A week of antibiotics seems to have cleared up Khloë’s pneumonia. After two and a half days on amoxicillin I began to notice a difference: hardly any suctioning had to be done and the junky sound in her chest was just about gone. Hurray! Jordan and I were pretty worried for Baby Girl but she pulled through. Fingers crossed this will be her only illness this winter!
Mid-week we bundled Khloë up and attempted an autumn leaves photo shoot. She was afraid of the leaves… Luckily a few pictures still turned out!
We took Khloë, with friends of ours and their two children, to a pancake breakfast at a community centre in town. Even though Khloë can’t really play with the toys–I always bring toys for her that are easy to clean if dropped or touched by another child or adult–I like for her to be able to socialize with other people. She loves watching other kids play.
The same friends came with us to a church dinner on Sunday. Their 4 year old hit it off with another little boy and they were inseparable all night. And then Monday evening we enjoyed a delicious turkey dinner at their house. Khloë and Carly (a year and a half) smiled a lot at each other and Khloë kept her eyes on her to see what mischief she was getting into.
Lastly, the CCAC dietician popped in to see how Baby Girl was doing. She weighed in at 18 lbs!
Khloë was sick all week with a cold. Anytime she was upright in a sitting position she would cough and choke, so this week’s picture was taken laying down. My mom was here for the week and did the cooking and dishes, etc, while we took care of our sick daughter.
Every day Jordan and I spent a lot of time suctioning and coughing her. By “coughing”, I mean using the CoughAssist to simulate a strong cough (Khloë’s is weak and she can’t bring up mucous like a normal child or adult can). She absolutely hates being suctioned; she would clamp her mouth shut as soon as the machine was turned on! Unfortunately, it was something that had to be done because if we didn’t suction out the mucous, she would choke. In between these treatments I would do chest therapy by tapping percussor cups over the lobes of her lungs and then propping her bum higher than her head (postural drainage). This is meant to loosen mucous and drain it out of the lungs into the throat, to be suctioned out.
As you can see, an illness as simple as the common cold is a scary thing for a child with Spinal Muscular Atrophy.
To help her sleep, I gave her 1 ml of Advil. If she was still feeling awful after a few hours, I administered the same dosage of Tylenol. The great thing about her G-tube is that the medications can go right in the tube!
On the morning of Wednesday, September 24th, she gave us a scare. We noticed her breathing was different; she was working a lot harder to get air and kept coughing. Her colour looked fine. I spent 20 minutes suctioning before deciding we needed to take her to the local emergency room. I held her in my arms for the drive, suctioning the whole way, while Jordan drove. Upon arrival at the hospital, I explained my daughter has a neuromuscular disease that affects her breathing and that she needed to be seen ASAP. We were called right in to see the triage nurse. By the time we saw the doctor, Khloë was all smiles and breathing normally. The doctor explained that she most likely had a mucous plug that I was luckily able to dislodge on the drive over. To be on the safe side, he sent her for a chest x-ray. The Pigg-O-Stat is an evil contraption that scares the crap out of me. I hate seeing her in that thing for x-rays. At one point the technician asked me to put on the lead vest and support Khloë’s chest while he took a picture of the side profile. We were told that her lungs and trachea looked clear and were sent home.
Before we left the doctor told us these wise words: “Khloë has SMA, she will die before she’s two. You will just go through this over and over.” Seriously? We are her parents, I’m pretty sure we understand her diagnosis.
We made our exit and headed home. Mary from Infant & Child Development popped in to make sure Khloë was doing okay. She was supposed to stay and teach more infant massage, but Khloë needed a nap pretty badly. Then Dawn from CHEO called and asked us to come on Friday to see Dr K, one of the respirologists. And so off we went on Friday, all the way to Ottawa, after saying goodbye to my mom. I wasn’t comfortable with having Khloë in the car seat and she did have some coughing episodes. I sat in the backseat and suctioned her when she needed it.
