Category Archives: Health

Dental surgery tomorrow

Callie is scheduled to have her dental surgery tomorrow morning around 11 am. We’ve made some progress at home with getting her to wear her Bi-pap, but she still won’t sleep with it on. After she’s extubated, our hope is that if she’s awake enough to scream about not wanting to wear the Bi-pap mask, her oxygen levels will be good enough so that she doesn’t need it. But we plan to go in armed with books and movies to keep her occupied in case that doesn’t happen.

We will post an update about Callie’s surgery either Tuesday night or Wednesday morning.

As an aside, people are usually interested in how our boys interact with Callie. We always say that they, naturally, adapt everything they do to accommodate her. This video shows just that. Isaac and Ezra had new Star Wars lightsabers, so one afternoon, Isaac decided to get some of the action on video. That turned into him wanting to make a little movie. And you can guess who he decided to cast as the heroine.

(Note: Callie’s glasses are just for play. Isaac and Peter recently got reading glasses, and when Callie had her eye exam, she cried when they told her she didn’t need any. So Nathan couldn’t help but get her a pair of fake glasses to play with.)

New problems

We’d like to thank everyone who has prayed for Callie and our family as we’ve dealt with her back pain. We were referred to a palliative care clinic at Brenner Children’s Hospital that deals with medically fragile children. Managing pain is one of their specialties, so we’ve been trying several combinations of medicines to try to find a magic solution.

A new, much bigger concern we have is that Callie needs dental surgery. For many people, this would be a basic, outpatient procedure. But with Callie’s high aspiration risk and her inability to protect her airway, this procedure will require general anesthesia, and she’ll have to be admitted to Duke Hospital.

Callie at the beach earlier this month. (Photo by Debbie Bagwell.)

This presents a few challenges for us. First of all, Callie has major anxiety related to anything medical. She loves her pulmonologist, Dr. Kravitz, yet still cries and begs to go home constantly when she has appointments. Another challenge is the fact that when she’s taken off the breathing machine after surgery, she’s likely to need her Bi-pap machine – which she hates. So we’re working with her now to try to get her to tolerate it.

We saw Dr. Kravitz last Friday, and as always, he’s already planning. As soon as he heard from the dentist that Callie needed dental work, he contacted one of the pediatric anesthesiologists and a doctor who leads the pediatric intensive care unit (PICU). Dr. Kravitz likes to plan for every worst-case scenario, then hope for the very best. Having him around makes us feel a lot more secure. He says that hopefully, she’ll wake up in recovery, need her Bi-pap minimally, or not at all, and be out of the hospital in 24 to 48 hours.

The procedure is scheduled near the end of August. For the past few weeks, and likely for a number more, we’ve felt overwhelmed, stressed and worried. We’ve seen some things worsen quickly, such as not being able to ride in a car seat more than 15 to 30 minutes without having to be repositioned due to pain and discomfort. Some things we can’t really pinpoint.

On a positive note, we had a wonderful trip to the beach a couple weeks ago. Callie loved sitting in the water, looking for sea shells and playing in the pool. It was nice to have such a good respite before the chaos of school begins.

Questioning our decisions…again

Callie has been doing well recently. She, of course, loves school and thoroughly enjoys her classmates, teachers and nurses. But one issue we’ve been dealing with the past couple of weeks is back pain. Callie has scoliosis (an “S”-shaped curve in her spine) and kyphosis (another curve in her spine that results in a “hunchback” look). This is nothing new, but it might be becoming more of a problem. Our back muscles hold our spine in place, and if the muscles weaken, the spine can’t remain straight.

As Callie continues to grow, the curves in her back will get worse. This affects her ability to sit, breathe and hold up her head. Callie’s back pain was so constant and severe that we took her to get X-rays last week. We were concerned that she may have fractured part of her spine, simply due to bone weakness all children with SMA have. Fortunately, the X-rays came back negative and we’ve been able to control her pain with medication.

