We're home... and our flight in the NOT so friendly skies

Friday, September 18
Well, Faith and I are home. I apologize in advance if I start ranting in this post. It has been an incredibly long day.
I, being the procrastinator that I am, didn't start packing our things to go home until probably 2 AM, went to sleep around 4:30 AM, intended to wake up at 6-ish to finish getting things together,hoping to get to the hospital by 7:30 to drop off our extra Omegaven and pick up my camera after I forgot it at CAIR yesterday. I figured we'd drop off the Omegaven, say goodbye again to everyone, and catch a cab by 8:15 at the latest to get to the airport.
I actually ended up waking up at 7:33, hurried to get dressed and get everything together, and then walked as quickly as I possibly could to get to the hospital. As quickly as I could wasn't all that quick, since I was wearing Faith in a sling, wearing her backpack with a feed running, pushing a stroller with our 2 carry-on's and her carseat on it, and pulling our big suitcase along with me, so it was almost 8:30 when we got to the hospital.
We got my camera and headed back to Dr. Puder's office, where we were able to say goodbye to Dr. Puder, Danielle, Alexis, and Dr. Gura. Then we headed downstairs and caught a cab to the airport, and got there just shortly after 9:00.
We had absolutely the most horrible airport/airline experience I have ever had. I will NEVER fly United again, even if it does save us money up-front since our insurance buys the tickets with them. I have always flown JetBlue before when we've gone to Boston; it's cheaper, you can check a bag for free, you have your own TV and plenty of legroom, and they have good customer service and are super helpful and accommodating of Faith's (and my) needs.
United was awful on the way to Boston on Monday, and they were even WORSE on the way home. The only reason we flew United this time was because we didn't have the money to buy our ticket up-front and be reimbursed by our insurance company, and the travel agency that books flights for our insurance used United. I can guarantee the next time I talk to Faith's insurance case manager, she will be getting an earful about our experience. The fact that the airline made no attempt to make accommodations for the fact that I was travelling alone with Faith and all of her needs and the stuff we need to travel with her, seems enough reason to me for the insurance company to think twice about using that airline next time.
It all started last week, when I called United's customer service line to get our seats changed, since they had us assigned to row 32. I've done the same thing every time we've flown JetBlue, and even when the flight is full, they've always moved us up to the front, where it's easier to get on and off the plane, and the flight attendants are right there available if we were to need them. Well, the United customer service line is not a real person, and it's not even a push-button phone tree... it's one of those annoying computers that you talk to. After the third time it didn't understand what I said, I was pretty upset and used some choice words... apparently they've programmed it to understand those words, because as soon as I called it a stupid [non-abbreviated] POS, it transferred me to an actual person. Not that it helped, because she promptly told me that I'd just have to wait and ask at the ticket counter when I checked in on Monday. So then I asked what their policy on medical baggage is, and I was told that medical bags can be checked for free (good news when they charge $20/bag!).
Monday, when we got to the airport, I stood in the check-in line to see that they don't actually have PEOPLE there, either! I told the lady who was directing everyone to the next open computer that I was travelling with a medical needs baby, and would need to talk to a person when we checked in, and she very rudely said, "I am a person!". Ok, well you're not standing at the counter, why would I think you'd help?? So she directed me to the next open computer and I told her we needed to change seats to a more accessible part of the plane, and she said if there wasn't anything on the screen, there wasn't anything she could do, and I'd have to ask at the gate. She did check our bag for free without much of a struggle when I told her it was full of medical supplies, and then I went to go find our TSA escort.
Travelling is SO much easier and nicer when you get a hold of TSA at the airport ahead of time. Denver has a really good security process anyway, but having an agent to walk you through really helps. Your escort makes sure that everyone knows you need special screening, that all the bins your stuff goes in get sanitized, that everyone wears fresh gloves, etc. When we fly out of Denver, they hardly even look at our stuff. I never have to take Faith out of the sling, and I never have to take her backpack off. They never even look in her backpack, they just swab it for explosives and call that good enough.
So security was a breeze, and we got to our gate almost 2 hours before our flight was due to take off. I went to get a coffee, and some food to take on for lunch since we were flying United and they don't do free snacks. When I got back, there were customer service people at the gate, so I went to the counter to tell them about our needs and ask if they would move us.They said there was nothing they could do, so I said if they weren't going to move us, then we would definitely need help getting on the plane. Then the rude counter lady said that only a wheelchair pusher would be allowed to help me, so they'd have to call and see if one could come.
So Faith and I went over and sat on the floor to wait until it was time to board. In the meantime, I noticed the dressing on her line was starting to come up, so I pulled some tape out of her backpack to tape it down and keep it occlusive. A lady standing nearby asked if we were travelling alone, and when I said yes she said something about how brave I must be. A few minutes later, she asked me what was wrong with Faith, and I gave her the "short" version of the story (there's really no such thing as a short version...). For the most part, I find it offensive if someone asks what's "wrong" with her; I feel like compared to how she used to be, there is absolutely nothing wrong with her, and other than her tube she's just a "normal" baby. But I didn't say anything about it this time, because the lady was being nice. Then, she said she wanted to help me when it was time to get on the plane, to get all our stuff on and get to our seat. She told me I should bring my stuff and stand by her and her husband so they could help us. They were flying first class.
