Tag Archives: clinic visits

Oh yeah.. and last week…

Blogging has been on my to do list for a couple of days. But when I sat down to write last night, I was so full of the thoughts and worries of that 48 hour period that I forgot there were other events last week that I’d meant to write about.

We had a couple of appointment last week. We finally got back in to see Patrick’s psychologist yesterday. Can I tell you how amazing she is? When Patrick’s insurance case manager called me to tell me about a new Autism clinic that she’d seen open at the University of Utah THE SAME DAY THAT SHE CALLED I was pretty speculative. Especially since we have never been big fans of the diagnosis of autism for Patrick. Spectrum diagnoses are tricky and, while time and learning have convinced me that Patrick does have struggles that fit into the definition of autism, his presentation is so atypical that I don’t feel like the diagnosis serves him well. Well, unless you are dealing with someone who really does understand autism spectrum disorders. Which the people at this clinic really do. And for all that I don’t willingly introduce Patrick as autistic, we have found the autism clinic to be a tremendous help for us. I’ve been anxious to get him back.

When Patrick met “Dr. Joo-la” and her “piggies” (guinea pigs) there was an instant connection. I could see that he clicked with her and listened to what she said to him.As icing on the cake, she also saw that with the responsibilities of being his caregiver, I wasn’t going to have a chance to go seek other help for myself. She told me in the first meeting that if we sometimes needed to spend sessions talking about and taking care of me, too, that she considered that an important part of taking care of Patrick.

This last visit, I took her up on that. First of all, she spent a lot of the session reassuring me that Patrick really HAS made great progress. I’ve said before that it doesn’t seem like he is as plagued by constant sensory seeking as he was before. She pointed that out, too. Saying he seemed more focused, more grown up. Of course, his exploding language skills are an amazing step.

She reminded me not to be overwhelmed by after-school meltdowns. Pointed out that we had the same problems last fall, too. And she helped me brainstorm ways to make coming home from school perhaps a little better.

She also reminded me not to feel guilty about not being able to do all my heart says I should be providing for Patrick. She’s been following this blog, so I know that she was aware when she told me that she knew that a lot of days, we are just still surviving the day. She encouraged me to embrace summer school as respite time for me and NOT to try to spend it doing things for him or feeling like I need to save them from problem behaviors. I really need to call and see if it’s an option for me to swim in the mornings while he’s at school. If not, at the least there is a track at the high school on the same campus and I can walk.

And then she reminded me that I need help and tried to help me work up the courage to go and tell some of the people in my support system that I’m feeling lonely and overwhelmed and could use some company, if not some help. I don’t seem to be very good at that. (Does this count?)

Anyway – we talked about some other strategies for summer, for respite, for behavior, etc. We talked about bringing him back to their social skills group. (Which I’m very pleased to have found works well this summer.) We played with the piggies and Patrick tried to trade our bird Max for one. And then we made some return appointments.

That was the happy appointment of the week. The next day, I took Patrick to his allergist and I’m afraid it didn’t go as smoothly.

I learned two important lessons. 1) Don’t schedule appointments immediately following school. Patrick needs time to unwind first. 2) Don’t go to the allergist alone.

Because of his ADHD and sensory processing disorder, Patrick doesn’t do well in new environments and Patrick’s allergist just moved to a big, beautiful new facility. I’m very excited about this because he’s no longer sharing space with a regular healthcare clinic and there’s less risk of catching a virus there. But for Patrick, new spaces have to be explored thoroughly with doors banged, containers emptied, equipment disassembled. It’s a disaster. Also, because of a lifetime of doctor’s visits, Patrick doesn’t like it when I talk to a doctor about him and will do just about anything to get me to stop.

This day was particularly bad. I’d managed to get a tired Patrick to nap the day before, but insomnia kicked in that night and he was up till 12, getting just 6 hours of sleep.

The end result is that Patrick threw all of the flashcards, snacks, magazines, and tissues on the floor. Then ended up having to sit in a chair with all other furniture moved away from him. And then he screamed for most of the rest of the appointment.

I have to give props to Patrick’s allergist, Dr. Gleich. He still smiles, talks to Patrick like Donald Duck, tells me that I have my hands full but am doing a good job being patient, and just gets us through the appointment as productively as possible. He is a very good man.

So while I tried to keep as much calm as possible, Patrick’s allergist and I tried to talk through how transplant might change the strategy for his allergies. Obviously, the ability and need to eat are a significant step. And I wanted to talk about how to safely explore what he can have.. and just how safe it is to be dabbling in some of Patrick’s milder allergies while he is on immune suppressants that are making it so he doesn’t have many reactions.

I wish Patrick had been feeling better so we could have covered more ground. We reviewed Patrick’s last test results. The gist of them is that Patrick’s test results show him allergic to a lot of foods that he tolerates, at least to some degree. We still need to stay far away from cashews, pistachios, peanuts, and unbaked eggs with caution for other foods we’ve seen cause a reaction. He said to keep encouraging Patrick to eat eggs as an ingredient in baked foods as that mild exposure is believed to help kids outgrow allergies. He gave blessing to my efforts in allowing Patrick traces of milk, in extreme moderation. (Goldfish crackers, for example.) He actually was surprised that I was still being cautious about butter and regular cheese, but I pointed out that we see reactions to those foods.