Although we have chosen a palliative approach to Callie’s care, which focuses on comfort and quality of life over procedures that will prolong life, Callie’s pain was severe enough for me to start researching surgical options, particularly rod placement, for correcting the curve in Callie’s spine on the chance that it might add to her quality of life.

Although I had some hope, in the end I found what I expected: Surgery isn’t recommended for children Callie’s age. And although rods have been placed in children Callie’s age and even younger, the long-term effectiveness is still unproven. In addition, there are always risks for infections, respiratory, nutritional and orthopedic complications with this surgery. I also discovered that the non-invasive approach to scoliosis, a back brace, doesn’t prevent scoliosis – it doesn’t even delay the progression.

Surgery would put Callie through a major procedure that has no scientifically proven benefit, cause her tremendous pain and put her at risk for developing serious complications.

This disease is relentless. I wish we could save her from it, but we can’t. The past few weeks have provided yet another reminder that Callie will be healed someday, but it won’t be here.

Six!

Yesterday, we celebrated Callie’s sixth birthday. She took mini-cupcakes to school and for dinner, Zaxby’s was her restaurant of choice. Her favorite presents were mini Lalaloopsy dolls – a perfect gift for children with muscle weakness – and a tiny, shelf-sized guitar.

Despite a couple illnesses, Callie’s health has been good overall. She’s determined and continues to excel in school, despite needing frequent breaks. Her teacher and nurse are wonderful and regularly adapt activities and play time so Callie’s always included.

Birthdays tend to be bittersweet for our family. It was around Callie’s first birthday that she was diagnosed with SMA. With each year, we’ve watched her personality and intellect explode with curiosity as her body has grown more and more fragile.

We’re grateful that Callie has reached this birthday, and we are looking forward to the next.

Wedding fun (and other news)

Alicia, the bride, and Callie before the ceremony.

The event of the spring for our family was my sister’s wedding. Alicia got engaged last August and asked Callie if she would be her flower girl. So from August until April 19, when she started down the aisle in Nathan’s arms, flower basket in hand, she talked constantly about her upcoming job.

And boy did she relish her role! With a happy, yet serious, smile on her face, she dropped the petals one by one—on her way in and out of the ceremony.

Nathan helps Callie, the flower girl.

The wedding couldn’t have been at a better time because Callie has had several illnesses this spring—some before and some after the wedding. She would’ve been heartbroken if she had missed the wedding.

As always, those illnesses took a toll on our family. We’ve been concerned because she’s never had so many problems in such quick succession. With each illness she becomes weaker and as a result, more vulnerable to complications. She finished her most recent course of antibiotics a week ago, and we’re anxious to see her return to her typical strength.

For now, we’re looking forward to our extra time together this summer before our big girl heads off to kindergarten in the fall.

Chipper again

Good news — Callie is back to her chipper self. She pulled through what we hope has been the worst of this illness.

Callie has always been a happy girl, and she’s never lost her spunk even when she’s sick. But each time she’s ill it’s a reminder of how incredibly fragile she is. We called the Hospice nurse out to our house twice on Sunday night because she was doing so poorly and we weren’t sure what to do. At some point, there really wasn’t anything else we could do except wait things out.

Fortunately this morning, after having slept the vast majority of Sunday and Monday, Callie really turned a corner. It’ll take some time for her to recover — we’ll still have aspiration issues to deal with — but it’s amazing to see once again all the life she has in her.

A difficult weekend

Callie has had a rough weekend. What started as extreme fatigue late last week seems to have turned into aspiration pneumonia.

We’re thankful to have good guidance from Callie’s doctors and nurses, access to medicine and medical equipment and the support of friends and family. As usual, our goal is to help Callie rest and recover at home.

We’ll post more updates as things change.

Summer news

Next week Callie will start her last year at Child Enrichment Preschool. Summer has been enjoyable and fleeting for our family. We live near a YWCA where our older boys have been swimming almost every day. And Peter and Callie enjoyed their 3-day-a-week summer preschool sessions.

In early July, Callie had an appointment with Dr. Kravitz, her pulmonologist at Duke. Her lung tests looked good in that they’ve pretty much stayed the same with no decrease in capacity that we can tell.

