16 Months Old!

Aberdeen is 16 months old as of yesterday! She weighs about 19.5lbs (8.8kg) and is about 29in long. She currently loves her classic stacking toy, sunglasses, lids, boxes, and turning everything into a drum. Silly Songs with Larry continues to be a winner, but she loves watching herself more than pretty much anything else (mirrors or phone in selfie mode).

Therapies are going really well. She is tolerating tummy time better and better and isn't nearly so defensive about food getting near her face! With more time on her tummy has come some brand new attempts at crawling!!! She is getting the hang of army crawling and has been getting into all sorts of trouble already. We honestly weren't sure that she would crawl. It seemed like she was making so much progress with her standing that she might just skip crawling. Being on all fours is really challenging for her, but she's figured out a method that seemed to suit her just fine. We are so proud of her!!!

Speaking of standing progress, she has started pulling up to stand all by herself in the last month! Since she was actively showing an interest in standing, her PT started her in the gait-trainer (basically, a really supportive walker). She's only been in it a few times, but she's really catching on to the idea of using her legs to propel herself forward! We're working on getting her a gait-trainer to use at home as well, which I think she'll love. 

We've had a lot of fun around here lately! Thanksgiving was great, we've been enjoying visiting family and lots of holiday festivities, including decorating the tree and lights at the zoo.

 

Aberdeen's medical appointments have continued to be frustrating and confusing following our crazy trip to Houston last month. Her local cardiologist insists that their measurements were NOT contaminated by the mitral valve regurgitation, and are still quite concerning, while TCH continues to feel that things are fairly stable at the moment. We just don't know what to think anymore. We're having all of her stuff sent off to Cincinnati for a second opinion, since we trust them wholeheartedly. Hopefully they can give us better insight on who to be listening to right now. We do our best to be informed and knowledgeable about Aberdeen's conditions, but in the end, we simply aren't cardiologists, and we need some help.

I won't lie, this past month or two have been immensely stressful for me. Between the complications associated with moving Aberdeen's care cross-country, and facing the one-year anniversary of so many of last year's difficulties, I've had to admit that I'm dealing with something akin to PTSD. I know that this is common amongst hospital parents, but up until recently, I thought I'd made it through everything ok. Dealing with so much doubt regarding her current care set-up is definitely not helping. Things just aren't running as smoothly here as they were in Cinci: I feel like we're constantly fighting the military to get her the care she needs, we're having issues with TRICARE that we never had in Ohio, and having everything split up amongst so many different facilities has run me pretty ragged. 

Thankfully, I have some really wonderful friends and family who arranged for me to have a much-needed night off at a beautiful resort out here. It isn't easy for me to admit when I've hit a limit and I am so grateful that I have people in my life who can recognize it for me and make it possible for me to recharge a little. Thank you, thank you, dear people. 

This next week holds lots of appointments, including another trip to cardiology in Houston to ensure things haven't changed. Hopefully all will go smoothly!!! 

1st Heartiversary and the Houston Saga

Sometimes, real superheroes live in the hearts of small children fighting big battles.

Dear Abby,

Today is a pretty emotional day for our little family: it is the first anniversary of your open heart surgery, in which Dr. Bryant closed your ASD and PDA. If I'm being totally honest, all of last November was quite trying, and remembering it a year later has been emotional on the whole. I will never forget the moment when Dr. Bryant came into your CICU room just days before your operation to tell us that not only was he not sure that this operation would improve your overall quality of life, he wasn't even sure that the operation would get you out of the hospital.  We had to try though.  Your respiratory episodes were getting more severe and more frequent, and your work of breathing had noticeably deteriorated. It was thought that it could be because of the holes in your heart, which he could fix, or it could be a byproduct of your hypertrophy and suspected airway issues.  Honestly nobody was sure.  But God watched over you and Dr. Bryant, and though the period immediately post-op was quite taxing, not only did the operation get you out of the hospital, it left you able to grow and develop in ways your body couldn't previously allow because of how hard it was working to keep everything simply functioning.

