Tag Archives: information

Minimize admissions – maximize quality of life

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A quick update.  I’m sorry I won’t be going into it all right now, but I am just too tired and need to get to bed.  Patrick’s respite workers are finding it tiring when here as well.

Patrick is being admitted tomorrow morning to hospital.  A Shunt-o-gram is being done and the idea is that during this admission, the G-Tube and possibly the 24hr EEG will be done as well.  This admission will likely be approx 2 weeks, give or take a few days depending on how everything co-ordinates.

Trying to do as much as possible in an admission to prevent the back and forth between hospital and home.

A lot has gone on and been talked about and discussed yesterday and today and I will try to update when I have time while in hospital with Patrick.  I really need to go to bed now.  I still don’t have everything ready for tomorrow!

We welcome all thoughts, prayers, support and hugs and thank you for them as well.  Visitors are especially welcome to come see us.  Message/text/bbm or call to find out what room we are in.

Goodnight my friends, tomorrow is a long day, be in touch soon!

 

Passports for Children with Special Needs

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So…as I mentioned previously, we had passport photos taken the other day.  With the strict guidelines Passport Canada has regarding photos, I knew it would interesting.

Passport Canada has a page with general information for persons with disabilities.  You can take a look at it here. (Note:  I was quite surprised to see the address/URL for the page uses the word handicap in it.)

I’d like to know what YOU had to do, if anything, for your child(ren) with special needs to get their passport.

I called Passport Canada ahead of time to inquire what I would have/need to do if we couldn’t get a photo with his mouth completely closed.  They informed me I would have to get a letter from a Doctor explaining why.  Okay, I got on the phone with the Ped. Dentist and asked if they would help and provide a letter.  I explained the circumstances and situation and today I got a call back telling me the letter was being sent off in the mail today! THANK YOU Dr. Weinberger!! :)

During the photo taking, the photographer had asked me to remove Patrick’s glasses for the glare.  No problem, I took mine off for my photo as well.  She kept asking him to look at her or the camera, and he was, but it doesn’t look like he’s looking at you.  I told her he was and also asked if that would be an issue for their guidelines as well.  She wasn’t sure.  I called Passport Canada (PC) again and asked if there would be an issue with his eyes.  She informed me it would be up to the discretion of the individual office.  Needless to say, I’m looking at getting a letter NOW instead of later, just in case!  It also dawned on me that all children over the age of 11 have to sign their own passports, so I inquired about that as well.  Again, another letter from a Doctor is needed stating why he is not able to sign his own passport.  Patrick can write PAT, but not his full name, nor could he do it in the small space requested by them.

All of this will be worth it to know and see how much he will enjoy the trip! :)

Have you had to do anything in particular to get a passport for your child(ren) with special needs.  What do you think about the process?  Do you think they ask too much information?  Do you think all the letters are necessary?  Do you or did you have to pay for these letters?

Please share your experiences, I’d love to hear them.

Have a great evening!

What is Accessibility to you?

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Wikipedia defines accessibility as the following:

“Accessibility is a general term used to describe the degree to which a product, device, service, or environment is available to as many people as possible. Accessibility can be viewed as the “ability to access” and benefit from some system or entity. Accessibility is often used to focus on people with disabilities or special needs and their right of access to entities, often through use of assistive technology.”

The dictionary has an interesting definition of accessibility:

1. Easily approached or entered.

2. Easily obtained: accessible money.

3. Easy to talk to or get along with: an accessible manager.

4. Easily swayed or influenced: accessible to flattery.

 

Both have offered a very broad, general definition.  What does accessibility mean for you?

For many people who live with disabilities, accessibility can mean the difference between being able to get out of the house to attend to the daily chores/outings/events and things typical for many people, or NOT being able to get out or get to many places to do what many take for granted, go to work, go shopping, visiting, etc…

Accessibility means different things for different people.  We all need to have accessibility to some extent.  You may be thinking, “I don’t have a disability!”.   Disability or not, we all use things everyday that help make things ‘accessible’ to us.  Think about it.  Can you think of 3 things you use every day that help you do things and get places?

