Never have I ever

'Never Have I Ever' is a drinking game I played in college.  The gist is you follow up that phrase with an action and if you have done the action you have to drink.

   Never have I ever gotten lost ..........drink
   Never have I ever been arrested.......drink
   Never have I ever thrown up in public.....drink

You get the idea.  As a mom, I have said a bunch of time, I never thought.  If I took this game from my college days and changed it around a bit, I would be face down on the bathroom floor.

Never did I ever think I would be so familiar with the hospital...........................drink
Never did I ever think I would l to worry about my child's fat intake.................drink
Never did I ever think I would potty train my kids at the same time..................drink
Never did I ever think I would have a medication schedule..............................drink
Never did I ever think I would carry around a medical resume.........................drink
Never did I ever think after all the hard work a G-tube would be needed........drink

Here's the thing about CHD, it impacts so much more than just the heart.  And sometimes that isn't always discussed when you get the diagnosis. I mean, I get why.  Not all kids are the same.  Some have their surgeries and encounter minimal other issues.  But kids like Lucy, that is just not the case.  A perfect example would be our latest hospital stay.  In those 100 days we saw at least seven specialties.

Cardiology
Respiratory
Nephrology
Infectious disease
Gastroenterology
ENT
Psychiatry
Radiology

 Last week we went back to the hospital for a swallow study, ENT evaluation and her bridle change.
The swallow study went really well.  It was so fun to watch Lucy interact with Jen.  She was goofy,  talkative and showed no signs of being scared.  Quite a difference from our hospital meetings.  Lucy got up in the special chair, next to the big camera and sampled the food that Jen "made".  For the study, a dye has to be put on all the food so it can be tracked through chewing and swallowing.  We sampled thin, nectar, puree and solid food.  She passed on everything as long as the volume was small.  We got approved to give nectar liquids in amounts of 2.5 to 5 mL at a time.  We are not on a liquid (amount) restriction since her diuretics are so high, but we are trying not to go overboard.  We aim for four to six ounces by mouth a day.  The ENT evaluation was a little more traumatic and Dr. Sherman had to put the scope up her nose to view her vocal cords.  She sat in my lap and I held her like a straight jacket, while the nurse held her head and Dr. Sherman placed the scope.  She screamed, maybe the loudest I have heard in awhile.  Lucy's vocal cords have healed a bit but  there is still some compensation from the left side to close them all the way.  At this time, no intervention was needed, but he stressed that the NJ tube is impacting all of it.  And then he said those dreaded words:  G tube.
Now, I'm not scared of the actual g-tube.  I have heard amazing things about kids getting them.  I think it's that is another surgery and another hospital stay.  But honestly the hardest part is that we worked SO SO HARD to get her eating, that to be back here talking about g-tubes is just another punch in the gut.  I was hopeful we would have some time to work on her eating before definitively deciding about the surgery, but my gut was telling me get prepared.

Fast forward to yesterday and our cardiology appointment.  We had a blood draw for labs and it only took me two months and five trips to remember the lidocaine for arm.  It didn't help much, so maybe it's not that big of deal that I haven't remembered.  Then an EKG and vitals.  Last we sat down with Dr. Husayni to discuss what has been happening over the last month.   Since our last appointment we have seen her physical strength increase along with her energy level, but her oral intake has decrease tremendously.  We are lucky that we have not seen her weight tank as that would mean an admittance.  And he finally said it, we need a GI evaluation so we can get an idea of what her digestive system is doing.  I asked what the probability of the G-tube was and his response was, she needs it.  My eyes get watery as I start to dread another hospital stay.
Me:  How long is the average stay
Dr. Husayni:  about 2-3 days
Me:  So Lucy at least a week
Dr.  Husayni:  You are veteran, you know how it goes
Me:  When?
Dr. Husayni:  We should do it this year.

And there you have it.  2017 can officially suck it!!!!  We will start with GI evaluation, then look to schedule the surgery.