Only a few days ago we feared that this week may hold another heart surgery for you.  Thankfully, your team of doctors (which includes quite a few more nowadays) decided it was not yet time to have to face that fight again. We get to keep you at home, snuggling, playing, and hopefully celebrating an uneventful holiday season!

We are so in awe of how far you've come and how much you've conquered this past year. You fought through a life-threatening event mere days after your heart surgery, an additional procedure to repair the sternal wires that were damaged during that event, countless tests and procedures, a bajillion appointments and therapy sessions, as well as a cross-country move! You are absolutely amazing. As always, we don't know where the future will lead us, but today we are so thrilled to have you here with us and able to celebrate your miraculous journey. 

We love you so much, baby bird - our heart warrior!!!!

Love,

Your Mommy

__________________________________

The Houston Saga:

I made a harried post documenting our whirlwind trip to Houston last week, which I wanted to delve into in further detail.

After completing multiple echocardiograms in the last month that seemed to suggest that Aberdeen's hypertrophy was getting exponentially worse, we scheduled a surgical consult with the cardiothoracic surgeons at Texas Children's Hospital to discuss what options there were for Aberdeen at this time.

We ended up having to precede that visit with a trip to the San Antonio Children's ER last Monday night after Aberdeen spent a whole day presenting symptoms of what could have been heart failure (increased work of breathing, lethargy, sweating, etc). Naturally, by the time we reached the ER that evening, Abby had decided she was over whatever had ailed her and was acting 100% fine.  Such a stinker.  They sent us home and told us to follow-up with her local cardiologist the following day.  We did, but he said that as long as she was acting fine, we could keep her home until her scheduled appointment in Houston the following day.  She continued to behave herself, so we hit the road Wednesday morning and arrived to her appointment a full hour early!

Upon arrival at TCH, we were told that her appointment had been cancelled, because they had received word from San Antonio Children's that Abby was being transferred from their facility directly to the TCH CVICU.  We were obviously confused, considering that we'd been sent home from San Antonio Children's and were never even admitted.  No one seems to know where the breakdown in communication happened, but we were quickly assured that her appointment slot had not been filled, and we would be seen by the surgeon as previously scheduled.  We sat in the exam room for three hours after having vitals taken (we'd actually been sitting for four hours, thanks to our super-punctuality), without anyone ever coming to check on us. After some prodding on our parts, we were encouraged to go get some food, as it was still going to be quite a bit.  When we returned from dinner, we talked to one of the nurses (who was wonderful) about what could possibly be going on.  She explained that this surgeon was extremely meticulous in his consults and gave each family as much time as they needed to discuss and explore every option out there.  Cool.  We like anal-retentive people, especially if they're going to be potentially performing surgery on our child.  But good grief, it had been a long time to keep a 15 month old confined to either the car seat, exam table, or our increasingly tired arms.  Abby handled it like a champ though, thanks to some toys supplied by another awesome nurse.  Five hours after her appointment time, we finally met with the surgical team, who started things off by apologizing that our appointment slot had been filled after the mix-up with San Antonio.  Cue the confusion again, as we were told this HAD NOT happened.  Anyway....

The team was very thorough, as promised, but ultimately left us pretty crestfallen. Aberdeen's condition simply isn't one that is easily fixed, by any means.  The first option we discussed was a septal myectomy (removal of excess heart muscle).  I've explained previously about the thickened muscle associated with hypertrophic cardiomyopathy - here's the thing though, it isn't thickened normal muscle, the cells of the muscle itself are different, and even if they remove the muscle that is blocking the outflow from their heart, they cannot change the cell structure associated with hypertrophy.  That means it can grow back, and no matter how much muscle is removed, it wont reduce her risk for life-threatening arrhythmias and sudden cardiac death.  The surgeon explained that the risks of the surgery itself may outweigh the benefits.  He also explained that her size really impedes his ability to remove any muscle effectively at this point.  Ideally, they like to wait on this sort of operation until late childhood, once the aortic valve is large enough to use an entrance point to the left ventricle.  Meh.

