And that, my friend, is what they call (stoma) closure.

Waiting with her Tubie Friends bear - who also got a hospital bracelet

Zadie is now blessed with only the holes God gave her.  She went in last week to have her trach stoma surgically closed.  At the same time, the surgeon cleaned up the scar tissue at her Gtube site and made sure that was fully closed.  I was able to go into the OR with her and be with her until she was asleep.  The surgery took about an hour and a half.  The anesthesiologist told me after that she was easy to intubate, which is excellent news, since a huge reason for her being trached was how difficult she was to intubate.  It's another sign that her lower jaw has grown out significantly and her upper airway is vastly improved.  A lot of Pierre Robin kids get jaw distractions, and it was suggested as a possibility for Zadie at one point.  We're very happy we elected to wait and see how her jaw grew out on its own.   


All ready to go!

When I first got to see her in recovery, she was still asleep.  They extubated her while still in a very deep sleep so that she didn't cough.  I saw Dr. Bergman right after surgery, he said everything went great.  I asked about the main possible complication, which is when air gets trapped between layers of skin.  It can be a very serious complication.  He was very confident that it wouldn't happen, since they had tested the closure in the OR by pushing air through. 


Once she was awake, she was pretty cranky, which is what she's typically like after anesthesia.  But, her oxygen sats were awesome.  Upper 90s.  I was so relieved to see that.  One of my worries going into this surgery was that she was relying on the open stoma to breathe and she would struggle once it was closed.  Seeing the good oxygen levels really reassured me. 




Great numbers!

She was to be admitted for the night just for observation, and it took forever to get a room in the PICU.  Unfortunately, she couldn't eat or drink anything for 6 hours after the surgery.  She was getting IV fluids all along, but she was hungry and thirsty.  Once we got past the 6 hours, she was allowed liquids, which included jello, yogurt, ice cream, juice, etc.  Then, the next morning, she was finally able to eat real food. 










Her new bear got bandaids in the same spot Zadie did. 

First meal, 24 hours after surgery

Feeling great and ready to bust out

 

She got released on Saturday afternoon.  We took the dressings off on Sunday.  She was a little freaked out by the sight of the incision on her belly.  She was asking a lot of questions; why was there blood, how did the doctor cut her, etc.  I wasn't expecting that!  But, it's amazing to see her neck without a hole!  And it's amazing to hear her talk without hearing the air rushing out of the stoma. 

Escaping!

Every day, she shows me her belly and her neck and says, "Look, it's healing up!" and asks me to take a picture.  She's definitely a strong kid and I would love it if this is her last surgery and she can just be a regular kid now. 

Some info on decannulation and stoma closure: http://www.chop.edu/treatments/tracheostomy-and-decannulation#.VvGl2W_mqM8

I was and am a successful breastfeeding mother!

I'm very excited that Zadie and I were included in a kellymom.com article about the different faces of breastfeeding.

When you think of breastfeeding, it's usually a mom with a baby on her breast, but that's not always the case.  Zadie couldn't even drink from a bottle very well, so direct nursing was out of the picture.  Not only did her cleft palate make forming a seal in order to suck a bottle impossible, her small chin and tongue falling on her airway made everything even more difficult.

I did try to nurse her once, but she and I were too stressed out and I decided that it wasn't that important.  What was important to me was that she got what she needed, however she got it. We attempted feeding her orally every day, just about every feeding, using a Haberman, or Special Needs Feeder.  It has a special nipple which allowed us to squeeze the milk into her mouth while she tried to suck.  We only tried for 30 minutes at a time, because after that, we were told that she would be expending too much energy.  She was primarily tube fed for her first year.  Once her palate was repaired when she was 11 months old, she really got much better at drinking.  

I exclusively pumped for her for 18 months, and the majority of her nutrition for those 18 months was breast milk.  She was eating very little in the way of solids, but I was continually reassured (by doctors and nutritionists) that my milk was all she needed at that age.  We did transition to formula, with plans to further transition to a blenderized diet, but luckily for everyone, her solid food intake increased.

Flash forward to today, and I'm successfully nursing Zadie's 8 month old little sister, Beatrix!

