Isabella: Summer 2012 Update

Here is a long overdue update on how my little Isabella has been doing….

The Stats:

In May 2012 Isabella weighed in at 21 lbs and 29 inches. No wonder our backs were already hurting, she got so heavy, she slips down from my arms from all that weight. 

However, sometime in June 2012, a weight check in one of her appointments revealed that her weight went down to 19 lbs, BUT, what she lost in weight she gained in length (30 inches).

That’s why she can see what was on the other side of the booth

Renal and GI:

We went to see her Renal doctor in June and the labwork reveals that her kindeys are NORMAL. But, before our appointments are cut down to being once a year (instead of every 6 months) they decided to change her diet to a non restrictive one (which meant she can now eat anything and I do not need to read labels) and do final lab tests to see how her kidneys handle it. In coordination with the GI clinic they also decided to wean her off the formula and give her only all Boost Kid Essentials (1.0) for her overnight feeds.

Blood drawn shows good creatinine levels, which indicates that she has rock star kidneys. But renal says that they need a urine lab check to get a more complete picture of how her kidneys are doing. So as much as we tried getting this done before she goes to surgery, our attempts at collecting urine failed 3 times (I never thought that it is super challenging to collect urine from a girl baby). So, while she was at the hospital (post surgery)we let the nurses do it. We have yet to see the results, but I have a strong feeling that her kidneys will be fine… this would then translate to seeing the renal doctor just once a year so I’m keeping my fingers and legs crossed.

Feeding:

I got crazy using the puree-er and used it to puree table food (pasta, stew, meatloaf and potatoes, etc.) Basically anything we ate, she now ate too. Turns out, Isabella loves avocados and bananas (which she used to not eat because of the high potassium content). Daytime feeds became really fun (more fun for me with my new found kitchen tool) and she was taking in and keeping down food really well. The success in feeds brought her weight back up to 21 lbs in July 2012. Throw ups were non existent, and daytime feeds are all via mouth. We still do the continuous feedings at night, but now she takes it a rate of 50 mls/hour. This will make her feeding OT and GI doctor really happy.

With the diet change, she has been eating more, and gaining weight! But, we needed to deal with the occasional constipation that we have managed according to certain constipation alert levels.  Click here for that blog post.

Isay with her"chunky" legs

Neuro:

Isabella had 2 seizures in the past that we think might be induced by chlorine exposure. So in May 2012 we decided to do an experiment and we went swimming. As it turns out, she did well in the pool and we’ve taken her swimming again since then …. so that chlorine induced seizure myth is busted.

Us swimming with the baby... I mean, toddler.

We do note seeing drop seizures. Neuro asked if they were “new” but we said we never really saw her "drop" before as she was not really up and mobile before. Now that she crawls, kneel walks, climbs and cruises around at home, we’ve seen it more often. So he recommended another seizure medication, Clobazam, and also decided to increase the Kepra, and wean her off the Phenobarbital. During the first week of giving her the new medication she was lethargic, and after that she went back to her usual self.  No more drop seizures noted since then, so the new seizure med cocktail is actually working.  

Isay and Nanay walking at the beach

Sleep Study , EENT, Audiology, and Surgery:

A sleep study was done in April and it revealed that Isabella has obstructive sleep apnea. So an order for surgery was done to remove her adenoids and tonsils, which we are hoping would be her last surgery. Also, since, she will go under anesthesia, we requested that another sedated ABR be done to finally get a conclusive answer regarding her hearing issues. After moving surgery dates several times, we finally got it done on July 27^th. Giving us a week to squeeze in a short family getaway in Tahoe before we face the work that recovery from surgery entails (and also enough time to care for her post op before the new school year begins and we need to be back at work).

ABR revealed that she has NORMAL hearing. When we asked questions about seeing an audiologist for our follow up appointments, the doctor said we don’t need to do it every 3 months. So we wondered about all the cyclic-audiologist-appointments that we diligently kept (and missed work for) in the past 2 years, when her very first ABR (done when she was 4 months old) revealed the same normal result. Doctor said that with her disability, the behavioral audiology tests were not developmentally appropriate for her, and even if she cannot prove through those tests that she can hear, testing needed to be done. It almost sounded like it was a waste of our time since she can hear perfectly well during all those times that she was failing the tests that were not developmentally appropriate for her to begin with, but, nonetheless, hearing the word "normal" in anything about Isabella, is music to our ears. Doctor says that from now on, we would now only need to see an audiologist every 6 months, not necessarily to check for hearing, but to check for obstruction, i.e. fluid in ears or cerumen so that an EENT referral could be made to check ear tubes or clean her ears. We decided to go to a different audiologist for this. 

