heart – Page 3 – Hana's Heart

Outside

Posted on January 4, 2016 by katmeander

Things have been moving along steadily. Hana seems a little too tired during the day. They say this could be from withdrawal, as they are very, very slowly decreasing her Ativan and Methadone doses every other day. I think it is also because her sodium has been a bit low. This happened before and once she got sodium replacement, she perked up. Unfortunately, I think it could also be from boredom and depression.

We haven’t been able to get Hana out of the room as much as I’d like. We have to get a nurse to go with us and their patient load is not always such where they can easily get away. Also, with the holidays there are many programs and staff that are not around for activities and services that are normally offered. Hopefully that will all change this coming week.

Today we got to take Hana outside for the first time in more than six weeks. It was only to just outside the main entrance of the hospital but I do think she enjoyed it. She and Poppy also got to see each other for the first time too. While I thought it might be an emotional reunion, it was not. Neither seemed to impressed with the other. Oh well!

We also got to take Hana to see the toy trains, which she really loved. Later in the day we got to take her to the playroom. I think the excursions do her good. I also think familiar visitors help as well. I’m sure Hana gets tired of seeing my face and welcomes the change.

This week Paul and I should get our parent training on the Berlin Heart. That way, we can take Hana out of the unit and around the third floor without a nurse. That will give us more freedom and independence and hopefully will help with Hana’s boredom and depression. We’ve been doing our best to keep her active and engaged in the room but sometimes the same four walls just make you crazy.

Hana’s fibrinogen level has been elevated. They have also noticed more white deposits on her Berlin Heart, so they’ve started to keep a much closer eye on her. They are also watching closely to see if she has any signs of having a stroke. The alarm on the Ikus, which is the huge box on wheels with the laptop on top and basically runs everything going on with the Berlin Heart, has been going off like crazy the last couple of nights. So we are not sure what is going on with that. Hopefully everything resolves itself quickly.

Today I got to go on a nice jog with Poppy. It really improved my mood and I am very grateful for the opportunity! Thank you to all the people who help make that happen. There are many people who may not even think they are helping make it happen, but you are! I think we rely on each other more than we realize or even appreciate. This is something I think about alot especially as I am jogging. There are so many people who have helped Hana. Medically speaking there are the medical professionals who have committed to education and training and their families that have encouraged and supported them. There are medications and equipment and supplies and all those things came as a result of so many people’s effort. Then there are all the people who have supported us with cards, packages, texts, emails, meals, notes, kind words, etc. We are so grateful.

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Day 46 in the hospital, Day 28 post-Berlin Heart, Day 19 on the transplant list.

The Balance Of Fluid

Posted on December 20, 2015 by katmeander

Today Hana was fast asleep with a heart rate in the 160s – that’s way too fast. Her temperature has been normal, thank goodness. She is very sleepy even at 10:30 am. So, the doctors scratch their heads and puzzle over this latest change. The heart failure/transplant doctors are worried that fluid is backing up where it shouldn’t and the right chambers of her heart are working too hard or are in failure. The CVICU doctors wonder if she is too dehydrated, except that her fluid output (they measure exactly how much fluid she gets compared to how much they can measure that comes out – they weigh her diapers, etc.) does not suggest dehydration. Her BUN and creatinine levels (from blood work) do not suggest she is overly dehydrated.

The attending physician looks at Hana and he thinks she looks very dehydrated. Her eyes are sunken, her lips and hands and feet are very dry. He said that BUN and creatinine are not reliable tests for children. He also says that her sodium has been on the low side for a while and that can wipe her out. He orders sodium replacement and some IV saline. The heart failure Doctor requests that they use her Power PICC to check Hana’s CVPs (central venous pressure) and he talks about doing an echocardiogram to look at the right side of her heart. By the way, Hana’s CT scan came back with no problems so that is a huge sigh of relief!

