Tuesday, June 24, 2008

June update

How time flies! It's so hard to believe that the boys are now 9.5 mos. old...where has it gone?! They are growing so fast it's literally hard to keep up with them these days! Ethan and Evan are now mobile and are moving so fast! They want to explore and are crawling EVERYWHERE. They are both standing up on their own and "walking" while holding on to...everything. They have both taken a few steps and we expect that they will soon be walking on their own. I guess then it will be 'no holds barred'...uhoh, we are definitely in TROUBLE!!! Ethan and Evan are no longer liking their bottles or baby food so much. They want the real thing, "big people" food and cups. Aiden has been rolling around and is starting to sit up on his own and loves being around Ethan and Evan. He wants to talk and play with them so badly, and loves to smile and 'chat' at them (in the video below, go to the 1 minute and 20 seconds point to experience one of the funniest thing you will ever hear: --> Evan cracking up). Aiden has grown so much in the last couple of weeks that his new nickname is "The Little Magnificent Head." Manish says that he is simply an "adorable, glorious little head!"

We know that many of you are wondering what is going on with Aiden. He had a rough couple of weeks when he caught whatever Ethan and Evan had, and started having significant difficulty breathing. We were so determined to do everything we could to keep him out of the hospital this time...and, as always, our pediatrician was a wonderful help. It was difficult for all of us, but as he was starting to get over that patch, he started throwing up large quantities of bile. Of course, this made everything about the vomiting and breathing difficulties even worse. We were very concerned, as was our pediatrician. While we were waiting to hear back from Boston, we had made an appointment to visit a new GI doctor over in Ft. Worth who had been recommended to us, to see if he had any suggestions or might be able to help with the vomiting. The GI doctor did not seem at all concerned, but told us that "this could go on for years," gave us a couple of prescriptions and told us to come back in a couple of months.

That weekend, Aiden pulled his ND tube partially out -- not a lot, but with an ND tube, placement can be very tricky and any little movement can be a problem. Rather than sit in the ER for hours on end over the weekend, we decided to hold his feedings for a short time and try to allow it to work its way back on its own, then take him for an x-ray on Monday to determine placement. We were able to do an x-ray and bloodwork to check his electrolytes at a local "urgent care" center, so we did not have to go all the way to Children's in Dallas. We thought (and sort of even hoped) that perhaps he might have some kind of electrolyte imbalance due to all of the vomiting, which would account for the way his hands have been shaking for the past month or so. The x-ray showed that the ND tube was well into the duodenum, but Aiden continued to vomit large quantities of bile.

Did I mention how very thankful we are for our wonderful pediatrician? She is literally a God-send! She knew that something just wasn't right, and at her suggestion, we went to the ER at Children's to double-check his tube placement.

It was a very long night, but in the end we were so thankful that we did go. We made the tough decision to replace the ND tube rather than trying to re-position it. This is especially hard on Aiden, because he is placed on a little "rotisserie" with his arms strapped above his head and his whole body strapped to a board while they turn him around and push and pull the tube up and down his nose under live fluoroscopy, attempting to get it into his duodenum. He is awake and alert and screaming the entire time -- they do not give him any kind of sedative or anything for the pain -- and it usually takes at least an hour and a half or more. When they pulled the old ND tube out, they found the reason that he was vomiting so much bile. Somehow, the tube had looped back around on itself and had developed a good-sized knot just before the exit point, and for some reason, it did not show up on the xray. They believe that this was holding his duodenum open and allowing the bile to pour back into his stomach. The doctors, nurses, even the radiologists and technicians could not believe it. They said they have never seen anything like it, and were showing it to everyone. That's Aiden -- without fail, it is always the most unlikely, impossible things that happen to him. He is now back to throwing up primarily stomach mucous, and as odd as it sounds, we are strangely relieved.

On another note, we have heard back from Boston. They do believe that they can help Aiden and have requested a copy of his complete medical records before they begin to schedule any procedures or testing for him. It has taken a lot of foot and finger work to obtain his medical records (we are still waiting for the remainder from his long stay at Children's), but this weekend, we sent a whopping 1500+ pages and numerous CDs of Aiden's medical records to Boston. These were primarily his NICU records from Baylor...he has taken out a few trees! Once they receive and review his medical records, the folks in Boston will be able to give us a more definitive schedule. Right now, we anticipate that we will likely be taking him to Boston sometime around late July/early August. Everything is still very tentative and there are still many, many details to work out, including how we will transport him there, so please pray that God will give everyone involved wisdom and will continue to work everything out.

In closing this update, I want to share an excerpt from a Spurgeon devotional that was such a timely blessing recently. It is entitled "The Troubles of My Heart" and references Ps. 25:17. He writes:

"It is wonderful how difficulties flee in the face of Omnipotence. The sick, who have been given up by the physician, often recover. It is, perhaps, God's mercy that the physician gave up. When you reach the end, God has only begun. The old proverb, "Man's extremity is God's opportunity," is certainly true. If God wills it, fevers fly and diseases disappear. As a soldier obeys the commander, God says to Death, "Go," and it goes, or "Come," and it comes.

It is the same in our circumstances. Often, days open dark with gathering clouds and yet end with a bright sunset. I should not wonder that some of you in looking back are quite surprised with your current situation. This morning I was talking with a gentleman who said, "I cannot tolerate waste in my home, and this is the reason: if ever there was a poor wretch who lived on hard times and envied a dog its piece of bread, it was me. But now God has been pleased to prosper me, and I often look back on that season of poverty and thank Him for having helped me through it." You see, dear friend, God can turn the wheel; He can make the bottom spoke the upper one, and He can do it all in a few days.