Since Dr. Kravitz is Callie’s primary specialist, we also discussed our continued commitment to a palliative approach with Callie’s care. With SMA, there is no treatment, but there are many interventions that can be done. It’s easy for us to cling to the idea that these interventions can somehow save her. They can buy her time, but at what cost?

Callie’s spine is now curved forward and we know that eventually it will impact her lung function, if it hasn’t already. We could put rods in her back, but we’ve chosen not to. Even if we found a surgeon willing to operate on her, it would take Callie away from everything she loves: her school, her home and her family. She would be in tremendous pain. And to what end? What would be next? As horrible as it is, our little girl was not made to survive.

I have a friend who was watching her husband die from ALS. She said to me recently, “I’m trying not to make selfish decisions.” That’s how we feel as well. And truth is, the longer we prolong Callie’s life, the more we put her at risk for more complications and more pain.

There’s a different kind of pain associated with SMA that Callie is now experiencing: the pain of knowing she’s different. She talks a lot about walking. We’ve been honest with her and have told her that she will walk when she gets to heaven. But just a few days ago, she asked Nathan if he would teach her to walk.

This summer, with the help of our children’s social worker with Hospice, we took our older boys, ages 10 and 12, out for an evening and told them that Callie is likely to die from SMA. Back in February, two days after her birthday, we almost lost Callie. She’d already been sick, but suddenly her muscles were too exhausted to coordinate her breathing. Her oxygen levels dropped, her heart rate spiked and she turned gray. We had to force oxygen into her lungs and it took a total of 8 mg of morphine to relax her muscles enough to where she could coordinate her breaths on her own again.

Our oldest son was at a friend’s house that night. We realized he could’ve come home and his sister could have been gone. We don’t want our children to feel the responsibility of adult problems, but because of SMA they do have adult problems and we need to all be able to talk about it honestly.

Last week we went to the beach with my family and had a great time. Callie absolutely loved it! We took her bath seat and put it in the sand and let the waves wash up to her.

We also had an unexpected surprise: My little sister got engaged while we were there! The wedding is set for the spring, and Callie’s been asked to be the flower girl. She’s very excited about getting a pretty dress and the importance of her job. She could drive her wheelchair down the aisle, but I’ve been thinking that maybe her daddy should carry her down the aisle.

Good news

Callie is getting better. She has been stronger for the past few days. She has been awake more and was able to go to school for a few hours at the end of last week. We hope she’ll regain her full strength this week.

We’re still doing breathing treatments, but she finished her antibiotics today. Aspiration has been less of a problem the past few days. Her doctor saw her a few days ago and said her lungs sounded a lot better.

We’re grateful and relieved.

A health update, part 2

Callie is still sick, but we’re hopeful she is getting better. Today, her pediatrician said her lungs sounded much better than they sounded Thursday.

We are grateful for this good news because there have been times in each of the past few days when we thought Callie might not fully recover from this sickness.

On Thursday night she suddenly was unable to breathe properly. With help from her doctor, nurses, bi-pap machine and medicine, she got through that frightening hour. Both her pediatrician and her pulmonologist (who was in touch with our pediatrician) thought Callie possibly had a mucus plug blocking the flow of air in one of her lungs. We also know that fatigue was a big factor.

Since Thursday Callie has slept a lot. When she’s not asleep, we often are using cough assist, chest physiotherapy, breathing treatments, oxygen or medicine to control her symptoms. These therapies help Callie rest. Rest is key to her recovery.

Callie continues to aspirate on food and drink. Since she’s on two antibiotics, she should be safe from infections that can result from aspiration. Over the next week we hope she will regain enough strength to keep from aspirating as she prepares to go off her antibiotics.

Right now the only way to prevent aspiration is to stop feeding Callie orally. But telling Callie she can’t eat when she says she’s hungry would detract from her quality of life.

We’ll post another update in a week or so. We are thankful for the prayers, thoughts, comments and e-mails, and the invaluable support from Callie’s entire health care team.