Friday, December 18, 2015

Goodbye meds!

We had a cardiology checkup today, and guess who is getting weaned off of medications?

JAMES!

One med going away, another one in the works. He's wearing a monitor for the next 24 hours to follow his heart rate. Depending on the results, a second med - the one keeping his heart rate in check following that scary August atrial flutter episode - will also go away.

I've told him the monitor is his "pocket computer" so he doesn't take it off.

Merry Christmas from a happy and overall pretty healthy little superhero!


Thursday, December 3, 2015

School days

James is in school now, and starting to actually be happy about it! It took awhile to get over being angry every morning, but he is back to his habit from last year of looking forward to the bus and chattering in the morning about "the yellow bus" and "James is going on a bus".

He has done some artwork lately that I'll share soon - he is starting to draw recognizable images. The bus is, of course, a favorite subject.

He is finally approved to stop the no-fat recovery diet, so we've been gradually working him back into a regular diet. We'll see the cardiologist again in December for hopefully a full back-to-normal clearance.

Also... no throwing up in over a month! Hooray!


Tuesday, October 6, 2015

Our boy in recovery

It's so wonderful to be home!

We've been so busy catching up on sleep and chores, re-establishing routines, and helping James adjust that we haven't gotten around to posting since James' discharge. We've had a fantastic and fairly normal week and a half, although James is in a recovery period where a lot of medications and continued monitoring is necessary.

Getting the chylothorax leak to stop was a major step, but now it has to stay stopped and gradually heal. This means a minimum of 6 weeks on a very strict no-fat diet, hard to do when the patient is a little boy who barely eats as it is. He has a prescription for a medical-grade powdered calorie drink so he can get some of the calories and nutrition he needs without any fat. It's still not enough to meet his nutritional needs, so we have weekly checkups and blood tests to make sure his vitamin levels aren't dropping too low. Keeping him healthy means carefully balancing a no-fat diet with healthy nutrition.

He also has a hefty mix of drugs to take each day. Fortunately, James is a champ at taking his medications. We spend about an hour and a half each morning, then the same again in the evening, administering meds and spacing them apart as needed.

He's had regular checkups with his 3 primary doctors (cardiologist, pediatrician, and GI) and they've all been huge successes. His doctors love how rosy he looks! His X-ray is still perfect, his chest is clear, his lungs sound good, and his blood work has shown improvement. He is supposed to have physical therapy and occupational therapy, but the home health service basically wasted a lot of our time and hasn't provided any service yet (though they've managed to make me thoroughly angry).

James is rebounding all on his own though. He walks and climbs stairs and does most everything he did pre-surgery. He walks a bit stiffly, but he hasn't even been home 2 weeks... we are positive he'll continue to progress. He wakes up each day and asks for solid food: bagels, pizza, broccoli, cereal, hummus, macaroni. Pre-surgery, he ate 90% liquids only, and now he chows through solids! It's been an exercise for us to figure out how to make all these foods fat-free, but we are rising to the challenge.




Thursday, September 24, 2015

HOME!

Maybe there's a confluence of beautiful things happening with the Pope coming to town? Or maybe there's something magical about 72 days?

It'll be a busy evening getting settled and unpacked and caught up with the home medication schedule (a hefty set of stuff)...

...but James is home!

We scooted out just as barriers and police officers were starting to fill the streets, and had an easy commute headed away from the Pope visit. James did great - climbed the courtyard steps on his own and walked around his room pulling out favorite toys. He has been a little powerhouse, constantly in motion, rediscovering his favorite places and things and getting into snacks that he can't have for a long time still. His room was all ready for him after this long 10 weeks and 2 days away!

More to come but for now, we are kicking back with our kiddos and enjoying being home together, at last :)




Monday, September 21, 2015

Tube Freeeeee!

The good news:
The second tube came out yesterday!

............

The not-so-good news:
It was taken out mainly because it was starting to come loose anyways (they only last so long). Docs still weren't quite sure he was ready, and today has shown that he probably wasn't. His Xray shows that the fluid effusions are starting to collect inside again.