After the IV saline, Hana’s heart rate crept down, her CVP which was at 1 or 0 and that came up to 5 or 6 and Hana woke up and wanted to play! The heart failure Doctor was still skeptical but he did put off doing the echocardiogram. Hana should get one soon regardless. So despite feeling very stressed for a while this morning, it turned out to be a good day. Hana even got another chest tube out.

We spent some time in her room opening some packages and decorating while playing some Christmas music. I haven’t heard any Christmas music this season before today!

Out Of Bed

Posted on December 18, 2015 by katmeander

Today they are continuing to wean Hana’s Precedex (dexmedetomidine) drip. Her clonidine patch should be effective so they can start to wean a little faster. Overall she is a little overly sedated. We are trying to be careful that Hana doesn’t get her days and nights mixed up! Last night she was wide awake and playful at 10pm. They are also increasing her aspirin to 3 baby aspirin a day (crushed, mixed with water and sent down her feeding tube). Since they took out her arterial line yesterday, Hana must have blood drawn peripherally- the way we all do, with a needle stick. This will still happen every day for a while until her results are stable and then she will only do it it twice a week.

The physical therapist and occupational therapists came again today but Hana was so sleepy that she didn’t do much. However, they did get her out of bed and had her sit on my leg on the floor. We did that for two hours! Hana would fall asleep sitting up (with me supporting her) and then wake. I think it was really good for her to start using her muscles more and to get out of bed!

Last night my mom made a Berlin Heart for Hana’s Christmas reindeer! Everyone loves it. Thank you all for the packages and cards and goodies! But most of all, we are so thankful for all the well-wishes and prayers. It really does help us knowing we have so much moral support. We feel very lucky.

Listed

Posted on December 15, 2015 by katmeander

Today Hana had a fever (38 degrees Celsius) and a high white blood cell count (70 K/uL). This makes everyone worry about INFECTION. She had finished her post-op antibiotics yesterday so they started her on 3 antibiotics today and they also cultured her PICC line and IJ (internal jugular) line and they did some other blood work. By the time they rounded on Hana the results came back and it does not look like infection but a reaction to the steroid that is used to treat high fibrinogen levels (which need to be low so clots don’t form in the Berlin Heart). For me, it feels like an internal roller coaster ride.

They are moving right along, especially to get her off her IV drips so they can take more lines out and reduce the threat of infection. They took the IJ line out (my least favorite, I’m glad it’s gone!) The fentanyl has been off since yesterday evening. They took off the Nitroprusside and are going down on the Milrinone and increased the enalapril that she gets through her feeding tube. They stopped the Heparin drip and she will now get heparin as an injection twice a day (Lovenox), everyday she has the Berlin Heart. They decreased her versed drip. She is getting alternating methadone or Ativan every three hours. Her withdrawal is somewhat borderline in my opinion, her hands often shake when she is awake. they stopped her TPN and lipids and she is now getting a “normal” volume of continuous feeds (NJ tube right now). They’ve been decreasing her CPAP pressure (6) and hope to have her on high flow nasal cannula by this evening.

I did not get to hold her yesterday purely because of logistical reasons but hopefully that will happen today. The great surprise yesterday was that Infection Control took her off isolation- so no more gowns, masks and gloves! It makes it so much nicer to touch skin to skin (but I also realize how much the masks and gloves were helping to keep my nasal passage and hands moisturized, the hospital air is very dry and can make my nose bleed)!

Despite the infection scare, which was a big deal for a few hours this morning, this is not the biggest news of the day. The big news is that today Hana has officially been listed as status 1a for transplant. Today is Day 0 and the average wait time in our region for her age range is 6-8 months but it could be any time.

Today is Day 27 in the CVICU. I asked how much longer Hana may be here before moving into the floor and they said the soonest she would move is 48-72 hours, if things move as they have and she really doesn’t have an infection. I was just hoping to be out of intensive care before Christmas!

Good Vibes

Posted on September 26, 2015September 26, 2015 by katmeander

I’ve been too tired to write updates! I’ve been falling asleep while breast pumping, something I didn’t think was possible. But there has been a lot going on.

