Friday, September 13, 2013

No news is good news

No news is good news here. While Wyatt still has the remains of this lingering cold, it doesn’t really seem to bother him much aside from being a bit more sleepy. Everyone else in this family thankfully has finally kicked this bug to the curb.

One thing that is worth mentioning though, especially to the families out there using Keppra, is that we (once again) decided to stop using it. We left the hospital with full intentions to follow through on the twice a day 2.5mL dose at least until we do another EEG in about 6 months. After all, we had no way of knowing whether the Keppra was what actually stopped those silent seizures or whether getting over the trach infection itself was what made that EEG activity stop. From the time we were discharged on September 3rd until that following Sunday September 8th we were giving him his dose almost on the dot at 8am and 8pm. We did noticed that Wyatt was really irritable and just not his happy usual self but brushed it off to being the effects of the cold. In retrospect, we should have picked up on it right then that something different was going on because he has never acted that cranky with any of the colds he had previously. Then on that Sunday he was actually so cranky that he threw several back to back breath holding/passing out/blue spell episodes that we ended up having to give him Ativan to make him stop and go to sleep. That was a major red flag because we have not gone to that extreme in over 6 months. Still, we didn’t realize what was causing him to be so cranky until the following day. On Monday September 9th I was so busy with all four kids that I didn’t realize until after bedtime that night that I had totally forgotten to give him any Keppra that day. Ironically, he was happy as can be all day. That’s when the light bulb effect happened and I was curious. He still had the cold so that variable couldn’t be considered as the cause of his crankiness anymore. The only thing that had changed was that he no longer had Keppra in his system. Damn, we should have known and went with our gut feeling in the first place when the suggestion was made to try him on this medication again. This was exactly what happened when we first tried Keppra with him over a year ago. He doesn’t tolerate having any loss of control when he’s drowsy. That’s one of the side effects of this medication and that’s what makes him have increased breath holding episodes. Just to be sure, we went without the medication the next day and the same thing happened. We had our happy go lucky 2 year old kid back who was unstoppable running around all over the place. So once again, we had to conclude that while the intention of medication to reduce his breath holding and therefore seizures was good, it ultimately contributed to more episodes and therefore an increased risk of seizures and we have to say no.

Thursday, September 5, 2013

Finally home and almost back to normal

I am having a hard time thinking straight since I now have the full blown cold that has been lingering and making rounds in this house since the beginning of school, back on August 19th. So forgive me if I may miss important facts or simply sound a little out of it.

After Monday’s battle of once again stopping doctors from experimenting on our son trying to fix his breath holding episodes, which we all know cannot be fixed, things finally took a turn for the better by Monday afternoon. We insisted that instead of yet another miserable attempt of holding the kid down to place an IV line to give the second dose of antibiotics, we went with an IM (intra-muscular) injection instead so that we had the best chance at preventing another breath holding event. With Wyatt in our lap and one nurse with a needle in hand on each side, and another person standing in front of him playing Signing Time on the laptop, it was a quick one, two, three, poke, and done. He cried but didn’t hold his breath and just gave a mean face when all was said and done. Neurology was pleased that there was no more seizure activity visible on the EEG but wanted to keep it running to now get a good baseline since Wyatt was starting to act like himself again. Although we were second guessing that approach, we ended up agreeing, under the condition that “if it happens to come off then it stays off”, just to have a good comparison of sick vs. normal crazy Wyatt self. However, once Wyatt totally returned to his normal self and started itching his head, we noticed skin irritation underneath several of the leads. The nurse of course had to first tell the ICU doctor before she could do anything about it. Well, not us, we don’t need a doctor’s order to make decisions so that thing came off before they even had time to think about it and then we were mad at ourselves for pushing the envelope when we instinctively should have known better than to leave that stupid EEG on that long. Well, the blisters will heal but it’s not pretty. Tuesday morning Neurology came in for another chat and seemed a bit more at ease. Wyatt being back to his crazy two year old self, he performed well when asked to show off his developmental skills which are all on task. The Neurologist then said he had spoken with another neurologist up in Chicago who is familiar with the EEGs done on their CCHS patients and she reassured him that it was a normal CCHS thing and as scary as the data and images look, they are just part of the deal. While he still stated his curiosity about wanting to do an arterial blood pressure, he also allowed for a good discussion and accepted our viewpoint. In our book, that’s what makes a good doctor whom we can work with. One who is willing to research and learn about CCHS but also accepts it when we step on the brakes. So the plan is to just do a follow-up appointment with Neurology in 2-3 weeks so that he has time to review Wyatt’s record regarding old EEGs and MRIs and we can then discuss when to move forward with a repeat MRI. Since Wyatt does have an underlying trach infection at this time, we cannot be sure whether the seizure activity stopped because of the start of antibiotics or because of the seizure medication Keppra. Therefore, the plan is to continue the Keppra daily until we do a repeat EEG in about 6 months. Upon news of the second blood work coming back negative on Tuesday, the ICU doctor also concluded that the first positive blood result was a false positive and contaminated and therefore, we were ok to discharge on Tuesday afternoon. In the end, all we know is that this cold that has been lingering in our family for a few weeks now progressed to an infection in Wyatt’s trach, which in turn raised his body temperature to over 99F (for CCHS that’s comparable to a high fever), and it is assumed that the combination of these factors then made Wyatt more susceptible to seizures. Whether or not he would have had the long seizure on Friday without his self-induced breath holding episode, no one knows. But we do know that he has more of those episodes when he is not feeling well. As usual, we dealt with the difficulties at hand and left the hospital without precise answers. Such is the life of CCHS. Once we got back home, it was nothing short of controlled chaos. Wyatt was bouncing off the walls happy to be home and so were his brothers, while Mommy and Daddy’s brains felt fried and we couldn’t form simple sentences. The adrenaline had definitely worn off and rest of that day is kind of a blur. All I clearly remember is that putting Wyatt to bed that night, still with the drama of last Friday in mind and knowing that he almost always throws a breath holding episode in protest when it’s bedtime, that night was the most nerve-wrecking breath holding episode ever. The anticipation of whether or not a seizure would follow made me hold my breath. Thankfully nothing followed and we all got some much needed sleep. We woke up Wednesday morning just hoping for an uneventful, boring day just to catch up and to let our brains recharge. Instead, that lingering cold was throwing punches for Calvin and Mommy, Wyatt still had diarrhea from the antibiotics and probably partially because of this bug that’s going around, and the two older boys had to catch up on school work from last Friday and Tuesday, plus what was scheduled for Wednesday – they’re doing virtual schooling. While it all seemed very hectic and overwhelming at times, that routine stress was far easier to manage than the hospital stress.

