Narrowing down the list of Specialists

Here are some updates from last week:

A 72hour Holter was done Mon-Thur last week by Cardiology. They'll call with the result within 10 business days. Unless something abnormal shows up on the Holter or there is a clinical change, we won't need a follow-up until April 2012.

Pulmonology is continuing the monthly Synagis shot until March (which we may need re-approval for from our insurance at some point). No ventilator changes yet until I am able to continuously monitor Wyatt's CO2 levels. Wyatt is still on Pulmicort twice a day per nebulizer and Pulmonology added an order of saline updrafts 3-4 times a day to try to improve Wyatt's thick secretions. They also typed up a letter/order requesting a back-up ventilator which our DME company (Children's First) is very resistant to provide.

Physiatry was happy with Wyatt's progress and told us that they had high hopes for him and since he’s meeting all the milestones so far, follow-up PRN only.

Early Steps has put us in contact with "Beyond Therapy" to provide Speech Therapy with Occupational Therapy (for Wyatt’s feeding problems) once a week at our house. They will try to bill insurance first though, then Medicaid if the request gets denied by our private insurance, and then if Medicaid denies it also it will then be covered by either CMS or Early Steps.

Nephrology explained that sometimes babies in the NICU have what they refer to as transient high blood pressure, meaning blood pressure readings could be high due to the stress of being in the NICU or simply because the readings were done during or after other assessments which can give a false high reading. They at this point do not believe that Wyatt has true high blood pressure issues and put in the order to check his BP twice a day on the arm and at rest. If his systolic runs >115 consistently, then we will have to call them back and go from there. If that's the case though, Nephrology does not want Wyatt on Clonidine due to the drowsiness side effect and would switch medications then. Otherwise, follow up PRN only.

Regarding Nephrology, Children's First – our home nursing, DME and pharmacy company- is not being very cooperative. Since Nephrology put in the order to check Wyatt’s blood pressure twice a day, Children's First is trying to put it through our private insurance to supply us with their blood pressure equipment and they are asking for a monthly rental fee of $300 from our insurance. I explained to them that I do not want to go that route since we have the donated Critikon Dinamap Plus which has blood pressure capabilities and all I need is the tubing and the blood pressure cuff. Children's First is not willing to supply that to me since the Dinamap is patient-owned and was donated and therefore, they are unsure of the maintenance schedule etc. I assume it's a liability issue, as well as financial motivation on their part. Needless to say, we are not in agreement. I am now trying to see if my insurance will let us purchase the tubing and blood pressure cuff out right, which comes out to a one-time fee of only about $65 instead of the $300 monthly rental fee for Children’s First equipment. I definitely do not agree with our current DME company charging insurance $300 a month for blood pressure equipment we already have. I do not want Wyatt's lifetime maximum insurance benefit drained for unnecessary reasons. I also tried calling the Co-Owner at Children's First about the AC Power Adaptor for the Capnogrpah CO2Monitor which I am still waiting on. She just transferred me to person in charge in Equipment who then said, she has to get with the sales person from Smiths Medical (the manufacturer of the Capnograph CO2Monitor). Apparently, we haven't gotten any further with that issue yet either. I explained to that person in charge of equipment that it has been months since the order for the CO2Monitor has been put in and now that I finally have it, I still can't use it to continuously monitor my son’s CO2 levels per order of Pulmonology. She said she'll put "urgent" with her request. I'm getting the feeling that