livingwithevan.com

Category: Photos

  • A weekend spent out and about

    On Saturday we went to GrandRapids in search of some good deals on baby stuff since USA baby is going out of business. With prices like that it’s no wonder that they are closing their doors. We thought we could get a toddler car seat on sale but their “retirement sale” price was no different than what I can buy the same seat for on Amazon. We went to Woodland Mall and daddy bought got some good deals on clothes. Evan spent most of the time awake, taking in all the sights. Any fussiness was short lived. Carrabbas for lunch… we took some pictures while we waited for our food to come. We also went to the Carter’s store, the baby clothes mecca. We were hoping to get some non-onesie clothes since onesies will be a pain once Evan has the g-tube installed. We got a couple things. A little girl came over to me while I was pushing Evan in the stroller, she was probably 6-7. She wanted to know all about Evan, age,  name, why he’s making those noises, and most importantly what that tube on his face was for.  We give people, especially little kids, very generalized information about Evan’s condition.  We love talking about our warrior son and everything he has been through and how awesome he is, so don’t be afraid to ask us or others about their children.

    On Sunday we went to Ann Arbor for the open house of the brand new U of M C.S. Mott Women’s and Childrens hospital. We stopped to see little Mia, Wendy, and Bobby Wilson and got to see a couple of Evan’s nurses. Nurse Bethany snatched Evan up as soon as I walked in the room with him. Everyone kept commenting on how good he looks. The new hospital was beautiful and the open house was a success, it was packed. Getting from floor to floor was a waiting game for elevators especially for us with a big stroller. Organized chaos. Unlike the ICU’s in the old hospital, the new hospital has all private rooms and every room has a beautiful view and a nice big flatscreen TV. The nurses have little stations outside each room with a computer and a window so the can see inside each room. In that sense the room isn’t private at all since anyone walking by can see into your room but at least your not sharing a room with a loudmouth anymore.

     Evan did exceptionally well with all of this weekend’s travels.  It was interesting being back in the hospital.  We definitely don’t get as many looks or questions because people just know.  We did hear that he is “definitely a boy” which means mama can’t throw a dress on him and slap a bow in his hair and think that people could be tricked into thinking he was a girl.  We have quite a few pictures in the gallery this time.  Some are  from hanging out with Daddy in his room.  A decent amount are from the hospital and have captions.  The last bit are the result from a busy weekend out and about. 🙂

     

  • Cardiologists and Pediatric Surgeons oh my…

     

    I just wanted to let everyone know about our most recent appointments and of Evan’s upcoming surgery. Yes surgery.  😥

    On Wednesday morning we met with pediatric surgeon Dr. Downing at Bronson Methodist hospital in Kalamazoo. We were referred to him by our cardiologist Dr. Fountain-Dommer for the installation of a g-tube. I have mixed feelings about him. On one hand he was very knowledgeable, answered all of our questions, spent quite a bit of time with us, and was very nice. On the other hand he clearly didn’t read one shred of Evan’s file as he mentioned running a bunch of tests that Evan had already had. I guess it’s not a big deal; he sees dozens of people a week and can’t possibly read everything nor does he probably need to. I think it’s just one more point of irritation with the hospitals and doctor’s offices. How many times do I have to tell people at these offices the same things over and over? Evan’s medical history, the medications he’s on… Come on, ever heard of a computer? It’s pretty neat, you can share information, buy the latest copy of Dairy Goat Journal, watch live video feeds of bald eagles giving birth to their young high up in their nest, and watch videos of people doing things to themselves that you don’t even want to know is possible. Sorry… rant over, on to what happened at the appointment.

    Evan will go in for g-tube surgery on Tuesday November 8th at 7AM. Sarah and I were reluctant when it was first brought to us as a possibility but as the weeks have gone on and we’ve talked to more and more people we feel that it’s the best thing for Evan. There are many drawbacks to the NG tube that Evan currently has and it has become clear that his tolerance for eating orally is not getting any better. If anything it’s getting worse. The last several days his feeds have been almost entirely by tube because he’s refused nearly all attempts at feeding by mouth. I’m afraid he’s already developing an oral aversion because of the tube in his nose/throat. I’ll be happy when it’s gone and I am sure Evan will feel much better as well.

    The surgery should only last about 30 minutes but they will keep Evan throughout the day and likely overnight just to make sure that all is well, he’s tolerating his feeds, and to teach us about the tube and pump. Here’s what the surgery consists of:

     

    A small incision will be made in the belly button and a camera will be inserted, another small incision will be made where the port will go. The stomach will be pulled up to the abdominal wall, an incision made into the stomach, and the g-tube inserted. A balloon on the inside portion of the tube will be blown up such that the tube and stomach is held securely to the abdomen. Over time the stomach will adhere permanently to the abdominal wall and may be cut away at a later surgery but is not necessary.
    On the outside the tube/button will look like this. It will rotate fairly freely and will be rotated on a regular basis to keep it clean and healthy. It comes about 1/4″ off the surface of the skin. When it’s time to feed the cap is opened and a tube is inserted and locked in place. He can either be fed by gravity like we have been doing with the NG tube, via a syringe by pushing food into his stomach, or with a pump that can perform feeds at regular intervals or continuously overnight. How he’s fed will depend on what the nutritionists would like us to do.