When it came time to start boarding, the rude counter lady realized these first class passengers were going to help me, so SUDDENLY she forgot she had told me they couldn't help me, and ran over to say she'd help me get our stuff on the plane. Once we got on the plane, the flight attendants were all rude, except for one older guy who asked every time he saw us if I needed anything. So that was our Monday experience. Enough to tick me off, and make me not want to fly United again.
Then today, it was even worse. I was more mad than I have been in a REALLY long time. Probably since Faith was in Denver and I had to deal with Dr. Potter. We got to the airport, went in and stood in line to check in, and went to the little computer, just like we were told to on Monday. I went through all the steps, saw that there weren't any seats near the front of the plane and knew based on Monday's experience that they wouldn't care, and then got to the step where it wanted to know if I was checking a bag. There was a young guy behind the counter, so I told him it was a medical bag so there wasn't a charge for it. He said he had never heard that, and that he'd have to ask a supervisor about it. I said ok, that it's what I was told when I called the customer service line and that we weren't charged in Denver, and then the "supervisor" came over and proceeded to pretty much say I was full of crap, that they always charge for bags, and even if they didn't charge for medical bags there's no way they'd let me check that big bag for free (it wasn't overweight... it weighed 45 lbs...). I told her the same thing I told the kid, and she said she'd ask a supervisor about it. I thought she WAS a supervisor, so that ticked me off.
So she had me follow her down to this other lady, who also told me I was full of it and that there was no way they'd let me check that bag for free, so once again, I repeated what I was told by the customer service line, and that we hadn't been charged in Denver. Once again, I was told that they'd have to ask a supervisor, because none of them had ever heard it. This was TWICE that they led me to think I was talking to a supervisor... finally they took me down to this other lady, who told me the same thing, and that they'd have to open the bag to see that it was actually medical supplies. Then, she looked it up on the computer, and read out loud the policy- "Bags containing medical assistive devices and supplies may be checked free of charge." At that point, I was yelling that that's what was in the stupid bag, and that I didn't care if they opened it, but all they'd see is that it had MEDICAL SUPPLIES in it. Note that the policy doesn't say that it has to be ONLY medical supplies, it says it has to "contain" medical supplies. So even though I had other stuff packed in there too, I did have almost all of her medical stuff in that bag, so it qualified. Technically, I could have put one freaking enteral bag or saline or heparin syringe in each of my bags, and according to their policy, they'd have had to check them all for free!
So then, the last lady said I still had way too much to carry on. It was NOT a good idea to mess with me at that point, and I loudly told her the purpose and contents of everything I had to carry on- the carseat Faith was going to ride in, the stroller that is free to gate-check, a carry-on with medical stuff in it, my computer bag carry-on, and Faith's backpack, which she was about to get hooked up to. The lady at that point was like, ok, whatever, and told me to go ahead to security.
The thing that probably made me the most mad about all of it was that these awful women were being rude and acting like I was stupid, embarrassing me in front of other passengers!
And since I came home, I looked on their website for verification of their policy... they don't have anything on the website I can find about medical baggage, BUT Faith and I are active duty military dependants, and since our health insurance (through the military) bought our tickets, we were travelling on orders. So I found this policy on their website, which makes me even MORE mad about it all, because they shouldn't have given me a hard time about ANYTHING- "You are exempt from the above fees for checking your first two bags if you are: active U.S. military personnel and/or a dependant with ID and traveling on orders" and then on this other page, there's this chart that says we could actually check THREE bags that weigh up to 70 lbs each! And, since Faith and I were both on the orders, that means we could have checked SIX- 70 lb bags and they COULDN'T have charged us!!
On top of that, I didn't contact TSA at Boston ahead of time, and Boston's security is not run nearly as well as Denver's. I had to tell 3 different people that we needed sanitized bins and fresh gloves before they actually did it, and the dumb guy by the metal detector was yelling at me for not putting Faith's backpack, which was attached to her, through the x-ray. (She wasn't actually running, but it makes security a whole lot easier and less to explain when she's hooked up.) The dumbest thing is that they made me put Faith's leather-soled baby shoes through the x-ray, and then they didn't even look in her backpack!
So finally, I got to the gate, and at that point I was obviously not happy. I didn't even try to be nice to the not-helpful ladies at the counter. I pretty much just said that I knew they wouldn't care and it wouldn't make a difference anyway, but that I was travelling with a medical needs baby and needed to be moved if at all possible, but that I knew they wouldn't move me, and since they wouldn't move me, I would need help to get on the plane and I needed to pre-board. They took the stroller and one of my carry-ons, and I left the carseat behind the counter so I could go get something to eat for breakfast and lunch. By the time I got back, it was pretty much time to get on the plane, and in the 15 minutes since I had talked to them, they already forgot that I needed help. I guess those counter people don't have common sense, because here I was, with Faith in the sling, wearing her backpack, pulling a carry-on, and they thought I'd be able to carry her carseat down the 10 inch wide aisle to row 31!!
The flight itself was pretty uneventful... then we got to Denver, it took forever for our bags to get to the carousel, and the only real road to leave the airport was closed because of a car accident. Needless to say, I hope our next trip is better than this one, and I pray that we'll have the money to buy tickets with JetBlue and just have the insurance reimburse us. Oh, and on top of all of that, I think I lost my driver's license somewhere along the way today...