they are intentionally dragging their feet on this issue for the same financial reasons. I previously explained to them that once I can use the portable Capnograph continuously which also has Pulse Oximetry capabilities, plus using the Dinamap Plus as a "stay at home" Pulse Oximeter, I will no longer need Children's First Pulse Oximeter and we won’t have to unnecessarily charge my private insurance the monthly rental fee anymore. They were not too happy about that request back then either. Children’s First only wants to use their equipment despite the fact that we already have some patient owned equipment. Sounds like bad business tactics to me… As if that wasn’t enough, when I called the staffing manager at Children's First to get an update on the nursing schedule this week, she casually mentioned that Wyatt is on a weaning schedule and that we will be down to 8hours a day as of this Friday per Medicaid. She said the Co-Owner is trying to fight for at least 12-16hours but if we do go down to 8hours a day it will be hard to staff since most nurses only want to work 12 or 16hour shifts. Quite frankly, I almost lost it on the phone. We were told that we were originally approved for 24hours the first 30days, then 16hours the next 30 days, and the 8hours a day per Medicaid but that they would continuously fight to keep the hours as close to 24 as they could get. That second 30 day time frame should not be up until the first week of November. All along I've been asking for updates on that and all I was ever told was that the Co-Owner is working on it and they'll let me know if we drop from 24hours. Last week was the first I heard that we're going down to 8hours THIS Friday. And to top it off, we never even came close to receiving what we were approved for in the first place. We didn't even have a nurse this entire weekend. In the beginning we were told there would be occasional gaps in service yet we haven't had a night nurse in weeks and days have been covered 8-12 hours a day maximum. Considering all these problems, I don't think Children's First understands, it's not just a nursing issue anymore. Strictly from a business perspective, our son's diagnosis makes us long term customers and the way they run their business is not acceptable. If we switch companies, we are pulling everything, not just nursing but also DME and pharmacy! My husband and I are willing to look into different nursing companies at this point if we can take one particular nurse with us. I have already contacted another home nursing agency and the local direction is coming to meet Wyatt by the end of this week. Whether or not we can keep that one nurse as our primary nurse will ultimately be up to her. I’d love to keep her but it’s not my place to ask her to switch employers. I’m crossing my fingers that she’s willing to do so but even if not, we can’t stay with Children’s First considering the way things have been going. I shouldn’t have to call every day to see who’s coming in the next day and not get a response back from them if any until 10pm, and I shouldn’t receive phone calls from their staffing manager on my phone when she’s trying to speak with the nurse we have working that day. That’s so unprofessional. Children’s First is making me want to give up on nursing altogether and when they can push my buttons that much, it’s time to fire them. The same goes for the equipment issues with them. Even though switching DME companies would be hard since we'll have to switch all the equipment out, I'm sure there is a better company out there who is willing to work with us in terms of patient-owned equipment, yearly maintenance checks, a back-up ventilator, etc. I’m already also pulling Wyatt’s prescriptions and switching to a local pharmacy. Unless the other home nursing agency has some major red flags (that tops Children’s First issues), we’re ready to switch! It’s down to us calling the quits on nursing completely which we would regret some day or giving it another shot with a different agency. I'd like to be able to start my business back up some time soon, even if it's just part-time.

