Sunday, March 22, 2009

Taylor's Difficult Diagnosis

We have some difficult news to share, we have shared this with some of you already, but certainly not all. Unfortunately the struggles Taylor faced in her first couple of weeks are not behind her, they're sadly just beginning.

Shortly after Christmas I was getting concerned that she wasn't yet smiling, which should have happened by about 2 months. As each week passed with not even a subtle smile it worried me more and more. I was so pre-occupied with the absence of a smile that I wasn't noticing that there were so many other things she also wasn't doing. Getting further into January as she passed her 3 month mark and close to 4 months my worries kept growing. Her head wasn't getting stronger, still no smiles or expressions of excitement, no reaching for toys, no holding on to a toy, no playing with her hands and feet, not following objects with her eyes...all the things that she should have been doing by that stage. At our 4 month checkup with the pediatrician I took my list of concerns and he was also very concerned. On his examination of her he said that her visual attention was very poor, she won't focus on something or follow it. He had us do a 4 month questionnaire, and the results showed that she was significantly behind developmentally in all the categories...communication, motor skills, fine motor skills, problem solving, and personal/social. He put in a referral to the Infant Services Program at Children's Hospital, a program that has access to different therapists to assess her needs. He also put in a referral to Early Intervention, a program that sends someone to the home to assist with encouraging her development in different areas. And he also requested vision and hearing testing, and another EEG. She failed the initial screening test for hearing and the Audiologist said to not be concerned yet, as it may just be a result of fluid behind the eardrum, and they scheduled a follow-up diagnostic test. As we got closer and closer to her 5 month mark I got more and more worried and had a gut feeling that something was wrong.

Two weeks ago, on March 6th, she was having her first morning bottle and I noticed something strange with what she was doing with her arms. I stopped feeding her and immediately knew something wasn't right. She would bring her arms up, tighten and roll her eyes to the right. Each time only lasted a couple seconds and she would repeat it every 5-10 seconds. This went on for a few minutes and I thought she was having seizures. I put her down and grabbed the video camera and managed to capture a few of them before the battery died. I called the HealthLink line and it put me on hold so I called my friend Kim to get her sister-in-law's number who is a nurse. She told me to just call 911, so I did. They got there within about 10 minutes. Me not being technologically skilled couldn't figure out how to change the battery on the camera to show the paramedics. I explained what had happened and they couldn't really confirm whether or not they were seizures, but after hearing everything that happened with her when she was born, they said it wouldn't hurt to go to the hospital. So we got her in her carseat and into the ambulance and Francis left work and met us at Children's. She was still stable when we got there so we were sent to the waiting room. I called the pediatrician's office from the waiting room and he was immediately worried, said it sounded like Infantile Spasms and faxed a letter over to Children's with his observations of her. We got in after about an hour.

We showed them the video from home but they didn't confirm one way or another. While we were there at about 2pm she started having another one and it was witnessed by the nurse and the Resident Neurologist and they were confirmed as seizures. They brought down a technician right away and did an EEG on her to record the electrical activity in the brain. They were hoping to capture an episode while she was hooked up but of course she had one not even five minutes after they finished. The results came back and the EEG showed a characteristic pattern with very chaotic and unorganized background brain activity. The Neurologist then told us that the seizures were called Infantile Spasms, a very rare and very severe seizure disorder (epilepsy), and that it is often associated with existing neurological or developmental problems. Infantile spasms often go away by the time the child is three or four years old, but often sooner than that. However, many children with infantile spasms continue to have neurological and developmental problems, or may develop other even more severe forms of epilepsy later in life that are even more difficult to control. What's characteristic of infantile spasms is that they occur in clusters. The seizures repeat every 5 to 30 seconds, sometimes 10 to 40 times in a single attack. Her attacks last about 6 or 7 minutes. The spasms become less intense and farther apart as the cluster progresses. She was admitted to Children's that night and started on anti-convulsant medication called Vigabatrin. A flurry of blood tests, urine tests, spinal tap, and an MRI were all put into action to try and determine the underlying cause. Hearing and vision tests were done and we are still waiting on those results.