    Here is another view of the device: 

    The most shocking or disconcerting news that we received was the answer to this question. “Do you expect that Evan would have the g-tube through all of his heart surgeries?” To which Dr. Downing answered, yes. This means that Evan will have the tube until he’s 2-3 years old. That was not what we wanted to hear but after hearing the doctor’s explanation it made sense and I am much more comfortable with it. Just because Evan has the tube does not mean that we need to use it if he starts taking all of his feeds on his own. On the other hand if we need the tube for feeding or medication it will be there, especially following his upcoming surgeries when many heart kids have trouble feeding normally.

    We’ve heard from many parents and doctors that the g-tube was the best thing they could have done and they’d wished they did it sooner. I hope we have the same experience with Evan.

    Following the appointment with ped’s surgery we met Dr. Loker, one of the other pediatric cardiologist’s at Bronson. We met with him because Dr. Fountain-Dommer was not in the office that day. I got a really good impression of Dr. Loker as well. And….. Evan has gained another 5 ounces!! He’s up to 11 lbs 7.7 ozs!! Hooray.

     

  • Last really long update….

    Ya don’t hold your breath… but I’m going to try if for no other reason than these loooong posts really suck to write.

    It’s been two and a half weeks since the last post. I keep saying that i’ll make one more big post to get caught up and then make smaller posts thereafter because… 1) they take forever to write 2)make writing a post that much more time consuming and easier to put off and 3) people don’t want to spend more than 2 minutes reading a post anyway. So here goes…

    Since the last post we’ve had:

    2 Pediatrician appointments
    Normal, nothing out of the ordinary to note.

    2 Cardiologist appointments
    We’re still getting ‘the weight talk’ from the cardiologist and for some reason we sometimes get this vibe from her that she’s annoyed with us as though it’s our fault that he’s not gaining weight. <shrug> maybe it is…maybe we’re not putting enough in his tube, maybe we’re moving him around too much after he eats and that doesn’t help his puking problems. I don’t know.

    We’re doing much better, we’re pushing him harder than we did before. We’ve increased the amount of formula that we add to the breast milk, increased the amount that we give him per feeding, and we’re still getting up in the middle of the night to give him a sneak feeding while he sleeps. He seems to be puking less than before maybe 1-2 times instead of 2-3 times per day. At the last appointment he had gained 4 ounces from the previous week, an all time high since we’ve been home so that’s definitely a step in the right direction. Since he’s gained a little weight some of his meds were increased a little bit. At the last appointment Dr. Fountain-Dommer also added a new medication, Digoxin. After looking at the echo-cardiogram she added this medication to increase the force or distance that the heart contracts on each pump.  We’ve got an appointment with pediatric surgery next week to discuss and probably schedule G-tube surgery.

    Lunch with LIMS people
    LIMS stands for Laboratory Information Management System, it was a big project that I worked on implementing at work for over 2 years. Of course everyone hates it as they do all new things…they have good reasons and their old system had all kinds of custom things built in that were lost… anyway, it’s all Karen’s fault 😀 . We met at Angelo’s for an Evan meet and greet. Barb and Karen spent a majority of the lunch holding the little man. I think they are both in need of some grandchildren.  😉 Michelle, Paul, and Will also came to spend some time with us. Thanks all! It was great to see everyone again.

    Lunch with the QOTT Quad

    Three people in my group at work all had kids in July. Brooke had a girl, Jenny had two boys, and I was blessed with Evan. Our group Quality Operations Technology Transfer (QOTT) refers to the babies as The QOTT Quad. 🙂 The seven of us met at North 11 for a nice meet and greet. Evan was on his best behavior and slept through almost the  whole thing. It was good to see all the babies and talk to the Brooke and Jenny about how life has been over the last few months and express my jealousy for neither of them being back at work yet. From left to right is Cameren, Evan, Garrett, and Cody.

    Early on Evaluation

    In each state there is a program for infants and toddlers that have developmental delays and/or disabilities. In Michigan, this program is called Early On. When we were at the hosptial a social worker suggested that we have an evaluation just to see if Evan had any delays and if the program could do anything to help us. In general, children in the hospital lose a day of development for each day that they are there. On a Friday morning three women came walking up to the door and I thought, “uh…. wow, you have to be kidding me. This is serious business.” As it turns out one of their cars broke down about 5 minutes from our house and the third woman was the person that rescued them. The evaluation was very thorough and we were very impressed by the people that came. They looked at overall health, vision, hearing, fine motor, gross motor, cognitive thinking, communication, social emotional, and self-help. As we would expect due to his long hospital stay Evan showed that he was a little behind. The categories of concern were fine motor, gross motor, and cognitive thinking. This encompasses things like holding his head in symmetrical positions, bringing hands to midline, holding hands open or loosely fisted, playing with hands at midline, and reaching for things. They gave us some information and some things to try including baby massage techniques  which we have done a few times and he really seems to enjoy. We’ve already seen an improvement in his motor function since we’ve started focusing on getting him to bring his hands together and reach for things. They also set us up with an occupational therapist that can give us suggestions and help with getting him to feed. It was a great experience and I am glad that programs like this are available to people.

