Playing catch-up

Whew, what a week!

Leah had her surgery one week ago, and came home Saturday morning. The procedure went well, and everything is tucked back into place. The hernia was definitely a congenital defect, and we were told it was quite large – but they were still able to repair it laparoscopically, thankfully. There was another small defect they found that did not need to be repaired – I can’t remember what the surgeon called it.

The docs had initially told us to anticipate a 3-5 day hospital stay, but after the surgery her surgeons felt it had gone smoothly enough that if she did well with overnight observation she could go home the following day. Leah spent nearly the entire day sleeping, and was super-fussy when she was awake. We got a few weak smiles out of her, but she was mostly just wanting to sleep. She got pretty puffy by Thursday evening, and they had to give her an extra dose of Lasix (she hadn’t gotten her meds before the surgery Thursday morning). Leah spent most of Friday sleeping as well, but when she was awake she went back and forth between moderately cheerful when still and red-faced and screaming when moved.

On the bright side, by late Friday morning, Leah’s numbers were good enough that the surgeons felt comfortable discharging her as soon as her pain was under control. Since she is tube-fed and has oxygen at home, there wasn’t a whole lot they could do for her in the hospital environment that we couldn’t do at home, aside from administering IV pain meds. So once she was able to transition from IV morphine to “oral” (g-tube) hydrocodone and acetaminophen, she was good to go. We wound up leaving the PICU around 6:30PM or so, but not before delivering a pie to the nice food service lady who brings the evening meals. It was pretty funny. A few days before Thanksgiving, Mandy’s brother had told her he would bring her a pie from his work, and then we were discharged before he could do it. She forgot ages ago, but he remembered that unsliced promise. When he came to the hospital Thursday night, he came bearing cookies for the nurses (because he’s cool like that), and yes, a PIE.

That wasn’t the only special delivery we made in PICU on Friday! We also brought up the blankets that Binkeez for Comfort sent for the kids of PICU. They each have a tag that says something to the effect of, “We are officially Binkeez Buddies! Love, Leah Valerie.” Pretty cute. We delivered those to the child life specialist, who will distribute them as needed. It was cool to be able to do something nice for the PICU kids. I hear the NICU babies get all the attention.

After our special deliveries, we went back to the Ronald McDonald House for the night so we could be near the hospital in case there were any issues. Thankfully there were no big issues overnight. Leah was still in a whole lot of pain, which is understandable, because abdominal surgery is pretty miserable even with just laparoscopic incisions. She managed to get through the night with only one set of heart-wrenching screams at about 4AM when Mandy had to change her diaper.

The hernia repair wasn’t Leah’s only procedure on Thursday. They also did another esophageal dilation with steroid injeciton. Leah’s stricture continues its refusal to cooperate. The docs were able to dilate up to 12mm on Thursday, but unfortunately, at the outset the stricture had already tightened to about 2-3mm, so the odds are pretty high that Thursday’s 12mm will be 2mm again by the next procedure. They have said they will keep dilating biweekly for three months along with the steroid injection, and if that doesn’t work then we are likely looking at another major surgical repair. We’ve been told there is about a 50% chance that the dilations will work – which means there’s also a 50% chance that they won’t. (Hey look, I did math!) To me these are not good numbers. I do not like them, Sam I am. (Seriously. Smile and nod. Very little sleep over the past few days.) It’s particularly disconcerting because we’re told the procedure they would recommend if they have to repair the esophagus only has about a 50% chance of success itself. More unpleasant numbers!

So yes – we came home Saturday after a shorter-than-anticipated stay at the Ronald McDonald House and PICU. We don’t love being at the hospital, but since we had to be there, it was really nice to see friendly and familiar faces. Leah had lots of visits from her PICU nursie buddies and other PICU folks, and in the cafeteria on Friday morning I ran into a family we knew from NICU last summer. Their little girl had surgery on Friday and it sounds like it went well, so yay. We saw some familiar faces at Ronald McDonald House, too, although we didn’t get to see everybody.

We left Ronald McDonald House around 9:30AM on Saturday, aided by our dear friend J, who came to our rescue and helped us shlep 7 days’ worth of packed suitcases back to our house. Had we known we would only be there for three nights we could have packed a heck of a lot less!!! But it’s okay – I’m just glad we got home early. Leah was in surprisingly good spirits for the rest of the day. You could tell that she was uncomfortable, but we were able to hold her, and she took a nice long nap in her Gran’s arms. We gave her a little sponge bath, washed her hair, and even let her sit in her special high chair at the dinner table. She had her moments of owie-ness, but overall she had a pretty good day, and continued to improve a little bit each day. She was a tiny, tiny bit wheezy as well, and although it has improved, it’s still a little worse than usual.

