November News

2020 seems to be flying by! I guess that's a good thing for most of us! Here's a quick rundown of Verity's recent medical checkups...

UROLOGY:

You may remember poor li'l Verity had 6 UTIs in the February - September time frame. After her last one (diagnosed 9/10/20), following her 10-day stint of antibiotics, the doctor put her on a prophylactic dose (preventative) twice a day. When we saw the urologist on November 18, things were looking good! He dropped her prophylactic to just once a day, with a slight adjustment for her weight gain. Verity's weight is now at 25 pounds, 12 ounces, length just about 35 inches. Since her recent abdominal scans looked good, we are all content with not having any more immediate follow-ups, just returning to our regular schedule of checking in with him every 3-6 months unless we somehow have another UTI.

NEUROLOGY:

This consultation came as a result of Verity having her first seizure in September, which coincided with the onset of her 6th UTI. To our knowledge, there has not been a repeat of this incident--and she is very carefully monitored day and night (at least with machines, even on the nights we have no nursing and rely on our parental instincts and alarms!). Basically, the neurologist told us Verity gets a big fat PASS because of her genetic condition PLUS having the infection present with the one event. This means she isn't going to jump into putting Verity on any medications, which is just fine with us. However, we did discuss in detail what to look for and what to do if something like this happens again. Also, she gave us a prescription for a rescue medication to have on hand (one for at home, one for our diaper bag) in case there is an emergency and Verity has a seizure she doesn't come out of within five minutes. Just having that sets my mind at ease, because even though we haven't seen any evidence of seizure activity, we know it can become a severe problem for many Trisomy kiddos.

UPCOMING APPOINTMENTS:

Orthopedic/Clubfoot Clinic

Opthalmology 

Gastro/Dietitian

Thank you for following our journey and caring about our girl!

Update: Spring Appointments

Recent posts have detailed the couple of respiratory illnesses that Verity had in March and April, so now it's time for a general update on the slew of other appointments we've had over the past few months! October was our busy month in the fall as the referrals finally went through and we started seeing her specialty providers, and April of course was the 6-month mark for follow-up. So here is the list of what all we've been up to!

March 22: Pulmonology
The pulmonology follow-up was scheduled even before Verity's first illness struck, but it was timed well as she had been out of the hospital about 10 days or so. At that time her lungs sounded amazingly good, and since we had never had any lung issues before, the doctor said she would leave it up to the Sleep Clinic doctor as to whether or not she would continue to follow Verity. Of course, little did we know that Verity would have pneumonia about a month later! Sleep clinic is scheduled for May 25...

April 2: Ophthalmology
We drove 45 minutes to get to Ft. Carson to spend a whopping 5 minutes with Dr. B, who assured us Verity's eyes are looking great and he doesn't need to dilate them again until our fall appointment. Okie dokie then.

April 17: Orthopedics
At this follow-up appointment we got another hip X-ray, which indicated her left hip is still stiff but not any worse than in the fall. Her feet are looking good and we are to continue using the bar (supposedly naps and nighttime but in reality more like 2-3 hour chunks a couple of times a day).

April 19: Pediatric Visit
We needed a doctor to look at Verity's umbilical hernia, which was repaired with her G-tube surgery May 2017 but has been flaring up again recently. She ordered an abdominal ultrasound. (This is the day we realized Verity was getting sick, and at 3am the next morning we took her to the hospital, where she was diagnosed with aspiration pneumonia.)

April 24: Renal ultrasound and barium enema
The ultrasound looked normal (per the follow-up the next day), and the barium enema did not reveal any particular reason for Verity's difficulty pooping, although it did show a "tortuous" pathway. (Once she gets started going she does pretty well, but we frequently have to give her a liquid suppository to start the process.)

April 25: BAHA fitting
Verity got her Bone-Assisted Hearing Aid, which fits on a headband! We learned lots of details about how to use this device and have a whole bag of STUFF to go along with it. She wears it in stints, as it is very overwhelming for her to have it on all the time at this point. Slowly we are working up to it! She isn't terribly responsive, although we know for sure when she is DONE!

April 30: Adaptive Stroller Shopping
We went to an equipment provider that we know of through The Resource Exchange (our home therapy program) to look at and take measurements for an adaptive stroller for Verity.

May 3: Echocardiogram
Our cardiologist is very optimistic about the way Verity's heart looks right now. Her large VSD has completely patched up! She still has a teeny tiny one that causes her heart murmur, but everything is balanced, and he does not think PH will be a problem. Whew! He feels comfortable waiting another year before we do another echo.

