Apollo Update {Pulmonologist 1/13}

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Yesterday we headed out for yet another appointment at Seattle Children’s Hospital. Because the hospital is a hundred miles from our house, we have to leave early to account for traffic, etc, so we often arrive early. And arriving early often means a trip to one of the hospital’s two Starbucks. 012213_9360 blog

While Apollo nibbled oh-so-slowly on a cake pop he regaled us with an animated tale of climbing up on the ceiling…012213_9361 blog

…and then falling down…012213_9363 blog

…and how Daddy would catch him and he would be safe.   012213_9365 blog

While we waited Apollo asked  Daddy to  take him to see “Monkey Mouse”.storyboard001 copy

I cannot believe how big Apollo is getting! He’s gone from being stripped naked and lying on the baby scale, to being too scared to stand on the big scale alone, to doing it like an old pro! And he’s growing…growing, growing, growing.012213_9373 blogPulse ox? That’s old hat too.

And now to the nitty-gritty of our visit.

But let me preface it with this: Apollo will never have a “normal” trachea or airway. He won’t have a “normal” airway because it didn’t develop normally in the first place. As a fetus, when his heart formed, his double aortic arch wrapped around his developing trachea, therefore his trachea has never been “normal”.

With that out of the way, let me say that Apollo’s pulmonologist, Dr. R, was thrilled with his breathing yesterday! The good news is he is much better since his re-operation at Texas Children’s Hospital. Dr. M, really did perform the miracle we were hoping for.

Here in an excerpt I wrote from his visit that day. The entire, detailed entry, is here.

“This time, unfortunately, he was not happy. He said he heard a lot of noise still when Apollo breathes it and it is not what he expects to hear post-double aortic arch division. He kept mentioning the possibility of an underdeveloped airway. Not at all what we want to hear…. He most emphatically told us he  thinks we should seek a re-operation for Apollo in another state. “Don’t mess around with this. This kid’s had enough things that are screwy with his case already. Find someone who knows how to fix it and have it done sooner rather than later”.

Quite a change from what we heard yesterday! Dr. R wasn’t thrilled that he does still retract when he breathes and it is visible from across the room- in part because Apollo is so thin. He also said that he still has a really long inspiratory phase when he breathes, but he is so much better than before the re-operation!

We asked what we could expect in the future. Unfortunately, there is no way to predict which kids have on-going airway issues that affect their daily lives, and those who recover so well they aren’t affected. He said he is “very hopeful” that Apollo’s airway will grow and develop. When he is five or six they will start doing lung function tests (he is too young for them now).  For now, we keep him healthy and keep him growing.

As far as the g-tube, his pulmonlogist said he will need caloric supplementation for long time. Very likely longer than he even needs the g-tube. The thing is, when a person has to work hard to breathe, they burn extra calories. Therefore, eating what a healthy two-year old would eat, isn’t enough for Apollo to grow.

Yesterday’s visit gave us the best news we’ve ever had about Apollo’s breathing. He is healthier and doing better than he even has in his life. In fact, he currently has no appointments scheduled at Seattle Children’s hospital. None.

Thank you so much for your prayers and support as we continue this journey.

 

2012: The Year of Apollo

Is there honestly any other way to describe 2012 in our family?

In 2012, Apollo has:

* Had two heart surgeries

* Six procedures requiring anesthetic

* Eighteen trips to Seattle (200 miles round trip)

* Two trips to Bellevue (200 miles round trip)

{Yes, I drove 4,000 miles to and from doctor’s appointments last year!}

* One trip to Houston, Texas

* Spent eighteen nights in the hospital

* Four g-tube infections required antibiotics

* Three stitches after falling into our brick hearth.

Here it is, written out, for my own sanity:

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January 18: MRI and diagnosis of double aortic arch.

February 7: Visit to his pulmonologist, first echocardiogram.

March 6: Pre-op day.

March 7: First double aortic arch repair.

March 9: Discharge from hospital.

March 20: Post-op visit to cardiologist. Apollo’s heart is declared “repaired”!

March 26: Visit Bellevue for sleep consultation.

April 10: Feeding evaluation in Bellingham.  I am told they can’t help him with therapy.

April 20: Vsits on-call pulmonologist in Seattle because of severe larygomalacia causing “squeaking” while he breathes at night.

April 23: Admitted to Seattle Children’s Hospital for testing. I jokingly tell Chuck I’m going to chain myself to his crib and refuse to leave until they figure out why Apollo can’t eat.