The effusions are still relatively minor, so he's on increased diuretics in hopes they will dry him out and he can pee it all off, and we can stop the leaking again without needing a new chest tube inserted.

No promises.

But, walking around with an unencumbered and tube-free James for the first time in 10 weeks was a pretty awesome time! We did some artwork, and played some music in the playroom, and took his wagon outside. He saw a black car and made a beeline for the car door... alas, not our car, and not his time to go home.






Saturday, September 19, 2015

ready set go!

And one tube is out!

(stop sign)
Right tube is staying in another day.

Hopefully tomorrow we'll speed up again and chest tube #2 will come out.

I wonder what James will be thinking when he finally tries to walk again with no tubes dragging behind him?

Thursday, September 17, 2015

For the First Time in Forever

We brought James to the hospital on Tuesday, July 14th.

It was less than a week before we knew we'd be here longer than expected, and just under two weeks before we knew we'd be here indefinitely. It was just under a month before the idea of going home for recovery was completely obliterated from our thoughts, and just over a month before hospital folks were able to be comfortable treating James like a whole person and child instead of an urgent care case (it is the ICU, after all). Finally, it was just over two months, what seemed like the first time in forever, before doctors uttered our favorite four-letter word: home.

Tuesday, September 15th, after noticing James' pleural output (for reasons still unclear) had dwindled to almost nothing, the ICU team finally uttered a mention of sending James home.

Today, Thursday, September 17th, a plan is in place to bring James home within a week.

As always, no promises, but to have a plan to bring James home at all is amazing. Especially since as of last weekend - all the way up to a mere 5 days ago! - the plan was another surgery, a heart surgery which was to have been fairly massive and risky and entail permanent repercussions and would have required transfer to another hospital because even NYP/Cornell didn't feel up to the task...!

Then all of a sudden, James' body decided it was ready to heal. His fluid output has remained low for about 4 days, indicating his chylothorax is drying up, so tomorrow the team has plans to remove one of his two chest tubes. If his output stays low for another day and his chest x-ray looks clear, they'll take the other tube out Saturday. If things still remain clear Sunday, he'll come home Monday or Tuesday.

That's a lot of ifs to send this boy home, but mommy, doctors, nurses, and I are all confident James will be home soon.

Keep your fingers crossed, and send your prayers, happy thoughts, and homeward bound wishes.




Sunday, September 13, 2015

Kiddos growing up

We've been in the ICU for 2 months, and that's a serious amount of time in the life of a little one!

Elise has grown from 6 months old to 8 months old. She started solid food and formula. She learned to crawl, sit up, stand, and cruise. She began babbling and dancing and playing peek-a-boo. She fits in the toddler stroller now, loves music, and loves the swings. She hates being confined so we have to coax her to stay in the baby rocker and playpen long enough to let us do chores. She picks up snacks with her fingers to feed herself, and will be walking within days... she's almost there. She's grown in height and even more around the middle, and she's got the cutest chunky legs.

James has also grown, in his own ways. His feet are gigantic; he just started wearing new shoes this summer and he'll need new ones again this fall. His t-shirts are still tight, even though his swelling has pretty much gone down by now: he's simply bigger. Two months is plenty of time for him to continue growing into his preschooler body, with IV nutrition pushing him along.

I hope he's home before he grows out of his entire wardrobe...!




Tuesday, September 8, 2015

Favorite Sayings

My dad, rest his merry soul, is an unknown legend in the modern world. In the 20th Century, a fan of classics, he re-appropriated and resolved centuries-old debates, he reminded us of the importance of selective geography, and he even invented Latin words and phrases. And he did all of these things through simple, everyday sayings and re-minted coined phrases.

He would often spout these nonsensical Latinate sayings and other quotidien quotes in response to the outlandish and childishly (and naturally) silly requests and behavior from his eight children and loving wife (and occasionally members of the general populous).

Though he would never tell us what these words meant, and I never learned latin (or greek) well enough to figure them out at the time, it was clear he expected we would learn from his eternal wisdom and expertise, glean something of the nature of the universe that had yet to be revealed, or maybe just take a moment to reflect on how our demands and actions must seem to the rest of the world.