May 4: Post-hospital follow-up with PCM
Verity had been off oxygen for some time before we had this appointment, and she looked quite well. Her PCM was pleased.

May 7: Abdominal ultrasound
This was a pretty quick appointment, but we didn't hear anything about the results until I asked a week later. We have a referral to see a pediatric surgeon since clearly the hernia is there.

May 15: Dietitian assessment
Our Verity weighed in at 14 pounds, 14 ounces!! And she is 26 inches long now!! In less than 2 weeks, she will be 15 months old...15 pounds by 15 months!!! Clearly she is growing and thriving on the Nourish formula. Now that she is 100% on this whole-foods mixture (plus plenty of water), our next step is to meet with the GI doc and formulate a plan for compressing her feeds so that she can get on more of a bolus feeding schedule. Her vomiting can still be a problem, particularly when she is bearing down to poo or pass gas, but it is much less frequently to be sure. I'm not going to lie...I would LOVE for her to not be hooked to the feeding pump 24/7. But...counting my blessings. Our baby is growing and thriving and becoming SO much stronger and sturdier!

In between all the above listed appointments were nearly weekly visits to the chiropractor as well as nearly weekly occupational and physical therapy sessions in our home.

COMING UP:
May 25: GI follow-up and Sleep Clinic

May 31: Surgery consult

June 6: Speech evaluation

June 7: BAHA check

Whew. That's all for now, folks!!!

Genetics Appointment

On Friday we drove to a Denver-area children's hospital to meet with a genetics counselor and doctor. I honestly wasn't sure what the purpose of this appointment was, but even though we didn't gain a huge amount of information, I still think it was beneficial.

First things first: Verity has gained weight! As you may remember, we switched to a 24/7 continuous feed when we saw that she had been losing weight with all her terrible vomiting issues. In exactly one month, Verity gained 13ish ounces, so she is now 13 pounds, 3.1 ounces. And she is now exactly 2 feet long!

One wonderful thing: we were given a hard copy of the Care Book, which is a resource from SOFT (Support Organization for Trisomy 18, 13, and Related Disorders). I had started reading the online copy, but to get all 70-some pages in a printout was wonderful and told me right off that this doctor is up-to-date with the research!

As an aside, we ONLY support SOFT as a resource for those with trisomy conditions. There is another organization out there that is much more negative. If you feel led to support an organization, please, please, PLEASE ask someone before throwing your money at what seems to be a worthy cause but maybe isn't really what it seems to be.

Back to the appointment: We answered lots of questions, reviewed Verity's history, and talked about possible resources for us within the Children's Hospital network, some of which may be helpful but others maybe not as much because we are already getting great care in our more local area. The one piece of info that I think can help us tremendously is knowing about a couple of other ways to know for sure what Verity's caloric needs are--we can't seem to get her total intake up to the volume that the dietitian and GI doc would like to see, and I can't help but wonder if she really doesn't NEED that much. Clearly she is gaining weight, and she looks so incredibly healthy! (Praise God for that!)

We don't need to have a return visit for another year. Dr. L said that mostly he would like to check in to make sure that we can have the most up-to-date research and information and discuss Verity in particular and see what she might need. It was very refreshing to have such a perspective from someone in this field, as I have heard awful stories from uninformed doctors who make outdated assumptions. We are grateful that the many caregivers in Verity's life are so supportive and either already knowledgeable or else very willing to receive new information.

Pulmonology

Today, a visit to the newest member of Verity's Village: Dr. Tina, our pulmonologist. After chatting with other Trisomy moms, I am kind of amazed that we haven't made it into the Breathing Institute before now, especially since we already did a sleep study! I guess typically those are ordered and evaluated by a pulmonologist, but anyway, the important thing is we had a study AND that today we had the opportunity to speak with another specialist. Even though Verity has had oxygen at night, we have not noticed ANY improvement in her sleep patterns, and if anything, it has been even more difficult because she hates the nasal cannula!

Here are the notes from today's visit...but first, the exciting news: Verity is ALMOST to 13 pounds! Her weight today was 12lb, 15.4oz, a nearly 10-ounce gain since December 19 when we discovered she was losing weight. So, the continuous feed is working! (She has had a few vomiting episodes, but not nearly the volume as before--we can tell she still suffers from reflux, but at least she is keeping most of her food down.)