    Trip to Ann Arbor
    We went to Ann Arbor for a baby shower, the MI vs MI State football game, and to visit friends at Mott Children’s Hospital. Evan does great in the car, he spends nearly the whole time sleeping. This trip taught me something… don’t leave the house with an infant, especially one with medical needs and feeding problems. By the time we got to the hospital Evan was hungry and mom had to go pump. I fed him in the hallway, but as usual he didn’t take enough by mouth so I had to setup the feeding  tube on his stroller. We saw Mia Wilson for a little while and talked with her dad Bobby. If you’ve kept up with our website you probably remember Mia. Please keep her and her family in your thoughts and prayers. Little Mia has been at Mott since February and was very close to going home last week. Since then she has had a couple setbacks that have kept her in the hospital. She’s doing better but the doctor’s have not been able to trace the cause of the issues. We made it to the baby shower about an hour late, Evan was pretty good to start but got fussy and inconsolable pretty quick, clearly tired from all the action. I put him in an empty room in his bouncy seat, fed him, and he fell asleep. I went outside to play some bocce to be called back in after only a few minutes since baby boy projectile vomited all over the kitchen floor. Then to top it all off, we’re driving home and I realize that we forgot our camera and more importantly his heart medication in the refrigerator. Oh no. Very lucky for us our neighbor had not left yet and after a quick phone call they saved the day. Thanks Jason and Carin.

    Milk Scan

    This is a test where radioactive material is added to Evan’s milk and he’s continuously scanned for a long period of time (1 hour) to see how much reflux is present. After an hour we leave for an hour and then come back for one more 5-10 minute scan to check for any aspiration into the lungs.  This test was done on the morning of 10/19 and took all morning. Evan did pretty well, slept through most of the scan. After the initial hour we started to put him into the car seat and he threw up all over the floor. Then about 15 minutes later when I was on my way to get some much needed coffee he threw up again. Did I mention that I had given his meds right before he threw up? Ya…. that happened twice. I gave his meds 3 times that morning. They say that if he throws up within 15 minutes of giving the medication then you give it again. Bah…. poor guy. Results of the milk scan? NORMAL?! What the!? <sigh> ok, well I guess that’s good but we we’re hoping for something to point at his throwing up issues. On the great side, this probably means that he will not need the Nissen wrap that was suggested. We’ll find out for sure at the pediatric surgery appointment next week.

    Sarah went back to work
    Sarah went back on October 17th. That week  we had an appointment on Monday, Wednesday, and Thursday. Logistically, appointments are such a pain. I either have to work from home for a half day, lose an hour driving back and forth, or Sarah has to take time off of work. It doesn’t help that work is 20-25 minutes from work or that the pediatrician is 30 minutes from the house. Sarah is not very happy about being back at work, for obvious reasons. She misses Evan terribly throughout the day, being gone for 12 weeks and coming back is difficult, you feel like you’ve forgotten everything, and pumping at work?! Bleh. My mom is doing a great job and Evan has taken to her just awesome. Most of the time he takes more food by mouth for her than she does for us and he almost never pukes when my mom is taking care of him. Maybe she’s just lucky. Ya, let’s go with that.

    3 Months old last Friday
     Yay!!! Oh baby boy, you’re growing up too fast already. What a great feeling it is to know that we’ve spent more time at home with him than we spent at the hospital.

    Halloween Party

    I know it’s a little early for a Halloween party, but people are busy the next couple weekends so we got some of the babies together for a party/costume contest. I told my friends to prepare themselves for a loss because there’s no way anyone can top Evan’s costume. Much smack talk happened and I refused to tell any of them what he was dressing up as. In the end our little dragon took home the win! Look at how cute he is. The costume is waaay to big for him, to the point that I am sure he’ll still fit into it next year which is good because I’ve never spent so much money on a costume for myself let alone a small baby. The pictures of the party are not very good, we’re going to take more of Evan in his costume and i’ll post them when we do.

     

  • Grandparents, testing, and someone’s not eating…

    My parents have lived in Florida for the last 12 years. For some reason I can’t begin to understand they prefer the warmth, beautiful weather, and year-round beaches to the ever changing weather, overcast skies, and snow of Michigan. Well all of that is behind them now as they made the 1200+ mile drive with a 26 ft truck, 12 ft trailer, a pickup, cats, and my nephew to Kalamazoo at the end of September. We are very grateful that my parents are willing and able to make such a life change to help with Evan. Instead of a daycare, my parents will watch Evan during the day while mom and dad are at work. Thanks Nana and Papa! Thanks to all my wonderful friends that helped get them settled into their new apartment just a few miles down the road. And if any of those people are reading this…. there’s plenty of work left to do in my garage and basement with the things that wouldn’t fit in their apartment. I’ll supply food and beer.

