're little mouth hasn't quite mastered the motions for pronunciation. Some "funnies" that you've picked up as of late - - "Oh, tute" which is "oh, cute" - - something that I say a lot and apparently, because of that, you easily learned how it's to be used! In the last several days, you have commented on Gracie's sheets, her braids in the morning and a drawing we did together. You also say, "Oh gosh" which really cracks up me and Daddy! If you are running around the house looking for something or someone, you say, "Are you?" while signing, "Where?" You are rather chatty and people are constantly commenting on how much you talk, especially "for a boy." I think you come by it naturally - - you are, after all, my child... and I am wordy! And, the fact that you spend about 95% of your time with me, it's bound to rub off! We chat about everything... what we see, what we hear, what we read, what you learn from your favorite shows.
Speaking of your shows, your current playlist is quite "sophisticated!" You love "Signing Time" (on this one, you don't really have a choice, so it's good that you like it!). You also love "Curious George," "Sid the Science Kid" and any of the Frog/Boy/Dog videos directed by Gary Templeton. (These are silent movies, set to classical music that feature real kids and real animals.) Like Sid, you are very inquisitive and want to learn how things work and how they are put together. Now that Gracie goes to school like Sid, you said just this week, "Bubba go school." We working on it, dude! There aren't many preschools that will allow kiddos as little as you! Anytime you watch TV, you love talking about all the things that are happening. You're favorite thing to watch on the laptop (besides slideshows of yourself and Gracie) is an Italian video that features rescue dogs being trained to jump from helicopters into the water. It's no wonder you love this... it has water, dogs, helicopters and adventure! Games on PBSkids.org and Sesamestreet.com are fun for you and you also love several of Gracie's school games and learning software.
You've been drinking from a real cup for a while now, although I still give you a sippy cup most of the time - - only because I don't trust your urge to be "two" and dump the cup! You love bath time, all things related to your self-care and picking out your clothes! Sports are a huge hit with you and you are naturally very coordinated, just like your daddy. You love hitting off the tee, but even more, you love hitting a slowly pitched ball... and often, can do it! You and daddy recently started hitting tennis balls at the courts and you now have your very own racquet! You haven't yet proven to be left-handed or right... but seem to favor your left and are certainly more coordinated as a south paw at this time.
As busy as you are, you are equally eager to settle down and read... thank goodness! You love books, but unless they are board books, you must be carefully supervised because you've discovered how fun tearing paper is. We read together at least 30 minutes a day and you love reading to your stuffed toys, the dolls and, of course, Gracie. You would read all night and avoid sleep altogether if I let you - - another thing you come by naturally! While it's difficult to list favorites, a current "daily must read" is "The Very Busy Spider." When read together, it is a little sing-song back and forth. You have most of it memorized, so I can stop reading at almost any word and you'll say it for me!
You know you're alphabet - you can say it by voice, sign (although not completely accurate by sign yet, you do recognize all letters that are signed to you) and you recognize all capital letters no matter where we are! Street signs, stores, the sides of trucks and buses... it doesn't matter where we are, you "read" me the letters. We are now working on lower case letters! You have counted to fourteen independently, you try to sign when counting, but again, your fine motor hasn't caught up to your brain! The difference between now and a couple of months ago, though, is remarkable and you've become quite obsessed when trying to sign, asking for help and sticking up your hands! You just mastered "I love you" with your left hand - - this made mommy, daddy and Gracie very happy! Gracie now signs it back to you when you "say" it because you are signing to her... which we love seeing!
You are a little sponge, thirsty for more from the moment you wake until you finally rest your head again at night. You fight naptime, I am sure, because you are afraid you will miss something. (Mommy really wishes you'd not fight so hard! She needs to recuperate a bit during the day, too, get some things done and regroup just to keep up with you!) It's a joy to sit back and watch you, Preston... the way you observe, solve problems, role play... it's miraculous, so seemingly effortless. You have impressive manners, often remembering to thank daddy and me when we give you food or refill your cup. You say please, bless you (beesh you) when we sneeze and "cuze me" when you burp or toot! (You also laugh hysterically at the later!)
You relish in making your sister laugh or smile. You always offer unsolicited hugs and kisses, and never go to bed without saying goodnight, giving a kiss and saying "I love you." Like your sister, you have an amazing capacity to love and are eager to share your affection. And then, amidst all this great loving, play and discovery, you hit or kick something or someone... and I am reminded that you are, indeed, TWO!
Happy Birthday, Bubba! I love you with all my heart and am so proud of you!
Mommy
Friday, May 8, 2009
Foto Friday vol. 13 - Some things Bubba