Since today is Thursday, I think, I am happy to report that we are all alive and for the most part well. So cheers to this f… cold leaving this house by the end of this weekend.

Monday, September 2, 2013

Here we go again

My timing on the last blog post must have been some sort of premonition. As with every hospitalization, there always seems to come a point when doctors stray away from the original reason of the admission, this time due to a blood and trach infection, to a sudden interest in Wyatt’s breath holding abilities. And then from thereon out it always turns into a snowball effect that brings out the most stubborn scientists in even the best doctors. Don’t get me wrong, I am scientifically minded also and I wish there were a concrete answer and a set treatment plan for Wyatt’s breath holding episodes because those are the most difficult part to deal with daily. And it certainly tends to start out well when a new doctor joints the team of fascinated spectators of the Wyatt Olympic Breath Holding Event. But when you stare at data long enough it can get the best of you, suck you right into the narrow medical analysis mode, and you fail to see the patient side of things. Basically what happened is this: The EGG showed what we, as his parents, already knew. There are no signs that anything medical is causing Wyatt to hold his breath. Once he starts the breath holding, his heart rate slightly starts to increase (opposite of what would be expected in a person with a normal autonomic nervous system response) and his EEG waves start to become more erratic while his oxygen saturations drop and he stiffens up and turns blue. Once he actually passes out and relaxes, that’s when his heart rate drops for a few seconds before climbing back up, his oxygen saturations climb back into the normal range also but his EEG waves actually give a near flat line while he comes back to himself and opens his eyes. The near flat presentations of the EEG waves for those 15-25 seconds while Wyatt wakes back up out of the breath holding episode is what set off major alarms in the mind of the new Neurologist of course. Then that once again started the conversation of the possible risks of brain damage with each episode and the need to investigate the sequence of events further to be able to medicate appropriately. Oh boy did that open a can of worms again that I am so tired of discussing. What was unclear in the EEG is Wyatt’s blood pressure response during such an event. Therefore, the scientists came out and suggested to go ahead with a procedure to check Wyatt’s arterial blood pressure. To do so, he would first need to be sedated to place such a device and then Wyatt would need to have another breath holding event to get any real data. Let’s pause here for a second.  If we’re so worried about the potential damage to be done by his breath holding and passing out, why are we suggesting tests that require us to make him mad enough to cause him to hold his breath? Are we the only ones who have a problem with that contradicting approach? So the good doctor’s reasoning, while well intentioned, is that even if we can’t prevent the breath holding, maybe we can gather enough data to map out the sequence of events that happen as a side effect of the breath holding (heart rate climbing, falling, then climbing plus the unknown blood pressure response and near flat EEG waves), and then maybe we can give a daily maintenance medication to at least minimize these side effects. Again, so we want to intentionally cause more episodes, so that we may or may not get a better understanding of the potential risks, by continuing a bunch of tests that ultimately increase the risk of long term consequences by intentionally causing what is supposed to be avoided? Aside from feeding into the good doctor’s curiosity, I can’t see a good reason to turn my child into a guinea pig. As with every new doctor that joins team Wyatt, we have once again reached the point of trying to diagnose and cure his breath holding episodes. Let’s pause here again. Just as a reminder, the reason Wyatt had an episode on Friday that started this whole mess was that I told him to finish the food in his mouth first before he could have another bite. That’s an intentionally behavior, a two year old’s temper tantrum. But just for giggles, let’s hypothetically go with the idea of wanting to stop his episodes altogether because of the risk factors involved. There would be two ways to go about it. One, Wyatt rules and we always give in to everything he wants when he wants it and how he wants just so we don’t tick him off. Or our second option is to give him daily medication that keeps him drugged up enough to not care about anything which then also means he wouldn’t be able to function properly, progress developmentally or learn how to deal with life’s frustrations. Given these two options, I’d rather acknowledge the risks but raise a child who’s mind is not numb from daily medication so that he has a fair shot at developmentally staying on track and learning that life sometimes just simply sucks and you don’t always get it your way. So we once again sounded like a broken record and made it clear that we weren’t in the hospital right now to find a cure or to gather data. We were there to treat the acute illness and nothing more. So sorry doctors but you may not be the superheroes that fly in and fix everything because the thing you are trying to fix isn’t fixable. We choose to accept Wyatt for who he is even with all his brain farts as I call them and any potential future challenges, and we choose not to run every imaginable precautionary test simply out of fear of the unknown.
So I guess this is our imaginary line that we are not willing to cross.