The next option we discussed was heart transplant.  We'd been warned in the past that many facilities refuse to perform transplants on patients with Noonan's Syndrome because of the likelihood that things will not turn out favorably.  However, we know of a family whose son with Noonan's received a heart transplant at TCH in the last couple of years and is doing well, so we thought this was as good a chance as we were going to get if transplant became necessary.  However, because of Aberdeen's ongoing cranial issues and airway problems, the surgeon was not convinced that she would be a good transplant candidate.  While it felt as though he was saying that she wasn't worth trying it on, the more I thought about it, the more I think he was trying to say that she simply wouldn't make it through the process. Meh again.  However, Dr. Bryant wasn't sure her first surgery would make a difference for her and it absolutely did.

They essentially said that there were no good options, and with her not having consistent symptoms at this time, they wouldn't recommend any surgical interventions right now.  They did recommend sticking around Houston until Thursday to meet with the cardiomyopathy team to get their take on things and have another echo and EKG performed.  

We left (at 8:15 after a supposed 2:00 appointment) and crashed at a nearby hotel until her appointment the next day. On our way out we asked one of our new nurse friends about the whole filled-appointment thing, and she said that our appointment had NOT been filled. They'd scheduled four consults for that day; when ours was cancelled, they were down to three, and when ours was reinstated they were only back to four again. Ugh, whatever.

Day Two: Aberdeen received her echo and EKG right on schedule and a member from the cardiomyopathy team was in shortly to discuss the results with us.  The gradient associated with her left ventricular outflow obstruction was still quite high, however, it was nowhere near as high as the readings she'd received at her two echoes here in San Antonio.  In fact, it is almost exactly where it was when we she was last seen in Cincinnati in August.  CUE SO MUCH CONFUSION. The cardiomyopathy doctor drew us a lovely picture of Aberdeen's heart and explained that in the case of the two local echoes, the "gnarly" (his word, not mine) regurgitation across the mitral valve (also not good, but not as concerning as other things), was contaminating the measurement used to obtain her gradient. So, it didn't magically get better, the echo was simply being read incorrectly.  While this sounded like good news to us, ultimately it didn't make one bit of difference from the cardiomyopathy team's perspective.  They have literally NEVER cared about that gradient number - which we've always found hard to believe, I mean, they have to consider the quantitative data relevant at some point, right?  Nope.  Not at all.  The effects of HCM are truly a case by case thing.   One person may be horribly symptomatic with a gradient of only 50, while another completely asymptomatic with a gradient well over 200.  They really, truly only care about Aberdeen's symptoms, especially considering that there wasn't anything on the echo suggesting that she was experiencing pulmonary hypertension.  They do care about that potential for pulmonary edema and hypertension a lot though, and because of that actually felt like any muscle removed during a myectomy could have a very positive impact if she were indeed symptomatic.  We found this encouraging: if she does become consistently symptomatic, maybe there is an option we can try, outside of transplant.

While the cardiomyopathy docs made it very clear that the change in perception regarding her gradient number didn't matter to them, it does feel different for us.  We'd begun to feel like we were on a runaway train that was hurtling toward a brick wall.  Now, it feels like we're on a train that's going a little too fast for comfort with an unreliable conductor that may or may not run the train into a wall at some point.  Which feels...a little better, I guess? I don't feel as panicky, and am crying less than I was a week ago, so that seems good.

