Friday, December 15, 2017

Happy Holidays!

I have so much to update y'all on, but I shall save that for later.  Instead, The Theurer Clan would like to wish each and everyone of you a very Happy Holiday!

Stay safe.  Stay warm.  Most of all, have fun!




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Tuesday, November 28, 2017

Speech Breakthrough, an unexpected IEP, Funky Breathing, and Mama Gut

The exciting and most wonderful new!
I’ve been waiting 8 years to hear my daughter say those 3 little words.  Words I was never sure that I’d hear.  Using her CHAT device, Ellie Bear said “I love Mama”.  There, may have been a few tears.  Okay, a lot of tears, happy tears were shed.



Speech therapist on Ellie quarterly report: we need to meet ASAP for her IEP revision!

A few weeks ago, we received Ellie's quarterly report card.  For those of you who do not have kiddos with special needs, the "grades" are based off of Individualized Education Plan (IEP)'s goals.  You have things like met, continued progress, regression, and N/A.

I was scrolling along beaming with pride because most of her goals were close to being met already.  Then I get to the speech section - no "grades" typed in at all.  Instead, a note to meet with her ASAP.  My heart plummeted as well as the thought  of "if we need to meet ASAP, why didn't she call?".

Panicked, I approached the meeting room with the teacher and SLP with a wicked fast heart rate and mild tremors.  I apparently freaked out for nothing.  We have a new SLP this year and her goals were written by the old SLP at the end of last year.  The new SLP, Mrs. A ,said that these goals are not really appropriate - not that she couldn't maybe meet them, but not the types of things they want to her to accomplish in the Functional Communication Classroom. 

Ellie's teacher wants her annual ARD (the big IEP meeting with all teachers, therapists, vice principal, etc) because her goals are also inappropriate and pretty much met.  She based Ellie's goals off of what her FAC teacher said she could do last year.  For instance, he couldn't tell her exactly how many sight words Ellie knew and said "just a few" or something along those lines.  The FCC teacher, Ms. L, thought a good goal would be 27 sight words.  Well, when she started working with Ellie, she discovered that Ellie already knew over 500 words!  She calculated the new words she has learned since the beginning of the school year and it is already over the 27.  With the introduction of the speech device this year, the teacher is finally able to assess what Ellie truly knows and that may have been why FAC couldn't measure her true progress.  Hence why we need new goals. 

Showing Mama Bear around her classroom



 What is up with these oxygen saturations? and always trust Mama Gut

Two weeks.  That’s how long the Bear has been ill.  I was at Ellie’s school for the Thanksgiving lunch and she was coughing.  Nothing that I normally wouldn’t think too much of, but mama gut told me to take her to the nurse to get a pulse ox reading (this checks the amount of oxygen in the blood.  Normal is 97-100%).  She was hanging out at 92%.  Her inhaler helped her a bit, but she kept returning to the low 90s.  I took her to CCC the next day.  Totally anticlimactic.  I was told she might have mucus plugs in her lungs and is coughing them up. Therefore, coughing is good.  I wasn’t to give her the inhaler unless she was either 1. under 88% oxygen saturations or 2. wheezing.  She started getting better, but then spiked a few fevers off and on during Thanksgiving week.  The day before Thanksgiving, she was a snot machine, which she didn’t have before, but not worrisome.

Then, yesterday morning, her cough was bad and I checked her saturations - 88%.  So we used the inhaler.  I had her checked out at school and same thing.  The inhaler helped a bit.  I was finally called to come pick her up because she was trying to nap on the classroom floor (of course she gets home and is miss energy).  She looked horrible.  Today I took her to CCC and I noticed her lips were turning blue.  She was at 86%, but came up to 91% with the inhaler.  Her lungs had crackles (a sign of fluid in the lungs like with pneumonia).  We are to give her inhaler every 4 hours and start her on Omnicef.  If no significant improvement after 48 hours, she’ll be started on a course of steroids.  If she either 1. can’t keep her sats above 88% with the inhaler or 2. has a >101.5 fever Friday or thereafter, she needs to be seen again.  I think she’ll be fine. 

She's pretty excited because she put her PJs on all by herself
Another milestone today!!!



