My girl’s last week as an eleven month old:
51 weeks (November 25)
She couldn’t manage to sit up without coughing, so we did our photo shoot laying down this week. I have been dying to have her wear those sparkly leopard print pants!
The biggest thing this week was the increase in the amount of times Khloë needed saliva/mucous suctioned out of her mouth. This is definitely a progression of her disease; she will slowly lose the ability to swallow. She also coughed quite a bit on her own, which in itself is pretty good as they were strong coughs, but they sounded phlegmy. However, she wasn’t sick.
I used the week to prepare decorations for her upcoming birthday party. I’m also working on decorating the backdrop for her birthday photo shoot. The blue lace romper I ordered from OnceUponATimeTuTus on Etsy arrived!
On Thursday the Occupational Therapist from CCAC came to take Khloë’s measurements. We have started the process to get her a medical stroller because she is quickly growing out of her current “baby” stroller. The one we use now allows her to lay flat, but her feet are touching the end so we need something different. Plus our stroller is not meant to hold heavy medical equipment. We will be working with a vendor in Ottawa who will bring us sample strollers to try out. ADP and ACSD should cover the cost of the stroller. The application, though, could take 4-5 months for approval. While we wait for that, I hope the vendor will let us borrow the stroller we eventually pick out until payment comes through.
Also, we received the grant money for enteral feeding supplies from ADP. Our application was submitted in August and was just approved–that’s how long this stuff takes! A large portion of the checque will go toward purchasing a Kangaroo Joey feeding pump and the rest is meant for supplies (syringes, Mic-key buttons, extension sets, feeding bags, etc). I totalled up our invoices and, since September, we have already spent $500 on enteral feeding stuff for Khloë.
My cousins Delia and Andra, and four of Andra’s kids, came to the house to visit on Friday. Little Eleanor played with Khloë the whole time!
After they left we packed up and drove to Pembroke to see Christkindlmarkt at the Germania Club. Inside there were many vendors selling European-style Christmas items. We pushed Khloë around in the stroller, even though it was pretty packed and hard to navigate. When we first arrived, we parked the stroller near the back in the quietest spot we could find and set up her feed. The lady whose stall we had stopped near came out to talk to Khloë while I got everything ready. She didn’t even bat an eye when I pulled up Khloë’s shirt to attach the extension set to her Mic-key button. She was very friendly and said we had found the perfect spot to get our baby’s milk ready! When we were leaving I saw there was no line to see Santa, so Khloë and I got our picture taken.
We don’t do the Santa Claus thing, but I thought we should at least get a picture. That was the best one Daddy could get.
Wow, she’s getting so big!
40 weeks (September 9)
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.
9 month collage
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.
Here we go:
37 weeks (August 19)
At the beginning of the week CCAC sent an Occupational Therapist and Physiotherapist to our home to meet with Khloë. The ladies were very friendly and Khloë gave them lots of smiles. I showed the OT the feeding chair and the infant rocker chair we currently use and explained that, although they work fine right now, Baby Girl is growing quickly and will soon be too tall for these chairs. Since she can’t support her head when upright, Khloë needs to be partially reclined when sitting in either of her chairs. These chairs are meant for babies who develop into strong toddlers who can hold their heads up and don’t need extra support. The OT said she would look into finding us a tumble form chair.
On Wednesday we went to Prenatal Nutrition. In the late afternoon, Mary from Infant Development came and worked with Khloë for an hour. We agreed that she would benefit from infant massage and we will start that in September.
The most important part of the week was Khloë’s appointment at CHEO on Friday. We met with an anesthesiologist to discuss Baby Girl’s upcoming G-tube (gastrostomy) surgery. It looks like surgery will take place next Wednesday, August 27th, but we must wait for confirmation. In our original discussion with the surgeon, we were told to expect three days in the hospital for recovery and training on how to use the feeding pump. I voiced my concerns to the anesthesiologist about fasting, as it’s not good for an SMA child to go more than 6 hours without adequate nutrition–Khloë will need to fast starting four hours prior to surgery. Other SMA families advised us to have PPN (peripheral parenteral nutrition) given to Khloë, but even though I asked for it and the doctor said she would make a note about it on Khloë’s chart, I doubt she will get it. We were told that it’s not protocol at CHEO to do PPN.
The following quote, taken from the “Consensus Statement for Standard of Care in Spinal Muscular Atrophy”, is on the dangers of fasting:
Spinal Muscular Atrophy patients are particularly vulnerable to catabolic and fasting states [and] are more likely to develop hypoglycemia in the setting of fasting… Thus, it is necessary to avoid prolonged fasting, particularly in the setting of acute illness, in all Spinal Muscular Atrophy patients. Nutritional intake should be optimized to meet full caloric needs within 4 to 6 hours after an admission for acute illness, via enteral feeding, parenteral feeding, or a combined approach as necessary. Prompt postoperative caloric supplementation is recommended to avoid muscle catabolism, particularly in a child with reduced fat store.
As long as the surgery goes well, she’ll be given Pedialyte; if she tolerates that and has been extubated with no breathing issues, I’ll be able to breastfeed. If Khloë is too tired to nurse, I can give her pumped milk with a syringe. I have no idea how long she will end up going without eating if she isn’t given PPN and can’t breastfeed right away.
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On a happier note, my sweetpea has added the sounds “guh guh” and “ba ba ba” to her repertoire of baby babble. She’s being saying “mum mum mum” for awhile now but usually while upset. She even mouths it without the sound coming out, which is really cute. She also tries to copy me when I make a certain noise with my tongue. It’s hard to describe but she’s fascinated by watching me do it!
My girl is six and a half months old:
28 weeks (June 17)
At the start of the week we had an appointment with Dr K, Khloë’s family doctor, to discuss her recent diagnosis of Spinal Muscular Atrophy Type 1. She wanted to see how we were handling the news and had a nice discussion.
On Wednesday we had an enjoyable morning at Circle Time and Prenatal Nutrition. Khloë loved watching the other babies. She’s pretty content to lay on her wedge, slightly propped up, with a toy while we make lunch. The next day we hung out with Amanda and her boys at play group and then continued over to the marina playground for a picnic. Khloë fell asleep in the stroller on the walk over. A play date with a mom and little boy we met at the doctor’s office was supposed to be on Friday, but they cancelled due to a contagious skin condition.
And Sunday after church we drove to Ottawa. Monday was a pretty full day even though there were only two appointments. We met with Debbie at CHEO, the Occupational Therapist (OT) assigned to Khloë. She told us we are doing a great job in regards to the proper head and leg supports in the stroller and car seat. I brought some mashed banana and sweet potato for Khloë to eat and she did well, no choking. She liked the banana best, I think. The texture of the sweet potato might have been a bit much for her. Debbie gave us the go ahead to continue with purees and watch for symptoms like an abundance of drooling, choking, or coughing while she’s eating.
The second appointment of the day was at Roger’s House, the pediatric palliative care building. We met with Nancy and a couple of the doctors, and then toured the facility. We will be staying there in July when we have two days of appointments for Khloë. It seems like a great place for kids with life-limiting illnesses and their families. Nancy sent us home with some paperwork to fill out.
No changes in regard to weight, diapers, or clothing sizes.