What we do when we’re not in the hospital

I’m almost afraid I’ll jinx us by writing this post. Patrick finished his course of antibiotics and antifungals a week ago. So far, so good. We’ve been settling into life at home in this break that the super anti-infection medications have given us.

Patrick seems to be on a mission to make up for all of the time and opportunity his illness have caused him. So, I’m doing all I can to support him and help him to be successful in doing this. Last fall, he couldn’t roll over. Now he’s crawling, climbing stairs, and cruising along furniture. Because he’s in such a focused, productive period of development right now, we’ve called in the troops to help him to accomplish his goals.

He’s got 5 therapists right now, making for a total of about 10 therapy visits a month. We’re working on speech, motor skills, feeding, and more. It seems that every time we meet with one of these experts, Patrick learns some new and amazing skill from the visit. After a little bit of reinforcement at home, he’s doing things that had previously seemed impossible, or at least a long, long way off.

Of course, a more active, mobile, and as one physical therapist describes him “impulsive” Patrick requires much more supervision. He breaks a little connector piece in his IV tubing a minimum of 3 times a week. And a backpack on wheels is not capable of following him up the stairs. We have many more bumps and bruises than we used to have. Patrick’s a big braver sometimes than his skills can allow for and I don’t think it would be a normal day without him falling and bonking his head on something. But, as tired as I am from chasing all the time, I wouldn’t have it any other way.

Last week we made a change in his IV therapy. Once a day now, he gets a one hour “break” from his TPN. No tubes. No pumps. I just disconnect him, put up the baby gates, and let him go. He plays and plays and then we reconnect the IV’s and the combination of activity and change in blood sugar knock him out completely. The only problem with this plan is that he’s taken to napping as late as 7 p.m.

Being at home with an easier medication regimen (just 2 oral meds and two nutritional supplements given morning and night) has actually given us time to do other things like cooking or playing and working in the yard or  taking care of the amazing friends who’ve taken such good care of us. I’ve had time to really dive into plans for the upcoming benefit concert (which sound more and more amazing by the day!) One of these days, I’ll even catch up on the ironing. (This is a little bit thwarted by the fact that Patrick really likes to stand holding onto the ironing board.)

It’s so nice to go to bed at the end of the day exhausted from a day of work around the house and playing with my little boy. It’s been a treat to be at home with my family and friends nearby. Things are good right now and we feel very, very blessed. It can’t be this way forever. Until Patrick’s transplant, there will always be another hospitalization around the corner. But we are grateful for this little moment of peace.

“Pennies for Patrick” – Edison Elementary

For the past month, Edison Elementary in Salt Lake has been doing a fundraising drive called “Pennies for Patrick.”

Today, they asked for Patrick and his family to come and be interviewed for their morning school news. What a treat this visit was! We got to meet the 5th grade class who’s been spearheading the fundraising efforts. (Pictured above).

I was amazed at how much they knew about Patrick already. And at how well thought out their questions were. They wanted to know about his TPN. (They knew it by name). And why he needed his nutrition to go to his heart instead of his belly.

Two kids took us to the faculty lounge where they did an interview that couldn’t have lasted more than 2 minutes. It was so well rehearsed, though, and very professional. When we told the kids that Brian had gone to school here years ago, they were pretty excited. But when the camera’s rolled, it was all business.

All of the kids were so excited to meet Patrick! Brian’s mom is the secretary at this school so some kids put 2 and 2 together when they saw her with him. We started to hear “Is that Patrick?” whispered as soon as we entered the halls. Soon, kids were chasing us down the halls to be able to meet him.

My favorite quote of the day was from a little hispanic girl who said, “I thought he was all white. But he looks a little brown.” In school where the “minority” population is the majority, it was nice that Patrick, with his Korean features, fit right in.

The generosity and kind-heartedness of these children is amazing! For weeks, they’ve been sneaking in before school to put money into donation boxes. One teacher lifted theirs today and struggled under the weight.

I met a girl who put together a yard sale all by herself to collect money for Patrick. She came to school with a jar full of cash she collected. She told me today, “I knew a little girl who was 8-months-old who was sick and my church helped her. When I heard about Patrick, I wanted to help. I like helping babies. I want to be a doctor when I grow up.”

Pennies for Patrick was scheduled to end last week. The school voted to extend it till the end of this month, though, because they were having such a good time.