Today, as James continues to recover from another of his myriad procedures, docs line him up for another, and family and friends continue to shower us with support and happy thoughts, I am reminded of three of my dad's favorite sayings:

1. Honesty is the best policy. Clearly, adults need to remember this saying more than children, though we hope our kids learn this adage early so they are less likely to become the kind of adults that need to remember the importance of true honesty. Kids are more prone to trivial lies, the kind that make us smile and laugh and say "awww, that's so cute," but adults can take that same trivial lie and turn it into something much more complicated.

In the last few weeks, all of our doctors told us cute little white lies about some not-so-common things: chylothorax is common; octreotide and/or TPN and a low fat diet commonly have a positive, sometimes curative, impact; thoracic duct ligation is a common step when TPN doesn't work. The trivial part: yes, these things are common. The complicated part, that none of our doctors wanted to say, but all were yelling implicitly: James and his progress so far is not common. That our doctors wouldn't come out and say this caused much confusion, because they were all trying to say things that sounded better, instead of simply telling the honest truth: James is the first patient anyone at NYP has seen after a Fontan to go this long with chylothorax.

Is honesty actually the best policy? Which would you prefer if it was you or your child?


2. Going to Buffalo for pencils. I can see how someone not from upstate NY might not get this, except that everyone knows the unfortunate Buffalo Bills, and I bet no one would want to go to Buffalo, a grey, steel-belt town on the Canadian border, just to get something you can pick up at any five and dime (aka, corner store). To keep this one simple, going to Buffalo for pencils is the opposite of keeping it simple. It is the accidental (or accidentally intentional) process of making something simple insanely complicated.

James has, by all medical reckoning, an insanely simple, albeit amazingly annoying, medical condition. Chylothorax pleural effusions are not complicated: high pressure causes a vessel to pop, and it leaks. The trick is, of course, how to stop an oil (aka, fat) leak. But even that isn't that complicated, it's just very difficult to stop (think Deepwater Horizon oil spill).

Our medical team does amazing things, and is capable of doing even more amazing things than I hope we ever get to see. I am extremely happy and grateful for what they have been able to do to keep James smiling still to this day, as well as their willingness to include mommy, James, Elise, and me in their decisions and decision-making process.

But for some reason, many of us involved in this epoch of James' life have decided that going to Buffalo for pencils is just the right plan.

Maybe the extra time for reflection and meditation while on the extended journey for something simple is just the right thing. Maybe not.

You decide.


3. Fortis stomis screatus scrat. This one's my favorite, but also the most strange of the bunch. Dad would say this supafast, “fortistomiscreatuscrat,” and for years and years I had absolutely no idea what it meant. Then I learned some Latin: 

Fortis (adj.): strength
Stomis (n.): voice/music/flute (also, Greek: stomach)
Screatus (n.): to clear the throat; throat-clearer
Scrat (?.): This one doesn’t have a Latin equivalent, though there are many words this could come from or be a part of, and it seems to be of Greek origin used in Latin. For example, -(-)crat(-), a common suffix to many words, usually in the form of “cratus” or “crate” or “cratis.”

The ones that seems to fit best with the other terms are:
Consecratus (v.): to consecrate, to curse, to vow.
Sacratus (adj.): hallowed, holy, sacred   (also, Greek as a suffix: to govern, to rule, authority, power, etc.)

So, in other words, for all things holy and true and honorable, clear the throat, use your voice, and say whatchoo gotta say loud and clear and with force, cuz otherwise no one will listen.


That was a lot to read, wasn't it? This might be one of my longer posts in a while, if not ever on this blog. I do have a purpose here, I promise.

I'm going to be honest, because I was told this is the best policy...

To all of you reading and following, we appreciate your care and concern, and we thank you deeply for all of the support you've been providing. For those of you who have been able to take time out of your days and lives to come visit with us, having someone with James all the time, to keep him company and help keep his spirits up, is crucial, so we thank you immensely.