    We transmitted our first set of pacemaker data to U of M with our fancy little gizmo. How fancy? Well when it dials its circa 1995 AOL beeping and clicking let’s you know it’s working. It worked just fine and the response we got back the next day from U of M was that everything looks good.

     

     

     

    Let’s talk about eating, or lack thereof. Evan has gained…. nothing since we left the hospital? Shocked? We were too. Feeding continues to be something that we battle. Between Evan not taking enough food, being visibly uncomfortable when he does, and throwing up afterwards it’s been an uphill battle that we’re not making any progress on. Evan had a swallow study and an upper GI study to make sure that his anatomy is correct and to check for reflux. Both tests showed that his anatomy is normal and he’s not swallowing into his lungs.  

    The GI study was inconclusive about reflux, but we didn’t need a study to tell us whether or not he has it, it’s pretty obvious if you spend some time feeding him. Both studies involve Evan drinking a bottle of a barium mixture and then watching him swallow on a live x-ray. The barium looks like liquid chalk and doesn’t  make for easy diaper cleanup. When Evan eats it’s a roll of the dice whether or not it will stay down… sometimes he’ll take a huge bottle and not throw up, sometimes he’ll take 1 ounce and throw up, sometimes he’ll even throw up 2 hours after he ate. He’s on Zantac to reduce the acidity of anything he refluxes so it does not irritate his throat and he’s on Reglan to help promote digestion. Baby boy… you’ve got to eat and you’ve got to keep it down.

    Other than feeding he’s really good. We’re still going to the doctor constantly, generally 2-3 times per week. This week we were at the cardiologist and they are doing the normal routine, EKG, listen to his heart, check his sats… in the 60s! Oh S!@%. They should be in the 80s. What’s going on? She listens to his heart and then we go to another room for an ultrasound, everything looks good. They check his sats again, and they’re back in the 80s. What changed? Well the room where the ultrasound machine is… 15° warmer. That’s right folks, he was cold. Cold makes the veins constrict and less blood gets to the extremities.Another cause of low sats? Dehydration…BAH! It all revolves around feeding.

     Last week we started fortifying Sarah’s breast milk with formula to raise it from 23 cal per ounce to 27 cal per ounce. That didn’t help… Evan just will not take enough milk. So we  had to do it… we had to put the feeding tube back in. We didn’t want to do it and we’re concerned about Evan developing an oral aversion because of the irritation but we don’t have a choice, we’ve been home for 5 weeks and he has not gained 1 single ounce.  😥 We’ll get there it’s just going to take more time. The cardiologist mentioned the G-tube again… I’m beginning to think that it might be the best option. Not yet… I want to give it some more time, but maybe it is the right thing for him. The success of the second surgery and his recovery is more important than him having a tube coming out of his stomach for a little while and the risks that come with it. We’ll see how things go….

    I love to sit and watch him watch things. He absolutely loves the television, the bright light and the moving pictures. It has become more frequent now, so it’s got to be more than a coincidence but when he doesn’t want to eat and you put the bottle in his mouth he’ll actually swat it away with his hand. If he’s swaddled he’ll push it out with his tongue or keep his mouth open wide until the milk drips into his throat, he starts to choke, and you remove the bottle, then he’ll close his mouth. He’s no dummy, and boy does he have our number. He also likes to look at himself in the mirror, there is one in his crib and another in his swing that he just stares at. He’s holding his  neck up really well, kicks his feet  out and stretches his whole body out when he’s mad.

    He’s absolutely the most amazing thing that’s ever happened to me and my life is forever better because I am Evan’s dad.

     

  • Feeding and cardiologist updates

    10 days.  No post in 10 days means good news for Evan.  But no post in 10 days also means a bunch of well-intentioned individuals need their baby Evan fix.  I apologize for that.  The post delay is my fault.  Seems to be that having a baby makes you the busiest you have ever been.  It’s all I can do to keep up with a calendar for all of Evan’s events.  And it’s all we can do to keep up with photos and videos, so they are a little bit more scarce as we aren’t always as camera ready as we were before.

    Since the last post Grandma Nancee (my mom) came down and spent a few days with us.  Unfortunately zero photographic evidence of this exists, but it was a lovely time.  She was very useful in helping us get organized, putting things away, cooking, cleaning, gardening, and of course watching after the little man.  I honestly don’t know how couples manage by themselves (I mean without extended family help).  One fortunate thing throughout all of this is that I am healed, am physically able, and we were able to learn a bit about Evan’s personality and his routine before coming home.  I can’t imagine having other kids at home and/or coming home with a 2 day old baby.