April 24: Upper GI and swallow study show severe compression to his esophagus. The doctors suspect it is “a vascular structure”.

April 25: Rigid bronchoscopy, flexible bronchoscopy and CT scan. These tests reveal what we are later told is a “diverticulum” compressing his esophagus. For some reason, at the time, we were told it couldn’t be fixed surgically, but maybe one day, years from now, he would outgrow it.

April 26: Sleep study.

May 3: Pre-op for g-tube placement.

May 4: PEG tube is place so he can finally be nourished and grow!

May 14: Visit to Seattle to check on g-tube.

May 15: Sleep center in Bellevue.

May 29: Visit to pulomonologist.

May 30: Visit to GI doctor.

June 4: Visit to ENT.

July 18: Feeling evaluation in Bellingham. I am still holding out hope he will “learn” to eat. Once again I am told they cannot help him.

July 31: Nutritionist in Seattle.

August 7: After a series of phone calls and email with Apollo’s cardiologist, we meet with him again. “Apollo’s anatomy and physiology are too complicated to discuss on the phone or through email” I am told. At this visit we are told his left subclavian artery no longer works and it is a “complication” to the first surgery.

September 11: Visit to pulmonologist- he suggests we take Apollo out-of-state to be evaluated. Visit to cardiologist where we come armed with a whole new slew of questions. Some have answers, some don’t.  Pre-op appointment for mic-key placement.

September 17: Mic-key is place. Not more 8 inch PEG tube!

October 5: We meet with heart surgeon at Seattle Children’s to discuss possible surgery. We are told Dr. P has never done a surgery quite like this. In fact, they’ve never had a patient at Seattle Children’s Hospital who required a re-operation after a double aortic arch repair!  Dr. P, however, is willing to try to remove the diverticulum. Dr. P tells us he would wait until Apollo was older to repair his left subclavian artery (requiring a third heart surgery!)

{Meanwhile I have contacted the top three Pediatric Cardiac hospitals in the country: Boston Children’s Hospital, Children’s Hospital of Philadelphia and Texas Children’s Hospital. I spent eight hours one day copying and packaging Apollo’s medical records which I send to all three hospitals. In the end, we decided on Texas Children’s Hospital because they have a surgeon who has re-operated on a double aortic arch.}

October 12: Three stitches in his eyebrow. And antibiotics for g-tube infection.

October 23: Chuck, Tilly, Apollo and I fly to Houston, Texas and move into the Ronald McDonald House.

October 24: CT scan and Upper GI at Texas Children’s.

October 25: We meet surgeon Dr. M who tells us that Apollo’s surgery will be his “sixth or seventh” re-operation on a double aortic arch. He also tells us, in 14 years, he has done a total of 30  initial double aortic arch repairs.

October 29: Pre-op.

October 30: Re-operation on his double aortic arch. Dr. M removed the diverticulum and tells us Apollo’s esophagus now “hangs free”. He also repairs his left subclavian artery! WE. ARE. THRILLED.

October 31: We find out Apollo’s lymphatic system has been damaged (a known risk with re-operations on the chest). He has developed chylothorax and will be on a fat-free diet for two miserable months.

November 8: Apollo is discharged from Texas Children’s hospital. We have to stay in Houston for a week for follow-up appointments.

November 14: Last follow-up appointments in Houston.

November 15: Tilly, Apollo and I fly home (Chuck returned home November 4th).

November 27: Follow-up with cardiologist in Seattle.

December 17: Apollo’s mic-key gets changed for the first time.

Here’s to 2013 being year of health and growth!

Swapping Out a G-Tube

{A special thank you to Tilly for taking photos of the actual g-tube swap! Oh, and she was using my fisheye, because it’s a wide angle lens so expect a bit of distortion.}

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Having a g-tube, it seems, is a process. Apollo had his g-tube surgically placed May 4th, 2012. He had the original PEG tube replaced with a mic-key September 17th, 2012. And yesterday Apollo had an appointment so I could learn to swap out his g-tube, something that will be done every three months from now on.121712_8433-3 blog

 Do you have any idea how much time we have spent by this sign, between the pulmonary and GI clinics? A lot.

Apollo was hi-lar-ious yesterday.

While we were waiting to see the doctor, Tilly was showing Apollo pictures out of The Diary of a Wimpy Kid Movie Diary. When the doctor walked in, Apollo ran over to him and yelled, “Look, it’s a naked guy!” and showed him a picture (of a man laying in a swimsuit on a lawn chair). Needless to say, the doctor and nurse laughed and Apollo shrieked with delight. That pretty much set the tone for the rest of the visit. It was so nice to have a pleasant doctor’s visit. 121712_8440 blog

Here Dr. F is pulling out the package with the new g-tube and explaining the process to me. Thankfully, I had watched several YouTube videos (with Apollo) so I was confident I would have no trouble. Apollo was, of course, a little nervous.

