Fever & Seizures

July 8, 2011

One month ago today, Josie had her bone flap in her skull replaced.  Time at the hospital is kind of like the “Twilight Zone” – fast and slow at the same time.  For the life of me, I can never remember what day it is and sometimes even what month we are in.  The one thing I do know is that we were supposed to celebrate Josie’s birthday tomorrow with everyone and of course that has been postponed since the birthday girl is still in the hospital.  There have been some talk of the “H” word (home) by her actual birthday – July 11 (Monday), but the doctor has made sure we know that is only a “thought” at this time. 

Meanwhile, as we continue to wait to go home, I can at least catch all of you up to date on what has happened since the 4^th of July.  Actually let me back up to just a little before that date to give you some idea of how Josie ended up in the PCCU (Pediatric Critical Care Unit).  We had been told last Friday that we might possibly go home over the weekend, if Josie’s counts continued to go up – we had a little hope of this, since she finally did have counts and it was a big deal.  We would have to give her shots at home, but they thought she would be okay if things continued to progress.  Well during Saturday and Sunday, her counts went down and then up and then down and then she needed transfusions, so we knew we were not getting out until at least the following week.  We were still hopeful even with these setbacks to be home in time for the birthday bash and even on Monday morning, the doctor thought maybe Wednesday or Thursday for going home.  It would be a crunch, but we decided we could do it in order to still have her party.  Josie had other ideas…

Monday afternoon – things for Josie turned terribly sour and caused quite a commotion on the 9^th floor.  Josie spiked a high fever – not only did she spike, but it came out of nowhere.  She had not had a fever since June 22 and she hadn’t even had a fever that morning.  When she spiked, the nurse and I noticed possible seizure activity, but it was not more than a blip and then she was fine.  They had just ordered blood cultures because of the fever and the resident doctor was consulted, but the consensus was to watch her and see if this fever went away as quickly as the others.  Josie had been crying out in pain during this time too and I was starting to get a little panic stricken with these symptoms.  I decided to get her calmed down, laid her in bed and went to the bathroom so that I could come out and just hold her while we waited this out.  When I went into the bathroom, she was calm, when I came out, I noticed she was not responding to me and then I sat her up to try and get her make eye contact with me and she was completely limp.  I quickly ran out to the nurse’s station and told them she wasn’t responding.  When the nurses came in they found her in a seizure, her oxygen level had dipped extremely low and she was turning blue.  From that point on – everything became a blur – they called a “code blue” and literally within seconds, her room was filled with doctors, nurses, respiratory techs and multiple other people.  Josie’s seizure meds were not up to her normal level and when someone has a high fever, automatically the threshold for having seizures drops.  The combination caused a severe seizure.  They were able to stop it with a powerful drug and then whisked her off to the PCCU, where we stayed for 2 nights until they were comfortable that her seizures had stopped. 

The fever this time had been brought on by a bacterial infection that got into her blood.  She is now on an antibiotic for that infection and seems to be doing well – i.e. no fevers for the past 48 hours.  This antibiotic is done through her IV and is the complicated reason we may or may not go home.  We have not had to access her IV line at home other than to keep it clean and flushed.  The antibiotic treatment is a couple weeks long, so the doctors are mulling over if they want us to do it at home. 

Yesterday Josie had a CT scan and a bone scan to check her head to see if there was a secondary infection area where her bone flap was replaced.  Thankfully these scans came back clear and negative for infection.  Praise God for that!  The doctors that ordered these scans wanted to make sure that they weren’t missing something else.  We so appreciate the thoroughness! 

At this point, that is the latest on Josie – we are constantly hoping and praying for healing, recovery and getting home.  A friend sent us this verse earlier this week and it has stuck with me and sums up where I believe we are at:  Psalm 119:81  “I am worn out waiting for your rescue, but I have put my hope in your Word.” 