Well we know she can hear us….  maybe not so much when she was younger because she does not wake up or get startled by loud sounds (and believe me, we tried banging pots and pans while she was asleep and she stayed soundly asleep), but now we know she does because we can hardly sneak in the room without her hearing our tiny catlike footsteps, and we can no longer take her to the movie theater even if we time it perfectly with her naptime schedule because the surround sound wakes her up. The question though was not so much if she can hear, but how much she can hear, so with this normal ABR result, her hearing issues have been resolved. She can hear everything perfectly fine!

As for recovering from surgery, well except for pouty lips (like that of Angelina Jolie’s), and the excessive drooling (like that of Angelina Jolie's onlookers) from not wanting to swallow,  she recovered well. The most important part was that there were no seizures post op. Yay!

While recovering, we noticed an increase in oral aversion, and oral feeding was a futile attempt. The only thing we can seem to give her orally was vanilla ice cream, which she occasionally manages to swallow, and which is the only thing that has a high swallow success rate. So mommy’s pureeing frenzy would have to be put on hold and we would need to be satisfied with bolus feedings during the daytime (it is in times like these that we are thankful she has a G-tube… that and during periods of long drives). Also we noticed that her cry is louder, most likely with the increase in square footage inside her mouth that amplifies the sound…. and most most most likely because it was time for her next dose of pain medication (duh?!?)

Sleep Study and After Tonsilectomy and Adenoidectomy Surgery

Cardio:

Prior to surgery, a referral to cardio was made. We were anxious to know if the PFO and PDA holes in her heart have been resolved. The other doctors hear a murmur when they listen to her heart and so we were anxious to hear what the cardio has to say.

After an echo and a sonogram of heart was done, it revealed that her heart was normal and NO HOLES WERE NOTED. The murmur is still there, but what she has is called a Still’s murmur (because it is "still" there, hahaha!), which actually a benign type of murmur that we should not be really concerned about. Two thumbs up for Isabella’s heart! 

Speech and Communication:

I noted in a previous blog update that Isabella shakes her head to tell us “no”…. she has not done this for a while.  We also noticed that the head shaking that she does is more of a stimming activity and not really a “no”. Well that “head-shaking-stimming”, if it indeed was that, has stopped too. So, I don't really know what to say about that. It's confusing.

As much as I want to have something really significant to report in the area of speech/communication, I have yet to wait for signals from her. She does not reach or point or gesture for anything, just yet. But I do know, that there is this desire in her to tell us something, it’s just a matter of finding and teaching her a way to know how. Her sounds are mostly “Mmmmms”, and an occasional “Ahhhhh” to communicate displeasure or delight. She cries, but not so much… she is a pretty quiet laid back baby (toddler?). Although, just recently, she does this “fake cry”, perhaps in protest for when our world does not revolve around her. (See related blog post here)

I have noticed frustration though, so we started using sign language and have told the nurses taking care of her and the rest of the family swear (via a blood compact) to use consistently. One time when she seemed restless and was making sounds that seem to communicate that she is somewhat not happy and needs to be entertained, we signed a wiggling W to ask her if she wanted to watch the Wiggles (which is her favorite show), and the sound she was making stopped, which indicated that she understood. Other than that, I have yet to see a real communication “output” from her.

Although…. there were these two instances that she seemed to communicate something.  Click here for that blog post.

Motor Development:

After drop seizures have been more controlled, we noticed an increase in her getting around the house. We would find her by our feet, in the kitchen, while we are washing dishes in the sink. We would find her halfway up the stairs, perhaps going after her brother, who just went upstairs. And one time we thought we lost her only to find her in the big bin by the TV getting into her basket of toys. Looks like it IS time to set up the gate and baby proof the house.

The therapist got her this really cute Pepto-Bismol-pink seizure helmet with a rainbow stripe strap that looks really cute on her. She looks like a little pink helmeted wrestler or boxer in training. She still needs to get used to wearing it though.  The therapist is also trying to have her work on using a walker. Check out this video.

With some help, she has also managed on several occasions to take 2 to 3 wobbly steps on her own as seen on this other video.

Other Things to Celebrate:

* Because she thinks she already is a big girl, Isabella has cut down her daytime naps. Every now and then she manages two 30-minute to 1-hour naps, but mostly she only does one in the afternoon. Every now and then she also tries to convince herself that she is not sleeping even if she actually is.

Isay's not really sleeping, she's merely sitting.

* Isabella is set to start preschool in January 2013. So when we had our IFSP in July, it was almost hard to believe that the specialists have worked with our daughter for almost 3 years, and I  thank them immensely for everything that they did to help our daughter. She has come really far. Our next step is to see the classes sometime in early September so we will be ready for our transition meeting (IFSP to IEP).

