I remember

I remember and I also don’t remember much from when we were first told that our son had suffered a bleed in the brain. I reflect on it often when thinking about where Thomas is now from his very first beginnings that started with the brain hemorrhage. I was home alone, in Thomas’ bedroom when I took the call. My husband was at work. I called him immediately. After I called him, I cried.

I remember being in shock. Holding back tears. Confusion. I prepared for the reality that Thomas would die, or remain in a severe comatose like state. The specialists were thrown into fairly unknown territory needing to call on Starship for advise. Thomas was only 10 days old when I was first introduced to epilepsy when seizures became as regular as every few minutes.

I learnt how to do CARES (temperature check, nappy change, wipe nose, mouth and eyes) through the incubator holes. The sounds of the many different monitors. All of which terrified me. I watched my son, motionless. Intubated because the medications slowed his breathing. Pumping milk became a regular slot in the day that led to me storing unused milk because Thomas was no longer tolerating feeds. I remember feeling a mix of hope and a sense of loss as to whether the milk would ever be needed again.

Nurses became friends. Friends kept a distance. Doctors rounds were a regular event each day, not to be missed.

I visited Google regularly in desperation for information on anything related to brain injuries, specifically a Grade iii hemorrhage. Not much, it turned out at the time.

I remember seeing quite a few babies come and go through the NICU and thinking, will we be able to leave with our son one day?

When Thomas started to move a limb and open his eyes. I remember these moments too. I felt like I was witnessing a real miracle. That the seizure medications worked and the seizures ceased.

Thomas was very drowsy for quite some time and he would need time to heal and adjust. That from now on, he was experiencing his world, post injury, for the first time. Celebrating that he could pee again. Tolerate feeds. Move out of the intensive unit. Able to regulate his temperature. Learn to breastfeed. I remember thinking how amazing it is that he would wake and cry. That he could communicate by crying. After so much silence, it was lovely to hear him cry!

Thomas came home after 7 weeks in the NICU. He was born 6 weeks early. We were told he would come home on a feeding tube. Instead, he came home fully breastfed and this continued up until 13 months old. We were told that Thomas might have cerebral palsy and this I had accepted. I was just so thankful that he was still with us.

Thomas is nearing 3 years old and gearing up for kindergarten. Thomas has come a long way since then. He has had a lot of challenges, which still continue every day. But, he is a mostly happy boy who gives and receives love. He is able to communicate in his own way the basic needs like being tired, hungry, thirsty, bored, scared, happy, angry and excited. He smiles, giggles and gives kisses. He comprehends words and follows instructions. He finds ways to move around on his back using his legs and feet. He has a cheeky personality and he loves attention. He loves music and playing.

If there is one thing that every parent/caregiver/family member/friend should know about brain injuries in babies is that every brain injury is different regardless of the grade (1-4) and it’s resulting prognosis. It takes time, a lot of time. Time to grieve, to find one’s way through acceptance and that the grieving cycle runs on repeat every time there is a new diagnosis, event or trigger. It can be very lonely at times simply because it is not a common event and when it does happen, you realize that you may or may not know anything about it or anyone who can walk/talk you through it. Again, there is no way to know how things will unfold. We were told again and again to ‘wait and see’. That was pretty much it, besides having Home Care nurses on board, a developmental therapist and to expect seizures. Having a really understanding GP helped get us fast tracked through certain scenarios. There are plenty of Facebook support groups that are private. There are a lot of blogs out there too. Just find the ones that you can relate to.

It takes courage to reach out when you so desperately want others to reach you. 💕

Lots of updates…

It’s been pretty busy in our household lately. There are so many different focuses at the moment for Thomas.

Everyday is fairly routine but within that day there are lots of different things we need to work on. So many in fact that not everything gets seen to and I feel the pressure often due to this. I know that I cannot achieve everything I set out to achieve everyday but I like to feel that I’d like to try. If you catch me after a bad night with Thomas, those are especially harder days. 