First, Hana saw the GI doctor and dietitian. From that they decided she should start on some pediatric formula since her nutritional needs have outgrown the infant formula now that she is over a year old. We also scheduled some weight checks. A few days later six cases of Pediasure arrived. This stuff smells disgusting. It is made to be very sweet so that it entices kids to drink it, but it really turns my stomach. I slowly started adding it to Hana’s feeds, mixed with the regular fortified breast milk. I started with 25% and a couple days later went to 30% and a couple days later up to 35%. That’s when Hana started vomiting.

I ordered a can of an alternative to Pediasure, called Pediasmart. It only comes in powdered form, whereas Pediasure comes as a canned liquid (it also comes in a powder). I swapped out the Pediasure for Pediasmart and the vomiting stopped. Then we had to scramble to find more, this stuff is not easy to find in a retail store! We eventually ran out of Pediasmart so I substituted Pediasure back in for one night and she vomited alot, so that’s the end of me attempting to give Hana Pediasure. The next day (Monday) our amazing GI nurse proactively anticipated that we would run out of the formula before the supply she ordered for us arrived. She called all over the city trying to find some, talked to colleagues and the Pediasmart rep and she dug up a can of chocolate Pediasmart for us!

Hana had a weight check on the same scale as her last weight check and she gained 130 grams over 18 days. That’s 7 grams a day, which I think is pretty okay. They did say that kids’ weight gain generally slows to 3 or 4 grams a day after they turn a year.

Feeding by mouth has been going terrible. I should say, there has been no progress whatsoever. Our feeding specialist talked about getting Hana into a feeding program, one where they come to the house. At first I was excited but then I wasn’t sure if I liked the idea. I’ve heard mixed things about the feeding program that we would be referred to. I’ve been thinking about this feeding stuff a lot. It consumes my brain power. After much deliberation I decided that I think Hana just needs more time. I feel pretty confident about that. I think her brain is at work figuring out the world (including learning to walk) and even though we don’t see progress in her eating, I think things are at work inside her head.

Of course, I still want to give her opportunities to show us she can eat and drink, but I can’t be stressed about it. Or anxious. Or have expectations. She will do it when she is ready. So, I plug along, packing snacks and milk for her milk bear. I’ve mostly given up trying to have her “eat” while sitting in her high chair. I try offering food while we are out and about – at the park, in the stroller, at the playground. But mostly she is not interested, or she just wants to throw it on the floor.

Then on Sunday it got really hot in San Francisco. It was over 90 degrees! I made sure to offer Hana lots of cold breast milk. She drank and drank. She drank 380 mL, that’s almost 13 ounces. Then she did it the next day too! The day after that it cooled back down to our normal 65 degree weather and she drank 300 mL (10 ounces). The next day I tried adding some Pediasmart to the milk and her drinking slowed significantly, but she still drank more than 180 mL (6 ounces) which is more than she has consistently been drinking. I went back to straight breast milk the next day and she drank 290 mL and then 360 mL yesterday. I know that eventually she needs to eat or drink something more high calorie, but for now I want to see if she will consistently drink that volume.

At our feeding appointment this past week we went at a new time – in the morning, versus lunchtime. Hana “ate” a lot more yogurt than she has lately. She also tried some apple flavored crunchy snacks. She did this for an hour before she wanted to be done. It was great progress! Some things to note – she is perhaps still experiencing some reflux, she seems to be constipated and gassy from the new pediatric formula and she drank some milk so fast that she threw up. I think its because some went down the wrong tube and she coughed and threw up rather than her stomach bothering her. But either way our feeding specialist is going to discuss all these issues with the GI doctor and dietitian.

We have been getting out a lot more. I think it is good for Hana to be out, she seems to really thrive when she does. Its actually quite amazing. We go to the California Academy of Sciences every Tuesday morning. We go to the pool once a week and music class twice a week (to help stimulate her speech development). We go to the playground almost every day and she watches the other kids and climbs things. She loves to climb!

