Wednesday, August 23, 2017

Organizing Ellie's Medical Care

It has been an eventful past 2 weeks.  Well, not too much so.  We’ve just had 5 doctor appointments.  Most were anticlimatic, such as ENT where we have graduated to yearly appointments.  Can you say “woooohoooo!?  

First up was ophthalmology.  The Bear still isn’t wearing her glasses.  We’ve been doing atropine drops into her good eye to dilate the pupil thus making seeing out of that eye blurry.  In theory,  by having blurred vision in both eyes, she should more likely to wear her glasses.  Except that didn’t happen.  We discussed patching her good eye as we want to force her bad eye to stop turning in.  I gave the doc my “you are delusional” look because can you see Ellie keeping that on?  So we are now doing atropine twice a month which will act similar as patching.  The thing with nystagmus (turning in of the eye), if left untreated, that eye eventually goes blind.  Obviously we do not want that to happen.

If only she would wear them for more than 2 minutes

Next up was GI. We graduated to 6 month follow - ups!  So let’s do another woohooo! Her constipation seems to be well controlled - I hope I didn’t just jinx it!  She is dealing with some random vomiting issues.  Since June, she throws up about 1/3 of the time with the enemas.  We figured this is because we administer a high volume of saline into her colon and it pushes on her stomach.  Except, this is new.  We’ve had 3 other instances where she throws up once randomly - not associated with enemas, eating or drinking.  We are debating on whether or not they were stomach bugs or reflux.  To be on the safe side, we restarted her reflux meds.

As it turns out, we did have to go back to Infectious Disease.  When they called me while on vacation, saying her labs were mostly normal for her, they only had some of her results.  Her B cell lymphocytes were still very low, but she had a moderate immune response to her vaccine.  ID isn’t worried because she has never had sepsis or required IV antibiotics and she did great with the vaccine.  Yes, her lymphocytes are still low, but her immune system is functioning okay.  

Waiting for audiology at ENT

Friday, we had an appointment with our new pediatrician at the Comprehensive Care Clinic.  We had been waiting months to get in.  Dr. B, coincidentally, was Ellie’s very first GI specialist and she has a son with Ds. The appt was nearly 3 hours long and did great until the very end when the phlebotomist used a band-aid instead of purple coban.  One of the goals of CCC is to minimize specialists visits and try to do most “visits” over the phone.  We have our assigned nurse’s cell # and any time we need to talk to a specialist, Dr. B calls them.  She is going to take over most of her care for pulmonary, ID, ENT and possibly neurology.  We are up in the air about urology since Ellie gets bi-yearly renal ultrasounds and CCC doesn’t have that capability in their office.  Her eye issues and GI issues will continued to be predominantly monitored by her specialists.  

Don't you always take baths with your swimsuit?

We learned yesterday that Ellie has hypothyroidism.  It would explain why she has been sleeping 13 hours and asking for naps all summer.  Hypothyroidism is very common in Down syndrome.  It is why we monitor via yearly blood work.  The signs of hypothyroidism in a child are fatigue, weight loss (in adults it is weight gain), constipation, and cognitive impairment.  Because cognitive delay and mild constipation are common in Ds, it is difficult to differentiate between Ds and symptoms of hypothyroidism.  Thankfully, we do not need to add endocrinology to list of docs we see as the CCC will handle it.

According to the pharmacist, synthroid (synthetic thyroid hormone) is supposed to be taken with water only and not within 4 hours of other medications.  Seeing as Ellie takes meds 4 x day, she would have to get up at 2:30am to take the synthroid.  The pharmacist agreed that it isn’t practical so she will take it with her morning medications and routine lab work will monitor her thyroid levels.

Now the good news is that we have NO doctors’ appts for the months of September and November so I will hopefully get to blog about other exciting things besides medical stuff.

She was so excited to ride the bus and go back to school.

Ellie started 2nd grade yesterday and she had a blast!  Here’s to hoping for a good, successful school year!

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Tuesday, August 8, 2017

Immunology and Vacation

We are back!  We had a lovely time in Seal Beach, CA and some nice visits with Andrew's dad and wife.  It had been 5 years since Ellie had seen them and she was just thrilled to see her Papa.  We tried to stay pretty busy and enjoy the gorgeous 80 degree weather which was a good 20 degrees cooler than scorching Austin.