While this news definitely overshadowed the good that has happened this month.  There is still good!  We have decreased some medications and stopped another one.  We have adjusted her feeding times.  Hooking her up at 4 pm was not working out because Lucy can't quite grasp that the feeding pole has to come with her when she gets up to move.  We started feeding her at nap time so that we could delay the night feed until she went to bed.  The other change we made was moving up her night dose of diuretics to 4 pm, so that there were no more accidents and I don't have to wake her up to change her diaper 3 times overnight.  BUT what I love is that Lucy loves Dr. Husayni.  While we were getting vitals he walked by and she got so excited she made him come in for a hug.  Then she helped him listen to her.  When we were finished, she asked if he would walk us out.  I hope this sweet relationship grows stronger as he helps to guide her through this journey.

My biggest fear with this surgery is how it will impact Lucy's mental state.  She still has anxiety when I leave and many times at night she asks "you're not gonna leave".  We try really hard to ease her fears and to explain everything that is happening but sometimes that is just not enough.  While she is smart enough to understand she still get scared.  I truly hope I will be able to say, this was the easiest one yet.

Eating, it's always the eating

Where do I start?  HOME, HOME is amazing.  I actually went back and read my blog from our first homecoming (Lucy was six pounds at five months old, that seems crazy) and some of the feelings are the same.  New medications, oxygen and feeding pump were a big change from when we came to the hospital and I definitely was feeling a bit overwhelmed.  But just like last time, a day in and I felt a lot better.  Our wild card: Connor.  Luckily, my parents kept him at their house for our first week home.  It really allowed us to focus on Lucy and get settled.  The first few days Lucy slept a lot and she needed it.  She was able to be awake for about two hours at a time and then would crash.  She would fall asleep wherever, family room floor, sitting up on the office couch or her fabulous, comfortable BIG GIRL bed.

Her extended napping allowed me to re-organize the medication cabinet and unpack.

our schedule looked like this:
7 am - 8 medications
7:15 - weigh in  and breakfast
9 am - napping
12 pm - lunch
1 pm - 3 medications
2 pm - napping
4 pm - 1 medication and start feeds
6 pm - 4 medications
6:30 pm - bed time
7 pm - 8 medications
8 pm - add formula to feeds
11 pm - 1 medication
12 am - add formula
4 am - shut off feeding pump and flush NJ tube

The one thing I did not anticipate (although I probably should have) was the effect of the diuretics.  The first two nights, at least once, Lucy peed through the diaper.  Let me tell you, there is a fine line you walk, allowing her to sleep without interruption and changing her diaper before it leaks through  to her sheets.  When that happens, it's a big production.  Getting her out of bed, changing the sheets, you know the drill.  After three times of missing the window, I came up with a new plan.  Her bed is now an arsenal of protection against a leaky diaper.  First fitted sheet, then mattress protector, next another fitted sheet, and last a thick blanket.  This leaves me three leaks before I have to completely strip the bed.  We are on to week five and have a pretty good night time routine.  She gets her last diuretic at 7 pm.  If she goes right to bed, then we diaper change at 8:30, 11 pm and 3 am.  If she stays up until 8 pm, we get a clean diaper on then a change at 10 pm and 3 am.  3 am is when her feeds usually error out, so I am getting up anyway.  Error out sounds like the wrong thing to say, but what I have found with the feeding pumps is they are not calibrated very well.  She usually gets her total amount of formula (720 mL) in under the twelve hours and when the formula is gone, the pump will display a error message.