Taylor's seizures were under control by Sunday afternoon, she responded well to the medication within 2 days which is a positive. The blood, urine and spinal tap results that have come in so far have not shown anything. The MRI was done and revealed a brain malformation. The corpus callosum (the fibres that connect the two hemispheres) is thinner than it is supposed to be. The significance is that the corpus callosum is the communication link for all brain activity. It is most likely the reason for the seizures and that she is so far behind developmentally, however it is possible that there is an underlying metabolic disorder/disease that is a contributing factor. A full metabolic workup is under way, some of the results take weeks to come back.

Because her development was so behind prior to the onset of the spasms, the Neurologist feels confident in saying that she will never develop as a normal child. What they can't predict is what kind of gains she will accomplish. That is the part that is breaking our hearts right now. That is what we want answers for and they can't give them to us. We just have to wait and see and in the meantime be educated on what we need to do to stimulate her development and the rest is up to what she is or isn't going to be able to do. Like I said earlier, I've had a gut feeling that something was very wrong for a while, but I had no idea it could be something so devastating. We are still trying to digest all this and are overwhelmed beyond belief. We're holding up okay, and trying to absorb the fact that our little angel is never going to be normal, and we can only hope and pray that she will be able to make slow steady gains and just always be behind. The possibility of her not being able to develop any further is our biggest fear and we're trying not to go there because it's just too much to bear, but we're so scared right now it's sometimes hard not to let our minds wander. We can just take this one day at a time, be strong for each other, and stay positive and hopeful that her development will slowly progress. We love her with all our hearts, no matter what her future holds, and we're going to do everything we can to help her along this journey.


We got home from Children's on Tuesday night and it has been nice to be home and all together. The seizures are still under control which is a positive sign. She has an appointment in a couple of days with an Opthamalogist to do a thorough examination of her eyes. The anti-convulsant medication has a side effect that can cause loss of peripheral vision so they are going to need to monitor her eyes closely while she is on it. I think the only other outstanding test is that they need to do a muscle biopsy in a few weeks which is part of the metabolic workup. It's just day surgery but she'll have to go under general anaesthetic and they'll make a small cut in her leg and take a sample of the muscle.

We're going to be inundated with appointments for some time between all the different doctors, services and resources available to help us. It's all so overwhelming. Sorry for such a long note, but I wanted to try and explain everything as best as I could.

Friday, November 14, 2008

All Is Well On The Homefront

We haven't written since we brought Taylor home but as they say "no news is good news" and we are happy to say that things are going very well. We've been settling in to the new routine and are happy as can be to have Taylor home.


We met the pediatrician on Oct. 31st and he did a very thorough exam of her and recorded a detailed overview of everything Taylor went through in the hospital. He'll follow her for now until such time that it's appropriate to send her back to a family physician. We went to the cardiologist last Thursday and that went very well. The type of arrythmia that she has is common in babies and the vast majority of babies grow out of it within 6 months to 1 year, so that is very hopeful. The arrythmia she has is not dangerous because a) it does not produce fast beats, and b) it is not incessant. Before she went on the beta blocker medication, the arrythmia was occurring 8% of the time, and since she's been on the meds, it's down to 2 or 3% of the time. The way it was described to us is that there is an irritable patch of cells that are competing against the heart's natural pacemaker. Because this patch of cells isn't beating any faster than the natural pacemaker, it doesn't produce runs of fast beats, but rather just occasional extra beats. The cardiologist is going to monitor her over the next 6 months to a year, with the anticipation that this will outgrow itself within that time. So for now she'll continue the meds until at least the next appointment which is 3 months from now. They will evaluate her in February after doing another 24 hour holter monitor and ECG.

