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

Chemo, Sodium and Infection

December 18, 2010

We are home with Josie and we were able to go to church as a whole family yesterday!  She is stable and holding her own, so the doctors were comfortable with her going home.  We are so thankful that we will get to spend Christmas all together as a whole family.  The girls couldn’t wait to see Josie – they had not been up to the hospital since she was admitted for this round of chemo, so it has been a long wait.  In one of Reese’s papers from either church or school, one of the questions asked was “what are some things that are hard to wait for” – her answers were things like “Christmas, new snow pants, going home”.  Then the next question asked “What has been the hardest thing lately to wait for?” – her answer: “My sister to come home”.  Needless to say, we are all ready for Josie to be home. 

The stay at the hospital this last time has been a bit more stressful.  The chemotherapy that she received was quite strong and ended up wiping out her blood counts.  For a few days, she only had around 100 white blood cells working in her body when the norm is around 10,000.  This is quite typical for chemotherapy, and they are constantly monitoring her, but it is still very nerve wracking.  Josie’s hemoglobin dipped twice and she ended up needing 2 transfusions. After she receives these transfusions, she always seems to glow with a pretty shade of pink all over her body.  The first time she had one, I thought something was wrong with her, so I kept asking the nurse if she was okay, but I was assured over and over that it is absolutely normal.  Now I don’t worry, I just enjoy her pretty pinkness!

Josie ended up giving us two scares during this time period.  The first was that she ended up with a bacterial infection in her blood.  We are not sure where she picked up the bacteria – it could have been her broviac line or it could have come from something in her sinuses, we won’t ever know.  As soon as it was discovered, she was immediately put on antibiotics – 3 in fact.  They put her on several types that cover a general/broad spectrum of bacteria’s until the culture that they took grows enough in the lab to let them determine what exactly it is.  This seemed routine and no one appeared terribly concerned – until later when we found out it was an extremely dangerous bacteria.  Thankfully they had caught it early and were able to get it cleared up before it became really bad.    

The second scare – which was scary right from the start, was that her sodium counts went really low.  A normal level is around 130-160, Josie’s started going down first to the 125’s, then the 120’s and finally to 115.  The doctor that was on during this last week informed us of how serious this situation was and let us know that she had called in the kidney doctor.  It appears that Josie had a situation where her kidneys were getting rid of too much salt.  After trying to correct the sodium issue on the Hem/Onc floor, Josie’s sodium kept going further in the tank.  Finally, the Hem/Onc doctor had Josie transferred to the PICU (intensive care) for further treatment.  In the PICU, the doctors can be a little more aggressive with the treatment plans because they can have a nurse in her room watching her more carefully.  They did a great job of getting Josie’s sodium turned around.  They ended up giving her this medication that helps sodium stick to the cells and then gave her a pretty high dose of concentrated sodium.  The nurse that Josie had when we got up to the PICU was a bit nervous about the concentrated sodium and was very thorough with checking and rechecking the rates before he gave it to her since this type of sodium can be toxic if given incorrectly.  We were thankful for his thoroughness!  Her sodium is now holding strong in the normal range.  On Saturday, we talked to her primary oncologist and found that the real reason for her salt wasting was due to the steroid that Josie has been on since her second surgery and how it affected the adrenal gland on her kidneys.  They have since stopped giving her this steroid and balanced her sodium with other medications.

 

The funny thing about this sodium problem is that the doctors were perplexed by Josie’s demeanor.  For a typical 5 month old with a sodium count of 115, the child should be extremely lethargic, if not close to comatose.  Josie on the other hand doesn’t like to be typical, so throughout all of this she was happy, wide awake and flashing that sweet, sweet smile.  In fact, she wouldn’t even take a nap, she would stay up from 8:30am until 2:30pm and then she would finally give in to sleep.  When the Hem/Onc called to tell the kidney doctor that Josie’s level had dropped to 115, she asked if Josie was unresponsive and was blown away that she was wide awake and happy.   If you’ve seen the latest pictures on facebook, those were taken the day that her numbers were the lowest.  She is a funny girl!

After Josie’s sodium numbers leveled off, she was then sent for an MRI to check to see if there was something that had moved or changed in her head to cause this sodium wasting.   She did great for the MRI and this time she was stable enough to not need a ventilator during the scan.  The results of the MRI were only slightly changed.  The tumor did not grow any larger from her previous scan in November, but it didn’t really shrink either.  The radiologist said that it was maybe 2-3 millimeters smaller, but not significantly smaller for the types of chemotherapy she has undergone.  What does this mean?  The chemo is at least keeping it from growing, but it did not shrink like they had planned.  There are varying opinions about the next stage for Josie, depending on the doctor.  Josie’s case was taken to the tumor board (a group of up to 40+ specialists for tumors) and there was no “right” direction, but several options, all with pro’s and con’s. 

At this point, we are planning on going ahead with 2 more rounds of chemotherapy – the first will be a 3 drug cycle and then the second round will be the 4 drug cycle that she just completed.  This would mean that Josie will be in the hospital again for 3 weeks at a time to be observed for complications.  There are always the risk factors of complications – no matter which route we go.  Please pray with us that she will not get another infection and that she handles her counts going down to nothing again. 

We would love for someone to tell us that this is exactly the right route, but ultimately, we have to make the decision with God’s help, and it weighs heavy on our hearts.  The one thing that we have not lost sight of though is hope.  Our desire is for Josie to be cured and be rid of this tumor and for that we are praying intensely.  We also know that there is a greater hope beyond this world and we know that we must hold on to Josie as best we can in this world, but hold her loosely too.  At this point, we are just enjoying each day with her and she is indescribably precious and sweet. 

This update has taken me 4 days to write, so I need to wrap it up.  Continue to pray for Josie and for us as we wade these deep waters.  We have been so blessed this Christmas by so many – it will truly be a special year!

Merry Christmas,

Marc & Darcia

Sodium problems

December 12, 2010

Today didn’t start off quite as well as I was hoping.  The doctor came in this morning and said that Josie’s sodium levels are not staying where they need to be and that this is of great concern.  They are working on getting her body what it needs, but it appears to be a symptom of the tumor and brain injury. 

The doctor suggested that she might go back to PICU since that is more of their specialty, but was also good with her staying on the Hem/Onc floor if they could get her sodium regulated.  So we wait. 

Josie appears fine and has given us lots of smiles and sweetness so far today. 

We are definitely in need of prayer today. 

In Him,

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

Respirator Update

7/15/10 Respirator Update
Marc and I were able to go home last night and get some better sleep, which is
much needed. We completely trust the doctors and nursing staff here at the
Pediatric Critical Care Center (DeVos Children's Hospital) and could rest with
this in mind.
We were able to meet with the Doctors and nurses this morning for their daily
updates and we met individually with Josie's Neurosurgeon. We hope to have a
plan of action sometime tomorrow if all goes well.
Josie was able to have her breathing tube removed this afternoon. It was a
little more nerve racking than anticipated and Josie experienced quite a bit of
pain, but she is breathing on her own and resting with some pain meds while I
write this update. She needs to have a good cough or cry to help things smooth
out in her breathing. Keep praying for this.
As for things to pray for, the doctor said that when the biopsy results come
back and when they do the next surgery, the best outcome would be that they
find that the tumor is growing from the outer area of her skull (not really
medical terms used here) rather then near the center of her brain. Everything
is waiting though for final results on her biopsy.
Thank you for praying! We are truly blessed by the support that we have been
receiving.