Dr. Tina would like Verity to go back to the sleep clinic, this time with the intention of looking at CPAP/BiPAP. She thinks we can do better with having Verity do some desensitization with a mask prior to going in, and then having the specialists adjust settings to see what works best for Verity. My only fear with all of this is...how will Verity suck on her pacifier with a mask?! LOL But hopefully if she is able to breathe well, she can sleep deeply and not wake every few minutes wanting her pacifier...?

Because Verity has not had any respiratory infections or pneumonia, Dr. Tina doesn't feel she needs a bronchoscopy at this time, something that most Trisomy 18 kiddos end up having (this is a test that requires sedation). I was reluctant to push for one just for the sake of having one--I really like this doctor and trust her judgment.

Finally, she is putting in a request for us to get another pulse-oximeter, which we haven't had since we turned ours in when we left Omaha. Our ENT didn't seem to think we needed one, even though Verity's sleep study showed her sats went as low as 74%!! So, I will be glad to have one so we can monitor her more regularly.

GI and Urology Test Updates

My poor baby is crying...so this will be as quick as I can make it.

The upper GI and SBFT showed that Verity's anatomy looks just fine, but stuff moves slowly through her system. Not surprising. Poor baby--that was a rough day, with them having to give her barium multiple times because she kept vomiting it out.

The good news is that she is doing very well with the 24-hour continuous feed. We are currently at 26ml/hour during the day and a bit lower at night (because she did struggle with reflux recently and we are being cautious). We are to increase by 1ml/hr every 2-3 days until we get to 30ml/hr, and then after she is stable with that amount, we will work on cutting the time down while maintaining the volume so that she can have some tube-free play time.

At the urology appointment today (which was scheduled because of her two UTIs in the fall), Verity weighed in at 12 pounds, 12.8 ounces! She was down to 12 pounds, 5.9 ounces when we last saw the GI on December 19.

Today was a hard day. Ted took the day off because the tests were up north, and we decided to have him take Verity with our nurse. I'm thankful he was able to do that--it sounds like it was an absolutely awful time. :-( The renal ultrasound went well. The VCUG got off to a rough start since they had to cath her FOUR TIMES, finally calling the urologist himself to do it. Grrrrrr.

The scan showed that she does have some renal reflux; the urologist called it a 3 out of 5 and at this point only wants to follow up with another ultrasound in 3 months unless she gets another UTI in the meantime.

As I said, it was a rough day, and there was much screaming, crying, vomiting (from the screaming and crying), and more screaming and crying. She is finally pretty quiet--she must be exhausted, poor dear. I know it will be painful when she urinates the next few times, so prayers for quick healing would be appreciated.

More thoughts later when I'm not so tired...

More GI Discussion

Sad news: Verity has been losing weight. She is down to 12 pounds, 5.9 ounces, from a high of just over 13 pounds.

Good news: We have a wonderful doctor. Every time we meet with him, he confirms what my instincts are telling me and helps us see clearly what our next steps for helping Verity should be. I have heard horror stories of not-so-great doctors, and I am beyond grateful for the ones who have been helping us along with our Verity journey.

Notes from today's GI appointment:

1. We are going to switch to continuous feeds of 23ml/hr for 24 hours a day. If this seems to work well, we will increase her feeds slowly until we get to 26ml/hr. We will continue to give Liquigen to boost calorie intake.

2. If we continue to have vomiting issues, we will try Elecare (a formula) at the same rate.

3. We can then work towards consolidating to 18 hours per day of feeds.

4. Upper GI/SBFT as soon as possible 

5. If the new feeding regimen is not helping and there is more than a week's wait for the Upper GI, then we can admit to the hospital for further workup and trials of NJ or GJ feeds and consideration of fundoplication.

UPDATE: 

After returning home, I was able to call and schedule Verity's GI series for TOMORROW morning, December 20. This test may take up to 4 hours as they watch the barium travel through her digestive system. Please pray that they can see clearly whether there are any anatomical issues that need addressed; also, please pray that over the next few days we can see whether the continuous feeding may be enough to address our current concerns. If we need to do this for awhile to get some weight on our girlie, then so be it. If further intervention is needed, then we pray that will also become very clear to us.

Verity's Vision

On October 3 we saw a pediatric ophthalmologist to assess Verity's vision. I was pleased to hear he had worked with other Trisomy 18 patients, and he was obviously well versed in our kids' needs. I was also pleased to hear that Verity's eyes are in good shape: her optic nerve looks fine; she is a bit farsighted (common for this age), but at this point she does not need little bitty glasses (somewhat common for T18 kiddos). Dr. B wants to see us again in 6 months and especially wants to monitor her right eye because of the slight droop. (It's so endearing to me, but I didn't think about how it could affect her eyeball!)

