Monday, February 25, 2013

Part 2: Head Injuries and Seizures After a Fall

This is Part 2 to a two part series.  Part 1: When things go bonk, call an ambulance covers Ellie's accident



Now that I (and Ellie) have recovered from the initial shock of last week's head injury, blue spell, and grand mal seizure, I am finally able to sit down and actually write a more informative post about head bonks, post-fall seizures, c-spine precautions and atlantoaxial instability [AAI], and about remembering to list Down syndrome as a medical diagnosis.



Head bonks happen.  Children fall off changing tables.  They fall down stairs.  They climb over baby gates.  They scale walls. . . oh wait, is that just Ellie?  Anyway, falls happen.  It is a part of being a child. A right of passage into toddlerhood. Wipe away the mama guilt and the feelings of inadequacy.  It happens.  We cannot hover over our children with outreached arms 24/7.  It is not humanly possible.  Plus, there is that ever-so fine line of allowing your child to explore.  To gain independence.  Besides, that is what bubble wrap is for.


So we have established that kids fall.  The question is, when do you go to the pediatrician or even the ER?  If I took Ellie to the ER every time she bonked her head, we would be there every single day.  Literally.  I am not exaggerating.  Those who have met my spunky Ellie know that I am not kidding.




Signs your child needs to be seen by a health care provider after a fall:


  • Loses consciousness
  • Stops breathing
  • Unequal pupils-the dark centers of the eyes should be equal size and get smaller when light is shined into the eyes.  
  • Convulsions or seizures
  • Vomits more than once
  • Lethargy, difficultly arousing
  • Blunt trauma / open wound /profuse bleeding that does not stop
  • Difficulty walking or unequal movement of limbs
  • Bleeding or clear fluid draining from the ears
  • Slurred speech

Please note that the above signs may not occur immediately after the fall.  You want to watch your child closely for the first 24 hours.  If your child is due for a nap or it is close to bedtime, be sure to check on her frequently for the first few hours to make sure she is breathing okay, no color changes, and is arousable.  

If she is unconscious, try not to move her in case her neck suffered an injury.  With vomiting and/or seizing, carefully place her on her side, but try to keep her neck stable (yeah, I know, it is easier said than done.  With Ellie, I did not do such a great job on the stabilizing).  With seizing, do NOT attempt to place anything into the her mouth.

If an object is lodged into your child's head (scary, I know!), do NOT remove it. Yes, yes, I know you want to remove it and if your child is conscious, I am sure that she is trying to remove it as well.  Keep your cool and leave it in because removing it yourself may cause further damage.

Finally, when in doubt, trust that mama gut of yours and call the pedi.  If your child seems off to you or things just do not seem right, it takes just seconds to contact the pediatrician and ask to speak with the nurse as she can guide you.  




Which happened first?  Seizure vs. Fall

For Ellie, it was quite obvious.  She fell.  She screamed for a minute.  Then she had a tonic clonic/grand mal seizure--full body rhythmically jerking  (this is the same type of seizure Ellie had during a high fever).  However, in some cases the kiddo seizes and it is the seizure that caused the fall.  Occasionally, it is difficult to answer the question of which came first because the seizure appears to happen immediately upon hitting the floor or because the fall is not observed.

Then there are those tricky absence seizures. The child appears to be staring into space.  There may be mild twitching of the mouth or lip smacking.  The eyes may shift.   Additionally, atonic seizures produce an sudden loss of muscle tone.  The child just falls to the ground or her head suddenly drops.  Unless you are familiar with these types of seizures, they are hard to detect.  Nonetheless, a child may be hanging out on the monkey bars and seems to be paused in mid air and then falls.  Is she planning her next move or is she having a seizure?

Many times, children who endure many falls accompanied with seizing are evaluated for a seizure disorder.  Tests such as EEGs and CT/MRI scans may assist in diagnosing seizures and there are several medications that can help control seizures.

Above, I mentioned three types of seizures-grand mal, atonic, and absence.  There are several types of seizures and more information can be found HERE.