Tonsillectomy

It's been a rough week!  Zadie had her tonsillectomy at CHOP on Tuesday.  She was scheduled to stay over one night.  The whole family went down to Philadelphia for the surgery.  She was scheduled later in the day, which was nice for getting a later start, but since she had to fast for the surgery, we all had to fast!  The surgery went fine.  Her adenoids had grown back a bit, so Dr. Javia shaved them down again.  I know that adenoids can grow back, but it's only been seven months since her adenoidectomy!  I hope they'll stay small.

Immediately after surgery, before she woke up

Cracking a little smile! A couple of hours after surgery

The plan was for BJ to stay in the hospital with Zadie overnight.  Jonathan, Beatrix and I were lucky enough to get a room at the Philadelphia Ronald McDonald House.  I will write more about the RMH in another post, because it was such an amazing place.  It was my first time at a RMH, and while I've heard nothing but good things about them, I just couldn't believe it.  For a "suggested donation" of $15 (meaning they will take less if you can't swing the $15), you get a room that's just as nice as any hotel, plus a fully stocked community kitchen that's open 24/7 and several play areas for the kids.

Jonathan and Ronald

Zadie required a little bit of oxygen overnight while sleeping, which is not unusual for her after a surgery or when she's sick.  We're fully equipped with oxygen at home, so this didn't concern us.  Of course, the hospital wanted her completely off oxygen before she was discharged.  I understand their position, but for a kid like Zadie, to keep her in the hospital just for something like that (when we can perfectly handle it at home) is silly.  She was drinking fine, which was the big requirement.  They had also put her IV in her foot, which really bugs me.  She's almost 3 years old, potty trained, and she can't get up and walk around!  She's always been very hard to find a vein, but I think they could have tried harder to find a vein in one of her arms/hands.  They do it once the kids are under anesthesia, so it's not like they're fighting a wiggling child.  I kept asking them about taking it out, but they wouldn't take it out until they knew that she was being discharged.  But, I wasn't going to let them keep her another day if that meant she was confined to the bed/chair that much longer!

They finally released her and we were on our way.  I was kind of (no, really) missing her Gtube, just because she was really fighting us to take her pain medication.

Thursday and Friday (two and three days after surgery), she fought the pain medications really hard.  We had to force her to take it just about every time, so she definitely wasn't getting full doses.  Probably because of that, she wasn't drinking as much as she should have been.  So it was a bit stressful.  She was drooling horribly a couple of times, which indicated her pain was out of control, since she wouldn't even swallow her spit.  I felt bad that we weren't helping her more.

Friday evening, she took a late nap and woke up about 7 pm, very miserable.  She was drooling and I went to wipe her mouth when I noticed bright red blood in her mouth.  Everything we were told and all the paperwork we were sent home with said any amount of blood is cause for concern and to call the ENT immediately.  She coughed up a big load of mucus and it was streaked heavily with blood.  I called the ENT resident on call (since it was 8 pm on a Friday night) and as soon as I told her what was going on, she said, "you have to take her to the nearest ER right now."

Waiting in the ER

So off Zadie and I went.  There was no more blood by the time we were at the ER, and the ER doc looked at her tonsils and saw no blood back there.  He said he'd call CHOP to consult with them.  I figured that they'd send us home.  I was wrong!  They wanted to admit her to keep an eye on her in case she started bleeding again.  Apparently, sometimes there's a small bleed and then later on, a larger bleed.  I would normally fight against her being admitted, but I had done enough googling while waiting that I was scared enough to agree.  I read about kids who had died from bleeding to death after a tonsillectomy.  The tonsils are very close to major arteries, and sometimes, when the scabs start coming off, a kid can bleed out.  A friend of mine messaged me on Facebook to tell me about a scary experience her daughter had after her tonsillectomy.  Very scary.

Like she owns the place!  Waiting for discharge, roaming the halls.

The hospital kept Zadie until about 3 pm on Saturday.  There was no more blood, and she was drinking pretty well.  We had finally gotten to a point where she would take her meds willingly if she could give them to herself (push the syringe), so from then on out, things just improved.  She would take her meds when she was supposed to, she was eating a little here and there and drinking better.  We started gradually spacing her meds out longer and she did well.  Yesterday, Saturday, about 11 days after surgery, was the first day she didn't have any pain meds and did great all day.  She's definitely lost weight but I'm hoping she'll re-gain what she lost.