Current Events with Verity!

In a recent update, I mentioned that we may have found some solutions for Verity's reflux. I had to leave it hanging, hoping to be able to detail our new feeding routine sooner rather than later. Facebook is faster than blogging, so I posted a video a few days ago about the open syringe gravity feeds we have been doing for Verity. I'm hoping that even if you aren't on Facebook, perhaps you can view the video? If not...just know that it has made a huge difference overall--no vomiting at all!--and while we aren't totally rid of the tummy issues, the lack of spewing out of her mouth and nose has made her AND us much happier. Our T18 babies unfortunately just have lots of digestive issues due to their smaller physiques or other anatomical issues. (She is fussing and grunting in the background even as I type...her daddy is with her, though, so I'm sneaking some time here.)

I've been on overload the past couple of weeks. Now that Verity is in The System and referrals are coming through, I have spent an extraordinary amount of time on the phone and/or dealing with paperwork. The good news is that my calendar is filling up with appointments. The bad news...is that my calendar is filling up with appointments. :-/ Here's a rundown of what we've been doing the last couple of weeks JUST related to Verity's specialty care:

18 Sept - Chiropractor appt
19 Sept - Physical Therapy (at our house)
20 Sept - Occupational Therapy (at our house)
21 Sept - 40-minute phone consultation with dietitian
21 Sept - Physical Therapist & Vision Specialist visited/assessed Verity

26 Sept - Physical Therapy (at our house)
28 Sept - morning - Meeting with Dietitian (at our house)
28 Sept - afternoon - Occupational Therapy (at our house)
29 Sept - morning - GI appt
29 Sept - afternoon - Chiro appt

Note this does NOT include all the time on email and the phone setting up future appointments, dealing with getting new medical equipment from a local medical supply company (feeding pump & supplies, suction machine...), fending off calls from bill collection agencies, contacting TriCare, contacting TriCare again, finally getting TriCare to pay for all the stuff they said they'd pay for...

The Resource Exchange (TRE), which is (I believe) the equivalent of Iowa's Early Access services that we were getting before moving, has been fabulous in working with us regarding our immediate goals of helping Verity with her feeding and sleeping issues. I am very fond of the ladies we see on a weekly basis at this point, and I am immensely grateful that they come to our house instead of me having to pack up and go somewhere. They are very flexible, also, and when it works out, Christine (PT) and Susan (OT) try to come at the same time...it just hasn't always worked out.

Upcoming appointments, aside from TRE meetings:

3 Oct - Ophthalmology
16 Oct - ENT (for requesting a sleep study)
17 Oct - Orthopedics
26 Oct - Cardiology

And don't even get me started on all the different dates I will be dragging children to our new dentist's office for overdue cleanings. Sigh. I hate moving.

But...finally we are moving forward with our continued commitment to providing Verity with the best care we possibly can.

Doctor Input...Finally!

After two months, Verity finally had an appointment! I never thought I'd be so happy to take her to a doctor, lol. After her first several months of life, with multiple appointments each week, I thought I'd enjoy a bit of a break so we could focus on our move, unpacking, getting settled, etc. And it would have been fine if Verity's condition hadn't changed once we moved to Colorado!

Anyway, we saw our new military pediatrician, Dr. Hatch, and I like him just fine. He's not Dr. Toth, who did happy dances every time he saw us because of how amazing Verity was doing, BUT I will give him the benefit of the doubt since he needs to get to know us, ha! I did feel bad for him because, despite our best efforts (including an in-person visit by my in-uniform husband ahead of time), somehow he was not given any of Verity's information beforehand...so I spent a half hour waiting with a nearly naked Verity in the exam room while he went through paperwork to acquaint himself with Verity's file. Verity passed the time by soiling two diapers and made a FABULOUS first impression by having a full-on blowout on the table just after Dr. Hatch came in the room. Ha!

So, the rundown: Verity is 11.6 pounds, 22.5 inches. She has only gained one pound in the last 2 months, but she is proportional and following her own growth curve, and Dr. Hatch was not concerned about that. I was relieved, because when I realized her weight gain was only one pound, I immediately began worrying that her reflux was harming her growth. :-( But he is pleased with how she looks overall and stressed that she has her own growth curve and based on that, she is doing great.