You see, most children develop and achieve certain milestones and move onto something else. With Thomas, I’ve learnt pretty abruptly to leave all those expectations behind. I stopped the plunket visits early on and reading typical child development books because none of that could apply to our situation anymore. I was living with no expectations except to just see how things develop. For the most part of a year, it was extremely tough watching Thomas having seizures, develop dystonia, struggle with feeding, reflux, eczema, and the crying. I’m seen a lot of that so much so that I’m de sensitised to it. I don’t freak out about seizures, unusual spasms or aggressive crying because it has become a norm for us. Don’t get me wrong, seeing all of that does upset me and make me feel powerless to help. But I have learnt that freaking out does not help the situation at the time. It is best to focus on comforting Thomas. 

I get by most days by prioritising what needs to be done and what can wait another day. Like washing, that can definitely wait!

What I try to focus on with Thomas has often been the same for many months because Thomas needs more time to work on certain things. I’ll list those below with how each is going.

• We have been working on using his new cause and effect switches from the Speech Language Therapist. He seems to have clicked onto this idea pretty quickly. He will press it and either listen for it or respond.
• His sensory room that gives him independent playtime. He enjoys this but does not spend much time in it like he used to. He seems to be getting bored being on his back.
• He has his standing frame to practice bearing weight on his legs and hips. Thomas is still a little weary and unsure during this. There is a lot of crying and fussing as he gets used to new things. He does seem to want to push on his legs and lift his head more which is pleasing.
• A big focus is on feeding and keeping a track of how many mls water, formula, and solids and ensuring they are given timely. Thoma has been eating chunkier solids for about a week now which is an amazing development for him. He used to gag on chunkier foods but is now starting to chew a little first before swallowing. His cough reflex is strong so if food gets stuck, he seems to be able to clear it independently.
• Working on cup feeding to encourage more taken from the cup instead of through the tube. He seems to tolerate more when he is thirsty and more alert. Usually he can tolerate anywhere from 20 – 60mls. He prefers water and nothing else. We have tried a few different liquids but he always enjoys the water. So refreshing!
• I try to get Thomas on his tummy often during the day. He is enjoying being off his back and able to get his mouth to his hands easier this way.
• Assisted rolling, side lying, sitting with bearing weight on arms and hands, and bringing hands midline continue to be a therapy focus. Depending on how Thomas is feeling, we can get varying results however in general I believe that Thomas is developing an awareness of what he should be doing and is trying to attempt certain physical maneuvers independently like trying to roll and swing his hips over. His head control is improving. He wants to lift his head and hold it up for longer periods and at times look around the room. He seems to be opening his hands more. His right side in general is tighter, therefore weaker than the left side. 
• Vision therapy such as assisted play with me. We use certain IPad apps, playing with light up toys or bright coloured toys. I have noticed him using his peripherals a lot to try and look out of the left side at people, or things. He is starting to show that he can hold his focus for maybe 2 seconds or follow an item but this fluctuates depending on how alert he is.
• I have posted photos of Thomas on his Facebook page where he is often getting stuck in uncomfortable positions in his cot. To address this we have been using the Safe T Sleep to strap him safely in the middle of the cot. He transitioned straight away with no issues. The only problem now is that we only have 1 because they are not cheap and he’s been out of it for a day or so while it dries from a wash. Bit of a hassle but not the end of the world!
• Thomas is still attending regular twice weekly Conductive Education sessions. These are going really well. He is still receiving individual sessions as these best address his needs. 
• No news on the Gastromy surgery. We are still waiting! Patiently…
• Another focus that I am trying to be consistent with but sometimes let it slip is working on communication with Thomas. Things such as Objects of Reference that are small physical items or words I use repeatedly for certain situations so to help him learn associations and be prepared for certain things. At the moment it is letting him touch a nappy before a nappy change, touching a spoon before eating, or applying gentle pressure to his thighs when he is on his back to let him know he will be picked up or putting my hands under his arms and saying “up, up, up.” This way he knows he’ll be picked up. It seems to me that he is learning to remember these prompts because he will still and wait or when getting up out of a chair he will try to push himself out a little. He is also very cued in to his auditory environment. It’s not that he has super hearing. He’s just very tuned in and knows what certain sounds mean.
• Orally, Thomas continues to chat and babble away. He sometimes says words clear as and other times it is a bit harder to decipher. Words that he will say include hello, more, no more, mum, muma, love you, hello mum, no, and bang. He does not always say words functionally but he sure likes to practice them. Words he uses functionally are love you, mum, hello and more.