Recently Hana was mentioned in an online article about rare diseases for Children’s Cardiomyopathy Awareness Month (which is September):
https://rarediseases.org/hope-for-kids-with-heart-disease-september-is-childrens-cardiomyopathy-awareness-month/

Hana turned 13-months on Saturday and she also took her first steps! I’m hoping that once she really starts to walk that she will want to shift her focus more on learning to really eat.

There is nothing new to report about her heart. She wore an EKG holter for 24 hours which they said she would need to do twice a year. Everything came back normal. When she takes a long nap, two hours or more (she has never napped longer than 2 hours and fifteen minutes except in the days right before she ended up in the hospital) I get anxious. Yesterday was one of those days. Is she napping so long because of her heart? I can spiral out of control very quickly. I’ve been working on some things to help ease that anxiety. Hana does not need anxious vibes right now (or ever, really). She needs good vibes! Calm, relaxed, nurturing, positive vibes. We hung up a homemade tree in the house for Hana’s birthday party. It is still up! We cut out dozens and dozens of paper leaves for the tree and asked people to write well wishes (or bring their own “leaf” to add to the tree) for Hana. I’ve been starting to add my own good vibe, well wishes to the tree. It is a good practice for calming my anxiety!

If anyone would like to add a leaf to the tree, let me know. I can send you a leaf or you can make your own and send it!

Losing Weight?

Posted on September 2, 2015September 2, 2015 by katmeander

There has been a lot going on and much of it I wish I had made time to give it the recognition that I think it deserves, but its has just been too crazy. First, we had Hana’s big birthday celebration and it was wonderful! We had amazing food, amazing decorations (more on this later…) and amazing guests! Second, Hana and I flew to Bend, Oregon for our first trip after being discharged from Stanford. We were very nervous to have Hana fly and for her to be so far away from our usual medical facilities in case something went wrong. She handled the airplane ride just fine. There were no complications other than the usual difficulties of traveling with a one-year old – she didn’t sleep very well, naps and bedtime were harder, she might have felt overwhelmed by the new environment. She did vomit more – at least every day, which brings me to the next point.

We saw Hana’s Kaiser cardiologist on Monday and she has lost weight (130 grams or 4.5 ounces) from the week before. Now, when she saw her pediatrician the week before she was weighed on a different type of scale (a real scale versus a digital scale) and the nurse did it very, very quickly, maybe not so accurately because she is not used to parents who are tracking every ounce (or gram) so carefully. But lets say the reading was way off, still, her weight is just barely more than her weight at Stanford three and half weeks ago, its really the same. Her Kaiser cardiologist said she does not get worked up over one “bad” data point, such as this drop in weight.

In addition, Hana had an echocardiagram by the usual tech at Kaiser, Doug, who also did Hana’s very first echo, while her cardiologist looked and watched and we saw how bad her heart was for the first time. On Monday, Hana was Doug’s very last patient of his career. After 30 years he was retiring, so that was kind of an honor for us (and sad because he is really, really amazing). Regarding her echo, her Kaiser cardiologist said, “there isn’t anything significant” to talk about, but her heart is larger than it has been, so that is a change. She did say, “sometimes that happens”. This made my own heart plummet. I will say that her Kaiser cardiologist has seemed much more worried or concerned than the heart failure/transplant cardiologists at Stanford and she did not seem worried or concerned, but still, I was hoping her heart was getting smaller not larger.

Lastly, during her exam, her cardiologist thought she saw “pulling” of her skin between her ribs, as if she were having to work hard to breathe. She also said this could be because she had just been upset the minute before. But still! That is three things! I walked home from the appointments in a teary daze. Everything feels so fragile. I tell myself to take a deep breath, she looks so good, she is acting so much happier, she is talking so much more! Maybe her stagnant weight is because she is moving around so much more! I hope so. But still, it has been a little bit stressful and I am reminding myself to not take for granted the days and moments and all the good things. I remind myself not to make it something it isn’t. I remind myself to imagine what life will be like when all these things are no longer a worry. I remind myself to cherish my sweet girl!