The appointment was sort of pointless. Dr K asked us the same questions as the other doctor. Listened to her lungs. Explained how to count her respiratory rate. After he left, Carlie (respiratory tech) gave us our Masimo Rad8 pulse oximeter and showed us how to use it. Finally! She also demonstrated deep-suctioning through her nose, which Khloë absolutely hated!
What a lonnnnnnng week. And I was sick too.
But that’s not all. On the 29th Dr K called and said that the x-rays showed pneumonia. She called in a prescription for amoxicillin for Khloë and we started the antibiotics right away.
Khloë had her 9 month well-baby check-up with Dr K. She weighed 17 lb 3 oz and measured 29 inches long. What?! Wasn’t she 28 inches only a few weeks ago? I swear, this child grows overnight! I noticed her pyjamas, which she hasn’t been wearing that long, were getting tight but I thought I was just imagining the growth spurt.
I pointed out that Khloë’s yeast problem on her wrist is still an issue and now looks infected. I have to pick up a prescription for mupirocin, an antibiotic ointment, to clear up the infection. After seven days I should be able to go back to using the clotrimaderm cream on her wrist.
We also discussed Baby Girl’s upcoming vaccines. She’s eligible to receive the RSV (Respiratory Syncytial Virus) shot. RSV is a virus that spreads by coughing or sneezing and is like the common cold but can cause bronchiolitis or pneumonia, both which could be fatal for Khloë. She also needs the flu shot and then the regular 12 month vaccines. However all these shots need to be spaced out. We still aren’t certain when Khloë will be given the RSV vaccine. I’d rather not have to go to Ottawa every month to get it.
On Wednesday we had a demonstration of infant CPR at Prenatal Nutrition. I’m not sure I’ll remember what to do in an emergency, though! The demonstration was to give us a taste of what the official St John Ambulance CPR course is like.
Later in the week we drove to the Pembroke Hospital for our appointment with Ralph. He made fiberglass casts of Khloë’s feet so that he can make the plastic AFOs for her. These contraptions are worth $1800. No, they are not made of solid gold, but of plastic. Funny, eh? Luckily ADP will cover a good chunk of that. I really hope ACSD approves us for 100% coverage.
On Friday a respiratory tech from Kingston drove up to see us. He came all that way to fill out paperwork about the CoughAssist. The bonus was he showed us how to unlock it and change the settings.
Around 1 am Friday morning Khloë woke up crying. I discovered she had a stuffy nose and felt warm to the touch. By 5 am she wanted to be out of bed but clearly didn’t feel well. I couldn’t believe she already had her first cold of the fall season! I cuddled with her on the sofa and she ended up falling asleep for a half hour. The day before I had assumed she was teething since her cheeks were red and warm, but she didn’t register a fever on the thermometer. Turned out to be a nasty cold instead.
My mom arrived Monday afternoon. She planned to stay the week, even with Khloë sick; she was a huge help! And of course Khloë was happy to see her Oma. Oma was the lucky one who discovered the second tooth that had popped through! Teething AND a cold, brutal. In 9 months, this is her second illness and I hope she pulls through it. I’ve had to suction mucous out of her nose and mouth quite a lot and now she hates the machine. After talking with another SMA mom, I decided to use the CoughAssist as well to help bring the mucous up so it could be suctioned out. Khloë’s cough is weak and this machine helps push air in and pull air out, simulating a strong cough.
A few days after Khloë was discharged from the hospital, we went to our second Neuromuscular Clinic appointment. We met Dr L, an orthopedic surgeon, who was very friendly and great with Khloë. He liked that her feet aren’t terribly formed yet and he wrote up a prescription for Ankle-Foot Orthotics (AFOs). There’s an ADP form that goes with the prescription as well, which means we will only pay 25% of the cost.
In case I haven’t explained what ADP is, it’s short for Assistive Devices Program, and it’s for residents of Ontario. Once approved, ADP pays 75% of the cost of the device. In this case, the AFOs. We are awaiting ADP approval for the suction machine and feeding pump. Khloë’s equipment is very expensive! Another program we are hoping to be approved for is ACSD (Assistance for Children with Severe Disabilities). If we get approved for that, then ADP will actually cover 100% of the cost of the devices I listed! ACSD is based on our income.