Though sin and sorrow rests like a double burden on your body and soul, go to Him and say, "Turn Yourself to me, and have mercy on me, for I am desolate and afflicted. The troubles of my heart have enlarged; bring me out of my distresses! Look on my affliction and my pain, and forgive all my sins." (Ps. 25:16-18)."

True, there have been many days in the past 9 mos. when we have wondered why and had many questions. It is human nature when you see your child in pain on a daily basis and can do nothing to help. The human council that we have received during this time has wide range of extremes: everything from sympathy and sorrow, to strongly expressed advice from those who have not the faintest idea what it is like to go through something like this. We are so thankful that those who have no understanding have not had to experience anything of this nature and hope that they never do have to understand what it is like. Ultimately, we must trust that our Heavenly Father holds the future in His hands -- He is faithful, and His ways are not our ways. As we are reminded every time one of the boys smile -- we truly have so much to be thankful for. God has been so good to us, He has given us so much, and we have to trust His heart and know that He makes NO mistakes -- there truly is a purpose in every change He makes.







Aiden is sound asleep



The boys just wanted to say "howdy" to everyone!



Evan wonders what is going on



Evan and Aiden are laughing it up



Here comes Trouble...(a/k/a Ethan)



Evan and Ethan have been exploring everything on the floor



Evan...I don't quite know what to say. Just don't forget your butt cream.



Ethan thoroughly enjoyed his meal!



Ethan enjoys playing in the laundry basket



Dad got this shirt for his Father's Day/Birthday gift



The back of the shirt states how I survived the brutal on slaught of Ethan and Evan for over 12 hours while Hannah was at the hospital with Aiden. I was bit, chewed on, harassed, mocked, attacked and emotionally abused...but I survived!



Mom & Dad used my birthday as an excuse to come visit (actually, it was really to see the grandkids)



Grandpa just can't get enough of Evan



Grandparents and the boys

Thursday, June 12, 2008

From May...

Below are some additional pictures from May that we wanted to share...


Ethan thinks he is so cool



Classic Evan



Happy Aiden!



Aiden is saying his bedtime prayers



Evanly Boo, what are you up to?



Ready to play, Ethan?



The twins are loving it!



"Prince Pea" on his new throne

Wednesday, June 4, 2008

postscript!

Several of you have made suggestions and asked "have you tried this...?" in relation to the persistant vomiting and retching that Aiden continues to experience. We truly appreciate any and all ideas and suggestions, so if you have any thoughts, please let us know! Briefly, in addition to the many tests and procedures that were mentioned in previous posts, here are some more of the things that we have tried:
- Zofran (anti-nausea med used primarily for cancer patients)
- Bethanacol, Erythromycin and Reglan (motility agents)
- Cyproheptadine (rule out cyclical vomiting syndrome)
- Switching from breast milk to hypo-allergenic, amino-acid based formula (rule out milk or protein allergies)
- Thickening the milk
- Drugs for reflux (i.e., Prevacid, Prilosec, Zantac, etc.)
- Different timing and types of feedings, to see if there is any connection (from continuous to very slow to bolus feeds over a smaller period of time)
- He had been on several diuretics to prevent him from retaining fluids due to his lung issues, and we stopped those since they had possible side effects of nausea and vomiting. It did not impact the vomiting, but his fluid output actually increased -- how strange!

There is more...I can't remember everything off the top of my head
;-) ... but those are just a few of the things that we have looked at. Some of the doctors have told us that if he just gains a pound or two, it should go away; however, he has gained almost 5 pounds and grown many inches since this started and there has been no change.

To answer a few more questions:

There is no discernable pattern /connection to when or how Aiden throws up, and some days are "good" days, where he may do a lot of deep retching, but will only throw up a couple times. Other days are not so good and he may throw up multiple times starting from the minute he wakes up in the morning and retch and gag every few minutes...we simply never know.

During one of Aiden's previous hospital stays, when they performed most of the other tests, they did perform testing for metabolic disorders/vitamin deficiencies at our request (organic acids testing). The results came back normal.

The doctors that we have seen are puzzled and not certain what else to do. They say that he should not be throwing up with the ND tube (feeding into his small intestines) since it is bypassing the stomach, but he continues to constantly retch and throw up.

Tuesday, June 3, 2008

Please Pray Today...



On Friday afternoon, we heard back from the folks at the Boston Children's Center for Aero-Digestive Disorders (CADD). They have been so kind and very responsive. They said that they would be unable to provide us with a second opinion on the laryngeal cleft issue based solely on the images that were taken during the laryngoscopy/rigid bronchoscopy. The only way they can verify whether or not Aiden may have a laryngeal cleft would be for the doctor who is the director of CADD to perform the procedure and actually touch and probe the larynx for himself. Given the situation, we expressed our concerns about taking Aiden to Boston solely to re-perform the same tests that have already been performed and no hope of any answers. We do not want to take him all the way and put him through these invasive tests again just for the sake of going somewhere else -- but by the same token, if they can do anything at all to help him, we will go wherever we need to go. This also is a major prayer request as the past 8 mos. have also been hard on Ethan and Evan, and we would need to find someone to care for them during that period if we were to take Aiden to Boston for testing.

They understood our concerns, and when we spoke with them again yesterday afternoon, said that they will be presenting Aiden's case at two different meetings today to see if there is anything else that they can do or suggest that we should explore. They will present it when the group of inter-disciplinary CADD physicians (GI, pulmonology, radiology, ENT, etc.) meet this morning and will also present it at their CADD conference later this afternoon, which is open to all physicians at the hospital and has a much wider attendance. Right now, this is our only remaining option. We do not know where else to turn or what else we should look at. Please pray that God will send the right doctors to these meetings and that if He wills, something will come out of this to help Aiden, and that He will give us clear direction and wisdom as to what we should do.