    Dad had to go back to work starting Tuesday the 6th.  It stinks that all of his time was used up in the hospital but we are grateful that he was able to be there and not have to use vacation, which we are both saving for the second surgery.  He does have more of an opportunity to have a flexible work schedule and has been able to be around as much as he can, which is very helpful.  I love being able to be home with baby boy, even if it is tiring and feels unproductive at times.  Just relishing in those itty bitty baby moments makes my heart soar, so I can’t imagine how much Dad must think of coming home to snuggle with Evan.  I mean, who wouldn’t want to snuggle with this cutie pie?  Especially when he is zonked out in a milk coma.

    We are still working on Evan’s feeds, which apparently is the thing you do with your heart baby.  We have ng tube feeding supplies but Evan has other plans and has pulled out his tube.  We decided to leave it out and see how he does on his own because we truly don’t know.  Doctor’s orders are to feed him 75ml (about 2.5 oz) every 3 hours, with a total of 600ml at the end of the day.  He is drinking unfortified breastmilk (mine tested between 24-30 cal/oz) and is doing OK but never really hitting goal.  He is closer to hitting it some days more than others.  We are concerned about his weight gain, or lack of it.  A visiting nurse is also coming to the house 1-2 times a week and he is weighed at this appointment along with cardiologist and pediatrician appointments so maybe because so many scales are being used it is not providing consistent and reliable data.  Maybe it is becoming a bit over-analyzed at this point.  At our cardiologist appointment on the 12th, we voiced our concern about feeding and weight and our doctor wants us to keep the tube out until our appointment next week and see how he does.  She feels the ng tube can do more long-term harm than good and she believes that if Evan truly needs assistance in getting his caloric intake, he should be fitted with a g tube.  I’m not too excited about that idea so hopefully Evan was listening and will kick up his feeding a bit.

    The rest of the cardiologist appointment went just as planned.  The shunt looks great but she wants to keep an eye on it so we will have weekly cardiologist appointments. The echo on his heart showed that everything still looks like it should.  She looked over his meds and agreed at the amounts.  His heart med, captopril, is a compound medicine and there are only 2 pharmacies we can go to to get it refilled, so I’m glad we found that out.  Uneventful is good. 🙂  The next day we had the visiting nurse stop by and of course you think of more questions when you aren’t at the doctor’s office. I asked about his potassium levels because when we were in the hospital they gave him potassium pretty frequently because the diuretic furosemide that he is on can deplete it. She’s going to check with the cardiologist. I am also on the lookout for dehydration since he does not seem to have the same huge pee diapers that he was having after a dose of furosemide. Other than those very minor things, he is just wonderful.

    Evan and I also tested out a moby wrap that a friend is letting us borrow.  I still need lots of practice with it but so far he really likes being in it.  It is a bit warmer than I had thought and the material is pretty stretchy and it is supposed to be that way but after wearing it for a bit it tends to stretch too far so I need to make it tighter.  Evan doesn’t appear to mind too much tho 🙂 We also gave Evan a bath in his new big boy tub.  Previously he had only gotten sponge baths so immersion in warm water was a new adventure for him.  He kept looking at us with a “what the heck are you people doing” expression.  No crying or fussing but plenty of big-eyed expressions.  Afterward, however, he gave us the signal to get him clothed and bundled up as quickly as possible.

     

    Pretty Cute from William Wood on Vimeo.

    Evan was sitting with mom and was a very happy little boy, until he got hiccups.

  • Enjoying being at home

    Sorry that it’s been several days without an update… I know you won’t believe it but we’ve been pretty busy. This having a kid thing is pretty time consuming. Who knew?

    Let’s see… Evan sleeps really well. So far the nights have been pretty good, he’s been sleeping for 6+ hours at night but we have to feed him in between so we’ve been putting it down his NG tube while he sleeps (2AM feeding). The tube is actually pretty handy. I mean, of course I want it off of his face, but it has it’s advantages. 1) he always takes his entire feed whether he’s awake or not 2) having a problem getting him to burp? nope, you can syringe excess gas right out of his stomach, 3)wonder how well he’s digesting his food, you can pull up what’s left, if anything before a feed to see what’s left from the prior feed, 4) doesn’t like the taste or doesn’t want to take oral medicine? (see video), just put it down the tube.

    Follow up care for Evan will be handled by doctors here in Kalamazoo. Evan’s first appointment with the pediatrician was Saturday morning. It was very basic, they just did the normal measurements, weight, listen to lungs, and heart and we filled out a ton of paperwork. The doctor admitted that she was late because she was reading all of the doctor’s notes from U of M. Uh ya…lot’s to read. We have another appointment in a couple weeks. Additionally, we have a cardiologist here in Kalamazoo and U of M set us up with several visits with a home care nurse as well. Her first visit was Sunday morning. The home care nurse comes every couple weeks to check on Evan’s progress. I’m looking forward to seeing the cardiologist, it was her that correctly diagnosed Evan and got the ball rolling way back in March. Look at him now.