The White Food Experiment

Posted on August 7, 2015August 7, 2015 by katmeander

Tuesday we took Hana to Stanford for an appointment. I remember when she was still in the CVICU at Stanford and was starting to stabilize and we started hearing about what might happen next. One of the things they mentioned was that some kids stay until in the hospital until they get a heart transplant, they may have to go on ECMO or a Berlin heart. But then there are some kids that get “well enough” to go home on oral medications and some of those kids even do well for years before they need a heart transplant. There are some of those kids that even end up improving. They couldn’t tell us which scenario would be Hana because they don’t yet understand why some kids do well or even improve.

So far, Hana is one of the kids doing well on oral medications. Her echocardiagram, although not worse, is still very severe. On the outside she looks like a normal baby. She is thriving and growing and developing. The term they used was “exceptional compensation” – her heart is very, very sick looking but she appears to be doing very well. There was a pediatric cardiology fellow that joined Hana’s attending doctor for the exam. He, especially, seemed to be very impressed to look at her (after having just reviewed her latest echo).

I feel very fortunate. It’s a reminder on how fortunate we have been.

At Stanford talked a lot about weaning her from the tube and the risk that they are willing or not willing to take with the wean. She is doing well, perhaps because everything is managed so carefully right now. Once the tube is out that becomes harder. They would like her to weigh 10kg before we do anything drastic like pull the tube out and see if her hunger will make her eat. She weighed in at 8.45 kg, so she is still gaining about 7 grams a day. They decided to drop her mid-day Lasix dose because her BUN was so high, but we’ll see how she does and if she starts to retain fluid. We don’t have to take her back to Stanford for three months!

I got the impression that I need to be more patient (when it comes to her feeding progress).

On a daily basis, moment to moment, some things are still a lot of work – mostly on my mind in this category is feeding. Today I made specially prepared baby food in forms and textures that I thought would be more conducive to eating. I took them to our feeding specialist appointment, which we haven’t been going to because the therapist was on vacation. Hana didn’t want to eat the split peas. We mixed them with yogurt and then she ate some, but just a little, maybe a teaspoon. Then we tried some string cheese. Hana ate almost half a stick! It was very encouraging. The final conclusion was that she likes and trusts white food.

I really had my doubts at first – could a baby really prefer foods that are white? But the feeding specialist assured me that it was not crazy to think she only likes white foods. I guess it makes sense, breast milk is white. Yogurt is white. Mashed potatoes are white. All the foods that we have the most luck with are white. So we wrote down a list of white foods. Over the next week I am going to introduce as many white foods as possible to see if that makes a difference. So far we have yogurt, cheese, cottage cheese, vanilla pudding, chicken breast, cauliflower, white asparagus, tofu, rice and white beans.

New Bloodwork Results

Posted on August 3, 2015 by katmeander

This past week has been about the same. Hana had a cold with a runny nose and she really didn’t want to drink from her Milk Bear. Today she only drank two ounces although she’s been averaging 6-8 ounces. She was definitely more cranky and then I worry it is her heart. Maybe “worry” is the wrong word, perhaps its more like I’m on high alert.

One day last week, she vomited in the middle of the night and her NG tube came out. We decided to leave it out rather than place it again at one o’clock in the morning. The next morning we wanted to give her as much time free of the tube, so Paul went to work and I thought for sure I would be able to find someone to help hold Hana while I put the tube in. Well, it was getting late and I needed to give her medications (via the tube) before too much more time passed. I wasn’t able to find anyone around to help hold Hana. I was getting desperate so, of course, I called my mom.

My mom was able to instruct me on how I could hold Hana so that I could put her NG tube back in by myself. If you have not witnessed NG tube placement on a baby, I can tell you that it is very unpleasant. Hana is squirming, arms flailing, head going from side to side. She is screaming, sputtering, crying, choking and gagging. It’s awful and as the mom or the parent, it feels even worse. I had to take a few moments to take some deep breaths and psych myself up. I decided that if I couldn’t get the tube in, I was going to walk down to Kaiser and ask someone there to help me.