I wrote the first draft of this blog a few days ago. Since then, we’ve had a bit of an adventure. Leah has been hiccuping and gagging more than usual all week. I have been communicating with her surgical NP to keep her apprised of Leah’s status, but it seems those symptoms are not too abnormal considering that she just had surgery on her diaphragm. However, on Monday and Tuesday Leah started spitting up a little bit, and on Tuesday morning she had spit-up on her face and outfit when we woke up. Later in the day she spiked a little bit of a fever – it was up to about 100.6 when we gave her Tylenol around 2:15PM, and went up to 100.9 before starting to come back down. Not too terrible, I know, but considering the recent surgery and the even more recent spit-ups, we decided we might as well have her checked out. I had mentioned the fever to her NP and asked when we should bring her in to see her primary care doc, and once she knew Leah had a fever she said now would be a good time to check in with primary care. We made an appointment for Wednesday afternoon, but when Leah would not calm down and her fever started going up instead of down, we decided we wouldn’t wait and would just bring her in to urgent care. We left the house around 3:30 or so, and got to urgent care a little over an hour later. They made an appointment for her at 5PM, the first appointment available for after-hours urgent care.

During her appointment we got to have the fun new experience of introducing Leah to a doctor who was not at all familiar with her history. The conversation started with, “What are the little stickers on her cheeks?” and ended 11 months later with a referral to radiology for a chest x-ray to check for potential aspiration. We trekked down to the next block for her x-ray and then trekked back to await results. The doc came in a while later and told us the radiologist had seen something small and subtle on the x-ray and they wanted to run it by surgery – they took her off of feeding at that point in case she was aspirating due to reflux. Her last feed had ended around 4:30 or 5 and by now it was 6:30 and she was starting to get hungry, but he advised that we wait until we heard from surgery. He observed that everyone he talked to seemed to be very familiar with Leah. Yep. She goes way back with these folks. Maybe half an hour later he said surgery wanted to examine her, which meant we had to walk across the street and bring Leah to the emergency room, since that’s the means by which a person can see surgery after their clinic hours. Thus began the second half of our BabyBug 11-Month-Birthday Adventure. I think we all know that 90% of the time in the ER is spent waiting, waiting, waiting. So here’s how the evening went:

Wait.

Speak with surgical resident, who IS, thankfully, quite familiar with Leah’s case. (Not that there was anything wrong with the doctor we saw at the peds clinic – he was very nice. It’s just a lot easier working with docs who know Leah’s history since it requires so much explanation.) He had not had a chance to review the x-ray results but wanted to examine her. She sounded fine. Yay.

Wait. Wait. Wait.

Surgical resident comes back with the ER doc on duty and tells us that radiology’s interpretation of the x-ray was possible aspiration, possible atelectasis (in which the lungs don’t open all the way). It is a pretty common complication after intubation, although they see it mostly in adults. They don’t want to resume feeds until they have a chance to speak with the attending.

Wait.

Get frustrated over neighbor’s IV, which beeps for 10 minutes. The staff do not seem to notice. Someone finally turns it off. I thank him. Several minutes later it starts beeping again. *facepalm*

Wait.

Meet our cool nurse with shiny butterfly earrings. Surgery wants her to draw blood for a CBC but she thinks maybe an IV might be better just in case they decide to admit her. I tell her Leah’s veins pose a challenge. She goes to find the charge nurse, who is reportedly excellent at placing IVs.

Wait.

A guy comes in and says he’s going to get the same charge nurse.

Wait.

At some point, yet another guy comes in, sees that the baby is sleeping, and leaves.

Wait.

The nurse returns. Apparently guy #2, who didn’t identify himself, was the charge nurse but didn’t want to place the IV because the baby is sleeping. HELLO. PLACE THE IV. We have been waiting an hour for this lab. The sooner she gets blood drawn, the sooner we can leave.

Wait.

Attempt to shield my sleeping baby’s ears from the barrage of profanities that streams from a room down the hall, where a patient has decided he prefers the previous nurse and would like the current nurse to leave. It’s not the ER if there isn’t a screaming patient in another room and what appears to be a homeless guy sleeping it off on a gurney down the hall. Said homeless guy is the one with the beeping IV. The evening is complete.

Wait.

Nursie with shiny butterfly earrings (Leah is a big fan of these) gives up on the idea of an IV and draws blood herself. Baby has a history of poor bleeding from heel pricks so she draws from the fingers instead. It takes so long to get enough blood that the blood clots before it reaches the lab. Lab sends it back. They have to draw again. This time they get it from the heel. Now we know – her heel gives blood again. Woo.

Wait.

Wait.

Wait some more.

Surgery was in the OR but they finally come down and tell us the labs are good and we can go home, but we should space out her feeds to prevent aspiration, and watch for any more fever or vomiting. We can resume feeds. He goes out to prepare discharge papers.

Wait.

Someone comes into our room. Ready? Nope – he just wants something from the cabinet.

Someone else comes into our room. Now? Nope – she wants something from the cabinet too. Suddenly our room is very popular. Someone else starts to come into our room but changes her mind.

FINALLY, we get our discharge papers and leave. It’s close to midnight.

Soooooo. That’s how we spent Leah’s 11-month birthday – with an 8.5-hour trip to the hospital. I’m glad that they didn’t keep her overnight, but it was still a very exhausting day. It sounds like they do think she’s experiencing atelectasis, and they said it is something that should self-resolve over time. Leah did pretty well yesterday, but today she had a projectile vomiting episode in the morning. The previous episodes had been just regular baby spit-up, but this was full-on spewing of her feed. My only consolation is that maybe, possibly, perhaps this means the esophagus is still open. Please?