The first day we went to the beach, but we stayed in the way back so she couldn't see in the ocean and want to go swimming.  She also spent time on the playground right on the beach, swinging to her heart's content.

So Disneyland.  It was an adventure and the first time that Ellie and I have ever been to any type of Disney resort.

We made the mistake of waiting in line for 45 minutes to get a disability pass.  A disability pass allows wait to go on a ride without waiting in the line.  For instance, say the wait is 40 minutes, you can go do something else and come back 40 minutes later to get right on the ride.  We did this specifically for Dumbo.  Ellie did not want to ride Dumbo.  Instead she wanted to ride the King Triton Carousel and the Circus Train a gazillion times. The wait times were not too long which was great for someone who has meltdowns, but we learned halfway through our visit that we didn't really need to wait at all or use the disability pass.  Ellie's stroller is actually a wheelchair.  That gives us access to the disability line and allowed us to hop right on the carousel and trains.  Apparently, this is for all the smaller rides.  The bigger ones, you have to have the disability pass.

Unfortunately, Ellie did not get to meet Mickey Mouse.  I am pretty bummed because I think she would have peed her pants with excitement.  She was pretty tired by the time we wanted to go to Mickey Toon Town I saw on the app that the wait was 35 minutes. You cannot use the disability pass or Fast Pass for any of the characters.  Andrew and I knew that there was no way she could wait that long. So yes, we went to Disney for a whopping 2 rides, but I am still glad we went.

Convaid Scout Wheelchair.  Goes up to 100lb.  Ellie's is purple.  Our insurance paid for it because 1. Ellie cannot walk long distances and 2. because she is a runner which is a safety concern.  

The following day, we went to this fancy smancy mall the size of a small town with stores like Dior, Armani, Michael Kors, etc. for the sole purpose of riding their carousel.  Can you tell that Bear loves the carousel?  She went on it 6 times and had a blast.

On our last day, we went to the beach up near the ocean.  That was a colossal mistake.  At first, Ellie Bear was quite content to play in the sand.  Then she realized that she was right by a lot of water and wanted to go swimming.  She didn't understand that, as per Infectious Disease, she could not swim in the ocean due to her cecostomy tube and possible immunodeficiency.  We ended heading back to the hotel room and used their swimming pool.  Ellie's idea of swimming is sitting on the edge and kicking her legs in the water.

A few hours after going to the beach, we get the call from Infectious Disease.  Her labs came back in early.  Great news! Her labs are mostly normal, well normal for Ellie (her CD19 B cell Lymphocytes [a type of white blood cells] are always a bit low).  That means she does not need IV immunogammaglobulin therapy!!!  So. . . she could have swam in the ocean.

On a side note, shortly after entering Disneyland, I managed to throw out my mid-back.  That area of the spine just below the shoulder blades.  It happened while I was transferring Ellie from her wheelchair to the toilet.  I started to get better and threw it out again on the way home due to trying to maneuver Ellie onto the toilet in the airplane bathroom.

The next two weeks are jam packed with doctors' appts - we now only have 4 since ID canceled- and back to school stuff.  Today, we see ophthalmology which should be fun because I have to tell the doc that Ellie still won't wear her glasses even with the atropine drops in her good eye.  Last visit, she said if this doesn't work, we will have to patch the good eye.  Riiiggggghhhhhtttt.  Because this stubborn child is going to leave a patch on.  Thursday is ENT and I am expecting that to be routine.  Yes, a routine appt!!! Next week is GI.  We plan to take her off the Protonix for reflux.  I am not sure that is going to happen seeing as about 30% of the time post enema, she throws up. This is new in the past 1.5 months.  She also had one day where she threw up twice for no obvious reason and then puked all over her iPad while in Seal Beach.  Next Friday is our new patient appt. with the Comprehensive Care Clinic. We have been waiting months for this appointment.  I am told that the office visit will be about 2-3 hours.  It should be fun.  This doctor will become Ellie's new pediatrician seeing as our really awesome, amazing, fabulous current one is no longer in our insurance plan.  Dr. B at the CCC, coincidentally, was Ellie's first GI specialist during the first 2 years of her life.  I am hoping that we can have a few playdates and make it to the neighborhood pool since Bear Bear needs to have some fun in her life..

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A mask for kids with Down syndrome

Do you hear crickets?  Yes, we are here!  We are alive!  We are safe and healthy!  We haven't been inside a restaurant or store since m...