Where is your line?

As I am sitting here in this intensive care hospital room and take a look around, it all seems like a scene from the series ER. I see a two year old boy lying in a crib who is mostly unfazed by anything going on around him, who is disinterested in eating or drinking, has 20 wires hooked up to his head all bundled up into a neat head bandage leading to a big computer screen and camera that are recording his every brain wave and movement.  Then there is another set of leads hooked up to different parts of his body and a different monitor continuously checking all his vital signs. And then of course, there is this big blue box standing next to the crib with a bunch of overwhelming ever-changing numbers and tubes attached that lead directly to that boy’s trach making it possible for him to breathe. There are various other medical supplies and emergency equipment set up around the crib and various people in multicolored scrubs keep going in and out of the room writing down numbers, checking on the many wires, administering medication, and throwing out educated guesses trying to analyze the problem at hand with fancy medical terminology. This is the kind of stuff that most parents worst nightmares are made of. For us, this is the reality we have been living with for over two years now. Nothing could have ever prepared us for this and never will we be completely prepared for what might be ahead. Yet on the good days, you try your hardest to enjoy the calm waters. And just when you think you have reached some sort of a comfort level and routine, something else knocks you right back down. After two years, you shouldn’t be surprised by this sudden change of events anymore but somehow it still catches you off guard.

I have to let some thoughts out of my head right now that will raise eyebrows, so be forewarned.

Every medical situation is different and even among patients with the same disorder, there are a lot of variables that can make for quite a list of possible presentations and therefore management approaches. When you hit bottom due to a medical complication and you think you can’t take anymore, it is human nature to start to compare. In the ICU you may look around and wonder what other patients were admitted for and whether, in your mind, that situation would be easier or harder to deal with. In all fairness, this mental assessment is totally subjective as your opinion of easier or harder is solely based on your own personal experiences and you cannot possible presume to know what it is like to live in someone else’s shoes. Still, comparisons have a strange comforting effect. Likewise, they can also make you imagine worst case scenarios, again very subjective to your own imagination and experience. Whenever Wyatt hits a challenge that requires hospitalization, I always run into this wall of asking myself where the line is. My beliefs and expectations of life have been challenged on so many occasions, it is hard to distinguish which ones are scientifically based and which are emotionally driven. I recently read a blog post that examined the difference between the pro life activists and the true meaning of pro life compared to the socially accepted definition of only including issues related to abortion laws. It was fascinating to me that the writer pointed out that there is much attention given to the seemingly never-ending discussion over the value of the life of an unborn child, yet hardly ever is there mention of the value of life of a child born with a physical or mental disability. That blog post questions everyone’s subjective stand on the overall value of life, or quality of life as some may call it. So where does this fit into my never-ending struggle to redefine my beliefs? Well, it’s fascinating food for thought but doesn’t help the dilemma. As a scientifically minded person, I usually take the stand of not messing with nature whenever possible. I feel that medical advances and technology are a double edged sword. Survival of the fittest is a principle I strongly belief in. I believe that medical technology and advances get in the way of that principle and the overwhelming human population and all the challenges that come with it are the consequence. With that in mind however, I also realize that medical technology and advances are based on not only scientific curiosity but primarily driven by some form of emotional attachment. I often ask myself, knowing what I know now two years into having a life support dependent son, would I be(true) pro life? If I answer this question from an emotional standpoint, the answer would be a clear yes. With the right support system it is certainly possible to lead a meaningful and fulfilling life despite the challenges. However, if I didn’t have the emotional attachment due to the person I am referring to being my own son, I would most definitely advice against such a challenging and stressful life. In fact, just to make it clear how deeply rooting this belief is, if I was the one on life support depending on other people to take care of me, I would not want to live like that and I would seek legal action to establish my right to choose.  So that then begs the question of why as humans we tend to question our own beliefs when it comes to the lives of our children? Are we truly acting in their best interest by keeping them alive? Should we embrace medical advances and technology at least long enough to eventually let them choose for themselves what they consider a life worth living and true quality of life? Or are we just selfish, unable to let go of the person who we have become emotionally invested in, unable to bare the thought of letting go? Where is the line? As hard as it is to answer any of these questions clearly, what are we to do when the next hurdle requires even more medical intervention and possible technology? When is it too much? When does the emotional attachment outweigh logical thinking to even ask the previous questions? Remember, all these questions and potential answers are all very personal and therefore highly subjective.  There is no guide book that you can buy to point you in the right direction. You can only make decisions in that moment of time as they are required to be made and only with the perceived knowledge that you have at that same instance. As human being, we will always use retrospect to doubt our own decisions and if we’re smart enough we will realize that most of the time, there are no clear cut right or wrong answers. But what is one to do when that decision could be the difference between life and death? Is ventilator dependency crossing the line for you? What about mental retardation? How about cancer? What statistical survival rate subjectively justifies the side effects of cancer treatments? What if someone you know had been in a car accident and hasn’t woken up out of a coma in 3 weeks? How long would you wait before you can emotionally justify pulling the plug or would you cling on to the news stories of miraculous awakening and if so, for how long? What about kids who were paralyzed from the neck down unable to physically do any daily tasks by themselves and requiring a ventilator to breathe? Or to keep it even simpler, how do you decide which preventative tests to do and how often?... Where is the line for you?