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Dr. F is getting ready to lay Apollo down on his back. 

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Apollo is reaching out for Enoch to hold his hand. 

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 I love how Apollo is eyeing the doctor so skeptically here.

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And it’s all done!121712_8456 blog

Giving Enoch a knuckle punch after we were all done.

It didn’t even hurt!” he said.

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And afterward we took the time go to the hospital play room and hang out for a bit.

I swapped out Apollo’s g-tube.

Cause I rock like that.

 

Toddlers, Surgery and Trauma

Did you know Tilly is my newborn assistant? She’s been helping me for the last three years or so. She’s awesome and knows exactly what I need and when. This shot was taken when I was testing the light at our last shoot.

Thank you all so much for your thoughts on nightmares. I read every single comment. I had not heard about a connection between melatonin and bad dreams. We decided to give dropping it a trial run. Apollo hasn’t taken it for four days. He had nightmares the first two nights and none the last two. I’m not getting excited yet, because he only has nightmares 3 or 4 times a week, so we need to give it some time and see. I am sure he is having nightmares and not night terrors because he remembers them and talks about them (by definition that discounts them as night terrors). He is also now afraid of the dark. Some of that I’m sure is age appropriate and he’s experienced so much trauma in his two years…

We had an interesting conversation at bedtime last night…Apollo asked something about the surgery and I told him the doctors had to do it to fix his throat so he could eat. We looked at some pictures of him in the hospital and he asked, “Did the doctors cut me with a knife?”

“Yes, a special knife called a scalpel.”

“Was is sharp” he asked. “Did they do this?”

He then made cutting motions on his arm.

I said yes.

He reached back and touched his left shoulder and said, “But it hurt when they did that to me!”

I then showed him pictures of Chuck holding his hand in the hospital while he slept. I reminded him that I slept in bed with him every night in the hospital. I am hoping that as his verbal skills grow talking through it will help. If the nightmares continue I will definitely ask for some type of referral for him.

In other news, I have this whole week with no appointments for Apollo! A rare week indeed. The 17th he sees his GI doctor and I will learn to put a new mic-key button in. The next day I meet with his dietician again.

His chest x-ray was clear last week, so this week we get to double his fat intake, now adding in 4 teaspoons per day. Chylothorax with a two-year-old is something of a nightmare. Tomorrow will be six weeks post-surgery and we are still not even close to a normal diet.

 

 

Update on Apollo {Chylothorax Mangement}

This photo of Mordecai is a couple of years old, but one of my favorites. Go check out my Little Earthling Photography blog for more from the same series. 

Apollo had his first post-surgery check up with his cardiologist in Seattle yesterday. Aside from the boy being completely out-of-sorts (he went from crying and crying and crying some more in the waiting room straight into hyper-overdrive in the exam room) it was a great visit.

His lung x-ray was clear! This means we can begin to wean him off of his diuretics. He’s on  two different types and they are making him pee pretty much 24 hours a day and once again delaying the potty-training he is so eager for. The copious peeing is so bad, the other day I changed his diaper, drove to his doctor’s office and by the time we got there 30 minutes later he had soaked through his diaper, jeans and shirt!

Because chylothorax is potentially life-threatening we have to be extremely careful as we wean him off  the diuretics and eventually add in fat. Today I stopped giving him the first medicine, Thursday we begin giving him the second medicine only once a day, Saturday we stop giving it to him entirely, and Monday he needs a new chest x-ray to see how his body is responding. If all is well, we can begin adding in small amounts of fat and checking, by x-ray, to make sure his body is handling the fat. Such a long, tedious, x-ray filled process. *sigh* at least it is progress.

Apollo has lost a pound and a half since his surgery October 30th (if you look at the photos from Sunday you can see his little ribs poking through and his skinny little arms). Not surprising given his non-fat diet, but discouraging. Every ounce he has gained has been hard fought. His BMI is now down to 13% which put him in the very underweight category.

The other great news is that the blood pressure in his arms has evened out! The cardiologist called it “an excellent repair job”. His body is taking over where the surgeon left off, by rebuilding and repairing his vessels and arteries! Thank God for marvelously made bodies that can repair themselves.

All in all, a great visit.