Wednesday, September 7, 2011

My favorite time...

If you could hear me say it, you would hear the sarcasm. Anyways, it's another start to a preschool year for us and time for us to send our 'letter to the parents' regarding Sam. We were asked last year because there was parent who...had some concerns about our enrollment and the thought was information may put them at ease. I'm not really sure whatever happened with that but either way we were asked to send another letter because a student this time was 'upset'.

Long drawn out way to say "Happy Craniofacial Acceptance Month!". Seriously-no sarcasm here. September really is Craniofacial Acceptance Month.


So #1-if you are a cranio family in the DFW area I hope you are planning on attending the picnic this Saturday and we look forward seeing you there! More info at www.ccakids.com.

#2...in an effort to promote craniofacial acceptance I have pasted an article I wrote for something else that addresses talking to your young children about differences. It was also attached this year to my 'meet Sam' letter. Enjoy!

As a parent of a child with Treacher Collins Syndrome, we get a lot of unexpected thrown at us and families quickly learn to roll with the punches and navigate what seems like impossible situations. However, there is one situation we often find ourselves in that relies on other families to be responsible and navigate their own potentially awkward social situations. I am baffled time and time again when I see parents ‘dodging the questions’.

We have a son born with Treacher Collins Syndrome, a genetic syndrome that is characterized by severe facial deformities. Nearly every time we are out in the community we are approached by another child with questions like: “What happened to him?”, “Why does he look that way?”, or “What’s wrong with him?” When the questions are coming from a child they are almost always coming from a good place; they are simply curious. I am happy to answer those questions and help the child understand that everyone has differences. Nonetheless, the reaction is typically a very embarrassed parent rushing over to distract the child or encourage them to play somewhere else. I understand their embarrassment, but they should also understand I know my child looks different.

So how do you bring the subject up? In my profession they are called “teachable moments”. So take advantage of a learning opportunity. Of course, the difficult part is you don’t know when the opportunity is coming so you need to be prepared. When your child asks the question, “Why does he look that way?” go ahead and answer as best you can by focusing on the differences and then how we are all different. Highlight differences your child has always known in his or her life that may not be as severe- different races, different eye or hair color, glasses, gender. If you have other, more prominent differences in your life focus on those as well-anyone in a wheelchair, a physical handicap, or mental handicap. You probably want to also touch on similarities to shift the focus from ‘how are we different?’ to ‘how are we alike?”.

“He does look different from you, but he probably likes French fries like you do, or has brown hair like you do.”

If accepting diversity is top priority in your family, I suggest assessing the situation and if the family seems open to a conversation, feel free to start one. Only once has a mother approached me with, “my daughter has a couple of questions about your son-do you mind answering them?” Of course I didn’t. Parents of children with different needs can be in various stages of accepting the difference, but you can feel safe that if they are out in the community that they have come to terms with it on some level and are in a good place. We are all striving for our kids to live as normal of a life as possible and being accepted by our communities is a big part. By ignoring the questions our kids ask we are teaching them it is not okay: it is not okay to ask questions and it is not okay to explore the possibilities. Early childhood literature tells us time and time again, young children learn from experiences so it is our goal to make them as meaningful as possible.

Saturday, September 3, 2011

I love my trach

It has been 9 days.

9 days since we sat down in that little, bitty room by the OR's to talk about Sam's airway. 9 days since we were reminded of his very difficult airway and the fact it will always be complicated. 9 days since we were told there are not a lot of people that can work on Sam-just a few at the largest Children's hospital in our metroplex. 9 days since we decided to leave the trach in...even if only for emergencies.

I love our physician and I love our trach.

It started a normal morning. Boys up between 7-7:30 playing away. Breakfast of sausage, fruit, and waffles served around 8:30. Coffee a little late this morning and poured around 9am that corresponds to a TV show started at 9. Paul was reading through some material about the boys' school starting next week and I started work on a grocery list. Boys took their place on the couch with toys in hand.

A few days ago we had gotten down a marble maze that had been given to us (maybe last Christmas?). Anyways, all of sudden Paul jumps (maybe 9:10?) to alert me Sam has swallowed the marble. Lucky for us, LUCKY FOR US, we have a trach so we can immediately take off his cap to give him an open airway. He gasps, but seems okay. We think he has swallowed it so I grab the phone to see if we need to let is pass or go in and have it checked out. As I am waiting on the phone Paul alerts me he can barely see the marble-way past palate repair, at the top of his esophagus. That is when we start to move. We don't know whether it can do down, and would love it to come up but know we are going to need help. We arrive at Cook's around 9:30 (engaging in numerous traffic violations along the way).