He also took care to warn me of just how serious it is that Patrick’s spleen was removed, leaving him without a major defense against illness. He wanted me to be sure that, for any fever, I know I need to go straight to Primary Children’s. Some things don’t change.

And then, because we weren’t getting much further with Patrick screaming in the corner, we decided to not try additional testing that day. Instead, he asked me to bring Patrick back in July or August for repeat blood and scratch testing. In the meantime, we are supposed to explore and even push a little bit, with epi pen and benadryl nearby, and keep a log of what we discover about Patrick’s tolerances for certain foods.

I find that the further we get down this road the more obscure my question are. Neither Patrick’s allergist nor his transplant team really know how food allergies and immune suppression will affect each other. I don’t want to compromise Patrick’s new gut with a lot of foods he’s allergic to. (Food allergies can cause a sort of rashlike reaction and ulcers in the intestine). But I also don’t want to limit his nutrition and ability to wean off of tube feeds if that’s not necessary. I find myself wishing that I knew of an allergist somewhere who has an interest in transplant and immune suppression. I’m not sure such a person even exists.

Anyway – Patrick was asleep in the car 5 minutes after we left the appointment. Next time, I’ll try to allow time for a rest after school. Next time I’ll try not to go alone.

And maybe over the next couple of months we can figure out a schedule that lets Patrick outgrow naps, like he’s trying to do, without spending afternoons and evenings too tired and grumpy to function.

One other appointment this week, feeding therapy. Inspired by Patrick’s interest at a memorial day barbecue, I decided to work on hot dogs this week. I’m pleased to report success. So long as you cut the hot dog in half so he can fit it in his mouth. And watch him and remind him to take small bites. And maybe let him decide he’s done with the bun. Still, a victory in time for summer for a kid who doesn’t like his burgers grilled.

And speaking of burgers, I’m trying to figure out how to translate Patrick’s love of certain fast foods into a working menu at home. I’ve got him eating ham on english muffins a-la Burger King breakfast sandwich. And we’re working on thin sliced roast beef on hamburger buns as a tribute to Arby’s.

I do have one lingering worry. I’ve realized that if they do decide that Patrick can continue on to first grade next year, that means eating lunch at school. And right now, I mostly have taught him to eat warm foods. He does great with fast food, mac and vegan-cheese, pasta in red sauce, hot dogs, cooked veggies, soups, chicken nuggets and french fries. And this is exactly the sort of food that will be being served in the cafeteria. Except, well, that an elementary school cafeteria is not an allergy-safe place. I can’t expect them to watch for cross-contamination.

So I’ll be packing lunches. But I think one of the conversations we need to have in this week’s school planning meeting is whether or it’s an option to heat up food for Patrick in a staff microwave. (It’s already non-negotiable for me that he’ll need an adult to sit with him in the cafeteria.)

And Patrick’s feeding therapist and I did some brainstorming on cold foods that he might be able to eat if we work with him over the summer.

I’ve decided that we will for sure be frequenting the lunch park at the school next door again this summer. But this time, with the hope and goal of being able to figure out lunches that will work to send with Patrick to school next year. Last year, I was able to follow their menu and pack matching foods 80% of the time. But if those things can’t be warmed up at the school, then we may just have to work on being ok with eating the food you had packed for you, even when it isn’t the same as everyone else’s.

One other item of note from this last week. A family moved in across the street from us while we were in Nebraska. They have a little boy Patrick’s same age. We’ve talked about but not found a way to get them together to play. Until this week.. when this boy came and asked if Patrick could play.

This was a growing experience for this mom. I am trying VERY hard to stop being a helicopter parent now that Patrick doesn’t have IV’s to monitor. But it meant that both of us were a bit thrown by a same-age playmate. I’m not sure Patrick knew quite what to do with him. In many ways, he is like his peers. But in many ways, he still has a lot of growing to do. They drew on the sidewalk with chalk a bit, tried out all of Patrick’s ride-on toys. Then they went across the street and played in his yard, too.

I was doing my best to stay looking busy but also keep an eye on them. And to let Patrick build this relationship on his own without my coaching. Mostly they drove Patrick’s ride-on car up and down the street.

When I picked Patrick up for dinner, he was enjoying a snack of animal cracker. I was grateful they were safe, and I decided that next time I send him to play I need to make sure they know he has allergies.

It’s been a full week. I sometimes think my head might explode trying to hold all of this and have a normal life, too.

Getting ready for summer

It is disorienting to realize that next week is kindergarten’s last week of school. We only just started and it’s almost over again. I feel really bad to be just gearing up while teachers are working to try to take care of the mountain of things that need to be done for the end of the year, I’m here trying to squeeze every last drop out of the few weeks that we have available to us.

I am amazed at all that they ARE doing for him, though. For example, I noticed that Patrick’s class was at recess every day when we arrived. So I asked and they revised his IEP to allow him to go to recess with his friends every day. He is in HEAVEN getting that extra time with his friends. And I understand that he is doing better in class, too, as a result.

Also, I’ve been working all week with his special education teacher on getting the forms completed for him to be able to participate in Extended School Year (a.k.a. summer school). They hold 3-day weeks on 4 weeks during the summer. He’ll attend in the morning. The goal is to keep up the momentum that has just started again.