How many times have you used the automatic door openers to enter buildings?  That’s accessibility!  How many times have you chosen to take the ramp instead of a few stairs?  That’s accessibility!  Have you ever used a ‘jar gripper’ to help you open jars and other lids difficult to open?  That’s accessibility! Do the taps in your kitchen or washroom have ‘lever-like’ knobs instead of the usual ’round’ ones?  Believe it or not, that’s also accessibility!

More and more I think about how things are looking and how they will be, accessibility-wise, with regards to my son.  Where can I take him that will be accessible?  What if he wants to go places with his friends more as he continues to get older, and it’s not accessible?  My thoughts already go to even just the simplest things like going to family dinners.  Not everyone has an accessible place.  At 14yrs old, he is too big to be carrying on my own.  Even to do a 2 person lift, how many doorways are wide enough to accommodate?

1 in 7 people in ON have a disability and that number will increase as our population ages. The Accessibility for Ontarians with Disabilities Act was passed in 2005.  Its goal is to make Ontario accessible for people with disabilities by 2025.  Through province-wide accessibility standards, they will improve accessibility by identifying, breaking down and preventing barriers to accessibility.

In the near future, I’m going to take a look at accessible housing to begin with.  How many homes are actually accessible?  What does the market consider accessible? (Yes, it will be different for each person’s needs, but in general, their definition)  Are the accessible houses affordable for those who actually need them?

I’m also going to look at transportation.  It’s availability; it’s cost and is what’s in place working? Is it enough?

If you know someone in either of these areas that would be interested in meeting with me, discussing this and even possibly giving me a ‘guided tour’ to see what’s out there, please contact me, I’d be pleased to meet you.

I will be writing about the information I find for articles and for my blog.

Water in my brain – A Child’s Explanation

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Last year I wrote an article about Hydrocephalus for information purposes and to add to the resource guide Sylvia McGrath and I have been writing the past couple years for families/individuals who have chronic illness, learning disabilities and/or special needs.  Section One (A-I) is done, available online and in the Canadian Library Archives.

I was asked to write about it, from a childs point of view.  I chose to take the route of explaining it how I think my son would explain it to one of his friends or to another person in general.  I wrote using terminology/words that I think most would understand.

As we know with most children, there aren’t too many details when it comes to stuff like this.  Things are typically explained as much and in as little time as possible so they can continue on with whatever they were doing.

As I mentioned, since my son has Hydrocephalus, I used him to write this.  I look forward to your feedback and comments.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Hi, my name is Patrick, I’m 14yrs old and I have ‘water in my brain’.  In the hospital, they call it Hydrocephalus (Hi-droh-cef-a-lus).

All of our brains make ‘water’.  The doctors call it, CSF (Cerebral Spinal Fluid).  For most people, the ‘water’ gets soaked up in our bloodstream and then goes away when we go to the bathroom.

For me, the water doesn’t soak up.  It keeps collecting and fills up the spaces inside my brain called ventricles (ven-trick-culls).  When there gets to be too much water in them, I feel a lot of pressure in my head and I get bad headaches.  Sometimes my eyes go funny and sometimes I even fall asleep.

The doctors have fixed it though, so I don’t feel pressure all the time or get headaches all the time.  They put 2 shunts in my head.  A shunt is a little thing they put in my head that has a dial and some small tubes attached to it.  One tube goes from the dial into my ventricles, the other goes from the dial down into my stomach.  You can’t see them when you look at me, they are underneath my skin.  The doctors set the dials, and when the pressure in my head gets too much, the shunts ‘turn on’ and take the water out of my head.  The water gets pumped down to my stomach where it gets soaked up there instead of in my head.

I go for Cat Scans (CT’s) once a year to see how my ventricles look.  It’s a big round machine that takes pictures of your head.  You have to lay very still when they take the pictures.  It doesn’t take long at all if I don’t move.

If the pictures show my ventricles are bigger than normal, the doctor will do some other tests to make sure my shunts are working ok.  If they look ok, then I go home and come back in a year so they can see how I’m doing.

 

 

Written Oct/11 by:  Renee MacLachlan

Update 6 – one of those appointments

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It’s been a few days since I’ve done an  update.  I’m so tired when I get home in the evening and getting up so early in the morning.  I’ve been setting my alarm for 530am so I can get used to being up when he goes back to school.  I’m at the hospital just after 730am and I try to be back home around 8pm as long as nothing is going on.

