4 eyes?

Friday, December 11, 2009

4 eyes?

We got a letter from the health department about a month ago stating that Amaya had failed two different vision tests and that we need to have her screened in a more formal manner. (I laugh as I type this because with everything that has been going on around here, I have let this sit on the back burner for a little while) At the time that I got it, I thought that she really probably does need glasses, but that we could wait a little to get them, as we have had a ton of $$ go out lately.
I was talking with Amaya about her vision tests, and she was telling me that she asked them if they intentionally made the letters blurry (laughing again). Poor girl!
Anyways, I took her last week to get the exam and to order her new glasses.
We picked them up today and she was so excited with the fact that she could read things better and that everything looked so much better. (laughing again) While walking out of the optical place, she said, "I love my new glasses".
She is so cute in them too!!

It's Negative!!!!!!!

Dr. Forness called the other day to let us know that Ryan's MRI came back negative!!!! Phew! He said that he must have been "over reading" the xray, and with his history, that he is still happy that he had it done. Ryan continues to limp, so he is going to have us get some lab work to rule out some arthritis problems.....I am going to delay on this, as I think that he (and I) have had enough medical stress lately.

The cannels came out!

The cannels came out....

Ryan has been sick with cold like sympotms the last couple of days. I have been teaching him to blow his nose. Tonight, after he blew his nose, he repeatedly told me that the cannels came out. I kept asking him, "what", but he just kept repeating it.
Then I remembered: I have been teaching him to "blow- like you are blowing the candles out (like on a cake), but through your nose".
He has apparently taken that as he is blowing candles out of his nose!

Wednesday, November 25, 2009

Will you hold my thumb?

Today Ryan went for his MRI. It has been rescheduled 4 times in the last 2 weeks, two of those times they moved it up for us, one was cancelled because Ryan has been sick, and of course, the last one we kept! He had to be there at 8am and the procedure was to begin at 930. Scott was not able to go with me because of the last minute schedule thing, so I had to go alone, with Ryan. I really didn't want to go alone, but there is so much going on with everyone right now, that I didn't really have any other options.
 I was anxious the whole way up. I know, an MRI is no big deal, but they had to sedate him because of his age. He is only 3, and there is no way that he would be able to lie in a tube that makes a ton of very loud noises, for an hour. Let alone, not be scared.
I am a nurse and know what to expect. Heck, I do this to people, even kids! However, it is a completely different thing being on the patient side of things. They are so nice there and did SUCH a great job, but still, I was anxious!!!

Ryan with his "lotion" on. (numbing cream-EMLA for the IV start)

We hung out, watched TV, played trucks, then 2 nurses, and 2 other women came in. Two nurses for the IV start, and the others to distract and play with Ryan. He did an awesome job! 

After the IV start, he wasn't that happy, but he really did get over it very fast. We kept blowing bubbles, and he would swat them with his hands, popping them. 

When he couldn't hold the bubble container, he got a little sad, and asked "will you hold my thumb"? So sad, it is awesome how kids accept situations, and make the best of them. 

Then after a while, we went down the hall to the MRI room. He didn't want to get on the "other" bed, so they said that I could just hold him. The peds anesthesiologist came out with his syringes of meds, and administered them right then and there! Diprovan, (the Michael Jackson drug) was the drug that they used. So there I am, just standing in the hall, holding Ryan in my arms. He was sitting up, not lying in my arms, so when they gave the drug, he just lightly fell down into my arms more, and became unresponsive.What a horrible feeling! To just watch him like that was the worst thing ever! They helped me lower him to the cart, I gave him a kiss, then they wheeled him into the MRI room. 