Obviously we are very relieved at this point. First and foremost, she is apnea-free! The arrythmia is not a dangerous one, nor one that she can feel, and it will most likely outgrow itself within the year. So things are looking very good for little Taylor. She's a month old already and has grown from 5 lbs, 15 oz and 18.5" long to a very healthy 8 lbs, 10 oz and 20.5" long! Like her big sister, she's a good little sleeper, already doing 7 (occasionally 8) hour stretches through the night. Good job Miss Taylor! She seems to be kinda gassy, so she's a bit more fussy than Marissa was, but nothing overwhelming. Still sleeps a fair bit of the day, but when she's awake she is very alert.

Taylor's birth certificate
The bottle looks bigger than her!

Marissa is adjusting to being a big sister very well. She is very affectionate and is showering Taylor with millions of hugs and kisses, not sure how long this love affair will last but for now it's going strong! At any rate, she seems to be a happy big sister and even though 'gentle' is not part of her vocabulary, Taylor is holding up to it all just fine!

Tender kisses
A gentle pat on the tummy
"Help! She Won't stop crying!"
Can't get enough of her little sister
Endless kisses
Likes to help feed her too

Thank you so much for your phone calls, emails, visits, cards, gifts and even dinners - the support and encouragement we have had from our family and friends has been overwhelming and we appreciate it so very much.

Happy Halloween!

Saturday, October 25, 2008

Home Sweet Home

Just a short one today, we are VERY happy to say that Taylor came home today, she was one full week clear of the not-breathing episodes and the doctors said she's ready to be home. We're very happy, a tad nervous, but we were much more comfortable bringing her home today after a couple extra nights in the hospital. Her monitors came off yesterday and Daddy gave her a bath last night when he went to visit. We got home early this afternoon with our beautiful bundle and she's doing great.

Getting ready to leave the NICU
Bundled in her carseat
Our completed family home together
Happy Mommy
Happy Daddy
So tiny in her playpen

Marissa is quite intrigued with her new little sister, every time you ask her to do anything she replies, "No, watch Taylor".


Well I guess I'd better go, Francis is trying to entertain Taylor with a movie in the "theatre room" and by the sounds of it she's less than impressed with his selection!

Taylor's Nursery

Wednesday, October 22, 2008

Almost Ready To Go!

Still no more episodes, 4.5 days clear now. She was cleared to come home tomorrow but we managed to put it off a couple more days. Although we really want Taylor home and for things to get back to normal, we're still pretty nervous about bringing her home. The doctor came and talked to me at length today and I did feel a little better afterwards, but they have agreed to give her a couple more days to help us feel a little more comfortable about being discharged, so Saturday should be the big day. They cannot obviously guarantee that she'll be free and clear of these episodes but they are able to say with confidence that they believe she is ready to go home, based on the tests she's had and the results they have shown, and all the things that were ruled out. She's got an appointment with the Pediatrician next Friday, and will start seeing her Cardiologist the following week. The Cardiologist will be putting another 24 hour monitor on Taylor the day before her appointment then she'll take it off at her appointment, read the results and we'll go from there. It's all so overwhelming, I'm looking forward to meeting her so that we can better understand the arrythmia that Taylor has, what it will mean for her, and where we go from here.

Tuesday, October 21, 2008

On The Right Track

Things are going well, Taylor hasn't forgotten to breathe since the last episode on Saturday morning, we're 3.5 days clear now. There needs to be a 5 day stretch before going home, so pending no more, they have slated a possible discharge of Thursday afternoon. I think Francis and I would both be a bit more comfortable waiting until the weekend, not sure if that's an option though. I'm working on a list of questions so that I can talk to the doctor tomorrow and get some reassurance, clarity and confidence around bringing her home. She's continuing to eat like a PIG, at least she knows how to do one thing right!! To borrow a phrase from a friend of my mom's, "I must be pumping ice cream" because she's already up to 6 pounds, 11 ounces. We're sure looking forward to having her come home and get settled into some normalcy, but in the meantime we're hanging in there. Will let you know how things go over the next couple of days.

Here eyes DO open once in a while!

