Sunday, May 10, 2009

Happy Mother's Day

Nothing new to report. I just wanted to share this article from the LA Times that was posted on a special needs parenting board I frequent. So timely, and all so true.

Happy Mother's Day to everyone!


These moms know true love
Mothers face tough challenges in raising children with disabilities, but there are rewards in the role.


Deedra Williams doesn't need breakfast in bed or a spa massage to celebrate Mother's Day tomorrow. She received her gift last weekend at a quiet Montecito retreat from 15 women who, like her, are mothers of children with disabilities.


They hiked eucalyptus-shaded hills, listened to music and made collages with pictures cut from magazines. They talked for hours about the challenges of mothering children who may never be able to walk or speak, to go off to college or get married.


And everyone knew better than to interrupt, criticize or offer advice.


"No one tried to fix it here," explained Williams, a mother of two sons -- a "developmentally typical" 7-year-old, and a 14-month-old whose newborn jaundice left him with brain damage, hearing loss and cerebral palsy.


"We can relate to what each one is going through because we're all in the same boat," Williams said as we sat at table at La Casa de Maria Retreat with four other mothers.


"What I took away from this weekend," Williams said, "is acceptance."


And what I took away was a new appreciation for the unconditional mother-love that many of us give lip service to, as we continually push our children to improve themselves, carrying around our mental check-list of all their shortcomings.


Raising a disabled child requires a sort of hyper- vigilance. "Motherhood amplified," Nina Loh called it, describing life with her 7-year-old twins -- a "typical" daughter and a son with spina bifida, who has had 13 surgeries and may need more. "The stakes are so high. And there's really no end in sight."


Woodland Hills therapist Diane Simon Smith knows the feeling well. The mother of two disabled sons, she began offering "Healing the Mother's Heart" retreats six years ago, to give women a safe place to vent "the anger, the guilt, the joy . . . all the feelings."

Smith's first child was born weighing less than 2 pounds. He was blind, mentally retarded and was never able to "walk, talk, sit, use his hands or feed himself," she said. He died of pneumonia at 17. His brother, two years younger and now 21, was born with Fragile X Syndrome, an inherited disorder that causes severe cognitive and behavioral problems.


I asked Smith if she felt cheated, robbed of some of the joys of motherhood.


Not cheated, she said, with its implied resentment and bitterness. Just sad, sometimes, "when I hear my friends talking about what their kids are doing . . . going off to college, getting married."


Every woman around the table talked of feeling isolated, separated from the larger sisterhood of mothers.


"I never wanted to be different," said Eileen Sunderland, whose 7-year-old son has autism. "I wanted to fit in. . . . But you can't go to lunch with all the moms at preschool. You can't meet them in the park, because you always have a therapy appointment or a doctor visit to get to."


And what do you talk about, anyway, with a mom who complains that her daughter wants pricey True Religion jeans, when you're trying to get your son to stop flapping his hands like wings.


Still, some said their children's diagnosis provided an odd sort of relief -- a validation of a mother's instinct that something was wrong, or a vindication of their parenting.


"I thought I was an inadequate mother," recalled Lisa Hannifin, whose 4 1/2 -year-old son was diagnosed with autism. "I wondered 'Why am I so stressed out? Why can't I take my boy to the market?' Other kids sit in the cart and behave. There must be something very wrong with me."


For others, the verdict triggered fear, panic and disbelief.


When her daughter, now 5, was diagnosed with autism three years ago, Julia Gosnell "was hyperventilating into a paper bag for 10 minutes."


Gosnell had every prenatal test her doctor offered during her pregnancy, "because I did not want a child with a disability," she said. "I really considered myself too selfish. . . . I was a workaholic . . . not really cut out for raising kids."


But children can stretch a mother's boundaries.


Since November, when Gosnell was laid off, she has been a stay-at-home mom. Last week, the child she once feared might not speak said, "Mommy, I want to teach you a magic trick." Tears spilled down Gosnell's cheeks as she shared the story. "Her progress has been so astounding in the last seven months, and everybody agrees it's because I'm home working with her. . . . I've learned about patience and love and how to give myself to someone else."