I know I already posted this on Facebook, but I just want to say that we are SO grateful to all of you for your sweet messages, comments, thoughts, prayers and encouragement this past week (this past year, really, but you know what I mean). It’s not easy to see that beautiful, sweet, tiny face all scrunched up in pain. It really does help us to know that people are thinking about her and sending positive energy in her direction.

In thanks, I shall shower you with photos. Behold, photos!

<3

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“Yeah? You got a problem?”

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This is the face of a sleepy Bug.

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A few minutes later…

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Our little rock star at therapy! I wish they still made this toy – the one they make now has different songs and they aren’t as fun.

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“Just a baby eating her toes. Nothing to see here, people. Move it along.”

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Selfie time! Duck face for Aunti Staci, sparrow face for cousin Anya.

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The sweetest baby I ever did see. Also… eyelashes.

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Watching Cool Auntie Erin’s band practice. Or, you know… sleeping through Cool Auntie Erin’s band practice.

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And to think, mornings used to have no redeeming qualities.

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Somehow the baby grew a cat nose and whiskers.

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“Timber!”

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A brief moment of interest…

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…followed by a competition for Mommy’s attention.

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Oh great – now everybody has to get involved.

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Family selfies! “Mommy, you are SO WEIRD.”

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“Mommy, where did your tongue go???”

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“You see what I put up with? These two…”

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Reading the book that somebody bought from LeahBug’s wishlist. There was no name on the packing slip, so if you’re reading this, THANK YOU!

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It’s a no-dresses day! Time for our friend B’s birthday party.

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BabyBug chilling with Auntie Faithie.

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Tuning out the party.

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A day at the park means we wear a hat! Leah says: “HAT. DO NOT WANT.”

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“Are you kidding me with this thing?”

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“MOMMY! WHAT DID YOU DO TO TIGGER? Don’t worry Tigger! I’ll save you!”

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Raspberries

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Happy Bug

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She’s just too cute.

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That smile!

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BabyBug Beak. She has been making this silly face since her NICU days.

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A screenshot of my very favorite moment from the swinging video. That is pure baby joy!

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Wheeeee!

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MamaBug and BabyBug

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MamaBug’s nails provided entertainment for the whole ride to RMH. Good times.

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“They’re doing WHAT to my diaphragm tomorrow?”

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“Is there any chance I can talk them out of this?”

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“Oh well. Let’s play!”

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Silly baby

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SuperBug all ready to fly off to surgery. This picture brought us incredible support during Leah’s surgery. The Special Miracles – Down Syndrome page shared her photo and roughly 18,500 people liked it on their page. A little over 800 people shared it on their own walls. Another 13,700 saw the picture through Leah’s Facebook page. The Butterfly Fund, the org that so generously shared Leah’s wishlist, also posted it and over 600 people liked it. This means that at minimum, almost 33,000 people saw the photo, not counting the friends of the folks who shared it. It received well over 1,000 comments wishing Leah good luck and sending her positive thoughts and prayers. These numbers just completely blew us away. We’re grateful for the continued support of our family, friends and community, and also amazed at how many people cared enough to take a moment out of their day to send good wishes to a baby they don’t even know. The constant flow of positive energy really kept me sane during Leah’s surgery and later when she was sleeping off the pain. I know she felt it too.

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Mom’s Superhero!

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This cape was made especially for LeahBug by Tiny Superheroes and was sponsored by one of Leah’s friends on Facebook who also has chronic health problems. Leah is definitely a tiny superhero!

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Several friends and family members sent us sweet pictures of themselves in their Team LeahBug shirts on Thursday. Pretty sure little Josie’s was the cutest one. :-)

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Auntie Z’s little boy Ry Ry made this special gift for LeahBug in day care!

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LeahBug does love her toes.

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Just a girl and her GloWorm.

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Puckering up. She’s been doing this a lot lately. I think it’s because I make this face at her so often.

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We have everything we need – Binkeez, GloWorm and toes. Armed and ready for surgery!

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Leah was VERY fussy and uncomfortable after the procedure, but after a while she finally fell asleep. Poor bunny. They told me to try holding her but I felt like that made things worse after a few minutes, so I put her back and let her rest in bed.

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Gran and Bug

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Always with the wires!

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Saturday morning, after a night of morphine and sleep.

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Leaving PICU at last! Bugs for dinner!

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Toes. I love it when her tiny feet just randomly poke out of the stroller.

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Do we look cool or what? They let us take her home in the gown so she wouldn’t have to have tight clothes against her sutures. We added some flair.

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Uncomfy, but managing a smile for Mama nonetheless. Our little superhero.

Popping in for a quick update

Good afternoon, everyone! Shabbat Shalom! I just had to say hello and be grateful for a moment. The Butterfly Fund recently posted LeahBug’s Amazon wishlist, and several people we’ve never met have sent Leah gifts, including some new diapers and covers (because she’s outgrowing the old ones), a sweet outfit, a toy, some books, and medical supplies – AND somebody sent her the ARK Z-vibe, a therapy tool aimed at oral stimulation to help with speech and feeding. We are super-psyched to start working with this as it comes highly recommended by other parents of children with Down Syndrome. Just need to do some reading first as there are specific exercises that help with particular issues.