We left Houston with a Holter Monitor (a 24 EKG, essentially, to make sure she isn't having arrhythmia issues, as we may need to adjust her meds if that's the case) and plans to follow up in a month (with a local cardiologist visit - sans echo - in between).  I'm still concerned about some out-of-the-norm behaviors she's been exhibiting off and on, in addition to the fact that she hasn't really gained any weight in the last two months, when she had been steadily gaining since her heart surgery a year ago.  Ultimately, we'll just have to wait and see how she does though.  Going into Houston, I thought that sounded like the worse possible option - waiting.  Now, however, I'm okay with it.  I feel like everyone is on the same page now and she's being very closely monitored.  We're just going to enjoy our Thanksgiving and all of the wonderful moments we get with our precious girl!

Consults in Houston

We had Aberdeen's surgical consult at TCH yesterday. It was a very long, disappointing day. We're sticking around Houston today for some more appointments and I will update here as we know more. Abby's still acting like her spunky, smiley self, for which we are so grateful.

From Facebook last night:

Well, very little today went as hoped. Due to some confusing circumstances, we ended up waiting 5 hours past Aberdeen's scheduled appointment to actually be seen by the surgeon. He essentially said that there are no good options. They can try the myectomy, but because of her size, they really won't be able to remove much of the thickened muscle. And while removing what they can MAY reduce the risk of things like pulmonary hypertension, it won't reduce the risk of sudden cardiac death, arrhythmias, etc. Because of everything else she has going on (ongoing cranial issues, sleep apnea), he's not convinced she'd make a good transplant candidate. We've scheduled a last minute echo for tomorrow and will hopefully meet with the cardiomyopathy docs to get their take on things and determine if they think she needs to be monitored inpatient. We're pretty heartbroken right now and hoping for even a smidgen of better news tomorrow.

Update after today's appointments:

We just finished up with our appointments in Houston. You want to hear something completely baffling? It turns out, Aberdeen's left ventricular outflow gradient is no different than it was when we left Cincinnati...it never was. Her first echo here read a little higher than 100 because she was being a fuss-bucket, but the two really high, panic-inducing readings from the local cardiologist were inaccurate. Aberdeen's heart is a confusing place, and the regurgitation across her mitral valve (whose numbers can be quite high) was being mistaken for the gradient across the aortic valve (the outflow from the left ventricle). Apparently it was an understandable mistake given Aberdeen's anatomy, and we should only be doing echoes with a cardiomyopathy specialist from now on.

Just as the cardiomyopathy docs have always told us, the gradient number doesn't really matter, her clinical symptoms do, but it DOES mean that her condition isn't worsening at an exponential rate. It doesn't actually change anything the surgeon said yesterday - if she becomes symptomatic tomorrow, we'll still be in the same place we thought we were yesterday, but because she is currently mostly asymptomatic (she's had a weird day here and there that have given us pause, but her symptoms haven't been consistent so far) it isn't a discussion we have to have TODAY. Which we'll take.

They've upped her beta-blockers and are doing a Holter to make sure there aren't any underlying arrhythmias, and we'll follow up with TCH again in a month. We have to keep an eye out for all of the same symptoms of heart failure we always have, but I think I'll at least sleep a teensy bit better tonight.

Thank you so so much for all of the prayers and positive thoughts coming Aberdeen's way. 

15 Months Old!

Aberdeen is 15 months old today!!! That's right, today - look at me being all on time and stuff. She has gained all sorts of skills in the last month: giving kisses, making kissy noises, brushing her hair, and standing while hanging onto things for brief periods (without my help!). She loves waving at everyone and showing them how big she is. She is now just under 20lbs and is cutting a few teeth - oof. 

Things have been going really well in all of her therapies! We've taken a new approach with feeding therapy: everything is on her terms. She isn't actually eating anything by mouth yet, but she is playing with the food and occasionally even bringing it to her mouth, which is a huge step forward. Us trying to feed her was always a disaster, so if we can get her to a place where she is actually interested in the food, maybe we'll have a chance at making some progress. We aren't sure of how effectively she is swallowing these days, but we'll get to that in time. OT and PT are happy with all of the strides she's making as well!