* PSA found another nurse, so now we have consistent full work week care for Isabella. YAY! 

So that’s it for the Summer of 2012…. As for me, with the cyclical anxiety that I have to go through

-Ughhh, another appointment and another appointment and yet another appointment. 

- Is she getting enough oxygen while sleeping?

- Will she have seizures after swimming?

- Does she still have holes in her heart?

- Why did she lose weight?

- Will she have seizures post op?

- What degree of hearing loss does she have?

I realized that it ALL turns out fine and all the anxiousness was a waste of time (I have to keep remembering that).

- There will still be appointments but there are less to keep up with.

- No seizures post swimming nor post op.

- What she lost in weight she gained in height.

- There are no more holes in her heart and the murmur is benign.

- She is not getting enough oxygen but after surgery she will, etc.

- She most DEFINITELY can hear.

With my expectations kept at a realistic level and with her always happy, there is really NOTHING to worry about!

LIFE IS GOOD.


For the previous developmental update, click here.

Ah-uh Yes and Ah-uh No

Isabella has not showed us any communicative output really. She makes sounds, but they are usually Mmms, and Ahhhs, and the Ah-uhs that, depending on the context, can mean anything random. However, with the occasional change in tone in how she says it, it seems that sometimes she means Ah-uh as a "Yes", and other times Ah-uh means "No".

Here are 2 instances…

Instance #1: After rolling in her crib and crying for about 20 minutes, I realized that she will not go down for her nap, so I went to go get her and asked her “Why didn’t you sleep?” and she said “Ah-uh”, in such a diva-nated tone that tells us “Ah-uh, I don’t want to.”

Instrance #2: We were in the car and it started to smell like something died. So I asked my husband if he farted and he defensively said No. I asked my son if he farted and I got another defensive No. Since I was asking and was 100% sure that it wasn’t me, I asked Isabella if she farted, and she answers, “Ah-uh”… like “Ah-uh, I sure did”.

Apparently, It’s All About Her

Isabella has developed this newfound assertiveness, which is actually a euphemism for stubbornness (hahaha!). She is curious (another euphemism for nosy), and loves getting into everything that we are into. She loves interacting with her brother (more of bothering him actually) and she will block and grab whatever he is getting into, which makes my son upset.

Isabella wants everyone’s attention, and she has her menacing ways to remind us often that the world revolves around her. (Yes, this also includes the dog as she would lean on Missy like it was her personal warmed up couch when the dog finds a cozy corner to lay in).

She wants to be on your lap while watching TV, she crawls on top of you when you manage to find 5 minutes of quiet rest on the floor mat, and she will smack your face with her hand (doesn’t hurt, but she will keep on bothering you) when she finds you with your eyes closed when you barely laid down, like she's trying to say "How dare you get 5 minutes of shut eye!", That or she tosses her shoe on your face (which hurts sometimes).

This is Isabella's way of telling her brother that it is HER turn to use the laptop. 

(WARNING: Don’t be fooled by that smile on her face)

Here are other examples…

Example 1: She cries for attention.
Oh she cries when she wants us to just pay attention to her, it is this fake loud cry with no tears (that I suspect will be more amplified since her last surgery). She cries when she sees us getting dressed up, thinking that we are leaving her. She cries when we leave the room to go to the kitchen to make her food, she cries, and her plea for attention is most definitely heard.

Example 2: She loves herself.

She likes looking at herself in the mirror or looking at pictures of herself on the computer. She also likes watching a slide show of her pictures, and the moment the slide show stops, she cries to tell us that she wants more.

Example 3: She messes up my chore schedule.

Isabella wants me to just focus on her when I need to do something else. Whenever I fold the laundry, what normally will take me only 15 minutes to complete, takes me a whole hour. I would have to resort to playing endless rounds of peek-a-boo, and make it feel like something exciting each time, needing to do it for each piece of clothing I need to fold, because otherwise she will sit on top of whatever it is I'm trying to fold, or she will mess up the stack of neatly folded clothes, or get into the laundry basket and take all the clothes out and sprawl them all across the floor, getting dog hair all over it.

Example 4: She will judge you.
When I take a shower, she will crawl her way to the bathroom and sit in front of the glass shower door and just sit there watching you…. judging you.. making sounds, that make you feel uncomfortable having a baby look at you naked and making comments that you do not understand that you step out all soapy and semi rinsed. I swear, the moment I wrap my naked body with the towel, the “comments” stop.

Example 5: Your time is HER time.
When I lock myself in the commode, she will crawl and bang on the door with her shoe trying to tell you to hurry up with whatever sit down business your attending to. Almost like she's telling me that anything else that I do is less important than the privilege of paying attention to her. If I open the door so I can pretend to watch her, she will climb up and would want to sit on my lap, while I’m doing my “deposit”…. which leaves me doing my business in installments. 