This past week has been a reminder of how truly awesome people are. Not that we needed a reminder – we are grateful every day for your support and generosity and it continues to amaze us.

<3

So many photos! So very many!

Whew! How did I manage to go so long without blogging? Here is what has been going on in LeahLand:

-Leah had a dilation last week and made a little friend in the hospital. A little girl (maybe 6 or 7?) had been staring at LeahBug in the waiting room, and she was called in a while before we were. When we went in, we could hear her crying that she wanted to leave and go home. I wanted to bring Leah down to her little “cubicle” to say hello, but I didn’t want to bother them. Gran, being more gregarious than Mama Lisa, brought LeahBug down and introduced her. The little girl perked right up, and asked about the baby, and we didn’t her her cry again after that. We waved at her and she waved back as they rolled her off for surgery, and we saw her being wheeled out afterward to go home and her mom said she had asked how the little baby was doing. :-) Very glad our sweet Bug was able to bring a little sunshine to another little girl’s otherwise yucky day.

-We celebrated our first World Down Syndrome Day as mommies with our friends Jess, Toni and Wesley. Wesley is 20 years old and has Down Syndrome, and he just graduated from a cool program at UCLA for students with developmental disabilities. What a great model for our little BabyBruin! Mama Jess made a beautiful Shabbat dinner and Wesley held Leah for the first time! Pics below.

-Leah will not be having a Nissen fundoplication next week after all. They will be repairing her diaphragmatic hernia and putting her little colon back where it belongs. I do think that is causing her some discomfort, and it seems to be affecting her little poops too – usually she has one every day but lately it’s been every few days. Regarding the fundoplication, there is some speculation that the reflux may not be the primary cause of the stubborn stricture, and a Nissen is a huge step to take if there’s a pretty good chance it won’t work. Instead, they will continue with the dilations for a few more months, and if they don’t work then we may be looking at a surgical fix; it’s possible that the scar tissue is just too severe to be repaired. That is the main reason they aren’t doing the Nissen – if Leah needs another surgery to deal with the stricture, they need to preserve as much of the esophagus as possible, and a Nissen would create more scar tissue and damage to the area and would give them less native esophagus to work with. So they will hold off on that procedure for now.

-Leah had an echocardiogram and the cardiologist still feels confident that Leah does not need heart surgery right now. Again, the jury is still out on whether she will need it later down the line (like, in a couple of years) – she does have the increased blood flow to the lungs, and the VSD has not improved. But he doesn’t feel that immediate intervention is indicated.

-LeahBug had her very first play date with a couple of other babies who live within our general area and also have Down Syndrome! They have to be the region’s three cutest babies. I’m pretty sure of it. Pics below.

So, that’s what’s what! Let’s break out the pictures!

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Out cold

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Ladybug Toes! It’s so much easier to polish toenails when the baby is asleep!

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Going on a trip!

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We took Leah to the pier to see her first sunset for her 10-month birthday. This is her looking very excited to see the ocean for the first time.

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The beach is so pretty!

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Mama and Mommy love a nice ocean sunset!

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Mommy and Buggy and sunset (oh my)

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Leah woke up in time to see all the pretty colors

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Mama and Bug

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The Monkey Queen

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Faithy’s birthday!

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More monkeys!

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Sweet monkey

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Silly monkey

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Goofy monkey

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Working hard in PT

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Play date with BFF once-removed, Ry Ry (see how big he’s gotten????). He’s giving Leah some sort of turtle sticker.

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Staring at the Team LeahBug ladybug on Ry Ry’s t-shirt. She loves that ladybug.

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Ry Ry’s sweet face!

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Ry Ry teaches LeahBug how to play after bath time.

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Sleepy Bug

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Just because. Can’t handle the cute.

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Baby staring wistfully at Gran’s soup. She’s started making wishful noms when she sees us eating. See below, for example:

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The eagle has landed! We have a thumb in the mouth!

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Poor cheekies! Heal, cheekies, heal! We tried the hat, but we wound up having to use tape anyway, so we’re back to the Tender Grips. We’re trying to keep them a little higher up on her cheeks.

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Dilation day! Sweet Buggy having a nap with Mr. Glow Worm.

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I told her to smile for Aunti Staci.

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Ladybug toes under the bright hospital lights.

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Our little acrobat – she was half-drugged and still trying to grab that red foot.

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“MOMMY!”

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Well, here we are again! They kept Leah overnight for observation because of her breathing, and wound up discovering by accident that she has a diaphragmatic hernia. Good times.

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Mr. Monkey knows this hospital well!

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We got out of the hospital on March 14. It was Pi Day. After a long and difficult day of waiting with a hungry baby, we felt we deserved to celebrate Pi Day with pie. Well. Really, it was Leah who deserved pie. Someday we’ll be able to give her pie!

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Home sweet home for this silly bug!

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We were so cheerful the next morning!

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Can you handle the cute?

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Mama Baby Selfies!

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Raspberry in progress! Grab the umbrella!

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Fingers for breakfast!