Blessings,

Marc & Darcia

not home yet and reflux

November 15, 2010

Josie will not be coming home this week and actually not for several more weeks (we think).  The vomiting/refluxing is terribly worse and the only explanation is that the changing pressure in her head is messing with her central nervous system.  For example of how bad her reflux is, this morning between 8am-10am, she refluxed around 6-7 times.  She didn’t get tons out, but each time there was either saliva or stomach acid, not to mention it makes Josie miserable as she tries to get it out.  Then during the ten o’clock hour alone, she refluxed 4 times, plus gagged quite a bit.  Marc and I have been very concerned that they would send us home with her like this – since it is much worse than what we were dealing with in the summer.  We are starting to keep a running log of every time she throws up so that we have a better handle on how often it happens and how much she gets out each time.  We should have started a log earlier, but now have and it has already been helpful when we talked with the doctor. 

We did just talk with the doctor and he said that due to her increased vomiting, they don't see her going home right now.  This is good in many ways and yet it’s hard to stay here even longer.  We did voice our concerns about taking her home in this condition and they agreed that it would be more stressful and they can observe her condition more closely here.  There is a secondary rationale for keeping her here as well.  Since her blood counts have been staying even - not dipping down, and she is handling chemo so well, they would like to proceed earlier with the next round of treatment.  Instead of taking a week off, they will start the next cycle toward the end of this week, which means she would stay in the hospital anyway. 

Last night they took Josie for a CT scan because her head has started changing shape during position changes, such as when we hold her or move her in her bed.  She will get a fairly good-size "sink hole" toward the front of her head where the skull flap is missing and then it seems like fluid fills the back side of her head.  Change her position and her head goes back to "normal".   The CT results thankfully did not show anything dangerous or irregular going on inside.  The only difference is that some of the swelling has gone down around the edges of her head and that change in less fluid is most likely causing the shape changes. It’s similar to when someone loses quite a bit of weight and the first place you notice it is in their face because they have lost some of that puffiness/extra fluid.  Best analogy I could come up with to explain Josie’s head shape change! J

We hope and pray that she can come home soon, but we are also praying that a solution can be found to relieve Josie of this reflux, or at least lighten it up.  She is on several medications to help with nausea and even one that is suppose to help with inner-cranial pressure nausea, but so far not much has helped.    We just wait and see as they try to figure her out - each day seems to bring something new for Josie’s treatment. 

Keep praying...we serve a God who hears!

Marc & Darcia

Post-Surgery Update

October 23, 2010  Post-Surgery Update (this will be a long post and somewhat detailed, so if you get queasy, it may be hard to read)

It’s hard to know where to begin – we have lots of information that we would like to share.

Let’s start with the day before her surgery.  Josie was in the hospital the day prior for a procedure called embolization.  Embolization is a process by which they take a micro fiber catheter and feed it to the specific artery that they want to “block” the blood flow.  The doctor that did the procedure was able to find a large artery that was feeding the tumor and was able to block it off.  Basically, this was a successful procedure.  The hope was that when Josie went to surgery, there would be less bleeding because this artery was blocked.

The day of surgery:  Josie went to an MRI first thing prior to surgery.  This was to help them during the surgery so they could tell from the images where they were and what was tumor and what was brain.  Later we were informed that the tumor had doubled in size since the last MRI, which was a little less than 4 weeks ago.  This made the tumor the same size again as when they first found it right after birth.  It is an extremely aggressive tumor.

Everything was going well during Josie’s surgery; every update seemed to be a fairly positive report.  One of the last updates, they said that she had a little bleeding, but they had gotten it under control and were continuing.  Then we were told that she was out of surgery – that she was fine and to wait in a little conference room for the doctor.  We thought it was odd that we got a conference room when most people were told right in the waiting room how things went for whomever they were waiting for.   But since they told us that she was fine, we did not anticipate what the doctor came in to tell us.  He sat down and looked weary and then told us that things did not go so well.  Josie started bleeding, they would get it under control and then she would start bleeding from somewhere else, they would get that one under control, but then she started bleeding from places they weren’t even touching.  She received 3 volumes of blood and then her body stopped coagulating (wouldn’t clot).  She was in serious condition.  They ended up leaving some cotton balls soaked with a clotting medicine inside and then closed up her head.  We were obviously devastated.  In fact the doctor was even shaken by the way things turned out since they had gone so well for the first 4 hours. 