We're here!

Tuesday, March 24
I am completely exhausted, but I wanted to post quickly and let everyone know that we got here ok. Going through security at the airport was a breeze, thanks to an awesome suggestion to contact the TSA manager before flying (thanks Paige!). The flight itself was ok... I really don't like flying much, and it was the longest flight I've ever been on (about 4 hours), and there was turbulence for probably 2/3 of it. I think I may have slept for about an hour. Faith did awesome, and slept pretty much the entire flight.
We got admitted right around noon, and are now in room 36-A on 10 East. It's going to be interesting getting used to everything being so different (we're in a shared room, I'm allowed to eat in here- in fact, since I'm breastfeeding/pumping I get to order meals for free!, there's a shower in the bathroom, I can sleep in the bed with Faith, plus about a million other things that are completely different!) I already met Dr. Puder and his team (Danielle, Alexis, and Kathy Gura) and signed the consent for the Omegaven, they will start that tonight and Faith will be Omegaven baby #115. Tomorrow we should meet a number of other doctors, including docs from the motility clinic and a feeding team. Dr. Puder seems optimistic that when we get her liver healed, her gut will work better, and she might even be able to eat by mouth again. He also was optimistic that we might not be here that long, since in the scheme of things her labs aren't that bad, and she has almost all of her intestine.
Anyway, I am having to fix typos pretty much every other word, so I am going to get some rest now and will post more later! I have a bunch of pictures to post, too.

Homeward Bound!!

Friday, March 20

I am packing up the last of our things, Faith took another carseat test, we're loading up the wagon... we are getting out of here this morning! I've done all the learning, I know how to work the feed pump, the TPN pump, and the lipids pump, I know how to mix the TPN, I can't say I know how to hook up the TPN tubing since Maree and I sort of had to guess at it last night, and we're pretty sure there are pieces missing... but there will be a nurse coming to our house tonight who will help with that. Technically, I'm already ahead of the game since I know how to mix it, because she was supposed to be showing us all of that tonight, but I had to figure it out last night on my own. Not that hard, I can cook and read a recipe, and it's basically the same thing, but with a lot more needles and alcohol swabs.

We have our room in Boston and a ride from the airport to the hospital, I've talked to the airline and TSA about our upcoming flight, I have the TSA Operations Supervisor's number to call as soon as we get to the airport on Monday, and there's a gate pass already arranged for Dave... I think all our bases are covered there... We've got one more nurse for Faith to take a picture with, and then we are done!