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Later that day… we went to meet with Sue of Binkeez For Comfort, who sent Leah the sweet polka-dotted blanket you always see with Leah when she goes to the hospital. Recently they made a special lovebug Binkeez in honor of Leah (pictured above), and we will be delivering some to the children in the PICU just as soon as the blankets arrive. Sue delivered Leah’s special Binkeez by hand as she was already in Los Angeles to visit Children’s Hospital LA for another special delivery. Leah loves to stare at the cute bugs on this special blanket! Thank you, Binkeez! Sue took this sweet picture when we met her at the hospital. Then we had a nice visit – we went to get frozen yogurt, and then we drove Sue back to her hotel via the “scenic route” (i.e. Hollyweird Blvd!). Such a fun day!

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Posing with Sue – but mostly trying to grab her hair. And maybe her glasses too. <3

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We went to an event for Mandy’s work and there were lots of people there. You do what you gotta do, right?

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I know there are millions of pictures of this kid asleep in her car seat, but isn’t she just so sweet? I can’t help it.

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The next day, Leah celebrated her very first Purim! It is customary for children to dress up as the characters in the story, so Leah dressed up as Queen Esther. Cabbage Patch Queen Esther.

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She was in a much better mood than she was the last time she wore this dress… it fits her a heck of a lot better, too!

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Serious Queen Esther

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Grandpa Bill came over to visit and to bring us hamentashn from the best Jewish bakery in the Valley, because he is SO COOL like that. We decided to surprise him with little Queen Esther.

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“HOP! MAYNE HAMENTASHN!”

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Grandpa Bill saved BabyBug from the sillyprecious hat, but Mama insisted on one last picture with the sillypretty flower. I can just see the “SIGH. MOM.” on her face.

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“Mama says I can’t put my hands in Grandpa Bill’s beard anymore? Fine then! I’ll just pull it with my toes!”

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Gran and BabyBug stirring up trouble in the cafeteria!

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“Gran, I have a foot!”

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“Whatup, Gran?”

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Sweet girl!

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Silly time at speech therapy

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“What is it?” Leah’s speech therapist suggested that we try a sippy cup for tiny tastes since she doesn’t seem to do that well with the bottle.

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“Huh. Okay. I can try that.”

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“Uh…” It was a little bit too much for her, but it was fun while it lasted!

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Big appointment day!

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“Oh, don’t stick out my tongue? Don’t stick it out like this?”

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Leah was pretty tired when she got home from the hospital after a long day of appointments. She just wanted to relax on the couch…

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Mommy has been giving LeahBug tiny non-nutritive tastes. She even let her lick an orange slice.

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“OH, I LIKE THAT! MORE PLEASE!”

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Little Purple Riding Hood

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Baby Burrito!

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“Look, Mama, I’m a baby! I need some therapy!” (At which point Mama immediately broke out the disinfectant.)

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“Well, this is new! Thanks for the cool chair, Gran!”

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FaceTime with 94-year-old Great-Grandpa and Aunti Staci! Ain’t technology grand?

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We play hard and then we sleep hard.

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And here we are again! Another dilation day.

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Eating our Binkeez for breakfast.

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Our first World Down Syndrome Day! Break out the funky socks! Not quite sure how that started, but we’ll play along!

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Mama feet and Babyfeets

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We celebrated our first World Down Syndrome Day with Jess, Toni and Wesley! Leah and Wesley had lots to talk about.

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“Cheeeeeeese!”

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Jess and LeahBug!

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Jess and LeahBug and Mommy!

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Nakie Baby getting ready for bed!

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“Five more minutes!”

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Leah had enough dresses for one week – time for some overalls!

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Nummy fingers!

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Fingers are the best breakfast.

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“Well hello there, strange and interesting creature!”

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Our first play date with a baby around our own age (well, a couple of months younger)! And she also happens to have Down Syndrome! Neato, huh?

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“Listen, kid, I’m old and experienced, so let me tell you how the world works…”

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“But before I tell you how the world works… could you please tell me how you sit up so well?”

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Tiny feet x 2!

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“Fingers, fingers are delicious. You understand?”

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Baby A showed LeahBug how the whole head-holding-up thing is done.

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Along came Baby D! It’s a baby party!

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“There’s another baby? There are three babies in the world? I’m learning all sorts of new things today!”

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Baby party: Birdseye view

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Leah was the first to fall asleep, but the kids were nice at this party and nobody played any tricks on her.

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Later, we went for a play date with Great-Grandpa!

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Yay Great-Grandpa!

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We love Aunti Staci, even though she has a funky scorpion painted on her arm. What’s up with that, Aunti Staci?

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LeahBug finally got to meet our dear family friend Andi. Happy birthday, Andi!

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Aunti Staci’s brilliant idea! Dress-up!

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Somehow this makes me think of vaudeville.

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Pokey tongue!

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Besties!

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Sweet face with antennae.

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Smiles!

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“CHEEEEEESE!”

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The world’s tiniest cat burglar?

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More dress-up!

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We LOVE dress-up! Sometimes.

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Baby Bug and Baby Sister (Mama’s)

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Sweet smile

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Sleepin’ on Grandpa Bill.

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Snuggling with Great-Great-Auntie Joan for the first time!

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“I love Great-Great-Auntie Joan!”

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“GGAJ, tell me a story!”

