Never Underestimate a Qualitative Analyst

Never Underestimate a Qualitative Analyst

Before I get going, let me just state that Lyra is finally home and doing great.  Not to toot my own horn, but it had everything to do with my strategy to feed her and persistence to get GI involved in the hospital. This is directly relevant to my title.

By trade, I am a Qualitative Analyst. Don’t get it confused with a Quantitative Analyst, those are the number crunchers. I deal with words, not just numbers. Now, data analysis is important and often plays a role in qualitative analysis. The difference is, I work with things that can’t be quantified. I take information from various sources and tell a cohesive story. I answer the questions, “So what?”, “Why is this relevant to me?”. I also use that information to propose solutions to complex problems. Many people (including my sister) have been baffled about how to apply this skill set in and out of the work place. So, let me put it in context of caring for Lyra.

Lyra has many people who are on her team. Her care (outside of family) involves an occupational therapist, dietician, gastroenterologist, cardiologist, surgeon, pediatrician, geneticist, and we will be adding physical therapist in the near future.  All of these people orbit Lyra and have opinions and insights to her care. However, they do not all communicate directly and the only common denominators are Lyra and myself. I am at EVERY appointment. Part of my job as her mom is to take the information that each of these caregivers, along with my own observations, and present it in a way that makes sense to everyone. My job is to tell the story that is “Lyra” that goes beyond test results and numbers on a paper.

According to test results, Lyra should not have been throwing up while getting NJ feeds. Also, according to test results, she should have been able to handle the volume/hr of formula the surgeons were prescribing. However, Lyra WAS puking and Lyra was NOT tolerating the volume/hr of formula she was being fed. Looking at the problem a few things came to mind:

  1. I know Lyra has trouble adjusting to rapid changes in volume. I have been puked on enough times to have solid evidence of this
  2. Her dietician had mentioned that, with cases like hers, you often can only increase feedings by 1 mL at a time
  3. Genetics has told us that most rules probably won’t apply to her since we have no idea how she will be physically/mentally impacted by her genetic abnormalities
  4. GI had previously told me that we will likely have to go by trial and error with her. If something doesn’t work, we just have to try something new

Using this information (mostly 1&2), I was able to come up with a solution for feeding her and present to the surgical team in a rational way. Was I sure that it would succeed, hell no. In fact, I anticipated it would fail. However, it has been about 6 days, Lyra is HOME, she is tolerating the total volume she needs every day, and she has only thrown up 3 times since we started using my method. What we had been doing wasn’t working, and we needed to try something new. Even the “wait and see” method had been tried and failed. With my professional skill set I was able to take the information from multiple sources, put it in context, and solve a problem. I didn’t spread sheets, or complicated equations. I took words from many sources, told a story that was relevant to audience, and proposed an information based solution. Because of my qualitative analytical skills, my daughter is home.

So what is a Qualitative Analyst? It is someone who using words, not just numbers, to tell a story and come up with solutions. In today’s world of big data, never underestimate the power of a Qualitative Analyst.

“Yay, a Fart!”…. Something I Never Thought I’d Say

“Yay, a Fart!”…. Something I Never Thought I’d Say

Okay, I never thought I would be so excited about a fart. Well…. three farts to be exact. Why am I excited? Because it means that Lyra’s pipes are starting to move again! This means taking one of the tubes out of her nose and being able to ween her off of IV fluids. One happy Mamma!

To catch some of you up, in my last post I mentioned that Lyra needed another surgery. Well, about two days later she stopped being able to keep anything but pedialyte down. While we were able to keep her hydrated, she wasn’t getting any nutrition. On Sunday the decision was made to admit her to the hospital and for her to have surgery ASAP. They tried to fit her in Sunday night, but she ended up not having the surgery until Monday afternoon. Due to some other tests they had to run, she was under anesthesia for over six hours. It was gruelling for Mark and I, but luckily my parents were there to keep us distracted (we will have to have a Hearts rematch later). Lyra did  great during the surgery and has been recovering really well.