And about how important a mother is to her child.


I had to admit on my drive home that I had visited the retreat to turn those moms into an object lesson. I envisioned this column as a reality check for mothers like me -- a "see, it could be worse" reminder to count your blessings this Mother's Day.


But it was their spirit, as much as their stories, that took me down a different path.


The way every description of a child's disabilities also included the strengths their mothers see: The beautiful smile, the sense of humor, the determination, the innocence.


The way they never labeled their other children "normal," just "developing typically."


How much freer would we all be to love if we could let go of our preconceived notions of what our children should do or be? If I worried less about my daughter's tattoo and appreciated her sense of humor more. Or focused less on the "C" in statistics class and more on the hard work she put in to earn even that.


These women are not saints or martyrs. But they see gifts where others might see only hardships.


"Write this column for them," Smith told me, as the mothers packed their cars to head back to their families. They are not looking for pity or praise, just acceptance of their challenges. "We're not special," she said. "We're just human beings, doing what we do with love."


Just like every other mother.

Wednesday, May 6, 2009

Gender Confusion, Among Other Things

Lots to update! It seems this blog has temporarily shifted from Lessons from Joey to Complicated Pregnancy Updates.

First off, I had my 19-week anatomy ultrasound on Monday. I told the tech we already knew the sex, so at the end she said it was a boy. WHAT?! We've been planning on a daughter for the past 4 weeks! She told me this before Jason came into the room, so of course he thought we were joking. The tech showed us what is supposedly a scrotum and penis, but to be honest, I just didn't see it. With Joey is was extremely clear, I didn't question it at all because it was so obvious. This time, not so much. And the first tech was so sure it was a girl! So the jury is out for now,thank goodness we haven't gone overboard with the shopping or decorating! Not being able to stand the suspense I've booked a 3D ultrasound next week, so hopefully we'll have it confirmed one way or another :) Boy or girl, we don't care, except for two things...boys are statistically more likely to develop "issues"" like Joey, even my OB says that boys really are the weaker sex in that regard. I did feel a sense of relief when I was told it was a girl, so a bit of panic has now set in. The other thing is a name...we have NONE for a boy! Not one that either of us even kind of likes. This is going to be tough.

Today Jason and I went to Mount Sinai Hospital to meet with a high-risk OB at the Special Pregnancy Program. We had to give all of our history again, which were of course accompanied by the sympathetic looks and obligatory words of condolences. This is often an issue when Joey isn't with us as I think people get a picture in their mind of what a non-verbal, deveopmentally delayed 3-year-old who doesn't yet walk must be like. They don't actually see the happy, smiling, social, sweet, easy-to-please and affectionate little boy that Joey is. I often find myself thinking (if not actually saying) ''it's not as bad as you think!!!''

Anyway, the doctor was fantastic and basically reiterated what my regular OB has already said...yes, I have had multiple complications but none of them, in isolation or in combination, is likely the cause of Joey's disabilities. He, like everyone else, is stumped but feels from our history that everyone has done everything right, ordered the right tests, investigations etc. to determine a correct diagnosis, but it really looks like we're just a part of that 3% of the population who has a disabled child with no explanation. Regardless, he does think that my previous complications warrant being followed by him, and he even feels I should give birth there rather than at our local hospital. I didn't like that idea at first but then I started thinking about how in addition to Mount Sinai there are 3 other world-class hospitals in 2 city blocks (including Sick Kids) so why would I turn down that kind of care???

We reviewed my test results for the cholestasis. A normal reading for bile salts is 4. High is 8. My reading at 10 weeks was 15. They've seen as high as 40 and above, and in his experience there have been little complications as a result. He's happy I've started the medication already and will continue to monitor me closely, along with my regular OB. Today he ordered another blood test to see where my levels are, hoefully they've come down as I've been on the medication now for 3 weeks. I'll call at the end of the week for the results. The doctor is also referring me to another high-risk OB that specializes in liver disorders during pregnancy, for another consult.