They did offer one amazing thing that I hadn’t even imagined as a possibility. There is a therapy pool at the school. And, because by the time summer school starts he won’t have a broviac line, Patrick’s doctors have given him the ok to work in the pool. It feels like this little piece of normal… my son being able to be in the pool during the summer. Even if it came about in the most abnormal possible way.

Speaking of doctors, we had a follow-up with Patrick’s GI this week. His dietitian came in, too. It’s the first time we’ve seen her since transplant. I wondered if she was amazed to watch him eat a kids meal while we talked. His growth charts look amazing. I think it’s the first time I’ve really looked at one post-transplant. He’s growing at a normal rate. He’s in the 50th percentile.

They ordered some labs to check to make sure that his vitamin levels and overall nutrition are still good as he’s learning to eat on his own, but doesn’t exactly have a traditional balanced diet yet.

Also this week, or maybe the end of last week, I talked to the team in Nebraska about Patrick’s next follow-up with them. We scheduled an appointment in June to replace his central line with a port. (This is why he’ll be allowed to swim, by the way. No more external central line.) We will be going out the first week of June and it will be an outpatient procedure.

I thought we’d have clinic, too, but it sounds like they feel we’re doing a great job communicating by phone and don’t need the extra visit.

So it sounds like we have a game plan for our summer. At least the start of it. Patrick’s last day of school is the last Friday in March. June 1, he’ll have end-of-year testing. June 3, we’ll meet with the school to make plans for next fall. That night, we’ll get on a plane and fly to Nebraska. The next morning, he gets his port and we come home that weekend.

The next week, Brian leaves on a business trip to Norway. And the week after that, Patrick will go to his first day of summer school. He’ll have two weeks on, then off for the July holidays. Then back again. Brian has a pioneer trek with the youth in July and another international business trip in August. And before we know it, it will be time to come back to school.

I’m trying to pull together some materials to keep working on mommy school in the down-days. I’ve let Patrick develop some lazy at-home habits this month but, really, we have a lot of ground to cover over the summer. Hoping that the extra respite time while he’s at school will give me a breath of energy to keep up with all the rest.

Kindergarten – untraditionally

It’s a quiet snowy afternoon and seems like time for an update. This is a busy week comparatively for us. With spring break over, Patrick’s back to a regular schedule with his home hospital school. In this district, they have assigned him a teacher for 2 hours a week. She comes one day a week on Tuesday afternoon and stays and works for 2 hours.

When I heard that schedule I was actually really upset. We had 3 hours a week scheduled as 3 one-hour sessions when we were in Nebraska. Patrick rarely stayed on task for the whole hour. We often didn’t get all 3 sessions in. And I really wondered if this schedule could possibly work.

I would never have expected how well this would work. Ms. Emily is a special education teacher in a “behavioral” classroom in another elementary school in the district. That means that it’s no longer just me with strategies to keep Patrick on task. His teacher is really good at finding a balance between pushing him to do hard things and finding ways to turn breaks into educational opportunities or “teaching play.” It’s teaching Patrick to ask for a break when he feels overwhelmed or frustrated and that is a skill that will go a long way for him.

I really worried about the long sessions, but she’s good at keeping a variety. Patrick earns the chance to play educational games on her iPad when when he completes more challenging work and that seems to make the time pass. (And gives us moments where she stops and teaches me ways to work on the same skills at home.)

I think the best thing, though, is that she is bringing me tools that actually are helping me to make good use of the time I spend teaching Patrick. Not that I wasn’t doing my best before. Thank goodness for the resources of the internet or Patrick would have been much further behind. But there is something to be said for materials prepared by a professional educator for your child’s needs.

For example, she brought me a stack of sight word flashcards. They are printed on goldenrod yellow paper which she says is the color our minds learn best reading from. Patrick was pretty resistant to these when she first used them to try to test his knowledge. But she started to plant the idea of sounding out words to him and pointed out a few sight words that he could use that skill on. Patrick and I sat down that week to run through the cards and before I knew it, Patrick was figuring out words by sounding them out, and asking me for more cards to work with.

He is practicing with about 20 sight words cards right now, most of which he’s mastered at a glance. As he gets good at these, we just add a few more in at a time and soon he’ll have that whole stack memorized. She added to that showing me how to use some touch prompts on his arm to help him sound out and blend words together and he’s really starting to be good at reading most any CVC word, new or not.

In the same session, she gave me a stack of worksheets that she’d cut out of a handwriting notebook. And two plastic page protectors. I really doubted this one… but as it turns out, Patrick is totally in love with this particular workbook. I looked online to just get a copy of it and it’s about $100 off the shelf. Basically, it’s pages where he practices tracing numbers. But it has just the right mix of activities that catches his interest. Trace a number 6 times and then practice drawing that many pictures of a totally simple object for a kid to draw, for example. Who knew Patrick would love drawing suns and balloons and candy canes? And on the other side? We practice counting and patterning. I really need to make it to a teaching supply store and get some tanagrams and counters to match the workbook.. But he doesn’t seem notice they’re missing so far.