Most people don’t give these kinds of questions too much thought because they are just too sad to think about and emotionally draining. And they naively assume it will never happen to them. Well, that is the kind of a mental game that living with CCHS or any other so to speak “abnormal” medical challenge brings along. Most affected families would never admit these thoughts publically yet they linger all too often and resurface whenever a new medical challenge presents itself.

Saturday, August 31, 2013

quick update

Today there are definite signs that Wyatt has some other underlying illness that may be to blame for most if not all of this whole mess. He's been lethargic all day and hasn't been wanting to eat or drink anything. For a while he was even unable to sit up and support himself. The major red flag came when he didn't even move to get blood drawn. They drew just enough blood to recheck all his levels in comparison to yesterday's readings during the long seizure. When attempting to put an IV line in to give the Keppra, he reminded everyone of his breath holding episodes - twice - so those are officially on the EEG now to see if it correlates with the intermittent silent seizures. As the day progressed things went from bad to worse. His heart rate started dipping up and down periodically from the 130s to the 80s and with the cardiac risk factors in mind, that's something to take note of. What that also tells us though is that heart rate dips are one of the Wyatt's few reliable signs that he's sick with something more than just a cold. It could be the flu; it could be a pseudomonas flare up. The flu seems more likely since he has also been running a temperature of 99.3F. In Wyatt's world anything over 98F is cause for concern but 99F are major red flags waving. So priority number one to get his temperature back down with a Tylenol/ibuprofen regiment. To avoid another IV attempt or NG tube, we are also working on syringe feeding him 50-100ml of Pediasure every couple hours. His blood sugar was down to 69 early but we convinced the staff to let us try syringe feeding first before going the more invasive and breath holding risky route. That's my mommy trick to normally get him to take medication and I was able to also give him his first dose of Keppra mixed with the Pediasure. Fingers crossed this method keeps working through the night to keep him hydrated and get some calories into him. The second priority of course it to observe if or how the Keppra is able to manage the intermittent seizure activity. At this point there is no way of knowing when he'll come back around but knowing Wyatt's history, there tend to be 2-3 downhill days before he snaps back out of it.

doubts and suspicions

I want to write this while it’s still raw so forgive me if it comes out a bit scattered or even more opinionated than usual.

