A Happy Day, With Another Coming

We are celebrating today for two reasons. Today Natalie turns 12 years old; and in ten days Natalie and our family will experience a milestone: her first year with no seizures. Natalie has had seizures since she was six months old. She has lived with seizures and epilepsy in some form her entire life. Natalie’s life and ours are changing in ways that are profound and inexplicable.

It has been 355 days since she experienced her last seizure, and since her surgery was performed. In almost a year’s time we have experienced a normalcy that is unheard of for us. July 26 is what we call Natalie’s second birthday, and we will celebrate that with an EEG in the morning and with cake at night.

At six months of age, Natalie was diagnosed with cerebral palsy, epilepsy and left hemiparesis caused by an inutero stroke. Since that diagnosis she has been on combinations of anti-seizure medications and the ketogenic diet with sometimes temporary, but mostly partial successes to control her seizures. Through all of this Natalie has been a very happy, outgoing, and social kid. On July 26, 2011 Natalie went to Primary Children’s Hospital for a Pediatric Peri-Insular Hemispherotomy, a surgery that would disconnect the stroke-damaged right hemisphere of her brain by cutting the corpus callosum, and removing a walnut sized portion of her right temporal lobe. The surgery was the last option to stop her seizures.

Before this year, Natalie could have up to ten seizures each day. Mornings started by waking her up to come downstairs for breakfast. She invariably drank enough milk to swallow her anti-seizure meds. We would coax her to stop talking long enough to eat a few bites of breakfast before getting dressed for school. Somewhere in that time each morning a seizure would strike, forcing her into the awkward position: left arm raised, head tilted to the left, her eyes turned, her breathing rapid as she became rigid. She generally felt her heart race right before the seizure and would startle up from the chair, or attempt to race to us as the seizure set. We would catch her in her chair or hold her in our arms, or in the cases that she fell to the floor we would hold her until it passed.

Seizures happened outdoors, in stores, at the theatre, in the pool, on the stairs, in the bath. We were wary for when they might occur. We were always with her, and purposely disregarded the looks from passers-by when Natalie had a seizure in public.

In addition, lack of sleep, dehydration, changes to diet, minor infections, or sickness could trigger more frequent, aggressive seizures. A peculiar trigger for Natalie was change in light – turning the light on in a dark room could cause a seizure. She would get nervous when she dressed for fear that we would take too long removing or putting on a shirt as it went over her eyes. Natalie would have seizures at night while in bed, and for that reason she regularly slept between us. Each seizure was counted and became an event to capture so we could track to know if the frequencies or durations were maintaining, or going up or down.

On January 8, 2011 we woke up at 4AM with Natalie vomiting, and a 100 degree fever caused by a mild ear infection. Fevers typically mean seizures, and the worst seizure we have ever witnessed occurred before 7AM. She stopped breathing, and it scared the hell out of us. After a morning at Primary Children’s Emergency Room, it became the day that set our resolve. Natalie’s seizures were becoming life threatening. We wanted her to be here with us. Tests in preparation for the surgery were already underway, but we knew our decision was made when we were given the final recommendation to proceed with surgery.

Since the surgery we have counted days, then weeks, then months. 100 days passed, then six months. Natalie has maintained, and although we have some concerns there have been no visible seizures in the past year. On her one year anniversary after surgery Natalie will have an EEG in the morning so that her neurologist can see whether any seizure activity is still there, potentially hiding but not entirely visible to us. With good news she begins to taper off of her anti-seizure medications. Regardless of that outcome she has a new chapter on her life, and we intend to celebrate that.

You can check out some amazing photos of Natalie that Kelli Bramble took for us in celebration of today:
http://kellibramblephotography.com/2012/07/natalie/

 

 

Day 19, School Starts Tomorrow!

Natalie’s Day 19 Update: We are on day 19 with no seizures, or any signs of seizure activity. She starts school tomorrow, and that will be a big test for us on how well she is doing. We’re still keeping her off the trampoline and told her not to engage in any hard physical play. The good news is that we haven’t given her any Motrin the last few days. We had tapered down to 200mg Motrin before she stopped. Her incision is healing nicely. Most of the scabbing is gone, with some flaking present around the incision. Her hair is growing where it was shaved so it’s making it significantly less noticeable.

She still gets dizzy after taking her Oxcarbazepine in the evening, but she hasn’t experienced any nausea since we reduced the morning dosage as our neurologist instructed. She wants to lay down while she’s dizzy and needs some assistance if she walks. I’m wondering if reducing the medication down again to 600mg twice daily for a total dose of 1200mg/day is possible. We’ve got a request in, hoping we can do this.