This work has been reinforced by another little bonus this school district threw in. To honor Patrick’s IEP, they send an occupational therapist out to work with him for 20 minutes a week. 20 minute, again, sounds like nothing. I feel bad for the therapist who devotes 2 times as much driving as she spends teaching. But her support in handwriting and other fine motor activities has taught us a few helpful things like labeling the lines on Patrick’s page with sky, flowers and grass that help him fit his writing within the lines. And because the therapist comes from the school he used to attend, she brings along familiar things that he worked with before that really make him happy and willing to work.

The grand sum total of this is that instead of spending time hunting for curriculum for Patrick, I’m given tools to work with and all the time that I can fit in for school work is spent working and Patrick’s making good gains.

The more I see how things are being done right here, the more convinced I am that things were done very, very wrongly by Omaha Public Schools. Patrick’s teacher was a sweetheart who really meant well. But I’m certain that several of the rules governing special education were broken. I can tell you I certainly will do things differently if I ever have to work with that school district again.

The upside is that things are good here. It’s still a struggle. Patrick is a little bit TV addicted right now and he isn’t always happy when I pull him away to work. But only at first. He’s always happy once we get started.

And we especially struggle on the days that Patrick doesn’t feel as well. We finally finished the 2 week course of antibiotics. It is so nice to only have to get up to refill formula, not to wake up and stay awake to try to give antibiotics. It took a few days to get Patrick past the insomnia that giving him Benadryl every time he woke up was causing. But finally, the family is getting a little better sleep and that helps all of us do better.

Sadly, though, allergy season hit just as Patrick came off of the Benadryl. He had some hayfever symptoms those first couple of days. Or at least, that’s what we thought was going on. Two evenings ago, Patrick started to sound stuffy, too. By yesterday morning, he was sounding pretty congested. Of course, there was also this massive wind-storm that came through and I thought that was to blame. Then, overnight, it snowed. 6 inches. It has snowed all day today. And Patrick isn’t breathing better with the air cleared out.

We had an appointment with his GI and an intro appointment with the liver transplant clinic today, too. I took him, masked. And his doctor thinks this is likely a virus.. so far, he doesn’t think it’s anything overly concerning. (Though I guess we are watching in case his immune suppression causes a latent virus in his body to get worse. But they don’t think that’s it. It’s more likely he caught something over the weekend when we splurged a bit to spend time with family.) Anyway – so far, we are just supposed to keep a watchful eye. Patrick isn’t horribly sick or getting worse. He’s not running fevers. His oxygenation isn’t the best while he sleeps, but humidifiers seem to help with that. And he sounds pretty cute when his little voice gets croaky and cuts out.

Otherwise, it was a productive appointment. It is actually kind of comforting to know that Patrick’s been assigned a transplant nurse coordinator here in town who can get us a doctor quickly is Patrick needed things. They’ll also be watching Patrick’s weekly labs and making phone calls to doctors, the Nebraska transplant team, and us if anything looks off.

Dr. Jackson and I talked about getting orders in place for Patrick to be able to go back to school part-time. He needs to write a letter summarizing what Patrick’s medical and nursing needs will be as he goes back to school. So we talked about my goals and how what he wrote could help with those. He said would recommend for nursing support for Patrick because, as he put it, a multivisceral transplant makes him “one of the most complex patients in the valley.” I wonder how the district will interpret this. I’ve been trying to get an appointment to talk about and plan for Patrick to transition back to school and need this doctor’s letter first because the district trying to figure out what services he needs to attend school and where he’ll go that those can be offered.

Anyway – in brief summary, this is what the school year is looking at right now at our house.

With a lot of Bob the Builder in the background. Patrick rediscovered Bob the Builder this week. He is thrilled to find that he already owns Bob the Builder toys. He doesn’t remember this was his favorite show when he was 2.

I’m trying to figure out how to make Bob the Builder do math. Surely that would increase the incentive and willingness to work at it. Patrick hates math because counting is boring. (And hard in the midst of his ADHD and brain injury.)

Oh, P.S. As I cleaned off my car this morning, I was pretty sure that that much snow overnight would have shut down Nebraska school. Kudos to Utahns for being hard-core in all sorts of weather.

A transplant recipient’s guide to Omaha on a budget

I never blogged about our “vacation” days in Omaha. See, insurance pays for Patrick and one parent to travel for care.. but if daddy comes, too, then we worry about airfare costs and sometimes that means staying a few days. We were  beyond bored of our usual Omaha/Ronald McDonald House activities. So Brian declared that we should make it a vacation and try to find new things.

Sometimes circumstances lead you to discover things you might not try otherwise. Like today I had roasted red pepper hummus, veggies, saltines minis and chicken nuggets for lunch.. something i may not have ever planned for lunch if not for short gut and oral aversion and food allergies. But back to travel. Brian did his homework and here are a few discoveries.

Old Market

One of the things that you may not guess about our family because I’m not exactly fit is that we are a fitbit family. Especially on vacation. Brian loves to walk. I love to walk with my family. And so we walk. So of course, when we arrived in Omaha, after unpacking and dinner, we went out for a walk. We heard often about a place called Old Market when we were living in the city. But it was brutal winter and bitter cold for walking and we were too poor and immunocompromised for eating out. So we didn’t go.