Why it is important to list Down syndrome as a medical condition and in the past-medical-history:

You have heard me say it again and again "My daughter is not Down syndrome.  She is a child who happens to have Down syndrome".  That still holds true, however, the fact remains that Down syndrome is a major part of her genetic make-up and there are several physiologic traits that my daughter possesses as a result of her designer genes.  The main ones being low muscle tone, loose ligaments, and small airways.  For some children, their list may include holes in the heart, hypothyroidism, or a history of heart surgery. These are important to know if your child is injured.  Moreover, if your child is ill (as in heading to the ER for something other than a fall), mentioning that your child has Ds helps the doctor zoom in on certain illnesses such as heart issues/infections, thyroid issues, diabetes, Hirsprung's disease, and leukemia.

Surprisingly, many health care providers may not even recognize that your child rocking an extra chromosome.  At 7 months old, I took Ellie to the ER for anaphylaxis.  She was hanging out with a hole in her heart, serious reflux, and, well, anayphylaxis.  The triage nurse did not realize Ellie had Down syndrome.  She just brushed past the medical history and said "no health issues" and proceeded to tell me that she is fine.  Meanwhile, my daughter's lip and throat were closing.  Being the mama bear that I am/was, I shoved Ellie's medical binder at her and said "she needs to be seen now!  she does have complex medical issues and this cannot wait".  The doctor got it, BUT the receptionist and then the nurse--the first two people you must get past to see the doc did not recognize Ds.

The same held true for our most recent ER trip.  The EMS had no idea.  It was up to me, as her mother, to state that Ellie had Ds and that as such she also has low muscle tone and needs C-spine precautions.  They assumed that my daughter was "a baby" because she is small when in reality she is 3.5 years-old!  C-spine precautions didn't cross their minds. Screaming and then later half-passed out, it can be difficult for someone unfamiliar with Ellie / or your kiddo to detect the facial features associate with Ds.



C-spine precautions after a fall and atlantoaxial instability in Down syndrome:

For me this is a big one because the American Academy of Pediatrics recently updated their health care guidelines for the child with Down syndrome.  In this new update, routine X-rays to screen for AAI are no longer recommended.  This means that your child could be walking around with AAI and then have a serious fall.  Add that to the low muscle tone and the loose ligaments and joints (see about section about why it is important to list Down syndrome in the past-medical history)and your child could have a neck injury (ie. join dislocation) to go with her head injury.

Photo courtesy of: specialneedsjudo.eu


This was actually the most interesting part of our EMS interaction.  Apparently, when the child is very young or very little, EMS uses a car seat to help stabilize the neck [C-Spine Precautions].   The car seat is strapped to the stretcher--the stretcher's belts are threaded through the car seat the same way you would install it in a care.  The neck brace is applied to the child and then the child is strapped into the car seat.  Foam padding and tape are further used to stabilize the head/neck.  In the picture above, Ellie is indeed sitting in her car seat. The EMS said that the added benefit to this method is that the scared child is in a familiar seat.  I will be honest with you.  Ellie was pretty out of it so I doubt she really cared about being in her own, familiar car seat, but I do understand what EMS was getting at!




*Disclaimer: this post does not substitute any medical information or advice provided by your child's pediatrician or other health care provider.  This post is a compilation of my education and experience as a peds nurse practitioner as well as my experience as being a mother.  A mother to a very active little girl who happens to have Down syndrome.  All medical questions and concerns should be directed to your child's health care provider.*-- A.T.



Resources for Parents:

"Head Injury ER Patient/Caregiver Packet." Loyola University Health Services

"Head Injury and Seizures". Epilepsy Foundation.

"Keeping Your Cool When Kids Bump Heads" KidsGrowth.com

Kids Health Parent First-Aid on Falls

"Seizures". Boston Children's Hospital

The Epilepsy Foundation

"Cervical Spine; C-spine; spine precautions". London Health Sciences Centre

"Atlantoaxial Instability". eMedicine.com
Photobucket

30 comments:

  1. I am just now reading all about her accident. I have been out of town! I cannot imagine how you must have felt!!! This is a very informative post. Thank you. Everyone doing alright now?

    ReplyDelete
    Replies
    1. Hi April, Ellie is up to her usual antics. She is doing well :)

      Delete
  2. I can not tell you how many times I have forgot to write Ds as a medical condition. I dont now why but when I am filling that stuff out it is the last thing on my mind! This was such a good post btw and I am SO glad that Ellie is doing well!

    ReplyDelete
    Replies
    1. Hey, you are not alone. I have read that so many people often forget to write down Ds. I get it! You are thinking about why your are in the ER/doc office. Makes sense to me! For me, it is always one of the first things I write down,but that is because I work in health care.