He sounds clear, no labored breathing so we had remained pretty calm up to this point but as we are getting closer to Cook's I am trying to decipher in my head what to say to get this handled as quickly as possible without everyone freaking out. I know I have to say it's a complete airway obstruction, which is top of the list as far as emergencies are concerned, but I have been in that packed room, in the emergency situation, and while it may be impressive-it is no fun when it is your child. In fact, the last time we were in the room with an airway obstruction it resulted in an emergency tracheostomy. So we know the severity...and we know the reaction.

So we run in, abandon the car in the ER turn around (because they actually do have people that will take care of it-just leave your keys in the car) and have to relay the words "complete airway obstruction". That's when I start to lose it because I remember the course of events that follows. I scribble here and there-nurse confirms that blue ball in the back of the throat and off we go. What has probably now been 5 minutes maybe, we are in a room (with about 10 others), relaying history, listing meds, requesting specialities and specialists, yelling for child life because Jack is with us, and the ER physician reassures his breathing is normal, reassures to all of the other people in the room and we quickly get to a place where everyone understands the situation which immediately calms me down because I see the "freaking out" in all of their faces and it is not helping me stay calm.

So there we are, with normal breathing and this big, blue marble stuck in Sam's esophagus. We decide it's too big to be swallowed and try some very unpleasant attempts with the forceps, but as he gets more upset his muscles tighten around it. Plus, his palate repair is blocking it a little.
We talk out some options, exhaust the ones that don't require sedation and then start down that path.

We need to wait a little since his breathing is stable and he ate breakfast. We are going to try a local sedation but could very likely end up back in the OR. Time to call for back up for Jack and start the waiting. At 11:30 we can try a little sedative, a dental tool to keep the mouth open, then forceps again.















And there you have it.




WE LOVE OUR TRACH and can be thankful for it for the days to come.


Thursday, August 25, 2011

10.1 & 10.2

There is always a plan...the plan is always to adapt to the situation and keep on truckin'.


To relay the mornings activities, I have to go back a few days. Last Friday we finally took Sam to the dentist. I had definitely been avoiding it on some level knowing that we were going to have some issues, but with a surgery on the schedule thought it was best to bite the bullet in case anything needed to be done under sedation. Wise decision.


So, it was a little worse than expected and we discovered (after 4 adults holding him down) that....

1. He had 6 cavities (A, J, K, & T; then see #2).

2. He also has some tooth gemination going on in his 2 front teeth. As I have come to understand, it is when two teeth develop from one tooth bud...resulting in extra teeth. (awesome since we don't have enough room for the normal amount). There was significant decay between the teeth (and decay into the pulp) so we were given a very poor prognosis of saving these. Yes-his 2 front teeth.

3. Finally, the x-rays showed some pretty "odd" permanent teeth and there is question whether we will even let them come in due to deformities. Basically, we were told to prepare for a regular schedule of distracting teeth for the next decade.

So, this morning we thought the plan was...go in for dental work + laryngoscopy & bronchoscopy. We were fairly certain they were going to pull Sam's front teeth and trach, but actually came home with 2 front teeth & trach.

Right off the bat, ENT tells us because of the signifcant dental work she is not authorizing decanulation for today due to swelling issues, bleeding, drainage, etc. Best case scenario we come back next week and do it then...then we get the reminder that nothing is certain.

Our ENT is highly qualified and we respect her opinion and are confident in her abilities. She happens to be (hands down) the most conservative member of our team. We have always thought this was smart since her main responsibility is airway. So when she came in after the scopes to tell us she wasn't going to authorize decanulation and all of the reasons (as diasppointing as it is) we trust our planning in picking the right physicians and listen to her expertise. She is always impressed with all Sam has accomplished and how healthy he stays and doesn't doubt we could remove the trach and be pretty safe. The concern arises if Sam ever got sick. Since airway & nose are so small for Sam to begin with, small respiratory infections or congestion can get out of control very quickly for us and if we remove our "backup" airway we put him in a very difficult position. There is a diagnosis of 'difficult airway' that Children's gives to about 100 of the kids they see...and as a whole they see 1000's. She explained the criteria is very strict to keep that list as short as possible because only a handful of people within the system are allowed to work on those kiddos due to the expertise required to even get in to the airway and we are still on the list. As long as we remain on the list we will continue with the trach.