    Evan got his first real bath tonight. We’ve still got to get a countertop tub for him, but tonight we put him in the bathtub with a baby bath sponge thing. Turning the shower down to a trickle he really seemed to like the whole thing. He’s such a good baby.

    We have two small dogs, Molly and Maggie. While we were in Ann Arbor various friends watched them for us and we’re very grateful. The dogs came back to the house Friday afternoon and have been great around Evan. They leave him alone and surprisingly do not seem to be interested in him at all. We’ve managed to coax them into smelling him but they really don’t seem to care.

    Here are a couple videos from the past couple days and also some photos.

     

    Evan finds his thumb from William Wood on Vimeo.

    This is the first time that Evan really found his thumb and latched onto it. We put him on his belly for tummy time and he was not real happy about it but once he found his thumb it was just fine.

     

    Yucky medicine from William Wood on Vimeo.

    Evan likes most of his medicines, apparently not this one. Poor guy.

  • Back in General Care!!!

     

    It’s a very surreal feeling, being back in general care. We were here once before for a very short time. We thought then that we were on our way home, that was two weeks ago. Hopefully this time will be different. It feels different. All that stands in our way is one more trip to the OR to remove the Broviac catheter from his chest (scheduled for Wednesday morning), his little boy surgery, to continue doing well with feeding, and all the normal stuff that goes with discharging a baby. We’re being told Friday. Evan will go home on 4 medications. Lasix for fluid retention, captopril for heart function, phenobarbital to suppress any more seizures (this one we will only have for a month), and baby aspirin which he’ll take forever to help prevent clots. I’m not sure how long the Lasix will last. The captopril will last until the next surgery at the very least.

    As strange as this may sound to most of you, it will be with very mixed emotions that we leave this place. The biggest thing is knowing what to do with and how to take care of Evan if something happens. Not having the safety net of doctors and nurses right there is a scary feeling. The hospital is doing a great job of preparing us and providing us with resources above and beyond our doctors in Kalamazoo. Additionally, over the past 40+ days and nights we have met many great people, both families and staff.  Even though we have not grown really close to any one person it feels, at least to me, like we’re some kind of big family. Maybe family is too strong of a word but  we’re all here for similar reasons and we all have the same goal, to get these kids healthy enough to go home with their families where they belong. Sarah and I spend much of the day on our computers looking at various things on the internet, one of these things is blogs of other families who have been in our position already or are walking this winding road with us. Sometimes this can be very difficult since not all stories are happy ones, but other times it is very uplifting and therapeutic to see how well kids do after having these surgeries. One such case is Aly Jean. Aly was born in June of 2009 and has had all three of the surgeries that Evan must have. Her last surgery, the Fontan, was performed here in Ann Arbor (as were all of her surgeries) in March 2011, she was in the hospital for a mere 8 days after that surgery and is now thriving like any two year old. Among a group of kids playing, you would never pick Aly out as being any different. She’s an inspiration to us and I can only hope that Evan does as well as this amazing little girl. You can follow along with Aly here.

    There are several other families here that now hold a special place in our hearts as well. The Butcher’s are a family we met through Aly’s website and happen to be here at Mott right now as well. Their daughter Brittany (13 years old) had a heart transplant in late 2008 and her body is now rejecting it. For the past several days she’s been sedated and paralyzed to let her body recover stress free. She’s on about 20 medications, a ventilator, and her blood is being removed, ‘washed,’ and put back in her body. This is called plasmapheresis and essentially strips her immune system to zero in order to stop the body from attacking the heart. Mia Wilson is another miracle in the making. Her and her family (parents and 3 sisters from Akron, Ohio) have been here for nearly 6 months and unfortunately little Mia still has a long way to go. Before she was born her parents were told that she wasn’t going to make it, but 4 days after birth she was still holding her own. She was flown to Mott Children’s hospital where the amazing staff here has helped with her heart problems, a stroke, bouts with severe hypoglycemia, hyperbilirubin, hepatic insufficiency and multiple stomach and bowel problems. Mia’s website is http://www.miasbigheart.com/ and I highly recommend watching the 13 minute video. Please keep these and all CHD families in your thoughts and prayers. Congenital heart defects are the #1 cause of death among all birth related defects. Nearly twice as many deaths occur from CHD than all childhood cancers combined.

    A group called Metals4Mettle came by today and gave Evan a medal from the Detroit Marathon. They had dozens to choose from but I chose this one because it’s close to home and looks very cool. These metals are donated by finishers of marathons all over the world and given to children and adults that are “fighting debilitating illness who might not be able to run a race, but are in a race of their own just to continue to live their life.”

  • Two scary steps back

    The short of it: Evan had a seizure early this morning and several more throughout the day.  They are the result of a stroke he had some time ago but not sure when.  He is comfortable, sleeping, and stable.  His brain activity is being monitored continuously for 24-48 hours.  He is NPO again (removed from feeding).  We were scared but it appears he is ok for now. Here is how we got here…

    I received a phone call at 4:45 am from a cardiology fellow.  Overnight calls while your child is in the hospital are never a good thing.  I was so out of it that I didn’t answer the phone, but had my bearings enough to immediately listen to the voicemail he left.  Heart racing, I learned that Evan had a seizure and that he was currently undergoing a CT scan.  Thank God he said the phone number for Moderate Care twice so I could make sure the reality of what I was doing was not some scary dream.