Example 6: She is better than her brother. 
We will sit and chit-chat with her brother or have a silly wrestling tickle match on the floor and she will be there, putting her tiny body in the middle of it. She will yell, watch you with a stink eye, make those judgmental sound comments, fake cry, or toss her shoe. She will do anything in her power to put a stop to all the brother related fuss so we can all just focus on her.

Example 7: She torments her brother. 
She will take apart the Lego sculpture he spent all morning building, she will sit on top of whatever he is reading, topple over the bin of little toys he is playing with that we would have to tell HIM to clean up, and she likes pulling his hair, and HE will cry. Not a fake cry, rather a full-of-tears-he-is-hurt-cry or a my-sister-is-so-annoying-and-he-is-so-frustrated kind of cry. While Isabella, god bless her menacing heart, would give him a smile when he looks at her with tears in his eyes, or when we look at her and ask her what she’s up to.

We have put Isabella on time out for not having “gentle hands” (pulling brother’s hair), and after three days of time outs, she seems to get the picture that she cannot pull her brother’s hair if she wants his attention, which she seems to want a lot of.

Not to say, of course that she does not cry when brother does something, she cries when her brother changes the channel (while she’s watching the Wiggles, so he can watch his 7 year old boy TV shows), and he proceeds to watch while she proceeds to cry and crawl to grab away the remote from him, which she is usually not successful in doing, because it is HIS turn on the TV.

While we are enjoying this exchange in torment between brother and sister, (which is a typical sibling thing in any household), and her tormenting us, (which is typical in any home with a toddler), we also enjoy that she has turned into this little diva, making everything all about her. =D

Okay Baby Girl the rest of this year you can make it all about you, 

then come 2013 we’re gonna have to work on tapering it off a little.

Poop Happens

Isabella poops two to three times daily. With two being the minimum quota and three being having extra marginal profit, and the occasional four being a reason to celebrate the extra commission.

The ideal poop consistency is that of peanut butter (if you are eating, and you decide to stop reading this, I won’t be offended, promise.)

With the diet change,  ordered by GI and Renal to a non-restrictive diet, we were faced with dealing with the occasional constipation that we have managed according to its constipation alert levels that is signified by certain poop consistencies.

Level 1 Alert: 
Level 1 Constipation Alert means different things. When Isabella has not gone in the morning like she usually does, or when she does go but they are like small pellets and are dry (like that of a rabbit or a goat), or if she gives us a donut hole (like a piece of a chocolate donut hole from Winchell's), or if she produces what we call Play Doh- a pasty kinda flat piece of brown doughy poop, this is called a Level 1 Constipation Alert. This level of constipation is usually managed by giving her some prune juice. While usually a successful means to make her go by lunchtime, every now and then, we do need to proceed with a plan to remediate a …

Level 2 Alert: 
After being prune juice-boarded, and still not going by 4 pm, a Level 2 Constipation Alert will be in place. At this level, we will have to give her a dose of this minty-flavored-chalky-substance called Milk of Magnesia. At this point, because level 1 remedies did not work, and she has already skipped about 2 bowel outputs, we will need to deal with diaper overflows, poop went throughs, and sometimes, just sometimes, the all the way to the back poop cleaning.

It is important to note though that this level of intervention usually works and would not necessitate the need of a Level 3, but sometimes, rarely really, we do need to up the ante to a…

Level 3 Alert: 
It is already day 2 with the constipation battle. For the first half of day 2 we will try a Level 1 approach, and  and if she still has not gone, a Level 2 approach will be administered in the afternoon, and if that does not work, by bedtime (after already doing her daily bedtime ritual of a bath, brushing her teeth, taking her meds, and being dressed in her pretty jammies, and no luck with the production of her precious poop) then suppository Baby Pedia Lax will be necessary. Pedia Lax is really our last resort, and we are usually hesitant to give her this, so we would try and give her some belly massage and wait it out. But since she gets really restless and cranky when she has not gone (and I can’t blame her, for I will feel the same if  I’m all plugged up.) then Pedia lax seems to be the only way to go.

Usually, due to our hesitation to give it at the right moment (which is always the time frame before we did it plus the time we wasted on waiting after we give her the belly massage), she would go in her sleep and we will have to deal with all the all the plugged-sordid-mess-of-bowels in the middle of the night.  So lesson learned, when faced with a high level of constipation alert, DO NOT hesitate to give Pedia-lax by the afternoon of Day 2 Level 3 Constipation alert if we do not want to deal with giving the baby another bath in the middle of the night, and the need to address the dirty bedding laundry, ASAP.