I woke up this morning convinced we were still looking at the same scenario as we have been for the last 2 years: Wyatt causes his breath holding episodes when he’s uncomfortable or frustrated and if he does it long enough, seizures can follow. Well, based on what we found out today that may only be partially true. All 5 previous EEGs done in the first 1 ½ years of his life showed no seizure activity before, during or after breath holding episodes. So in theory during that time frame our understanding of the cause of his episodes seems correct. However, after yesterday’s long seizure activity (possibly related to his bad cold), the current ongoing EEG showed 15 silent seizures, meaning only visible on the EEG without physical signs, lasting 15-30 seconds each. That then begs the question, what the hell happened between all his previous tests and now? As usual, we don’t have an answer for that and can only speculate. The priority right now is to start Wyatt on Keppra, an anti-seizure medication, and continue to monitor him on the EEG to see if the Keppra is alleviating the silent seizures. If so, it is recommended for him to be discharged with a daily maintenance dose, to closely monitor for side effects of the medication and developmental implications, and then to repeat the EEG in a few months. As if that isn’t complicated enough since such observations are highly subjective and mainly would fall on us at home, it doesn’t help that he has a cold which makes it harder to distinguish between the normal red flags verses weird cold symptoms for a ventilator dependent child. The Ativan given yesterday morning to stop the long seizure in the ER should have worn off by now and he hasn’t been given any other medication since then. However, he is very lethargic, more so than he would normally be if we were at home and he was fighting a cold. Yesterday’s blood work, as well as today’s didn’t show anything out of range to blame it on. Since he doesn’t run a fever, another lovely side effect of having an autonomic nervous system disorder, we can’t use that as a guide either. So in my head, it’s either related to the exhausting day yesterday and the intermittent seizure activity or, fingers crossed I’m wrong, pseudomonas has flared up again. Either way, he’s definitely not like himself, not even in a having a cold and feeling miserable kind of way. But let’s get back to the more puzzling concern. How come all 5 previous EEGs didn’t indicate anything and now we’re having a concert of events going on? The thoughts started to creep back into our heads of what went wrong in June after Wyatt’s surgery. I didn’t write about this then because I didn’t want to freak anyone out and quite frankly, I had a hard time finding nice enough words to use. Short summary, the hospital staff in the post-op area failed to hook Wyatt back up to his ventilator for over 30 minutes while he was recovering from anesthesia. For the ventilator-dependent child I think it goes without saying that we are lucky he survived. With that in mind though, how do we know what long term effect that could have on him? Given today’s dilemma, how do we know or even address the possibility that the sudden change in EEG results only two months after that hospital error may be related? As inexcusable as that hospital error was, I am not out to point fingers now. Given the lack of any other explanation though, it is something to consider. Then I ask, how can we now scientifically pinpoint when the changes in Wyatt’s brain occurred that caused seizure activity to begin, to either confirm or deny if the hospital error is the cause? Even more important is the question of how to bring up that conversation with the hospital staff without shutting doors since that is a potential legal liability and negligence battle?

As always, more questions than answers and even more worries and hurdles to overcome.

Friday, August 30, 2013

expect the unexpected

Today was supposed to be Wyatt’s long awaited electro physiologist appointment to finally get connected with someone who can better manage the cardiac risk factors associated with CCHS (Congenital Central Hypoventilation Syndrome). Well, as we were getting ready in the morning to head out the door, Wyatt, in true Wyatt fashion, decided he had other plans. Making his parents age by another ten years apparently was on the memo he forgot to send us. Mr. Crankypants gave a typical two year old response to something he didn’t like by throwing a tantrum, which in his case still means he held his breath until he turned blue and passed out. Sadly in our family that has become such a daily routine that we don’t even think twice about and so we went through the motions of cranking up the O2 and watching the volumes on his ventilator as he started to recover. As his skin turned pink again, he then started seizing. He’s done that occasionally when he managed to hold his breath just long enough, so it wasn’t anything too unusual. While he does his lovely breath holding spells anywhere from 1-15 times a day, seizures after the fact typically only occur maybe once a month and only last 2 minutes at the most. Well, expect the unexpected because when you throw in the factor of having a cold, things can turn ugly very fast. His seizure didn’t stop. To make matters worse, when he started his breath holding episode, he had a mouth full of food. Most of it I was able to get out right away but when he started seizing more food appeared in his mouth. Being at risk to now aspirate which would make a bad situation even worse, you just react out of instinct. With nothing handy right around me to hold his mouth open, I went for it and tried to get the last bit of food out when Wyatt happened to open up on his own. Unlucky for me, just like an alligator, as soon as he felt my finger in his mouth he clamped down hard. Thankfully, my finger is still intact with just some bruising, broken skin by the nail bed and what appears to be a cracked finger nail underneath. I screamed out of pain but at least the kid didn’t aspirate, I guess that was the priority, life over limp so to speak. 15minutes of seizure activity had already passed at that point and we had no choice but to load everyone in the car and head to the hospital. Calling the ambulance wasn’t really an option because we knew per protocol they’d have to take him off the vent during the ride and would take him to the nearest hospital where they are not equipped to handle the complexity of Wyatt’s care. With the Co2 Monitor, Pulse Oximeter and a cranked up O2 tank all hooked up, we jumped in the car. I have to mention here that our other three kids are absolutely amazing and went into full emergency mode without hesitation, helping load everything and everyone up as quickly as possible, and sadly, as if they had practiced it hundreds of times before in the last couple of years. Speeding limits were none existent driving to the hospital and not much explanation was needed to be escorted right into the trauma room at the ER. There’s just something about running in with a toddler on a vent and O2 tank that no one questions your urgency. Long story short, 1.5 hours of seizing were finally stopped after several attempts of getting a line into a stiff kid and then administering two doses of ativan which then knocked him out cold. After being moved upstairs to the PICU (Pediatric Intensive Care Unit) and a discussion with Neurology, we all came to the same conclusion that we will do yet another EEG (number 6 since birth) just to rule out an actual underlying seizure disorder by checking for residual signs and hoping to catch him during another breath holding episode sometime during the night once the Ativan wears off. However, we are all convinced that there is no seizure disorder but instead the prolonged lower levels of oxygenation during his breath holding episodes are in fact the reason for the occasional seizure activity afterward. The assumptions at this point is that today’s seizure was so intense because Wyatt has a cold and that combined with the long breath holding episode lowered his threshold for seizure activity. If this EEG confirms this hypothesis, then we will be discharged with a suppository seizure medication to be administered at home only in such instances as today. Overall, that is really the only “positive” outcome here because we have Ativan at home already for really bad days but it’s an oral medication that we cannot give him while in the middle of a seizure. A suppository would be the best option to stop a seizure and avoid another hospitalization.