It is going to be strange to be home after living here so long, I've gotten so used to popping my head out the door to ask the nurse a question... I'm going to miss all of our nurses, they've been almost like a surrogate family while we've been here. The surgeons came by on rounds for the last time a little while ago, I'm pretty sure they said something like, "Thank God these guys are finally getting out of here!" ;-)

I probably won't post much over the weekend. It's going to be insanely busy with packing for an indefinite trip halfway across the country, and we're doing a last-minute baby dedication on Sunday at church. I will do a quick post just before we leave here today, with pictures of Faith in her going-home outfit, but otherwise stay tuned for an update when we get to Boston Tuesday morning!

Boston hopes

I've been looking alot at Boston Children's website in the past couple of days, just doing everything I can to familiarize myself with the hospital and the services available there, both for Faith's healthcare and for my own sanity (and the sanity of whoever joins me there). In all of my reading, I've found that not only do they have the Center for Advanced Intestinal Rehabilitation (the CAIR program) that I've mentioned before, but they also have a Center for Motility and Functional Gastrointestinal Disorders. Technically, Faith would fit under the scope of both programs. So, I am feeling very hopeful and positive that with the help of the experts in these two programs, we will be able to get Faith's gut working like it should, and maybe even get her eating by mouth!
Anyway, that's all I wanted to say :) Click on the links, read more about the programs, and some of the things that might be in store for us!

The flight is booked!

Friday, March 13
I just booked our flight to Boston! We will be leaving at about 11:30 PM on Monday, March 23, and getting to Boston at about 5:00 AM on Tuesday, March 24! That's only 10 days away!!!

Four months old!

Friday, March 13

Faith is four months old today! It's hard to believe... she's starting to act more and more like a four-month-old though, and I know from what I've read of others' experiences that once she's on the Omegaven and her liver starts getting better, she'll be even more like a "normal" baby.

She loves the little fishies on her swing (the mobile) and gets so mad when they stop! And she's started holding her hands together a lot more, playing with her fingers... and she's started trying to reach for toys hanging in front of her! She's started trying to roll over from back to tummy, and she's getting better with head control, but is probably a little behind there... I think once I can start wearing her more in the wrap that will help.

I am asking a million questions a day now, just trying to learn all of her stuff at a more gradual pace, rather than the cram-session that usually accompanies NICU discharge (or so I hear). I find it all intimidating, but I think it'll be ok... there's just SO much to remember, and some of the stuff (especially involving her Broviac) is SO important to keep her from getting an infection! She's made it 4 months now without ever having a line infection, which is amazing and wonderful, and I want to keep it that way!

Faith will be having her surgery at about 9:00 AM tomorrow. I've been searching all over for pictures of what her tube will look like, but can't find anything, and really can't picture myself what it will be like. Dr. Potter explained it yesterday (as best as Dr. Potter can explain anything!) and it will be like a regular G-tube with another tube like the one she has in her nose fed down it and to her intestine. I've seen pictures of the regular G-tube, but never anything quite like what he described.

When we were debating the G-tube before, everyone whose kids had them said they weren't a big deal, and when you eventually take it out the hole closes up and looks like another belly button... so I thought it was kind of funny, Faith doesn't have a "normal" belly button, and as it is now what the surgeons tried to give her probably won't look much like one with the extra times they've had to go in that incision, but she does have two scars from her chest tubes that look like belly buttons, and then she'll have a third one from the GJ-tube. So when she's older if anyone says anything about how she doesn't have a belly button (kids are mean!), she can come back and say she actually has three :)

I heard from the Boston social worker (Stephanie) today; I had emailed her asking if they had resources for getting from the airport to the hospital. Thinking about the flight, flying by myself with her and all of her "accessories", is kind of scary... please pray that I'll have peace with that. I'm not a big fan of flying anyway, and have only flown alone a couple of times, and have never flown with a baby... and I'll have to make sure that everything is timed right that she'll be all taken care of for meds and TPN and feeds and everything... her feeds last 4 hours, so I'll have to start a new one right before we leave and then the next one right after we land... and then I have to make sure that I've pumped right before we take off and pump again right after we land... I'm looking at booking a red-eye flight so that it's non-stop (it's the only non-stop we can afford), so we'll be leaving Denver around 11:30 PM and getting to Boston at about 5:00 AM. I find all of this slightly overwhelming... so many things to think about all at the same time!