Out of surgery she had three tubes. One goes down her left nostril, past her stomach, and past her duodenum We will be using it to feed her now that her intestines are waking up and are moving again (she just started getting 3 mL/hr in that tube). The second one, down her right nostril, was draining fluid from her stomach to reduce pressure on the areas where they performed surgery (they were able to take that tube out this morning). The third tube is her G-tube, which is currently just being used as an additional drain. Once we know she can tolerate her food and things are really working, we will start to feed her through this tube.

Since surgery she has only had to have four or five doses of morphine. Other than that, she has only been on tylenol and ibuprofen for pain (not bad for having your intestines mucked around with). She has had moments of smiling and playing. Her current favorite thing to look at is a giant dragonfly balloon that Grandma brought in yesterday. She has also been sleeping soundly when she sleeps. As I mentioned at the beginning, there are signs that everything is starting to move again! She farted a whole three times! Now we are waiting for her to actually poop…. I have never anticipated someone else pooping so eagerly in my life.

Anyways, the point is, she is recovering well.  She will likely be in the hospital for at least two weeks, but it’s for the best. She is well taken care of here and Mark and she has lots of eager visitors. Thank you everyone who has reached out to offer support.

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Lyra right after surgery

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Lyra yesterday (I couldn’t resist putting a bow on her)

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Lyra today… Good Morning Mommy

(The brace is just so she won’t pull her tube out. She has been trying)

P.S. I do have more photos like the series from her last surgery, I just have to use a different computer because mine is having issues with downloading photographs from my good camera.

Prepping for Surgery and a Note From a Friend

Prepping for Surgery and a Note From a Friend

For those of you who don’t know, we are back in the hospital already waiting to have surgery. Lyra stopped tolerating her formula, and she couldn’t live on pedialyte. Upon admittance yesterday we were told they were going to have her go in for surgery ASAP. There was the potential for it to happen last night, but now it looks like it will happen this morning.

A friend of mine sent me the narrative below (in bold) the other day, and I wanted to write about it. She did not write it, but it really struck me. I was thinking about it quite a bit last night, but fell asleep before I could write about it:

Some Mothers Get Babies With Something More
-Lori Borgman

My friend is expecting her first child. People keep asking what she wants. She smiles demurely, shakes her head and gives the answer mothers have given throughout the ages of time. She says it doesn’t matter whether it’s a boy or a girl. She just wants it to have ten fingers and ten toes. Of course, that’s what she says. That’s what mothers have always said. Mothers lie.

Truth be told, every mother wants a whole lot more. Every mother wants a perfectly healthy baby with a round head, rosebud lips, button nose, beautiful eyes and satin skin.

Every mother wants a baby so gorgeous that people will pity the Gerber baby for being flat-out ugly.

Every mother wants a baby that will roll over, sit up and take those first steps right on schedule (according to the baby development chart on page 57, column two).

Every mother wants a baby that can see, hear, run, jump and fire neurons by the billions. She wants a kid that can smack the ball out of the park and do toe points that are the envy of the entire ballet class.

Call it greed if you want, but we mothers want what we want. Some mothers get babies with something more.

Some mothers get babies with conditions they can’t pronounce, a spine that didn’t fuse, a missing chromosome or a palette that didn’t close.

Most of those mothers can remember the time, the place, the shoes they were wearing and the color of the walls in the small, suffocating room where the doctor uttered the words that took their breath away. It felt like recess in the fourth grade when you didn’t see the kick ball coming and it knocked the wind clean out of you.

Some mothers leave the hospital with a healthy bundle, then, months, even years later, take him in for a routine visit, or schedule her for a well check, and crash head first into a brick wall as they bear the brunt of devastating news. It can’t be possible! That doesn’t run in our family. Can this really be happening in our lifetime?

I am a woman who watches the Olympics for the sheer thrill of seeing finely sculpted bodies. It’s not a lust thing; it’s a wondrous thing. The athletes appear as specimens without flaw – rippling muscles with nary an ounce of flab or fat, virtual powerhouses of strength with lungs and limbs working in perfect harmony. Then the athlete walks over to a tote bag, rustles through the contents and pulls out an inhaler.
As I’ve told my own kids, be it on the way to physical therapy after a third knee surgery, or on a trip home from an echo cardiogram, there’s no such thing as a perfect body.