He looked so small with that huge machine, so helpless. I was only allowed to watch for a few seconds, then went back to the quiet, empty room. The nice women helped me get back there, but on the way they were trying to comfort me, offering me coffee, etc. but all I said, was, "If I talk, I am going to cry", so they left me alone and.....I shut the door, and cried.I still can't believe that I cried, that was so unexpected!After an hour, they wheeled him back in. He was trying to roll a little bit on the cart, but didn't have a lot of coordination, so I just rubbed his back and loved on him. He recovered quickly and didn't cry or anything! I asked him if he went to sleep while at the hospital, but all he says is, "I slept in your bed" (which he did last night). So, it is nice that he doesn't remember any of it. Even after showing him pictures, he says he doesn't want to go in the dark hole because it is scary. Then I tell him that he already went in it, and he looks at me like I am crazy!Anyways, it was a hard morning for me, which is crazy, because he wasn't affected by it at all. Oh well, the joys of motherhood. Now, we just wait for Forness to call with the results. 

Ryan, recovering while watching TV. It is funny how he is having a hard time keeping his eyes open. 

Ryan back to his normal, active self. It didn't take much time at all for him to recover!

Thursday, November 12, 2009

Ryan Joe

We have been working on brushing teeth with Ryan lately, but I don't think he quite has the hang of it yet!!

Sigh...

So, Ryan has been limping for like 2-3 months. He had no trauma, injury, bruise, swelling or redness to think that he hurt himself.
He went in for a well check last Thursday with Dr. Galvin, so I told him what has been going on, and with Amaya's history of this type of problem, he ordered some xrays and blood tests. His office called us and said that everything came back negative, and that if we wanted to be referred to an orthopedic specialist, to let them know. So, I called back, and of course, got that referral. Two days later, today, we got in to see Dr Forness (same ped orthopedic as Amaya). He checks Ryan's range of motion.....limited, as his L leg won't cross over the midline just like Amaya'swouldn't. Then he looked at the xrays that I brought from Hackley and tells me that he thinks he sees something on there in the L femur head. "It looks a little white, patchy, but I'd like to repeat the xray, and get a peds radiologist to read it".
Okay, repeat xray done, Forness comes back in to the room, and says that the radiologist agrees with him, and there is something going on, and that it is an abnormal xray!! Ryan needs to have further testing, which means an MRI. He will have to be sedated for it, so will require some preopstuff at his primary care doctor, then will need an peds anesthesiologist for the procedure....ugh!!
I am sad, mad, and confused. I don't understand. How can 2 people in the same family havePerthes', same leg/bone, etc. I wonder if it isn't something else, congenital, hereditary, or something else. Forness says that we will talk about it after the MRI, and that more blood tests will need to be done. Amaya had 2 of the many lab tests come back abnormal. They were blood clotting studies, they were elevated, so maybe that has something to do with all of this...who knows...?
Sigh, here we go again!!!

Tuesday, September 1, 2009

Gardens??

Ohhh, the gardens.....

I have never been to the Meijer Gardens before, and I just can't believe it! It was awesome, so beautiful, the kids loved it, and we will definitely be back....and soon!!! I ended up buying a family pass so we can go whenever we want.

Monday, August 24, 2009

The end of summer?

I have to say that we had a pretty good day today. I feel like the summer is coming to an end, but we haven't been able to do a lot this year, because it has been so unseasonably cold! We hung out at home this morning, then went to Fredric Meijer Gardens in the afternoon. THEN, we went to the SL beach after dinner. I feel like I am jamming in all of the stuff that I wanted to do this summer into the last few weeks. Thursday, I want to go to Chicago!

PS, I LOVED the gardens!!!

Pics to come later.

Peeee U!

Jake: Mom, do trees poop?

Mom: No Jake, trees do not poop, why?

J: That tree that fell over stinks, and I just wondered????

Alright then!

It is funny to look back at these pics, as he said this today, and realize that kids are smelling it and plugging their noses. I think it stinks because of all the moisture at the base of the tree and down in the roots, and whatever fungus, etc has been growing down there all this time. These pics are from like 2 weeks ago.

Tuesday, August 4, 2009

Just a peek!