Thomas babbling and chatting.

http://youtu.be/ozArPSSh_jE

Thomas using the switch for the first time.

Hope you enjoyed the videos. Any questions, feel free to ask because maybe I left something out?!?!

Today in Auckland it’s raining so best to keep in doors. ☔️ 

Have a lovely day 😀

The choices we want to make.

Please note that I wrote this post and we ended up in hospital numerous times while Thomas was unwell. I now realise that Thomas is now due for his vaccinations…just due. Now the worry is very fresh in my mind. I am still waiting to hear back from the doctor about what I’m supposed to do. 

Vaccinations…
A hot topic. I’ve seen a lot of articles popping up about this especially with the Disneyland Measles outbreak. Every time I see an article, I see hundreds plus comments to follow. Often these comments are ongoing arguments between people, yes mostly parents, who are for and against vaccinations. It’s interesting to read the comments because of the different perspectives that arise for parents against vaccinations. And not because of choice in some situations.

If Thomas had no major health issues I wouldn’t worry so much. It would probably be a case of a grumpy baby for a day or so and its over with. I don’t know quite honestly. I also don’t believe it’s an easy process even if you have a healthy child. There’s nothing worse than seeing your child poked with a needle and tears to follow.

Thomas was 6 weeks premature but still received his first 6 week vaccination when he should have been in my tummy. It completely wiped him out too. He was so tired he couldn’t breastfeed and required nasal gastric feeds for the rest of the day. I felt thankful that he was able to be fed but sad that it wasn’t from me. I felt powerless and useless.

What followed were two more vaccinations at 3 and 5 months. With both vaccinations, Thomas was hospitalised within 2 weeks with seizures. The second hospital stay was over a week due to a rare seizure type, infantile spasms/west syndrome. His form of treatment involved over a month of intensive steroid treatment which left him immunosuppressed for 6 months. This means that he was extremely vulnerable. During this time we held what is called an open letter that means that if he had a slight fever or runny nose, we were to take him to hospital and present the letter which placed him as a high priority. During the 6 months which followed, including winter, I lived in constant fear or worry that Thomas would catch a cold and end up in hospital. We stayed home a lot. Visits were limited with friends and family. Fortunately, Thomas had one cold and terrible eczema.

It’s now been more than 6 months since the treatment and Thomas’ neurologist has advised no vaccinations for now. He’s not due for his next for a few months yet. His GP recently raised the topic during an appointment. She said she would do some research on the process for children like Thomas. This made me realise that vaccinations will never be straightforward if medical professionals are needing to put a plan in place. She mentioned two possible options such as increasing his seizure medication over a 2 week period or hospitalising him for a short duration.

I wanted to write about vaccinations so to encourage people to please not judge one another so quickly. I’m not against it but because of Thomas’ complicated association with it, it makes me appreciate that not everything is so straightforward and that some parents do not get a choice. For now, my choice is limited to following instructions given by medical professionals. 

There is a part of me, a big part, that worries about the next vaccination and what will follow. I understand the feelings of hesitation, desperation and resistance towards vaccinations. I only want the best for my child.

Downhill, fast.

Things went downhill, and fast. Since my last blog post everything was ticking along quite smoothly. Thomas was enjoying his paddling pool, was getting pretty interactive and his therapy sessions were going really well. He had been having a tough time with 4 top teeth coming through but once they had broken through, he still seemed not quite himself. He began having the odd seizure and seemed more irritable throughout the day. We made contact with his neurologist who then doubled his seizure medication. The seizures seemed to ease off but Thomas did not settle within himself.