    I called Moderate Care and spoke to nurse practitioner Denise who gave further details on the fellow’s message.  She explained that at around 3 this morning, Evan’s oxygen saturation alarm was going off.  The nurse suspected that perhaps the pulse ox band just came undone (it does happen a lot, but mostly when they are awake and moving or when you are holding them and moving around.)  When she came to check it out, she noticed that Evan looked “mottled and dusky.”  She took a blood gas sample and gave him oxygen.  His pH was a little low, lactate was ok.  After a little while he started doing better and became more responsive.  The plan was to take another blood gas in an hour and see how it looks at that time.

    At 3:30, the nurse went to reposition him and have him sit in his Boppy.  Suddenly he stopped crying and moving, his breathing became sleep apnea like, his head moved to the left, his eyes deviated off to the side.  She said he went “unresponsive” and called the cardiac fellow in to look.  They pulled another blood gas and this had a better pH,  lactate was still ok, white blood count was normal (indicating no infection), hematocrit was fine (indicating good response to transfusion yesterday), and his potassium was a little low so they gave him some extra. There was a concern he was having a seizure so they started him on phenobarbital.  His feeds were turned off and they ordered a CT scan (he can’t get a MRI due to his pacemaker, but I think the CT is the default test).

    Evan getting hooked up to the EEG

    By the time we got to the hospital at 6:45, Evan was already back from his testing, his birthday balloons detached and bunched together because they had to move him in his bed for the procedure.  He looked completely normal, still had his feeding tube in (which Evan ripped out but that’s for the better considering he is NPO again).  I got to snuggle with him until 8:30 (Dad is feeling sickish and wants to keep some distance) until I had to step out for a bit.  When I came back at 9 people had arrived to place Evan on EEG or Electroencephalogram.  They are going to continuously monitor his brain activity for 24-48 hours, depending on what they see.  Additionally, he is being video and voice recorded as well, so they can see what happens when he has one of these fits.


    Dr. LaPage playing with pacemaker settings

    At 10:30, Dr. LaPage, the electrophysiologist, came by to check Evan’s pacemaker setting.  He has been having low diastolic blood pressures today and they wanted to see if raising his heartrate from 110 to 120 would improve this value.  It didn’t so they left it at 110.  When your heart is in diastole, it is filling with blood before it contracts again.  Your diastolic BP is the lower number.  The fear is that a low diastolic BP may have contributed to his previous cardiac episode on the 16th, so they’ve been monitoring this value as well.  It had normally been in the 40s but it was in the low 20s when they started trying to make adjustments.  Its a teeter-totter balance between pacemaker rates and medications.

    Yet another echo

    An echo was ordered to see if perhaps there is something lingering with his broviac, a catheter placed into his heart during his first surgery.  Perhaps a blood clot formed and traveled to his brain – the nurse suggested.  Wait – blood clot?  That sounds like a stroke.  Thought we were talking about seizure here.  A thorough echo was performed around 1:45 pm.  It was perhaps the clearest images of his heart we had ever seen and we were pestering the technician with structural questions.  “We’re nerdy science people who didn’t go into medicine,” is our explanation.

    Dr. Leber and Neurology Fellow exam Evan

    During the echo, the neurologist, Dr. Leber, and a fellow came to talk to us.  During the conversation we talked about the CT scan images and he said, “Do you want to see them?”  Why yes, yes we do.  The majority of the questions resulted from the images.  Evan had a stroke, not yesterday and not when he was born, but sometime.  The doctor did make a comment like it might have happened “a week ago.”  Hmm a week ago… what happened then… Oh that’s right his cardiac incident where he went critical with acidosis and was rushed back to PCTU.  Unfortunately this is the only CT scan we have so we can’t compare to anything, but Evan did have an ultrasound performed on his head the day of his surgery and when looking at those images (although not nearly as easy to see) the doctor did not see any damage at that time.  Damage.  Yes, Evan has some on the left side of his brain.  On the CT images, it looks quite large.

    This isn’t Evan’s brain and I think it is a “normal” adult one but I’m not sure.  I just drew this up for visual reference.  A CT scan is like slices of your body from your toes to your head, so when you look at images of the brain its like looking up someone’s nose.  The left and rights are backwards.  The area of injury permeates through several “slices” of Evan’s brain.  The image I drew would be the damage at its largest.  As you travel the slices toward the top of his head or toward his toes, the area tapers in dimension.  CT scans are gray in color, and the damaged areas turn darker gray.  White is the skull.  Black is water and having some at his age is ok.