While I thought our biggest obstacle at home was going to be physical therapy, it appears that once again feeding issues will take the cake.  But not in the way I thought.  Lucy very much wants to eat and aside from thin liquids and fat our options are unlimited.  (Did you get that joke?).  Our fat free diet has us really restricted, but I have been able to get some variety into her diet.  Purees are our best because they take the least amount of energy to consume.  Our diet has been made up of soups, fruits, veggies, mashed potatoes and noodles.  Her favorite, by far, sour cream, plain, in a bowl eating it with a spoon.  Here is our hurdle, Lucy has thrown up at least once (but most times 2 or more) every single day since we have been home.  Sometimes it happens immediately after she eats.  Other times it's hours after a meal.  However, it doesn't seem to phase her.  She has thrown up and in the next breath asked for more food.  I was hopeful that her want of eating would allow us to decrease her tube feeding quickly, but her throwing up does not really let us get a good picture of her caloric intake.  Until we have a string of days without throw up, we will probably remain on twelve hour feeds.  The good news is we are coming up on the end of our eight week fat free diet.  I asked our cardiologist if we could remain on fat free formula so that we could increase her fat intake by mouth expand her variety of food.  We got the green light, so we will be able to foods with 3 grams of fat per serving.

We started physical therapy through Easter Seals and our therapist is able to come to the house while Lucy is still on two liters of oxygen.  We'll see her once a week, then when Lucy goes back to school, Laura would be able to come take her out of school for therapy and it would not be an extra trip.  She is so ahead of where I thought she would be.  She wasn't able to stand when we first came home but know, she is walking and WITHOUT her walker most of the time.  Then we will just need to strengthen everything.  In no time, she'll be jumping and running just like she was.  Let's just hope when that time comes she is not still on her feeding tube.  It has been slightly hard to explain to her that when she is getting feeds she cannot just get up and go.  She has to make sure her pump comes with her.  I have been trying to get her to use it as support for walking but it's quite awkward to do on carpet.

Lastly, our one month follow-up went very well.  We ended up not changing the bridle on her NJ tube which was why it went so well.  Her echo had no changes from her previous one.  Clinically she looked good and her saturations were in the high 70's.  Her last two INR's (test for warfarin) were both 2.0 (which is in range: 2.0-2.5), so we are able to now test every two weeks.  We decreased one of her diuretics and also stopped another medication, which was nice because I was able to re-arrange her medication schedule so that she no longer is getting medication during nap time.  We go back in another month and we will probably start talking about a swallow study and ENT consult.  She has snagged Connor's sippy cup a few times and even drank her bath water, so I think we are at the point where we need to give her another try at thin liquids.

We continue to be blessed by all of you who keep us in your prayers for continued healing, THANK YOU!
Here she is taking her first few steps! 

a bittersweet goodbye

This will sound weird, but leaving the hospital can be bittersweet.  Discharge can be filled with so many emotions: excitement to be home, anxiety to be the sole caregivers, worry that you will miss a warning sign and fear of a re-admittance.  But the hardest thing to describe is how a group of individuals doing their job can easily become like family.  For 100 days I spent twelve hours or more a day in Lucy's hospital room.  To give you an idea, that's thirty work weeks. (assuming you work 40 hours/week)  That is over 1/2 a year of work.   Just think about the co-workers you like (we all know there are some we don't) and what relationships you can form within that time.  Here is what I know, not only did they care for and love Lucy, but they made my days tolerable.  And that's not an easy feat.  When you don't see an end in sight and someone can walk in the room and put a smile on your face, it speaks volumes about the type of people who work in the Surgical Heart Unit.  I can't say enough good things about the team!