We also saw the physiotherapist (not much to remark) and Kellie, the dietician. Kellie is looking into Pediatric Vivonex, an elemental formula, for when Khloë turns 1 in December.
Dawn, our nurse coordinator, gave us the CoughAssist machine to take home. She suggested we have Khloë play with the tubing and mask to get used to it first. Not sure what happened to the pulse oximeter we were supposed to be given… Both of these pieces of equipment are loaned to us from the Ventilator Equipment Pool at no cost.
Next we saw Dr MacL, a different respirologist. He doesn’t think Khloë needs BiPap just yet, but he wants to do an overnight pulse oximetry at home to get an idea of her sleeping O2 sats. We professed interest in the BiPap because we know Khloë will most likely need the extra breathing support when she gets sick.
And lastly, Khloë was assessed in her car seat with the pulse oximeter attached to her toe. We were trying to see if her blood oxygen level was different while upright. The OT still doesn’t want to help us with getting the car bed from FSMA Canada.
Later that afternoon Jordan and I met with a genetic counsellor. We found out that we are indeed carriers of the SMA gene. No surprize there! In order for Khloë to have Spinal Muscular Atrophy, both of us had to be carriers. The counsellor drew our family tree, explained a few things about autosomal recessive genes that we already knew, and said that she would be mailing a letter to us that we could give to family members. The letter would explain our family history of SMA and would encourage family members to get tested to see if they are carriers of the gene that has changed our lives!
So that shirt she’s wearing? It’s size 2T! Must be made small though; her other T-shirts are 12 or 18 month.
Lots of appointments and meetings this week. Here’s what went on:
Tuesday: We met Leona, a dietician with CCAC, for the first time. We talked about Khloë’s current diet and I explained that we would be switching to an elemental formula when she’s a year old. Jordan and I have discovered that any dieticians we deal with are trying to get us to feed our daughter as if she was a child with normal muscle mass. She needs less fats and proteins than a “normal” kid. There aren’t any documented studies on SMA and nutrition. I have spoken with other parents who have been feeding their SMA kids special amino acid formulas, baby foods, and breastmilk and we plan to do the same; but to get the dieticians on the same page is a hard task! These parents are not considered “professionals” to them. She had a portable scale with her and weighed Khloë at 16 lb 13 oz and she measured 28″ long.
Wednesday: Mary demonstrated some infant massage techniques to use on Khloë’s legs. She loved it! Mary lent us a Tumble Form chair to use for Baby Girl, as well. We also discussed the latest car bed issue–that CHEO doesn’t want to deal directly with FSMA Canada, but Khloë’s neurologist is willing to write a prescription for the Hope car bed and EZ-on Vest.
Thursday: A military chaplain came to our house and spoke with us about Khloë’s condition and how it will relate to Jordan’s work. He assured us he’s there to advocate for us and will do his best to make sure we don’t fall through the cracks, so to speak.
Sunday: After church, we had a delicious lunch at Ken & Sandra’s. They let us bring Khloë’s stroller inside and park it in the kitchen. It’s too awkward to hold her on our laps while eating since she needs extra support, and the stroller in the carriage position is perfect for her to lay flat and play in.
Monday: Taunia (Occupational Therapist) and Christine (Physiotherapist) from CCAC stopped by. Taunia gave us a larger Tumble Form chair. I attempted to feed Khloë while sitting in that chair but she started choking. The recline position is just not right. Taunia also gave us a few ideas for messy and sensory play. Christine just observed Khloë and made sure we were still comfortable doing chest therapy. Later in the afternoon, Kathy (Case Coordinator from Infant & Child Development) met with us for the first time. Her role is to help us with applications, find relief workers, and to offer any other kind of help we need. We had a great conversation with her. She walked us through the application for Special Services At Home, yet another program of funding we would like to be approved for.
You're just as sane as I am. — Luna Lovegood (H.P.)