      Delete
  3. As usual, you take the unexpected and turn it into a learning experience for others. Have I mentioned you're my hero? You're my hero.

    ReplyDelete
    Replies
    1. Oh Leah, you are too kind! Guess what I did a lot of in college? Research papers. Can you tell? I mean, doesn't this read like a research paper?

      Delete
  4. Great post and VERY informative! I am glad Ellie is ok! I have been thinking about you guys! xox

    ReplyDelete
  5. Great information. Thanks for sharing a very scary experience.

    ReplyDelete
  6. I get frustrated when Drs assume that it is because of Down Syndrome that my daughter is having issues or it is because of her heart defect.
    She was 6 months old before we got her treated for reflux because they all said she was too low tone to eat or her heart condition was eating up all of her calories or made her too tired. None of those were the case as I have seen her drink a 9oz bottle in minutes. She was just in so much pain, she only ate what she had to.

    ReplyDelete
    Replies
    1. Ah Katherine, I am sorry that your little girl had to suffer with reflux that long! She must have been in such misery :( Ellie was a "happy spitter". Constant spitting up but no back arching or anything like that. Just remember that mama bear gut instinct. You know your child better than any one else.

      Delete
  7. NATURAL & EFFECTIVE TREATMENT TO SEIZURE
    I am happy today that my son have been cure from seizure, which he had for
    10 years now, he do have the attack five to seven times a week, which
    affecting his educational system and his life. when i was going through the
    internet i come across Owens post thanking Dr Lewis hill for curing his
    seizure problem, and i got the contact of Dr Lewis hill i quickly contacted
    him then he made me to know that the medication is 100% cure, and that was
    how i got the medicine which i used for my son, after which i took my son for
    medical test It worked! Over a year now, my son have not show any symptoms
    of seizure and I believe my son is cure if you need his help email him on
    drlewishill247@gmail.com or call him on +1 323-244-4884

    ReplyDelete
  8. I had my first seizure. I was in high school and didn't want anyone to know that I had epilepsy. I had seizures on two occasions. I was so ashamed and didn't want people to think that something was wrong with me. I finally got to the point where I told people that I had epilepsy. I came to the place that I realized that I had to own my epilepsy or it would control me. Epilepsy hadn't really affected my life until about 9 years ago after my first child was born... I am a wife and mother of two beautiful children. I have lived with epilepsy for 20 years Yet, my life has been dramatically impacted by epilepsy. I had search for cure online without no hope. I met a Man called DR Lewis hill, i contact him I made an order of his medicine and I do not experience seizure anymore i was cured form it. So if you are in the same situation as mine contact him on this email drlewishill247@gmail.com

    ReplyDelete
  9. MY BABY DEFEATED SEIZURE
    I have to share this story; it could help someone out there. A mother, father or loved one facing stigma caused by epilepsy and seizure. There is hope. Thank you to the Admin of this blog for sharing this story.
    Joan was born a healthy baby until after 6 months when her seizure started. We took her to the hospital where doctors diagnosed her of seizure disorder. She had more than 50 grand-mal seizures in a single day. It was terrible for our little angel. Doctors gave us Pharma meds upon meds. (Phenobarb and Keppra) which caused her more complications. She was so young that the side-effects were really bad on her. We went back to the hospital where doctors told us that she might not survive more than 24 months. I and my husband went in search for better treatment that will reduce her complications and keep her alive. We never gave up on her. We started searching for at least a treatment without Pharm meds. Fortunately for me, I came across a testimony shared by Brenda Coker on how her baby was cured from epilepsy using HILTON herbal medication. I followed the email she shared and also read Dr. Mohan blog. We realized that there was hope for our baby. We started HILTON treatment, she responded very well, and became Seizure free after 5 months of Herbal medication. Joan is 5 years now and never had any seizure. She survived doctors’ predictions of 24 months.
    As a mother, I am here to encourage people with seizure or epilepsy to contact Doctor Mohan for a cure read more about his Herbal meds via www.seizurecure.blogspot.com

    ReplyDelete
  10. Hello viewers all over the world am Jacky scob, I want to testify of what Dr Lewis hill did for me. i was having a very notorious and serious sickness called seizure and i was very in lost of hope i never believed i was going to be cured until i meant these great man called Lewis hill who God sent to help me cure my sickness . just a few moment with these great man he cured my infection His herbal remedy is the only permanent solution to Seizure. i want you to know that all hope is not lost until every thing is done if you also have these following infections contact his email drlewishill247@gmail.com