Fun, fun

Oh boy, what a weekend it’s been. Our two year old developed hand, foot and mouth disease. It’s highly contagious through contact and presents with fever, sore throat, loss of appetite and itching/pain sensation in the hands and feet, which eventually shows with little red dots that will become blisters. Those dots turning blisters will then also migrate and spread to the mouth and randomly across the body. I have no idea how he got this strange disease since he’s basically home with me all day but it could have been as simple as a grocery trip or the movies I guess since anyone can be a carrier of the virus. It only turns into the disease in kids under five years of age. That being said, that meant we had to basically quarantine our two year old. We sent him off to stay at Grandma’s house for the expected 5-7 day course while we went disinfecting crazy around the whole house for five hours to try to prevent Wyatt from getting infected. Not my idea of weekend fun but hey, that’s our luck lately. It seems like we manage to keep it contained though as Wyatt has not shown any symptoms yet and we’re now five days into it. Keeping our fingers crossed and keeping the two year old under quarantine until he’s all clear. (I really miss him though!!!) Aside from that drama, we’re working on making arrangements to go up to Children’s Memorial in Chicago in mid-February to see Dr. Debra Weese-Mayer who is specialized in CCHS. It will be a five day hospital stay for extensive evaluation and to develop a more detailed treatment plan which will allow us as the parents to make ventilator changes ourselves as needed, as well as give our Pulmonologist a better recipe for treatment. How to get up to Chicago is the biggest issue for us, especially in the cold of February. Driving would be ideal to have our big truck for all the equipment needs but it’s a minimum of a two day drive with an infant on a ventilator who doesn’t even like the car seat. And when I say he doesn’t like the car seat, I mean he absolutely hates it and will show off with plenty of Smurf moments. Flying on the other hand poses the risk of being around crowds and potentially getting Wyatt sick. Plus, there is the hassle of getting through the airport and taking all his gear as carry-on. Driving or flying, both are expensive. So I am attempting to find a way to either get a reduced rate on a commercial flight or to go through agencies like AngelFlight Southeast or OperationLiftoff to arrange for a potentially free flight on a smaller plane due to medical necessity. There are definitely some road blocks I’m running into trying to plan this trip in regard to the documentation needed for Special Needs, but after a day of banging my head against the wall (and catching up on some sleep), I’m back in the game and ready to attack. We’ll get it sorted out one way or another. We will need to arrange for transportation and accommodation though when we get to Chicago. I hope that won’t be an issue in the middle of February in Chicago weather. We’ll see, we still have time to plan… From a strictly medical standpoint, Wyatt is doing very well right now. We found a great Cardiologist who did his homework ahead of time and right away arranged for a 72hour Holter Monitoring, which Wyatt is hooked up to now. I am nervous about the result though since Wyatt is at such a high risk of having prolonged sinus pauses which could result in the need for a cardiac pacemaker some time in his future. This yearly test will probably always be nerve-wrecking for me. Pulmonology is on top of their game and ordered an abdominal ultrasound to check for Neuroblastoma which Wyatt is also at risk for and we’ll have to check for yearly. A Sleep study was already done also so we have a better understanding now what his breathing capacity or lack thereof is during each stage of sleep. Once we go to Chicago, they will repeat those tests among others and look at everything in more detail. Early Steps also called me today and they found an agency that can provide a Speech Therapist who’s also trained in Occupational Therapy to come out to our house. It’ll still take a while to get services started but hopefully soon they can come by once a week to help work on Wyatt’s feeding issues. I’m still waiting to get an AC power adapter for the Capnograph CO2Monitor so I can continuously monitor Wyatt while sleeping and we can then fine tune his ventilator settings to keep his CO2 between 35-45. Can you believe it, our insurance bought the Capnograph out right but the DME company failed to check that it only comes with one battery and a battery charger. That battery only lasts eight hours and then I would have to turn it off until the battery is fully charged again. So stupid. Of course I need either a second battery or an AC power adaptor to be able to continuously monitor. So I’m still waiting on that. Another fun thing I’m waiting on is Wyatt’s monthly delivery of a new trach. The one thing we really need is on back order, on manufacturer back order none the less. Fantastic. There is no way of knowing when it’ll get here. It’s bad enough we only get one new trach a month yet his trach is to be changed once a week, so we end up having to sterilize used trachs and reuse them. But this being the middle of October and the trach is on manufacturer back order, I’d be really surprised if we even get a new one this month. See, it’s so much fun dealing with home health care. There is never a dull moment. Speaking of home health care, I’ve come to the conclusion that Wyatt and I just don’t like home nursing care. Given my personality of wanting to do everything myself anyway, the nurses will probably never be able to live up to my expectations of multi-tasking. And Wyatt at 4 months old only wants to be held by either myself or my husband otherwise he’ll have back to back Smurf moments. I tested that theory today and sure enough, even when he got really fussy and over-tired, he didn’t have an episode when I was holding him. But when I handed him off to the nurse while he was content, he immediately switched his mood and had an episode every single time I walked out of the room. Way to make me feel guilty, Wyatt. Well, him needing to be held all the time led to me becoming really good at holding him in one arm while doing everything else with the other arm, like suctioning him, hooking up his feed, venting his G-tube, giving him his nebulizer treatment, etc. The bad thing about me being able to do it all one handed now though is that I have also lost my patience for the nurses, for example when they take forever to get things ready to get out the door for appointments or they spill my hard earned breast milk trying to pour it into the feeding bag or when they can’t even figure out how to secure the ventilator in the travel backpack. I really am trying my best to accept that nursing is just part of our life now but it’s just not working well for me. I am always so irritated when we have nurses and so much more relaxed when we don’t. Not trying to offend any other nurses here but in our situation where we as the parents are so involved in everything about Wyatt’s care, home nurses are just a glorified and very expensive medically trained babysitter. That’s just my opinion though and I am kind of annoyed by them today so maybe it’ll pass. And it really ticks me off when they kiss on him like he’s their baby or something. Ok, I’ll stop now. I just had to get that out. Oh well, that’s it for this week I think. Wyatt has a bunch of appointments this week, six to be exact, but most are just follow-ups and then his usual Pulmonologist and Pediatrician appointment. Hopefully November will be calmer.

