Tuesday, April 13, 2010

Rollercoasters

I feel like I have been on a rollercoaster since we decided to conceive --- so many ups, downs, unexpected turns, flips and loopty-loo's. [for those of you that want the Cliff's Notes version... B had surgery today for tubes due to mild speech delay and mild hearing loss but this post originated from the fact that sweet P needs an MRI of his brain and quite possibly an endoscopy/pH probe as well --- I just became a bit tangential... but read on if you care to know why].

Six months and one miscarriage later, on December 27, 2007, a little stick told us that we would be parents. After my initial bloodwork and an ultrasound at 6 weeks, my fantastic doctor confirmed that our dream of being a mommy & daddy was coming true.

I avoided morning sickness... I was on Crinone (progesterone suppositories) until my second trimester... I was monitored closely due to my short cervix... I narrowly avoided a cerclage... started contracting at 22 weeks... I dealt with hydronephrosis of the right kidney... I gained 29lbs... I was scheduled for a c-section on August 29, 2008... somebody decided that he couldn't wait any longer in my warm, loving, yet out-of-space womb and on August 28, 2008, my water broke [I discovered it had broken around 2:50am - one day I will post his birth story] and at 10:11am, we welcomed a 7lb4oz baby boy by the name of B into our loving arms.

[complete side-note: On September 1, 2009, a lovely hurricane by the name of Gustav hit LA and we were without power for 1...2...3...4...5...6...7...8 days --- yes you read that correctly, 8 days with a newborn!]

In the days following B's birth, Daddy was married to a marshmallow and the father of a yellow baby with equally yellow eyes... for me it was postpartum looking-like-the Michelin-man syndrome (aka edema in my legs) and Mr. B wanted to be yellow like the sun (aka jaundice) but we both recovered rather quickly!

Breastfeeding was not the natural, nurturing, bonding, blahbidy-blah-blah-blah experience that the hospital lactation team made it out to be. I went through every breastfeeding problem known to man (ok... I didn't have an abscess... so almost every potential problem)... sore/bleeding/cracked/wanted to fall off my body nipples, double intraductal yeast (thrush) infection, mastitis a couple times, clogged ducts every time I breathed the wrong way, low supply, etc. After 6 weeks of nursing, I made the emotionally painful, yet physically what-I-needed-to-do-to-be-healthy-overall decision to stop lactating. I beat myself up. I hated that I was giving my baby formula. I hated using bottles. I hated it all. And then one day, I woke up and was over it. I realized that I was happy. I realized that formula wasn't poison that was going to kill my baby... heck, I am a product of formula and I tend to think I am a pretty smart chick. Life was good again.

B was a chunky little nugget (70% from 2 - 12 months old).

B got really sick on February 9, 2009. According to his pediatrician, Dr. B, he had bronchiolitis [90% of the time it's caused by RSV... we fell into the other 10%]. He was put on an inhaler (ProAir) with an opti-chamber. We suctioned his little nose, used our nifty little cool mist humidfier and just prayed. Then every few weeks, Brice had some sort of virus leading up to August 2, 2009 and a visit to the ER. B had been running high fevers for several days... it finally hit 103.7* and the on-call nurse said it wasn't a big deal. I felt differently and we went to the ER. Turns out the nugget had pneumonia. After switching pediatricians, to Dr. L, she ordered another chest x-ray and bloodwork on August 14 (same day my grandfather passed away)... pneumonia was notated along with a really high wbc and low Ig levels. After more bloodwork, a couple appointments with an immunologist, a few weeks of waiting/praying/worrying that our baby had an immunodeficiency, we found out that all was well. Praise God. Dr. L started treating the nugget for Reactive Airway Disease --- pulmicort daily and xopenex as needed for wheezing.

But let me rewind for quick second...

April 26, 2009 --- for the third time in my life, a little stick told me I was "pregnant" --- SURPRISED was an understatement. I kept saying "I know how this happened, but really, how did this happen?" B was 2 days shy of 8 months old... I wasn't ready to have another child... I wasn't ready to be miserably pregnant again... I just flat wasn't ready... but He was [it's so hard to remember that my plans aren't the ones that really count in life...].

I called my MFM and said "Guess what... I'm pregnant again" after some laughing and congratulations were exchanged, I was scheduled for my initial bloodwork panel and an ultrasound at 5.5 weeks... my hcg levels came back really high, but only one tiny bambino was occupying my womb according to my second ultrasound... I avoided progesterone... I was still monitored closely... started bleeding heavily at 13 weeks because of a tiny subchorionic hematoma... my gallbladder decided to revolt and at 21 weeks gestation, it was removed laproscopically... started contracting at 17 or 18 weeks (I can't remember)... had an amnio at 8am on December 18, 2009 which confirmed mature lungs... walked into the OR and at 11:15 am, we welcomed a 6lb15oz baby boy by the name of P into our loving arms (and Cheerio filled hands).