Everything we talked about went onto a notepad, and he granted everything we asked for as far as tests and referrals PLUS some we hadn't specifically addressed. His nurse called me early the next morning to confirm the vast list of referrals, which include GI, orthopedics, cardiology, ENT (for a sleep study), ophthalmology, PT, OT, neurology, genetics...and I don't even know if I've listed everything! (My list is hastily written elsewhere...)

Meanwhile...we still had a really rough week with Verity's feeding and tummy issues, but we may have stumbled upon some solutions. I will have to leave you hanging, though, because it's time for AWANA! Plus, I want to give our new protocol time to see what happens. But the good news?

Verity slept for 8 hours last night!!!

GI Scope & G-Tube Surgery

On Monday Verity and I returned to Children's Hospital for a GI evaluation. She had to stop eating 4 hours beforehand, but thankfully she was pretty sleepy in the early morning. The scan itself didn't take very long, but it was strange and a bit sad to see her strapped on her back to a board with large velcro bands covering her tiny body! Her arms were raised so her little clenched fists were above her head. Once the doctor was ready, the tech rotated her on her side and fed her barium from a bottle. I was glad to see that she did suck and swallow from the bottle! After a bit of this, they did switch to a syringe. Similarly to the swallow study, we watched as the barium made its way down her esophagus and into her belly, but then it went further: her stomach seemed to swell up like a balloon as the barium filled it and made it light up on the screen.

Verity was such a little trooper. She had some reflux, and since she had been dealing with congestion for a few days anyway, it was a bit of a mess that I got to clean up and comfort her before we continued the test. After her tummy was all the way full, we waited and watched...and we did see some reflux that didn't come out of her nose/mouth. Granted, she was flat on her back, a position we NEVER have her in when we normally feed her! But still. It makes me wonder how often she deals with reflux like that.

The results of the test were then sent to the pediatric surgeon, with whom we consulted the next day. He agreed that the risks of a G-tube surgery would far be outweighed by the benefits to Verity, as she is doing so well overall. I was so pleased that he had obviously read some more current research about Trisomy 18, and we were on the same page as far as proactively improving her quality of life. I really liked this doctor--once again, we are so thankful for God's guiding hand in allowing us to meet with caring, compassionate doctors who are working on Verity's behalf rather than fighting us as so many in the medical community do when it comes to children with "dire" diagnoses.

The surgery could have been done the very next day had it not been for the fact that Charis and I left yesterday to travel to her regional speech tournament! So the surgery date is set for Monday. We would appreciate prayers for the doctor and medical staff as well as for Verity to do well under anesthesia and to recover quickly. The G-tube will allow us to pump Verity's food directly into her tummy, freeing us from the horrors of the NG tube she has had since birth!! I am grateful for the feeding tube for keeping our baby girl alive, but I will NOT miss the paranoia we have lived with being worried that it might come out, even more so now that she is alert more often and flailing her arms and hands so much.

We will continue to offer food orally--from the syringe and/or breast prior to starting the feeding pump. We will use the same feeding pump with her G-tube that we use now with her NG feeding tube. I will try to post a video showing you how we currently do feedings for those who haven't seen anything like this before. It was completely new to me when we began caring for Verity outside my womb...almost two months ago now! TOMORROW IS HER TWO-MONTH BIRTHDAY!!!!!

Swallow Study

Thursday was Verity's last appointment for the week, a swallow study to evaluate whether she is ready for/capable of eating orally. She wasn't allowed to eat anything for 3 hours beforehand, so we adjusted her feeding schedule accordingly. Since the appointment was in the morning, she was still pretty sleepy (she does her best sleeping after we wake up for the day!!). In fact, it was kind of hard to get her to wake up enough to feed well enough for the doctor and therapists to see much!

We started by using a tiny syringe to squirt a special liquid in her mouth with barium (I think?!) to make it show up on the X-ray. Once they were able to view her swallowing from the contents of the syringe, they moved to a bottle. I think she would have done better with this if she had been more awake, but at least the main encouragement was certain: there is nothing structurally that would prevent Verity from having oral feeds. This is definitely good news and encourages us to take the next steps and work hard to make sure she doesn't end up having oral aversions, as many Trisomy kiddos experience.

Can you see Verity's feeding tube?!
Her nose is pointing toward the left.

So, our plan for now is to start feeding her with the little syringe (1ml) about 10 minutes before normal feeding time. We will give her however much she will take until feeding time, and then do the rest via her feeding pump (currently using the NG, or tube through her nose, but planning to move to a G-tube which will feed the stomach directly). So far 3ml seems to be about her limit, but the good news is that she really enjoys it, though she has started to sputter a bit and not do quite as well toward the end, so it has been pretty clear when we need to move on. The nice thing about this transitional step is that we can involve the older kids, too!