I'm still waiting to hear from our case worker here (Jann), she's supposed to be talking to a case worker there today hopefully, to find out more about the insurance stuff, like how likely it is that they'll pay for everything if we go out there on our own. I'm holding off on booking our flight until I hear confirmation from her that the insurance most likely will pay. We know they might not pay for the Omegaven, but that's not a big deal b/c the hospital pays for it if the insurance doesn't, but theoretically they could deny everything else (labs, inpatient stay, etc) saying it has to do with the Omegaven. So I want to know they probably won't do that before I book the flight, since we can't afford to do this if the insurance won't pay anything.

Anyway, I could go on all day about all the little things that have me nervous/worried right now, but I won't, I'll just post some cute pictures instead :) Stay tuned tomorrow for cute pictures without the tape mustache!

Faith got all dressed up for her four month "birthday" :)

Faith was feeling spring-y yesterday :)

Wednesday, March 11
Well, things are seeming to fall into place and become more definite. Faith will be getting her G-J tube on Saturday. She has to be NPO for that, but hopefully re-starting feeds after that will go smoothly, and we will go to that place that starts with an "H" soon after that. From there, we will most likely go on to Boston on our own.
Our case manager came in this morning to tell me that Boston Children's is a non-network provider for our insurance. They also are refusing to cover anything for Faith until she is discharged from the hospital. SO, what that means is that if we did a hospital-to-hospital transfer, the insurance won't cover the transport, or the initial inpatient stay in Boston. (The transport alone would be $26,000!) That's the bad news.
The good news is, they seem to really want to send us home from here anyway, and then we'll be able to fly commercial to Boston. We have pretty good insurance, and they'll pay once Faith is discharged, so even non-network, we can make it work and just pay the out-of-pocket costs. I was never very worried about the healthcare costs associated with the Boston trip... it's the rest of it- eating, living, getting around- that's going to be a drain on us financially. We are very blessed to have this insurance available to us now.
There seems to be an interesting power struggle going on with Faith's doctors right now (well, for the past week really). Surgery has followed us and been her primary doctors the whole time we've been here. But pretty much since Dr. Sandoval switched to his urology rotation, I haven't seen a surgeon. The last time a surgeon talked to me was when we had our conference with Dr. Partrick. And neonatology has gotten more involved, with Dr. Kinsella making decisions and writing orders about Faith's feeds. So last night around midnight, when I posted last, he bumped her feeds to 17 mL/hr. This morning, Dr. Potter bumped her feeds to 18 mL/hr. Of course she threw up and was just generally unhappy and uncomfortable, since anyone who really knows anything about her knows that it's NOT smart to increase her twice in 12 hours... So Kinsella said to back her down and hold her at 17 mL/hr. So Dr. Potter must have seen that, and he wrote another order to bump her back to 18 mL/hr, and then increase to 19/hr tomorrow and 20/hr the day after that.
So Donna the NNP came in and asked if I thought she'd be ok increasing like that, and explained that they couldn't hold her at 17 if surgery wrote to increase to 18... so I asked whether we could hold her at 17 if I said no to increasing her, since realistically they can't do much of anything without me agreeing it's ok. I told her that Faith was really uncomfortable and threw up this morning when she was at 18, and I don't see a point in making her uncomfortable when we're planning to go to Boston anyway and if she's going to get pushed to take more, it'll happen then. So she called surgery to talk to Dr. Partrick; he and Potter were in the OR together, so she was able to confirm with both of them that we're holding Faith at 17 mL/hr.
All I can do is hope that we get out of here soon, and that the doctors in Boston have slightly better communication skills than they do here... Still no more definitive word from them...