Hate the G-Tube

October 11, 2011

Oh, the G-Tube. Can I say that I’m annoyed by it yet? We had a surgery follow-up 2 weeks ago and the nurse practitioner told me that they have to wait at least 12 weeks post-op to switch him from the 12FR G-Tube to a Button (the surgery was July 19). Well, I got a phone call now saying that the surgeon is not comfortable switching infants to a button and that we don’t need another follow up appointment with surgery. Well, isn’t that great since Wyatt loves pulling on his G-Tube. Now I have to wait till Wyatt’s next Pediatrician appointment to come up with a plan of action. The Pediatrician gives us the guidelines for adjusting his feeds so we didn’t really need a GI doctor so far and weight gain definitely has not been an issue for Wyatt since coming home.  Now, if we want Wyatt switched to the button though, we apparently do need to add a GI doctor to the endless list of Specialists. Wonderful. Did I mention that I’m not a fan of doctors or the G-Tube to begin with? The G-Tube is such a controversy for me. I know Wyatt bottle-fed and nursed before being intubated and I understand that he lost the sucking instinct and has to relearn it. But I also know from a strictly muscular and coordination standpoint that he can do it. In fact, he sucks on his fingers now all the time and has shown no issues with swallowing. But I feel like with the G-Tube we’re just teaching him how to take the easy way out. He’s smart enough to know even at 4 months old when it’s time for the next feed. I hate the strict 4 hour daytime feeding schedule and the continuous nighttime feeds. What normal baby actually gets hungry on a consistent 4 hour daytime schedule and requires continuous nighttime feeds for 8 hours straight without a break? Some babies feed every couple hours and then sleep half the night without needing any food, or vice versa. How is Wyatt ever supposed to learn to wake up when he’s hungry and therefore have the motivation to try to bottle feed if we just always hook up his G-Tube feed when the clock says so, regardless if he’s sleeping or playing or being fussy at that time? It seems like we’re just teaching him to be lazy when it comes to eating. This kind of set schedule was supposed to get him in a daily awake/nap cycle but instead it has done the complete opposite. He just sleeps all day long now until about 5pm, only waking up when he needs suctioning or a diaper change. From about 5pm till about 10pm he’s Mr. Cranky Pants with several episodes and then around 3am we’ll have a hard time calming him down again (with several episodes) to go back to sleep. That’s not normal baby behavior. By the time he shows interest in playing it’s supposed to be time for his next feed which again makes him cranky and sleepy. I’m ready to throw that schedule out the window. As long as he still gets the overall total amount in feeds, I don’t see why he shouldn’t be able to give us cues on when he wants to eat and play and sleep. I know we can’t go cold turkey and expect him to suddenly go straight to the bottle but come on, let’s try to be as normal as possible and let him set the schedule. There's got to be a better balance between attempting the bottle and gradually weaning him off the G-Tube on his time schedule.