Ay, yi, yi, it has been sooo long since I have posted anything. It's not that there aren't a million and one things going on in my life, but I just haven't been in the "mood" to blog. We have had a busy summer, even though the weather hasn't been the greatest, but this week it is finally calming down. This is the first week, all summer, that Amaya and Jake get to sleep as long as they want, and don't have to get up and get ready to go to swimming or tennis. Ahhhh, this is how the summer is supposed to be!

Hopefully, I will get back into blogging, like I was last year at this time!!

Here is a peek at how big the kids really are now!

Friday, July 3, 2009

If you love something..

A turtle, is all Jake wanted, as far as pets go. We got the rats, but he always wanted a turtle....So Granny found a baby turtle walking in her yard one day and gave it to Jake. He loved that turtle, but wouldn't take care of it as often as he needed to. He agreed to set it free, but back at Granny's house/pond, so that he could get back to his mommy!

Obviously, he is sad about this, but it is so much better for the turtle this way!! This was hard for him, and I am so proud of him for letting it go (before it died) and making the best choice for "turtle".

Friday, June 12, 2009

Ryan

Scott took the older kids to GR with him to check out a sea doo (more on that later), so I was left here with just Ryan. We went over to the Brown's, then went to G & L chili dogs for dinner. It is so fun to just hang out with one child. You get to see them in their own little light for a small time, and actually get to pay close attention to it. He is growing so fast! I love how he speaks in full sentences, uses reference to past things, and has such a funny sense of humor. He reminds me a lot of Jakers.

After dinner, we went down to Chinook to look for ducks and boats. Every time he saw a bird, he would try and catch it. He wouldn't do a full out run, but tried to sneak on them. It just made me laugh. He would even say, "Shhhh", and hold his finger up to his mouth so that I wouldn't scare them away, or give away his hiding place, so that he could pounce. Bird after bird, he had no success, but had a great time doing it. I treasure these small, unplanned times with the kids. They all grow so fast, and change even faster, so we need to cherish every minute!

Wednesday, June 10, 2009

Big Boy

Ryan is spending his first night in a "big boy bed" tonight. It melts my heart. I am sad, yet excited all at the same time. His eyes just lit up when he saw what Daddy was doing, then he started jumping on it as soon as it was all put together. Two nights ago, he decided that he could just crawl out of his crib all on his own. He has never even let Amaya or Jake get him out, it always had to be Momma or Daddy, so to all of a sudden just do it himself, cracks me up.

I can't believe that my baby is in a regular bed and not in the crib (he looks so small in this full size bed). That crib has been such a huge part of our life for the last eight years. Ugh.....my baby is growing up!

As Scott was hauling the crib down the steps, with all the kids in tow....Amaya says, "maybe we can keep the crib so that I can use it when I have a baby".

Hold up girl! I am just getting used to packing it away from my baby. I don't want to think of being a grandma already. (yet secretly I am so excited that she would even think of using it on her children!)

Thursday, May 7, 2009

Hello, Hello?

It has been so long since I last blogged, that......I couldn't even find myself under "my favorites" on my computer.....

Thursday, April 2, 2009

more on this....

Huh, this is just crazy!!! I am saddened and have shed some tears, but relieved at the same time. I said that I would take anything over CA or a life threatening illness, so here it is. We can get through this, it will just take a while.
Amaya is NOT to jump, run or play any high impact or competitive sports. She IS able to ride horses, but not able to trot or canter. She is sad about this, and just states, "I want to do whatever I want on the horse". In a couple of years, hopefully, she will be back to normal with minimal effects into her adulthood.
We have to watch this closely, as there are risks of dislocating that hip through all the stages of the disease. If that happens they will have to take measures to keep it in. (most probable- hip surgery) We are just hoping and praying that she will not need that and this will be a minimalist type of the disease. It is just a wait and see, doing xrays periodically throughout to keep an eye on it.
She doesn't have a lot of pain, but it it DOES get worse with activity. Such a nice, gentle reminder of the dying bone. (ugh!)
She is such a tough little girl, and has taken this all so well, we are so proud of her!