At the last update, we were waiting for the new valves to come in so they could get into surgery and fix them.  We did go home for the long weekend.  Patrick did alright, nothing major to warrant an earlier return to the hospital and thankfully didn’t need to give him any codeine over the weekend either. :)

Tuesday afternoon we went back to the hospital to get admitted again.  The valves arrived Tuesday and surgery was Wednesday, first one in the morning.

I’m going to try not to go into too much details, I know for some it is over-whelming and difficult to understand.  If there are ever any questions about anything I have written, please feel free to email/comment and ask.  I will happily answer.

Surgery Wednesday morning went well.  They took the full 3hrs and a tad more.  Both valves were replaced as well as the upper end of both shunts.  Testing during the surgery indicated no issues with the bottom ends.  At the upper end, the left was blocked/plugged and the right was likely partially plugged as it was quite slow, hence both got replaced.

Both shunts are set at 60, where they had been set for the past 6-7 years.  For those interested, the settings range from around 30 – 300.  The lower the number, the more it allows the shunts to drain the ventricles.

Patrick came out of sedation and recovery quickly.  They were actually paging us throughout the hospital to get us to go back to post-op.  We didn’t hear the page even though we were just in the hallway talking to Dr. Ranger.  We went in and were able to get him calmed down.  The nurses were amazed apparently at how well we communicated and got him settled.  They said they were getting alot of ‘no’s’ and didn’t know what he was saying.  Understandable.

The days following surgery have been up and down.  A CT was done Friday morning.  Results were that the ventricles were a ‘little’ smaller, but still generous in size.  They were heading in the right direction.

Friday afternoon, Patrick started to become symptomatic again.  Lethargic, uncomfortable, fidgety, head pain, slow responding and there was ‘swelling’ at the shunt sites.  The swelling is actually fluid, not swelling.  He was having times of alertness, smiling and such, but then would go down and have the aforementioned symptoms.  He had slight elevated temps on Friday, but none since.  His vitals have been good, blood pressure, temps etc…  Saturday he began having longer periods of lethargicness and periodically breaking out in rashes.  His chest was sounding crackly and a bit rough with a phlegmy cough.

Too make a long story short, as a result of how he’s been this weekend, another CT has been ordered for today.  We’ll see what the CT shows, pharmacy is looking into how his meds are made up and what’s in them to see if that might be the cause for the rashes (they don’t think so), we’ll see what Dr. Ranger says tomorrow (she’s going to scratch her head again and sigh wondering why this is happening when he has 2 new, great working shunts).

It’s frustrating when people (Dr’s/Residents etc.) come to see your child who have never seen them before and think that because what’s happening isn’t “typical” or “by the books”, that it’s probably nothing serious and to ‘give it time’.

It’s frustrating when explaining to them about your child and they look at you as if you are reaching for ideas and/or looking for something to be wrong, when in fact you are trying to tell them what IS typical/normal for your child!

It’s frustrating when they talk to you as if you know nothing and can’t understand what they are saying/explaining!

Thankfully, this afternoon the adult Neurosurgery Team Resident that came, remembered Patrick from last fall and all that happened there.  He remembered seeing Patrick a couple times and hearing about his case.  I think Southwestern ON heard about him!  He said it was quite the interesting case.  I’m thankful he listened to us and understood what we were saying and explaining and didn’t try to brush things off or us off.

I’m glad that I am a great advocate for my son.  I ask questions until I get answers I’m satisfied with and understand.  I work with the Dr’s/Nurses to decide what the best plan of action should be.  I keep them informed and help out as much as possible.

I know things will get sorted with Patrick this week.  Until last fall, he had gone 6yrs or so with no pressure issues, and now if this is what’s happening again, we aren’t even a year yet since the last.  I’m hoping this isn’t a sign of things to come.

I’m going to post a Poll asking your thoughts on Doctor/Nurse – Patient/Family Communication and how you feel about it based on personal experience.  I’m quite curious.  I hope you will take a quick minute to answer it.

Thanks to everyone for their continued thoughts and prayers for Patrick.  Again, it is truly appreciated.

