travel – Page 2 – Patrick Hoopes

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.

Home again

I just wanted to take a minute to let you all know that Patrick and I made it home safely Saturday evening. The flight was a bit late and very full, but overall the trip went very smoothly. Patrick and I even got the opportunity to ride home next to a very kind woman. She and her husband are considering adopting and I got to spend the whole flight talking up adoption, especially special needs adoption. Patrick liked her, too, and even spent some time playing and cuddling with her during the flight.

We’re all pretty tired. Patrick and I both still have pretty bad coughs. Fortunately, Brian’s healthy.. but has been struggling to make up for the time he took off at work. On top of that, they scheduled a power outage last night. He ended up spending the whole night working to get servers back online.

On a different, and happy note, Brian and I celebrated our 6th wedding anniversary yesterday. With all that we’ve been through this week, it was a pretty simple celebration. My parents took Patrick for a couple of hours and we went to dinner and our first movie in well over a year.

It’s funny how life changes change perspective. Our anniversary was very low-key, yet I found myself overflowingly grateful to have the kind of marriage that doesn’t need a lot of frills to be happy. I love my husband more today than the day I married him.

Adoption Reflections: The journey home

I think this will be the last in my adoption reflections series.

Things started to come together quickly once the court granted us full custody of Patrick. The adoption agency put in a petition for something called an “interstate compact” or “ICPC”. Basically, Michigan and Utah had to formally agree on which laws would govern the adoption. Meanwhile, the hospital social worker and discharge planner started working on the bigger question of how exactly we’d get Patrick home.

Patrick’s care needed to be transferred to specialists in Utah. He needed doctors here arranged and home care set up before he could leave the hospital environment. That meant he couldn’t just be discharged from the hospital so we could fly home commercially.

Eventually, it was decided that our best option was a medical flight. It took some juggling, negotiating, and everything short of outright begging to come up with the $20,000 cost of the flight, but eventually between our insurance company, a private donor, and our own savings, we had enough to book the flight.

Two days before Thanksgiving, the ICPC and flight were arranged, Patrick had a bed and a doctor at Primary Children’s hospital. We were coming home!

There wasn’t room for both of us and our month’s worth of luggage on the flight home, so Brian flew home Tuesday evening with the luggage. I stayed behind to take care of Patrick.

We were scheduled to fly out early in the afternoon on Wednesday, but some bad weather put the flight crew behind so it was after midnight before we left. We bundled Patrick up as warmly as possible. Then they strapped him to a stretcher. We went by ambulance to the airport, where a Leer Jet was waiting. We flew at 70,000 feet to stay out of turbulance. Patrick just slept the whole way.

Finally, we landed in Salt Lake and took an ambulance to the hospital, arriving about 4 a.m.

It was so disorienting to be in a new hospital. Nothing was familiar. I was tired and somewhat lightheaded from the long trip.

Brian met us at the hospital, and once we were checked in, took me home to rest. Leaving my baby all alone in an unfamiliar place was probably one of the hardest things I’ve ever done. But I knew I had to take care of myself.

After a couple of hours’ sleep, we got up and got ready for Thanksgiving. I finally got to see the nursery Brian and our friends had put together for us. We took hundreds of pictures with us to Thanksgiving dinner. And then, once we were rested and fed, we went back to the hospital – where’d I’d spend most of my days for the next 2 and a half weeks.

For the first time, it was our last name on Patrick’s nametag. We were just the parents, not the “adoptive parents”. Our families got to finally meet him. It would be a couple of weeks more before he left the hospital, but Patrick was home.

This year, he gets to come with us to his first ever Thanksgiving dinner. Two of them in fact! We’ve come a long way to get here. Probably the best journey I’ve ever experienced.

Through Grandma’s eyes

I have so far resisted the impulse to write and to let Emily handle all the blogging. But after reading her most recent post about the beginning of this journey, I feel like adding some of my own thoughts.

It is difficult for a mother of seven to see her daughters struggle with infertility. I always have a prayer in my heart for them to be able to experience the joy that I feel as a mother and grandmother.

When Emily and Brian came to us with the story of the little baby born in Michigan that might not have a long life, I had such mixed feelings. I wanted them to have this little guy in their lives, but didn’t want them to have to suffer any more sorrow. There were so many unknowns. I can’t tell you why I fell so instantly in love with that little 2 x 2 inch digital image, but I did, and hoped that things would work out.