"You all have worked to hard to get where you are for a bad cold to result in devastating consquences". We can certainly understand that.

The good news is we do not require another jaw distraction or any other surgery to make the area bigger (it would not address the area that is too small). So, hopefully with time and some growth we can move off of the list and on with decanulation. She was as disappointed as we were but we are all on the same page and in agreement. We will try again next year and hope that Sam's airway has grown enough to get us off of that list.

Dental went a little different than expected in that we filled 8 cavities and came back with our 2 front teeth. He did 4 silver crowns in the back, 4 caps, and 2 root canals. There is a good chance the front tooth (where the root canals were performed) will still fall out but we will see how it goes.

So instead of staying overnight in the original plan we are home. Sam is snoozing away and Jack has been promised a Star Wars marathon to allow us time to digest...keep on truckin!

Sunday, August 14, 2011

Children's Medical Center

So...I have had several (unanswered) questions regarding the new gig for me, so inevitably it is time to address. I wasn't trying to keep it a secret, or be incognito...I was definitely a little nervous, unsure if I was really going to do it or it was really going to happen. But alas, I have re-entered the working world and so far-really couldn't be happier with the outcome.

I had been looking for awhile...long before my notice was given and really wasn't haven't much luck. I didn't like what was out there, nothing was part-time, and we will just ignore the black cloud of our economy to focus on the facts as they are relevant to me (even though the poor economy=cuts in school districts=several behavior analysts looking elsewhere as the behavior specialists positions are cut within districts=a lot more behavior analysts in the job market=you better be good if you want the job because for once there is a little competition for the 'good' jobs in behavior analysis). So I applied a little bit, interviewed a little bit, liked nothing and then applied for a position that I was blatantly over-qualified for. Why? Because, I truly believe in the purpose of the program, love the work you are able to do with it, and saw potential for growth.

So I fought a little, they fought a little and....I am the new behavior analyst for Children's Medical Center Autism Intensive Outpatient program. I am joining the other (1) behavior analyst there who is actually a buddy from graduate school. It is a program with one of my greatest passions as it relates to autism intervention...parent training. I tried several times to really get an exclusive parent training program going at the center but for whatever reason it never really took hold and this is essentially the same program. Plus, billing from a hospital setting and the added services we can bundle it is really just a great little program.

So with my addition, growth is now feasible for the program (which I obviously love). We are trying to get 'typical' ABA codes billed PLUS...wait for it...offering services to inpatient kiddos with autism (or any behavior disorder) to help their stay and procedures, etc. This I find really interesting; particularly, given our personal history. It is a chore all the same and we have our work cut out for us.

So there it is in a nutshell. The best part is it's kind of 'under the radar' as far as services at CMC which is fine by me. Because for me that equals, ridiculously reasonable case loads, time for yoga at lunch, time for research, time for all kinds of things that I just used to dream about being able to accomplish.

The drawback (and it's a big one) is it's full time; Monday-Friday. We had decided to keep the boys at their current school and hire a nanny which so far has worked really well. Just hard to not see them as much so rest assured....I am not blogging, I am not facebooking because I am enjoying my greatly reduced time with Thing 1 and Thing 2 (who also happen to be working really well too).

I guess the other issue is it's in Dallas...and yes, I consider it the 'bad' side of the metroplex. HOWEVER, the TRE that picks up downtown FW will drop you off at the CMC so I have zero complaints of now gaining 45 minutes of quiet time to read or what not on the way to and from work. It has been my haven and something I have now learned is an absolute necessity for my sanity. I get to decompress my day and be ready to go with those Greer boys as soon as I walk in the door. So after a few weeks of the train I don't think I can actually put it in the 'con' category.

So all and all-so far so good! I don't like to post much about work on the blog so that is probably the rest you will hear from me about it...hope it suffices!

Sunday, August 7, 2011

Get your recipes ready!

Okay all you people who e-mailed me and said you were going to enter...the deadline is quickly approaching!