Patrick asked for Bruiser to come visit him tomorrow.  I have given Bruiser a bath tonight and will confirm with the Nurses it’s ok to bring his dog up to see him again tomorrow.

Patrick didn’t want me to leave tonight.  I told him I had to pack up some things for him and to bathe Bruiser if he wanted to see him tomorrow.  He seemed ok with that.  Dave, Patrick’s father has been staying the night at the hospital so I can go home and sleep.  He has been up since the week of his Shunt-o-gram and likely will not leave until Patrick is ok and able to come home.  If Dave wasn’t up here, I’d be at the hospital 24/7.  Someone needs to be there all the time.  It’s mandatory in most cases.

I appologize if I seem all over the place here, I’m tired and heading to bed.

More to come…

 

Update 5 – one of those appointments

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Change of plans…

The past couple days have been fairly quiet.  Not much really can be done until the new valves for the Shunts come in.  Can’t really do much else either until there is O.R. time available.  Should he deteriorate quickly, he would be taken into the O.R. of course and given another type of Shunt, if his aren’t in.

Patrick is still getting heachaches, but none like the other day thankfully.  He has been going down to the Child Life Playroom and doing some crafts for about 20-30min depending on how he feels, which is good and gets him out of his room for a bit.

Today a Ventriliquist was visiting on the floor, her name was Sue and she brought Boomer the Mouse with her.  She came and saw Patrick twice today, he liked that and thought she/they were pretty funny.  Boomer told some jokes, made some funny comments, asked Patrick questions and sang a few songs ranging from The Lazy Song by Bruno Mars, The Black Eyed Peas to Kesha.  He liked the singing.  Patrick likes Jeff Dunham, so it was no surprise he liked Sue & Boomer.  Thankfully she caught him feeling not too bad to enjoy it.

This morning at 7:30am was Patrick’s CT Scan.  Dr. Ranger and Dr. Pinkoski were by afterward to see how he was doing and discuss the results.  It was nice and surprising to hear Patrick’s ventricles have come down a little.  They still are large for him, but down from previous, which was good news.  What does that mean?

It means, regardless what the scan says/shows, the programmable valves on his current Shunts are not working properly and still need to be replaced.  The valves will arrive Tuesday and surgery will be Wednesday.  Again, if he has issues and deteriorates in the mean time, he will go in to the O.R. and have different shunts put in.  We are all hoping he can hold off till his come in, as they are specific for/to him for a reason and have been working great for him the past 6-7 years till now.

The change in plan is the following:

They were going to allow Patrick and LOA (Leave of Absence) for a night, to go home and get out and away from the hospital for a little bit.  My concern was if he had another headache like the other day, I have nothing here to deal with that kind of pain for him.  They said they would send a script home for codeine just in case.  At that point I felt ok with that and being away for one night.

The more I thought about it, the more I thought perhaps going home for the weekend would be a good idea.  It would mean having to be dishcharged instead of having an LOA.  The LOA’s are only 8-10 hrs typically, but one overnight was agreed for Patrick.  Anything longer requires discharge.  At first, I didn’t want to go through the whole admitting thing again, or sit in emerge if something happened while at home.

I decided it would be ok and good for everyone to go home, sleep in our own beds, no interruptions, comforts of home, cooked meals etc…and I had the script to fill if he got another bad headache.  Of course there were stipulations, obvious as well, he was to be watched, if he deteriorated get him in, if he had bad pain again give him codeine and bring him in if necessary…AND…we had to be back Tuesday after lunch to be admitted again and prepped for surgery and see anesthesiology.  We can sit around at home and be more comfortable.

I am ok with him home and having the script, just in case.  I know him and what he’s like and what happens with him well enough and Dr. Ranger knows I am good that way, that if i have concerns, I will take him in.  If he goes into emerge with pain that bad in his head,…we won’t be waiting long!!

So…we are home, although temporarily, we are home!  Script filled and relaxing.  Sleeping interruption free and being comfortable.  :)

update 3 – one of those appointments

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Today was a long day.  Ever notice how slow time seems to go while you’re sitting and waiting?  Especially in/at a hospital?

Waiting for updates, results and to find out what the plan is going to be, time went by slowly.