I swaddled Hana’s arms by her sides and then sat in an armless chair with her on my lap. I put one of my legs over hers and then had all the things I needed laid out on her high chair tray. It took a couple of attempts but I got the NG tube in and I managed a pretty nice tape job too. I don’t know if I’ve ever been more proud of myself. It was very empowering. I had thoughts of letting her go tube free more often, for several hours a day because now I could just put the tube back in myself. I don’t know if I want to subject her to that much trauma every day. I wish I knew which was worse – having the tube in constantly or getting a break from the tube but having to endure getting it put back in more often.

Last Friday we had to get bloodwork for our upcoming appointment at Stanford on Tuesday. From what I can tell, the majority of her tests were basically “normal” or at least the same. One test – BUN (blood urea nitrogen) was twice as high as the upper range of normal at 34. I know they talked about maybe having her level be close to 30, but then last time, when it was 15, they seemed satisfied. BUN measure dehydration. They want to keep her dry because it is less load on the heart.

The other test that was different was her BNP which is B type natriuretic protein. I’ve talked about this before. It is basically a substance that is secreted by the ventricles when the heart is in failure. It was going up and up and up since Hana was discharged from Stanford. At the highest it was 1055. Now is is at 589. I think that is great, but we’ll see what the cardiology team at Stanford says. I’m still happy that it is going down instead of up! (By the way, normal levels would be below 100).

Now we just need to get her eating! I’ve been researching a tube weaning approach developed in Austria called NoTube. They have a netcoaching program where they talk with you via web conferencing every day for an hour or so for three weeks. Apparently they have a high success rate. It does cost $4,000! What really turns me off is that they seem like really pushy sales people so I have a level of mistrust. Maybe it is just a cultural thing. I don’t know.

Her Happiness Breaks My Heart

Posted on July 15, 2015July 15, 2015 by katmeander

Hana had a bit of a fussy night and in the morning I found some damp vomit on her bed and pillow. It always hurts my heart a little bit to think that she vomited at night an no one came to comfort her. But maybe she really is ok with it and its just me. This is the third time its happened.

About twenty minutes after she had all her morning meds, all were given a little on the early side, I very quickly pulled out her NG tube. She cried a tiny bit. Then I took her to see Paul and drink her morning milk. Unfortunately, it seems that the first milk of the day comes right back up. At least it is an easy vomit, not like her really bad retching vomit episodes. Unfortunately, she vomited on our bed, which is not protected for baby vomit. She recovered quickly and was back to drinking milk.

All in all, Hana drank 14 ounces of straight breast milk today! That is three more ounces than yesterday! Tomorrow, I will start fortifying it just a little to add calories and hopefully get her used to the taste. We didn’t have a whole lot of luck giving her Lasix, which is the only medication in the middle of the day that really needs to be given at a certain time. I tried letting her taste the Lasix from the syringe and dropping a little bit in her mouth but she was gagging before the syringe even hit her lips! Then she vomited a mouthful and I decided to try another approach. We put the Lasix in some of her milk and she very slowly drank almost all of it. I don’t even know if you can give meds that way, but I figured trying it once wouldn’t be terrible.

The most amazing thing about the day was how happy Hana was most of the day. All babies have fussy periods of the day or a few moments of unhappiness when they don’t like something and Hana certainly had those. But she was noticeably a much happier baby all around. She laughed and smiled more. She was more active and playful. She babbled more. I really think she was so much happier not having the NG tube and not being hooked to the feeding pump. It breaks my heart to think that she could be this happy every day if only she didn’t have that tube. If only…

It broke my heart to have to put the tube back in before bedtime. It is traumatic every time you have to put the tube back in – she cries and screams and gags and almost vomits and squirms. Its terrible. I imagine for nurses that have to do it for babies its not too fun, but to have to do it to your own baby really sucks. On top of all that, it almost felt like I was forcing her back into this unhappy state. I hate it. Afterward, I cried a little.