    ReplyDelete
  11. I myself have epilepsy. Not to this extreme with grand mail seizures daily, but it still affects me in other ways daily. I am on medicine, which has slowly stopped working and I notice my twitches, blank stares, and memory loss (even in the midst of a sentence) starting to return. The side effects of this drug is noticeable and painful to deal with. It is so strong that if a normal person were to take my dose, they will die of an overdose.when i was going through the internet i come across Owens post thanking Dr Lewis hill for curing his seizure problem, and i got the contact of Dr Lewis hill and i quickly contacted him then he made me to know that the medication is 100% cure, and that was how i got the medicine which i used, after which i went for medical test It worked! Over a year now, i have not show any symptoms of seizure and I believe that am cure permanently if you need his help email him on drlewishill247@gmail.com

    ReplyDelete
  12. My son has seizures. He had a cardiac arrest when he was six months and he has seizures but they are under control. He too, first started out with phenobarbital and keppra and one more other seizure med I can't remember but 5months he changed to sabril and his been more communicative and reacting towards others and having more emotions now. It's been a year now since his event and hasn't had any seizures since but he does sometimes when he gets the flu or high fever, I just wanted to know more about what to do when my child falls off from a counter bathroom table, it's the first time he ever fell off something and I got worried, he cried for a good 10-15minutes until he calmed down while I was holding him and calming him down cradling him in my arms, his seizure didn't activate until now after 3 days. He turned red after the fall and calmed down and was able to breathe well and be calm after I gentle rubbed down on his back and head and body and just hugging him and saying it's ok while giving him kisses. I felt so bad after his fall I picked up his hand to get me in my chest and cheeks and he started giggling gently but I know he was still in shock and hurt on his body. I held him upright and held him close to me while holding him and just gently rubbed his back and the sides of his body and waist and head and he gently fell asleep. Sometimes he cried at night and I think he still remember what happened to him Everytime we go to the bathroom he seems scared. If I think his having a headache cause he'll seem fussy sometimes and cry and be upset I give him infant Tylenol and he calms down after and his all better. I just felt scared and feel bad afterwards and had to Google what to do and what are symptoms I should look out for when my child has fallen down. But he hasn't had a seizure so far and his been ok just the usual upsetting tones if he wants to be picked up and wants to play. I feel guilty when I feel like I've let my son down, cause I have no one else to help me and it's a struggle when I try to take a bath for me and my son and no one else is there to watch him. Sigh. I just felt like a failure after he fell down. I'll never let it happen again.

    ReplyDelete
  13. My son started having seizures he had his first seizure at 6 year within 12 hours We spent 6 days in the hospital where different doctors looking at different things couldn’t agree on why he suffered a seizure… He has had genetic tests including a muscle biopsy. I used to wonder why my son were getting so many vaccinations shots at such a young age, Still the doctors wouldn’t admit it was the vaccination shots. After his 2nd seizure I wouldn’t allow my son to be vaccinated anymore but I
    believe the damage is done. It was during a casual conversation with a friend that I learned about Doctor Lawson Bryan i was so glad to know him on how his herbal product work, I contacted Lawson and explain everything to him and make purchase of his product. few days later i received the herbal medicine my son used it for 3 mouths i notice improvement in less than a month my son was totally cured of seizure now he have not experience any sign of seizure. Contact doctor Lawson Bryan on this + 1 (979) 475-5130 or e-mail dr.lawson52@gmail.com.

    ReplyDelete
  14. Am One of the happiest woman on earth since my son was cured from the problem of seizure,which he has been having for eight years now,he do have the attack two to three times a week,which is affecting is education and his life.i got the contact of a doctor from the post of one Mr paul thanking him for curing his seizure problem,i got the contact and contacted him then he made me to know that the medication is a permanent cure, and that was how i got the medication which i used on my son,and for six month now there have been no sign of seizure in him again.any one with such problem can contact him on his email drwilliams098675@gmail.com

    ReplyDelete
  15. HERBAL MEDICINE THAT CURED MY EPILEPSY

    I can call myself a miracle, one who had survived all odds against epilepsy and got cured through herbal medicine after several years on trioptal, Keppra and clonazepam. I am happy that it has been 10 years, I became totally seizure free.