And now for the scary news...This doctor, Dr. R, also received the results from Monday's ultrasound while we were there. It shows a choroid plexus cyst on the left side of the brain. Often a soft-marker for Trisomy 18 (babies with Trisomy 18 rarely live past one year, if they make it to birth at all), it can also indicate absolutely nothing and resolve on it's own, a much more likely scenario. According to the rest of the report, they weren't able to get the best anatomy scan because baby wasn't cooperating with his/her positioning, but from what they could see everything else looked normal. That fact, combined with the negative results from my first trimester prenatal screen, certainly lowers the risk that this is Trisomy 18 but doesn't eliminate it. So I go back to this hospital for a high-level U/S performed by a doctor (usually they are performed by a tech) in 2 weeks. I've been told that most often, when this type of cyst is found in in the absence of any other anatomical abnormalities it results in a positive outcome, meaning the cyst resolves before birth and there are no other effects. So I'm hoping if it hasn't actually resolved that it has at least shrunk from the 8.5mm it was measuring on Monday. The Dr. who is performing the ultrasound in 2 weeks is an expert in brain and spinal anatomy, so that's comforting.

So a very eventful few days, filled with more and more stress. I'm trying to keep calm and not worry but that's almost impossible. I just have to keep reminding myself that I have the best possible care...my regular OB, the new high-risk OB, another high-risk OB specializing in liver disorders, an OB that specializes in fetal brain and spinal anatomy scans, my family doctor and my nurse pracitioner. I'm not really sure how many specialists I haven't seen! Dr. R. called me "an interesting connundrum" and seems genuinely concerned, I feel like this baby and I are both in very good hands.

P, J & J

Friday, April 17, 2009

Let the Complications Begin

Today was my second appoinment with the wonderful Dr. S, my OB/GYN. The good news from the appointment is thatso far it doesn''t appear I am developing gestational diabetes again, and I am also now feeling her kick more strongly and more frequently, all great things. But...after my last appointment at 10 weeks he ordered a bile salts test, to get a baseline to compare against later on in case I began developing symptoms of Intrahepatic Cholestasis of Pregnancy, which is a liver condition that I had during my pregnancy with Joey. As it turns out he won't be getting a baseline, because the values are already substantially elevated, indicating that it has already started with this pregnancy. It's relatively early for this to have started already which can indicate that it will develop more seriously as well.

In case you don''t know what ICP is, here is the description according to the March of Dimes:

INTRAHEPATIC CHOLESTASIS OF PREGNANCY (ICP)

What is ICP?

ICP is a pregnancy-related liver disorder in which there are abnormalities in the flow of bile (a substance produced by the liver that aids in the digestion and absorption of fats). These abnormalities lead to a build-up of bile acids (components of bile) in the mother's blood, resulting in symptoms such as severe skin itching.

What are the symptoms of ICP?

The symptoms of ICP can range from mild to severe. Symptoms usually start in the second or third trimester of pregnancy. The most common symptoms include:

Skin itching: Itching often is most severe on the palms of the hands and soles of the feet, but many affected women itch all over their bodies. It often gets progressively worse and may interfere with sleep and daily activities.

Jaundice: This yellowing of the skin and whites of the eyes occurs in 10 to 20 percent of women with ICP. Jaundice is caused by a build-up of a chemical called bilirubin in the blood, resulting from the liver disorder and decreased bile flow.
A pregnant woman should call her health care provider if she has these symptoms.


How common is ICP?

In the United States, ICP affects less than 1 percent of women.

What are the risks of ICP in pregnancy?

ICP can be very uncomfortable for the pregnant woman. It also can hurt the baby. Up to 60 percent of women with ICP deliver prematurely (before 37 completed weeks of pregnancy). Premature babies are at increased risk for health problems during the newborn period and for lasting disabilities and death. ICP also increases the risk for stillbirth, though the risk is small (1 to 2 percent). It is important to diagnose and treat ICP to help prevent these potential problems.



How is ICP diagnosed?

There are a number of skin disorders of pregnancy that can cause itching; most do not harm the mother or baby. Blood tests can tell if a woman's itching is due to ICP. These often include a blood test that measures various chemicals that show how well a woman's liver is functioning and the amount of bile acids in her blood.