The following pictures somewhat capture how active she is nowadays: much more interested in grabbing the camera than cooperating, haha.

We got to celebrate Halloween at home this year! Yay! She was teething and had a cold, but we still had fun getting her dressed up and walking to a couple of neighbors' houses (since it was still quite warm out. Oh, Texas). We had a chance to go to a pumpkin patch earlier in the month, and have been generally trying to do all of the things we couldn't last year while she was in the hospital. It was a blast.

On a less stellar note: things with Abby's heart are not going well. We had hoped that her obstruction would at least level out after the jump we saw in her gradient at her echo last month. Instead, however, it increased at an even faster rate, and is now in the 170s (it was 140 last month). We've been told that if her gradient were to reach 200, she would almost definitely be showing signs of heart failure. We are getting scarily close to that number now, and nobody is happy about it. We are so thankful that she's been asymptomatic up to this point, but we're now worried that with how significant her obstruction has become, if she were to start showing symptoms of heart failure, things could deteriorate quickly. Our local cardiologist called Texas Children's to update them on her echo findings, and they are working on getting us scheduled for a surgical consult. We really aren't sure what they're going to say. We're hoping that they'll be amenable to the idea of the myectomy (removing some of the thickened muscle), though last month they felt that she was still too small, and she really hasn't grown much since then. If this is still not an option, we may talk transplant, or they may tell us that we just have to wait and hope that by the time she becomes symptomatic she'll have grown to a more favorable size. We do not like the idea of rolling the dice and keeping our fingers crossed (option 3). When Abby does things she doesn't mess around. With the increasing obstruction, there also becomes an increased risk for an arrhythmia, and our local cardiologist doesn't know if we'd get a second chance if she went into ventricular tachycardia (such fun conversations we get to have).

I wish I could say that we are holding up great under the circumstances, but I have to admit, we're really stressed out and nervous about what comes next. We're really, really hoping TCH will have a proactive option.

 

14 Months Old!

Aberdeen is 14 months old toda...errr...this past Saturday. I have been terrible about keeping up

with these updates, for which I apologize. Truth be told, this move has been hard for me, and in trying to regain my balance, I've let some things fall by the wayside. I completely failed to send out thank yous for Aberdeen's birthday, which is inexcusable, and I continually forget to update y'all on our goings-on. I hope to fall into a groove sooner rather than later, but until then, please excuse my slacking.

We have taken Aberdeen to a lot of medical appointments in the last three weeks. Seriously, like, at least 20. We ran into some issues shortly before moving out here with the way we'd organized her care, but everything has worked out satisfactorily. We are seeing most of her specialists in San Antonio, but because she requires special anesthesia that is not administered by all anesthesiologists at all facilities, anything sedated/surgical will need to be done at Texas Children's Hospital in Houston, approximately 3 hours away. Because of this, we are seeing cardiologists in both San Antonio and Houston (we still needed a local contact to follow Abby between Houston visits), and will be making the trek out to TCH for all craniofacial/neurosurg appointments. So far I am pleased with the providers we've met - which I think is just about all of them - and we've gotten hooked into a great facility for Abby's therapies. 

Aberdeen has made this transition much more smoothly than I, and seems to be doing well overall. Unfortunately her echocardiograms suggest otherwise. The measure of obstruction of her left ventricular outflow is called a gradient. Aberdeen's gradient was approximately 80 when we left the hospital last January. In August, it was sitting around 100. As of last week, it is now at 140. This is not good. Our local cardiologist said that if he had his druthers, we would be moving toward surgical intervention in a matter of weeks, and would certainly have something done by the end of the year. The cardiomyopathy teams at both TCH and Cincinnati think we still need to wait. They agree that the number is concerning, but because she isn't showing clinical signs of being in distress or heart failure, it's important to get as much size on her as possible before going forward with another open heart surgery. This operation (septal myectomy) would involve the surgeon entering the heart through the aortic valve in order to remove the overgrowth of muscle from the ventricular septum. Right now, her aortic valve is very small because she is very small. The bigger she gets, the better the chances that this surgery will be effective. Right now, we're thinking this will probably have to happen in the Spring. Until then, we will continue with what we've been doing (meds, CPAP, etc), while being very mindful of Aberdeen's breathing and behavior. Our local cardiologist, being the more nervous of our team, will be following her on a monthly basis - which I don't mind at all. I'm glad the cardiomyopathy group is comfortable with watching and waiting, but I don't mind having someone breathing down their necks at the same time.