As you can see our extended family is pretty fabulous

Discharge was not like any other we experienced.  Due to having to draw labs up to the very last day and the fact that she had no open real estate for a picc line, we were discharged from the ICU instead of moving down to Floor 2.  The last week we had been fine tuning her warfarin, potassium and sodium dosing.   The goal was to get a schedule that was manageable at home.  To me, the schedule didn't matter, I would have given medications every hour through the night if it meant we could go home.  On top of packing up the room, getting our home medications ordered and figuring out tolerex, we also had to change the bridle holding the NJ tube.  The bridle, like an NG tube needs to be changed every 30 days.  We thought it best to change it, right before discharge instead of at a follow up appointment because we were able to give a dose of versed.  However, after changing it, I am convinced that versed does nothing....Lucy screamed bloody murder through the whole thing.  If you aren't familiar, the bridle is a string that is looped around the vomer bone and secured with a clip on the NJ tube.  To place the string there are two flexible tubes with a small magnet on the end.  A tube is inserted into each nostril until the magnet connects and then it is pull through and clipped.  I do not look forward to doing that again!
By 7 pm on Friday night, the room was mostly packed into Mike's car to be brought home, all but one medicine was received and tolerex was to be delivered Sunday.  My room at Ronald McDonald House was also packed except for necessities.  The last part of discharge was to review medication doses and timing , feedings and review appointments.  Let me tell you, it's a bit overwhelming, even though we've done this before.  The biggest change is that multiple medications have to be cut and dissolved.  And the sheer number is steep.  Her current medication list is



Bumex
Bosentan
Potassium
Sodium Chloride
digoxin
diuril
aldactone
Sildenafil
warfarin
aspirin
multivitamin
melatonin
colace
pantoprazole




She gets eight medications at 7 am and 7 pm, then multiple medications throughout the day at 1 pm, 4 pm, 6 pm and 11 pm.  Her feeds will run from 4 pm to 4 am at 60 mL per hour.  She is still not allowed to drink liquids due to aspiration and we are still working off a fat free diet.

However overwhelming, it doesn't matter because..........WE ARE FINALLY HOME

It's hard to believe it's almost two weeks post discharge.  We have had three follow up appointments for labs and x ray, all which have looked good.  Today we go for full appointment with Lucy's cardiologist.  Stayed tuned for an update on our appointment and what it's been like at home.

Till then...

blessed with support

  First, I'd like to personally thank all my friends and family that came out to support us last Saturday night.  I was overwhelmed with emotion by how many people attended, donated items, money or time to our 4th Annual Have a Heart Event.  I am not going to lie, planning from Lucy's hospital room wasn't the easiest.  However, over the last three months it has offered a distraction that has gotten me through some of the tough days.  Two weeks prior to the event, we buckled down to get everything ready (which is why there was a lack of blog posts).  If you weren't able to attend, here's a couple things we talked about:

Most of you know the idea of LJ's Healing Hearts started from a fundraiser held for our family, but little know exactly what we did with the money raised that first year before creating the nonprofit organization.  Each year we have used a some of the money raised to cover costs associated with Lucy's care.  These costs include:
 - tolerex formula (it runs up to $450 a case, which covers about 1 month)
 - Early intervention family fee (yes, the service is not free and your fee is based on income)
 - medical bills (Lucy's pre fontan catherization in February cost roughly $2800 after insurance)

It will also cover insurance premiums this year (to keep Lucy's coverage) while I am on unpaid leave.

I am so thankful because it has allowed our family to do things that we might not have been able to, like move to a house where Lucy has her own room or upgrade our car to make room for Connor.  Through LJ's Healing Hearts we want to afford other families this opportunity as well.  However, many families have told us they are managing the financial impact of CHD.  We hope to expand our reach by working with social workers from local hospitals that have heart centers, this includes Advocate Children's Hospital and Ann and Robert H Lurie Children's Hospital.

Now back to Lucy!  After her effusion and being back on all IV diuretics, we needed to reassess.
An echo and EKG were ordered to check her heart function, still good.  The one thing that has held strong through all of this, thanking GOD!  Next we reviewed her medications and decided to replace lasix with oral bumex.  We also added metolazone.  Last we moved her IV diuril to oral.  By Tuesday night (8/22/17) we were back on all oral meds, albeit very strong diuretics.  The team felt she would need at least a week on all oral medications before a discharge date was even considered.  Over the course of the week we made no other changes.  On Friday she finished her course of the antibiotic augmentin.  It's used to treat pneumonia, or in Lucy's case, aspiration pneumonia.  This can develop after you aspirate food, liquid or vomit into your lungs.  With her vocal cord weakness, this is something than can happen easily.  It doesn't help that her stomach is not in prime working order either, because she has been throwing up at least once a day.

