heart – Page 4 – Hana's Heart

Focused On Feeding

Posted on June 17, 2015 by katmeander

My sister Laura was here this past week. It’s been really good to have the extra help, especially when it comes to feeding. Especially when its Laura. She’s an animal whisperer. At least, that’s what I think. Our dog Poppy came from her and I swear she works magic on animals. I think that includes babies.

After our feeding specialist session last week, in which Laura came with me, we decided to focus her week here on getting Hana to eat and drink more. She got to see how the feeding specialist worked and we just took that home and tried to build on those techniques. So, three times a day we tried to get Hana to eat and drink for 20-40 minutes each session. That’s a lot of time and it requires a lot of patience. It also seems to work better with two people. One person entertains Hana and the other person tries to slip food into her mouth.

We’ve discovered that Hana really doesn’t care for anything sweet. That leaves all prepared baby foods pretty much off the table (literally). I made some whipped potatoes and whipped broccoli. I whipped them with greek yogurt – which is Hana’s favorite food. I also whipped up a very small avocado. We alternated between these foods, mostly choosing potatoes and yogurt. Hana will actually grab the spoon of yogurt and put it in her mouth herself, which is really amazing. The others she’s not so crazy about. The more yogurt it has in it the more she likes it.

After trying to get her to eat we try drinking. I bought something called a Mr. Juice Bear which is used for special needs. It looks exactly like a honey bear container except that it has a straw in the lid. You gently squeeze the bear and liquid comes up the straw. We tried it with the feeding specialist first. Hana was ok putting it in her mouth, which was the amazing first step. Then we squeezed breast milk up the straw into her mouth. She didn’t protest, which was also amazing. Throughout the week of trying this we found we didn’t need to squeeze the bear to much, Hana was sucking it up through the straw herself!

It felt like a breakthrough week! It was not without a lot of time and effort. Still, she is only taking about 10-20mL of food and 10-30mL of milk in each session. That’s still less than a tablespoon of food, more like a teaspoon. The milk is an ounce or less. But I am seeing progress, although it is painstakingly slow! I think once Hana can be off the feeding tube life will become a lot easier!

In other news, Hana is speech delayed, so we are trying to also focus on promoting more babbling and making consonant sounds this week. We’ve been working on sign language. I play the Baby Signing Times DVDs for her when I need to keep her still and upright. She loves them! I don’t know what we would do without them but Paul and I are really sick of the songs, but at least we know the signs too. Hana is waving and clapping and the only sign she has made with the DVD so far is “outside”. It was amazing to watch! I also use an iPhone app for additional signs.

I will say a few words about diaper rash. Almost every diaper is a poopy diaper. Is this too much information? This makes it very hard to prevent diaper rash. I should buy stock in Desitin (is that Johnson & Johnson?). Even with a thick layer of maximum strength Desitin and an equally thick layer of Aquaphor, her diaper rash persists! She cries during diaper changes. We finally got a prescription strength cream from the pediatrician, which I think is making the difference. I change her diaper whenever I think she has pooped or every 1.5 to 2 hours. I am hoping that we can eventually go back to cloth diapers! I wish this kid could catch a break! She has so many discomforts.

Tomorrow we have an appointment with the dietician and then later we have to go to Stanford for a clinic visit. Hopefully everyone will be pleased with her weight gain.

This is how we hook up Hana’s feeding pump (in the hanging black backpack) and keep her upright while it is running.

Whipped broccoli face!

GI Recheck

Posted on May 20, 2015 by katmeander

Yesterday was kind of crazy. Hana vomited three, technically four times. She napped very poorly and I am beginning to think that there may be a correlation between poor sleep and vomiting. It was not a question that I asked when we went to see the GI doctor in the afternoon.

When we go to see the GI doctor she really sees three people – the GI nurse/case manager, the dietician, and of course, the doctor. I keep forgetting that we have a GI nurse/case manager in addition to our regular Kaiser chronic conditions case manager which is in addition to our Kaiser Outside Providers case manager whom I never talk to because I’ve never had a problem with Kaiser and Stanford. But anyway, seeing the GI nurse/case manager reminded me that I have another source to go to when I run into problems finding syringes, NG tubes, etc. She understands exactly what I need. Our chronic conditions case manager did get syringes for us, but they were the leur lock tip syringes meant to work with needles and even if you take the needles off they don’t fit into the NG tube port.