On another note, her legs are the same length again, and her gait is so much better. Physical therapy (Marty) has helped sooo much. I know that when we get to the recovery/bone growing stage that she will still need the PT, and it is nice to already know the therapist and to really like him.

I was talking to Amaya last night about this and she came up with such great questions.

#1 Why did this happen to me? It just happens, for no reason. You didn't do anything wrong, we didn't do anything wrong, it just happens.
#2 What happens to the bone part that dies? It just reabsorbs in your body, it kind of just dissolves.
Amaya- oh, just like those color tablets that we put in the bath tub to change the color of the water?
Mom- Just like those, what a great reference!
#3 If I jump, will it dent the bone more? No, it won't dent the bone more, but may cause more injury and pain.

All of these types of posts are to be continued.....

Wednesday, April 1, 2009

Define LCPD

Legg-Calve'-Perthes Disease

The National Osteonecrosis Foundation

Legg-Calvé-Perthes disease is a rare disease of the hip that afflicts approximately 1 in 1200 children. Of those children, only about one in four are girls. About 5% of all diagnosed develop the disease in both hips (bilaterally). Most of these children are very active and often very athletic. The age of diagnosis is usually between 2 and 12 years old, with the average age of 6. Legg-Calve'-Perthes children tend to be of shorter stature due to delayed bone age.

What is Legg-Perthes Disease?

Legg-Calvé-Perthes disease (LCPD) is a form of osteonecrosis of the hip that is found only in children. It is known by a few other names such as ischemic necrosis of the hip, coxa plana,osteochondritis and avascular necrosis of the femoral head. Most commonly it is called Legg-Perthes disease, LCPD, or Perthes.

LCPD is of unknown origin. It is known that bone death occurs in the ball of the hip due to an interruption in blood flow. As bone death occurs, the ball develops a fracture of the supporting bone. This fracture signals the beginning of bone reabsorption by the body. As bone is slowly absorbed, it is replaced by new tissue and bone.

Initial Phase
Reabsorption Phase
Reossification Phase/Healed


Four Stages of LCPD

Femoral head becomes more dense with possible fracture of supporting bone;
Fragmentation and reabsorption of bone;
Reossification when new bone has regrown; and
Healing, when new bone reshapes.

Phase I takes about 6-12 months, Phase 2 takes one year or more, and Phase 3 and 4 may go on for many years.


Who is at Risk?

There is no specific cause known for LCPD, however, there are some risk factors. Some of the factors identified as possible links include children who are small for their age and are extremely active. The disease is found more often in Asians, Eskimos, and Whites, with a much lower incidence found in Australian aboriginals, Native American, Polynesians and Blacks. Exposure to secondhand smoke is correlated with LCPD.


First Symptoms

The first symptoms characterized in LCPD are usually a limp and perhaps pain in the hip, groin, or knee (known as a referred pain). Often you will first notice limping during your child's active play. They usually cannot tell you an instance when they hurt themselves. They may not be able to tell you exactly where they hurt, especially if the pain is referred toward the knee area. They may not even experience much pain. Other cases may not be diagnosed until some precipitating event (fall, twisting injury) leads to an x-ray that uncovers the previously undiagnosed Legg-Calve'-Perthes disease.

Diagnosis

Initial diagnosis will require an x-ray, magnetic resonance imaging (MRI) or bone scan. Other diagnostic measures may include tests for limitation of abduction, a measurement of the thigh to determine muscle atrophy, and tests to determine the child's range of motion.

Extent of Disease

It is rare for a patient to have whole head involvement. However, age can play an important role in the prognosis of the disease. New bone growth typically reshapes better in younger children and it may improve with growth.

There are several different classifications used to determine severity of disease and prognosis.

The Catteral Classification specifies four different groups to define radiographic appearance during the period of greatest bone loss.

The Salter-Thomson Classification simplifies the Catteral Classifications by reducing them down to two groups: Group A (Catteral I, II) which shows that less than 50% of the ball is involved, and Group B (Catteral Ill, IV) where more than 50% of the ball is involved. Both classifications share the view that if less than 50% of the ball is involved, the prognosis is good, while more than 50% involvement indicates a potentially poor prognosis.