This first image shows the difference between a normal heart and one with hypertrophic cardiomyopathy - you can see how much thicker the muscle in the center of the heart is.

This next image is the difference between a heart with non-obstructive septal hypertrophy and one (like Abby's) with obstructive hypertrophy (aorta - aka red tube at the top of the heart - is blocked). If blood can't effectively leave the heart due to obstruction, it eventually backs up into the lungs, which is bad.

As far as all of her other specialties go, we're pretty much in maintenance mode. Most things are going pretty smoothly, and anything that may require addressing (i.e. neurosurg) is taking a back seat to cardiological concerns. 

At home, Aberdeen is really doing well. She has more room in this house to roll around, and had definitely started using it as a means of transportation. She has started babbling up a storm - she went from having no consonants to having at least 4 in about a month's time. She is even saying mama! It doesn't always seem to be in reference to me, but I'll take it! We're working on her transitions between laying down and sitting, and are working toward getting her standing without our help as well. We've been doing lots of hanging out with our friends and family here in Texas, and Abby has been very patient as we continue to get the house in working order. 

To sum up: we are very concerned about Aberdeen's heart, but happy with how she's behaving overall, I am stressed about pretty much all the things, Jameson is settling into his new job nicely, and the dogs are just happy the couches are back. :)

For your enjoyment, some pictures of the progress on the house...

13 Months Old, Texas, and 1st Cranioversary!

Aberdeen is now 13 months old!!! I know I'm late on this post, but it's for a good reason! Today is not only our first day in our new home in Texas, but it's also the first anniversary of Aberdeen's cranial surgery!  

As I watch Abby playing and laughing today, it's humbling to think that one year ago we were spending our first time anxiously waiting on B3 while Aberdeen was in surgery. While the experience was excruciating - we thought she would be having cranial surgery at about six months of age, not a mere five weeks old - I know that without it, we would have a very different daughter than we have today. Her poor little brain was so locked in by her fused cranial sutures that it couldn't grow the way it needed to without removing parts of her skull. Because she also has Noonan Syndrome, the neurosurgeon ran into some unforeseen complications - prompting him to say that the painstaking nature of the surgery figuratively shaved a year off of his life. I love the expression on his face every time he sees her now though, you can tell he's pretty pleased with himself - as he should be! There was no guarantee that Abby would be as interactive and present as she is without his concerted efforts. 

September 18, 2014

September 19, 2014

September 26, 2014

September 29, 2014

We went to Aberdeen's 1 year post-op follow-up about a week and a half ago and learned that eventually she will need another surgery to release the sutures that have refused since her first surgery (both coronals), but hopefully not for another year or so. He also said that we can consider her a helmet graduate!!! Her bones have healed enough that the helmet won't do much more at this point, so we can be done with it! Yay! They were thrilled with how playful and active she was - signs that her brain is not currently under undue pressure. 

We had a number of other follow-ups we had to check off before we could head down to Texas - all going similarly to neurosurg: some good news, some not so good news, doctors very happy with how she's acting. We finally completed all of her appointments last Friday, spent a week planning and packing, and boarded Abby's very first airplane flight yesterday!

It was a long, slightly stressful day, but all in all things went very smoothly and we made it safely to Texas.

We have been enjoying reconnecting with friends and family and look forward to what Texas holds for us (appointments begin on Monday)!

September 19, 2015