The overall consensus was that Hana looked great. Her liver is still enlarged (I think that is what they are calling it) as it goes across her entire abdomen. But the cardiologists all feel her liver each time as well. Her weight gain has been great – about 10 grams a day. Her weigh yesterday was 7.87 kg. They don’t want to change anything. We talked about NG tubes versus G tubes. Problems with NG tubes long term (besides them irritating her and creating an oral aversion and not encouraging her to want to eat by mouth they are easy to pull out when she gets older). We also talked about vomiting, which they aren’t overly concerned about. No one seems to be concerned about vomiting if the cardiologists aren’t worried its her heart and she is still gaining weight like she should.

I forgot to ask some questions. There are more details but I’m so tired. I’m trying to get more exercise, even go to the gym and do some other “pamper myself” sorts of things. I had my first ever facial and pedicure in the last couple of weeks. I even played some guitar, playing “Blackbird” and trying to remember the chords to “I’ll
Follow The Sun”. Hana liked it. She is now nine-months old and finally likes hearing me play more than “Twinkle Twinkle, Little Star” on guitar.

Little Things

Posted on May 18, 2015 by katmeander

Things have been going well. Hana still vomits once a day. Today it was in the morning and it wasn’t too much. I guess what makes her vomiting different, perhaps, from other kids that may vomit a lot is the intensity of it. There is usually crying, choking, and a lot of dry heaving. It is not like you look over and say, “Oh, she vomited!” It is usually much more dramatic. Not always, but most of the time.

I feel like things are really starting to come together. This is not without a lot of help and not enough sleep. What makes things busy for us, busier than a family with one baby might otherwise be, are the little things. It is pumping breast milk, washing pumping supplies, washing bottles, rinsing feeding bags, cutting bandages into ovals (and hearts), measuring and mixing formula, washing syringes, ordering meds, picking up meds, drawing up meds, ordering adhesive remover and NG tubes and feeding bags and syringes and adhesives and formula. It’s sending messages to doctors, logging when you fed her and gave meds and when she vomited and tried to eat solids. It’s starting her tube feed at the right time, but not when she is rolling around or when its time to nap. Its talking to the case manager about supplies and samples and breast pumps and prescriptions and what messages have come from Stanford and what echocardiagrams I need to take to them next time I am there and how much Hana weighs this week and how many times she vomited and when. It is a lot moving parts. Not too many of them can slide, either. They all have to get done and by a certain time and not too early either!

This is why all the help has been fabulous, because keeping up with all the new stuff leaves little time for normal things like grocery shopping and making dinner and cleaning and paying bills and doing finances and taxes and laundry. But each day it gets better, mostly. Today was a good, low-key day. We took Poppy on two good walks and spent the rest of the day getting naps (Hana, not me) and attempting solid foods and bottles and giving tube feeds while she was upright and awake but still getting time to practice crawling on the floor. Tomorrow we go back to the GI doctor. I have a long list (in my head) of things to go over, like choices of medications, and weight gain and types and sizes of tubes and formula, volumes and rates of feeds and how much to fortify and when I should stop pumping breastmilk. There are more questions, I hope I can gather them all together before I forget!

Here are some photos from the last couple of days.

Cruising Altitude – Checkup At Stanford

Posted on May 13, 2015 by katmeander

Today Hana had her regularly scheduled checkup with her heart failure/transplant cardiologist at Lucile Packard (at Stanford). Her weight is up to 7.7 kg (almost 17 lbs) which is 170 grams more than last Tuesday. They were able to get her blood pressure (sometimes, most times, they aren’t able to get it) which was 108/55. They could her an intermittent gallup in her heart. They talked about her creatinine levels. They decided to adjust her Lasix so she is more dehydrated. She is more dehydrated than most normal babies, but too hydrated for a baby with a poor heart. But the overall assessment is that she looks great. They called this her new cruising altitude.