Sunday, October 19, 2008

Another Setback

Unfortunately Taylor had another apnea spell yesterday morning (she hadn't had one since Tuesday night). So we're at least another 5 days from bringing her home. She's doing well otherwise, she has a Pediatrician and a Cardiologist lined up for once she's discharged. She's feeding really well on pumped breastmilk and nursing when I'm there and she's gaining weight really nicely. She is now 6 pounds, 7 ounces (born at 5 pounds, 15 ounces).


Taylor is allowed to have visitors in the NICU as long as either Francis or myself is there and you don't have any of the following symptoms:
- rash/itch
- cough or runny nose, sore throat
- diarrhea and/or vomiting
- fever
- exposure to chickenpox, measles, rubella (German measles), pertussis (whooping cough), or mumps within the last 3 weeks

So if you want to come see her, just give either of us a call and we'll let you know when one of us is going to be there. We'll do our best to keep you all posted on how she's doing. Thanks to everyone for your nice emails and calls, it means alot to us.

Saturday, October 18, 2008

Neonatal ICU

Well...where to begin! Things are going to be fine but there have been alot of scary moments over the past 9 days. It's been a rough start for wee Taylor and she has had quite the rollercoaster ride to say the least. We've done our best to keep our parents and siblings updated with all that's been going on but because it's been such an emotional time for us we haven't yet updated the rest of you. Things are looking much brighter as of last night and she should be coming home on Monday, but she has been in Neonatal Intensive Care since the day after she was born.


She hadn't been nursing well all through that night, but was showing all the signs of being not just hungry but starving. By 6am I was near meltdown and buzzed for the nurse because I didn't know what else to try. She said she'd move Taylor into the nursery for a couple of hours so that I could get some rest (I hadn't slept in 48 hours at this point) and she'd try to settle her with a bit of formula. At 8:30am the nurse came into my room to tell me that Taylor stopped breathing a couple of times, turned blue and needed free flow oxygen to recover, and that she was moved over to Neonatal Intensive Care. Oh my god. So she walked me over there (NICU) and when we got to Taylor she was surrounded by about 8 people working on her and of course I lost it. I was alone since it was early in the morning and Francis was still at home with Marissa. The nurses sat me down, brought me a box of kleenex and started explaining what they were doing and what was happening.

She was admitted to NICU on Friday morning after the 2 spells of apnea (absense of breathing for more than 20 seconds) in the postpartum nursery. The result of her not nursing properly had also drastically dehydrated her. They were also hearing tachycardia in her heart (where the resting heart rate is more than 160 beats per minute). She was slightly tongue tied, and had a transient skin rash. To see if she had any infection they took blood and created cultures in the lab which would have to sit for 48 hours to see if they would grow. They also took blood to measure the levels of oxygen in it. So an IV was started with two different antibiotics as a precaution until they got the cultures back and could rule out any infection. Chest and abdomen x-rays were then done to check for problems in the lungs, heart, or gastrointestinal system. Then they did a spinal tap on her, took some spinal fluid and sent cultures to the lab to also look for infection. At 3pm that day the doctor clipped the little flap under her tongue. She nursed right after and it did the trick because she fed perfectly. She had 3 more apnea episodes for a total of 5 that day.


Saturday they did x-rays again and the doctor ordered an ECG (electrocardiogram) of the heart. The ECG revealed premature ventricular complexes (PVC's), where an extra beat comes sooner than normal. Then there's a pause that causes the next beat to be more forceful. These are apparently very common and most people have them at some time. Usually no cause can be found and no special treatment is needed. The premature beats may disappear later. They then did an ultrasound of her heart, and the result was a normal structured heart. She had 5 apnea episodes on Saturday, 4 of them requiring free flow oxygen for her to recover.

ECG
Heart ultrasound

On Sunday the cultures came back negative, there was no infection so they stopped the antibiotics and took out the IV. A 24 hour holter monitor was put on her that afternoon to record all the activity in her heart over a 24 hour period. I was discharged in the afternoon and going home without Taylor was really hard for me, with everything she was going through I wanted to be there with her. She had 2 apnea episodes on Sunday, needing oxygen to recover on both. They still have no idea why she stops breathing.