Visiting Old Market was high on our list going back. It’s a pretty nifty few blocks of downtown Omaha. Lots of dining, some shopping, and on every other street corner, a musician. Not the creepy of musician begging on the street that you aren’t sure if you should cross the street. Just honest to goodness musicians with their instrument cases in front of them. A drum line. A girl in a flowy white skirt hula-hooping to her friend’s music.

Patrick was in his adaptive stroller and we learned that the combination of cobblestone roads and staircases made this the trickier way to explore the street. (Most businesses had ramps on one side, but few had them on both.) But it was a fun adventure nonetheless. Maybe someday we’ll have time and money and healthy immune systems and we’ll find a place to eat there. A few caught my eye.

http://www.oldmarket.com/

Henry Doorley Zoo

Omaha boasts one of the world’s  best zoos and, though we visit every trip, we never feel we have seen it all. It changes with seasons and because the habitats are so real, the animals in view are always changing, too. We spent Thursday morning there in beautiful weather on their spring break, so crowds were bigger and we stuck to more outdoor exhibits, caught the seal training, walked around the rhinos.

http://www.omahazoo.com/

 Lewis and Clark Monument

Right before returning home in February, Patrick and I went for a drive. On a whim, I followed some historical markers and we ended up driving to a historic monument in the bluffs above Council Bluffs, Iowa. My little Utah heart that grew up looking down on the Salt Lake Valley from various vistas leapt for joy to find an overlook of Omaha. And I knew I needed to bring Brian back.

So, Thursday evening, when we had just enough time for a drive after dinner, I directed Brian up to the monument. His reaction was almost the same as mine. And of course, Patrick did what he did last time. He started exploring. He noticed a set of stairs and a little trail going off to the side of the monument. We resolved to come back and explore that trail. Because we grew up in the Utah mountains and that is what people who grew up exploring mountains do.

The next day, we packed a crazy little dinner of ham sandwiches and pringles and jell-o cups and we headed out in the late afternoon to explore. We set our watches and checked our fitbits to know how far we’d gone. And we started walking.

We walked around this sometimes steep, often narrow and overgrown but clear train that followed the edge of the bluff. And then we got to where we could see the trail led down into the subdivision at the bottom of the hill. And we turned around and we went back thinking that it was nice, but a bit of a bust.

On the way back, we learned that the actual destination was DOWN the bluff. Down a nice steep incline by the railroad tracks, at the base is a spring. So if you ever want to go hiking there and you don’t mind really steep trails, so explore. It was a bit too much for us with Patrick and my asthma that hates hills. At least this trip. But do go. Especially if you can go in early spring. That was the perfect weather for a hike.

We picnicked overlooking the city. Patrick ate most of his ham sandwich. As much as most other kids would have.

http://lewisandclarktrail.com/section1/iowacities/CouncilBluffs/monumentpark.htm

Strategic Air and Space Museum

Of course, morning were still nippy so we didn’t want to hike in the mornings. Instead, we took a field trip out to Ashland, NE to visit the Strategic Air and Space Museum.

My father-in-law is an engineer. He loves planes. My husband grew up loving planes. This is one he’s wanted to explore for a long time. And it was awesome to let him take his son and share that same love of planes.

The museum has two hangars full of planes, mostly old military planes. Brian can name most models by sight. His eyes light up as he tells me stories of what they were used for. Patrick loved peeking in cockpits and engines and playing with the flight training demo. Though he’ll tell you we didn’t let him ride in any planes because we didn’t have quarters to put in the little ride on planes they had. (You know, the kind you find in front of grocery stores.)

After spending the whole morning in the museum, we bought a parachute toy in the gift shop and Patrick and Brian took turns trying to get it to fly off in the wind on the front lawn.

Then, we went and found the entrance to the state park next door. Didn’t go in, but bookmarked it for next time. We took a little drive through Ashland itself because we love small towns and were hungry. Then we took country roads back into Omaha. Again, hoping to find a quaint little place to eat. But we ended up at Five Guys instead. After several days of eating kids meal hamburgers (Yes, you read that right. Patrick, started eating burgers this trip.) this was one burger Patrick had no interest in at all. Kids and their tastes.

http://www.sasmuseum.com/

Donut Stop

Have I ever mentioned that finding little bakeries is a favorite foodie activity of ours on vacation? Donut and cupcake shops hold a special regard for us, especially. So when Brian found an all-night donut shop in Omaha, he knew we needed to go. After our hike above Council Bluffs, we took a meandering drive to our room through that city. And, along the way, Brian declared we were in the right neighborhood for donuts.

I can’t really capture the essence of this place in words. It was NOT the seattle donut shops we have frequented. It opens in the evening and stays open all night till morning. The stop itself has two big display cases full of a decadent assortment of donuts. And behind the case, two little old ladies frosting trays full of donuts more for the night. Our order was rung up on an old fashioned cash register that popped up our totals on numbered tiles and dinged when the drawer opened. The walls were adorned with pictures and souvenirs from Hawaii and an abundance of pictures of cats.

It was one of the most quaint and unique bakeries I’ve ever been into. We all think the donuts were amazing. Especially Patrick, who suckered me into letting him have his cake donut with pink strawberry frosting on it, even though I knew his belly might complain later.