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I couldn’t resist. This is our roommate’s doing. We asked her if she’d mind putting away a ball of yarn that Mandy left out so we wouldn’t find him knitted into it. She told us we were too late.

Medical update

Things have been pretty hectic around here, so I’ve fallen behind on pictures. I’m working on a photoblast, I promise!

Just a quick “diary” paragraph and then I promise I’ll get to what you’re really waiting for: the surgeon’s update.

On Leah’s 10-month birthday (March 8), we took her to the pier so she could see her first sunset. She slept through it, of course, but she did wake up in time to see all the pretty colors, and it was her first time seeing the ocean, so that’s pretty cool. That day I also painted her little toenails like ladybugs while she was sleeping. I’ve gotta have my fun, too! The following day we went out to dinner with our dear friend Faith and her family and some friends for her birthday, and LeahBug met her little friends Storm, Cady and Iris for the first time. Miss Cady brought Leah a little ladybug finger puppet. Very sweet. This past week we also visited a bit with Leah’s buddy Ry Ry, his mama Auntie Z (Mama’s BFF), and his dad “Bob.” (Not really, but I couldn’t resist). In the waiting room at OT the other day, we ran into one of Leah’s old NICU roommates and her mommy. I don’t think Leah’s seen so many other kids since she was in NICU! In other news, Leah’s g-tube popped out twice (uneventfully, thankfully), and she continues to make wishful noms when she watches us eat. So sad and yet so cute. And finally, LeahBug experienced (read: slept through) her second earthquake. This one was a bit larger than the last one she didn’t feel; the last one was around 3.0 or so and was in the middle of the day, and this was a 4.4 magnitude rocker at 6:25 AM. Sooner or later she will actually notice an earthquake, but I’m in no rush for a quake large enough to register with her!!

If any of that didn’t make sense, you can blame it on the fact that I was up at 6:25AM looking up the magnitude of the earthquake that woke me up.

Okay – now, what you’ve been waiting for. Yes, Leah is going to have another surgery. She will continue weekly dilations on March 20 and 27, and will go in April 3 for a Nissen fundoplication and a hernia repair.

As it turns out, it appears Leah actually has two hernias: a paraesophageal hiatal hernia (likely a result of her initial esophageal repair), and a Morgagni hernia, a type of congenital diaphragmatic hernia (CDH) that makes up about 2% of all CDH cases (which themselves occur in less than 5 out of every 10,000 births). In this case it’s a lucky thing that Leah has the more rare form. In many cases, congenital diaphragmatic hernias create problems with fetal development, as the intruding organs in the chest cavity can impede lung growth. Overall, CDH has a mortality rate of about 40-62% of live births, the primary reason being that the lungs have not been permitted to develop fully due to the presence of other organs in the chest cavity. So we are very grateful that Leah’s CDH is the type that has a better prognosis.

Nonetheless… it needs to be repaired. I mean… the kid has a loop of colon in her chest cavity. Really.

The big concern right now is Leah’s acid reflux, which appears to be the cause of much of the scar tissue in the esophagus. Leah’s surgeon wants to avoid having to redo the esophageal repair; he said if it didn’t work the first time, that doesn’t bode well for a second repair. He feels that a Nissen fundoplication is the best way to keep her reflux at bay. (Here is a longer and more technical article.) It’s always been on the table as a future option – I just kind of thought the future would be a little bit further down the line. But here it is.

Leah also saw her cardiologist today and he remains confident that Leah does not need heart surgery in the immediate future. He says the jury is still out on whether she will need it in a couple of years. She does have increased blood flow to the lungs, and the VSD has not decreased in size – but it hasn’t increased either. If it doesn’t improve then Leah will need heart surgery eventually. Let’s hope her heart patches itself up! Go BabyBug Heart!

Pictures soon, I promise!

Thirty Eight Hours…

When we arrived at the hospital at 6:45AM yesterday (Thursday), we expected to be home around 2PM. It’s now 8:47PM on Friday night and we are awaiting discharge from Peds.

Leah’s procedure took a bit longer yesterday – I think she was in the OR almost 2 hours or so – because they injected steroids into her esophagus to help with the inflammation and scarring, in the hope that it would keep the stricture from continuing to tighten. Prior to the procedure, Leah’s temp was a TINY bit high (98.8) and she sounded a TINY bit junky, but since she hasn’t been sick, we went ahead with the procedure.

Afterward, Leah was super-fussy, as usual, but this time they wouldn’t let us feed her until she was transferred from the recovery area to the discharge area. When she arrived at the discharge area she was feeling a little bit warm and her temp was about 100.3. They were getting ready to discharge us when I noticed that she seemed to be retracting a little bit – using her abdominal muscles to breathe. They called the anesthesiologist over to look at her and he suggested that she might be agitated from being hungry, so we could try feeding her and seeing if that helped with her breathing. She was also sounding a little junky (in her lungs), and was having a tiny bit of wheezing on exhalation (I wouldn’t call it stridor but it was going in that direction). We fed her and tilted her neck up at the doctor’s suggestion, and that seemed to help with the retractions, but after a while they started again, and her fever went up to 100.6 (don’t worry – that’s as high as it got). After a long chunk of time had passed, she was still pulling a bit to breathe and still sounding a little icky and still had the mild fever, so with all of those little things plus the fact of this being the first steroidal injection, they decided to keep her overnight for observation and also to do a chest x-ray to see if aspiration was causing the “junky” sounds from her lungs.