How is ICP treated?

ICP often is treated with a medication called ursodeoxycholic acid (Actigall). This medication relieves skin itching, helps correct liver function abnormalities and may help prevent stillbirth.

The health care provider monitors the baby closely (with ultrasound and tests that measure heart rate) to see if the baby appears to be developing any difficulties, such as heart rate abnormalities, due to ICP. If the baby is having difficulties, the provider may recommend early delivery to help reduce the risk of stillbirth. The provider also may do a test called amniocentesis when the baby is at about 36 weeks gestation to see if the lungs are mature. If the baby's lungs are mature enough for the baby to breathe on his own, the provider may induce labor at 36 to 38 weeks to help prevent stillbirth.



What causes ICP?

The cause of ICP is not well understood. Pregnancy hormones and heredity appear to play a role. ICP appears to be more common in twin (or other multiple) pregnancies, possibly due to increased hormone levels. About half of women with ICP have a family history of related liver disorders.



Does ICP go away after delivery?

Symptoms of ICP generally clear up on their own by about two days after delivery. However, about 60 to 70 percent of affected women develop ICP again in another pregnancy.



Doesn't that all sound so pleasant? The symptoms in my pregnancy with Joey weren't really noticeable until I was about 6.5 months along. It''s also very likely that ICP is wha caused Joey to be born a month early...I was scheduled to be induced at 37 weeks due to the ICP but Joey came on his own at 35 weeks 6 days. This time is a bit different...I started feeling itchy about 2 weeks ago but said nothing to anyone, I really believed I was being paranoid and imagining things. With me it also doesn't start on the soles of my feet and palms of my hands, which is the most typical. I started feeling my back get itchy (not fun when no one is around to scratch for me!) and the front of my calfs.

So today I started the medication, which will hopefully bring my bile salt levels in my blood down to a safe level for both the baby and myself. It should also stop the incredibly annoying itching, or at least make it more manageable I hope. In the meantime Dr. S. wants me to meet with a specialist at Mount Sinai Hospital in Toronto within the next 2 weeks for further advice on treatment.

Despite receiving this bad news today I am still so happy tonight, since our sweet baby Joey will be returning from Florida tomorrow! Jason and I have missed him terribly and we can't wait to see him. Unfortunately for him the vacation ends pretty abruptly over the upcoming week, he has an appointment with the pediatrician on Wednesday and a dentist appointment on Thursday, along with all the work he has to catch up on with his physiotherapy and walker class. Poor kid, he's more schedued than we are :)

- P, J & J

Tuesday, April 14, 2009

G-Tube Update

Today I received a call from Dr. J, the developmental pediatrician we met with in February. She was calling because Sick Kids Hospital sent her some forms regarding our consultation for a G-tube scheduled for May 19th and she needed further information from me.

When I told her of the new developments in regards to Joey's feeding she sounded quite alarmed, and said she will be calling Sick Kids tomorrow to get the appointment moved up because, in her opinion, this is now "rather urgent". She was not happy to hear that he was no longer taking any liquids at all (other than about 2oz of water in the morning and at night after we brush his teeth). I suppose there is a concern about dehydration, but I am very concious of it and know for a fact he is nowhere close to being dehydrated.

It was a bit disheartening to hear her language change from "if you decide to go ahead with a G-tube" to sounding more like this is a medical necessity, but I guess this isn't a shock. We've tried for over 3 years now to avoid a feeding tube, it has been difficult, time consuming and very frustrating. I think it's time to realize that we aren''t going to be able to fix this problem quickly, and in the meantime Joey needs to receive proper nutrition.

- P, J & J

Monday, April 13, 2009

Happy 3rd Birthday to Joey

On April 1st Joey turned three years old. We didn't have a big party this year, as we were leaving for Florida the next day, but we decided to have a low-key pool-side BBQ while on vacation. I can't believe it's been three years since Joey came into our lives! In some ways it feels like yesterday, but in other ways I can't remember what my life was like without him in it.