I don’t want to jump ahead too much from Emily’s story…but the best part of November last year for me was that I got to go to Michigan and meet Patrick myself. Brian had to come back to Utah and complete a project at work. Thankfully, we have access to Delta Buddy passes and I was able to fly out and stay with Emily for the week he was gone.

She picked me up at the airport and I don’t remember if we went to the hotel first, but we were at the hospital in no time. We had to check in at a secure desk and then off to wash. This was an event in and of itself. Roll up your sleeves, take off your jewelry, look at the clock and then begin to scrub and not just for a few seconds, it took several minutes.

Then through a maze of sorts (took me a couple of days to figure it all out) and we were in Patrick’s room. The lights were dim and there he was…big brown eyes and lots and lots of dark hair. He was so tiny. Just over 5 lbs. His tiny head fit easily into just the palm of my hand. Holding him was no effort at all, except that he had leads and tubes that connected him to life-saving and monitoring equipment.

The next few days were spent mostly at the hospital. We spent very little time in the hotel, just enough to heat up some food (can’t cook everything in the microwave believe it or not) and send home the many, many pictures that we were taking to keep Brian up-to-date. We had time to attend a Sacrament Meeting and catch some people at the Detroit Temple and ask them to place him name on the roll there. But we made sure that we were there for rounds morning and night as much as possible. Every day there were new things to learn about Patrick’s condition.

Emily was swamped with the details of the adoption, the insurance, medical decisions, travel plans and keeping family back home in the loop. Because she had phone calls to make, I got to hold Patrick for many, many hours. He isn’t able to have much by mouth and the instinct to comfort a crying baby with a bottle or breast just wasn’t an option. We quickly learned the value of a “paci”.

The nurses there are amazing. They are caring and skilled. They seemed to have an instinct for being available but not in the way. I felt comfortable enough to sing him and tell him stories and I know Emily did, too. And I know that when we weren’t there, they were holding him and loving him just like we did.

I will forever treasure that special week getting to know this grandson. I am grateful for the self-less decision that Brian and Emily made to bring him into our family. They are amazing, completely prepared by the Lord for their role as Patrick’s parents.

Top 10 ways you’ll know that Patrick has had his transplant

It seems that our fundraising efforts have created some confusion about Patrick’s transplant. The fact that the Produce for Patrick stands coincided with Patrick’s intestinal reconnection surgery has led a lot of people to believe that transplant has already happened. As much as we wish that were true, Patrick is still waiting for his transplant.

I’m asked every few days how the transplant went. And when I explain that we’re still waiting, the response I almost always get is “Well, you’ll let us know when it does, right?”

So – for all who are afraid that they’ll miss word of Patrick’s transplant, here is a list of ways you’ll know it’s happened. (It’s also a little intro to what we expect life to be like after transplant.)

1) We’ll be in Washington. Patrick is having his transplant done at Seattle Children’s Hospital.

2) Brian will be alone when he’s at home. Patrick needs to live near Seattle Children’s for at least 6 months. I’ll be there with him.

3) Brian will achieve frequent flier status. The plan is for him to go back and forth between cities until Patrick and I can come home.

4) We’ll be germophobes. To prevent rejection, Patrick’s immune system will be suppressed. We won’t often take him into public places, and when we do, he’ll probably be wearing a mask. If you visit us, we’ll demand that you be healthy, and that you make sure to wash your hands… often.

5) Patrick will be allowed to eat. Not just a teaspoon of formula and one bite of solid food every 3 hours. He will need normal quantities of real food because…

6) Patrick won’t need TPN anymore. At first they’ll slowly decrease the number of hours that he has it. A goal before he comes home will be that he doesn’t need it at all anymore. He won’t have an IV anymore. It’s possible that for a while he’ll be fed through the tube in his stomach.. but eventually, even that will not be needed.

7) Patrick and I rack up a different kind of frequent flier miles. For the first little while after coming home, Patrick will need to go back to Seattle Children’s much more often than he goes now. To make these trips while he’s on immunosuppressants, we will probably stop flying commercially and use smaller planes through a service like Angel Flight. Since small planes fly more slowly, the trip will take a day each way, not counting time in clinic.

8 ) We’ll have to start watching our budget even more closely than we do now. Right now, most of Patrick’s care falls under our insurance company’s catastrophe protection. However, immune suppressants are a pharmacy benefit, to which no out of pocket maximum applies. Co-pays for transplant medications average hundreds of dollars a month.

9) We’ll probably change a lot of what we do. Patrick’s care will require a whole new and different routine. Because his health will be at risk, we’ll have to be careful of where we go with him, as well as what we do around the house. (For example, gardening is a huge health risk for Patrick.)