However, when it comes to making medical decisions and determining his future care, while we appreciate the input from family, friends, and doctors, we can and will handle it on our own. We have been anticipating this, in as far as what is happening can be anticipated, for almost 4 years. We've done our homework, we continue to ask questions and do research where new situations arise, and we are constantly evaluating old information, even as it becomes less meaningful and helpful. 

It is kind to offer an idea or contact, but please stop there: we will follow up as we feel appropriate and necessary. Please do not try to make decisions for us, insert yourselves into our decisions, or ask to become a part of the medical and logistical decision-making process. And please do not ask about things beyond what we have shared.

James, and all of our family, needs your presence, your love, your caring, your support. Anything beyond that is... going to Buffalo for pencils.

Fortistomiscreatuscrat.

Monday, September 7, 2015

James having fun

Our boy has had some cranky days lately, but he's starting to show his smiles again. He has one particular iPad app that he LOVES and that makes him laugh. Several times this week, he's been playing this app while his doctors have gathered around him for morning rounds (which he normally hates) and he has astonished them all by breaking out in giggles.

The playroom in the pediatric ward has a fancy kitchen with lots of accessories, and our little guy has been enjoying cooking and grocery shopping. He will eat anything... as long as it's plastic and only pretend...

The duct ligation hasn't made much impact, so here we are with another week's update devoid of medical news. James is on track to be the longest Fontan-chylothorax patient they've had here (depending on who you ask).

His preschool started last week, but he obviously didn't attend. Instead, he should be starting the pediatric 6th floor preschool here in the hospital. Tomorrow is the first day :)


Tuesday, September 1, 2015

another OR trip checked off

It's been a bit of a whirlwind lately so we have some catch up to do on the blog. But for now, just the highlights: James had a thoracic duct ligation (surgery) this morning. It was performed by his heart surgeon, but this is not heart surgery, and was much lower risk than his past surgeries. They went in through his right side, so he has a new scar to add to the mix... our swashbuckling superhero.

He is back in his room now, on morphine, and doing fine. It'll take a few days at least, if not longer, to see if this is helping reduce his fluid flow or not. His chest tubes are still in, and the hope is that in the next couple of weeks he can heal on his own - the duct ligation ideally acting as a shortcut to help the fluid stop a little faster.

No walking or trips to the playroom until this new scar heals a bit :( but a few days should see him back on his feet!

Saturday, August 29, 2015

Back into the fray

It looks like surgery is going to happen. We have a meeting Monday to discuss the specifics of the procedure (his team is weighing several options), but he already has an appointment scheduled in the OR on Tuesday. 


More surgery: not what anyone wants, but here we are...

James walked across 3 units today though, easily the longest walk he's taken since this ordeal began. And he requested food today, after a rough week of not tolerating even a bite, so we are happy to see him resume some semblance of normal activity.



Wednesday, August 26, 2015

There are 6 weeks between a rock and a hard place

We've been discussing more immediate treatment options for awhile now, and are still playing the waiting game for one major reason: how recent his last surgery was. The Fontan requires about 6 weeks of recovery (only a week of which is usually in the hospital!) and our doctors were adamant that signing him up for another surgery before the 6-week mark is absolutely to be avoided... especially since all surgical options are "shots in the dark", bringing about new risks with at best a 50/50 chance of success.

As of yesterday, it's been 6 weeks.

This is the soonest they would even consider cutting into him again, and even then... no one is eager to rush into the OR again. So we'll keep waiting, but the next-level, more intensive options are unfortunately officially on the table now. His fluid output had decreased over the last month but has jumped back up significantly again recently, so the chance of needing another intervention is looking higher than ever.

James' general demeanor is improving though as he gets used to the ICU and gradually accepts his new routines. We have finally accepted that he won't be home and starting school on time, so we're making plans to give him preschool lessons in the ICU, bring more of his activities to him, take him outside more often, and make the coming weeks or more feel as normal and fun as possible.