This week, we stopped metolazone and watched each day to see if fluid or pneumonia showed on an x-ray.  On Wednesday it looked hazy again and my heart sank.  We would either have to go back on the third diuretic and wait for her x-ray to be clear or limit her foods a little more to stop her aspiration.  Luckily, for the first time in 99 days, yup that number is correct, it was a fluke.  Thursday morning her x-ray looked much better.  For the first time, we feel like we are in a good place physically.  And there is a light at the end of the tunnel that is home.

Now onto the best part of the last week.  Lucy's personality has emerged and it has been blessing to see, even better that it's happened in this environment.  Lucy has a catchphrase at home.  It's "I have an idea".  Usually the conversation goes like this:
    L:  "Oh, I have an idea" while holding her index finger up in the air, with a smirk
   Me:  "What is it?"
    L:  "I don't know"

It's been quite a while since we've heard that phrase and seen animation in her voice and gestures.  As she get stronger and stronger, she gets closer to the girl we brought to the hospital in May.  With her limited diet, we've had to be pretty creative with her menu.  She has been asking for ice cream (not allowed because it's a liquid), so the other day I got frozen fat free cool whip and put it in a cone.  She was so excited, I thought she night jump off her bed.

We also were able to bring Connor up to visit again and they were able to play on the floor together.
They even showed each some love with a kiss.

I can say the first thing I will do when we get home is plop her into a bath.  Her hair is covered in tolerex, blood and probably a hundred other things.  I mean how else does she wake up with hair looking this crazy

We are asking that you pray for Lucy's health to stay the course and that home is on the horizon.

waiting, waiting

I was waiting and waiting to write this because I really wanted to be able to say we were moving to floor two!  But alas, we hit another bump in the road.  A small bump, but one that is keeping us in the ICU.

Last week, we finally were able to come off nitric Wednesday morning and the team immediately scheduled the swallow study for the same day.  We had two full extra days of practicing with purees, so I was really hopeful.  Lucy got a dose of versed and we wheeled her, bed and all, down to radiology.  For the swallow study, the x-ray table is placed vertically with a high chair next to it.  We have a plate of food, that consists of thin liquid, nectar, puree and solid.  All have a dye that shows up in the x-ray.  We offer each to Lucy and watch as she swallows.  She was not a happy camper through most of it, but Jen (our speech therapist) assured us she did great.  She passed on solid food, but failed on thin liquids and nectar.  So what does that mean?  It means that Lucy is able to have any solid or puree foods she wants, but cannot drink at all.  Panic, right?  Not Lucy.  She has not asked for a drink since she has been able to eat solid foods.  We are still on a restricted fat diet, so our options are somewhat limited.  But Lucy has been happy with egg whites and fat free cheese, pasta with marinara, all the broccoli and beans she can eat and some fat free turkey.  This weekend we did a calorie count and she was up to about 250 calories a day.  I will keep having to remind myself that eating takes almost all of her energy and it will take time for her to be able to consume all her needs orally.

The rest of the week we looked to make more small adjustments to her treatments and medications.  We have been off all IV medications for over a week.  We slowly started to ween some of her diuretics, anxiety medications and are still getting the dosing right on her coumadin.  With the addition of food, we needed to increase her dose.  It looked like we were in a good spot over the weekend and even got outside both days.  After coming off the high flow cannula, there was anticipation of a possible move to the floor mid week.  Unfortunately, a small plural effusion showed up on the x-ray Monday.  We decided our best course of action was a dose of IV diuril.  Today, the effusion appeared bigger and two more doses were ordered.  The CPT vest treatments that were stopped over the weekend were also added back twice a day.  With rounds over in a matter of thirty minutes, reality that we would probably ride out the rest of the week in the ICU set in.  We need to clear this plural effusion and then get on a home regimen that will keep the fluid away.