10) WE’LL TELL YOU! I promise, when it comes time for Patrick’s transplant, we will be overflowing with excitement, fear, and anticipation. An intestinal transplant is MAJOR. You won’t be guessing if it’s happened. It will be all we can think about for a long time.

Now, the next question I’ve been getting is this. “If Patrick hasn’t had his transplant yet, why are you fundraising?” The answer is this… Patrick’s transplant is a VERY expensive one. It’s a newer form of transplant with higher rejection risk, and so follow-up care for this transplant is quite intesive. Furthermore, we have to travel to have the transplant done, which ups our cost exponentially, especially when you add in cost of living and travel on top of out-of-network medical bills and medication co-pays. Raising $70,000 can take some time, and we’re trying to be prepared and to help in the fundraising efforts while we are still in a position to do so.

There is, of course, the possibility that Patrick’s health could fail before he gets to transplant. This is one of the biggest reasons that we decided to work with COTA to do fundraising. Any money raised that Patrick doesn’t need will go to the transplant-related expenses of other children.

So there’s my educational spiel of the morning. Hope it helps to answer some of the questions you may have.

Children’s Organ Transplant Association

I wanted to take a minute to tell you about a group called theChildren’s Organ Transplant Association. This is a charitable organization devoted to making organ transplant available to children, regardless of financial circumstances.

The estimated price tag on a small bowel transplant is approximately $1 million. We are fortunate to have very good insurance and to be pretty solid financially right now. Nevertheless, every doctor’s visit, every trip to the E.R., and every new medication comes with a co-pay. And while we have an out-of-pocket maximum, it doesn’t apply to co-pays. Right now, that’s expensive, but manageable. After transplant, we are looking at doctors visits several times a week and about 50 medications at a time.

Besides the medical bills, an out-of-state transplant center brings its own expenses. We pay for transportation and hotels every time we go for an outpatient checkup. When transplant comes, we’ll need to book a flight at the very last minute, meaning steep airfare or, even more pricey, a charter flight to get to Seattle in the required 6-8 hours. Then we’re looking at splitting our income across 2 states for about 6 months as I stay with Patrick during his recovery while Brian works here at home.

If I think too much about it, the logistics of this make my head spin.

We’re doing all we can to save while times are good right now. Unfortunately, the more we put ourselves on solid ground, the more “needs-based” programs we are disqualified for.

Enter the Children’s Organ Transplant Association. COTA, as they call themselves, is a 501(c)3 charitable organization. Their purpose is to facilitate fundraising for children needing organ transplants. Funds raised are donated to COTA in Patrick’s behalf.. meaning they are set aside to help cover Patrick’s transplant related expenses.

These funds can help cover any of the costs I mentioned above. They cover anything related to the need for transplant (meaning all the medical stuff we’re doing now both in Salt Lake and in Seattle as well as, for example, medical expenses when he’s an adult that result from being transplanted.)

We have set up a fundraising campaign in Patrick’s name with COTA. It’s being organized by some of my family members and is staffed by family and friends. 100% of what is raised will go to COTA to cover transplant-related expenses. Donations are tax-deductible and some companies will match donations. On top of that, COTA has it’s own matching and incentive programs. COTA estimates we need to raise $70,000. Funds Patrick doesn’t use, for whatever reason will benefit other children.

I’m asked all the time what more people can do to help us. Well, this campaign could use help. It’s all run by volunteers, so if you have some time or ideas, then you can be of help to us. A training/planning meeting is planned for September 1st.

Re-evaluation at Seattle Children’s

You may have heard that Patrick had a day of office visits scheduled at Seattle Children’s hospital last week. After his cardiac arrest and the many complications that followed, they wanted to see him again to see if anything had changed that would affect his transplant status. They also wanted to look to see if he needed to be listed for a liver transplant.

What you may not have heard is that Patrick was hospitalized Sunday night with another infection. This time it was a staph infection which, if caught early, can be treated through his central line and clear easily or, if more established or more resistent, could become a very persistent infection that can hang on for months.

I called Seattle Children’s and tried to reschedule our appointment. However, Dr. Horslen was going to be away for the next several weeks and they didn’t want him to stay inactive on the transplant list for that long. After a few days and some discussion, we made the decision on Tuesday to have Patrick admitted at Seattle Children’s so they could both treat the infection and do the evaluation.