Monday, August 24, 2015

Gatsby's Long Haul

Did you know that one of F. Scott Fitzgerald's draft names for Jay Gatsby was James (Gatz)? I was never a huge fan of The Great Gatsby, but every now and again I can't help but notice my son embodying a meme-like stance of decadence and defiance as he sits and waits, sits and waits, sits and waits. He doesn't have the Long Island Sound to sit and stare at, but our view out the window at Weill Cornell ain't a bad place to wait: we get to see Roosevelt Island, morning NYC sunrises (weather permitting), and all the boat traffic scooting by on the East River. And no, these images are not James taking up smoking; that's a fruit snack. 


Meanwhile, as we wait, we find more and more ways to defy the system while seated. Even if we can't go home, we found a way to get him outside: it's as simple as a wagon ride. Of course, to achieve this we also needed to complain about being cooped up for over five weeks, add a little scientific argument about vitamins and sunshine, and remind them daily how much they take going outside for granted by asking them to tell us about the weather during rounds.


And what magical, mystical, blessed sciences does rounds reveal?

Nothing. Or little to nothing. Or virtually nothing.

They (doctors and nurses) are still confounded. They monitor bloodwork for reduced this's and that's, elevated odds and ends (yesterday, elecrolytes; today, albumin and IgA; "wait and see" for tomorrow's menu...); they still tally his daily pleural chest tube output (seems to be getting a little higher, not a little lower, which everyone says is strange, and means sooner or later they'll start talking about ligations and catheterizations and such, but "wait and see"...); and they still watch James stare them down each and every time they enter the room from behind the curtain (did the Wizard of Oz once say, "wait and see"?...).

This is, sort of, a standard protocol for chylothorax, "wait and see," because there is no steadfast cure, no proven way to expedite recovery, and almost no mathematical or scientific way to determine how long it will take (means, modes, standard deviations can't help us here). And while James seems to be defying even the norm here, letting doctors see virtually nothing as we all "wait and see" the days fly by (today is.... Day forty-one going on forty-two? but who's counting?... Everyone. James has surpassed the majority of patients most hospitals have seen in terms of duration of hospital stay for chylothorax, and he's on track to exceed them all...), it seems we need to embrace the big ideas for any long haul -- patience, steadiness, perseverance. With maybe an occasional dose of decadence, and a healthy batch of defiance.

Sunday, August 16, 2015

Lazy Sunday

What a perfect day for a nap in the summer sun! After 34 days, he finally got to escape for a few minutes outside. Being wheeled around like a little prince sure is tiring...


Friday, August 14, 2015

Has it really been so long?

Our last post was a week ago, and it seems that the days since have flown by in a haze of hospital beeping, interrupted nights, and bad coffee.
 
The short story? Nothing to report. Output is still high and we are exploring options for long-term treatment since nothing seems to be making this go anywhere anytime soon. Today marks 1 month in the ICU, though technically James has been here 32 days, and with no end in sight, we could have weeks or months to go.

The longer story: James is now on a no/low-fat diet, so we've been testing out food this week. He had a great day eating yesterday, but couldn't keep anything down today. (Solution: add a new med.) He has barely been sleeping. (Solution: add another new med.) His heart rate has been high ever since his atrial flutter episode last weekend, and docs are trying to slow it down (by adding a new med). Each med has its own side effects, including nausea, insomnia, and elevated heart rate, which circles us back to the beginning of this paragraph...

As a result of much of the above, folks here think James may be suffering from delirium, a common psychological condition that affects people in long-term hospital care. It would explain the poor sleep and his increasing agitation. (Mommy and daddy are pretty sure they're also beginning to suffer from delirium at this point, and they're only being partly facetious...) We've already started advocating for home care, or moving to a clinic closer to home, because we all know that James' crazy cornucopia of conditions will clear up faster in a familiar, happier environment...

Still, many mini-positives to note: James is still improving on the walking, and has made it all the way around the PICU now, albeit with many tears and complaints. He's been cranky a lot lately, because, of course, he's tired, but we've also caught him singing to himself and singing along with his playlists and videos. He has been coloring and using stickers a ton and is apparently ambidextrous now after having spent so long with his right hand out of commission. He is even starting to help the nurses, lifting his arms and offering his i.v.'s for temperature and blood pressure and other checks.