Natalie is excited about school. We also have her first TOP Soccer team meeting on Wednesday Sept 24th. She’s progressing well, and it seems like Angela and I are holding her back more than she wants us to, which is simply amazing. I don’t think we expected this after only a couple weeks.

Natalie plans to share some things with her new class tomorrow, including this picture that she drew:

First Day at Home is a Challenge

Natalie’s Day 6 At Home update: Our first full day at home from the hospital was tough due to nausea. Natalie got sick shortly after the 8AM dose of Oxcarbazepine, Dexamethasone and Motrin; and everything sort of went downhill from there. Anything that went into her came back up within 20 minutes so we couldn’t be sure what got into her system, and in the meantime the headaches came back and laid her out.  There were trips out to pick up the Lortab prescription as a backup to the OTC drugs (I had originally not intended to fill the prescription because we had so much trouble with nausea at the hospital), then for Ginger Ale, then for a new Tylenol that was easier to swallow/not expired.  A reminder about expired medication – you should plan to check your medicine cabinet at least annually to clear out old medications. We weren’t able to find any of the 325 mg tablets that we used previously, but were finally able to settle with the 500 mg tablets after a very friendly pharmacist at Harmons calculated the dosage and verified that her weight was sufficient for that dose.

We had to cancel a visit with some of Natalie’s school teachers because she wasn’t better in the afternoon. We pitched out the steroid because it has a side effect of nausea, and gave up on the Lortab because that wasn’t staying down either. The 2PM dose of Motrin stayed down, and the 5PM dose of Tylenol stayed down too.  The call into Dr. Bowers, the on-call neurosurgeon at PCMC didn’t get us any better advice than what we were already doing or planned to do.  She’s finally keeping liquids down with the pills so it looks like we won’t have to go back to the hospital to push fluids into her with an IV.  So, at 7:30PM the headaches are under control, she’s hungry but doesn’t want to eat, and has enough fluids that I think we’re okay.

The highlight was a visit from our neighbors the Dowden’s. They stopped in to say hello to Natalie and presented her with an incredibly cute pair of striped froggy footies that Natalie is wearing right now. They bought them thinking of the hospital, but they will be put to good use here too. Thank you Anita, Ron and Mary!

 

An Afternoon at Home

We’re home! Natalie has been set up on the couch, has had lunch, and is drawing on a little whiteboard while she controls TV with the remote. This kid is so happy to be home. It’s hard to believe that she’s back so quickly, but we are soooo relieved! Medicine schedule is up on the fridge as a reminder for us to follow the schedule.

It’s hard to stay low-key today.  I had earlier asked the Griffins to come by the hospital so that Eric Griffin could share his surgery story with Natalie because he had a similar operation and had a great scar to prove it.  We arranged to swing them over to the house instead of the hospital, and that seemed to work well.  It was good to hear Eric’s story from beginning to end, and Natalie was intrigued, at least as much as an 11 year old will be.

It got a little busier when the Poelmans came by to visit as well.  At that point we had 5 kids in the house and Natalie wasn’t so interested in sitting with the adults.  For a kid who was having issues walking to the bathroom, she was suddenly going down stairs, playing games on the Wii, and trying to go outdoors with the group.  There is sometimes too much of a good thing.

We Got the Okay to Go Home!

Natalie’s Day 5 NTU Update - Dr Walker and resident Dr Bowers from Pediatric Neurosurgery came in this morning to look at Natalie. Dr Bowers just came back with 3 prescriptions in hand and told me we could leave anytime today as long as we coordinate with the nurses. I’m sending a few text messages out to friends who were planning to drop by, but we are going to get out of here!

As we leave the hospital grounds you can just see her reaction that we’re actually on our way home.

Natalie and the Wonderful, Improving, Very Good Day

Natalie’s day 4 NTU evening update – we had a really good day today. We have switched off of the narcotics to a blend of Tylenol and Motrin, and are tapering off of the steroids. Natalie was able to get out of bed several times throughout the day, mostly assisted, but walked on her own to the therapy gym and later much further down the hall to have a bath. The swelling in her face is down considerably from yesterday.

A clear highlight of the day for us was opening up a care package sent by Stacey Nofsinger, a former and much-loved teacher who craftily coordinated building an album filled with pictures and letters from many of the teachers and staff who have worked with Natalie at Terra Linda and South Jordan Elementary schools. The album was beautiful, and the letters were all very touching – Angela was so touched that she was crying as she read the letters aloud to Natalie, and I had to read the last three because Angela was breaking up so much. Thanks to Stacey and John  Nofsinger, Mrs. Clayton, Mrs Kimber,  Ms Tamayo, Ms Sundell, Mrs Lilly, and Mrs Degn for some beautiful and fun letters for Natalie.