I said it a few weeks ago, how this stay was eerily similar to our first.  I did not realize how right I was:
2014 - 2 surgeries, 2 codes, multiple intubations, Laryngoscopy, 84 days in the ICU
2016 - 3 surgeries, 2 codes, multiple intubations, laryngoscopy, and tomorrow marks 84 days in the ICU

As we work to get the fluid off, I will continue to try to make Lucy laugh and remember that as hard as this is, for our family to be split, it is not permanent.
I went for a walk tonight, as I passed a church, 1 Peter 5:7 scrolled across moving message board.
'Cast all your anxiety on him because he cares for you'.  So I am going to try to do that!

Her personality is slowly starting to show through!  Oh how I missed it.

even a small milestone, is a milestone

Two weeks ago, Dr. Nater had been contemplating a laryngoscopy, but we really felt that Lucy, from a mental standpoint could not handle it.  The conversation continued and last Tuesday evening we ended up going ahead with the ENT evaluation because we needed to get a good look at her throat and vocal cords.  We wanted our speech therapist there to be able to give some insight.  Again, with her anxiety sky high, we gave her a healthy dose of versed and then the team kicked us out of the room.  Surprisingly, Lucy did fantastic with the laryngoscopy.  This procedure is where a thin flexible viewing tube is passed through the nose and guided to the vocal cords.  They were able to get a good look at her vocal cords and there was no additional damage from intubation.  On the fly, they decided to offer her some pureed fruits and she accepted.  We were able to see that she was not aspirating on thicker foods.  A big success and even better that they were able to do it all at the bedside.

We got the okay to offer pureed foods:  a total of five teaspoons, three times a day.  That equals about three medicine cups of food a day.  The funniest thing happened though, after the laryngoscopy, I thought she would be put off by foods for another couple days, if not more.  The very next morning I get to her room and she looks at me and asks for water and animal crackers.  I was able to steer her back to puree fruits, but another huge win.  I actually thought we wouldn't need a swallow study after that, but unfortunately, in order for her to consume thin liquids we have to again make sure she is not aspirating.  In order to do that, we need to be off nitric.  It was our plan to start weening on Friday to hopefully be off for a full day and do the swallow study Monday morning.  We started the day at 10 parts and got as low as five, but Lucy kept having these spells where she would dip her saturations into the fifties.  The worst part is that she was showing no signs of distress, no retractions, no increased respiratory rate.  It is really scary to think about being at home for that to happen.  You aren't hooked up to monitors at home, so you really rely on those signs to tell you something is wrong.  Needless to say, she did this all weekend and by Monday morning we were still on 10 parts of nitric.

Here's the crazy part, when you're doing good and improving it's really easy to lose sight of the progress you make.  The little things don't seem so important.  If I think back, coming off the breathing tube (twice), decreasing chest tube drainage over the course of week, pulling chest tubes and coming off all IV medications seemed like giant milestones.  As I stood in rounds Monday morning to discuss the plans for the day, I started to cry.  The first thing I said, "I'm so frustrated because I don't feel like we made no progress over the last week",  Yet in two paragraphs, I have summed up a week of milestones.  How easily I forgot that eating, just eating, is such a big milestone for Lucy.

Through the rest of the week into the weekend, Lucy continued to ask for food (none of which she can have), graham crackers, avocado, ice cream, and sour cream with onion strings.  Luckily, almost every time I can offer her pears or apples and she accepts.

Monday plans were to ween slowly.  Instead of dropping 2-3 parts every four hours, we dropped by 1 every six hours.  The hope is by tomorrow she will be off nitric and we can do a swallow study on Thursday.  The only other thing keeping us in the ICU is her oxygen.  We have bounced around from four to twenty liters based on her saturation levels.  Today, they also decided to give her blood.  What they hope is that this blood will bridge the gap and give her some extra red blood cells to carry oxygen to the body.  Since we are continually doing labs for electrolytes and coagulation, we are removing blood faster than she can create red blood cells to carry oxygen.  After the blood was given, her saturations took a nice jump to the 80's.  We'll see if that has a lasting impact and we can bring her oxygen down.