My heart was so touched. I wanted to cry, but couldn’t wipe the smile off my face as we talked with all of these children. Edison is not in a wealthy neighborhood. Many of these families don’t have much themselves. But they are so proud to be giving to help our son.

Thank you Edison Elementary!

An excellent Seattle trip

Patrick had his quarterly appointment at Seattle Children’s on Thursday. And it was a very good trip in every way.

Because Patrick’s morning med schedule is so complicated right now, I opted to fly out on Wednesday afternoon. Our flight left at about 2 p.m. As usual, it took some effort to get through security and I probably looked insane hauling Patrick, his duffel sized diaper bag, two suitcases, a carseat, and of course, him in his stroller around the airport. But we made the flight without incident. In fact, we landed early and had time to visit and exchange blogs with a very nice woman from the same flight while we waited for our ride.

We stayed with my friend Lindy, her husband Kelly, and her little girl, Lauren. Lauren is 4 months younger than Patrick. They have always gotten along really well and it was fun to let the two of them play. Most of the play consisted of stealing each other’s toys and pacifiers.. but they did spend some time dancing to YouTube videos and there was more than one hug exchanged.

Patrick and Lindy

Thursday were the appointments. It was kind of strange to actually be seen in clinic. This is the first time since Patrick’s evaluation a year ago that we’ve done this visit in clinic instead of inpatient.

They did the usual set of vitals: weight, length, blood pressure. As we finished, another little boy about Patrick’s size came in to be weighed. He had a Broviac line and TPN in a backpack, too. I think this is the first time that I’ve ever met another kid on home TPN. It was kind of strange for me to see.

Our first visit was with Patrick’s dietician. She walked in and her first words were, “This weight looks spectacular! I had to come see if it could be correct!” She remembered meeting a tiny, frail, jaundiced baby last year. To be met by a happy, chunky, energetic (almost to a fault) toddler was a surprise.

She looked at Patrick’s TPN, his labs, and his growth charts. We talked about his current diet and in the end, she said that she was nothing but pleased with what she was seeing. She even said that it’s time to back off a bit on his feeds so that we don’t make him overweight.

It’s been recommended recently by some doctors to try continuous feeds again so I asked her her opinion of it. She told me that it’s pretty common for kids with anatomy similar to Patrick’s to stop continuous feeds after this long. She said that focusing on oral feeding so that Patrick would have an easier time learning to eat after his transplant was her preferred goal.

She also explained that some kids who’ve had problems with hypoglycemia when tiny can outgrow the problem and tolerate breaks from TPN. She watched Patrick attempt a few head dives off the bench we were sitting on and said that she thought it might be good for him to have some untethered time. This is something I’ll discuss more in depth with Patrick’s GI and dietician here. We’ve always been a bit nervous, considering his history.

Looking at books in the waiting room

Next, Patrick’s transplant nurse came in and took copies of his labs and other medical history that I’d brought with me. Then Dr. Reyes, the transplant surgeon joined us.

Again, he was excited to see how much Patrick has grown. He asked me how well he was eating and pooping since his ostomy was taken down. I explained to him all the questions that had been raised last month about whether or not Patrick had an obstruction that needed to be fixed. Then I told him that some of the doctors wondered if he needed another surgery to try to correct the problem.

Dr. Reyes’ reaction was quite direct. He said “No. We’ll get him a transplant. That will fix the problem.” He didn’t think it was a good idea to mess with things when Patrick is otherwise stable and healthy… especially if that reduces the remaining pieces of intestine.

I asked how Patrick’s reaching 10 kilos in weight would affect his candidacy for a transplant. Dr. Reyes said that that was a really big deal for him. This size changes the rules a bit for what he needs in a donor. Before, we’d been told the donor needed to be the same size as him, preferably smaller. Now that he’s bigger, they can reduce the size of a larger donor, too. His donor could be up to 6 or even 8 years old. The result is that his chances of finding a match go up.

So I had to ask if they could estimate a wait time. The answer, for all who are wondering, is still no. Dr. Reyes was careful to explain to me that Patrick’s B positive blood type is a mixed blessing. It means that there will be fewer matches. However, it also means that there are fewer waiting children with his blood type, which means his priority is higher, even while he’s healthy. Dr. Reyes just kept saying “We’ll get this transplant done.”