Tough Decisions

October 8^th, 2011

Let me try to sum up the last couple weeks. I’ll try to stay positive but it’ll probably turn into venting sooner or later because I’m exhausted so bare with me…Wyatt and the rest of the family have been doing well and we’re getting in the swing of things. All the kids are definitely interacting more and Wyatt looks for the boys now when he hears them playing. He even gets upset when he can’t see them or they’re too far away and not getting him involved. So we’re trying our best to either let the bigger boys play in Wyatt’s room or bring Wyatt into the living room and kitchen with us whenever he’s in a happy mood. It still takes two people to move him to a different room with the vent and pulse oximeter attached to him but even the 6 and 9 year old are learning how to help me out with that. Wyatt is now also to the point where he scoots around the whole crib reaching for toys by now and is lifting himself up more onto his arms and knees during tummy time. That’s huge progress for him in only 4 weeks of being home. He’s made progress with the pacifier, too. He still only chews on it but he tolerates it for longer periods of time and even holds it and plays with it by himself. He still doesn’t like trach care but really, who in their right mind would. On another good note, I actually get to see my husband again for a few minutes a day now and not just for our nightly shift change. That’s progress, right?! Our two year old is the biggest trouble maker right now. He’s in the middle of potty training and has no accidents when someone is individually with him all day. But once I’m busy with Wyatt, the 2 year old will intentionally pee right on the floor just as an attention getter. I had never experienced the terrible twos with my two older boys but man, child number three is definitely making up for it. I wish I could afford a nanny! Balancing all 4 kids is what gets to me the most. I feel guilty for not being able to help the 6 and 9 year old with their homework and asking them to take on caring for the 2 year old. The lack of dependability with home nursing is not allowing me any room to breathe. We have one really good nurse once a week now who will be taking on Wyatt’s care 3 to 4 days a week in November and she’s the only reason I haven’t switched nursing companies yet. Making it through October without yelling at the staffing manager is the biggest challenge for me. I literally have to call every day to find out if/who’s coming the next day and often times we have open days and they fail to call me back with updates. Nights haven’t been covered for over 2 weeks now since we fired the night nurse who slept on the job. My husband and I have good routine but it’s still so exhausting. To be perfectly honest, while we are getting into somewhat of a routine and Wyatt is doing pretty well, I’m running on fumes by now. It’s really hard to be up half the night only sleeping on a fold out chair and then not being able to take a nap during the day because I’m either on the phone for hours with insurance, staffing, supplies, doctors, etc which is putting my phone bill through the roof for the second month in a row, or I don’t have a reliable nurse meaning I’m still doing all the work. Aside from a grocery trip and Wyatt’s doctor’s appointments, I haven’t really even seen the outside world. I was planning on taking a day to myself and going to the beach this Sunday but those plans had to be scratched since of course the weather is all gloomy and rainy all weekend. Overall, having Wyatt home is still a lot easier than when he was at the NICU and we had to drive each day but I’m starting to question whether the home nursing is worth the trouble. Even when I have a nurse, I can’t relax because having home nursing also means you have to keep updating a lot of different people on Wyatt’s medical status after each appointment when really it should only be between my husband and I. It’s such an invasion of privacy and a huge headache taking time away from doing what I really want to do which is spending quality time with my family. I’m really on the fence about it. We just have to make it until November to get that one awesome nurse several days a week. We may decide to only have her at that point and manage by ourselves the rest of the week. We haven’t decided yet though. Another thing we have to decide is whether or not to go up to Chicago to see the CCHS Specialist. At first I really wanted to take Wyatt up there as soon as possible and so we made the contact and filed all the paperwork with them. But now that Wyatt is tentatively scheduled for February 13-17, 2012 and I had a chance to speak in more detail with the staff up there to find out what tests and assessments will be done, I’m not so sure anymore whether taking him to the Specialist is of any benefit. We finally have a good Pulmonologist here in Florida who is on top of it all and has experience with CCHS. Most tests that are done during the 5 day stay in Chicago have already been done, some multiple times. The few tests we’re missing will be done within the next 1 ½ months. Yet the Specialist’s office routinely wants to repeat all those tests and what’s worse, they don’t let the parents stay with the child through some of those tests. I’m not ok with that. I want to be with Wyatt the whole time for his sake and mine. And I have seen him go through a bunch of tests already and I can’t find a good reason to put him through all those tests again. I’m not convinced at this point that we should go. I know they do all the research up there and they are good at teaching the parents how to work with the vent settings but that’s not a good enough reason for me. I’m sure I can get our current Pulmonologist to teach us whatever we feel we need to learn and exposing Wyatt to the long travel and then all these tests again at such a young age just for the greater good of research does not sit right with me. Even the simplest non-invasive assessments are really hard on him and throw him into more breath holding episodes for several days. I can’t watch him go through this anymore. I don’t know what to do. I just want him to be left alone and be a normal baby having normal experiences and not be traumatized anymore than necessary. He has enough doctor visits and tests ahead of him as it is. Having good doctors on board is important but when is it too much? When should we as the parents step up and say that’s enough. After all, doctors only look at a chart but we the parents know our children best and know when things need to be addressed and when things are better of left alone. Are we at that point?