Well. The peds unit was short on rooms at the time, so Leah wound up having her chest x-ray in the discharge area. We spent a good several hours in the discharge area waiting for a room to open up on “the floor” (as they call Peds). While we were waiting, Leah’s GI doctor came by to discuss the x-ray results with us. Her lungs looked fine, but the radiologist had seen something suspicious in the upper GI area and wanted to run another x-ray in case it was just a poor film. So we waited another couple of hours, and they took the second x-ray just before they brought her up to Peds. For reference’s sake, Leah’s surgery was at 8:30AM, she got out about 10:45AM or so, and Leah was rolled up to Peds at around 5PM. We did a lot of waiting yesterday!

We had a pretty mellow evening and got to see some familiar faces; Leah’s RT had treated her many times in PICU, and her overnight nurse had also cared for her several times. It wasn’t a bad night. They stopped Leah’s feed at 4AM, with the plan being to run a contrast study some time around or shortly after 10:00AM to determine what was going on in Leah’s chest – the second x-ray was not particularly helpful in determining whether something was wrong.

Well. 10:00AM turned into 1:30PM, which turned into 2:30PM, which turned into 3PM. I went to radiology with Leah and kept her entertained during the breaks; they had her ingest contrast, so they had to take breaks to give the dye time to move through her bowels. For most of the study they didn’t see anything wrong, but in the very last “take,” they finally saw what they had been looking for. Leah has a diaphragmatic hernia, which means that a segment of her bowel is poking through her diaphragm.

That’s about all I can tell you right now. We have many questions, particularly because this is usually a congenital defect that is detected either prenatally or immediately after birth when the newborn goes into respiratory distress. It is also possible that this is an acquired diaphragmatic hernia caused by trauma to the area, e.g. abdominal surgery (because yeah, that happened!). We really have no answers right now beyond the diagnosis. They are sending us home tonight since Leah is stable and relatively asymptomatic, and we will see Leah’s surgeon in the clinic on Monday to discuss plans going forward. The repair is surgical, and the big question is whether they do the repair now or wait.

So. Now, we go home!

A quick update

Sorry it’s been so long – busy week! Quick update – Leah had another dilation tomorrow (Thursday), and they will inject a steroid into her esophagus to help ease the inflammation and keep the stricture from tightening after dilations. They will keep her on the weekly schedule for the time being.

We also had an interesting discovery in speech therapy today – Leah has not been turning when she hears sounds and voices, but there seems to be a difference depending on what side the noise is on. She turned to investigate a rattle shaken on her right side even while she completely ignored it when it was on the left. In PICU all the bells and alarms were on the left – and the left side is also the side the ENT could not see. So we still don’t know what is going on, but it is something.

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Trying a little something new with the cannula… We will see how it goes!

BabyBug Updates and a Photoblast

So! Some medical updates for you:

-I mentioned in an earlier post that Leah has mild obstructive sleep apnea. The ENT reminded me that she also has some central apnea, which occurs when the brain simply doesn’t send adequate signals to breathe. Treatment remains the same, but I want to make sure I’m being accurate since I’m sure I’ll use this blog for reference later on.

-Speaking of the ENT, Leah had a miserable appointment the other day. She had to get her little ears scraped out because she had a lot of wax, and she had her little nose scoped. NO FUN. I know it was much worse for her, but I’m not gonna lie – it was pretty freaking awful having to hold her still while she screamed and sobbed uncontrollably on my lap. They don’t have an exam table in there, so I had to hold her still (with the help of one of the nurses). Her little tears were rolling all the way down to her neck. Poor Bunny. She is due for an audiology test later this month; we’ve had some concerns about her hearing since she is still not responding to noises from sources outside her direct light of sight. I still think it’s more an issue of attentiveness since she was in the ICU for so long and it’s possible she has learned to tune things out, but at the same time it’s important to rule out hearing issues since many kids with Down Syndrome do have ear problems. And you could probably hit a gong behind this kid and she wouldn’t turn around to see what’s up. The doc was only able to see into one ear canal (although this is the first time ANYBODY has been able to see anything at all), and she said Leah’s eardrum activity looks good and she didn’t see fluid. No word on the other ear. Too itty-bitty!

-Our little chunky monkey hit 13.5 lbs today!

-The big update: Leah had a dilation today, and while the last dilation took her esophagus from 9mm to 10mm, this procedure had the doctor re-dilating her from below 5mm back up to 8mm. He doesn’t know exactly how narrow it was, but he knows it was less than 5mm because he couldn’t get the scope through. So we’re essentially back to square one. Her next procedure is scheduled for next Thursday, but the surgeons and the GI will need to confer and decide what they want to do next, because there is not much sense in continuing to do regular dilations if the stricture is just going to tighten again. The GI discussed perhaps injecting steroids into the stricture, but apparently this requires special equipment that may or may not be available at this hospital, particularly before next week. He also discussed the possibility of the surgeons needing to operate on the esophagus again, as well as the potential for a fundoplication, a surgical procedure that curbs reflux. The fundoplication has always been on the table as a possible necessity in the future – it just seems like maybe the future has arrived a little sooner than we thought. But I don’t want to jump the gun – the surgeons and the GI haven’t yet conferred, so all I can do is speculate.