not even sure what to think

Wednesday, March 11 (technically)
I just had to post quick, it's after midnight so technically it's Wednesday...
Dr. Kinsella (the neonatologist) just came in and asked how Faith is doing. He explained that the tube they put down in fleuro this morning is bigger than any feeding tube she's ever had before (8 french) in hopes that it would be able to get further down and that it would be harder for her to vomit out. (I already knew that, since I was there when they put it in!)
Anyway, since it's apparently against the rules to let her have more than one full day comfortable and without any throw-ups, he wants to increase her feeds to 17 mL/hr and see what happens. He has said before and pretty much said again that they'd be happy with getting her to 17 mL/hr and making the rest up with TPN (not that we'd be happy or willing to settle with that, since it's only about 65% of her goal of 26 mL/hr, and in reality her goal should be increased to 27/hr based on her current weight, which makes it 63% of her goal). He said something about her not needing to be in this room anymore at that point... I think he's hinting at the "H" word- that one that rhymes with "Rome"...
I'm not letting myself go there though, and honestly even if we did get to, how much would it really matter if we're only there for a short time before leaving for Boston? 65% isn't enough for me to feel confident that her liver status will improve. I think she'd have to get to 75 or 80% before I'd feel ok about it... we'll see I guess... maybe she will prove us wrong after all, and miraculously get to full feeds or something... (but God save us if we have to go home with an NJ tube, and have to drive 45 minutes to have it put back when she pulls it out every other day!)
We'll be at 120 days, 4 months, on Friday...

a little yellower, field trip, and more info

Tuesday, March 10
We thought towards the end of last week that Faith's eyes are looking more yellow than they had been, so we knew her numbers would be different again. Her labs this week are a little worse, her direct bili is back up over 6, and her ALT (liver enzymes) went up to 325 from 299... I really hope the Boston stuff can happen quickly!
We took a field trip this morning to fleuroscopy again. I think Faith has a thing for Fleuro Room 1, she's down there at least once a week. As much as we don't want her to have a more permanent feeding tube, we don't want her to have NJ tubes put down every other day. So, we're hoping they'll decide soon to put in a G-J tube to save her some of that stress. They've said they won't even think about it for another couple of weeks, though.
We don't like the idea of tube feeds, but really until they figure out why she's not able to tolerate feeds to her stomach anymore, it's our only option. So we've come to terms with the fact that she may be on tube feeds for awhile... and realistically, she may be on a combination of tube feeds and TPN for quite awhile, since there's no magic wand to wave and suddenly make her tolerate full feeds.
I've been paying more attention to her Broviac care, since I know I'll have to take that over soon. And I've been asking more questions about everything, too, just to try and prepare myself for all of it.
I realized the other day I haven't really posted much info about the Omegaven, even though I've talked about it alot. There is a good amount of information on this website. It's not the only reason we want to go to Boston though, we are really looking for a second opinion on all of Faith's issues, and we're hoping that since there is a whole team of doctors there that specialize in issues like hers, maybe they'll have some different ideas and will be able to get things working like they should.

a little more certainty

Friday, March 6
I told Faith yesterday that it would be nice if she could just make it obvious if we were going to need to go to Boston or not... I said I wished if we were going to go, she'd just throw up or something so we'd know. Well, she listened to Mommy...
Yesterday I asked the docs on rounds if we could switch her back to oral Prevacid from the IV Protonix, since I had felt like that worked better for her. I didn't know it was going to be a gigantic dose (almost a full teaspoon)! We tried to give it last night, and she threw up about 20 cc of milk. (which shouldn't happen, considering her feeding tube is past her stomach...) Then around 2 AM, she threw up again... then this morning we tried to give her Prevacid again, and she threw up a bunch. This morning's throw-up didn't look like milk though... not sure if that's good or bad.
She's being fed at 15/hr right now, and I had asked that since we're going to Boston anyway, maybe they could just back off to 12, where she was tolerating it better with no throwing up... but they want to rule out that the Prevacid is causing it first, and confirm the placement of her tube, and just hold her at 15 and see what happens. We're going to try giving the Prevacid through her tube instead of by mouth, and hope that she tolerates it that way. (I had thought it had to go to her stomach to work.)
So we'll watch her for a day or two and see if she throws up more, and then maybe try to slowly increase her again. I told them I really don't care if she gets increased in feeds, because I don't think she'll get high enough anyway to get off the TPN, and that's what she'd have to do to rule out Boston. But it is important to try and get her feeds as high as we can, because the higher they are, the less damage is done to her liver, and since we don't know exactly how long it will take to get the Boston transfer organized, we need to do what we can to keep her liver fairly stable.
So it has become pretty apparent now that Boston is going to happen. (As long as the insurance approves it!) Please pray that the insurance approval process goes smoothly and quickly, with no denials, so we can get her to Boston, on the Omegaven, and start healing her liver!

update

Just wanted to post a quick update- I got an email response from the nurse practitioner in Boston about whether there is a limit on eligibility for Omegaven, since that would affect our decision of whether or not to transfer to Boston if feeds continue to progress. She said that as long as Faith is receiving any IV nutrition (and has a direct bilirubin of 2.0 or higher), she is eligible. So unless she miraculously gets to 100% feeds and her liver is cured before the Boston transfer is organized, it looks more like that is going to happen!