Close Call

We had a close call Tuesday night. Wyatt is fine now but I still can’t get that image out of my mind…

Wyatt had a good day on Tuesday. He was tolerating the bouncy seat and tummy time better than usual for a good 30 minutes each. We even practiced bottle feeding (a.k.a. chewing) for a good 15 minutes. Overall, his new schedule seemed to be working better for him and us, and everybody in this house had started to get into a good routine… But then came the sober reminder that things can go horribly wrong in an instant. My husband was still at work and I was eating dinner with my other 3 boys in the kitchen while the nurse was rocking Wyatt. I heard the pulse ox alarm go off which usually means he’s either having a breath holding episode or it’s just not getting a good read. When I walked in the room I heard a very distinct and familiar whistle-like noise. Wyatt’s trach had come out and the nurse failed to recognize that noise nor did she check. She just kept starring at the pulse ox waiting for his sats and heart rate to come back up. Turned out, she had attempted to do Wyatt’s trach tie change by herself. That’s why when he had his episode and the trach tie was loose, the trach ended up coming out during his episode probably when he was arching his back. I yelled at her that his trach was out and grabbed the supplies I needed to put it back in. In the nurse’s panic she ended up trying to wiggle the trach back in without supplies unsuccessfully and her hand just got in my way where I couldn’t see the trach site.  I told her to just hold him. Despite feeling a little resistance, I manage to get the trach back in. It doesn’t take long for the site to close off and I almost had to grab the emergency smaller size trach. But thankfully I managed. His sats came right back up to 100 and his heart rate was in the 150s but Wyatt was unresponsive. He had a blank stare, his tongue was sticking out a little with drool around his lips and he was completely limb. Normally after a breath holding episode he’ll have that blank stare while he’s returning to a pink color and his body will be stiff for about 15 seconds. But it was different this time. He was pink already, his number looked great but I couldn’t get him to respond. I gave him additional manual breaths through the vent because I did not want to let him ride on only the 30bpm back up rate his vent is set at And then I called 911 because he didn’t come out of this stare, he was limb. The nurse just kept saying “Why didn’t the vent alarm go off?”. She’s lucky I was more focused on Wyatt than her comments or I would have yelled at her so loud, the entire block would have heard us. I’m not a nurse trained on trachs and vents, and I’ve only been dealing with this for 3 ½ months but I recognize that distinct whistle-like noise. No matter how many times you’ve seen Wyatt’s breath holding episodes and are used to them, you never ever assume he’s just going to bounce right back. You always trouble shoot all the equipment, glaze at the vent circuit to make sure it’s all connected and look at his trach placement. And if he doesn’t come back up like he usually does, you always have to be ready to switch out his trach in case there might be a plug in it preventing him from receiving the breaths. You cannot ever depend on alarms. The pulse ox doesn’t even alarm until he’s already blue because there is a big delay. The vent won’t alarm when the trach comes out because the vent only has a disconnect alarm. Nothing was disconnected though so as far as the vent is concerned, it was still pushing air through. The air just wasn’t going into Wyatt. After the longest 5 minutes of my life, Wyatt finally come back around and started silently crying. By the time EMS got to our house, he was crying and responsive but I wasn’t taking chances. I directed the nurse to just keep holding Wyatt and trying to comfort him while I packed up all his gear. EMS wanted to ambu bag him on the way to the hospital and I had to set them straight on how this process was going to work. Ironically, the same EMS guys that came the day Wyatt was born responded to this call. Only this time