But, we move on. She saw the feeding specialist again today who still thinks she is improving, although slowly. Her drinking is certainly very promising. Hana is definitely more interested in playing with food, even if she is not putting it in her mouth. She is beginning to mimic us when we eat. It will come. I know the day will come when she is eating and drinking and the only reason we have the tube is for her meds. Now if only I could get her to take her meds orally!

Take Her To Hawaii

Posted on June 19, 2015June 19, 2015 by katmeander

Today, Hana is 10-months old! Half her life ago she had already started to show the signs of heart failure, but we didn’t know. Yesterday she went to Stanford for an appointment with her heart failure/transplant cardiologist and nurse practitioner.

Yesterday was a very busy day. I also had a phone appointment with Hana’s dietician, who wants to increase the amount of formula we use to fortify the breast milk. The dietician was also very encouraged to hear how much Hana has been eating and drinking. At Stanford they actually wanted to decrease her volume of fortified milk to entice her to eat and drink by mouth because she is hungrier. The Kaiser dietician and the nurse practitioner at Stanford will talk and get back to me on what the plan is for the coming weeks. If we can double what Hana is taking by mouth then we can start talking about a plan to wean her off of the NG tube! I couldn’t believe we were actually having that discussion. It just seems like it has been such a long, slow, painstaking process that I can hardly believe that the end may be in sight!

The overall conclusion from her visit at Stanford was that we should treat her like a normal baby. They didn’t hear a gallop on this visit, like they did last time, which they believe the increase in her Lasix has helped. As planned, they increased her Enalapril to 2 mL twice a day. Next week, if everything is going fine they will double her Carvedilol to 4 mL twice a day. They think she looks great. They think she is gaining weight beautifully. She weighed in at 8.05 kg. Her blood pressure was 90/60. We talked about traveling. They said to travel, just let them know when we travel out of the area and where. They said to take her on a flight. I asked if they really thought it was okay to go as far away as Hawaii. They said, “Take her to Hawaii!” We may finally get to reschedule our trip! They did say to keep our travels to Oahu because that’s where the pediatric cardiologists are in Hawaii. Someday we will still try to take her to Maui, so we can take her to her namesake, Hana.

But first things first – we need to go back east to see friends and family!

Even before that, we need to get her off the NG tube. To do that we need to get her eating more solids and drinking her milk. Then I need her to start taking her meds from a syringe. It has been really difficult to get her to take foods now that Laura has gone. Today was the most frustrating day yet. I will say that even though she was refusing anything but some yogurt (I tried whipped potatoes and whipped yams with coconut oil) she did drink 175 mL out of Mr. Juice Bear (we call him Milk Bear). It wasn’t 175 mL all at one time, but throughout the course of the day. That is almost six ounces! I am wondering if Hana’s ability to control the amount of milk she gets inspires her, rather than me trying to force foods in her mouth. Tomorrow I am going to try just putting food and a spoon in front of her and see what she does. I’ve tried this before with not much luck, but she seems more interested now.

Next Wednesday it will be time to replace her NG tube. I decided that after her morning meds I’m going to take out the tube and leave it out – at least until after our feeding specialist appointment and see if we can encourage her to eat more when the tube is gone.

It’s felt like a really long week since Laura left. The house is a wreck. Stuff is everywhere. Paul and I have had some late nights getting everything done. The time I spend trying to get Hana to eat is such a huge time drain. I was very grateful for some awesome help today. Tomorrow my friend Erin comes from Pennsylvania! We grew up in the same neighborhood and have been friends since we were two! I hope we can continue to focus on inspiring Hana to eat and drink even more.

After the visit at Stanford I was so happy! I can’t remember the last time I was that happy. I remember being happy when Hana was able to breathe on her own. I was happy when she was moved out of the CVICU at Stanford. I was happy when she was discharged from Stanford. The next milestone is to get the NG tube out. Then the waiting game begins. We wait and we see how Hana does. It could be a very long wait, hopefully, before she starts to show signs that it is time for a heart transplant. In the meantime, I will be daring and continue to hope that her heart heals completely.