Please pray that the insurance approval process goes smoothly and quickly!

Boston bound... maybe...

Thursday, March 5
Well, we've officially started the process of organizing a transfer to Boston. We haven't talked to Dr. Soden or Dr. Partrick since making the decision and getting things going, but we can pretty much guess how they will react, and we don't think it will be terribly positive... It's a lot of work to figure out the transfer, but we think it's the right thing to do. I've talked to the social worker and the nurse practitioner in Boston now, in addition to Dr. Puder, and filled out our intake form, and we talked to our case manager here to get her on board and working towards our goal of a timely transfer. She'll be assembling the documents they need to find out if our insurance will cover the transfer, and faxing them to the NP in Boston so they can start working on that. Then the social worker said it usually takes a couple of weeks to get the insurance approval (they deny a lot because since Boston does the Omegaven, which is experimental, it raises a red flag for insurance companies when babies transfer there). So, if all goes well (and she still needs it) we could leave for Boston by the end of the month.
I say if she still needs it because right now Faith is being fed at a rate of 15 mL/hr, which is about 58% of her goal of 26 mL/hr. They are going to hold her at 15 overnight (instead of increasing to 16 at 11, like they normally would), and increase to 16 tomorrow, and then hold her there through the weekend. 16 mL/hr would be about 62%; the idea is to get her to the highest rate she can possibly tolerate, preferrably at 75% or above, which would be about 20 mL/hr (obviously 100% is ideal, since every day that the Broviac is in increases her risk of developing a central line infection, which she's luckily not had at all so far, but can be very serious). On Monday we'll have her latest liver numbers, and we can re-evaluate the plan and how much we should continue to push her to tolerate. From what I've read, I think they have to be at 40% or less for feeds in order to qualify for Omegaven, so she'd have to stop tolerating the amount she's currently at... (although I'm waiting on confirmation on that from Boston)
So, as of right now we're unsure of whether she'll truly need to go to Boston. If she doesn't qualify for Omegaven, I'm not sure we'll go, because we can go to Omaha if she is discharged on a TPN/continuous feeds combo and work on intestinal rehab there, a lot closer to home. But, we're still going to make sure we have everything organized and set up, so that if she does need to go to Boston, we're ready for it. I think of the time when we were all set to go home, and then she stopped tolerating feeds and we had to stay, and I think that the more work we do, and the more we're set to go to Boston, the more likely it is that she'll just keep tolerating feeds and we'll end up going home instead.
I wish I would've known about intestinal rehab a month ago... I think we would've had her transferred then and it would have saved some of the strain on her liver... but hindsight is always 20/20, and I know now that if I ever read about another family going through the same struggles we've faced, I can direct them to the resources they need to get their child better.
Please pray that God will direct us in the way we should proceed, and that he would let Faith show us what she will need... if she's going to stop tolerating feeds, let it happen soon, and not get our hopes up yet again, and let us know we're making the right decision in getting her transferred to Boston...

decisions...