That means that we will watch the weight gain trajectory she is on. They will still be increasing some of her meds until they get to the levels that they want. We will watch the vomiting, since this is a normal occurrence for many tube fed babies, but there seems to be much hope that she will eventually take things by mouth and the tube can go. One vomit a day is not so bad, they say. She recovers well. They said we can all relax a bit more and just focus on enjoying our baby. The cardiologist said he didn’t even want to bring up “the transplant topic” on this visit.

They increased her Lasix from twice to three times a day. They doubled her Carvedilol again. They will wait until next time to increase her Enalapril. They want to do bloodwork again in a week to check how she is doing with the increase in Lasix. We will do another echo at Kaiser in a couple of weeks and we will go back to see them at Stanford in a month.

I am feeling much calmer and relaxed. They even said we could think about making travel plans, including a possible airplane flight. They said to just treat her like a normal baby. I can take her swimming again and they also said to go ahead and take her on the bus! I’ve been avoiding the bus because of small, enclosed spaces with lots of people, but it has kept us confined to walking distance from our house (and we only have one car which Paul takes to work).

I think we are really starting to get into a rhythm. We definitely need less and less help at home, most days. I could still use more sleep. Some of the conveniences that we pay for people offer to us are still making it manageable, but I definitely see a cruising altitude for all of us soon! We are so grateful for all of the support and help that we have received from so many people!

Plan For February 23rd

Posted on February 23, 2015 by katmeander

My dad left last night. I can’t imagine a more difficult goodbye. My mom is still here almost two more weeks. I don’t know what we would’ve done without them.

It took Hana a long time to get to sleep last night, it was midnight before we got to bed. She was still sleeping when I got up at 6:30 this morning. When she did awake around 8am, she was agitated and wanted to sit up. She was obviously still tired. It took a long time to get her to take a nap (which lasted less than an hour). I am so tired. We all are.

Hana seems like a teething, overtired, bored baby agitated by all the restrictions of tubes and wires attached to her. Today they will continue to wean her oxygen flow (she is on 2L). They will try weaning (I don’t know if they actually wean or just stop) her Heparin and start her on aspirin. They still need to get her diuretics right before weaning her down on the Milrinone (I suppose they need her electrolytes better balanced before messing with heart medication). She is getting 40mL of breastmilk an hour, which they will start fortifying tomorrow (for more calories without the volume). They talked about doing another echocardiogram. She has a standing order for Ativan is she can’t get settled. They are giving her Tylenol every six hours.

I heard the heart failure/transplant doctor say that 60-70% of dilated cardiomyopathy cases like Hana need a heart transplant within four months. Some percentage of those will need a heart transplant later in life.

Withdrawl

Posted on February 21, 2015 by katmeander

Today Hana has been very agitated. She has been awake since 6:15 without a nap. She has the shakes and is inconsolable. They believe it is from drug withdrawal from the morphine and Versed. Someone needs to constantly be with her to entertain, distract, console her and she is still crying (a strange cry/whimper like I’ve never heard from her before), kicking her legs and arching her back. We take shifts being with her. I’ve probably spent the least amount of time in her room. Between pumping breastmilk, trying to eat, drink water and go to the bathroom, there seems to be a shortage of time. Then I feel guilty. I am not doing a good job at taking care of myself. I am exhausted and copious amounts of coffee are only doing so much (and keeping me up too late). Thank goodness for my parents and Paul, who is so devoted.

They have her Ativan. Then more Ativan. Then they gave her a small dose of morphine. It wasn’t helping. Her heart rate was really high. Finally, they got the amount of Ativan and morphine right so she could rest. They also increased her high flow up to 10L and they increased her dopamine to 5. We will start again tomorrow trying to wean her off some drugs.

It was a stressful day. Poor Hana was the most stressed. It’s terrible watching a baby go through drug withdrawal. Nothing calms them. I hope her heart can get some rest from the last 12 hours of agitation.