In plain English what it comes down to is this. When Wyatt decides to throw a tantrum and hold his breath, turn blue and pass out, we always run the risk of today’s drama repeating itself. In other words, he’s causing his own downfall and there is nothing we can do to prevent it. I would love to say “oh poor baby, this genetic disorder is really hard on you” but what really came to my mind today was “you little shit”. Does CCHS suck? Yes, absolutely. Is it his fault or anyone else’s that he has to live with it? No, no one wishes for this, it simply is what it is. But the tantrum that started this mess today was over the simple fact that I told him he could not have another bite of food until he finished what was already in his mouth. Over that 2year olds frustration I almost got my finger tip bitten off to save his sorry ass and three other innocent kids have been traumatized once again. It was my middle finger, too. Wouldn’t that have been the icing on the freaking cake? I am so angry at him and the whole idea that no matter what genius parenting technique we come up with, it’s a no win situation. If we give in, he gets what he wants and only learns to manipulate people. If we apply tough love and let him know that he can’t always get what he wants when he wants it, then we have to do it with the thought that he might repeat today’s events completely intentional. That just simply sucks.

(And I swear if one more person at the hospital gives me the “He’s so cute.” line to try to make me feel better, I’m going to scream. There is nothing cute about a kid who has full control of everyone around him by threatening his own life if they don’t do as he demands.)
So, here's to my favorite song regarding Wyatt: Pink - True Love
"Sometimes I hate every single stupid word you say
Sometimes I wanna slap you in your whole face
There's no one quite like you
You push all my buttons down
I know life would suck without you

At the same time, I wanna hug you
I wanna wrap my hands around your neck
You're an asshole but I love you
And you make me so mad I ask myself
Why I'm still here, or where could I go
You're the only love I've ever known
But I hate you, I really hate you,
So much, I think it must be

True love, true love
It must be true love
Nothing else can break my heart like
True love, true love,
It must be true love
No one else can break my heart like you..."

Tuesday, August 6, 2013

how life changes once you have kids

When people ask how life changes once you have kids, it’s hard to come up with a good answer. No matter how detailed your explanation, the other person hasn’t experienced it yet. Therefore, it is impossible for them to truly understand.

Being 32 now with four kids ages 11, 8, 4 and 2, it’s strange looking back on how my life and my perspective on it changed over time. I am no longer trying to portray some image of myself like I did when I was single and trying to impress someone or trying to fit in. Life now is more of a “like it or leave it” approach and everything I do is in one sense or another connected to my kids needs. On the rare occasions that my husband and I get time to ourselves, we sometimes get on the topic of “What were we thinking?” No, not in the sense of what stupid things we did when we were young that we now regret, even though I realize you would probably like to read about that. No, simply on how even the best laid out life plan cannot prepare you for how you change as a person over time. Every experience, good or bad, changes you and usually you don’t realize it until much later. Who would I be if I didn’t have my first child when I was 20? What would I have done with my life if I went the traditional path of college, start a career, get married and then have kids? What would my career be? I know the “what if’s” are not practical as I cannot change the past, nor would I want to. But I do think there is value in asking these questions to learn something about yourself. So here is my retrospective view of my life so far:

In my early 20s I was out to conquer the world. I had something to proof, mainly to my parents. Nothing and no one was going to stop me and if someone told me it wasn’t possible, I’d be even more determined to prove them wrong. It was a very self-centered time during which I had no clue and no interest in what else was going on the world. Money was not an issue as long as I had food on the table, a roof over my head and clothes on my body and any job would be acceptable to ensure that much. Politics were just annoying. Protocols and expectations were meant to be followed only as much as needed but then challenged whenever possible. Having my first child in March of 2002 didn’t really change too much about my approach on life. In fact I was proud to say that I could juggle raising a child, working and going to college all at the same time. It was a challenge that I was eager to meet. When child number 2 came along in December of 2004, my goals didn’t change much at that point either but my speed of taking things on did. Life became more of a juggling act. Finding time to study became a multi-tasking job while changing diapers and throwing a meal together. Paying the bills didn’t get any easier either having to come up with daycare money for two kids. That increased financial pressure also made it harder to justify seeking a career that wouldn’t be a top paying job. But it was all I’ve ever done and luckily it was my passion, so somehow I was going to stick with it. What I didn’t realize at that time was that the struggle of putting food on the table for my family would change me in the long run. I can’t tell you how I survived of less than $15,000 a year with two kids while going to college. All I know is that I made it work and I learned to devalue materialistic things. That fear of living paycheck to paycheck again however will always be in the back of my mind. It scares me and pushes me to do more but it also holds me back from going after what I really want. I was no longer a risk taker who was out to challenge the world. From that time on I had to financially justify everything up front. It’s hard to explain to someone who has never been so dirt poor that they had to stop eating meals so they would have enough food to feed their kids. It’s a place you don’t want to be in. However, it’s also something that I am extremely proud of to have went through and come out of on my own. While my parents certainly wish they could have kept me from experiencing such hardship, I now view it as one of the best life lessons ever learned and it made me more resilient. Thankfully from that point forward life got a lot easier. In 2009, my husband and I were in a position for me to stay home with child number 3, born in April 2009, and start my own business on a part-time basis. While it wasn’t an option at that time, I wish I would have had that freedom with the older two kids when they were little. Having the ability to set my own schedule and avoid daycare altogether seemed like the perfect balance. Of course, in the moment we still got caught up with daily struggles and didn’t really appreciate that special time together as much as we should have. Giving in to the constant demands of three kids can still be overwhelming and suddenly made me want to send a thank you card to my own parents. But overall this structure to our life seemed to work best for everyone. With child number 4 on the way, the plan was to continue to do the same routine. I would stay home during the day with the kids and only work part-time on my husband’s days off. But then June 2011 came and our world would never be the same. If you’ve been reading my blog from the beginning, you already know what life has been like for us in the last two years. What I’m trying to get to here though is that child number 4 changes us forever. Having kids changes everyone. Kids bring back joy to the little things in life. They keep things honest and make you brutally aware of your own mistakes so you can become a better person. Having a medically complex child however only few people get to experience. All the things that we took for granted before were thrown in our faces and almost daily this incredibly unique child reminds us to get out of our rut and enjoy the smallest but most important things in life. I wouldn’t say, as some special needs parents do, that his diagnosis is a gift or a blessing. I strongly disagree with that because I wouldn’t wish this life on anyone. But I will say that without his diagnosis we wouldn’t have learned so much about ourselves and see the value in so many more things in life. Most people during their entire life never get to experience such personal growth in such depth as we have, and we are only in our early 30s. I am happy to say that child number 4 has brought me back to wanting to follow my dreams and to take life head on without worrying too much about the challenges ahead. I will never be able to get back to the worry free days of my early 20s and risks taken now are carefully calculated risks but I’m far from struggling to survive and closer to real happiness than ever before.
That’s how life changed for us when we had kids.

Wednesday, July 31, 2013

career options with a special needs child

I am Nicole Ott, a 2009 graduate of the UCF Bachelor degree program in Sport and Fitness. I would appreciate a few minutes of your valuable time to ask for some guidance. I have reached a point in my professional life in which I am at a loss on how to proceed.

I am not sure if you remember me from four years ago but I was the student who in her last semester pushed for early completion due to being nine months pregnant with her third child. I guess you could say I’ve always been a multi-tasker and embraced my circumstances to push forward with a deeper purpose. I distinctly remember having to write out and present short and long term career goals in one of our classes and upon graduation, I steered right towards those goals. The hands-on approach of your program, along with the detailed instruction gave me the confidence to pursue my dreams. With the support of my husband and three amazing children, I took on entrepreneurship and successfully ran my own Personal Training business in the Kissimmee/South Orlando area. Despite only working part-time hours in order to be with my family as much as possible, I still managed to appear on a radio show and contributed to a couple published fitness articles. Things were going very well and I loved every minute of it.

Life however, decided to throw a major curveball and my dreams had to come to an abrupt end. In June 2011, our fourth son was born with a rare genetic disorder which would make him lifelong dependent on a ventilator. To say that life changed in an instant would be an understatement. Without giving it a second thought, I dissolved my business and threw myself into the medical caretaker life that I would have to lead from that point forward. When not directly taking care of my son (or my other three children), my time was occupied with medical research, respiratory care studies, fighting insurance issues and medical advocacy, and learning sign language. It’s been a little over two years now since taking on this new life path. And while I am happy to report that our son is stable and acting like a typical two year old, I am personally now really struggling with the question of when, where and how to pursue my career again. Having no reasonable child care options for a medically complex child like our son, his care solely depends on my husband, my mother-in-law and mostly me. Part of me has accepted that I will not be able to work again until our son goes to Kindergarten and that even then, three years from now, his needs will still be the priority. At best, my work schedule would then have to fit his school schedule and in the fitness industry such a 7a-3p schedule is very hard to achieve. Another part of me though is the fighter who never wants to settle, who doesn’t want to wait another three years, and who wants to prove to her other kids that no matter what the circumstances, you can find a way to make your dreams come true. I have been out of the fitness industry for over two years now and I feel some sort of a disconnect. I have gone through tremendous personal change and even my entire outlook on life has changed so much that I am not sure where my original career goals fit in anymore. In a different life I have this Bachelor degree in Sport and Fitness and I have experience running my own Personal Training business but somehow that all seems just theoretical to me now. It’s like a void that hasn’t been filled for so long that I’m not sure how to get that passion for the fitness industry back. I know it’s still there somewhere in me, I just don’t know how to reach it and apply it.