Is it respiratory or reflux?

Reflex vs. Respiratory - Miss Pukes-A-Lot
Ellie has a history of esophageogastroduodenitis.  That is a fancy way of saying reflux and inflammation of the stomach and upper small intestine.  See, not that exciting, but it does mean the Bear gets to take reflux meds.  Last month, Chicka Boom was puking up her bedtime meds 2-3 x a week.  Usually about 1 hour after dinner and twice it wasn't related to her meds.  Once occurred, on the table at Chuy's.  Its cough, cough, cough, cough, puke.  After 3 nights in a row of not getting her meds, I called CCC.  Of course they don't get back with me. I call GI who calls the CCC for me.  Immediate call back.  My thought is that she needs a reflux med adjustment because back in June, we did a trial of the medication and she randomly vomited and it resolved after restarting the meds.  The docs agreed with me and had the bright idea to put her on cyproheptadine aka Periactin.

Periactin is an interesting medication.  It is a prescription allergy medication (antihistamine similar to Zyrtec)m, but is also used as an appetite stimulant, migraine prevention, and treatment of delayed gastric emptying.  Ellie was on this a few years ago as an appetite stimulant.  Uh huh.  The kid has packed on the weight these past few months.  She doesn't really need to gain anymore.  Anyway, fun fact about antihistamines: they help with nausea.  Histamine is what signals the release of gastric acid in the stomach to break down food.  If you block the release of histamine, there is less gastric acid to reflux back into your esophagus.  It seems to be helping.

I think that is all for now!  I am looking forward to hearing more of those "I love Mamas" and a future visit from my parents and my brother, Matt.









Thursday, November 2, 2017

The City of Brotherly Love and It's Always Something

The City for  Brotherly Love:  

Once upon a time, before Andrew and Ellie, I lived in Philadelphia.  I got my BSN and MSN at UPenn.  I thought that I would never leave my apartment, my friends or my awesome job at CHOP ENT, but then I met the love of my life and how could I not be with him. . . 



Anyway, during my years in Philly, I made several good friends.  Friends that I would do anything for.  Friends that have been with me through the worst and the best times. Friends that I'll always miss.  That is why I was so excited that I got to return Philly for my friend's baby shower!  Oh to see so many of my friends again and all to celebrate such a happy moment in my friend's life.  Of course, we had to watch the Eagles game on TV (they won, of course), indulge in cheesesteaks as well as dance and sing along to Run Around Sue in the middle of 2nd Street. I also finally got around to getting my Down syndrome butterfly tattoo.  It's only taken me how many years?

Left inner forearm. 


Drew managed to survive the entire 3.5 days I was gone .  Of course, the first night away I get a text saying that he couldn't get Ellie's nighttime oxygen on because "she moved".  That went on all 3 nights I was gone, because you know, she moved.  Uh uh.  He also forgot her mid-day meds, but she's alive and that is the important thing! My flight home went smoothly after my flight to PHL was as usual  when I fly there, was over 6 hours delayed. I'm not a big fan of American Airlines.

Top Notch: 
We have been going to this place that opened back in 1971.  They serve the best burgers, fried chicken, fried okra (if you like that disgusting veggie), and milkshakes.  They love to host car shows - whether it be VW vans from the 1970s or cars from the '50s.  The name of the place sound familiar to you?  A scene from Dazed and Confused was shot there.

Top Notch: hmm, seems like Andrew is way more into the coloring than Ellie.



Halloween! 
Ellie has this aversion to costumes.  I am not sure why, but for the last few years, she wears Halloween pajamas and goes trick or treating at the mall.  She'll go to 2 stores and end up with packets of gummy bears and goldfish crackers before charging into the bounce house.  This year was no exception and she had a great time.




The Out of Control Thyroid:
With our first visit to the Comprehensive Care Clinic [CCC], her blood work showed high TSH [thyroid stimulating hormone] and a low free T4 [thyroxine].   Both of these lab values suggest hypothryoidism.  Treatment is usually taking Synthroid/levothyroxine daily which is to improve thyroid function.  