they actually had respect for me and let me take the lead. You could tell they knew very little about the home vent. I had to give them the short version of Wyatt’s diagnosis and they got the point that the 911 call 3 ½ months ago after Wyatt’s birth was due to his diagnosis and not as they thought back then because Wyatt was born at home with a midwife. Even on the ride to the ER I was directing them on what to do and I what I needed. I was on the stretcher holding Wyatt in my arms to try to calm him down and the EMS guys made sure to place the vent between my legs so I could see it and work it if needed. Once at the ER Wyatt’s numbers were back in the normal range and I had to explain to the ER doctor to not be too concerned with Wyatt pupils being only minimally responsive as it comes with CCHS.  We were then transferred to Arnold Palmer Children’s Hospital for overnight observation. I must say, everyone at Arnold Palmer was amazing. As the leading children’s hospital in the region, they clearly had some experience with CCHS and were treating Wyatt appropriately (unlike the doctors at Winnie Palmer NICU across the street). It was close to 10pm when we got to APH and by then Wyatt was all smiles again and flirting with the nurses. Since we don’t have our CO2Monitor at home yet, I took advantage of our unplanned hospital stay and requested to put an in-line etCO2 on Wyatt’s vent circuit. He was reading in the low 20s which the RT was a little concerned with but I told them that before the pressure control increase on his vent, he used to be in the 70s. So I was ok with low 20s even though I guess it is considered to be the lower end of a good CO2 range. Weirdly enough, his CO2 was reading higher when he woke up in the morning, it was sitting around mid 30s. The RT said, it could have been reading a little low while he was sleeping because he has a significant air leak through his nose when he’s sleeping so it may not have been a true reading. I don’t know if that’s right or not. I have to trust the RT’s interpretation for now since I don’t know that much about CO2 readings yet. I’ll have to look into it more. By 10am Wednesday morning the attending doctor signed off on the discharge papers and we were back home by 12pm. Having only ridden in the ambulance with Wyatt so far everywhere we went, it took us a little while to get situated in the double stroller and then getting into our truck. But it was a nice first trial run - I’m trying to look at the positives here out of this whole mess. Of course, I had a stern talk with the case manager of our home nursing agency and made it clear to her that she’d better double check that all nurses coming to our house are adequately trained and that they are never to attempt a trach or trach tie change by themselves and that they are never to assume that he’ll just recover from his breath holding episodes. I expect them to always check his trach site and the vent set up during each episode and periodically throughout the day. Quite frankly, after Tuesday night, I was ready to say good-bye to home nursing altogether. I know it won’t be the last time for his trach to come out and it could have happened to anyone but for any nurse to play superhero and attempt risky things like trach or trach tie changes by themselves, that’s just unacceptable. I don’t care how much experience you have and how often you’ve done it one handed standing on your head. Wyatt is a strong kid and he’s managed to wiggle out of his trach previously even with the trach ties being thight. I don’t need superheros. I need nurses with common sense and the mind set to act when emergencies happen… Tuesday night was a close call. I know I can’t dwell on what could have happened if I didn’t step in the room but I can’t get that image out of my mind of Wyatt’s limb body with the blank stare. His sats and heart rate came right back to normal but he just wasn’t responding. There was nothing I could do but wait and hope and call 911. That helplessness of watching your own child go through that and there is absolutely nothing you can do but hope, it is an indescribably horrible feeling… But he’s ok now…