I would also like to give a shout out to all the friends and family that have helped with Connor over that last couple weeks.  As most of you know, he has stayed with my parents full time since Memorial day (holy cow, how long ago was Memorial day).  We clearly did not anticipate being in the hospital this long, so when it came time for them to move so many stepped up and helped to care for him so Mike and I could continue to focus on Lucy.  It is quite a relief to know he is in great hands!

We continue to be blessed by all that have supported us.  Thank you.

For those that like to have specific prayers, here they are:
For Lucy to pass her swallow study and be able to eat and drink to her desire (albeit fat free).
For her saturations to remain above 75
For us to be moved to the floor ASAP

I'll leave you with this cute interaction.  This past week, I brought up Lambie, one of Lucy's bedtime buddies.  She was so sweet when I showed her giving him hugs and then they colored together.

Promise

I definitely followed through on my promise.  Friday, the 21st, the breathing tube came out and I made sure we got time together out of the bed.  It was a long time coming, 58 days to be exact.

The biggest concern when pulling the tube was her lungs and making sure the secretions we being coughed up.  We started with CPT vest therapy.  This involves an inflatable vest that is attached to a machine.  The machine mechanically performs chest physical therapy by vibrating at a high frequency.  The vibrations to the chest loosen and thin the mucus.  This vest treatment is most commonly used in patients with cystic fibrosis.

We scheduled vest treatments every two hours during the day and every fours hours overnight to make sure her lungs stayed open.  Surprisingly, the worst part for Lucy is getting the vest on.  After its on, she usually falls asleep.  However, having the respiratory therapist come in her room every two hours, along with other staff in and out all day, Lucy's anxiety is at an all time high.  So much so, that she started grinding her teeth.  Can you imagine sitting in a room with someone grinding their teeth for an hour?  Now do it for twelve hours?  I may need medication soon!
We are working hard to keep the traffic in her room down and some anxiety medication throughout the day.  At night, we are using melatonin to help her sleep through the night and it has allowed for a string of good ones.  Better sleep equals better days!

Last week we started prepping for home.  Don't get too excited, there's no official (or unofficial) date.  Home oxygen and feeding supplies were ordered.  All of her IV medications have been switched to oral.  Coumadin has been started to get her dosing just right and we'll look to stop heparin.  In order to get to floor two (step down) we still need a few things to happen.  We need to be off nitric completely and off high flow.  That means Lucy needs to keep her saturations above 75 with less than two liters of oxygen.  Right now we are on four liters and are experiencing some episodes where her saturations drop to the fifties.  The other issue is her stomach.  We are still draining a significant amount from the NG tube.  When we have tried to clamp it to see if she can handle it, she ends up throwing up the bile.  Unfortunately, being intubated put her as a high risk for aspiration.  Aspirating on vomit could have a huge impact on her lungs.  We don't quite have answers and will have an ENT evaluation in the next couple days.  With that risk, it means she also can't have food.  Luckily for us, she isn't very interested in food or water.  We will need a swallow study before we can proceed with oral feedings.  Whether that happens as in patient or out patient procedure will depend entirely on Lucy's desire to eat.

We have been working to get Lucy stronger and have been out of bed several times.  She can usually last about thirty minutes and can sit up on her own without support for at least ten minutes.  Each day she is getting a little stronger.  And each day we get some more big smiles.

Her favorite thing is to play with play doh. For those at home, that's a hot dog, banana, blueberries and a cupcake.

We have had some minor set backs with plural effusions and hazy x-rays, but we have fought off anything major with an extra dose of diuretics and keeping the CPT treatments throughout the day.

Praying specifically for the following:
Lucy's anxiety to subside
Lucy's oxygen saturation to stay about 75 with less than 2 liters of support
Lucy's stomach and vocal cords to heal
Lucy to gain strength
For us to be home soon

much love and thanks to our tremendous support system.