Tuesday, March 3
This is just going to be a quick post, as I realized I haven't updated in awhile... We are in the middle of a difficult decision right now that will most likely result in Faith being transferred to another hospital out of state. Right now we are leaning towards Boston, for a number of reasons (Omegaven, their CAIR program, the great doctors). The doctors here aren't necessarily supportive of that plan... we have to wait a couple of days for our insurance to kick in and then I'll be in contact with them (and have our case manager talking to them, too) to see what they'll cover if we have Faith transferred to Boston for intestinal rehabilitation. We won't mention Omegaven, it will just be a happy extra if we go to Boston, but for all insurance purposes, we will be going there for intestinal rehabilitation.
Either way, we will likely be going somewhere with an intestinal rehabilitation program, although Dr. Soden feels it is much more important to go to Pittsburgh and get listed for a transplant, and that we'd get a second opinion and a rehab evaluation while we are there... but I've heard a couple of things now that make Pittsburgh not sound like the best plan... I've found a great deal of support and information from speaking with other short-gut families. Even though Faith has almost all of her intestine, that's essentially what they're classifying her as for now. They say she has "functional" short-gut.
I spent most of last week reading all about Max Munakata, a short-gut baby from Boulder who is also under the care of Dr. Soden and Dr. Partrick. He is an Omegaven success story, and I hope that we'll be able to get together with his family soon to talk about everything and learn all we can from them.
Faith will be 50% to full feeds tonight, if she continues tolerating them. We recently re-started Erythromycin, since we can give it to her intestine, and not her stomach, so it isn't making her vomit like it was before. But her reflux has gotten progressively worse as we've gone up on feeds. Still, her poops have also gotten bigger and more frequent, so maybe things are working better than anyone gives her credit for... Maybe she'll make us go through all of this trying to get things figured out to transfer to a different hospital, and then get better and not have to go. We're not holding our breath though...

Wake-up call

Friday, February 27

Wow. I just got woken up by a phone call from Dr. Puder in Boston (the one running the Omegaven trials). I emailed him last night, just to sort of update him on the situation and the fact that it's looking more and more like Omegaven may be our next step... and he called as early as he possibly could without being considered rude (7 AM our time).

Once again, he said that if we need to go to Boston and get Faith on Omegaven, just to let him know and he will get me in touch with the people there I need to talk to (the social worker and intake nurse). He said Tricare has paid for it in the past, so that was good news since that is what Faith will have for insurance as of the 1st of March. He explained the process a little more, too.

We would go to Boston. There would be an inpatient stay of about 48 hours (that's nothing!) and then we would stay somewhere else (he said there is hospital housing that is around $20/night but sometimes free). We would have to stay in Boston (or the area) until Faith's direct bilirubin measures less than 2. Just to give you an idea, right now it is 6.1 (which is high enough to qualify under their compassionate use guidelines!). Then we would have to go back every 2 months, or until Faith is off TPN. But he said they would work like crazy to get her off the TPN, and that they have experimental drugs for motility and stuff, too.

He thought they were crazy for bringing up the small bowel transplant, and was surprised that Dr. Soden is the one who mentioned it. He said he couldn't believe it, and that the thing with the small bowel transplants is that they don't even really work. He said he would be much more in favor of turning things around for her liver so that she can have the time to get the rest working.

SO- on my agenda today:

Talk to Dr. Partrick and Dr. Soden about what we do if feeds don't work. Ask if we can get on Omegaven here, and if we can't, let them know we're looking into our options for that as our next step.

Email the leaders of the trial in Omaha to see what they have to say.

(Oh, and go to Target and pick up my new glasses.)

I spoke too soon...

Thursday, February 26
Well, we tried to give Faith a bottle earlier today. (Actually, Maree tried last night, Jan tried this morning at 9, and then I did at 11.) Faith threw up in the night/early morning and threw up her feeding tube, so they took it out and replaced it, but just to her stomach. It only took until the bottle I gave her at 11 (and the resulting huge throw-up and having her throw up her feeding tube again) for us to realize that feeding to her stomach just isn't going to happen right now. Even if she could eat orally, she doesn't remember how to eat from a bottle anymore. She still has the desire to have things orally, but doesn't remember how to suck right, and mostly just plays with the bottle.
So, they took her back down to fleuroscopy to have the tube placed transpylorically again; now it is 8 cm past the pylorus. She is being fed continuously at a rate of 5 mL/hr right now, and they are going to try and raise it by 1 mL/hr two times a day... if she tolerates it. Her goal for full feeds is 27 mL/hr. Her reflux seems to be worse again, they are going to add the Zantac back into her TPN, in addition to the Protonix and Reglan she is already on.
We need all the prayers and positive thoughts everyone has to spare right now. If they aren't able to get her up to full feeds and off the TPN, there really aren't a whole lot of other options and that awful "T" word will be brought up again much more seriously, and we will have to probably go to another hospital, probably either Omaha or Boston, depending where we will be more likely to be able to get her on Omegaven and hopefully save her liver.
On a slightly more positive note, Faith seems completely oblivious of everything. She has been so happy the past few days, just smiling and laughing at everything. I hope to have more smile pictures to post soon, although she seems to know what the camera's for and stops smiling and just stares at it as soon as I get it out...