Everybody will bear something at some time or another. Maybe the affliction will be apparent to curious eyes, or maybe it will be unseen, quietly treated with trips to the doctor, medication or surgery. The health problems our children have experienced have been minimal and manageable, so I watch with keen interest and great admiration the mothers of children with serious disabilities, and wonder how they do it.

Frankly, sometimes you mothers scare me. How you lift that child in and out of a wheelchair 20 times a day. How you monitor tests, track medications, regulate diet and serve as the gatekeeper to a hundred specialists hammering in your ear. I wonder how you endure the clichés and the platitudes, well-intentioned souls explaining how God is at work when you’ve occasionally questioned if God is on strike.

I even wonder how you endure schmaltzy pieces like this one — saluting you, painting you as hero and saint, when you know you’re ordinary. You snap, you bark, you bite. You didn’t volunteer for this. You didn’t jump up and down in the motherhood line yelling, “Choose me, God! Choose me! I’ve got what it takes.” You’re a woman who doesn’t have time to step back and put things in perspective, so, please, let me do it for you.

From where I sit, you’re way ahead of the pack. You’ve developed the strength of a draft horse while holding onto the delicacy of a daffodil. You have a heart that melts like chocolate in a glove box in July, carefully counter-balanced against the stubbornness of an Ozark mule.

You can be warm and tender one minute, and when circumstances require intense and aggressive the next. You are the mother, advocate and protector of a child with a disability.

You’re a neighbor, a friend, a stranger I pass at the mall. You’re the woman I sit next to at church, my cousin and my sister-in-law.

You’re a woman who wanted ten fingers and ten toes, and got something more. You’re a wonder.

The part that got to me last night was, “You didn’t volunteer for this. You didn’t jump up and down in the motherhood line yelling, ‘Choose me, God! Choose me! I’ve got what it takes.'” While there is much in motherhood that no one signs up for, there are moments when I think, “I really didn’t sign up for this.” Those moments, for me, have nothing to do with anger. They don’t happen when she pukes on me for 8th time that day, or when she is screaming at night and won’t sleep (although those moments I have other thoughts…. a particular book comes to mind). No, I think that when I am getting news that something else is wrong with her, when I am holding her down and she screams while the perform another test, or when I sign more consent forms for surgery.

I am sure I will think it when I hand her to the nurse and watch them walk into the operating room. I will think it every minute for the 3+ hours the surgery will take. I will think about it when I see her right afterwards. And I will likely think it every day we are in the hospital this time (it could be weeks).

While I may not have signed up for it, I can’t change it. I am not a hero. I am not any more than any other mom. I do what my child needs, and what is best for her. Sometimes, she just needs a little more.

More Answers…. More Surgery

More Answers…. More Surgery

The results are in from the Upper GI test we had done yesterday and the provide us with some important answers as to why Lyra has so much trouble keeping food down. Unfortunately, it also means that she is going to need more surgery. We knew that she needed surgery to have the G-tube placed. However, the Upper GI has revealed that she also has a narrowing of her upper small intestine (duodenum). The condition is called duodenal stenosis and hers requires surgery to fix. At this stage, I don’t have an exact date for when surgery will happen. We are hoping for September 14th. I don’t have more information to give, but I have provided some links below with additional information about the condition:

Dealing with the Trauma

Dealing with the Trauma

Trauma is not a word that I like to use, but in this situation I can’t think of a more appropriate one to use. Also, I am not always sure how well I “deal” with it, but I do live with it. The fact of the matter is that my husband and I are traumatized by everything that has gone on. I don’t think a day goes by where I don’t think, at least once, “Am I going to have to take her back to the hospital?” Sometimes this thought occurs because the future is so unknown. Sometimes I have it because we are having a bad day. But, the thought is always there.

There are defiantly some triggers for both my husband and I. The two that come to mind are a poor PO (from a bottle) feeding, and throwing up. When Lyra is only willing to take a small amount from the bottle it flashes me back to desperately trying to get her to take just a little more, and knowing that it wouldn’t be enough to sustain her. Now, I know that she has the NG tube now and she WILL get the nutrition/calories that she needs. That doesn’t stop me from remembering being in tears and begging my baby to “just take a little more” because I knew her tiny body was in desperate need of calories and hydration. It doesn’t stop me from remembering how helpless I felt when I would bring the much needed bottle to her mount, only to have her scream and refuse to suck from it. Most of all, it doesn’t stop me from remembering how defeated I felt when she threw up what little we had managed to get in her.