Next up, another sleep study, which is scheduled for July 10.

Lots of updates!

Zadie had her bronchoscopy/sleep endoscopy in March at CHOP.  Dr. Javia said her airway looks great, with no obvious issues!  This is good news, but also bad news in a way.  At least if there was an obvious issue, there might be an explanation for her obstructive sleep apnea (OSA).  But, as it is, there are no clear reasons.  Dr. Javia did say that her tonsils were bigger than the last time he saw them (which was when he removed her adenoids.)  That's the last possibility for a cause for her OSA, other than just a hypotonia of her airway, which is something that can't be surgically corrected, she'd just have to grow out of it.  We are taking her to see him this coming week so he can look at her tonsils again and think about having them removed.  We'll be pretty upset if she has to go under for another surgery, when he could have taken her tonsils out when he was in taking out her adenoids in September, but at the time, he didn't think it was necessary.  Dr. Javia also said that there is the possibility of decannulating (removing the trach) and putting Zadie on CPAP.  We are very interested in this possibility.  I can't imagine it will be easy to get her to wear a mask on her face to bed, but I know other kids do it.

A couple of weeks after the CHOP visit, Zadie developed what looked like a pimple on her belly, right under her Gtube site.  It got bigger and redder and I ended up taking her to the doctor.  He took a swab of the pus inside and put her on antibiotics.  It turned out to be a staph infection.

Staph infection by Gtube

She ended up having a reaction to the antibiotic, Bactrim, so we stopped that, but her pediatrician felt that she'd been on it long enough and it was ok to stop.  

Red cheeks - reaction to Bactrim

Rash on chest that spread everywhere - reaction to Bactrim

Meanwhile, she was weighed when she went to the doctor for the staph infection, and she had gained weight since January, when she went to see the GI!  Between the weight gain and the fact that the Gtube site was getting yucky (and, I imagine, contributed to the infection), we decided to pull out the tube.  We waited until morning so that her stomach was empty, and just pulled it out.  It was a very exciting day.  I wasn't sure what we'd have to do to keep it from leaking, but it closed up very quickly, within a few hours, and we never had any leakage from her stomach.  Since she had some granuloma (scar tissue) built up around the site, it's not looking the prettiest, but I'm hoping as she grows that the scar tissue will lessen and be less noticeable.

One tube down, one to go!

In other news, Zadie has had two evaluations with the child study team from the school district so far.  One was with the speech pathologist and the other was with the learning consultant.  From what I understand, she did very well in the evaluations, which is great, but it also means she most likely won't qualify for the district pre-school.  It is pretty impressive that a kid who has had so many factors against her barely even has a speech delay.  Both Pierre Robin Sequence and having a trach are major causes of speech delays and issues.  But she is doing really well!  I'm back to work at the daycare now and when her nurse went on vacation last week, I took her to work with me.  Even though the class I have is a little younger than her, she wanted to stay with me and she did very well with the whole preschool/daycare thing.  She loved wearing her backpack and having a lunch box and she loved playing on the playground with the other kids.  One way or another, by the fall, I would like her in a preschool so that she gets out in the world!  She'll be turning 3 next month, so her speech therapy with Early Intervention will end at that point.

She's currently obsessed with Frozen, just like every other little girl in the world.  She's going to have breakfast with Elsa tomorrow morning, which should be a lot of fun!

I'll leave you with a picture of Zadie and her big brother and baby sister from a photo shoot we did about a month ago.  Super cute!

Jonathan, Beatrix and Zadie

Early Intervention transition

It's hard to believe, but Zadie will be 3 years old in less than four months!  Since Early Intervention only covers children until they're 3, we had the option of getting her evaluated to transition to the school system for preschool.  We decided to see if she qualified.  We had the initial meeting with the child study team for the school system last week, and they agreed to do a psychological, social, educational and speech evaluation on her.

We're not sure whether she will qualify, since she really is doing quite well, with speech being her only issue at this point, but her medical issues may help her get qualified.

In nursing coverage news, the insurance company approved Zadie's nursing hours until April, when they will be reviewed again.  They usually approve in six month increments, so I'm not sure why it's a shorter period before another review.  I do wonder if it has to do with the bronchoscopy she'll be having in March; they might be waiting to hear the results of that.

