Wednesday, May 16, 2012

C Diff Update University of Chicago Visit


Well, after a long day that started at 3:00 am when the alarm went off this morning, we finally feel like we are on the right path to putting all of this mess behind us!  We loaded up in the car and headed to Chicago which was actually a very smooth, nearly traffic back-up free ride.  The physician we met with today, Dr. Stacy Kahn, a pediatric GI specialist and associate professor at the University of Chicago is amazing!  She was so nice and receptive, open and informative.  After going over Grant’s case history with us and just general discussions we discussed the option of the stool transplant or the recently, formally named fecal microbiota transplantation (FMT).  The first item to note is that before we could go forward with the FMT, Grant would have to have another active, C Diff infection.  At this point, he does not because he is on medication.  History in Grant shows that his infections normally reappear at day 7-14 after discontinuing any medication.


Dr. Kahn did not agree with Dr. Werlin’s (of Children’s Hospital in Milwaukee) protocol of having Grant continue the medication for the next four months with 5 day breaks in between each month.  Instead, our action plan is to complete two months of medication (Grant just completed his first 30 days and is currently on day 1 of his 5 day break before starting month 2).  This will give both her and us time to prepare for the FMT if it is necessary.  There are some approvals still needed at the Comer Children’s Hospital and some hoops we will probably have to jump through with our insurance.  After Grant has completed his 2 months in mid-June we will just wait.  We pray the C Diff is gone for good and we don’t even have to cross this bridge but if it does return for the 6th time it is very likely we will have the FMT God willing with cooperation from our insurance.


Dr. Kahn talked more about the procedure itself.  Most likely we wouldn’t have much time leading up to preparing for the procedure.  We would have to be ready to go when and if Grant were to test positive again.  He would then be admitted to the hospital the night before the procedure and given an IV and have to fast.  The FMT would be performed with the use of a nasogastric tube being placed in his nose, down his throat, and into his stomach.  The donor stool slurry is then placed in the tube.  We would most likely be there for 48 hours for observation.  Dr. Kahn informed us that Grant would only be the 4th documented case of a FMT in a child and the first at University of Chicago/Comer Children’s Hospital.


Most of all, we thank everyone for their continued thoughts and prayers.  They are working!  Please continue to keep us in your prayers that we don’t have to resort to this but if it does come to this our prayers have already been answered… for this all to come to an end in some way, shape, or form.  We finally feel like there is a light at the end of this tunnel one way or another and you are all to thank! 


Grant and the penguin eyeing each other up
And it wasn’t all business… we even snuck in a trip to the Shedd Aquarium so there will be some more pictures to follow from that! 

Thursday, May 10, 2012

16 Months

It has been a rather exhausting month.  We found out Grant had C Diff again and had an appointment at Children’s Hospital in Milwaukee.  It seems like it has been one thing after another and I am very much hoping for a much quieter, fun coming month.

Reading in his favorite spot... the dog bed

Growth:  Grant now weighs approximately 22.8 lbs.  At a doctor’s appointment on 5/1 he had a naked weight of 22 lbs 12 oz so he is actually down a little in weight again.  More on that in the illness section…  I would say he is still measuring in at about 31-31.5"  Clothes are all still pretty much the same: 12-18 months and 18 months, shoes 4’s and some 5’s and size 4 diapers. 

Teeth:  He hasn’t gotten anymore new teeth but his remaining 3 molars are very close to erupting as well as some of his canines!  Yikes!  

  


Rocking on the front porch
Language/Comprehension:  Some of Grant’s new words for the month include night night 4/25, papa 5/5, pop 5/6, and more which sounds like mar.  We joke that he sounds like the sea gulls in Finding Nemo because he will say “mar mar mar” over and over while signing.  He signs “thank you” and is very good at signing “more please.”  When seeing a semi or big truck on the road, he makes a vroom sound and everyday he points at the cows on the way home and moos.  When we say "yuck" or "dirty," Grant will clear his throat over and over trying to imitate yuck.   

On 5/3 while sitting on his potty doing ABC flashcards, we had completed A-Z and were back at A.  I flipped the card over and he said “A.”  I thought maybe it was a fluke but a few minutes later in the bath tub he was surrounded by his foam bath ABC’s and I asked him where the A was and he grabbed it without hesitating and held it up.  He has identified A in several other places since then!


Writing with the sidewalk chalk
Personality: It has been a rough month for biting. Just when we thought it was getting better Grant set a personal record we never wanted him to hold. He bit 6 times in one week and 4 of those 6 actually occurred in one day! It is very frustrating and hard because we suspect he still isn’t feeling well and just isn’t himself and there is nothing we can do about that aspect.  I hope the other parents realize we are working on it diligently and not ignoring the issue.  We miss our happy go lucky little boy who feels good and isn’t irritable and crabby most of the time though.