And in keeping with the tradition he started last year, a few days before his birthday Joey went on a bottle strike. For the majority of 3-year-olds this is not a huge deal, in fact there are few 3-year-olds still drinking from bottles (I know this because of the judgemental stares I get from people while giving Joey a bottle in public). But for Joey this is a huge source of nutrition completely cut out of his diet. Up until now Joey would drink about 2 cans of Pediasure Plus (1.5 calories per ml.) from a bottle per day, one in the morning and one before bed, but now he's decided he wants none of it. Last year he replaced this with eating a huge amount of varied foods...this year, he's just increased the amount of the 3 or 4 things he already eats, namely Minigo (strawberry only), pudding (chocolate only), yogurt ("pink" flavours only) and blueberry baby food. This new phase is troublesome for so many reasons...Joey still does not feed himself at all, and does not eat a lot at one sitting, so that means he has to be fed at least 6x per day, which is time consuming, and he will only eat for a select group of people (right now that's Jason, Grandma Phyllis and to a lesser extent, me). Joey's caloric intake has dropped from about 1200/day to about 900/day, if we're lucky. I'm not even sure that 1200 calories a day was enough, given that he is still EXTREMELY thin and weighs less than 25 lbs at 3 years old.

So the light at the end of the tunnel, if things don't take a major turn for the better, is that we received notification that our appointment with the GI clinic at Sick Kid's hospital in Toronto for a G-tube consult is May 19. I can say for sure that if things don't improve drastically we will be going ahead with the surgery, and Joey will likely have a G-tube in place sometime this summer.

I've always said that pictures of kids covered in food were completely disgusting and should be viewed by the parents only, but since Joey has such a negative relationship with food I tend to celebrate any milestones, such as this little beauty:



Smiling while covered in chocolate pudding and strawberry Minigo...yummmmy!

Joey did extremely well on the flight from Toronto to Tampa. We had some very nasty turbulence that scared me out of my mind, but didn't bother Joey and actually seemed to act as a tranquilizer on him:






Joey also got a chance to sport his new fancy schmancy Superman swimsuit on the beach, courtesy of Zia Jodi and Uncle Jason for his birthday:





Last but not least, while we were in Florida decided to go ahead and get an "elective" ultrasound, something not readily available here in Canada. This was for the sole purpose of finding out the sex of this baby, since I am one of those people that would find out the sex at conception, if there was a way to do so. I was 15 weeks exactly, and the person doing the ultrasound said right away that this baby, much like her older brother, put her goods on display immediately and she could tell us that it's a GIRL! Joey is getting a little sister :) Here are some of her first pictures:


Umm, apparently since there's nothing "pointing back" towards the arrow this indicates that the baby is a girl. I'll just have to trust them on that one, since this just looks like a messy blob to me.





Now this one at least looks like an outline of a baby :)


So Joey is still in Florida with Grandma and Papa Roy for another week, lucky guy. We're both enjoying some lazy time but I miss the little guy terribly. Only 5 more sleeps!
- P, J & J















Tuesday, March 10, 2009

We're Still Here

I had to take a bit of a hiatus, this pregnancy is kicking my butt! It is infinitely more difficult being pregnant when you already have a child at home, especially when that child has extraordinary needs. Add working 4 days/week, a nasty case of all-day sickness and exhaustion like I have never known and you get a pretty good idea why I just haven't had time to update our blog.

The good news is that this pregnancy is completely different than my pregnancy with Joey in almost every way. As of Monday I will be exactly 3 months along, 1/3 of the way there! The sickness is fading away, thank God, and the exhaustion seems to be subsiding a little bit. I had my first OB/GYN appointment last Monday...Joey and Jason both came with me and got to hear the baby's heartbeat for the first time, very exciting! I was surprised to hear it at 10 weeks, They couldn't find it with Joey until after 13 weeks. Normally you don't get referred to an OB/GYN until 28 weeks, until then you are just monitored by your family doctor, but they have classified me as "high risk" because of Joey so I was referred right away. Our OB, Dr. S., is AWESOME. Very understanding, very thorough and says all the right things to make us feel at ease. Last week he decided I should be referred to a high-risk OB at Mount Sinai Hospital in Toronto, just for a second opinion and to talk about perhpas doing a c-section this time, and possibly even an amniocentecis.