    Through those dark days, waking up in fear, I thought I might not achieve my dreams of driving. It wasn't what I ever wanted to deal with because all I ever wanted was to drive. Carry my friends and family around. Work and live a great life. But it all became a nightmare when I got my driver's license at 18. I was diagnosed with seizure (tonic-clonic). I had frequent seizures, I used various medications. Worst was I could no longer drive. I was scared of life and everything around me didn’t make sense.

    After years of battling with seizure, I won through Herbal medicine called HILTON. At first I was in doubt, but I decided to give it a try, having spent a lot of money on doctors and drugs. I am so happy it came through for me over 10 years now, I have been seizure free. HILTON CURED ME!

    If you feel like you can try with herbs to get a seizure free life, I will advise you contact Doctor Mohan via his blog on www.seizurecure.blogspot.com

    ReplyDelete
  16. I am Shelley from Los Angeles,California, I want to testify on how i got cured from seizure, I have suffered from seizure since the year 2011 with so mush anxiety ,that i have to spend so mush money getting pain relief in the hospital, and I have visited several doctor ,but all to no avail, my world was gradually coming to an end because of the fainting and muscle spasms , until i saw a post in a health forum about a herbal Dr Williams who use herbal portion in curing people from different kind of diseases including seizure, at first i doubted if it we be able to cure my Generalised tonic-clonic seizure , but i decided to give it a try, when i contacted this herbal doctor via his email, he prepared a herbal portion and sent it to me via courier service, when i received this herbal medicine, he gave me step by step instructions on how to apply it, when i applied it as instructed, i was completely free from seizure just for 1 months of usage,i we recommend this to all my friend family in the world today who still suffering from seizure you can contact him through his email on drwilliams098675@gmail.com for help.

    ReplyDelete
  17. Just wanted to say a huge thank you to Dr Williams for everything he have done in my life. I have been in tears for so many years now, having found that my only son is suffering from seizure, lesion after some years of being under extreme stress., . I spent 24 hours freaking out and finally calmed down after reading some testimony on here about Dr Williams herbal medicine to seizure. The moment came and I mumbled out to my husband about Dr Williams product (with a few tears) and he was AMAZE – . He was just worried about our son been free from this disorder that was how will order for Dr Williams product on line , after my son finish taking Dr Williams medicine for just within a period of one month. Will went to the doc together who confirmed that he was seizure free.
    Thank you again for being upfront, truthful and taking this pain away from my family for more information about his product you can email him on drwilliams098675@gmail.com i hope you can also help other terrified people in a similar situation.

    ReplyDelete
  18. Thanks to Dr Williams I am so happy today, my wife have been suffering from epilepsy for so many years now, and i have spent a lot on western drugs which has all proved abortive, i have tried all means in life to get my wife out of this , but there was no answer until i decided to try herbal solution and i found Dr Williams online and i contacted him and after she took his medication as instructed, my wife is now completely cure from epilepsy within one month of usage, i am so much happy, thanks to Dr Williams for helping me get my wife life back again without any form of crisis, i promise to tell your name and good deeds to the whole world,if you have someone with epilepsy you can email him on drwilliams098675@gmail.com for more information .

    ReplyDelete
  19. HERBAL MEDICINE THAT CURED MY EPILEPSY

    I can call myself a miracle, one who had survived all odds against epilepsy and got cured through herbal medicine after several years on trioptal, Keppra and Epilim . I am happy that it has been 8 years, I became totally seizure free. i constantly felt my health was deteriorating as i constantly go out of breath,and this illness was really terrible especially when am going out with my friends, i have this constant disorder for about 27 years, this was really a terrible illness ,on one faithful day that i was going through the internet,and i came across a post of Mr Andrew on how he was been cured from epilepsy through the help of Dr Lewis Hill herbal product, I contacted his via email and explain everything to him and make purchase of his product,few days later he sent me the herbal medicine through courier service, when i received the herbal medicine i used it for 4 weeks as prescribed and i was totally cured of epilepsy within those week of usage,on thin now i have not experience any sign of seizure.if you need his help you can Contact his via email drlewishill247@gmail.com for more help