We had lots of toys and activities prepared to occupy him while stuck in bed, but we hadn't anticipated a month and more, so we're starting to cycle and recycle through things at home. Of course, we're starting to think about what else we can do now because kiddo is starting to get bored!, so if any of our faithful and creative readers have any brilliant ideas, please share away.

We are all so ready to go home...

Saturday, August 8, 2015

Compounding Complicated Complicating Complications

Day 26, Boatswain's Log from the SS James, hull leak is staying about the same, we're still adrift at sea with no sails or engines, and miraculously we're catching more fish for food, but high seas are making the remaining crew nauseous and mutinous, this ship is taking a beating, and still no land in sight...

A drawling, quiet week until Thursday, during which there was not much to report.

Thursday, however, we began a series of very eventful days, with one thing leading to another, and another, and another, and another . . .

Thursday morning, James went for a walk. Physical therapists gave him the cutest little walker, looked like a little old man walking down the halls and out to see the fish tank in the family room. Cried the whole way there, the whole way back, and at every point in between, but he did it all on his own.


Thursday, afternoon, Cardiology brought him in for a post-op cardiac catheterization. They wanted to check and make sure his chylothorax wasn't being exacerbated by a new Fontan connection that left too much pressure in his lungs. Kirsten and I weren't fans of this idea -- we knew high pressures were the most likely cause of the chyle leaking from his lymph system -- but the team presented a good argument for it, and we couldn't ignore the logic. It was very frustrating, as you can imagine, when they brought him out, confirmed his pressures were high, and then said there was nothing they could identify that would help: previous to the procedure, they mentioned ballooning, stenting, and coiling, but none of these options would have done anything, they said, to help. So, they performed a collage of minimally invasive procedures that will keep James knocked out for a few days, for what seemed/seems like nothing, reminding us what we all already know: James simply needs time for his body to adapt.

Friday, when he was finally awake after his restless night after the cath and long day-time nap, James suffered from another complication: atrial flutter. This is essentially one of his heart's atria running a sprint while the rest of his heart jogs to catch up, making all of his heart run fast, but his atria run super fast. While no one can say for sure that it was a direct result of the dyes or fluids or methods they used during the cath, because this does happen to healthy people without direct cause, this was one of the things they warned us could happen as a result of the cath, and required another procedure to get his heart rhythm's back into sync: cardioversion, or simply a nice little shock treatment.

Of course, James has a Fontan heart-lung system, with chylous effusions, so at this point almost everything that can happen to him puts him at substantially higher risk of clotting, and atrial flutter left to it's own defenses (most normal people would get back to normal rhythm without intervention) makes even more possible a clot in the heart. So, they did the cardioversion quick and fast Friday evening, shocking him back to normal rhythm, and putting him on digoxin to help maintain his normal heart rhythm.

And that gets us to Saturday.

Today, James was cranky, nauseous, irritable, and refused to sleep. After being woken every 30 minutes last night to check his heart, or give him meds, or take his blood pressure and temperature, or change his diaper, or give him another med, or do another EKG, James has decided he won't sleep. Beyond him becoming a vampire, he is now becoming an insomniac. He wouldn't stand, cuz the digoxin makes him dizzy and nauseous, and he wouldn't lie down, cuz the digoxin and the shock and the stickers and wires make him edgy, and he wouldn't sleep, cuz he's again wary of anyone in the room with him, including mommy and daddy.


But, he spent the morning watching videos, eating ice, playing ipad games, and generally wearing himself out with restlessness, so he finally went down for a nap -- eyes partly open just in case. And, tonight we got him to do some light standing, stomping, stretching, and a few unsteady, but purposeful, steps -- to get his ipad :)

Tuesday, August 4, 2015

3 week Fontanniversary

The Fontan was 3 weeks ago today, and we're still here, and nothing has really changed in the last week.

Our team of Doctors, who did an amazing job with the Fontan and have made some great efforts in getting him closer to going home, have admitted that no one knows much about chylothorax, why it happens, or how to fix it. The next step will be a catheterization later this week. It's a "just checking" move, which is unlikely to resolve anything, so we aren't expecting to see much progress or have much news to share.