   


 


Helping put the groceries away
Trying to cut his toe nails


One of Grant’s teachers made the comment that Grant not only likes to see how things are done and copy you but it’s like he truly wants to understand how you did it or how something works. We have noticed the same thing. He gets the cutest little crinkled face and look of concentration when he is trying to figure out how something works. I definitely think he will be handy like Matt and a Mr. Fix It. 








Things he likes:  Grant LOVES when I sing to him.  There aren’t enough songs and rhymes and poems.  He always asks for more.  He is probably the only person that has ever asked for more when I sing because Lord knows that I stink!  Grant is also very into bubbles right now!  If you don't keep them out of his sight he will beg and beg and beg.    

Funniest moment(s) this month:  Grant now knows all the motions to “If you’re happy and you know it.”  He will clap his hands, stomp his feet, say Amen and even touch his fingers to his cheeks when you sing the line “then your face will surely show it.”  And he always asks for more of course! 

He has also learned how to make farting noises by blowing on his arm :)

Biggest change(s) this month:  He is back to not throwing a fit at daycare when I leave.  He has also have very little appetite... I mean tiny!  We agree with the doctors that it is most likely because of the medication but its scary to think that he still could have 96 days left on it (more on that below).  The doctors literally told us to put a extra butter in everything for him as well as give him pediasure and carnation instant breakfast to add more calories where we can.     

Notable Firsts:  First trip to the dells on 4/13 and went hiking at Mirror Lake State Park. 

Sliding down the frog tongue
Splashing with Daddy






















On 4/29 he peed on the potty for the first time.  We introduced it the night before just to have him start sitting on it and getting used to it and the very next night he peed in it!  Of course it was a fluke and he has no idea what he did but you have to start somewhere right?!?

On 5/7 he climbed on couch for the first time.  We were watching TV and turned back to look and he had crawled up there and was laid down, sprawled out.  To this point he hasn’t been much of a climber so we will see where this takes us! 

Illnesses:  Just days after turning 15 months old and after exactly 7 days of being off his last rounds of meds C Diff returned for the 5th time.  Our doctor wasted no time in sending us directly to Children’s in Milwaukee.  Dr. Werlin came up with an action plan that we have started but still aren’t completely happy with.  (See the C Diff update post for some more details.)  It has been a struggle daily with Grant because we are convinced the meds metrodinazole (flagyl) which he has been on before (the first two cases of C Diff) but not for this long are making him not feel well.  He has very little appetite, is irritable, and from things I have read of adults on this medication it causes a metallic bitter taste in your mouth during the duration of the dose.  No wonder he doesn’t want to eat!

Because Grant will be on this medication for so long and antibiotics are known to cause hearing loss and problems, we were also advised by both our pediatrician and the GI specialist at Children’s to have Grant’s hearing checked and monitored over the next couple months.  On 5/7, we had our first appointment and didn’t get the best news.  He failed his screening in his left ear.  She tried three different methods to gauge his hearing and eardrum function.  The first, an otoacoustic emission (OAE) he passed on the right but failed on the left.  She then used a tympanogram to ensure that he didn’t fail because his tube was plugged.  Well, unfortunately it wasn’t as simple as that and once we got him in the booth with headphones for a screening it didn’t go too much better.  It was really interesting to see how they screen children that age because they can’t hold the clicker and press it when they hear a noise.  Instead, mounted up on the wall were a teddy bear on the left and right in a darkened box with plexiglass that you couldn’t see until the audiologist sounded a tone and lit them up.  She only lit the box and turned the bear on in response to Grant’s response and as a conditioning mechanism to get him to respond to the tones if he could hear them.  We repeated the same process both with the headphones on and without.  She said he is hearing ok at normal talking levels but isn’t hearing in his left ear below those levels.  We already had our 1 year appointment scheduled with our ENT to have Grant’s tubes checked so at that appointment he will be rescreened.  Our goal is to determine if the hearing loss is permanent or temporary and now that we have a baseline we will be able to see how things change over time.  She believes the most likely culprit is the antibiotics but improper tube placement has also been known to affect hearing and eardrum function.  It really brings about tough questions of what is the lesser of two evils.  The day I publish this post Grant will have 96 days left on the medication but I am pretty darn sure that if we took him off of it tomorrow the C Diff would come back. 

It is incredibly frustrating as a parent knowing there is something out there that has been proven to work more effectively than any medication (donor stool transplant) but we have had great difficulty finding anyone who is willing to perform the procedure on a child.  I have contacted the Duluth Clinic in Minnesota who has physicians who have pioneered the process and written numerous papers and they won’t touch a child.  Children’s hospitals in Milwaukee, Twin Cities, and Chicago all are a no go as well as Mayo Clinic in MN.  We did make a little headway with Children’s in Chicago who pointed us in the direction of a physician at University of Chicago who DOES perform them on children!  Dr. Stacy Kahn’s nurse just called me back this week and said that she would be willing to see Grant, reviewing his case, and possibly doing a stool transplant!  The doctor wants to set up a clinic and after that has been done the nurse is supposed to call us back and get us scheduled!  We are so happy and hopeful that this could finally be it.  Please say some prayers.