I’m sure we’ll be back.

http://www.yelp.com/biz/donut-stop-omaha

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Bob Kerry Pedestrian Bridge

Saturday morning, we drove through the traffic of a St. Patrick’s Day parade. We needed a less busy place to spend the morning and Brian needed some more steps. There is a bridge that crosses the Missouri River from Omaha to Council Bluffs. There is also a park on either side, both of which are worth a visit on their own. But our goal this morning was to walk across the bridge.

So, we grabbed some Taco Bell. (Waffle of the waffle taco was another hit for Patrick.) Then we bundled up against the Nebraska wind, put Patrick in his stroller and away we went. It was one of the colder days we experienced there so Patrick ended up wearing Brian’s hoodie.

It was fun and peaceful to be out for a walk above a river. Even if Patrick was in a grumpy mood and didn’t want us to hold hands or push his stroller one-handed or do any other number of things that made him feel out of control. After a week of walking, I knew I needed to do more walking when we got home. I was sore and tired. But it was fun.

And when we got to the Iowa side, we walked down in their park to the riverfront and let Patrick out to run for a little bit before heading back.

http://omaha.net/places/bob-kerrey-pedestrian-bridge

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Pizza in the park

For lunch, we met some friends at a park. It was one of the most perfect weather Saturdays of the year. The kids (with help from dads) played on the playground. And for lunch, we grabbed some pizza from one of our favorite unique-to-the-area pizza places, Mama’s Pizza. I highly recommend the chicken club pizza.

http://www.mamaspizzaomaha.com/

Pioneer Courage Park

Saturday, after enjoying an amazing roast pork dinner provided by volunteers at the Ronald McDonald House, we checked out of our room and moved to a hotel. We wanted breakfast and a smooth checkout since we needed to leave for the airport around 6 a.m. on Sunday.

We went to a hotel in downtown Omaha and, of course, after checking in went out for a walk. We walked past the ball park and arena and a mural that I don’t know how I didn’t notice was there until just this trip. The end destination was a place called “Pioneer Courage Park.”

The original address we were aiming for was a different sculpture park that we really need to go and see on another trip. But we found our actual destination almost by accident and were so glad to make it there.

Omaha was kind of a gateway for pioneers settling the American west. Especially Mormons. And many people know to travel back and visit Winter Quarters and the Mormon Trail Center. (https://www.lds.org/locations/mormon-trail-center-at-historic-winter-quarters). However, I think I’m going to add this park to my list of recommendations to those interested in that history.

This is an enormous bronze sculpture of a pioneer wagon train. Yes, a train. Several wagons. It is HUGE! You look across the street and there is a herd of buffalo across the street. As I understand it, go a little further and you’ll also find a flock of geese. Anyway, I have never seen the varied stories of the pioneers that settled the American West so completely and emotionally depicted all in one place. This sculpture was amazing.

And Patrick got to chase a bunny rabbit in the dark and jump off of slabs of rock. So we all had fun.

http://www.visitomaha.com/listings/First-National-s-Spirit-of-Nebraska-s-Wilderness-and-Pioneer-Courage-Park/57322/0/#.VRHXnI54rV0

We got back to the hotel and Patrick was greeted by the desk clerk with a gift bag full of toys. As we checked in, she asked what brought us to Omaha. She didn’t expect “transplant followup” as an answer. And she went out of her way to add some extra love to his day. People are amazing.

So – There you have it. How to vacation/staycation on a dime while immune compromised in Omaha, Nebraska. It was fun to come back to the Ronald McDonald House each day and tell the staff about where we’d been or where we were going and hear the interest in their voices about the places we were discovering that they hadn’t even been to themselves. It felt so good to be doing something DIFFERENT while we were there. Making some memories of our own choosing there. Kind of claiming the city for our own.

Transplant Day 132 and a follow-up visit in Nebraska

I am writing from the window seat of a room in the Omaha Ronald McDonald House. Today marked 1 month since they told us that he could go home to Utah. And so, today, he had a follow up visit to see how things are going.

It’s been an interesting few days. First of all, can I say how much it broke my poor little brain to try to pack for this trip? Travelling with TPN was hard. It took lots of big luggage and days of coordinating Fedex deliveries and special planning and packing for airport screening. In the past, I brought every suitcase we own packed to the 50 lb limit and also have at least 4 boxes shipped. This time, well, what I needed to bring was not iV supplies. It was formula. And food. I had to pack snacks.

i got everything gathered to put into suitcases and I looked around and I had too many suitcases. And the problem flustered me so much that I had to just go to bed and sleep on it. I had nightmares about not being properly packed. Then, I got up in the morning and I filled the extra space in one suitcase with pillows and blankets and I decided that we didn’t really need one bag as a diaper bag and another one to carry my electronics and medicines. And none of the bags weighed over 40 pounds. And it was all ok.

In fact, it was easier to get to the airport. Brian had flown in and out of this city enough times to know which flights would be fuller and have a busier airport and did a great time picking us a slow time in the airport. Patrick and I donned masked. (I wore one so Patrick wouldn’t feel so alone).. and i gave him a new pair of touch screen capable gloves. And we strode into the airport not struggling under the weight of overfilled bags.