I had posted this on Facebook and haven't mentioned it here yet, but Zadie's GI doctor has discontinued her overnight feeds!  She weighs over 30 pounds now, which is around the 50th percentile.  This is amazing progress considering just over a year ago, she was in the 5th percentile for weight.  We have to make sure that she at least maintains and ideally gains some weight in the next month or two.  If she does, we have the option of completely removing her feeding tube!  This is such exciting news!  We will most likely keep the feeding tube for at least some time, since she still has the trach and will be having procedures and possibly surgeries in the future.  The feeding tube is a very good thing to have at times.  I'm really proud of how far she has come.  When she was born, she couldn't even suck from a bottle, and there were several months where she took nothing by mouth.  Just 2 years later, the fact that she's thriving without the aid of the feeding tube is really remarkable.

Zadie's current favorite word is NO and her current obsessions are turning lights on and off and closing doors!

Sleep study...

Zadie had her sleep study on Sunday night.  It started off pretty eventfully, as her Gtube balloon (the tube is held in by a water filled balloon - read more about it here) burst and the tube fell out.  I didn't have a replacement with me and the sleep study staff insisted that we go to the ER to get a replacement.  I was pretty upset, because I didn't know how long it would take for the replacement, and I really wanted the sleep study to happen.  But, the CHOP ER staff was wonderful and we had a new tube in within 2 hours and we were back to the sleep lab.  I have learned a lesson: always take a replacement tube!

Zadie showing off her new tube

So now that we were back in the sleep lab, we started to get ready for the study.  Since she didn't get a good nap that day (she slept for a total of about an hour, in two increments, in the car) and we already had to mess with her to get the new tube in, I was worried she'd be very uncooperative.  She did great while the respiratory therapist (RT) started putting the electrodes on her head and body.  She got to pick which color wire was put on next.  I said to the RT, wow, she's being really good.  She said, yeah, this part isn't the hard part.  We found out what was.  The nasal cannula.

All smiles for first electrodes

Wrap my head up in gauze?  Ok!

A gauze hat with bunny ears?  Great!

Nasal cannula...not cool.

Once the nasal cannula was in (it measured the carbon dioxide she was breathing - it had a little attachment for her mouth in case she was mouth breathing), she was very unhappy.  She cried on and off until she fell asleep.  The RT brought her a coloring book and crayons and she would be happy with that for a short time but then start crying again.  We really tried to keep her from crying too much, because the cannula couldn't get too wet and neither could the tape.  I really didn't want her to have to replace the cannula.  Zadie would just think she was getting it off and then to have to put it back on would be awful.

Occupied with a new coloring book and crayons..

Zadie didn't know what to do with herself.  She was crying on and off, she wanted to be off the bed (but she couldn't be, since she was all wired up and connected already), she wanted me holding her, she wanted me on my own bed, she wanted her milk, she didn't want her milk.  I finally got her to lay down by telling her I'd come back to her bed if she put her head on the pillow.  She did, and I did, and she fell asleep soon after that.  The RT told me when it was safe to move (she could see from her readings when she was in a deep sleep).  She slept fairly well, but she did snore a lot (just like Daddy!).  I knew that wasn't a good sign.  But she would sort of wake up every so often, crying.  I finally got to sleep, and then she woke up about 4 am and puked.  Her cup of milk was still on the bed, and I think she drank it and it wasn't very fresh.  We got her cleaned her up and she went back to sleep pretty quickly.

Despite it all, a smile at 4 am!

We were woken up at 6 am.  The RT cleaned up the wax out of her hair as best as she could and we were sent on our way.  Zadie was so happy!

So happy to be heading home!

I got a call from the ENT's office today and she briefly went over the results.  Zadie did have some apnea and that has to be addressed.  We have an appointment to see the ENT on August 12 to discuss the plan, but there's no way I'm going to be able to wait that long to find out what the plan is, so I'm going to call tomorrow and try to get more information.

Busted balloon

I really look forward to the day when Zadie doesn't need any foreign objects in her body to help her live. There's always the concern of her trach or Gtube coming out. Today, her Gtube popped out as we were leaving soon. It's held in her body with a water filled balloon. Occasionally, the balloon will pop or get a leak. I realized that was the case this time since the balloon was almost completely deflated.  This is an illustration of the type of feeding tube Zadie has, a Mic-key button.