I have opted for the Integrated Prenatal Screening, which involves an ultrasound and bloodwork at 12 weeks to determine if there is an increased risk of some disorders like Down Syndrome or Spina Bifida. Of course I had all of this with Joey (minus the amnio) and all tests came back completely normal, so while they are great for detecting some things they obviously can't detect everything. As I've said before, we don't actually know what is wrong with Joey, so there is no way to test for it with future kids.

On to Joey news....what do these three things have in common???







They are the first non-fabric objects Joey has brough to his mouth and chewed on completely on his own. Maybe not a huge feat for most kids, but given that Joey has NEVER voluntarily brought anything other than fabric to his mouth this is a very big deal.

We've made some slow but steady progress with the walker as well. Here is a video of Joey in his walker about 2 months ago....he didn't really "get it", couldn't control it and didn't understand how to move himself around:






Here is a video taken about 3 weeks ago in the gym during physiotherapy. Again, HUGE progress for Joey! He can actually steer himself to where he wants to go, in this case it was the wooden rack with the velcro bells, which he loves:




In other Joey news we had an appointment with a Developmental Pediatrician, Dr. J. (we've been pretty lucky so far not to have more than one doctor with the same last initial!) on February 19. She spent about 2.5 hours with us but couldn't really offer anything further in regards to our search for a diagnosis. She will be changing his working diagnosis from Global Developmental Delay to something like Intellectually Disabled, which implies a more permanent condition. The Hypotonic CP label will stick for now, even though everyone unanimously agrees he likely doesn't have CP at all. It's best to get as close to an accurrate diagnosis as possible to save us time...right now we have to re-apply for a lot of things, like the disabled parking permit and money for a mediator, every few years because his current diagnosis doesn't necessarily mean he is permanently disabled, lots of people with CP go on to get a PhD, and many people can outgrow a global developmental delay. Dr. J. has recommended a follow up MRI to be done at Sick Kids, as well as a consult at Sick Kids for a G-tube. We're still not sold on that idea but we're willing to go for a consult.


Last but by no means least, in honour of my Grandmother who passed away Febraury 26, 2009, here is a picture of her with Joey when he was a newborn. She was the only Great-Grandparent Joey ever got to meet. She loved babies so much, and I am so sad she will not get to meet this new baby in September. But she did know we were expecting. I was able to visit her 3 days before she passed away, and when my Aunt reminded her I was coming and that I was pregnant my Grandmother told her that she was "praying for this baby to be healthy", so we're in safe hands.

We love you, Grandmere xxxxxxx





Sunday, February 1, 2009

That was Fast!

Joey is going to be a big brother! Apparently all we have to do is think about having a baby and it happens, for which we are very thankful but also very stunned. We knew what we were doing but really didn't expect for it to happen so quickly, so it took some time for us to adjust.

Joey's new sibling is expected to make an entrance around September 28/09. Of course we are thrilled but also terrified, this is going to be a long pregnancy filled with uncertainty and stress and worry. Because we don't know why Joey is the way he is we also don't have any way of knowing the odds of having another child with the same issues. We've been given the same odds as anyone else....5%

There are also the logistics of having Joey and another child, who we will assume for arguments sake will be "typical"...how on earth am I going to be able to carry a 3-year-old and a newborn everywhere? How am I going to carry Joey around when I'm 8 months pregnant? It's not as though it's just the occasional picking up and carrying, it's any time we need to leave where we are! Living in a 4-level sidesplit house doesn't hlep much...It's basically going to be like having twins...both will need to be fed, both will need to have their diaper changed, both will need to be carried everywhere.

But then there is the fact that Joey will have a little brother or sister to learn from, and that child will be so blessed to have Joey as a big brother. I'm excited about having a newborn again, I know a lot of people prefer the one or two year old stage, but I am truly a baby person.

So, boy or girl, Jason and I are excited to welcome the second, and last, baby to our family. Joey doesn't have a clue what is going on but I know he will love having a sibling.

- P, J & J