 

 

 

 

 

 

 

We also got visits from Elliot the Therapy Dog a couple of times during the day, which was another highlight. Elliot is a labradoodle, and he’s a big boy. Natalie must have had a heart attack when he jumped up on the bed and laid down next to her when they first met. He was gentle, he was well-behaved, he was endearing to Natalie. And he has the softest coat – Natalie was petting him and telling us that he felt soft like her blanket, and she wanted us to touch to compare. Elliot’s handler Joe is a good guy who makes rounds with Elliot 3 times a week to different hospitals as part of the Intermountain Therapy Animals program. I saw two other volunteers making rounds with pets on our floor, it’s an active program with incredible effect on the kids they visit.

 

 

 

 

 

 

 

Dr. Kestle (neurosurgeon) and Dr. Van Orman (pediatric neurologist) both made visits with Natalie today. Both were pleased with Natalie’s progress, and Dr. Kestle suggested that we could be out of the hospital by Sunday based on how well Natalie was recovering. This is fantastic news for us.

Natalie is finally eating normal meals now. She was able to finish her lunch of chicken nuggets and french fries although I think the meal knocked her out (she slept for about 3 hours after eating); and also had most of her dinner where she traded her grilled cheese sandwich for a slice of mushroom pizza (and here’s a quick plug for The Pie Pizzeria who will deliver to Primary Children’s). She had some cookie during the morning, and some chocolate kisses from the Leals during the day. She is talking, giving us all a hard time and has made at least one butt-box reference, is making jokes so we think the old Natalie is finally back with us.

A Visit from Elliot the Therapy Dog

Elliot the therapy dog came to visit Natalie this morning. Elliot is a Labradoodle who works with Intermountain Therapy Animals at http://www.therapyanimals.​org/, he even has his own Facebook page at http://www.facebook.com/el​liot.therapydog.  Joe is Elliot’s handler, and is a down-right good guy.  Natalie was motivated to get up and sit on the side of the bed, then walk out to the NTU therapy gym with Elliot at her side.  It’s the furthest she has walked since the Tuesday surgery.

Day 2: NTU Evening Update

It was a good afternoon but I think we pushed it too much. The Leal’s came to visit, which was just awesome.

 

 

 

 

 

 

 

 

Natalie is resting again after getting her “dinner” of Sprite, Oxcarbazepine, Dexamethasone, Zofran, Zantec, an un-named laxative, and Motrin for the 101 degree fever. The real dinner went into the fridge. I’m really hoping this kid gets some rest and feels better again soon.

I guess 6 hours was a little too long after the first dose of Lortab.  The headache came back, so we’re going to follow a four-hour regimen from now on.  So far no seizures have surfaced after the surgery. I’ve been watching her heart rate pretty closely for any telltale signs of activity, but so far nothing unusual.

I can’t ask for better kids….

I’m so thankful for my patient and understanding kids. Marisa – thanks for your beautiful picture of Natalie!

 

 

 

 

 

 

 

 

Day 3: a Morning Update from the NTU

The morning started out bad, but has improved significantly. Nat got sick at about 4AM when no-one was there to catch it. The nursing station has a laundry so we were able to get her blankets washed and back on the bed. Her headache continued in the morning, but right around noon it seemed to lift away.

Her catheter was removed this morning and she was able to walk assisted to the bathroom.  The nurses also disconnected her from the IV fluids  but warned us that if Nat doesn’t start drinking or eating more then it’s going back on again.

Angela ordered a lunch of chicken nuggets, french fries and a chocolate shake for Natalie, who was finally able to eat!

 

 

 

 

 

 

 

 

 

Natalie is able to take the Lortab now, which will replace the intravenous morphine (Lortab has the same pain reducing effects but is orally administered, and lasts longer).

Natalie had a bed-bath this morning, and is now wearing her own pajamas again, which is must better than the hospital attire she had to wear for surgery. Angela also made sure to brush her teeth. We were able to get her into a wheelchair and take her out to the 3rd floor playroom, where she drew a picture and played the Candyland board game. We went down to the first floor and spent a few minutes outside before going back in and visiting the hospital gift shop, where Natalie found “Squiggles” the elephant to bring back up to her room. That excursion exhausted her so we’re currently back in her room. She’s asleep.