Even though we have been quite the slackers on blog postings in our household, we have not been slackers on the recipe challenge. We have several contenders...a delicious pad thai, a noteable noodle recipe, and several recipes off of the Jamie (Oliver) at Home series which are super yummy and one of our new favorite shows. I also made a spicy peanut noodle recipe which was not exactly a "repeater" for me and Paul...neither one of us are huge peanut sauce people BUT our kids both loved it. Totally makes sense since it is basically peanut butter noodles. Thought it was worth a mention for the little ones.

And now, it's hatch chile season at our market so we have several more recipes to squeeze in before the final wrap up...so time to start getting them in! And by the way, I totally accept drink recipes too!

Best of luck!

Friday, August 5, 2011

Dog Days of Summer

I told Carrie that I would write the next blog post, that was about a month ago. I was going to wait until we had a day where the high temp was less than 100 degrees, but it's been 35 days straight and there is at least another 10 forecasted so I guess Mother Nature is more stubborn than I am.

So what's been going on?

-Sam's latest surgery was a complete success. His eyelids are now better functioning and better looking. I promise to post some photos soon.

-Carrie started her new gig and is enjoying her new professional life.

-Did I mention that it's been hot? We really haven't been able to do much outdoors and we are all starting to get a little cabin fever.

-Jack had a fun "squirt gun" birthday party at his grandparents house in Tulsa last weekend and is celebrating this weekend as well.

-Carrie went out and bought some running shoes and has been getting up at 5am to go running before catching the train to work. I guess she didn't have enough going on.

Long story short, everybody is doing well and we will try to get back to posting on a more regular basis. The big thing on the horizon (other than the start of the TCU football season in 28 days) is Sam's decannulation on August 25th. It's a big day for him and us. I can promise that there will be posts dedicated exclusively to this event so stay tuned.

Thursday, July 7, 2011

Storm Trooper

He is indeed a trooper...a Storm Trooper.

I try not to complain too terribly much about hospital stays, but after our last one I was really not interested in staying overnight unless absolutely necessary. The plan was to send us home unless there were any complications and we were out the door by noon-home by 1pm. I can't say whether it's because we are home or whether it was just the surgery in general but Sam is doing phenomenally well.


This picture is from the recovery room in the hospital where he is very tuned into some Penguins on TV. He almost immediately was saying he was hungry and wanting to eat.















True to our surgery ritual we picked up Chipotle for dinner and Sam was all over it ready to eat and sitting at his table, chowing down.
















We have had a little oozing (as expected) but I tried to take a closer pic so you can see. There are stitches below his lower lid & above his upper lid. It is unreal the difference it makes and he looks so good. Our swelling should peak at about 36 hours, but I can really tell what a difference it has made.

Good deal and done!

Just spoke with the surgeon and we are done and in the wake up & clean up phase. They did some work on the deep tissue using some collagen to add support to the lids. He is hoping it is enough to not have to re-do but time will tell. No skin used from anywhere else though. One more under the belt and getting ready to meet him in recovery.

9.1

Lower lid reconstruction got underway at 8:10 am. It's a little different for us in the fact Jack is with us today due to his turn with the GI bug so providing a very welcomed distraction.

Our hope for the surgery is he has enough skin to reconstruct both lower lids, but since his right eye is so severe this is a very high likelihood we will either
1-have to allow the skin to stretch a little and do this procedure again a little later or
2-he will take some skin from the top of his collar bone (typically taken from behind the ear, but since we will eventually have reconstruction there as well not as good of an option for us)

This should take about 2 hours...

Monday, July 4, 2011

Happy 3rd Birthday!

Happy 3rd Birthday Sam!

It was pretty low key for the day. The favorite present was opened in the morning before SuperDad headed to work and "cake" and presents were done around dinnertime.




Sam doesn't care for any sweets so coming up with a cake this year was proving to be a little tricky. From the inside out his involved hot dogs, sausage, a ring of pepperoni's, and finally a ring of bacon strips. Technically, you would just call it a meat platter but with the candle in the middle I will qualify it as a cake.





For his party this year we kept it small. I read something a long time ago that suggested you invite the number of friends to your party that you are turning so we took Sam +3 little boys to the new Cars movie. And while not a complete success for all involved, our boys had a blast. SuperDad and I missed most of the movie being seated the opposite direction of the screen but it seemed entertaining enough.

Happy Birthday Sammers!