I am also encouraged to continue attempts at breastfeeding, although I'm not terribly optimistic about this as she hasn't latched at all since before we left the hospital. We also have a preemie nipple we can use when we think she might be ready to try a bottle. She continues to suck well on her pacifier (though we have to hold it in her mouth).

I confess I am excited to get rid of the feeding tube; it is awkward and of course always keeps us on our toes trying to make sure it doesn't get dislodged. But I am equally excited about the opportunity to have some normalcy with feeding times! As Verity grows stronger and more alert, we look forward to feeding her in a manner more similar to her older siblings.

Hither and Yon

This week! Oh, my. I already posted about our GI appointment on Monday. It's late and my house is quiet, so I need to jump in bed while the opportunity is here. So I won't detail our adventures Tuesday, yesterday, and today, but here's a quick outline of what we've been up to:

Monday: GI Appointment
Tuesday: Echocardiogram and consultation with cardiologists; lunch for Mom and Dad; and then surgery for Verity's Achilles' tendons
Wednesday: No scheduled appointment; however, we made a trip to the ER when her feeding tube got a blockage. Sigh.
Thursday (today): Swallow study

Tomorrow Verity gets a break, although she has to come along to the military clinic for a couple of other family member's appointments.

Next Monday: Upper GI scope
Next Tuesday: Consultation with pediatric surgeon regarding placing a G-tube to replace the feeding tube...So we will presumably then mark another square on our calendar for the surgery.

Did I mention I have 8 other children?!?! Some days it seems I hardly see them. :-( BUT--I am extremely grateful that "out of the blue" three families from our church offered to bring meals this week, and I cannot begin to express how helpful that has been! I even got a much-needed nap this afternoon, the first in quite awhile.

And speaking of rest...bed is calling. We need to leave the house at 6am tomorrow for our appointments. I promise I will take some time this weekend to write about Verity's surgery and the swallow study results.

In the meantime, if you aren't already a member of our Facebook group Verity's Voice: A Trisomy 18 Song of Triumph, I invite you to look us up and see the new photo album I posted. Tuesday's events are also detailed there. I know not everyone is a Facebook user, but it's much faster to post updates there. But you'll get far more details here on the blog! I also hope to write more about what's going on in my mind (sometimes a pretty frightening place), not simply chronicle our to-do lists.

Going Rogue

About a week and a half ago, after asking for input from other Trisomy parents and having a doctor also weigh in with an opinion, we decided to "go rogue" and try an experiment for at least a week. I wanted to stop giving Verity the formula fortification that we've been adding to my breast milk. (Fortifying breast milk is typical protocol for smaller babes like our T18 girl so they can get extra calories to help them grow.) From arching her back to squirming and screaming and not pooping for several days in a row (and then it being a BIG ORDEAL when she finally did have a blowout), our poor Verity was clearly having tummy pains. I figured it would be worth investigating.

So starting Thursday evening, April 6, Verity began breast milk-only feeds. After 48 hours, we already were seeing a big difference. She was much more relaxed, and she hadn't really had any screaming fits--not like we had gotten used to dealing with. As time went on, another happy observation: she was no longer experiencing reflux! Before this change, massive reflux (milk spewing out her nose and mouth at the same time) was a daily occurrence, soaking everything and causing alarm because of the difficulty she would have breathing. It happened anywhere between 1-3 times a day. We utilized the suction machine almost daily, as the bulb syringe was not always capable of keeping up with the outflow.

Additionally, nights after dropping formula became--overall--more peaceful. While Verity wasn't exactly a great sleeper after the change, at least we weren't dealing with her painful screaming fits; the times she woke us up were more due to the discomfort she was likely experiencing because of her new castings or simply because she still has her days and nights mixed up. She loves to be held...which is all fine and good when it's 3pm instead of 3am!! Last night we had a happy surprise: Verity slept from about 8:45pm until after 5am! Was that ever a needed respite for her exhausted parents! We aren't sure if it's because we took her outside in the evening sunlight and tried our darnedest to keep her awake before starting her nighttime feed or whether it's because we diffused the Peace & Calming oil beside her swing during the night...but whatever the cause...it worked, and we shall try our best to duplicate it tonight, ha!