We have a backup tube, but it was at home. I decided to pop the broken one back in and tape it up. The closest thing I could find was Scotch tape. Not ideal, but fine for the two minute drive home. Somewhere between school and home, the tube fell out again and I haven't found it yet! When we got home, I put the new tube in. By now, this is old hat for both me and Zadie. I took a picture of her belly with the button in to share here. 

Cute Zadie belly

As I said, I look forward to the day when we don't have to worry about this stuff!

Happy New Year!

Zadie's 2012 consisted of too many ER visits, five bouts of pneumonia, one very nasty case of RSV, two surgeries and a lot of learning and growing and fun!  We got great news when I checked the mail on Christmas Day (mail that had been delivered the day before) and got the letter from the insurance company that our second level appeal had been approved and Zadie was now back to 16 hours a day, 7 days a week of private duty nursing.  We are in the process of trying to get the shifts staffed.  I look forward to sleeping in a real bed, since my air mattress seems to be losing air quicker and quicker every night.  It might have to do with the 90 pound dog that likes to join me sometimes or the cats that like to jump around on it.  I also look forward to Zadie being able to be home during the day, rather than coming to daycare with me and Jonathan.  It's nice for her to get some socialization, and it's really nice to see her all day, but her health is more important right now, and I'm afraid that she will have a very rough winter if she continues to come with us.  

Zadie learned all sorts of stuff in 2012.  She learned to walk and sign and she even gained back her voice!  It's not 100%, but she can get very LOUD when she wants to express herself.  She can also say mama and baba meaningfully.  She got her palate repaired back in May, and can drink like a champion.  

By 2014, I would love it if Zadie could lose her trach and her Gtube.  I won't get my hopes up or put too much pressure on anyone, but it would be great.  For now, she is happy and healthy and that's all we can ask for.  

Happy Trachiversary!

Today marks one year since Zadie was trached.  A year ago yesterday, on the 4th of July, we were woken up by a call from the hospital.  That's never good.  But the call was a few days coming.

On June 30 of 2011, Zadie had a G tube surgically placed.  Her eating hadn't progressed enough and the hospital wouldn't send her home with a nasogastric (NG) tube, the temporary one that goes through the nose to the stomach.  They didn't want to keep her in the hospital just for eating issues, so it was decided that she'd get a G tube.

She went through the surgery just fine.  It was scary for us to leave her with the surgeon and anesthesiologist, but it went quick.  She was intubated for the surgery, meaning she had a tube inserted down her throat to help her breathe through the surgery.  Since she had such a tricky airway (part of her condition, Pierre Robin Sequence, causes the airway to be funky), they were worried about intubating her, but didn't have trouble once she was under anesthesia.  They extubated her (removed the breathing tube) the following day.  She had always had trouble breathing in certain positions, but before the G tube surgery, if she was laying on her belly or her side, she was ok.  She also had a nasopharnygeal (NP) tube, also known as a trumpet, inserted in her nose when she was about 10 days old. The purpose of that was to help keep her airway open more.

Now, after the G tube surgery, she was pretty miserable.  Not breathing easily in any position, and her oxygen saturations were not great.  The surgery was on Thursday, she was extubated on Friday, and by Sunday morning the 3rd, she was on oxygen.  She was holding her own, though, and we kept being reassured that her airway was probably just swollen from the intubation.  I kept asking if the intubation possibly damaged her airway, but the doctors kept saying it was just swollen.

So, on the morning of the 4th of July, we were woken up by a call from Dr. Ruben, Zadie's neonatologist.  She said that Zadie's breathing had worsened to the point that they needed to intubate her again.  They tried to do it while she was awake, but were unable to, so they had to put her under for it.  Since we weren't there, we had to give our permission over the phone for her to go under anesthesia to be intubated.  During that phone call, Dr. Ruben also told us that Zadie would need a tracheostomy as soon as possible.  This was the first time we had heard that word in relation to Zadie!