Next we talked about liver health. Patrick’s biopsy in September showed some early scarring of his liver. However, doctors responded quickly with a low-lipid diet and for the past several months his bilirubin and liver enzymes and other measurable signs show that his liver is relatively healthy. The clarity of his eyes and skin are also proof of this fact.

I told Dr. Reyes that we’ve been worried that Patrick’s spleen reacts so severely to infection. He admitted that the scarring in the liver was probably contributing to problems with the spleen. Recurring infections don’t help either. However, he said that a large spleen wasn’t as much of a worry if the liver isn’t also large.

Transplants are scary in a patient with a failing liver because as the liver fails, the body stops clotting as well.  Dr. Reyes said he’s not worried about that at all with Patrick. He feels safe doing the surgery. Then he said that if you fix the problems with the intestines, the liver can heal, and the spleen will get better. And he told me again, “We’ll get him transplanted.”

I asked one last question. Should we be keeping our bags packed? The answer was a resounding “Yes”. I really need to wrap my mind around that and get things in order so we’ll be ready to go quickly. The regular trips to Seattle and to the hospital here keep me practiced in packing and packing quickly – but still, it would be good to feel in some way prepared.

The mood of Patrick’s appointments was almost celebratory. His good health, his weight gain, and just the fact that we made it to a clinic visit without being admitted were all worthy of celebration.

We’ll go back again in July.

Roughousing with Lindy

The rest of the trip was pretty laid back. Lindy, who was kind enough to drive us half an hour to the appointments and then wait two hours for them to be done, took us back to her house. Patrick and Lauren crashed early. I was amazed that Patrick put himself to sleep there on just the second night.

And then, after a pretty amazing feat of getting three babies (Lindy was babysitting a 4 month old that day) into the car and off to the airport on time to catch our flight home… including all of Patrick’s medical care.. was impressive. Not the smoothest, but we accomplished it.

We got home Friday afternoon exhausted. Patrick and I both went to bed early. We all slept in. And today has been spent mostly in recovering from a pretty intense week.

I can’t really complain, though. It may be exhausting to chase after a one-year-old who crawls around the house emptying drawers and making monster noises… especially when I am the only thing standing between him and many broken lines. But I wouldn’t want to trade having him happy and wiggly and full of life – and best yet, at home – for anything in the world.

Concert announcement

I hinted at this a month ago. Some amazing things have come together.

We are excited to announce that a benefit concert in Patrick’s behalf has been scheduled for May 22, 2010.

The list of performers is really exciting. They’ll include: Paul Cardall – pianist and transplant recipient, Sam Payne – singer and guitarist, Mindy Gledhill – singer,  Steven Sharp Nelson – cellist, and Charley Jenkins – country singer, guitarist. I’ve heard all of these performers in concert before and it should be a spectacular show!

The concert is scheduled for 7:00 p.m. on Saturday, May 22 at Eisenhower Jr. High, which seats only about 1000 people. This smaller venue should give the concert a bit more of an intimate feel.

A silent auction will be held starting at 6:00 p.m. It will close at intermission. Donations so far include tickets to sporting events, plays and concerts; gift certificates for river runs, ski lift passes, hotel stays, spa treatments and more; various gifts and gift baskets from local businesses; signed artist prints; beautiful handmade gifts; and much, much more. We are actually still looking for good silent auction ideas. If you’d like to contribute or have a lead you think would be worth following, let me know.

Planning this event has been a once-in-a-lifetime experience! It’s been a humbling experience to see the outreach of generosity and kindness from the community.

I’m sure it will be an evening never to be forgotten.

Tickets are on sale here. Be aware that, since our venue is small, they might sell out fast.

Easter

It’s Easter morning and here in Utah a light dusting of snow fell overnight. Nevertheless, as happens with each spring snow, the tulips in my garden are still peeking out cheerfully, opening and turning to the sun as it rises. To me, there could be no better symbol of the message of Easter. As spring’s new life breaks forth giving color and warmth after a long, cold winter, so too does the promise of Life everlasting bring light and warmth to the cold, winters of this life.

Over 2000 years ago, a garden tomb was found empty. Jesus Christ had risen from the dead, and in so doing had opened the door to Eternal Life for all of us. It is that knowledge that has carried our family through some of the darkest winter moments.