24-hour Holter Monitor

On Monday the holter monitor came off and was sent to a Cardiologist at Children's to analyze. She had another 2 apnea episodes on Monday, needing oxygen both times.

Daddy Love

On Tuesday she had an EEG to measure the electrical activity produced by the brain, recorded form electrodes placed on the head. This was sent to a Pediatric Neurologist at Children's to analyze. The results of the 24 hour holter monitor on her heart came back and showed ventricular tachycardia (VT), a fast heart rate that starts i the lower chambers. They started her on propranolol late that night to treat the VT. She had another 2 apnea episodes, again needing oxygen to recover.

EEG

Wednesday was her first day with NO apnea episodes, very good news. She also was back at her birth weight on Wednesday. I've been pumping round the clock so that she's got breastmilk at the hospital when I'm not there. She hasn't needed any formula and is taking bottles and nursing both very well. At least one thing's working for us!

Angelic isn't she?!

Thursday (yesterday) was probably our worst day. The results of the EEG came back abnormal, indicating an underlying structural injury. They then sent her for an MRI to visualize the structure and function of the brain. The images were immediately sent to the Pediatric Neurologist at Children's to read. Shortly after we were told that he would be coming over to give us the results in person. That can't be good is all that I could think all day. It was the longest day of my life waiting for him. When he arrived and said right away that he had positive news I can't even describe how instantly relieved we were, and of couse I immediately welled up. After going back and forth on the abnormal EEG results and the MRI, they finally discovered a technological error on part of the EEG. And it was that piece of the EEG that indicated the structural injury. So Taylor's brain is perfectly normal and healthy and he doesn't see any underlying neurological problems. Another holter monitor was put on her yesterday to record the heart activity for another 24 hours so that they can see the effect of the meds (propranolol). No apnea spells yesterday, that's 2 days in a row!!!


Today things are looking much brighter. It's quite possible that it's the ventricular tachycardia that was causing the apnea spells, because she stopped having them once she was put on the propranolol. They want to see 4-5 days without any apneas before she can go home, so that would be Sunday/Monday. Before she can go she also has to be set up with a Pediatrician and a Cardiologist and have appointments booked with each. The holter monitor came off today, was sent to the Cardiologist and apparently they are happy with what they saw, so the meds must be doing the right thing. No idea how long she'll be on the meds, that will be determined under the care of her Cardiologist who is apparently the leading one in the city for this.


She's done so well through this whole ordeal, she is very content, has tolerated all the poking/prodding/tests extremely well, sleeps well, eats well and loves to be cuddled. It's not over yet, we have to deal with her heart now but the Cardiologist that they've lined her up with is the leading one in the city for this, so we feel really good about the care she's going to get. Everyone in the NICU has been absolutely outstanding, we couldn't have asked for better people and care.

Mommy Love

So that's the scoop on the past 9 days. We are SO looking forward to bringing her home and settling down after this emotional time.

Thursday, October 9, 2008

Tiny Taylor Makes Her Debut

Happy Birthday to our beautiful new baby girl!

Taylor Elisabeth Dengis
October 9, 2008
at 12:19am
5 pounds, 15 ounces
18.5" long

Dr. Ward delivered little Taylor
Proud parents
It sure went fast! Went into the hospital for a stress test on the baby for the THIRD time, as I've been having high blood pressure the past month. Since it kept going up and we were at full term they decided to go ahead and induce me, from then it was full speed ahead! At 7:50pm they broke my water, 9:15pm they started the oxytocin drip, 9:30pm contractions started, 11:45pm epidural came (much to my relief!!!), 12:05am started pushing, and 14 minutes later Taylor made her grand entrance. Mommy and baby both doing well and looking forward to Marissa coming in the morning to meet her new baby sister.

Ready to push!
Freshly placed in Mommy's arms
Daddy soaking her in at the warming table











Bundled up tight and sleeping peacefully
Related Posts Plugin for WordPress, Blogger...