Thomas has always had involuntary muscle contractions but they seemed more pronounced and often. His involuntary movements include his neck repeatedly twisting to the right, his jaw clamps shut and his arms and legs stiffen and he sometimes holds his breath for 1-2 seconds during these episodes. He would do this during breastfeeding and it wasn’t that he was going through a biting phase, it was involuntary. He would be latched, suckling away and then, without warning, his body would tighten and yes, his jaw would clamp shut tightly. I persisted for a while through this and every time I breastfed, I was extremely nervous and kept my finger on the ready. In the end, it got to the point where he was not getting a decent feed because he kept clamping so much which led to our first hospital stay for dehydration.

Thomas miraculously took to the bottle that night in hospital so we were discharged the next day due to this. Now I realise that he was desperate and that bottle feeding long term was a difficult, tiring act for Thomas. He only lasted less than two days getting sufficient fluid from a bottle and became irritable again refusing solids, bottle, and cup. I knew we only had one option left. I really didn’t want it and I wasn’t ready either. But we had no choice in the end.

We were then admitted again a week later. This time for dehydration and a ‘plan’ to address the lack of options for getting fluid into Thomas. The plan was to have Thomas get an NG (nasal gastric) tube put in. This was purely for fluids if he refused cup or bottle. We were still feeding him puréed solids and the yummy tasting medicines orally. In order to be discharged from hospital I was required to observe x amount of feeds and be observed for x amount of feeds as well as give x amount of feeds independently with no supervision. Turns out it is quite easy to do. Changing the plaster on his face to hold the tube in place is not easy. The fear of him pulling it out by accident  will never go away. The NG tube is a short term plan until Thomas gets a G Tube which requires surgery. This will no doubt happen within the next 6 months. 

Since this discharge Thomas seems to have got worse. He has been having the odd seizure, and loads of dystonia episodes. For the last few weeks, it has been really rough. He has been crying or screaming most of the day. Hence why I haven’t written in a loonnnnggg time. I have been putting updates on his Facebook page but it has occurred to me that I haven’t on the blog. With all the crying and screaming, Thomas stopped showing interest in his sensory room or play in general, he was waking in the night stiffening and only wanted to be held. We grew desperate waiting to hear back from the Neurologist who is a very busy lady understandably, so, we went to the GP. She was fantastic! She got on the phone straight to the neurologist with the okay to start a new medicine. It is a strong muscle relaxant, Baclofen. He has been on it for over a week now and it does seem that he is having less dystonic episodes. However, he is still crying and screaming in pain. I believe it is constipation, with his low muscle tone, he struggles to move his bowels. He will spend a whole day pushing and nothing comes out. I really feel for him. I know he is in a great deal of discomfort and pain so I am giving him Pamol and Lactulose and lots of fluids. We are seeing his Pediatrician tomorrow to hopefully look at a stronger medicine to treat the chronic constipation.

I really hope that we are able to find out what it is for sure that is causing Thomas so much pain (even though I think I know, it is not confirmed!). I just want my boy to be comfortable and happy again.

Neurology and more updates…

We had a fairly good visit with Thomas’ Pediatric Neurologist during the week. Joe and I always ensure we go there prepared with questions because the appointment process goes really fast and you otherwise end up leaving annoyed because you forgot to ask something. Usually you also leave the appointment with fresh questions too. We won’t see his neurologist for another 2 months so the emphasis on being prepared is key!

So the good news is that Thomas has not had any worrying signs of infantile spasms but that if they do relapse we will go straight back on to the steroid treatment because Thomas had an initially positive response to this treatment. We will not need to have him re-admitted or require an EEG as they can do a visual clinical diagnosis. Yay! EEG’s are stressful! On that note, Thomas has a follow up EEG coming up to check for the specific hypsarrhythmia wave pattern indicative of Infantile Spasms. Boo hoo!

Thomas is still awaiting results as to whether he has another rare seizure disorder that the neurologist wants to check on. His blood results show that he is genetically fine which is a big relief for Joe and I. This also tells us that Thomas’ brain bleed was not of congenital origin. 