    ReplyDelete
  20. ALL THANKS TO DR WILLIAMS FOR THE GREAT DEED HE HAVE DON FOR MY FAMILY.This information will be useful for Epilepsy patients who is willing to use herbal medicine. My daughter had temporal lobe epilepsy, She had seizure and had a grand mal with rage episode. Our daughter's seizure is constant throughout the day. We had used several medicine which include: Epilim and Keppra, experience seizure control at the cost of serious debilitating side effects. It was during a casual conversation with a friend that I learned about herbal Dr. William,who uses herbal medicine in curing people from epilepsy,i was so glad to contact him on his email and make an order for his medication, it does not have any side effect. I am so glad to say that she has been seizure-free since July 2015 after taking William medicine. this a miracle cure?contact him for more detail (drwilliams098675@gmail.com) thanks once again admin for such an informative blog.

    ReplyDelete
  21. NATURAL & EFFECTIVE TREATMENT TO SEIZURE: My son has temporal lobe epilepsy, He has seizure and had a grand mal with rage, Our son's seizure always occur twice in a week according to EEG results. We had used several medicine which include: 600 Epitol 100 Zarontin,
    150 Epitec X2 Daily, Topomax lasted for about 3 days, but I put an end to that due to my son losing weight and being lethargic. I recently got dr williams herbal medicine,that's a natural medicine that cure my son Epilepsy with no side effect. It is an herbal medicine. it is a permanent cure and effective treatment of Epilepsy, for more info, you can also contact Dr.William through this email drwilliams098675@gmail.com for advice and his product

    ReplyDelete

  22. I had my first seizure. I was in high school and didn't want anyone to know that I had epilepsy. I had seizures on two occasions. I was so ashamed and didn't want people to think that something was wrong with me. I finally got to the point where I told people that I had epilepsy. I came to the place that I realized that I had to own my epilepsy or it would control me. Epilepsy hadn't really affected my life until about 9 years ago after my first child was born... I am a wife and mother of two beautiful children. I have lived with epilepsy for 20 years Yet, my life has been dramatically impacted by epilepsy. I had search for cure online without no hope. I met a Man called DR Lewis hill, i contact him I made an order of his medicine and I do not experience seizure anymore i was cured form it. So if you are in the same situation as mine contact him on this email drlewishill247@gmail.com

    He cure listed diseases

    .CANCER
    .HIV
    .ALS
    .HEPATITIS A AND B
    .DIABETIC.
    .HERPES

    ReplyDelete
  23. I have been suffering from (HERPES) disease for the last four years and had constant pain, especially in my knees. During the first year, I had faith in God that I would be healed someday.This disease started to circulate all over my body and I have been taking treatment from my doctor, a few weeks ago I came on search on the internet if I could get any information concerning the prevention of this disease, on my search I saw a testimony of someone who has been healed from (Hepatitis B and Cancer) by this Man Dr. Silver and she also gave the email address of this man and advise we should contact him for any sickness that he would be of help, so I wrote to Dr. Silver telling him about my (HERPES Virus) he told me not to worry that I was going to be cured!! hmm i never believed it,, well after all the procedures and remedy given to me by this man few weeks later I started experiencing changes all over me as the Dr. assured me that I have cured, after some time i went to my doctor to confirmed if I have been finally healed behold it was TRUE, So friends my advice is if you have such sickness or any other at all you can email Dr. Silver (drsilverhealingtemple@gmail.com) sir I am indeed grateful for the help I will forever recommend you to my friends!!! with your lovely Email Address ( drsilverhealingtemple@gmail.com

    ReplyDelete
  24. AM really grateful and thankful for what Dr voodoo
    has done for me and my family. I Was having HIV/AIDS for good three years
    with no solution, the diseases almost took my life and cause I was unable
    to work and I was also loosing lots of money for medication, but one
    faithful day when I went online, I met lots of testimonies about this great
    man so I decided to give it a try and to God be the glory he did it. he
    cured me of my diseases and am so happy and so pleased to Write about him
    today. if you need his help of you also want to get cured just the way I
    got mine, add Dr voodoo on whatsApp: +2348140120719 or just contact Dr
    voodoo via email, voodoospelltemple66@gmail.com

    ReplyDelete

I love your comments and I read each and every single one of them.

Cecostomy Tubes R Us

Here we are - two posts in 30 days! It's scandalous, I tell you!  Seriously though, I bet you all thought that I abandoned ship and woul...