I just knew breastfeeding would be different... well guess what... it wasn't. P's poop didn't transition until he was 8 days old. Lactation thought it was me - which it very well may have been (little did we know that we'd still be battling poop issues today) - I was told to start supplementing with formula (I cried and cried again). At 10 days old, I took him to the pedi for a weight check and he had blood in his stool. I was told to remove ALL dairy from my diet (SO stinkin' hard) and to start supplementing with Alimentum because P appeared to have a milk protein intolerance. Fast forward through another pediatrician change and 4 more painful weeks of nursing and at 6 weeks old he was on Alimentum (no more boob milk for him - he quit it cold turkey, lol). In addition to his poop issues intensifying, his reflux was as well (at 4 weeks old he was placed on Zantac). We were referred to a GI specialist. Dr. A (GI doc) placed him on Nexium 5mg BID (GERD), 1tsp milk of magnesia (constipation), Levsin prn, and EleCare formula (for milk protein intolerance; it's amino-acid based painfully expensive). In P's 4 short months of life:

--- February 18, 2010 --- Upper GI series (ruled out pyloric stenosis, esophageal stricture, malrotation of the intestines) and an abdominal ultrasound
--- February 21, 2010 --- ER visit for blue episode post-feeding
--- February 22, 2010 --- saw Dr. A --- ordered a stat pharyngogram (no aspirations noted); met with Cardiologist (Dr. B) for a stat EKG and ECHO (VSD ruled out; II/IV functional murmur; overall, structurally sound heart); bumped P up to 10mg Nexium BID and thickened feeds
--- February 26, 2010 --- 101.5* fever; pedi ordered bloodwork and chest x-ray; admitted to North Oaks hospital for right upper-lobe pneumonia
--- February 28, 2010 --- follow-up chest x-ray showed pneumonia breaking up but heavy bilateral infiltrates (viral bronchitis); on-call pedi worried about micro-aspirations
--- March 1, 2010 --- transferred to OLOL in Baton Rouge via ambulance to be near Dr. A; initially not impressed with hospitalist service
--- March 2, 2010 --- pharyngogram#2 (no aspirations noted; intranasally refluxes thin liquids); Dr. K said this is either an isolated illness or could be the start of Reactive Airway Disease in Pierce [given family history]
--- March 3, 2010 --- respiration rate in the mid 60s so NPO; Ng tube placed that evening
--- March 4, 2010 --- overnight, AMAZING turn around... DISCHARGED!!!

Overall, March continued to suck health wise for my boys. They both dealt with some rough respiratory problems (lots of Albuterol, Pulmicort and Xopenex were neb'ed in this house) and towards the end of the month, a nasty stomach bug. P had awful diarrhea for about 6 days and then went to the polar opposite with horrible constipation (which, in all honesty, he already deals with chronic constipation - the kid can't poop without his daily doses of milk of magnesia).

--- March 25 --- met with pediatric orthopedic specialist (Dr. W) for thoracic levoscoliosis in Pierce (we will follow-up in June our second "scoli-series" x-rays)
--- March 29 --- met with ENT (Dr. P) to discuss B's maxillary frenulum; while there we discussed B's propensity for left ear infections (1st - October '09; 2nd - January '10; 3rd - February '10). He advised that he would not recommend tubes because (1) he is conservative and like to see 4-5 ear infections in six months and (2) B was getting to the age where they typically begin to outgrow ear infections and we are out of "ear infection season" (aka cough/cold/flu season). We further discussed his frenulum and I asked him about B being tongue-tied - more specifically, if that could be the culprit for his lack of speech. He asked me to further explain to him what I meant. I informed him that B says about 2-3 words (mamamama/mama/ma and a very distorted version of kitty/mickey and eaaa [eat]). Dr. P said B had a mild speech delay and wanted us to have a hearing test. Upon examination, he agreed with clipping the maxillary frenulum, was up in the air on the tongue-tie and saw fluid in B's left ear. We had a hearing test. The speech therapist placed something each ear to test the the movement his tympanic membrane (ear drum) - she said both were more rigid then they should be (which could indicate fluid). The next step was a hearing test in a sound-proof booth - various sounds were made from different corners of the booth. He scored below normal. Dr. P said, given his mild speech delay and mild hearing loss, that he wanted to put a tube in B's left ear. His surgery was today (April 13... more to come on that in a different post).

Yesterday, P had a visit with Dr. A (GI) because we've seen some regression with his GERD. Dr. A seems to think P's constipation is under control but he was worried about the regression. He said that usually when a doctor places a child on medicine, he can predict the way things will go; and typically, by 7-9 months, children outgrow GERD. 95% of children will respond to standard medical therapy - the other 5% are serious acid producers. Dr. A said that 10mg of Nexium BID (2x/day) should be plenty for a child of P's size. He took several measurements of P's head, felt his suture lines (where the bones of the skull fuse together) and his anterior fontanelle (soft spot)... he stated that those measurements were all on the larger side. He initially wanted to do an ultrasound of P's brain but decided to go straight for the MRI because ultrasound imaging has a hard time looking at the cerebellum. He said it could be something as simple as hydrocephaly (I know, I just said simple... not quite simple, but in the realm of potential issues, it is simple). If his MRI comes back clean, we move onto an endoscopy with a 24 hour pH probe. Typically a pH probe is done for reflux confirmation but seeing as how we already know that Pierce is a refluxer GERDling, it's being done for a different reason. Dr. A wants to see if the Nexium is holding him based on his adicity levels over a 24 hour period. P will have a probe tip in the upper portion of his stomach and in his esophagus as well.

I received a call today from our GI nurse. P's MRI with sedation is scheduled for Monday, April 19 at 9:00am.

And for the heck of it, I'll finish with the other thing we've been dealing with in regards to our children... we met with Early Intervention regarding B... long story short (because this really bothers me/upsets me/makes me feel like I've failed as a mother/blog coming soon to a webpage near you about this guilt)...

--- March 31 --- Initial meeting with Early Steps (EI); B qualified for meeting with a speech therapist
--- April 8 --- meeting with speech therapist; ended with her saying "I can't promise you anything but I am pretty positive he is going to qualify"

In the next week or so, we will have a follow-up meeting to discuss his results, etc. I am happy that we caught this early and I am happy that he will get the treatment he needs but at the same time it's hard to swallow the idea that he has a "significant delay" --- more to come later --- I am tapped... emotionally and physically.

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