The Herring Classification studies the integrity of the lateral pillar of the ball. In the Lateral Pillar Group A, there is no loss of height in the lateral 1/3 of the head and little density change. In Lateral Pillar Group B, there is lucency and loss of height of less than 50% of the lateral height. Sometimes the ball is beginning to extrude the socket. In Lateral Pillar Group C, there is more than 50% loss of lateral height.

Many doctors utilize these classifications as they provide an accurate method of determining prognosis and help in determining the appropriate form of treatment.

Prevention
There is no known effective preventative measure.

TREATMENT

The Goal

The goal of treatment is four-fold:
I) to reduce hip irritability
2) restore and maintain hip mobility
3) to prevent the ball from extruding or collapsing
4) to regain a spherical femoral head

Types of Treatment

Often at the initial diagnosis, the physician may take a "wait and see" approach to get a clearer picture of the progression of the disease. As long as the patient's symptoms are mild, the physician may only prescribe physical therapy exercises to help maintain good range of motion. If the patient's mobility changes, then the physician may prescribe either non-surgical or surgical treatment.

Non-Surgical TreatmentNon-surgical treatments come in varying forms. Crutches are used for non-weight bearing treatment for pain. Casts, traction, and braces help return range of motion and mobility. Range of motion exercises may be given to you by your physical therapist to do with your child in the home.

Surgical TreatmentTenotomyA "Tenotomy" is a surgery that is performed to release an atrophied muscle that has shortened due to limping. Once released, a cast is applied allowing the muscle to regrow to a more natural length. Cast time is about six to eight weeks.

Osteotomy

There are different types of "osteotomies" (cutting the bone to reposition it) and, depending on the need they are performed at different stages of the disease. At times with the softening of the ball, there is the possibility of the ball slipping out of the socket. To protect it, a femoral varusosteotomy, with or without rotation partially redirects the ball into the socket.

Another approach to surgically treating Legg-Calve'- Perthes is to do an osteotomy above the hip socket. This allows the surgeon to reposition the hip socket in such a way that the femoral head will have less tendency to become deformed. The shelf arthroplasty gives added coverage of the ball from the top lip of the socket. Both the innominate and the shelf arthroplasty help in reshaping.


LOOKING TO THE FUTURE

Studies on long-term results of LCPD indicate that the incidence of late degenerative osteoarthritis is dependent on two factors. If the ball reshapes well and fits well in the socket, arthritis is usually not a concern. If the ball does not reshape well, but the socket's shape still conforms to the ball, the patient will tend to develop mild arthritis in later adulthood. Patients who~ femoral head does not shape well and does not fit well in the socket usually develop degenerative arthritis before the age of 50.

Although Legg-Calvé-Perthes disease cannot be prevented, much has been accomplished toward minimizing its effects. Research and clinical studies continue to provide patients with better long-term results.



This picture sickens me. You can see on the left side of the picture (pt's right) the dissolution of the bone. The neck of the femur is pretty much gone, and the bone is all jagged. This, I assume, is the latter stages. Crazy to think that this is what is going to happen!!!
Note: This is NOT an xray of Amaya, it is just to show what will/may happen over this course of disease.

This is just a different site I copied from, it gives more of the signs and symptoms. I swear, this could have been written after Amaya. She is the textbook case with these symptoms.


One in 1200 children younger than 15 years is affected by LCPD.

Outcome is extremely variable.

Race
Caucasians are affected more frequently than persons of other races.

Sex
Males are affected 4-5 times more often than females.

Age
LCPD most commonly is seen in persons aged 3-12 years, with a median age of 7 years.