They took Josie up to the PICU, where they worked for 1.5-2 hours trying to stabilize her, of which they were able to do.  Praise God.

Thursday morning:  Josie had another CT scan and then we talked with the doctor.  He was surprised that she was holding her own – said he thought maybe she was stronger than he gave her credit for.  The CT scan didn’t show any worse than right after surgery.  Josie even opened her eyes and looked at the doctor.  Earlier, she had moved her legs enough to kick her little blanket off.  The rest of the day she was pretty quiet – which is a good thing.

Thursday night:  Josie started having seizures again – not to be unexpected due to her trauma.  They are currently still trying to get these under control with meds. 

Friday morning:  Josie went for another MRI – this is for post-operative imaging.  During the MRI, the neurosurgeon came by to talk to Marc and me.  The news was quite sickening.  The part of the tumor that had grown back was checked by pathology and the new tissue is malignant.  The type of tumor she had at first, an astrocytoma can have multiple cell mutations in it.  When pathology checked it the first time, there were not indicators of malignant cells, but the part that was left in her brain from the first surgery must have either had those cells in it or they mutated since, which is a possibility.  

The first steps are to get Josie better from surgery, which at this point, she seems to be doing okay, although this morning they found that she has a urinary tract infection from her catheter.  They are on it though and are giving her antibiotics.  Stopping the seizures is another step they need to get under control. 

Next step…the doctors (neurosurgeon and the oncologist) are creating a plan for her.  At this point, they are planning on a new chemotherapy drug – used in infants.  Then they will develop a further plan from that stage. 

So…we wait and we pray.  This will be a long haul for our sweet baby Josie.  Not sure of the future, but glad that she is resting peacefully here in the hospital and also in the loving arms of Jesus.  My emotions have been pretty raw, but for the most part Marc and I are working through this moment by moment.  The girls (Reese & Eliza) are doing well; they are at Nana & Papa’s this weekend and having a great time I am sure.  Pray for them as they are going to get shuffled around a bit for a while. 

Thank you to all who have been and continue to pray for Josie – she needs it.  Thank you to all of our family and dear friends that have surrounded us – we need it.

Blessings,

Marc & Darcia

Back to work for Marc

7/26/10

Since it has been really quite quiet with Josie the last few days on Floor 7, I haven't posted much. We are very pleased and excited for all the good reports we are having about Josie. I was told at one point today that the doctors and nurses in their rounds are calling her a miracle baby. She sure is!!! We are truly blessed.

Today has turned out much more crazy than I anticipated. Marc was planning on going back to work today - he still did go, but he ended up going in later. Josie's CAT scan was moved to 9am (was at 5am), so when Marc got here to the hospital, he ended up waiting - hoping to talk with the neurosurgeon before he went to work. He left at 11:30 and of course the doctor came at noon. It was all good though and the CAT scan of Josie's head is looking good. YEAH!

From that meeting with the doctor, I ended up talking to so many other doctors, nurses, specialist and friends. Somewhere in there I was supposed to take a nap...it didn't happen. :) Everyone is coming to meet with us to prep us for going home.

Home...it's a wonderful, yet terrifying word. I am trying to turn my worries into trust in God as I hear these words. I truly believe we will be equipped by everyone here to handle the transition, but it will be quite the transition. For example, one of the discharge nurses is going to create a calendar for us with meds and dosage and other such information. Any help we can get...the better!

We were worried about Josie's neck having a kink in it because she likes to always look to her left side, but thankfully, PT (Physical Therapist) came today and let us know that she is only a little tweeked that way and promptly showed me techniques to get her to go the opposite way - and they work!!! Tried them already!

Lots of other information that I won't go into, but wanted to let you all know that Josie is doing well. We still covet your prayers as this next stage of life is going to be just as crazy, but in a different way.

We are thanking God for such a miraculous recovery that Josie is making. We couldn't have made it through without all of your prayers being lifted up on our behalf for our baby girl and our family.

Blessings,
Darcia

*By the way - big sisters are coming home tomorrow! Can't wait to see them - they've had a GREAT "vacation" with Uncle Josh and Aunt Tara and of course their cousins!