This is Gracie's "Slime" that she (unknowingly!) shared with Preston. Since he wasn't a fan of "mushing the bag" for the Amish Friendship Bread a few weeks ago (he has since squished other bags), I've been working with him to explore various textures. He had a blast playing with the Slime... and is officially over slimy, squishy things!
On Sunday, Preston and I attended Reuben's 2nd birthday party. It was a lovely afternoon in the Southern California spring sunshine. After enjoying more than his fair share of strawberries, having his face painted (He chose "happy faces" on each cheek - Thanks, Kristina!) and the much anticipated birthday song and cupcake, he was absolutely exhausted! This is what he looked like before we ever hit the freeway!
Wednesday, May 6, 2009
Homework
Yes... this is what we have worked for, hoped for and waited for, but when it came time to pull into the drop-off parking lot at her new school, I had to tell myself not to keep driving! It's not that I wasn't excited for her - - there's just something a little unsettling about dropping her off, watching them wheel her down the hall and knowing that the next time I see her, I will not have a clue about what happened, but for what they tell me. Her health aid and the school nurse met us at the "drop-off" spot. We got Gracie settled in her chair, chatted a bit and then... off they went... down the hall toward her classroom as I pulled out of the parking lot.
Three hours later, I waited in the same lot for them to bring her back to me. They shared what happened during her day - - what she enjoyed, what made her mad (and what they learned about her from it!) and let me know all of the team members who worked with her. They said that it seemed at one point she realized I wasn't actually there lurking in the wings. I am not sure if that's really true or them being kind and trying to appease my aching "mama heart," but in any case, I appreciated the comment.
When we got home, Preston was so relieved to see her. (He had stayed with John in the morning when I dropped her off and was a little distraught for about ten minutes when I returned without her. He cried and called her name over and over. It was sweet - - but John and I were glad when he moved on to shooting baskets in the backyard!) I unpacked her backpack and in her communication book (the notebook that will be passed back and forth between me and her team), I found her homework... her very first homework!
We completed it this evening. On Monday and Tuesday evening, I had worked on other activities with her that I had hoped would make the homework more "familiar," but she didn't seem impressed with any of it, so it took a lot of hand-under-hand and hand-over-hand help to get this done... but we did it!
Tuesday, May 5, 2009
Here Fishy, Fishy

On Tuesday afternoon, the Flock spent time with schools... of fish.
We took the kids to the Long Beach Aquarium and they, especially Gracie, had a ball!
We had intended to take them for Preston's birthday (which is Saturday), but since John starts an eight-day stretch at work on Wednesday, it wasn't going to work out. Then, as it turns out, Gracie's class was scheduled for a field trip to the aquarium on Wednesday, but because I can't take Preston with us, she won't be able to go. So, we combined it all and had our own field trip and pre-birthday celebration on Cinco de Mayo!

Gracie not only enjoyed it... she loved it! It's nice and dark in there, so for our incredibly light-sensitive girl, there couldn't have been a better outing! The most exciting part of the trip was how much she signed unprompted... fish, water, jellyfish, lobster, light... plus much more after prompting. She also floored me by recognizing fish I'd named for her when we passed by a second time.

Preston enjoyed it, but not as much as his sister. He's not a big fan of the dark or really loud noises, so when the main area became dark and the booming voice came over the sound system talking about whales, he said, "All done... bye fish." We had to talk him into staying! Like his sister, he was eager to tell us all that he knew. He recognized so many fish before we even told him what they were - - starfish, jellyfish, octopus, crab, lobster, seal... it was unreal to listen to him and watch him sign.

My favorite part of the visit was when John held Gracie up to the window and they watched the otters play. One otter, in particular, seemed to perform just for Gracie. He would speed past the window and then come down to where she was and literally stop, "clap" a bit, turn, twist, put his nose right to hers, and then speed away, only to loop around and "play" with her again. She loved every bit of it... and it was such a joy watching her take it all in.
Friday, May 1, 2009
Foto Friday vol. 12 (Making it's comeback after a hiatus!)

Preston helping wash Daddy!
Gracie's new hearing aid molds... a darling mix of pink, purple and clear swirls. She has yet to tolerate wearing them for more than ten minutes and really prefers her bone conduction aid (ten minutes is the longest she's worn this type of aid in over three years - so that's progress!). As usual, she is eager to wear anything for a photo op, though! Jury is out on how much either is really able to help her. That's another story for another post...
Easter Baskets with Nana! So much fun!
Preston has gotten into role-playing with all of the dolls and stuffed animals in the house! It's too cute! He had a lunch date on Wednesday with his stuffed leopard named, Meow, and his "big monkey" named, Max. He sat each of them in a chair and I had to serve goldfish crackers to all three of them!