And on that note… smile! It’s picture time!

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Partners in crime.

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“Aunti Staci, you are the master of selfies!”

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Quality Aunti/Buggy time.

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We love toys that make funny sounds.

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Combining new skills (holding) with old ones (nomming).

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Evolution of a raspberry.

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Mommyfingers are the best.

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Glow Seahorse has lost his batteries (due to a refusal by Fisher Price to issue a recall for spontaneously-combusting seahorses), but Buggy doesn’t seem to mind.

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They are still best buds. As long as she can still eat his nose, she’s happy.

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Goofy!

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Grandpa Bill brought his face-toy!

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“Grandpa Bill, I have a tongue! Nyah.”

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“I wonder if I can touch my tongue to my nose! First I have to find my nose!”

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Little troublemaker!

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She gets it for a few seconds at a time, but it’s something!

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Same with tummy time and neck support!

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Oh. Okay. Caption, please.

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“Are you for real with this outfit?”

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Precious innocent babyface.

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Practicing the “whatever” face for her teenage years.

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Cabbage Patch Baby nose.

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Oh, this face!

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Bugs Bunny with Cool Auntie Erin.

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Deep in conversation with Mr. LionBug.

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This faaaaaaace.

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“Cheeeeeese!”

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Look at those little arm rolls!!

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“It’s the funniest thing, Mama – somebody is pulling my hair!”

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“Is it possible for me to be any cuter? What do you think?”

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Yes. Yes, LeahBug. It is.

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A serious moment with Uncle Ralph.

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A less-serious moment with Uncle Ralph.

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More tummy time.

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Our hardworking little LadyBug.

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“Work or noms? Work or noms? I’ll take noms, please.”

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The physical therapist didn’t give her a choice. Work. No noms. So she raspberried instead. THE WHOLE TIME.

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There were, of course, a few moments when she just made silly faces.

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Silly baby, silly grandpa.

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Like Grandpa, like Mama, like BabyBug. All silly.

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That’s a troublemaker face. Oh yes. That’s an “I pulled off my cannula” face right there.

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“FEED ME KRELBOURNE, FEED ME NOW!”

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“Hmm. Mamafingers. Those could be breakfast.”

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Lion feet might be easier to chew.

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This is a disgruntled post-procedure baby. “Mama. Why must you make me wait to eat?” Sorry, Buggy! The nursie made me!

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Sleeping with a handful of cables. Some things just don’t change.

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“Well hello, Uncle Ralph!”

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“Uncle Ralph… what happened to your face toy?”

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Fun with the camera!

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No caption necessary.

I believe I said Nakie Baby can’t be trusted?

Apparently, neither can Clothed Baby.

Our little ladybug had an adventure today! Gran was with BabyBug because Mama had an appointment. Not half an hour after Mama left, Mama (that’s me, in case you weren’t sure) received a phone call from Gran. “Lisa! Emergency! Leah pulled out her g-tube! What do I do?” Oh, BabyBug. This makes the first time she has actually physically pulled it out herself as opposed to it getting stuck on something – and it has been a very long time since that happened. Definitely the first occurrence of 2014. Leah’s surgical nurse practitioner was kind enough to see her on short notice, so Gran and BabyBug took a little field trip. Good times.

In other news, Leah had speech therapy the other day, and the cutest little 4-year-old girl became totally enamored with her in the waiting room. So they came over to sit by us, and the other mommy and I chatted while the kiddo giggled nonstop at how funny and cute our little bug is. And for Leah’s part, she did not take her eyes off of this little girl the whole time we were chatting. She was fascinated. I’m pretty sure she was trying to figure out whether this was a very large baby or a very tiny grown-up. She hasn’t spent a lot of time around other kiddos. It was pretty adorable.

During our visit, Leah’s speech pathologist assessed her for non-swallowing speech services and found that she does qualify for speech therapy, so she is going to set some goals. Leah is so expressive that I think sometimes people don’t see her receptive language issues until we really point them out (which is funny, because from what I’ve been reading, in older kids with T21, it’s usually the other way around!). She doesn’t respond to sounds by looking for them or even responding to them, at least not until the source gets into her line of sight. I don’t think it is her hearing, though of course I could be wrong. She will be assessed again in the near future, I’m sure. I think that she learned to tune things out during her nearly 7 months in ICU, and now needs to be taught how to attend to sounds that are important. When Mandy came home the other day, she talked to Leah from the other room before she came into the living room, and Leah had no reaction – until she saw her Mommy, and then she was pleased as punch. Hopefully this is something we can work on.

I can’t remember if I already posted this, but at Leah’s GI appointment, the doc said he could feel her liver. He is going to run some tests next week when they do the next dilation, but didn’t seem too concerned.

Oh, one more thing: we are TRYING to have Leah sleep in her own room tonight. This will be a first. Wish us luck. I think it’s harder on us than it is on her.