When we went to see Zadie later on, she was already out of anesthesia and intubated.  They had her little hands pinned down to the bed so that she couldn't pull the tube out.  She was looking at me like she wanted me to help her.  That was probably the hardest day of all the days in the NICU.  It was the first time I was afraid that we were going to lose her.  I was crying and trying to get the nerve to ask a question that was floating around in my head.  I finally got the nerve and asked, "Is she going to be ok?" Her nurse just looked at the doctor, who said, "Her problems are all mechanical.  She's not a sick baby. We just need to fix her mechanical problems."  The fact that she didn't say, "Yes, she'll be fine" was not lost on me, but I did feel better having asked.

Since it was 4th of July, it was hard for even the doctors to get a hold of the surgeon.  When they finally did, he said he could do the trach surgery on Wednesday, the 6th.  Zadie's doctor wasn't satisfied with that.  She insisted he do it the next day, on the 5th.  The fact that she was so nervous and anxious to get the surgery done made me very anxious and nervous!  The doctors in the NICU were used to little bitty preemies, not robust full termers who could easily pull out tubes.  Zadie's doctor was very nervous that Zadie would pull out her tube and it would be so difficult for them to get it back in, that it might be a very bad situation.

So, on July 5, 2011, we walked our sweet little girl down to the OR for the second time in 5 days and she was put under anesthesia for the third time in 5 days.  Again, the surgery went quick and she did well.  When we got to see her, it was like seeing a different baby!  She was laying on her back (previously had always been on her belly or side) and she just seemed happier and more comfortable than she had ever been in her 5 short weeks on earth.

When I think back to that time, I realize how little of a clue I had about what lay ahead.  I understood what a trach was, I knew some people had them for awhile, but I could never have predicted what our life would turn out to be like.  I hope that Zadie is able to lose the trach by her next trachiversary, but I'll be ok with it if she's not.  It saved her life.

Tubie Friends

You might have seen the picture of Zadie with her new Tubie Friend that I posted today.  I'm so excited about this teddy bear (who BJ thinks look likes Ted.  From the movie.)

Tubie Friends is a non profit organization that was started by two mothers of kids with feeding tubes.  They want to help other parents and kids who rely on feeding tubes.  All of the "Tubie Friend Surgeons" are volunteers.  All Tubie Friends asks of applicants is for $8 to cover shipping.  If you can't afford that, it's ok.  They'll still send you a Friend.  The stuffed animals (Zadie got a Build a Bear!) are funded by donations.

I sent Zadie's application in on Sunday night and her Friend was on our doorstep on Friday!  Talk about a quick turnaround, when they tell you that a typical turnaround time is 2-4 weeks.  And it just so happens that Beary (as Jonathan named him) arrived the day before Zadie's one year anniversary with her G tube.

Check out their site.  Spread the word if you know a kid with a feeding tube.  And donate a couple of bucks if you have it!

Jonathan, Zadie, and Beary

Zadie's weekend away...

Zadie decided she needed another weekend away, so Friday morning, after a week of fighting what seemed to be a cold, she woke up with a fever. Off to the ER we went. She ended up being admitted, although I don't think it's clear what was going on. There are aspiration concerns, so she is on strictly G tube feedings for now, nothing by mouth. It's already not fun, because she's clearly interested in food. When she is recovered, she'll be getting a swallow study. I have asked a few times about a swallow study at her feeding clinic, but they have always said it was unnecessary. I will be mighty upset if it turns out that all her troubles recently have been from aspiration.

 She's still scheduled for her palate surgery next Tuesday, May 1. I was worried this latest illness would affect things, but she's still on, unless she's very congested. So, she'll be back in a hospital (a different one) next week, if all goes well! A nutritionist stopped by Zadie's room on Saturday. She said she looks like she's doing great on breastmilk. I asked her if she had any experience with the blenderized diet. She didn't seem to have too much experience with it, and mentioned how much work it would be. She mentioned that bacteria is a risk of that diet, because food is more likely to be caught in the tube. That seems like just another excuse. She also said that formula is already made to have all of the proper nutrients, etc. It's weird that a nutritionist thinks formula is better than fresh, real food. It seems like, for some reason, most medical professionals are not too enthused. I don't get it!