This past year and a half hasn’t been easy, and we know the road ahead will be harder, still. Many times, I have shed tears as I’ve watched Patrick suffer pain and illness beyond my ability to comprehend. And yet, I know that there is One who can comfort him when I cannot. I know that Christ went forth “suffering pains and afflictions and temptations of every kind; and this that the word might be fulfilled which saith he will take upon him the pains and the sicknesses of his people. . . . And he will take upon him their infirmities, that his bowels may be filled with mercy, . . . that he may know according to the flesh how to succor his people” (Alma 7:11-12)

Patrick’s body is imperfect now. Yet, because of the resurrection of Christ, “The soul shall be restored to the body and the body to the soul; yea, and every limb and joint shall be restored to its body; yea, even a hair of the head shall not be lost; but all things shall be restored to their proper and perfect frame.” (Alma 40:23)

And, in the moments when we are reminded that this life is fleeting and that Patrick’s life may be a short one, I find comfort in the knowledge that. “… little children also have eternal life.” (Mosiah 15:25)

Modern prophets have proclaimed: “The divine plan of happiness enables family relationships to be perpetuated beyond the grave. Sacred ordinances and covenants available in holy temples make it possible for individuals to return to the presence of God and for families to be united eternally.” (The Family: A Proclamation to the World)  On a winter day in 2009, our family knelt at an altar and were sealed together for time and eternity. The atonement made possible not only eternal life, but eternal love and eternal families.

We may not know what the future holds, “But there is a resurrection, therefore the grave hath no victory, and the sting of death is swallowed up in Christ.” (Mosiah 16:8) There is hope in whatever lies ahead.

This morning, I know of a little boy who is receiving a long-awaited heart transplant. Like tulips reaching for the sun on a snowy Easter morning, this boy’s family is seeing a miraculous glimmer of hope at the end of a long winter.

We hope Patrick’s turn will come soon, too. But whatever the outcome, this Easter I am grateful for the hope that brings springtime to my snowy days.. and for the knowledge of the atonement and resurrection of my Savior.

Patrick’s anatomy

For some of our more curious readers, here is an image that can hopefully help you visualize what all the hoopla of “bowel obstruction” is about. The connection point between large and small intestine isn’t very visible because it’s so narrow, but the results of this narrowing is apparent in how much the small intestine has been stretched out as a result of the pressure. Kinda reminds me of those cartoons where there’s a kink in a garden hose that fills and fills until it looks like a big balloon.

In other news, we should find out in the morning whether or not we can go home tomorrow. The docs are a bit worried about making sure that we have a plan to feed Patrick without causing him to loose too many fluids so it’s hard to keep him hydrated. So we’ll see how he does for the night and they’ll make a decision in the morning.

Results of today’s tests and surgery

Today’s been a pretty busy day. Patrick went at 9:30 to have an upper GI study today. They put a contrast solution into his stomach through his G-tube and then watched it move through his intestines. He’s had this test done a couple of times and the results are always quite interesting to see. As we knew, Patrick’s small intestine was quite fat and stretched out and his large intestine was pretty narrow, though not as narrow as I remember it being last September.

At the end of the study, the radiologist compared today’s images to the ones taken in September. Her result: “No significant change”. Yup, that’s right folks.. all that worry revealed that they officially discovered that Patrick’s anatomy is just as we expected it would be 6 months after his reconnection.

They are still wondering if this odd anatomy is to blame for some of the recent infections. (Bacteria or yeast from the gut leaking into the bloodstream through thin walls).. but are going to watch for a while to see rather than taking immediate action.

So – this afternoon Patrick had a new central line placed. This one has two lumens, meaning there are two tubes so you can put incompatible things in at the same time without them mixing like antifungals and TPN. We’ll be starting a new therapy hopefully tomorrow, too, where we fill the unused lumen with a solution that helps kill bacteria and fungus.

We’re still waiting for a plan to move forward from here. For some reason, even though little has changed anatomically, they’re acting as though something major was still wrong and therefore trying to make changes to diet, etc. I’m having to go all out working as Patrick’s advocate right now.. fighting for people to think things through and decide what’s best for Patrick based on himself, not on general rules and practices.

It’s exhausting work, so since he’s sleeping, I think I will too. Hopefully it’s a calm, restful night and I’ll be ready to get up and start pushing for a discharge plan tomorrow.