Six weeks after starting her thyroid medication, we got repeat blood work.  I fully expected to be still in hypothyroidism since she was still sleeping 13.5 hours / night, having trouble waking up in the morning, and laying around telling us she is going to bed.  In fact, her average bedtime is 6pm! Her labs were still abnormal, but her free T4 is now pretty high with a very very low TSH.  Essentially, she has gone into hyperthyroidism.  She was referred to endocrine and we cut her dose of Synthroid in half.  We will recheck a thyroid panel in 4 weeks.  The endocrinologist said that good news is that she did respond to the Synthroid.




Say what?  More GI issues?!?!
Seriously, what is it with this kid and her gastroenterology issues?  Fortunately, this one isn’t too exciting.   Of and on for the past few weeks, Ellie has been throwing up her bedtime meds.  We even had 3 days in a row where this happened.  Now missing the occasional dose of some of these isn’t all that worrisome, but 3 days. . . well that's not good.  Interestingly, she was not vomiting up her morning or afternoon meds.  I realized that it was related to dinner.  If she takes her PM medications within 30-60 minutes after dinner, she was more likely to vomit.  So I’m thinking an adjustment to her reflux med is in order.  

Otherwise, things are pretty calm over here for once and I am definitely not complaining!




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Monday, September 25, 2017

New Job, Birthday Girl, Thyroid Problems, Weight Gain

For the first time in 8 years, I went back to work.  I’ve been saying since Ellie entered full time kindergarten that I would sign on to work as a substitute school nurse.  However, with all of Ellie’s medical appointments, surgeries, and hospital stays during the past 2 years, I was never able to make the commitment.  Now that Ellie seems to be doing well, I took the plunge.  I can only work Tuesdays, Wednesdays, and Thursdays as that is what works with Ellie’s therapy schedule.  This is new for me.  I worked years ago as a PICU (peds ICU) nurse and then as a nurse practitioner.  School nursing is so different, but I like it so far.  There is a bit of a learning curve, lots of protocols, different school clinics set up differently, and I discovered that kids talk a lot.  Why this is shocking to me, I don’t know.  Maybe because my own 8 year-old doesn’t talk?  Seriously, the stuff that comes out of their mouths! I also was reacquainted with the games “rock, paper, scissors” and “I spy with my little eye”.  



Ellie has been in school for nearly a month.  The first week went well.  Now I am getting notes home from school everyday (along with the unhappy faces) about her being very distracted and unable to focus.  There could be a couple things going on.  One being her ADHD seeing as her medications have not been changed since she gained nearly 9 lbs and dosage is usually based off weight.  The other would be related to her thyroid.  It seems that the Synthroid (artificial thyroid hormone) probably isn’t where it needs to be, but we don’t retest her thyroid levels until October.  Ellie is exhausted.  Every morning I have trouble waking her up and every day when she comes off the bus, she looks so tired.  A tired Bear = cranky Bear.  Mornings, afternoons, evenings, and bedtimes are rough.  Weekends are slightly better because she can sleep in a bit, thus getting her required 13.5 hours of sleep.  One of the things that I have noticed, aside from being a crankypants, is that when she is tired, her ADHD seems worse.  So I wonder, do we need an ADHD medication adjustment or a Synthroid one or maybe even both?



I was going through some pictures of Ellie and came across ones from last year - her school picture and her allergy testing.  Looking at how skeletal she was.  How ill she looked with all of her ribs hanging out.  Then studied the pics from the beginning of this school year.  Nine pounds and 2.5 inches later, she looks so good.  She is still on the small side on the Down syndrome growth chart, but she is finally ON the chart! After a mention of a G-tube for supplemental feeding, if I had know Risperdal for her ADHD would “cure” her failure to thrive, I would have signed on 3 years ago.




Ellie has been taking her speech device with Proloquo 2 Go with her to restaurants and ordering her own food.  She hasn’t quite figured out that if you hold down the “sandwich” button, if gives you the option for “sandwiches”.  Ellie is getting creative:  “ I want sandwich is”.  



Bear turned 8 years-old a little over a week ago.  I cannot believe she is 8 already.  I sometimes feel like I am still in my 20s and can’t possibly believe that I am old enough to have a kid this old.  Other times, I feel like I am pushing 50 with all the white hairs I have been finding (I blame   Bear and my husband).  It was difficult trying to figure out what to get her for her birthday seeing as the only thing she really likes are those large milkshake-size straws.  So yes, she got straws and some winter clothes since she has finally grown.