Throwing up is the other major trigger.

Now, she does still throw up. I get that all babies throw up from time to time, but when you have a failure to thrive baby with a history of feeding issues, it can induce an anxiety attack every time it happens. When she throws up now, all that I can think is:

“What did I do wrong?”          “Did I move her too much/too quickly?”          “Did I push her to take too much from the bottle?”          “Did I start the NG feed too quickly after the PO feeding?”          “Is the NG feed too fast?”          “Did she get enough?”         “Will she keep her next feeding down?”

“Will I have to take her back to the hospital”

On and on and on…….

Now, I know that not all of these thoughts are productive. Sometimes, I did nothing wrong at all. But that doesn’t stop me from thinking some (if not all) of theses when it does happen.

The other thing I struggle with is hearing her cry, especially in fear and/or pain. I know her cries for fear and pain very well at this point, and sometimes I hear them when they aren’t actually happening. Knowing that she isn’t actually crying is a big reason why I don’t like to be in a different room than she is, especially when it comes time to sleep. Even if I am taking a nap and my husband is home, holding her, I swear I will hear her cry and it will send me vaulting out of bed. Tonight was a great example of what I struggle with.

Lyra was fussy most of yesterday (plus she threw/spit up three times). For the midnight feed she did not want to calm down and was very upset through much of the NG feeding. Sometimes, if she is too upset during the NG feed, she throws up. So, my husband and I spent the 25 minutes trading off trying to calm her down without picking her up or accidentally having her gag on her pacifier. Finally, we got her to fall sound asleep at the very end. Rather than risk waking her up in the transfer to her bed in our room, we decided to leave here in the nursery with the video monitor on. Laying in bed, I could swear I heard her crying. I could hear it building into real distress. Opening my eyes, I looked at the monitor only to see her still her peacefully sleeping always. However, even with my eyes open and watching her, I swore I could still hear it. Moments like this make me feel crazy and are hard to acknowledge and talk about, but they happen. I know why the fear is there and the moments that caused me to develop such anxiety about those two types of crying, but knowing and controlling are two very differently things.

For now, we are dealing with our trauma the best that we can. For me, I have to keep reviewing the signs that tell me that she is okay. I also try to find tools, like the monitor, to help show me that she is okay. When I start to panic, or fall apart, about some of this, my husband tells me what I can’t tell myself. I do the same for him when he starts to lose it a little. Right now, we are still a team.  We try to recognize when one of us needs a break to regroup, or words about what is different (and so much better) about having her home this time. At this point, we have had her home for the longest period of time yet. As the days go by, I hope the anxiety will decrease. But for now, the best I can do is admit it is there and deal with it by using the few (but powerful) tools that I have.

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Lyra’s first 4th of July.

Pink, white and blue was the closest I could get with the cloths that fit her.

Home Sweet Holy $h!t We Are Exhausted

Home Sweet Holy $h!t We Are Exhausted

Don’t get my wrong, being home is great! I love not having to drive 45 min. to see my baby. I love being able to take a nap without a doctor or nurse coming into the room. I love not having an alarm go off because managed to a lead off her chest. I love not eating cafeteria food all of the time. But just because I am home does NOT mean that I get anymore sleep. Her feeding schedule is tough and very involved. Here is what my/our days look like:

  • 12-1 AM: Mark feeds her (yes, feeding takes an hour)
  • 2:20 – 3 AM: My annoying alarm goes off. I pump while I blog, then I get ready for the 3 AM feeding
  • 3-4 AM: I feed Lyra
  • 5:40 AM: My annoying alarm goes off. I start to warm up a bottle from milk I pumped at 3 AM. Then I re-set the alarm for 6 AM and pass back out.
  • 6-7 AM: My alarm goes off and I used to pretend that I was going to do this feeding because Mark has to get ready for work…. I don’t pretend anymore. Mark does this feeding.
  • 8:20 – 9 AM: My alarm goes off and I debate if I REALLY need to get out of bed yet. The answer is always “yes”. So, I get up and pump and get ready for the next next feeding. Sometimes I even eat breakfast while I am pumping during this round.
  • 9 AM – 10 AM: Feed Lyra and give her the multivitamin (that causes her to spit up half of the time) and her inhaler (this is just for a few more days post opp)
  • 10 – 11 AM: This is when Lyra normally likes to be awake and play. If I have not had breakfast by this point, it is a lost cause until after the noon feeding.
  • 11 AM: Yet another alarm goes off.  Time for Lyra to take her Prevacid!
  • 12 – 1 PM: Feed Lyra
  • 1 – 2 PM: This is my best chance to get something done. If she is still awake, we play for a bit, but normally she falls asleep. I also normally try to eat something at this stage.
  • 2 – 3 PM: Pump and get ready for the next feed.
  • 2:50 PM: Normally Mark walks in the door from work. The angles sing, the baby smiles to her daddy, and I throw a little party in my head.
  • 3 – 4 PM: If Mark is home, he feeds her and I pass out in the bedroom. If he isn’t, I feed her and try not to fall asleep while doing so.
  • 4 – 5:30 ish PM: Lyra and I pass out together in the bedroom. If Mark is home, he finishes up his work in the living room.
  • 6 ish – 7 PM: *Sometimes Lyra is hungry a little early for this feeding*. If Mark doesn’t have training her does the whole feeding while “cook” dinner. “Cooking” is a term I use very loosely. Sometimes it means order food for delivery. Sometimes it means I throw something small in the oven. Rarely does it mean using pots and pans. If Mark is training, I quickly eat dinner (read “throw something in a bowl and hope it is filling enough”)
  • 7 PM – 8 PM: Play with Lyra if she is awake
  • 8 PM – 9 PM: Pump and get ready for the next feeding
  • 9 PM – 10 PM: One of us feeds Lyra. It really depends on the day and what we have going on. However, I always go to bed after this feeding and Mark often lays with her on the couch to catch a few Z’s.
  • 11 PM: Lyra gets her meds again and we start the whole thing from the top.

There is no “weekend” schedule. There is no easier way to do it. This is what our daughter needs, so this is what we do. It is just….. exhausting. In three weeks we will re-evaluate with the doctor and see if she has gained enough weight at that point. If she has, we might be able to modify things a little. Until then, this is what we will do!

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Lyra had rolled onto her side while I was pumping. Tyke was making sure she didn’t roll any more.

****Why it takes an hour to feed Lyra: First we change her. Every time. This helps wake her up if she was sleeping. Next, she takes what she can by mouth from the bottle. She has 20-30 min to do this, but she honestly is normally done after 10-15. Eating is hard and exhausting for her. She normally only takes about an ounce (30 mL- 40 mL) and than she is done. If we try to push it (and we have), she pukes. After that, we have to prepare the tools we need to feed her via the NG tube. We then check its placement, flush it, and feed her. She gets about 2mL/min. So, if she only takes 30 mL, we have to give 55 mL via the NG tube. This takes us close to 30 min. After that we have to clean the bottle and all of the tools used in the NG feed. All in all, it takes about an hour.****

More Questions than Answers

More Questions than Answers

This is a post that I have been waiting to write for almost a week. I waited, in part, because my husband and I needed to digest the information. Because of her challenges and a few physical anomalies, my husband and I decided to do some genetic testing on Lyra when she was admitted into the hospital this last time. Before getting discharged last week we received the results. Lyra has, not one, but two very rare genetic disorders.

Lyra has been diagnosed with trisomy 9p syndrome and 16p deletion syndrome. Not only are both very rare on their own, but there are no documented cases of a child having both. That doesn’t mean it hasn’t happened. After all, genetics is a new science. This leaves my husband and I in a tough situation. There is little information out there about either syndrome (and nothing about her specific diagnosis for 16p that I have found). For both syndromes, severe intellectual challenges have been documented. Physical challenges are also a likely possibility. However, in the case of 16p deletion syndrome, there has been at least one case of a child have an IQ of 130ish.