Brian also had applied for TSA precheck status which meant screening for him and Patrick went much more easily. I still had to go through a regular line which felt, well… very strange. To leave them and go off on my own. But things were simpler. Patrick’s many medications had to be checked in the mass spectrometer.. but that is so much simpler than checking a cooler of IV fluids that they still were done by the time I got to them. They’d have beaten me had they not decided to let Patrick be screened in his wheelchair/stroller.

The flight was difficult. Patrick really has a hard time not playing with the window shade and keeping his feet off of the feet in front of him. Under normal circumstances, you can redirect this. But his steroids make it very hard to change Patrick’s mind once an idea enters them and we had a few stretches where I just had to hold onto him to keep him from hitting the seats around us until he settled down. It wasn’t all that way, though. He ordered himself a “diet water” from the flight attendant and had a happy snack time and we played with stickers and some mommy school games I’d laminated and brought along. Patrick’s desire to learn still overpowers most other things. And thankfully, the flight was only 2 hours anyway.

We rented a van and drove to the Ronald McDonald House. It was strange to be back and feel so at home here. Before out of state clinic visits were big adventures in new places. Now, well.. this is just a second home. Patrick, in fact, loves pointing out that we are coming home when we come back to the Ronald McDonald House each time we do. He is very mad at me that we are not restocking the fridge with his favorite foods and are eating out instead.

However, I like him eating out. He figured out he likes hamburgers last week and I love seeing him eat half of a hamburger plus some fries when we get him a kids meal.

We are aiming for a more vacation-like trip. Last night we went out and explored a shopping district called Old Market that we heard about but didn’t brave in the cold. It’s kind of a cool atmosphere. Like a toned down Pikes Market in Seattle, but with fewer people. And well patrolled by police. They allow street musicians, but not others begging on the corner.. so you could enjoy that ambiance of that little addition. It is warm here and nice to be out.

We did stop at the store for a few snacks and staples (and some sugar-free soynut butter that I haven’t been able to find in Salt Lake). And we stayed up snacking while waiting for meds time, even though Patrick was far too tired and overexcited about being here.

Today’s been a really nice day. In the 70’s, so we have been able to be out in short sleeves. We have never caught nice weather in Omaha before. We got up with the sun, as Patrick always does.. and made it out to go to the zoo early. We really love this zoo and find something new each time. This time it was the otters that caught his fancy. He didn’t like the sea lion training, though we did. And he was tired and wanted to go back to the room early, but we didn’t let him.

I’ve been tired today. At midnight last night, as I refilled Patrick’s formula feeds, I noticed that I’d left the charger for his feeding pump home. And I tossed and turned worrying about it all night. Trying to think who I could borrow from and what it would take to get homecare set up again in this city for just a few days. It was top priority this morning. It wasn’t hard to fix. I made a call to our homecare company who said that they often will lend chargers to people in a similar situation. So I called Children’s Home Health, the company we used while we were here, and explained the situation. They said no problem and to come pick up a pump. I signed a form saying we’d pay if it wasn’t returned and they gave me an envelope to return it in since they won’t have open offices the day we leave. And that was that. Easy peasy and why did I worry so much?

Oh well..

Patrick’s clinic appointment was this afternoon. That was also easy peasy. We checked in and there was some confusion about insurance now that we are more than 3 months after transplant.. but they voted in the end to leave that for the financial folks to sort out. We weighed Patrick in and he’s gained again.. and even 22 kilos, or almost 50 pounds.

The doctor we saw today was the surgeon who did Patrick’s transplant, Dr. Grant. This made me very happy. Not only does she, literally, know him inside out but we really seem to click as far as philosophy of care. She said that he was doing remarkably well and to keep on this same path. They were happy to hear he was eating and the dietitian adjusted his feeds again so that he’ll have 8 hours without tubes in a day… I had to promise to keep him drinking in that time so he stays hydrated.

Dr. Grant asked what we were doing about school. We confessed that we hadn’t dared send him back yet and were setting up home school instead. She actually seemed pleased with this answer.. she kept saying “It’s only been 4 months.” Pointing out that it’s easy to overlook how new this all is because he doesn’t have an ostomy or a feeding tube in his nose as most kids do this short time after. She started out recommending summer school or back to school in fall.. then conceded that maybe sending him back sometime after spring break so he can finish this year with his same friends and teacher would be a good idea.

After his physical exam, she pointed out some stitches we could have removed next time he’s sedated. And she said that she doesn’t think he still needs any physical restrictions. Monkey bars here he comes.

And then she said the words we’d dreaded. “So what do we do with this central line?” I decided to just speak my mind. I told her that we were ok with him not needing a line, but worried removing the one he has given how hard it was to put in and the chance of losing that access. I said this once before to another surgeon and was told I was being overly conservative. But Dr. Grant suggested just what I had imagined as the best solution in my mind: A port. This is a central line but one that stays under the skin except when it’s needed. There’s a small disk that can be accessed with a needle.

The nice thing about it is that it isn’t as prone to infection as a broviac line. It won’t need a dressing and he’ll be able to bathe and swim and get dirty.  Also, it means that Patrick’s labs will be easier to draw and less painful, since they can numb the site. The disadvantage is that it’s still a central line and runs a risk of infection and needs careful monitoring for fevers.

We made a plan to come back after the end of the school year and have them change Patrick’s broviac line for a port. We’ll leave that for a little while longer till we know it’s safe, and then remove it.