My apologies for taking up so much of your valuable time. I am not even sure what it is that I am trying to accomplish here. I guess I am just reaching out from one professional to another hoping for some guidance. Maybe, despite of or because of my circumstances, there are opportunities out there that I haven’t considered, or maybe a unique idea could come out of this that could lead to a new outline of short and long term goals.

Thank you for taking the time to read this email and please know, your program not only opens doors for your students but also opens their minds to the many opportunities that life has to offer.

In gratitude,

Nicole Ott

Thursday, March 7, 2013

New Year, New Outlook

Who would have thought a year ago, heck even 6 months ago, that we could stop focusing on Wyatt's needs as our primary daily worry.

The hiatal hernia repair surgery in November of 2012 transformed this kid in such a positive way, I sometimes have to take a second look to make sure the hospital staff didn't accidently give us back someone else's child. Recovery was drawn out and argumentative as usual and we had some pump feeding issues for a little while post-op but it was because of these same pump feeding issues, that we were so sick and tired of, that we dared to take a chance. Every doctor we had ever met was always so concerned that Wyatt would lose weight, they didn't even want to try weaning him off the pump feeding, always stating that his body already uses so much energy trying to breathe. If they knew more about CCHS they'd know that his body, well specifically his brain, really could care less about breathing ;) Knowing our son's personality though of readily taking the easy way out or playing the sympathy card when given the chance, we knew that if we stayed on this path of scheduled pump feedings he's never learn to eat on his own. So we first switched him to only a continuous overnight feed making sure he got all his daily calories he needed, and then allowed him to eat whatever he wanted during the day. Based on how much he ate during the day, we'd lower his pump feeding volumes at night. Wyatt did ok with that method but still had days where he was simply too lazy to even try to eat and since he had all his calories over the course of the night, he wasn’t hungry for breakfast and he often had stomach pains from the pressure of the pump feeds. And frankly, hooking up a pump feed every night and making sure it doesn't come undone just to leave a big mess all over the place was getting old very fast. So we decided, what the heck, we'll try it for three days without any pump feedings and see how he does. Damn I wish we would have had the guts to do this a long time ago. By day two he had discovered his love for food and all we had to do was encourage him to drink sips of water between bites. That was the end of the pump feeds. Ironically it took us blindly giving it a shot against doctor’s recommendations and simply trusting in Wyatt’s abilities to realize he didn’t have feeding issues in the first place, he has saliva production issues that caused him to get frustrated while eating. He doesn’t produce hardly any saliva and therefore food gets stuck on the roof of his mouth easily. No doctor was aware of that or had even considered that to be a possibility. It was always assumed that CCHS also meant oral motor skills delays. We always knew his skills were there but couldn’t figure out why he wasn’t progressing in the oral feeding department. A few sips of water in between bites, problem solved! That’s what I hate about having a medically complex child. You start to over think everything and treat everything as a medical issue first before using your common sense. Well, lesson learned – simplify! Not only did the surgery lead to him now eating independently (NONSTOP), Wyatt is now also SLEEP-VENTILATED ONLY!!! I never thought we’d get to this point but again, it took having the guts to trust his abilities! For those of you who do not have a child on a ventilator, I’m sorry, there is no way I can explain to you what a difference that makes. Sure, we still have to take his equipment with us everywhere we go and we are still too nervous to try to let him sprint while driving in the car but we can pick him up and go in our backyard or upstairs now and leave his equipment on the chart. Since being able to come off his leash as I call it, he’s made huge progress crawling like he’s racing someone, crawling up the stairs, and standing up and walking assisted. He knows his limitations when he’s hooked up to the vent and is now able to take full advantage of his freedom when he’s sprinting. He still throws his tantrums and passes out so we can’t leave him out of sight but him being mostly independent of the vent during awake hours is a huge relief on all of us. And now that he’s vocalizing more making up his own language with the weirdest sounds, you can often audibly tell where he is at which is also something that wasn’t possible before. I swear he can call whales and sea lions, imitates donkeys even though he’s never met one, and plays like a dog by still picking up balls with his mouth sometimes. And the eye contact he gives you is so hard to resist. He’s a character, always ready to entertain and he so knows how to wrap people around his little finger… Last year we were not able to enjoy these moments because he always had some sort of medical issue and threw so many blue spells we could never relax. Today, he still throws 1-5 blue spells a day but we’ve learned to “ignore” them and only observe from a distance as they are now mostly attention getters and when hooked up to the vent, he usually recovers on his own. He’s learned to accept car rides as normal routine and rarely throws a tantrum in the car anymore which has allows us all more freedom and we are comfortable enough to not have an adult sit next to him in the backseat anymore. Heck, we’ve gotten so in tuned with his routine and cues that we don’t even hook up the Pulse Ox or CO2 Monitor to him anymore unless he’s sleeping or seems a little off. Overall, 2013 so far has started to be much more relaxing than 2011 or 2012. Let’s keep our fingers crossed that it will stay that way, at least for the most part.