home health care - fun times

September 23, 2011

Yesterday officially marked two weeks home with Wyatt. He has adjusted quite well. I’m amazed by how much he’s been thriving in such a short time. He’s picking up his head now (still a little wobbly at times with all his gear), he scoots around in his crib and reaches for toys until he accidently rolls onto his side, he loves tummy time and prefers to sleep that way now, and he doesn’t freak out anymore when his two year old brother comes running up to him and pretends to be a tiger by growling at him. As you may have heard in the video I posted last time, he is also an expert at pooping sideways out of his diaper as grandma can testify... The rest of us have adapted quite well also considering the mess of home health care. We have come to appreciate why it is even more important now to stand your ground and go straight to the top when things aren’t handled the way they need to be. Getting consistent nursing coverage of GOOD nurses is the biggest issue. There have definitely been a few nurses we could have done without and those few almost drove me to the point of saying good bye to nursing altogether. But then there are the few amazing ones who just have the right balance. The good ones are those that realize that we as the parents are the experts on our child and the management of this disorder, and nursing is only needed and wanted as a back-up. The ones that appreciate that Wyatt doesn’t need hourly assessments or a diaper scale, and when he’s sleeping, you leave him be. The ones that realize that even though we have three other kids running around, Wyatt doesn’t need to be sheltered from them. Wyatt will get used to them coming in and out just as they will learn to understand that when we are busy with Wyatt’s trach care or blue spells, the other kids just have to wait. Just like anyone else who already has kids and then adds a baby into the mix, everyone in the family has to learn to adjust. And I believe that just because of Wyatt’s diagnosis, it shouldn’t be any different. He’s not sick, he has a gene mutation. He shouldn’t be treated any different than any of our other kids. The only minor difference is the endless bottles of hand sanitizer, disinfecting wipes and paper towels spread around the house to minimize Wyatt’s risk of infection and illness. So far we found two good daytime nurses, one of which I hope will become our primary nurse starting in November. She has another patient with CCHS she’s taken care of for 5 years now. Nighttime right now we’re left without nurses since we fired the one that fell asleep. The nursing company is now scrambling to find nurses with appropriate trach and ventilator care experience who are willing to make the 1 hour drive. The actually had to post an ad for a night nurse to try to fulfill our needs. So for now I set up camp in Wyatt’s room at night. My husband usually stays up till midnight or a little later while I go to bed with the kids at 9pm to get some sleep in our comfortable bed. And then we switch. The biggest pro of continuous G-tube feedings at night is that Wyatt sleeps through the night from about 10pm till 6am. I don’t really like the idea of him taking the easy way out with G-tube feedings only right now but Early Steps is coming out next week to do an assessment and get us Occupational Therapy, Physical Therapy and/or Speech Therapy. Improving his sucking reflex is my biggest concern. He chews on his fingers well because he’s teething but the whole sucking thing is a foreign topic to him still. The feeding schedule we have him on doesn’t seem to work to catch him in a playful mood to try the bottle. We’ll see. We might have to change things around. I’m sure that would make the Case Manager of the nursing company very happy. After all, I have to let her know what every doctor said at each appointment, and any changes that are made by the doctor need an order faxed over to the nursing company because the nurses can only go by what the orders say. Even things as simple as Tylenol, which is only given on an as needed basis anyway, they need an order for. I know it’s a liability thing but who’s in charge here. Wyatt is our son and he’s not sick! It rubs me the wrong way on so many levels. She even told us that she’d prefer if we get a diaper scale. Yeah right, we’re done with the hospital protocols. That’s not happening. Wyatt was at 11lbs 12.5oz on Sept 12^th and now he’s already up to 12lbs 8oz today and pooping several times a day. I think we have no plumbing or input/output issues to would warrant the need for a diaper scale! Come on.  It’s frustrating to me that there are too many people involved when you have private home nursing. I’m already to the point of not answering my phone anymore 15 times a day. I want to be able to just make an appointment for Wyatt without having to let three other people know about it who then also need paperwork faxed to them. The supply department isn’t much better either. They send me the wrong syringes when they first delivered supplies but because I can’t reorder until October, they argued with me about switching them out. They were also supposed to give me a template of all the supplies with need with the order numbers and prices. I have yet to receive that template so I guess I’ll make my own. And we’re still waiting on our CO2 monitor even though it has been approved for purchase by our insurance weeks ago. But since the nursing company doesn’t carry them, they had to order one. As long as it’s been, it seems like they’re building one… Sorry, had to vent a little.

Fired the night nurse!

September 19, 2011

It’s 2am and I just fired our night nurse. I’m so sick to my stomach right now and my blood pressure is through the roof. Last night my husband went to bed last and specifically told her to leave the door cracked open. (I had told her that previously also). We have glass French doors to Wyatt’s room which allows us to see his crib from the living room and we can also see halfway into his room from upstairs. When I wake up in the middle of the night, I always look down to check on things. I caught our night nurse sleeping in Wyatt’s room with the door shut! She was on the rocking chair, covered in her own blanket, her feet propped up and her head bend over to the left leaning on her shoulder. I was furious and started shaking. She jumped up when I came in the room. Wyatt was sleeping and if it wasn’t for me not wanting to wake him up, she would have gotten it from me. I kept it together though (for Wyatt’s sake only) and told her to leave. She actually had the guts to tell me “I wasn’t sleeping. I was just taking a break and putting my feet up. Please give me a chance.” Are you serious? I saw her and her facial expression said it all, she was lying. I don’t have to see the face to know that she was sleeping. Body language says it all. I was furious and shaking. It took everything out of me not to yell at her. I told her I could not talk to her and she needed to leave right now. She kept on trying to reason with me and I just had to turn my back to her and look at Wyatt. You want another chance? Why, because luckily nothing went wrong while you were snoozing off?  The possibilities of what could have gone wrong, it makes me nauseous just to think about it. He could have moved and his trach could have come out enough to cause a large air leak but not large enough to set off any alarms on the vent and then the breaths he is getting wouldn’t be enough. His body doesn’t physically respond to low oxygenation and/or high co2. It’s not like he would get restless and wake up or start breathing more on his own while sleeping to compensate. Or what if he would have woken up at any time and started crying silently which could easily turn into a breath holding episode. The alarms wouldn’t go off until he’s already blue… I’m so mad at myself for trusting anyone with his care. This garbage makes me want to get a second crib and have him sleep in our bedroom upstairs at night. There are no taking chances, his life depends on it.