We won’t need to come back to Nebraska until then. Oh, and labs can now be once a week.

So overall.. still good news.

And now it is on with our mini-vacation. We have had a snack and a nap and are now headed over to the hospital for movie night.. then back here where some nice church ladies are cooking us a turkey dinner.

I don’t want to delay the fun, so pictures will have to come in a later post.

Transplant Day 42 and His First Checkup

Patrick asked me to take this picture with him and the Ronald McDonald on the wall.

Patrick asked me to take this picture with him and the Ronald McDonald on the wall.

Well, 72 hours since discharge as I’m writing this and I am amazed to say that today it seems we maybe hit our stride a little bit. Amazing, considering how out of control things still seemed last night.

Sneaking back into the room last night after blogging, I noticed the distinct smell of formula and knew that it meant that Patrick’s g-tube had come open and leaked all over him and the bed. That woke him enough that I gave in and crawled in his bed to sleep last night.

At 7, his pump alarmed, waking is both. It was an early morning, but meant we had time to get ready. It took some courage for me to figure out how to get Patrick a bath with his new ostomy without losing the pouch. Yesterday morning, I knew the pouch was about to fall off anyway so we tried it and, sure enough, I had to change the bag that afternoon. But today, we did a bath again and it was ok.

Putting Patrick in the bath helps mornings go much more smoothly than showers. It means I can leave him for a bit. For example, this morning I was able to get the bed stripped so it could be washed. Patrick is chilled so easily right now. I don’t know if htat’s because his hospital room was so hot for a month and the weather outside is so cold.. But he gets shivers all over at the slightest cold. So I’ve started wrapping him in two towels. His calls this his towel dress and it is the highlight of his morning.

Being up early this morning also meant I managed to get a shower in before the nurse came. And, amazingly, Patrick woke up feeling good enough to not need Zofran this morning. That will earn me an extra half hour of sleep every day.

I didn’t feel lost looking at Patrick’s meds this morning. I kind of know what he’s getting and when and how much prep to do in the room before taking them downstairs.  So after labs were drawn, we went downstairs and gave meds and mixed formula. (Which I remembered to make with warm water so it dissolved better.) And then I made pancakes. That felt like quite the luxury. Patrick ate 2 bites. Turns out we don’t love sugar free syrup from IHOP.

Then I glanced at my phone and noticed I’d missed a call when I was in the shower. It was the transplant clinic asking if we could come in early for Patrick’s appointment today.  So, we hurried off to run our one errand of the day, and then rushed to the transplant clinic.

I am used to doctor’s visits where the answer is “you’re doing as well as you can. Nothing can change till after transplant.” Instead, today things were moving. Patrick’s prograf levels were still high this morning, but for fear of swinging him the other direction, they are leaving his dose the same. That means that he gets to take the morning off of labwork tomorrow and have it done Saturday, instead.

Because he is tolerating feeds SO incredibly well, they are said that we can start giving him a break in his feeding schedule. We’ll increase his feed rate by 8 cc’s and he can have 2 hours off. If that goes well, then after the weekend, we’ll go up again and he’ll get 4 hours off. Because of the diproblems with his lungs, they will go very slow in transitioning him to a different formula. So he probably won’t gain much weight in the next little bit because he isn’t getting a lot of fat.. But slowly that can be reintroduced.

Alas, the formula that they often use next has milk in it, so we need to take our time going to a hyperallergenic formula instead.

And that’s that. We came home from clinic and tried to eat lunch. But Patrick was bored and sleepy, so he spent the afternoon napping and I have mostly just spent my afternoon laying here keeping him asleep… though I snuck out of bed to write this blog post.

I finally realized today that I can write the post in a word processor and then just copy and paste when I go in a room that has an internet connection. It might mean some delayed posting, but should be a little more effective than trying to get away in a room with internet long enough to write.

Follow-up added this morning after:

We were woken from nap by a phone call saying that dinner was ready. Patrick was still all over the place at dinner, but thankfully the crowd was small because he’d slept through the start of movie night at the hospital.  Dinner is very overstimulating for him. So we usually retreat to our room early.

Last night, we had good incentive. We’d picked up a Christmas tree earlier and I finally brought it into the room. We set up the Christmas tree and hung the ornament he’s made thus far on it. Then went and made two more. I cleaned out the room a little bit more. I think we may finally be almost moved in. I can’t even imagine moving houses with a kid this age.

And then, we made it to bed. Patrick’s prograf levels must still be high because he just can’t fall asleep at night. Last night, he wouldn’t stop playing with his hands. I was really grateful for the chance to visit with an older transplant patient who is staying here. He explained that the prograf makes his hands shake, hurt, and even lock. Last night, Patrick wouldn’t stop playing with his hands. So I thought to ask him if his hands were hurting. The answer was yes. And so I laid there and rubbed his hands till he settled down. Then I told him I was just too sleepy to stay up with him anymore. I went and laid down and he was asleep in 15 minutes.

We slept in till 8 this morning. No labs today. It felt luxurious. And now we’re downstairs letting him play in the playroom. Which means a little bit of internet time for me.

Yesterday gave me hope. We had some downtime and I think that will get better the more used to this new routine.