We were able to see a more up to date MRI scan of Thomas’ brain. It showed us that his brain injury was moderate to severe and that he will be globally delayed in all areas. I hope to get copies of this that I can share but in general terms there is a whole lot of white matter missing and replaced with fluid. The white matter that is missing is all on the outside surrounding the brain but also within the inner part of the brain where his ventricles are located which has left him with enlarged ventricles with bleeding still resolving. I’ve posted a pic below so that if you can imagine that part that is missing is exactly where the visual cortex is as well as part of his motor cortex. This explains why Thomas has a severe visual impairment as well as cerebral palsy. The neurologist said that when Thomas is about 2 years old we may have a better idea of what his capabilities will be in terms of development. For now, we will just wait and see how he develops. 

 

After his appointment he had quite a bit of blood taken for more tests. As you can imagine, Thomas was very traumatised by this experience. For any young bubba or child this is distressing I’m sure but double distressing for Thomas because of his lack of vision and an inability to reason with what is being done to him. I gave him loads of cuddles and he settled once we were out of there. Unfortunately, he had an unsettled night and we stayed home the next day which meant no BLENNZ playgroup for the day. So sad to miss these sessions as they are very awesome for Thomas and I. Thomas was still quite grizzly for the most part of Friday so I know it was the right decision to keep him home for the day. By Saturday, Thomas was feeling much better.

Here are some fabulous pics of Thomas continuing to make great progress with his strength during tummy time. In the most recent weeks, he is starting to show an awareness of his environment such as toys or people. He is trying really hard to get anything into his mouth and has learned ways to do this by shuffling around on his back. He does not have the strength yet to get his hands to his mouth or bring an item to his mouth so we help him out here as much as we can. 

Thomas patting the cat.

A very strong man!

Very smart how he moved sideways! He loves the keys on the side.

Thomas loves to suck on the cats ears!

 

 

 

Spoonfuls of sugar

Drugs, drugs, drugs!

At first, the thought of taking Thomas home and being responsible for administering his medications was quite scary. He had spent a total of 7 weeks in NICU and I’d become used to the idea of NICU nurses taking care of this side of things. I was responsible for feeding him and CARES and that was pretty much it. So I was thankful when they weaned him off his anti convulsant while he was in NICU so that he could be closely monitored in a safe environment. The idea of weaning him off it at home was frightening so one less drug was a relief.

This is just the morning lot of meds alone!

Fast forward a few months and now preparing and administering drugs is a regular part of our routine. In fact, that’s usually how I start my mornings. Thomas wakes for his morning feed, nappy change and medications. He’s usually very good at taking his meds but as he progresses he is showing a distinct awareness of which ones he prefers (the sweet tasting ones of course!) and the ones he does not prefer whatsoever (mashed up pills mixed with water or expressed milk). We are now starting to see him try to spit it or gag it. 

Medication is very much a big part of our daily routine with me trying to ensure that it is prepared and administered routinely.I have become so used to it and it isn’t until a new drug is introduced that I get a little anxious. The anxiety for me is ensuring I give the correct amount and whether there are going to be side effects or interactions with other drugs. Side effects are an unfortunate thing but I’ve found that sometimes you have very little choice. 

Most recently, we have delved into using a range of sedatives such as Midazolam, Melatonin (blimey expensive non-subsidised!) and Chloral Hydrate. These, to me, are the scariest because, well, they sedate my wee man. Midazolam is now only used when Thomas has a seizure (infantile spasm seizure) lasting longer than 10 minutes. Melatonin was used to help Thomas drift off to sleep due to the sleep deprivation side effect of the Prednisone. Unfortunately, he would sleep from 20 minutes to 2 hours so it was not so good at ensuring Thomas remained asleep for an appropriate length of time so we moved onto something much, much stronger.Enter Chloral Hydrate. He needed to be hospitalised while they trialed dosage amounts and to ensure that he was monitored as Chloral Hydrate can slow the breathing down a little. Thomas responded well to the sedative and so we were able to take a little home to see him through for the week. Unfortunately, you can build an immunity to it so that story ended quickly. Thankfully, Thomas finished the Prednisone treatment and is now sleeping much better as you already know as per my last post. 🙂

Big picture wise, for us, at the moment, it is about managing Thomas’ seizures so that they do not cause him discomfort, anxiety or further cognitive delays/regressions. We want to make sure Thomas is comfortable and happy. 

Thomas working hard.