James received a couple of care packages today, which we greatly appreciate. His "room" is now decorated with cards and pictures and there are Thomas stickers everywhere. And mommy and daddy have snacks! :)

The IV in his right hand forces him to draw with his left. He is right-handed, so it's frustrating, yet he keeps asking to color anyways. It's pretty amazing how well he manages :)


Monday, August 3, 2015

ugh, it's Monday

Many people share the sentiment: ugh, it's Monday.

Today, it's not a return to the work week that's dragging me down but disappointing numbers from James. The TPN and medication seemed to be starting to slow the leaking, but yesterday it ramped back up again. Total fluid output more than doubled.

It's hard to stay confident when the leaking has gotten worse.

Unless a miracle happens tonight, we're anticipating a serious discussion about other options.

Ugh.

At least James is happy today!


Saturday, August 1, 2015

Tug of War

Yesterday we did standing and walking, and more standing and walking, and more and more standing and walking. Yesterday was a long day. This past week has been a long week. And at the end of a long day, a long week, what better is there than a long, hard, peaceful rest?

James slept, without meds, for a full 9 hours last night, from 7 to 4 am. He has been awake ever since, and is looking happier and more James-like every day. We even got a James-original smile yesterday!

Medically, though, we are still playing tug-of-war. 

Tug-of-war was always one of my favorite family reunion and summer camp games. Two teams vying for victory over each other through a balance of weight, strength, and strategy. I think I liked it most, however, because who won wasn't always about the strongest or heaviest or most strategic: sometimes luck, or sheer will, or environment had a silly way of turning the tides. 

Despite the improvement often seen (~60%) through the conservative three-part treatment plan James is on -- TPN (i.v. nutrition), Octreotide, a medication used to slow the flow of lymphatic fluid, and no food or drink, all for up to 2 weeks -- James' condition still has yet to improve in the last week. There was a marked improvement in the first few days of this plan -- last Thursday, Friday, and Saturday -- down from about 800 cc's per side per day to about 150 cc's per side per day.  But then not much happened, so they took him off Octreotide to see if he just needed time to rest, recover, and start walking.

After a week and a few days, we're averaging about 200 cc's total, or a cup, per day for the last 3 or 4, but it has been fluctuating up and down, up and down. Progress, but progress has slowed, and sometimes reversed, so docs are gonna put James back on Octreotide. It should only take a few days for this treatment to do something noticeable, and we're hoping both that this plan will help and, more importantly, that James will be patient enough to get through Tuesday without eating or drinking anything.

This past week, James has been continuing a very long and hard game of tug-of-war -- he pulls a little, his condition pulls back a little. He's not happy about being here instead of home, being forced not to eat, or having all his i.v. tethers and these hospital walls keeping his freedom of movement limited, but every day he keeps playing this game of tug-of-war.

Friday, July 31, 2015

First Steps

Almost two years ago, we watched with joy and amazement as James took his first steps - at the park and into Daddy's arms.

I had that same experience again yesterday. James has gotten so much stronger this week, and is such a trooper about pushing himself. He cries throughout each standing session, and his little legs shake and buckle beneath his weight. Yet as soon as he sits, I ask if he wants to try again, and he says YES. Yesterday he crossed a hurdle: he stood entirely on his own, only lightly holding my arm for balance, and straightened his legs. Legs that went unused for almost 2 weeks supported his entire weight for over 10 seconds.

Just imagine, if you can, lying sedated with your legs bent for so long, with barely any food, then trying to unfold them and stand up. It was an awesome moment to see him straighten up, feel him let go of my arm, and stand on his own.

He tried to take a step, and even though he needed help, he initiated the motion all on his own. He has a "this is hard, but let's go for it" attitude. He says he wants to walk "to the car". One mountain conquered, and the next already underway :)

His pleural effusions are still leaking pretty consistently, though yesterday showed some improvement. Doctors have emphasized that this is a long, slow process, but James' heart is healing wonderfully so they are no longer worried... He will eventually kick this too, and we will go home.

Wednesday, July 29, 2015

Building Endurance

At every surgery, James has some setbacks.

