This update is long overdue, but the past couple of weeks haven’t seen a lot of progress and there has been a lot of discussion about where we go from here. Addison is still in the PICU. She was admitted and intubated on Thursday the 25th and extubated on Sunday the 28th. She has been on bipap since then. She’s had lots of ups and downs. She was fighting a lot of secretions and needed frequent suctioning up until the past few days. She has also had a lot of trouble maintaining her oxygen saturations – she was up to 100% oxygen several times. Her tendency to obstruct her airway has been a huge hurdle. Her bipap settings were weaned down and then increased again a few different times. Looking back over the past week, she has made a lot of progress – it has just been very slow. She is doing trials off the bipap during the day now. She actually had two four hour windows off the bipap yesterday, and she was on room air for most of that time. This was huge because prior to yesterday, she was on a mask with 28-50% oxygen during her time off the bipap. She also frequently wasn’t able to complete even an hour off the bipap for several days. Today, our goal was two five hour windows off the bipap. This morning she made it four hours before her oxygen levels dropped and her breathing became too shallow and she had to go back on the bipap. Currently, our goal is to get her to a point where she only needs to use the bipap at night and can be off it during the day. If she can do well with that schedule, we can go home with a bipap and continue using it only at night and possibly naptime. We would follow up with pulmonary and hopefully be able to wean her off the bipap more after she’s home to (ideally) get her back to using only a small amount of oxygen while she sleeps. She is back on her home feeding schedule and doing absolutely fine with that. This stay has been a lot of one step forward, two steps back and a lot of really difficult days. Of course, balancing time spent at the hospital with time spent at home is always challenging and it becomes even more so after a couple weeks. She’s doing better for the moment, but we don’t know how much longer we will be here. She has been acting more like herself the past few days and has been more alert and smiling at everyone, which is very reassuring. She has so many friends here in the hospital that she is never lacking attention or someone to tell her how cute she is. As always, thanks for all the well wishes and prayers.
I was really hoping that 2018 would be a year with less illness and hospital time, but it hasn’t started out that way. Addison is a girl who always has her own plans. Here’s a quick recap of what Addison has been dealing with over the past couple of months. We brought her in to the hospital Thanksgiving night and she spent two weeks in and out of the ICU. She (as usual) had a cold virus. She was on the vapotherm for a while, started doing better quickly and was transferred to the regular floor. Then, she started having a lot of seizure activity and her breathing worsened again and she was sent back to the ICU for a few days. After two weeks, they sent her home to finish recovering and I finally managed to get a pulse oximeter for home (yay!). She finally started getting back to her normal self after a couple of weeks at home and then she got sick again. I was able to manage her pretty well at home, but after almost two weeks, she just couldn’t shake what she had; I thought she maybe had pneumonia or needed steroids. She obviously needed something I couldn’t give her. We ended up ringing in the new year in the ER. Turns out she did just need some steroids and some deep suctioning. She only spent two nights in the hospital at that time. We finally recovered from that mess, got her back into the routine of PT/OT and preschool. She had a really great week this week – she was finally awake and happy at school. Thursday morning while I was getting her ready for school, she started having trouble breathing. I kept her home and tried inhalers and breathing treatments and oxygen and suctioning and her vest, but her breathing and oxygen sats just keep getting worse. So we were on our way to the ER by 11:30. Long story short – Addison has pneumonia. She tested positive again for the cold viruses she had back at the beginning of the month. Thanks to the pneumonia, they were not able to keep her oxygen levels up with vapotherm or bipap, so she was intubated last night. Her blood pressure was consistently too low, so she got a central line in her neck in order to give medications to bring her BP up and an arterial line to better monitor her blood pressure. She’s got what seems like a million IV medications running. Girlfriend was a hot mess all day and all night, but she seems to have settled down for the past few hours. I had a feeling yesterday that this illness was going to be a bad one and that she was going to end up on the vent. Sometimes, I hate being right. Plan for today is to get her oxygen requirements down and then maybe start weaning some of her vent settings. She’s also got more bloodwork this afternoon to check her electrolytes that were low and replaced this morning. Her blood pressure has normalized for now. She got a lot of fluid overnight and now she needs to get rid of some of that extra fluid, so hopefully she will start peeing some of that out on her own. Basically, we wait and watch and see what our little diva decides to do over the next 24 hours and we go from there.
After a long five month wait, Addison had her hip surgery this morning (Thursday the 21st). Thanks to the many, many abdominal x-rays she had in March due to her feeding tube issues, we found out that her hips were dislocated. We had known for quite some time that she was at risk for this due to her increased muscle tone. She had her first appointment with the orthopedic surgeon in April. After a lengthy discussion with him, and a couple of her other doctors, we decided to go ahead and schedule surgery. We felt that it was definitely worth it to be aggressive. Leaving her hips dislocated could have potentially caused more problems down the road (such as problems with her spine and reduced cartilage in her hip joints – which would have made fixing the problem in the future impossible).
Both of Addison’s hips needed to be relocated. We were very fortunate because she ended up requiring the less involved procedure. Basically, the surgeon only had to adjust the femur to get her hips in proper position, and did not have to do a larger incision to get to her pelvic bones. This also meant that she did not have to have a lower body cast, which definitely makes our lives and her recovery much easier. They lengthened some of her groin muscles so that they don’t pull on her hips.
Surgery itself went well, it only took about three hours (she was orignally scheduled to take about five). She was able to come off the ventilator in the recovery room. She still ended up in the PICU, because it is her home away from home. Seriously though, she has an epidural to help control her pain and with her history of breathing issues, we all figured it would be the safest place for her. She has been fairly stable after surgery. She was originally on plain oxygen, but was having some troubles with airway obstruction and apnea and after trying a few other things, she ended up on the trusty vapotherm. She has a PCA pump in addition to the epidural. She pooped all over herself at the end of surgery, so she’s getting some antibiotics just in case. Addison decided she needed to add a drug allergy to her health history, so right after they hung clindamycin, she broke out in a rash. She earned herself a hefty dose of benadryl and a steroid. She definitely doesn’t like being bothered, but she’s at least fairly comfortable. It was a pretty eventful 3-4 hours after she arrived in PICU, but hopefully she will have an uneventful night as it seems she has finally settled down a bit. Violet and Oriana had a fun day with Grandma and their first demand when we video called was to see Addison. Their biggest concern throughout our discussions about Addison’s surgery has been confirming that we will bring them to visit her. We have, of course, reassured them that we will do so and that they can see her on a video call every day. It’s been a long day, so I’m off to see what sleep I can get on the lovely couch in Addison’s room.