Well, that is all for now.  Things are even keel and fingers crossed they stay that way!

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Wednesday, August 23, 2017

Organizing Ellie's Medical Care

It has been an eventful past 2 weeks.  Well, not too much so.  We’ve just had 5 doctor appointments.  Most were anticlimatic, such as ENT where we have graduated to yearly appointments.  Can you say “woooohoooo!?  

First up was ophthalmology.  The Bear still isn’t wearing her glasses.  We’ve been doing atropine drops into her good eye to dilate the pupil thus making seeing out of that eye blurry.  In theory,  by having blurred vision in both eyes, she should more likely to wear her glasses.  Except that didn’t happen.  We discussed patching her good eye as we want to force her bad eye to stop turning in.  I gave the doc my “you are delusional” look because can you see Ellie keeping that on?  So we are now doing atropine twice a month which will act similar as patching.  The thing with nystagmus (turning in of the eye), if left untreated, that eye eventually goes blind.  Obviously we do not want that to happen.

If only she would wear them for more than 2 minutes


Next up was GI. We graduated to 6 month follow - ups!  So let’s do another woohooo! Her constipation seems to be well controlled - I hope I didn’t just jinx it!  She is dealing with some random vomiting issues.  Since June, she throws up about 1/3 of the time with the enemas.  We figured this is because we administer a high volume of saline into her colon and it pushes on her stomach.  Except, this is new.  We’ve had 3 other instances where she throws up once randomly - not associated with enemas, eating or drinking.  We are debating on whether or not they were stomach bugs or reflux.  To be on the safe side, we restarted her reflux meds.

As it turns out, we did have to go back to Infectious Disease.  When they called me while on vacation, saying her labs were mostly normal for her, they only had some of her results.  Her B cell lymphocytes were still very low, but she had a moderate immune response to her vaccine.  ID isn’t worried because she has never had sepsis or required IV antibiotics and she did great with the vaccine.  Yes, her lymphocytes are still low, but her immune system is functioning okay.  

Waiting for audiology at ENT


Friday, we had an appointment with our new pediatrician at the Comprehensive Care Clinic.  We had been waiting months to get in.  Dr. B, coincidentally, was Ellie’s very first GI specialist and she has a son with Ds. The appt was nearly 3 hours long and did great until the very end when the phlebotomist used a band-aid instead of purple coban.  One of the goals of CCC is to minimize specialists visits and try to do most “visits” over the phone.  We have our assigned nurse’s cell # and any time we need to talk to a specialist, Dr. B calls them.  She is going to take over most of her care for pulmonary, ID, ENT and possibly neurology.  We are up in the air about urology since Ellie gets bi-yearly renal ultrasounds and CCC doesn’t have that capability in their office.  Her eye issues and GI issues will continued to be predominantly monitored by her specialists.  

Don't you always take baths with your swimsuit?


We learned yesterday that Ellie has hypothyroidism.  It would explain why she has been sleeping 13 hours and asking for naps all summer.  Hypothyroidism is very common in Down syndrome.  It is why we monitor via yearly blood work.  The signs of hypothyroidism in a child are fatigue, weight loss (in adults it is weight gain), constipation, and cognitive impairment.  Because cognitive delay and mild constipation are common in Ds, it is difficult to differentiate between Ds and symptoms of hypothyroidism.  Thankfully, we do not need to add endocrinology to list of docs we see as the CCC will handle it.



According to the pharmacist, synthroid (synthetic thyroid hormone) is supposed to be taken with water only and not within 4 hours of other medications.  Seeing as Ellie takes meds 4 x day, she would have to get up at 2:30am to take the synthroid.  The pharmacist agreed that it isn’t practical so she will take it with her morning medications and routine lab work will monitor her thyroid levels.

Now the good news is that we have NO doctors’ appts for the months of September and November so I will hopefully get to blog about other exciting things besides medical stuff.

She was so excited to ride the bus and go back to school.


Ellie started 2nd grade yesterday and she had a blast!  Here’s to hoping for a good, successful school year!

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