Patrick did have his ultrasound this afternoon.  He did great!  Ultrasound was on his abdomin to make sure there were no pockets of fluid, cysts or the like that would/could be contributing to the issues with the shunts.  My understanding is that all looks great!

Finally just before 630pm, I was heading down the hall to get some cold water for Patrick, when Marilyn (Patrick’s nurse today) waved me over.  Dr. Ranger was on the phone.

It really makes Dr. Ranger think when it comes to Patrick.  Nothing is typical! Absolutely NOTHING!  He doesn’t follow any books, documents, research…anything.  Patrick is his own book, and he keeps writing new chapters for everyone to learn about and learn from.

It seems the thought and plan is/will be as follows:

  • Both shunts appeared to work during the shunt-o-gram, but the left was sluggish
  • They orginally thought they would replace the left shunt
  • Since the re-programming and having no change in his ventricles, it appears now both shunts are not working, but…it seems the programming valves are the part(s) not working now
  • Do they change one and see how he does?  If he doesn’t do well with one, then go in again and change the other.
  • Do they change both at the same time, set him back to 60 where’s he’s been for the past 6 yrs or so and see how he does?

Patrick’s shunts are not ones that are kept in stock.  They are special shunts and have to be ordered.  They will take a couple days to arrive.

Reading this, you think it all sounds so simple.  It’s not as easy as it sounds, trust me.

One last test to be done before surgery, a shunt series.  A Shunt Series is just x-rays of the complete shunt(s), top to bottom.  Checking to make sure there are no breaks/kinks etc…  It will likely be done tomorrow.

So we wait again.

Dr. Ranger lost her O.R. time this week because the hospital decided to close down the O.R. on Wednesday (her day) this week.  So the only time she can get is time someone else will give her, of their time, or to try to fit in on an emerge list.  She can guarantee surgery next week for sure, but she is going to try to see if she can get some time from someone somewhere and do it this week.

If she isn’t able to get time this week, and if Patrick is doing ok clinically, we will go home and come back next week, when she has time scheduled.  I’m really hoping to get this done THIS week!  Before School!!

Either way, it appears he will not be making the first day of school.  He’s going to be upset about that.

Like I said…now we wait……again!

I’ll keep you posted.  Thank you everyone for your kind words, thoughts, prayers and hugs!  It’s truly appreciated.

Have a great evening! I’m off to bed!

update 2 – one of those appointments

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Upon arrival on Friday afternoon, the idea was to program both shunts and turn them down to 30.  The thought was that by turning them down, that will allow them to drain the ventricles more.  Well, no one could find the device to turn them down.  The doctors went back to University Hospital to get the one from there, and didn’t come back due to some emergencies there.

Friday morning another from Neurosurgery comes around thinking the shunts had already been changed, and they hadn’t, so he set about looking for the case with the device.  With the change to the new hospital, it seems not everyone knows where everything is yet!

After calling the Nurse Practitioner at home hours later, they knew where the case was and had security go retrieve it in PMDU.

It’s time to re-program the shunts.

First try – the left goes down to 30 – all good!  The right – ended up somewhere between 50-60.

Second try – Just the right shunt – ends up at 90!

Five more tries later – the right shunt won’t re-program.  It’s stuck on 90!

You should know that between each of these programming times, an x-ray needs to be done to verify the setting is where it’s supposed to be.

Patrick’s own Neurosurgeon was going to come in and try to see if she could get it changed, but it seemed that it was decided to keep an eye on him the next couple days and see how he was doing.

As Saturday afternoon progressed, Patrick started becoming a little more symptomatic, more headaches, more tired, his left eye is turning outward more, off in a daze at times etc.  He was still smiling and laughing, but the other symptoms were coming through more.

Saturday night, they did bloodwork in case he declined quickly and had to go to the O.R.

Today is Sunday now.

Patrick still appeared to be as he was yesterday afternoon.  Then this afternoon, he got very agitated and upset.  He kept asking to go for a CT and/or x-ray and for me to call the doctor.  He said his head was hurting and when I offered to get him some Tylenol, he told me that it wouldn’t help.

I told him we had to go through the Nurse first, that I would call her; he could tell her what he told me and then she would call the doctor.  He was pretty upset and agreed.

