Sunday, January 13, 2013

a new vocabulary word.

shilo has been on a blenderized diet for around two months now.  it has completely transformed our lives, for the better.  no more puking or gagging.  no more constipation.  no more hours of being hooked to a feeding pump.  she recently came off of zantac completely (reflux medicine) and can sleep flat in her bed (instead of with her mattress at an angle).  when i think backwards to all of this, my eyes tend to fill up with tears.  i've had a few people suggest that maybe it was just the type of formula she was one.  but we had tried multiple formulas, and nothing ever changed.
our most exciting development, though, is that she is really interested in eating. by mouth.  she watches our forks from plate to mouth.  she wants to be part of meals.  and as always we continue to work with her on her oral feeding skills.
but it's become somewhat disheartening.  everyone keeps saying, 'oh she will get it.'  or, 'just give her time.'  the thing is she's not getting it.  she doesn't gag.  at all.  she loves food in her mouth.  she even moves it around with her tongue.  but she doesn't have a swallow reflex anymore.  it's completely baffling because she doesn't slobber at all.  so either she doesn't produce much saliva, or she swallows her saliva.
we've been working with an o.t. on eating stuff.  and tomorrow a speech pathologist starts.  but after many a conversations someone finally said, 'you know it's possible she has nerve damage from being intubated so long.'
i politely agreed, hung up, and jumped on google scholar (google scholar has medical articles, and reputable sources, where as if you just google something, you may or may not be getting truth).  i came across numerous articles on extended intubation and something called dysphagia.  dysphagia boils down to being a swallowing disorder that can be anything from tongue issues to the esophogus not doing what it should.  i read article after article.
then i came across one that made my heart sort of stop.  it was on pediatric patients who had open heart surgery and the risk factors for dysphagia.  i read through the numbers and statistics and looked through the list of things that put a child at higher risk for having issues:  under three-check, intubated prior to surgery-check, transesophogeal echocardiogram-check (an echo is a picture of the heart by ultrasound.  after ohs they do this by putting a probe in the throat to make certain everything is repaired before closing the chest), intubation of more than seven days-check.  sounds like shilo was a pretty high risk case for having dysphagia.
i continued to read.  and came across the lines about how a child who has this will do best if they have intense speech therapy as soon as possible.  nope.  we didn't get that.  matter of fact, we are almost nine months out from surgery and we are just now getting ready to start speech.
so we are taking deep breaths here.  with each new vocabulary word, label, diagnoses, that comes along with our children, i am always surprised at how disheartened i feel.  shouldn't i have this down by now.  both of our children have multiple diagnoses.  but this one stings a little more than others.  it isn't like when we found out she was deaf and just shifted to signing and finding other ways to communicate.
it's more of the wondering if i will be washing g-tube extensions for the rest of my life.  it has me considering that the blender i make jokes about being part of our family, really will become a standard part of each mealtime.  and it breaks my heart a little that my little who is very interested in eating food, may not  be able to be sustained by it.
i have made goals for shilo and eating.  and even with this new word looming (we don't have an official diagnoses yet) i still will continue to do all that i can to try to help her learn to eat. i just wanted one thing, for shilo, to work for her instead of against her.  but, somehow, i know that with each new obstacle before her, we will continue to see new and amazing things with her.  we will learn over and over to celebrate the small victories that other people miss, and we will learn that God's grace is sufficient to get us through.

6 comments:

  1. I'm sorry. What I have found with my daughter (4yr old typical) is that she has a hard time figuring out how to swallow things and the amount of things.

    I'm sure you've tried everything, but maybe putting a taste on your finger for her to taste and swallow when he mouth makes more saliva in response to the flavor would help? You can add more as she gets the swallowing?

    Yay for being interested and being able to move it around! Often that's the hardest part.

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    1. it isn't that she can't figure out how to swallow, it's that she, literally, does not have a swallow reflex. we do food taste every day. from fingers, spoons, forks, little eye droppers, speech therapy tools, q-tips. cold and tart are supposed to be the trigger for kids with no reflex, and it doesn't phase her.

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  2. I know you guys like your first step people and have been happy with the experience. :) But whenever the subject of speech therapy comes up for anyone living in central indiana, I feel morally obligated to sing the praises of BSU speech pathology clinci. When we were at Cincy NF clinic in October, Dr Schorry said that she thinks Ike has VPI (Velopharyngeal Insufficiency) and possibly a slight submucosal cleft - apparently new studies are showing that this is quite a common find in NF kiddos with hypernasal speech and other speech difficulties. Anywho... getting back to BSU... I told our speech therapist at the local elementary school first (who was our first steps speech person also) that Ike sees 1 day a week for 25 minutes. She didn't say anything about it for a few days, then said, "Oh I don't think he has that. We'll just keep doing what we are doing." Then I tell the director at BSU clinic (they see Ike 1 hour 2x a week) what Dr Schorry said and 2 days later that had done their research on NF and VPI, completely changed his goals, what they were working on, and wanted to know if we were going to use Cincy's cranio/facial specialists since they feel they were the best in the region. So what I am saying is... if there comes a time that your not sure your speech people are doing enough for your Shilo and think she may need more than what they are providing, you have a really great resource in your city. :) And high five on the blenderized diet working so well! Good luck and take care!

    Kara

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    1. thanks. does ball state have a feeding clinic though? our slp for first steps is one of the best in the region so i feel pretty confident if she is stumped by shilo that we are needing to move on.
      we managed to get into the same feeding specialist at riley that abigail saw for her aspiration and feeding issues early on. she is truly the best of the best. so i'm excited to hear what she says. :)

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  3. Ok I just wrote a book at the computer ate it. =P Not sure what all they could offer or how far they go into feeding therapy. The directors are great and return phone calls fairly fast. They could tell you what they would be able to offer as far as feeding therapy or in conjunction to her feeding therapy. You guys may be in a different boat with FS, but the elementary school would only give us 25 minutes a week for speech - that's it. BSU quadrupled that. So he gets a grand total of 2.5 hours a week which is GREAT. IT doesn't take the place of Cincy cranio speech people or the SLP at the local school, but another layer on top. BSU was more than willing to get on board with Cincy's plan and carry it through for us, which is much closer to home and more easily accessible. I will say the more "interesting" a case is, the more likely you are to get a spot with them. :) As you get further into this, they may be able to act as an extension of Riley's feeding clinic. Just a thought... :) Good luck and let us know what the feeding clinic has to say.

    http://cms.bsu.edu/academics/collegesanddepartments/spaa/clinics/speechclinic

    Kara

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    1. thanks! i looked at their sight after asking last night (google can tell me anything if i take a minute to type it in) and it didn't say anything about feeding, only speech. i realized after i responded that i wrote my post before seeing our slp for the first time. she was completely stumped. she says in her thirtyish years of experience that she has never seen anything like it. and i couldn't believe how quickly riley got us in (that's what happens when you bypass phone answerers and just e-mail the person yourself) so we go on wednesday. i'm sure i'll write about what we find out!! :)

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