Clinical History
Symptoms of Legg-Calv é -Perthes disease usually have been present for weeks because the child often does not complain.
Hip or groin pain, which may be referred to the thigh
Mild or intermittent pain in anterior thigh or knee
Limp
Usually no history of trauma


Physical

Decreased range of motion (ROM), particularly with internal rotation and abduction
Painful gait
Atrophy of thigh muscles secondary to disuse
Muscle spasm
Leg length inequality due to collapse
Thigh atrophy: Thigh circumference on the involved side will be smaller than on the unaffected side secondary to disuse.
Short stature: Children with LCPD often have delayed bone age.
Roll test
With patient lying in the supine position, the examiner rolls the hip of the affected extremity into external and internal rotation.
This test should invoke guarding or spasm, especially with internal rotation.


Causes

The etiology of Legg-Calv é -Perthes disease remains unclear; however, the following scenario generally is accepted:
The blood supply to the capital femoral epiphysis is interrupted.

Bone infarction occurs, especially in the subchondral cortical bone, while articular cartilage continues to grow. (Articular cartilage grows because its nutrients come from the synovial fluid.)
Revascularization occurs, and new bone ossification starts.
At this point, a percentage of patients develop LCPD, while other patients have normal bone growth and development.
LCPD is present when a subchondral fracture occurs. This is usually the result of normal physical activity, not direct trauma to the area
Changes to the epiphyseal growth plate occur secondary to the subchondral fracture.




Follow-up

Legg-Calv é -Perthes disease (LCPD) does not require emergent inpatient care.
Treatment may involve observation, usually in children younger than 6 years.
Bed rest and abduction stretching exercises are recommended.
Nonsurgical containment allows the femoral head to stay within the acetabulum, where it can be molded. Various casts, braces, and crutches have been used for containment.
Initially, close follow-up is required to determine the extent of necrosis.
Once the healing phase has been entered, follow-up can be every 6 months.
Long-term follow-up is necessary to determine the final outcome.
Surgical correction of gross deformities of the femoral head may be necessary.


Complications

LCPD may result in femoral head deformity and degenerative joint disease.
The femoral head may be distorted permanently.


Prognosis

The younger the age of onset of LCPD, the better the prognosis.
Children older than 10 years have a very high risk of developing osteoarthritis.
Most patients have a favorable outcome.
Prognosis is proportional to the degree of radiologic involvement.

Monday, March 30, 2009

MRI

Amaya's MRI got moved up to last Friday night, 5 days early!! Because I thought that she could tolerate not being sedated, they figured that they would try it. So, we went Fri night at 8:45. She got there, chatted with the nice lady, and lied on the table. They put a medium size pair of goggles over her eyes, then put earphones on her ears and she was able to watch and hear the movie BOLT during the entire procedure. She did soooo great. About 3/4 through the procedure, they had to stop to put a small IV line in to give her some contrast. Contrast helps get a better picture for different things. For example, it helps an infection show up easier, so, contrast it was. She cried more before the poke than she did when the actually poked her. She said that she didn't even feel it!! Brave girl. We are so proud of her. So now we are just waiting to see what the results of this test are.....tick tock once again. I plan on calling Dr Dixon's office this week, like Tuesday to see if they can call and get the results faxed to them instead of waiting for it to come in the mail. I know I am inpatient, but anyone in the medical field knows the true waiting times, and this won't be unrealistic. Hopefully we will have results in a few days, and they are good results. I will take anything other than cancer as a good result, even if she ends up needing some sort of surgery.
To be continued.....

Thursday, March 26, 2009

Amaya Basketball

I am late to blog this, but it was Amaya at basketball this year. She loved to play, and actually did well, scoring a few points each game that she played. Her Daddy was an assistant coach, which I thinkAmaya secretly LOVED. (as did SCOTT) Unfortunately, her season was cut short with leg pain....that got worse with the running. She tried so hard to keep playing that Scott said she would hop down the court, and would stand at the other end on only one leg. Poor girl! We are hoping this instills a love for sports. (bball preferably per Scott)


Amaya making a basket! Just look at that form!!!!


This is Amaya and Shayna. Shayna is Amaya's best friend and they are in the same second grade class together. She came with us to watch a game.