We got the final go ahead late in the day Tuesday. I was up till 1 a.m. packing. Wednesday he was discharged from Primary Children’s with just time to go directly to the airport. The flight went well. They only real difficulty was that Patrick’s ostomy bag started leaking at takeoff. Well, and that I got a tad bit lost in the airport because we landed in the international terminal and airports aren’t as well marked when you have to take the back elevator routes.

Nevertheless, we arrived at Seattle Children’s around 6 p.m. – just as they were changing shifts. We met part of the medical team that would be following him and, as usual, wowed them by giving them in writing all the information they really would need. It took some time to get orders written, so we had another late night as labwork and meds came trickling in. It was about 2 a.m. before we made it to bed again.

The nice thing about being inpatient is that it gave me a sense of what things will be like during his recovery after transplant. We started with an early abdominal ultrasound, specifically a doppler. Yes, this looks a bit like the weather map images, only it shows the flow of blood through the veins. They were looking to see if portal hypertension was developing. (As the liver scars, it starts to send blood through other vessels creating extra blood pressure through them. It can cause lots of complications.)

The team rounded about 10 a.m. It was a big group, about 15 people, including his GI Dr. Horslen, his transplant coordinator, nutritionist, and others who specifically follow him. They had looked at the ultrasound and the labs from the night before and at his labwork. Both looked as good or better than they had in April.

Dr. Horslen came back later in the day to talk to me and said he was very glad we’d come. He’d imagined he’d find Patrick in much worse shape after the reports he’d been getting. He did a physical examination, too, and then said that he didn’t think Patrick’s liver was really in bad shape yet. He said that the problems with his spleen were probably mostly due to the many months of infection that Patrick has been through, meaning that hopefully when he’s healthy, his spleen will improve, too.

We discussed other goals, too… including taking down Patrick’s ostomy and replacing his PICC line with a broviac line when he could have surgery. We’ve been going the rounds on the question on whether or not Patrick should have his g-tube removed, too, before portal hypertension makes it bleed and be more difficult to close. However, Dr. Horslen said he was under the impression it was unused when he recommended that, and that if we were using it, he’d be ok with us leaving it in.

It was great to talk to him and to watch him play with Patrick. Not only is he brilliant, but he has a wonderful bedside manner. It made me happy to remember that there was at least one big reason why we chose Seattle Children’s for transplant.

We also had visits that day from the nutritionist and a care coordinator. And then in the afternoon we got to have a little bit of lazy time. Child Life brought Patrick some bubbles and it was fun to watch him experience those for the first time.

When the nurse came on the night shift and Patrick was playing with her while she took vitals she frowned and said “Do you really have to go home tomorrow?” I was surprised because I’d expected to need to be there at least through the weekend… But before midnight they had me making lists of what would be needed for me to be able to go home on the 5 p.m. flight the next day.

Rounds in the morning confirmed that they felt Patrick could go… assuming that we made sure he got a visit from Dr. Reyes, his surgeon.

The rest of the morning I packed and kind of waited for word that we were really going. A volunteer came to play with Patrick so I’d have hands free. About noon, I still hadn’t heard one way or another, so my nurse started making calls for me. I looked at flights and now there was only 1 left and the price had doubled. But – the insurance company agreed they’d rather pay for extra airfare than another night in the hospital – and so I started working on booking a flight home.

Dr. Reyes came in about 1. We talked again about the importance of taking down Patrick’s ostomy. He told me a bit about starting intestinal transplants in Pittsburgh 15 years ago. (He was on the team that did the first ones.) And he explained how they’d learned that the surgery wasn’t really effective without a strong GI team behind it to make sure the patients stayed healthy. He also explained that one thing they’d learned in that time is that survival rates are better without an ostomy.

I ran our other surgical plans past him (liver biopsy, broviac line, and possibly g-tube.) He looked at me and said, “Leave the g-tube in. He’ll need in later.” So I guess that settles that.

He left and I immediately went back to booking a flight. Meanwhile, the care coordinator came and brought me a cab voucher. My nurse got Patrick ready and booked the cab while I got the ticket. And I literally hung up the phone, put away a few things, and walked out the door.

The flight home went smoothly. Howie was there to meet us. We had some adventures waiting on the way home including a flat tire, a broken jack, and eventually a tow home. But at last, we are home.

They discussed Patrick’s transplant status in their meeting yesterday. They were ready to move him back to status 1 for a small bowel. They will not yet list him for a liver. When they checked his labs, though, they found a blood culture positive for infection… so the doctors are discussing what to do now. He’s not sick and it could have been a contaminated sample. But they have to work that out before Patrick’s listing is made active again. Time will tell.