After the first surgery, the day he was born, he had to gain back the one-third of his weight he dropped during surgery, he had to learn to eat because, unlike normal babies, he never was given a chance to breastfeed when he arrived, and he had to learn to breathe on his own again.

After the second surgery, again we had some of the same issues as above, mostly about eating, having to put him on a naso-gastric tube to ensure he'd get enough calories, but also cognitive, psychological, and physical development. James needed to learn to be an infant: talking, walking, playing are foreign things, and his second surgery set him back to just about newborn status.

No small feats to overcome, these setbacks, even for healthy babies.

This time around, James awoke from sedation hungry, but silent, and immobile. He wanted to eat, he wanted to drink, like a newborn, but he couldn't (or wouldn't) speak, and he could barely lift his arms.

In the last week, James has begun to come back. He is talking more, playing more, moving more, and still very, very hungry. Still no classic smiles from James, but he is showing levels of determination, perseverance, and grit that I don't know I have ever seen in grown-ups. He has been, and continues to be, one of my greatest heroes.

We still have a long way to go medically before James can come home -- weeks, possibly months, before he's stable enough to take his pleural drainage tubes out -- but he has already come back to us in spirit, and I am positive he will continue to amaze us all as the days continue to fly by.

Monday, July 27, 2015

Split family

Elise hit the 6 month mark on July 14, the same day James had his Fontan. This milestone got lost amidst the activity, but not forgotten: I took a series of photos of her the day before to commemorate her little 6 month old size and personality.

Given the extended hospital stay and uncertain timeline, we finally decided to send our baby to stay with Grandma and family for awhile. She's going to have a great time, but we miss our little ladybug, and hate that we have to be split apart right now.

So tonight I'm looking at photos of my smiling, giggling, crawling, jumping, teething, chewing, grabbing, arm-waving, growing girl.






Sunday, July 26, 2015

Weekend Wrap Up


We had a long and determined conversation with our doctors on Friday about leaving James alone. Despite all their talk about how chylothorax takes time and he needs rest, the ICU is not restful and the constant regimen changes and status checks and blood work were wearing him out. People were in and out of his room nonstop, and he was terrified, and his blood pressure and heart rate and other stats were unable to stabilize.

We said: STOP, remember he is 3 years old, your bedside manner needs serious work, and quit scaring the daylights out of him!

So, he got a quiet, restful weekend. His team is being quiet around him and limiting interactions. He got some calming medication to help him adjust. He needs to have the energy and drive to fight this, and he's getting that back. He spoke a ton today! Thomas, bye bye, grandpa, funny, water, marker, yes, bumblebee, yellow, and more. He read The Very Quiet Cricket and said his favorite part, "not a sound". He had several visitors and took another wagon ride and sat up for a long time.

No walking yet, but his left leg has been very swollen so the IV came out today (there's a new one in his hand, but you win some, you lose some). Hopefully that will let his leg improve enough to try some standing tomorrow. Walking later this week?

This condition can take weeks to heal so we're hoping for sooner rather than later... and praying for no further complications.






Friday, July 24, 2015

Deep Breath

James had a second chest tube inserted last night (Thursday) to drain his left side. Over a liter came out, most of it almost immediately. His chest X-rays looked much better today, which is great: all that fluid needed to come out. However, he's otherwise unchanged: still leaking at the same rate, stats all still the same, oxygen has been hovering around 90-92 (when it should be more like 98). After a day of reintroducing food, he's back to a no-food diet with TPN feedings, and they have been discussing reinserting a central line. The more they poke at him, the more stressed he gets, but stress increases the leakage and directly contributes to this condition. It could be a week, or several weeks, or even longer of hospitalization... it could be months of return visits... it could mean other things that we don't fully understand yet.

This has been confusing, and scary, and I haven't processed it all yet so I'm not going to write anything else about it right now.

Instead, I'll share that James is getting stronger about sitting! He had another chair-and-Ipad session today. He took a ride in a wagon and looked completely adorable. He practiced standing. He still didn't really manage it, but he put weight on his feet for a few whole seconds. He has new headphones, and they seem to help him relax and tune out all the doctor babble over his bedside :)