Possible Bowel Obstruction

For the past few days, Patrick has had a really swollen, sore belly. A lot of it has to do with his spleen and how big it gets when he’s sick or when he gets a transfusion. He’s had both this week and so his spleen was really big.

However, with a yeast infection, there’s a chance of the infections building up inside an organ and causing similar symptoms. So, yesterday Patrick went for a CT scan. The findings weren’t fungal balls or absesses.. in fact, they weren’t what we expected at all.

Yesterday afternoon a doctor came to tell us that they’d seen evidence of a possible bowel obstruction. He then went on to describe findings that were kind of confusing to us. Basically, he explained that Patrick’s intestines were very dilated before an obstruction and very narrow after it.. kind of like when you blow up one of those long balloons and the air doesn’t go all the way to the end of the balloon.

The reason this confused us is that it sounded exactly like a description of the problem of a narrow colon that we’d discovered after Patrick’s ostomy was taken down. We didn’t know if the findings were new or if they were just telling us what we already knew.

Yesterday the GI attending and the surgeon, Dr. Rollins, who’d reconnected Patrick’s intestines back in September sat down and looked at the images together. In the end, the decision was that Patrick’s small intestine is much more stretched out than it previously was and that the place where the small and large intestine were sewn together is still very, very narrow and probably is the cause. (Like if you were to pinch your long balloon so the air can’t pass through all the way to the end.)

Now the question remains if this is something new or not. It’s possible that the surgical site has scarred making the connection even more narrow and unflexible.

Tomorrow morning, they’ll do another study where they put contrast into his belly and watch it move through to his intestines. If they find that the opening is about the same size at it was after surgery, they probably won’t do anything about it right now. However, if they find significant narrowing, then Patrick will probably have surgery tomorrow night or sometime Tuesday. They’ll take the scarred section out, taper down the small intestine to make it a better fit to the narrow colon, and sew the two back together.

Both the GI and the surgeon are saying that they think it unlikely that this problem is completely new or that Patrick will need the surgery. However, they want to prevent bigger problems in the future for him, if they can. So – they’ll do the study and then we’ll talk about it.

Either way, Patrick should be able to get a new central line in the next couple of days. They’ll try to put in a “double lumen” meaning that two tubes go into the vein, instead of one. The double access will make it easier to give antibiotics and antifungals and might make it possible to help prevent them by treating the unused lumen with medicines to prevent infection.

I’ll do my best to keep you updated here as we find out more.

Not again!

Infection is a vicious cycle! The cure makes you vulnerable for further infection. A couple of posts ago I wrote about a bacterial infection that hadn’t been fully treated by antibiotics back in February. Well, at the beginning of last week that same infection grew back yet again! We don’t know exactly why, but as a result we spent a few days in the hospital while they worked out a treatment plan that would help to knock this infection out for good.

The plan included a change to the antibiotics he takes to control overgrowth of bacteria in his gut and a regimen of super high dose IV antibiotics prescribed for the next 6 weeks.

We were sent home on Thursday without Patrick ever having really been too sick. We joked that it must be time to plan a family vacation because with so many antibiotics, how could Patrick possibly get sick again?

That’s what we get for uttering the word “vacation”. Tuesday of this week Patrick wasn’t a very happy kid. He followed me around all day just wanting to be held. That night, he got another fever. At midnight, when it was rising, we called one of our favorite doctors at the hospital, Molly O’Gorman. She also couldn’t explain the fever, given the antibiotics, and so she recommended we stay at home till morning with the hospital would be less busy. So, we gave him some Motrin for his fever and I set my alarm clock to get up every hour to check to make sure he was still ok.

At 5 a.m. Patrick woke up just screaming. By 6 his fever was back and climbing rapidly. We gave him more Motrin to keep him from getting into even more danger and took him to the ER. He seemed to feel ok with the Motrin and the doctors were stumped as to the cause of the fever. But throughout the night he just got sicker and sicker. Every time his fever reducers wore off he’d have chills and high fevers and nausea.

His first night in the hospital was just miserable! I think we slept a whole 3 hours. By morning, the blood cultures came back with a definitive result, Patrick had a yeast infection in his central line.

For those of you who don’t know, Patrick fought a yeast infection for most of last summer.. and almost lost that battle. Yeast has to be the scariest bug I’ve ever seen him with. Unfortunately, this infection doesn’t seem to be much of an exception.