The nutritionist also said that breastmilk should be enough for Zadie past a year, maybe to 15 or even 18 months! So I had been planning on quitting pumping soon, but I guess it looks like I'll be doing it for a little longer. And I guess that means that I should finally BUY a pump, rather than keep renting the hospital pump. Zadie should be released today. She got her batteries recharged and enjoyed the chest PT from the nice respiratory therapists. She's ready to get out of this crib and back to cruising around the house. And hopefully not coming back here any time soon!

The blenderized diet.

Since Zadie is getting close to turning 1 (crazy!), I've been thinking about what she'll be "eating" when breastmilk alone is no longer enough for her. Most people who are tube fed are fed formula, and I'm really not crazy about the idea of switching Zadie to formula after all my hard work pumping for the last 10 1/2 months.  I thought I could just puree up real food and put it through her tube (while still working to get her to eat orally).  Apparently, there is something called the blenderized diet, which is pretty much what I was imagining.  And apparently, it's sort of crazy talk in the medical world.  I brought up the idea to the nurse practitioner at Zadie's feeding clinic, and she was very discouraging.  The biggest thing she kept mentioning was how time consuming it would be.  That seems like a silly reason not to do something, if it's something that's good for her.

So I started looking into it more and I found out that it not a common practice, but every parent who uses it swears by it.  A lot of moms whose children were previously formula fed and then moved to the blenderized diet said it was the best thing to happen to their children.  A lot also said that their children were more interested in EATING real food once they had real food through the tube.

One thing I learned was that I needed a good blender.  It's doable with a standard household blender, but a professional grade blender makes things easier and faster.  I emailed the two big blender makers, Blendtec and Vitamix.  I had heard that they both offered a medical discount (their blenders run about $500-$600!) and also donated blenders regularly to tube fed people.  Within a day of emailing Blendtec's customer service, and telling them Zadie's story, I was informed that Blendtec was donating a blender to us!

I've been very excited about this blender's arrival, and BJ's been making fun of me (will he be making fun of me when I am able to make smoothies and shakes and daiquiris?  I don't think so).  Well, it arrived today and without even reading the book, I pureed up some avocados for Zadie.  I fed some to her by spoon, and she did ok with it.  A bunch came out her nose, which is something I won't miss after she has her palate repaired!  Whatever she didn't eat, I blended up some more and put it in with her milk through her feeding tube.  This is very exciting, and while we have a ways to go, I am less anxious about her moving away from breastmilk.  And I'm getting excited to quit pumping soon!

No real direction yet...

I've been wanting to start blogging about Zadie's condition and continuing progress.  I'm finally doing it!

A quick recap - Zadie is now 8 months old and was diagnosed with Pierre Robin Sequence the day she was born.  She has a cleft palate and micrognathia (an underdeveloped lower jaw), which makes her tongue fall back into her airway, making both breathing and eating difficult.  She spent 10 weeks in the NICU, and has a G-tube (feeding tube) and a trach.  She used to take some milk by bottle, but now takes 100% by the tube.  We're working on spoon feeding now!  Because of the trach, she doesn't make any sounds.  I never imagined that I would wish to be able to hear my baby screaming her lungs out, but I can't wait for that day!

Other than her main limitations (which are temporary!), Zadie is a very typical 8 month old.  She's almost crawling, and she just started pulling herself up yesterday.  She loves her new skill, but we're still encouraging crawling!  She's also very healthy.  She's only been hospitalized once since she came home (that's good for a baby with a trach!) and hasn't had any ear infections (knock on wood).   She does have fluid in her ears, which is almost expected with the cleft palate, but it is affecting her hearing.  She'll probably be getting tubes soon.

As for the title of this post, we're still kind of up in the air as to the course of action for Zadie, and it makes me more and more nervous as she gets older.  She will definitely need her palate repaired, and that will be done somewhere around her first birthday.  But, there are other things in play and different opinions about the best thing to do.  We've seen three craniofacial teams, St. Barnabas, St. Joseph's, and CHOP.  They all pretty much have a different idea of what to do, and none of them seem to have stepped up to say, we're the best ones to take care of your daughter.  So we're still trying to figure out what to do.  It's a scary situation to have to decide for your little baby which direction to go in, when our decisions will likely have a huge impact on her life.  Right now, we're just trying to keep on top of everything and hope that the right course will be revealed.