The Nurse came; he told her he needed to go for a CT and that he wanted to call the Doctor.  She was able to get him to take some Tylenol in the meantime while she called the Doctor.  He was ok with that and seemed to make him feel better knowing she was going to call them.

I gave him the Tylenol and about 20min later she returned saying she’d spoken to them and that they were going to order the CT.  Within an hour, we were downstairs having it done.  Then the waiting began for Neurosurgery to come speak to us.

When they did, and after looking at the CT scan, it seems there is no change to his ventricles.

With a setting of one at 30, that ventricle should show some improvement.  It doesn’t.  Neither has changed.

It appears there is an issue with both shunts.

The Doctor said tomorrow they will have to get on sorting it out and fixing them.  He is an adult Neurosurgeon and the only team that was on this weekend.

So, tomorrow when ‘our’ team is back, hopefully the ‘fixing’ process will begin.

More to come…

 

Cont’d – One of those appointments

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Well, you know how Friday went, or rather didn’t go.  Now here’s the rest of the story.

Shunt-o-gram was scheduled for 1230pm Monday.  A phone call from Paul in Nuclear Medicine informs me that Anesthesia had no information or knew about the test being done.  It is rescheduled for Tuesday, the same time.

Another call from Paul shortly after informs me that Dr. Reed (the Dr they want doing this, and frankly me too) will not be in hospital Tuesday afternoon.  Shunt-o-gram rescheduled again to Wednesday for 1pm.

NOW the fun began when we arrived at Nuclear Medicine on Wednesday.

Anesthesia arrived thinking Patrick already had an IV in place for sedation.  We came from home, as outpatient, obviously he had no IV.  There comes the next big undertaking.

It is unbelievable how strong Patrick is! It takes at least 3 to hold him while they try for an IV.  Poor guy has Mom’s veins, so they are small and collapse, which doesn’t help of course. FIVE tries to get an IV this day.  They had one at one point, but they didn’t secure his hand/wrist enough and they tried to inject something to calm him down, he fought and moved and the IV came out.

Finally after getting an IV and using half a roll of tape to secure it to him, we were set to do the test.

The next issue was figuring out where in the shunt the needle should go.

Let me take a short side-track here and try to explain what happens for a shunt-o-gram.

Shunt-o-grams are done in Nuclear Medicine.  It is a sterile procedure and everyone in the room wears masks and such.  The area where the needle goes is shaved down, cleaned and sterilized.  It typically involves inserting a butterfly needle into the reservoir of the shunt (depending on the type of shunt, some are inserted in the programmable area apparently).  Pressure measurements are taken and some CSF (Cerebral Spinal Fluid) is taken and sent off for testing also.

A small amount of radio-active material is then injected into the shunt.  He is then moved under a machine (similar to one used for bone scans).  As it flows through the tubing of the shunt, the flow is watched on a screen and pictures are taken periodically as it goes through.  This screen is a white background and the material shows black as it travels through the shunt.

They are watching that it moves through well and disperses well at both ends.  If you begin to see dark ‘blotches/spots’, it could mean a blockage.

After checking previous x-rays and scans, it was sorted where Patrick’s reservoirs were located and the test began.

Keeping Patrick sedated is another story in itself.  Since last fall, it seems Patrick metabolizes those drugs quite quickly.  It takes A LOT to sedate him and keep him sedated.  For a 14yr old boy who is only 92lbs, it has been taking more than an adult dose to keep him out long enough to do many of these tests.  For this test, 3 drugs were used, the main one being Propafol.  He needed 80mg more than they would normally give an adult (which is 200mg) to get him through the test.  Wow!

Thursday being called in to discuss the test, resulted in finding out that both shunts appear to work, although the left one is sluggish.  Both dispersed, albeit slowly, but they did.  The tubing is intact and in suitable places. (after the shunt-o-gram, they sent him for a shunt series – an x-ray to see where the tubing was and where it ended)

So the question is.  If both shunts are working, his ventricles should be normal size.  If one is working better than the other, then that ventricle would be smaller, but that’s not the case.  ALL of his ventricles are enlarged.

Update:  Patrick was admitted to hospital yesterday (Friday)

More to come…

Wish Granting Organizations/Programs – What do you know?

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