Anyway. Today was our follow-up with the GI doctor. Verity had been doing so well that I didn't intend to start adding formula to my milk again, but I did feel that I needed to be honest with him, especially since we were also consulting with a dietitian at today's appointment. Thankfully we had a track record of weight gain; I've been having Verity weighed between her castings, and she did gain weight despite not having the formula! Not a huge gain--from 6lbs, 13oz to 7lbs, 1/2oz. But still. She is trending upward, and equally important, she is a much happier, more peaceful baby! The doctor was pleased with how Verity looks; though he admitted that he had not looked at Trisomy 18 growth charts, he did say her growth is all proportionate. And he said he would look up those T18 growth charts!

The doctor and dietitian agreed that I can continue with breast milk only, but we are increasing her volume, which is something I was thinking Verity is ready for anyway, as she fairly consistently wakes before her scheduled feeding time. She and I also had a nice recreational nursing session late in the night a couple of nights ago, the first "success" I've had with that in a long while. We had a swallow study this coming Thursday and hope to begin transitioning to bottles (hopefully nursing at some point?), but it will likely be a fairly slow transition. Because of that, we are working on getting a referral for a G-tube surgery so that we can at least get rid of that HOSE, ahem, feeding tube in her little nose. :-)

So, new numbers: increasing from 400ml/day to 500ml/day, with 5 daytime feedings at 60ml and a 20ml/hr continuous feed 10 hours at night. We shall see how this goes!

Here is Verity, completely unconcerned in the GI waiting area!

Casting

Cast all your anxiety on him because he cares for you. 1 Peter 5:7

On Wednesday we had our first appointment at the children's hospital--the first of many, I might add. Kenna volunteered to go along as my set of extra hands, and I was grateful for her cheerful company as well as her willing help. It was a cold, rainy day, with poor visibility most of the way, always a joy when driving someplace new. Thankfully the free valet parking eased the stress a bit, allowing us to find the orthopedic clinic with a few minutes to spare.

Verity's clubbed feet the day of her birth

It was our impression that this visit with Dr. W would be a consultation, or an information-gathering appointment. Three different professionals (our NICU doctor, the physical therapist who visited us in the NICU, and our military pediatrician) had all indicated that anything we would do concerning Verity's clubbed feet would happen months down the road. So when Dr. W started talking about casting Verity's feet and the process she would go through, I asked when she recommended starting all of that. "Well, today! If you're OK with that," she answered, and I'm sure she was thinking, "Isn't that why you're here?!" I explained what we had been hearing on our end, and Dr. W responded, "The sooner the better!"

Well. I guess I should have done my homework prior to this appointment, but it actually did make sense that treatment would be easier and faster if we work while Verity is still newborn. In fact, Ted and I had thought in the beginning that intervention while her bones were still more pliable would be what the doctors would suggest. It was just a shift when we were thinking that nothing would happen before our move this summer, let alone immediately!

I called Ted at work to run it by him, and he said to go for it if I was okay with it. WAS I okay with it??!

I thought I was. It helped that Verity did very well on the table while the doctor quickly but tenderly worked. Verity had the hiccups, and she just lay with her eyes as wide open as can be (which for her isn't very!), looking around and shaking each time a hiccup came. She didn't fuss at all, which helped me feel that this wouldn't be so terrible.

But then the casting process continued right up her little legs! The doctor explained that the casts would just fall off if they only covered the feet or even just the lower legs. So, all the way up to the diaper line they went. A bit of smoothing and common sense reminders (sponge baths only, no signing or decorating the cast until after 24 hours) and the job was finished. I was left awkwardly holding my baby, trying (unsuccessfully) not to rub wet plaster on myself or the car seat as we buckled her in. By this time it was close to feeding time, and Verity was no longer hiccuping nor happy.

We stopped by the scheduling desk on our way out; the process really doesn't take that long in the scheme of things...only one week per cast, with 4-6 casts total, depending on how well the adjustments are made. The process is known as Ponseti casting, with the series of casts bringing the feet around to a neutral position. At the end there will likely be a minimally invasive surgery to lengthen the tight Achilles tendon. And then another cast will probably be in place for I don't know how long. And then we go to boots and bar to prevent recurrence.

During the long (and still rainy) ride home, I heard Verity make noises I've never heard her make before. She wasn't exactly screaming, but she was clearly unhappy despite the feeding that was going on. Her noises sounded like a cross between grunts and moans. It broke my heart, as did the memory of trying to hold her with her clunky casts.

What have I done?!

That's all I could think of the whole ride home. The driving rain didn't help my emotional state any.