Yesterday was an eventful and stressful day. Because yeast loves to set up shop in catheters, Patrick’s central line had to be taken out yesterday. He’s strong and wiggly and fiesty enough now that he has to be sedated for this to happen.

This had a few ramifications for him. First, he had to have a transfusion. His spleen gets greedy whenever it’s sick and he becomes anemic. He’d fare ok for normal things, but in that state would not have been strong enough for anesthesia. The transfusion helped his blood counts, but it also further fed his blood hungry spleen and as a result he’s all puffy , swollen and sore today. His belly is hard as a rock and hurts, too.

Also, Patrick still has to have IV’s to keep up his blood sugar and give his medications. Right now, he needs 1 all the time, and 2 most of the time. But between the scarring and damage to his veins from previous IV’s and the effects of this bad infection, they’re having a hard time getting them in, or finding places to draw blood from for needed blood tests. Yesterday, he was poked over 10 times in 12 hours.

My poor little munchkin is sore and sad and sick. He has to have splints on his hand and arm to keep his IV’s from being pulled out, so playing with toys is frustrating.

The good news is that pulling out the line and treating with antifungals is helping. He hasn’t had a fever since last night! And this morning, for the first time in days, he is resting well enough that I was able to put him down. Hence, I found time to write this blog.

I apologize for the lack of pictures so far. When I get a minute, I’ve got some adorable stuff from our hospital stay a couple of weeks ago. This stay so far Patrick hasn’t felt well enough for us to do something as frivolous as picture taking… but now that he’s on the mend, I’ll be doing that soon.

As for mom and dad, well.. we’re pretty darn exhausted. It’s been nearly impossible to get a good night’s sleep.. or even to get a nap in. On top of that, we’re worried. We still have bad memories and plenty of heartache from our last experience with yeast infections. It’s scary to be facing one again… And it is the hardest thing in the world to watch your child suffer and not be able to take the pain away.

Still, all we can do is live each day as its given to us. It is more than a miracle that Patrick is still with us. He fought so hard to be here and is fighting still. We are doing all we can to make sure that he gets the best out of each moment he’s here.

We’ll keep you posted as we know more. For now, it’s just a matter of waiting for the medicine to do it’s job and then keeping these two infections from coming back.

We need silent auction items

There are SO MANY exciting things coming up this spring for Patrick! The outpouring of generosity from friends, family, and complete strangers is astounding! I don’t want to spoil the fun by telling you all of what lies ahead, but there is one event that we can use your help with.

On May 1st, we’ll be having a benefit concert and silent auction. We’re pretty darn excited about the performer’s who’s coming. (Just for fun, all I’ll tell you now is that he’s a well-known local musician). We’ve already had some items donated to be auctioned including artwork, event tickets, and some amazing handmade items. We need your help finding enough to make this a great auction.

A silent auction is only limited by the imagination. Here are a few ideas:

1) Hotel stays, rental cabins or condos, restaurant gift certificates and other vacation or “night out” items.

2) Food gift baskets from bakeries, gourmet groceries, etc.

3) Personal services like hair styling, massage, manicures

4) Handmade items

5) Tickets to sporting events, plays, etc. (Know anyone who’s not using all of their season tickets this year?)

6) Household services such as carpet cleaning, gardening, car care

7) Recreation: Admission to theme parks, museums, golf course greens fees, ski lift passes, etc. Movie passes.

8) Themed gift baskets (For example, a basket of scrapbooking supplies, a collection of sporting goods, a basket of baby items, a collection of music or books, a basket of gardening supplies, etc.) Do you or someone you know sell or work for someone who sells items that they might want to donate?

9) Bigger individual items such as tools, fishing poles, golf clubs, etc.

10) Sports memorabilia (We’re requesting from local teams, but do you have any personal connections?), autographed books or music, etc.

This is just a handful of ideas. Really, the sky’s the limit.

Remember that all donations are tax-deductible. And, if needed, we can provide evidence of our 501(c)(3) status, donation-in-kind receipts, and anything else along those lines.

We need all donations by April 16th to give us time to get them ready for the auction. We’re also looking for volunteers to staff the auction and concert.

We’ll be sending more details about the event and how to buy tickets soon.

Thanks again for all that all of you do for our family!