    So what will the damage be?  It is hard to say in a baby this young.  If it were you or I, the doctor said we might have trouble feeling our right leg, hand, or right side of our face. We might have trouble with verbal comprehension but not talking.  We might have issues with being able to name/identify our fingers on our hand.  We could have attention problems.  Who knows how this will affect Evan.  His brain is growing so rapidly that maybe no damage will be done.  We don’t even know his handedness yet (I’m thinking southpaw but that’s just me).  There is another area of concern on Evan’s right side as well.  Evidently, as the damaged stroke area gets older, it gets darker in the CT scans.  There is a slightly shaded area on his right side that would be indicative of a separate stroke incident if it turns out to be something.  They are going to check in a week to see if the area darkens and to confirm if there was another stroke (think of the stroke areas as slowing developing polaroid images).  Even when he is 20 a CT scan will show a dark area on his left side from the confirmed stroke region.  It might get smaller, but it should get darker.  The neurologist said that in adults the area retains a brain look but in babies it often disintegrates into a watery slush (?) but couldn’t say why this is so.  Water on the CT scan looks black, so as he ages it should turn into a blackened mass.


    The treatment for now is to continue to monitor the seizures on the EEG.  Seizures can damage the brain cells on the fringes of the stroke region.  Or it can further damage blood supply to the stroke areas thereby causing more damage to previously unaffected areas.  If they see more seizure activity, they will manage that with phenobarbital doses.  We asked about other medications but that is the best option for babies.  In looking up seizure medication lists there are a lot of familiar names.  Phenytoin Sodium anyone?  More of the wait and see game.

    And just after the conclusion of all of this, a nurse drops a package off at Evan’s bedside table.  A gift from the VanEseltine family.  Lots of tears. Many thanks.  Your support, thoughtfulness, and kindness means everything to us and it couldn’t have come at a better time.

    Results of the echo are fine.  There are no indications of a clot on his broviac or associated with the heart.  Maybe there was one and it was missed before and that traveled to his brain?  The neurologist said it is possible that happened before, but this latest echo again did not show any smoking gun.  Good news is because we identified it as a brain issue, there is no need to keep him NPO so they will start feeding him sooner than later, starting over on the complex feeding protocol.

    Please pray for the doctors to have the wisdom to figure all of this out.  If he had 2 separate events then what is the source?  Are there still more potential clots out there?  Could there be more events?  How much longer will the seizures last?

  • We are eating again! Kinda…

    We are eating again! Kinda…

    It has been seven days since Evan’s cardiac episode (NEC scare) and the surgeons are slowly starting to feed the little guy again. This morning they started him out at 3 mL per hour for 24 hours. It’s being pumped directly into his stomach through an NG tube continuously. If there are no bad signs by tomorrow morning then they will slowly start increasing his feeds back up to the point where he was. Tomorrow they will increase the continuous feed by 3 mL per hour every hour until he’s up to 22 mL per hour. Once he’s there they will stop the slow continuous feed and him on a more normal ‘all at once’ type dose, (this is called a bolus dose) of 22 mL. The following day 44 mL every 2 hours, the day after that 65 mL every 3 hours. This will put him back up to what he was eating before. Once he’s okay with that then they will start increasing the calories of the breast milk from 20 calories per ounce to 22 calories, and then to 24 calories. If you’ve been doing the math that’s about another week of us being here.

    The nurse came in to give him blood today, this was news to us. She said his hematocrit (the percentage of red blood cells in blood) was low. We’re not sure why this happens, I think it’s just due to blood loss during surgery and such. We’ll confirm with the doctors when we see them next. It was not dangerously low by any means and in an adult they likely would not have done anything but they have found that in infants it’s best to have them at the high end of the normal range after surgery.

    Evan is still on Milrinone for cardiac function and we’ll likely go home on a similar oral drug called Captopril. Until his feeds are back up he’s also still on IV nutrition consisting of TPN and lipids (fat emulsion). With food back in his stomach, he’s getting Reglan to help digestion and of course he’s still on Lasix to get rid of extra fluids. As far as tubes and wires, he had the NG tube put back in his nose this morning, a catheter in his leg for blood pressure monitoring and blood draws (which may come out tomorrow!), the dual lumen intracardiac Broviac catheter going through his chest and into his heart for medication, nutrition, etc, the pulse oximeter (red LED thing), and the 4 sticky pads on his chest to measure breathing and pulse.

    Students are starting to show up here in Ann Arbor for the fall term. The streets are getting pretty busy. Get me out of here!

    Here’s some photos of the last couple days.

  • Happy 1 Month Birthday Evan!

    Happy 1 Month Birthday Evan!

    It may not seem like much, being one month old… but given what Evan has gone through in his short time here we wanted to celebrate a little.

    Evan,

    You never cease to amaze us. Every coo, every quivering lip, every smile, every scowl, every cry, every movement, and every look of amazement as you look around your new world melts our hearts. We’ll be forever in awe of what you can do and we’ll be there every step of the way. Thank you for choosing us as your parents and being such a strong little boy.

    Love,

    Mommy and Daddy