Basically, we now have more questions than answers. We have absolutely no idea what expect. We could have a child with mental retardation and extreme physical challenges, or a child with some physical challenges and/or intellectual challenges (such as a dyslexia). Or we could have anything in between. We literally have no idea. This is why my husband and I have needed time digest everything.

So, where do we go from here….. Honestly, we don’t really know. At this point our plan is to celebrate the accomplishments she archives (like smiling, cooing and making eye contact), and seeking out help when she struggles with something. We recognize that she will have major challenges, but if we play the “what if” game too much, we won’t be able to handle day-to-day life or enjoy our little girl.

So here we are.

 Resources:

Adjusting to being Home

Adjusting to being Home

So, Lyra is finally home. The sent us home with an NG tube so that we don’t have to worry about her not taking her whole bottle. While she has been making progress with eating, she still can’t seem to take the whole thing by mouth. She also still throws up occasionally.  I bet that the occasional throwing up wouldn’t both most parents, but for my husband and I, it makes both of us panic.  We are both truly traumatized by watching her throw up feed and after feed. Some days, as we fed her, we would silently pray that anything we gave her stayed down. While she now only throws up once every few days, it still makes my heart sink into my stomach.  I can’t help but think, “are we going to have to go back to the hospital? Is she going to be okay? What did I do wrong this time?”.  I just want my baby girl continue to grow. She is over a month old and still fits into newborn clothing. While this may be normal for premies, she was full term. At least when she was weighed before we left the hospital she has finally crossed into the 8lb range. Maybe being home won’t feel so terrifying one day. For now, my husband and I are just doing the best we can to keep our cool.

Truly Humbled

Truly Humbled

Todays post is more of that thank you. I am truly humbled by the amount of support we have received from friends, family, and even strangers. My family has been incredibly supportive, despite the fact that they can not always physically be here (the live on the other side of the country). Our friends, both locally and otherwise, have also been wonderful.  Two of our friends have been taking care of our dog (our first born) for over a week. We asked them to watch him for one night and they have taken care of him ever since. The words of encouragement and offers to help out with anything/everything have been greatly appreciated. My husband and I are not always the best at accepting (or asking for) help, but we have learned to embrace what has been offered.  Beyond the friends and family, I am humbled by those who I do not even know who have reached out and shared their stories and kind words. All of this reminds us that, although we are experiencing challenges we could have never prepared for, we are blessed. From the bottom of my heart, thank you all.

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Tyke and Lyra when we first brought her home

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Our first Father’s Day

One Step Forward, Two Steps Back

One Step Forward, Two Steps Back

It’s funny how you can go through a whole day feeling so positive, only to have everything turned upside down by a single number. When I came in this morning we found out that Lyra had lost a little bit of weight. The doctor increased the amount of milk she is supposed to take and we moved on with our day. Throughout the day she did great. She was taking more orally than she did yesterday and she didn’t have any trouble keeping down the extra volume pumped in via her NG tube. Her personality was also coming back today today. She spent a long period of time awake and checking out the world. We spent much of the day just looking at each other and making faces. She even did a little tummy time in her crib. With all of these positive indicators, I decided to stay until she was weighed again. I was really excited. We had done everything right today and she looked great.  And then the numbers came in….. 3.445 kg  (7 lb. 9.2 oz). It is a full oz less than she weighed yesterday.  She should be gaining an ounce per day, not losing it.

I just don’t understand. We are doing everything right. The surgery fixed the laryngomalacia. She is eating more AND keeping everything down. I am actually eating regular means and most of them have solid nutritional value, so my milk should be okay. I make sure to eat protein, fresh produce, and fats. Her reflux seems under control…. I just don’t get it. What are we doing wrong?  She has to do two things to be able to come home: 1) Consistently eat and keep her meals down, 2) GAIN WEIGHT. With the NG tube we have #1 taken care of. I don’t know how we will fix #2.  I don’t even want to go home tonight and see my apartment full of my baby’s things, only to know that I have no idea when she will be home again. I just want to be home and sit on my couch with my baby, husband, and my dog.