I did some digging and asked some questions of other Trisomy parents. The rational part of my brain assures me that we did make the right decision; we are setting Verity up for success down the road. Doing this sooner rather than later will mean a much shorter time in casts, though we will have to be vigilant with the boots and bar process.

The fact that we are treating her club feet now rather than later is even a good sign; other T18 parents delayed treating their children because they were in a fight for their child's life in the beginning and had to deal with all kinds of other health concerns or even surgeries. And this makes me feel a bit silly getting so worked up about the casts.

But I can't deny that it hurts my heart to see my sweet little babe half covered by these clunky, awkward casts. She will only be teeny tiny for so long; I already miss cuddling her whole soft self and playing with her little feet. I can barely see the tips of her toes now. I loved squishing her heels; the way her feet were formed caused her heels to feel puffy, almost like a big bubble from bubble wrap packaging.

The first night with the casts on was brutal. Neither Verity nor we parents slept much at all. Last night wasn't much better. But the days have been good; it doesn't seem as if Verity is in much pain or discomfort. And while the casts aren't any less awkward, we're learning how to manage them. Grandma and I gave Verity a sponge bath this morning, and she loved having her hair washed in the warm running water as we held her over the sink. And the kids enjoyed signing the casts...perhaps we can get more creative with her later ones!

So, all in all, I'm trying to reassure myself that we are doing the best we can for Verity, and while the casts aren't my favorite part of helping her, they are a piece of her own unique story, one that is being written completely with love.

The First of Many Appointments

Monday morning we took Verity in to see our pediatrician at the military health clinic. I LOVE Dr. T, who has seen most of our kids during our time at this assignment. He is so compassionate and practical! I had taken Rhema to see him for her 15-month well-child appointment soon after we got Verity's diagnosis last fall, and I ended up in tears in the exam room asking Dr. T what kind of support they could give us if we were able to bring Verity home. His response at the time was so encouraging and reassuring! We had touched base with him last week via the NICU staff, plus Ted had met with him in person during his TriCare runnings around on base, so Dr. T was well aware of how things were going with Verity after her birth.

Our appointment was so incredibly positive. Verity had gained weight and was tipping the scales at 6 pounds, 1 ounce (up from 5 pounds, 12 ounces the night before we were discharged). Dr. T was practically bouncing up and down, he was so excited to see how well Verity was doing! He literally could not keep from grinning as he said, "I usually try not to be overly positive in times like this, but when I look at her and all her stats and how well she's doing--it's really hard for me NOT to be super positive about her!" Oh, happy day! He answered the questions we had, talked us through our assignment transition process, and noted the case worker would meet us next week. He also wanted to schedule us to come in next Monday so he can have an opportunity not only to check up on Verity but also see how we as parents will then be coping with everything after having some time to settle in at home. He noted that we will have plenty of appointments to keep us busy and didn't want to add to our stress, so he won't make us come in randomly--however, we can say the word and come in anytime we feel we need to. And of course he wants us to do the normally scheduled well-baby appointments.

I'm starting a list of questions to ask him at next Monday's appointment, to include whether we can try continuous feeding at night to allow us parents a wee bit more rest. I'd also like to know exactly what evaluations she will be receiving in the coming months. Here's what I do know...all these appointments were scheduled on our behalf before we even left the hospital:

29 March = consultation with orthopedics
19 April = echocardiogram, immediately followed by a consultation with cardiologists
23 May = audiology testing with possible additional follow-up immediately after initial testing if further tests/info needed
19 June = comprehensive medical evaluations (4 hours) with a host of specialists

It's that last appointment for which I'd love a breakdown; what exactly will this entail? Other Trisomy parents highly recommend a sleep study to check for apnea and a swallow study before bottle or breastfeeding. I'd like to know if those are scheduled for that day and if not, see if we can get something scheduled before we move in July. Verity will be nearly 3 months old by the time we have this comprehensive appointment; I have no idea if she will be able and willing to nurse prior to that time or not, but I intend to keep trying!

Meanwhile...we are just plugging away at home, trying to figure out how to not only keep Verity fed and happy but also the army of other people God has put in our lives! We are grateful to have both grandmas with us for a short overlapping time. Ted's mom will head back home in about a week and a half. Hard to believe she will have been with us about 2 months!! It has been such a blessing to have her here, and we will miss her AND the wonderful help she has provided. My mom is able to stay somewhat indefinitely, and I'm thankful that we will have her and her years of nursing experience to help guide us as we navigate our new normal.