I went for a jog in the evening. I was assured by a number of people that it would be good for me to get out. I need movement and fresh air. I need it to give me the energy to get through days like today – and I have a feeling there may be a lot more days like today. Towards the end of my jog I started to cry and I imagined holding my healthy baby in my arms. It’s hard to find peace and yet, I think if I can manage some moments of peace, I can find some more strength. I might just need to take more deep breaths. We go from holding our breath to letting go of a sigh back to holding our breath. That takes a lot of energy (as does feeling guilty). I need to move breath more freely.

I sat outside the hospital on a bench in my running clothes and cried into my hands. I kept thinking, “My baby, Hana. My baby, Hana.” Then I went inside.

Oh, my sweet Hana.

This is Hana as we are waiting for her new room to be ready:

This is Hana finally resting:

Good Night

Posted on February 20, 2015 by katmeander

Hana was wide awake for many hours today. She spent a lot of the time looking around. We tried to entertain her with toys, songs, games, books, music. She’s not quite ready to entertain herself, it seems. She isn’t quite looking or acting like herself yet. She will look at you for long, long moments.

I’m hopeful and then almost scared of my hope. I need to remain in the present moment. That is my coping strategy. My baby, with a very sick heart, is sleeping (hopefully) down the hall where a nurse is constantly watching her. That is what it is, presently.

I love Hana. She would not fall asleep tonight. Much like it would be at home, on a normal night, I finally had to tell her “Good Night” and leave the room so she would allow herself to fall asleep.

There are so many people to thank. I’ve had people tell me I am strong, if that is so, it is only because I have been carried by all the love, support, help, thoughts and prayers of so many people. Thank you. It has touched us so deeply.

Here are some photos from today:

February 20th Plan

Posted on February 20, 2015 by katmeander

Hana had a good night. Her heart rate is still pretty low but they are watching it carefully and so far everything else looks ok. When her heart rate is a little higher they will start her on beta blockers. For her breathing support, they will continue to wean her flow and hopefully get her on low flow (I think this is what it’s called) by tomorrow. They will wean her dopamine today too. The optimal plan, I suppose, is still to get her on oral medications and bring her home. There is still a slim enough chance that her heart could recover (although probably with decreased function), so we need to give that a try. But the next few days or week might tell us more if that is a possibility or if we need to get a Berlin heart for her or continue to keep her heart until a transplant heart becomes available.

Hana was quite active this morning! We sang and showed her toys. Maybe today we can even hold her.

Big Day Today

Posted on February 19, 2015 by katmeander

Today, after rounds maybe as late as early afternoon, they are planning to take the breathing tube out. They will do another CPAP trial before then just to make sure. This is big. If she can successfully come off the breathing tube, then we continue the course of lowering medications. If not, she may have to get a heart pump (Berlin Heart). After the last drama of this attempt we are all nervous (doctors don’t look nervous, at least).

Maybe I will get to hold her soon. I fear I am forgetting what it feels like to hold my baby.

It feels a bit awkward to mention this, but people have started asking – we have a fundraising page. My friend Alyx started it. When it went live last night I saw people had already started to donate and I cried for a long time. It’s not so much the money I see as it is the love and support.

http://www.gofundme.com/hanasheart

Here is Hana when we were at my parent’s house after Christmas:

CT Scan

Posted on February 18, 2015 by katmeander

So, we were kind of hoping that the CT scan would show something wrong with Hana’s coronary arteries because that is easy to fix (relative to a heart transplant). We knew the likelihood of all this being a coronary problem was very slim. As it turns out her coronary arteries are just fine, that is no longer a hope.

With all the unknowns, my dad keeps asking, “What should I be rooting for?” There’s a very slim, outlying chance that, given enough rest, her heart could recover. Or it could recover enough where she wouldn’t need a transplant for years. The mortality rate for transplant patients increases the older they get, so delaying it seems best. But, because she is so young, if she got the transplant now they believe that there is less chance of her body rejecting the heart, therefore making now more ideal. They don’t have enough data on transplants in infants to be able to say with certainty if now is for sure the best situation. So, it’s hard to know what to root for.

Here is Hana about three weeks ago: