Cleaning house has been going....
I'm not sure if I can say well (yet), but I think it has potential.
It has involved a number of emails back and forth with our nurse. And some trial and error. And a couple of very large blow-outs. You need to laugh so you don't cry blow-outs. All I could smell all day was poop blow outs. Funny, right?
(Maybe now)
So I knew that we were doing something wrong.
And of course I'm a little bit ... lets say independent ... in my thinking and questioning and knowing what I want and how I think I should do something that I want. Like the bowel routine.
In my last post I discussed various sources of information. So I thought that I would share what I learned.
Timing is important. Specifically if you rush it, you will have blow-outs.
The internet-only information said "as fast as he will tolerate". Our nurse says "at least 5 minutes". And there is also the time for fluid to work that is needed.
So a little bit of timing changes and no more blow-outs.
I also found a research article explaining the process of what they are doing at the Cincinnati Centre. It reviewed what goes on during the week you are in Cincinnati, which we aren't going to be doing, but I thought it would get some basics down.
It did give me some questions to explore (they don't use cones, but foley for irrigation). And it helped me to understand some of the physiology of the spina bifida bowel. I gave a copy to Nick's pediatrician because he didn't know that much about the bowel program.
I've been keeping track of everything so that I know what is going on. I think it's the nurse in me - I always have to chart! I have dates, times, amount in, timing and results (just a check mark).
I'm told it takes 6 weeks, we are about half way there and I've learned things. A lot of zero's on my chart have me sure we are on the right track.
I am excited. I am trying not to be excited. But I can see it.
Big boy underwear.
I've been looking at them in the store. Pulling some off the shelf and then putting it back. I never would have thought that the thing I wanted to buy most in a store would be size 3 boys underwear.
So here we are.
It has been a change in our routine to spend 1 hour in the bathroom.
I can recite the backyardigans dvd we play by heart. But Nick is tolerating it well. It provides some one-on-one time for the 2 of us. And this is just the new normal for us.
A Journey with Love and Laughter
Read about our family as we journey through life as a family, with siblings, school and spina bifida, and lots of fun and laughter along the way!
More About Our Family
Tuesday, April 30, 2013
Saturday, April 20, 2013
Informing the Informer
As I am now a working Monday-to-Friday mother, my blog-writing clusters around the weekend, and if I have a couple of things I want to write about, then I'll stagger the posting through the week.
Well today is Saturday and I don't really have anything to write.
And then I was looking through some of the blogs I follow and found this article.
http://bloom-parentingkidswithdisabilities.blogspot.ca/2013/04/is-selective-abortion-for-disability.html
It brought back some of the questions that came up from the medical conference that I went to in the fall. I thought that I had blogged about my feelings, but I must not have. It was painful and very hard for me to sit through that day. And I do not recommend to any parent to go to a medical conference about something their child has.
The months that have passed since the conference have dulled the feelings and emotions I felt, so I guess now would be the time to write about it.
This is a conference that was directed at physicians, obstetricians specifically, and geneticists, but as a nurse I could go as well. One of the topics to be presented was neurotube defects and current research and news. They were going to talk about the MOMS study and I wanted to hear what they had to say.
I thought I would learn something.
I didn't. Or at least I didn't learn anything about spina bifida that I didn't already know. But I learned something about myself, and about how neurotube defects are seen by the medical, specifically the obstetrical population.
I heard all the medical information, all of the pictures about what forms in the baby and what doesn't, as well as when ect. A couple of doctors that I knew talked. And one of the speakers (the one talking specifically about the surgery in Toronto, was unable to make it).
Dr Church, our developmental pediatrician from Holland Bloorview was one of the speakers. She actually made me cry. She talked about the medical issues that kids have to deal with, but she had a positive spin to it (of course she would - she actually sees these kids). What brought the tears was a comment about how our kids sparkle.
They had another mother come and speak to the theatre full of doctors ect and talk about her experience with her child who was born with a serious medical condition (not spina bifida) and she was very positive and made the point that even though there is a lot of medical information and concerns, it doesn't make a child any less special.
There was a conversation during the conference about informed consent. With an argument back and forth about giving the diagnosis and making sure that parents are being given informed information. Some doctors people saying that giving just negative was enough, that is was true information, others said that it has to be combined with the positives and then there was the argument of how could you know either way. There is no such thing as a fully informed decision, and doctors are fooling themselves if they think they could provide such information.
And the doctor that actually gave me Nick's diagnosis was there. My heart was pounding and my blood pressure was rising and I knew that I had to stand up and say something.
So I did. I stood up and talked about how I received the spina bifida diagnosis when I was 20 weeks pregnant. And we were told "this is what you child has, you have 2 weeks to decide if you want to terminate." That we were encouraged to terminate, that they said he would have all kinds of difficulties, and how Nickolas does have everything that Dr Church said comes with spina bifida. But he is happy and 3 years old and not anything like what you (as in the doctors) think he is.
My voice was breaking and I was crying a bit.
And I felt like a total idiot.
But Satisfied that I had made my point.
I told everyone at work about how stupid I felt almost breaking down in a room full of people. I think It was worse in my head than it actually was. And I will never see any of those people again.
And I got to feel good about what I did, and hopefully someone will rethink their approach.
Of course I vowed never to go to another medical conference like that, unless it was directed specifically to parents.
So back to the article that got me thinking about that day.
http://bloom-parentingkidswithdisabilities.blogspot.ca/2013/04/is-selective-abortion-for-disability.html (In case you didn't read it the first time)
The article has a number of points in it, including the perception of parents who chose on a selective abortion becaue of a prenatal dianogsis. But I am not raising an abortion issue. I am raising an information issue.
Doctors actually believe that they are giving parents all of the information to make an informed decision when they tell them about all of the medical problems their child may face. They truly believe that combining this with information from families who have faced the same problems would be biased (and their are not-biased, even though many obstetricians have never seen a child with said diagnosis). Not all doctors of course, but a surprising number of them.
The article by Andrew Solomon, published this month in the New Yorker; Medical progress, social progress, and legal regression talks about abortion, both the blog and the article brought up a lot of different points, what really hit home was about how doctors are actually giving the diagnosis and thinking that women are making a choice. A quote from the article
I'm glad that other people are recognizing that there is a need for informed choice, or at least for doctors to recognize that they are not providers of all of the information parents need. That it is not just us parents that are saying it.
Another aspect of what both articles talked about was the perception of physicians about parents choice. I am not going to address this, and I find it very depressing that someone would think that we as a family are less deserving of support because we chose to have our child. That is too much to handle at the moment. I would hope that at least the 10 obstetricians that I see every day and know me and Nickolas are able to provide a more informed picture to parents receiving a diagnosis.
I recognize every day that my life is better because we have Nickolas. We appreciate things, I have a new perspective I might not otherwise have had. And I have no problem talking to a room of 90+ people, that fear of public speaking went out the window about 3 years ago!
I feel that a follow up letter may be in order.
http://riddingfamily.blogspot.ca/2010/07/letter-wake-up-medical-professionals.html
Well today is Saturday and I don't really have anything to write.
And then I was looking through some of the blogs I follow and found this article.
http://bloom-parentingkidswithdisabilities.blogspot.ca/2013/04/is-selective-abortion-for-disability.html
It brought back some of the questions that came up from the medical conference that I went to in the fall. I thought that I had blogged about my feelings, but I must not have. It was painful and very hard for me to sit through that day. And I do not recommend to any parent to go to a medical conference about something their child has.
The months that have passed since the conference have dulled the feelings and emotions I felt, so I guess now would be the time to write about it.
This is a conference that was directed at physicians, obstetricians specifically, and geneticists, but as a nurse I could go as well. One of the topics to be presented was neurotube defects and current research and news. They were going to talk about the MOMS study and I wanted to hear what they had to say.
I thought I would learn something.
I didn't. Or at least I didn't learn anything about spina bifida that I didn't already know. But I learned something about myself, and about how neurotube defects are seen by the medical, specifically the obstetrical population.
I heard all the medical information, all of the pictures about what forms in the baby and what doesn't, as well as when ect. A couple of doctors that I knew talked. And one of the speakers (the one talking specifically about the surgery in Toronto, was unable to make it).
Dr Church, our developmental pediatrician from Holland Bloorview was one of the speakers. She actually made me cry. She talked about the medical issues that kids have to deal with, but she had a positive spin to it (of course she would - she actually sees these kids). What brought the tears was a comment about how our kids sparkle.
They had another mother come and speak to the theatre full of doctors ect and talk about her experience with her child who was born with a serious medical condition (not spina bifida) and she was very positive and made the point that even though there is a lot of medical information and concerns, it doesn't make a child any less special.
There was a conversation during the conference about informed consent. With an argument back and forth about giving the diagnosis and making sure that parents are being given informed information. Some doctors people saying that giving just negative was enough, that is was true information, others said that it has to be combined with the positives and then there was the argument of how could you know either way. There is no such thing as a fully informed decision, and doctors are fooling themselves if they think they could provide such information.
And the doctor that actually gave me Nick's diagnosis was there. My heart was pounding and my blood pressure was rising and I knew that I had to stand up and say something.
So I did. I stood up and talked about how I received the spina bifida diagnosis when I was 20 weeks pregnant. And we were told "this is what you child has, you have 2 weeks to decide if you want to terminate." That we were encouraged to terminate, that they said he would have all kinds of difficulties, and how Nickolas does have everything that Dr Church said comes with spina bifida. But he is happy and 3 years old and not anything like what you (as in the doctors) think he is.
My voice was breaking and I was crying a bit.
And I felt like a total idiot.
But Satisfied that I had made my point.
I told everyone at work about how stupid I felt almost breaking down in a room full of people. I think It was worse in my head than it actually was. And I will never see any of those people again.
And I got to feel good about what I did, and hopefully someone will rethink their approach.
Of course I vowed never to go to another medical conference like that, unless it was directed specifically to parents.
So back to the article that got me thinking about that day.
http://bloom-parentingkidswithdisabilities.blogspot.ca/2013/04/is-selective-abortion-for-disability.html (In case you didn't read it the first time)
The article has a number of points in it, including the perception of parents who chose on a selective abortion becaue of a prenatal dianogsis. But I am not raising an abortion issue. I am raising an information issue.
Doctors actually believe that they are giving parents all of the information to make an informed decision when they tell them about all of the medical problems their child may face. They truly believe that combining this with information from families who have faced the same problems would be biased (and their are not-biased, even though many obstetricians have never seen a child with said diagnosis). Not all doctors of course, but a surprising number of them.
The article by Andrew Solomon, published this month in the New Yorker; Medical progress, social progress, and legal regression talks about abortion, both the blog and the article brought up a lot of different points, what really hit home was about how doctors are actually giving the diagnosis and thinking that women are making a choice. A quote from the article
I do see a problem, however, in the speed with which women who have no prior exposure to the conditions in question are expected to make these decisions. Women often terminate a pregnancy without knowing what life would be like with and for an anomalous child. It is worth publicizing the satisfaction that the experience may entail, so that the pro-choice movement becomes the pro-informed-choice movement.I have said all along how happy and thankful I am that I felt confident and comfortable enough in myself and my knowledge to listen to myself, to explore our options and make an informed choice. Along with Kyle of course. How if we had made a quick, scared decision we would regret it, and we would be missing such an integral and positive part of our lives.
I'm glad that other people are recognizing that there is a need for informed choice, or at least for doctors to recognize that they are not providers of all of the information parents need. That it is not just us parents that are saying it.
Another aspect of what both articles talked about was the perception of physicians about parents choice. I am not going to address this, and I find it very depressing that someone would think that we as a family are less deserving of support because we chose to have our child. That is too much to handle at the moment. I would hope that at least the 10 obstetricians that I see every day and know me and Nickolas are able to provide a more informed picture to parents receiving a diagnosis.
I recognize every day that my life is better because we have Nickolas. We appreciate things, I have a new perspective I might not otherwise have had. And I have no problem talking to a room of 90+ people, that fear of public speaking went out the window about 3 years ago!
I feel that a follow up letter may be in order.
http://riddingfamily.blogspot.ca/2010/07/letter-wake-up-medical-professionals.html
Labels:
conference,
diagnosis,
doctors,
letter,
medical professionals,
obstetrician
Friday, April 19, 2013
Cleaning House
If you don't care about poop - you might want to skip this post.
Tonight is the night for us to take the next step.
In the journey of spina bifida, continence seems to have the most impact on daily life. Not mobility, not if someone is walking or not, talking or not. It's pooping and diapers and bladder issues.
Because that leads to social issues. I remember that day in the office, when I was questioned about keeping the pregnancy and hearing "diapers for life". And I thought we can handle that - and we can. But do we have to? Or can we have social continence. This means that we do things so that socially, when we are out of the bathroom, Nick won't have to wear diapers.
Which has led to me pushing (pretty early) to work on getting him clean. Starting with a potty over a year ago. And progressing through the different steps (starting from 6-9 months old)
We have also been doing (for a while) some other things to maximize our results.
Bearing down, have you ever tried to teach someone how to do this? Think about it for a sec, if it doesn't come naturally, what do you say? I feel like I'm at work some days (helping women have babies). Some things that have worked for us is laughing and lifting his bum off the toilet seat.
Positioning. We have him sitting on the toilet (gravity) with a stool to keep his knees above his hips to help.
Timing. You bowels are most active about 20 minutes after you eat. So putting Nick on the potty after dinner has worked well.
So we put all of this together, did a lot of Internet searches, talked to people and got our medical opinion. And we started day 1 of a bowel routine with a cone enema.
There are a number of different websites we used, but the one with the best step-by-step instructions was from here http://lifestyleaccelerator.com/myblog/health/bowel/ and she actually has a video to go with this. http://youtu.be/_hINaZkGWwg
Then I had to figure out what to actually purchase.
We ended up with the product from Hollister and I searched to find the best deal online at Canmeddirect What we needed was a kit with the bag, the tubing and the cone. About $50.
It took over 1 week to determine if what we purchased was latex-free.
Nothing on the packing says anything about latex, which I was very surprised by. And when I looked in the Hollister website, I found their response was very confusing.
So. With my head full of all of this information, all of my supplies present and accounted for, our bathroom appropriately set up (we put a hook on the wall above the toilet to hold the bag), I printed out all of the directions I could find. Had directions from our nurse for the type of fluid to go in the bag (I have seen a wide variety of different recommendations for fluid).
I also had a bag of toys, a dvd player and some books ready to distract Nick to sit on the toilet for 30 minutes. And we talked about it.
I told Nick that we were doing something different today to help him poop. He was positive about it (which is good considering he hates when I have to help him poop).
And it went well.
It didn't bother Nickolas at all. He wasn't bored sitting on the potty and we got results. It wasn't messy, no leaking around the cone and it was easy.
After 30 minutes on the potty the diaper went back on and we were ready for bed.
I'm chalking it up for day 1 success.
But just because day 1 went well doesn't mean anything. But I'll still celebrate today's success!!
I also shared my knowledge on my "I want to learn about spina bifida" blog too!
Tonight is the night for us to take the next step.
In the journey of spina bifida, continence seems to have the most impact on daily life. Not mobility, not if someone is walking or not, talking or not. It's pooping and diapers and bladder issues.
Because that leads to social issues. I remember that day in the office, when I was questioned about keeping the pregnancy and hearing "diapers for life". And I thought we can handle that - and we can. But do we have to? Or can we have social continence. This means that we do things so that socially, when we are out of the bathroom, Nick won't have to wear diapers.
Which has led to me pushing (pretty early) to work on getting him clean. Starting with a potty over a year ago. And progressing through the different steps (starting from 6-9 months old)
- Diet (I had a great dried fruit combo that kept Nick regular when he was a baby), and staying away from cows milk (he still drinks almond milk or goats milk).
- Oral laxative (PEG flakes) that we put it in his oatmeal every morning, and we can adjust it up and down depending on what we need. Right now we are at 1tsp every morning (but have gone up to 3Tbsp when we really need it)
- We have tried some other medications lactulose (didn't like it, didn't work, it was a liquid and he needed to take it too often for it work into our lifestyle)
- Senna we haven't tried. I've heard very negative things about senna and want to stay away from it for now
- Omega-3 and probiotics, we used this as a supplement for a while and it made a huge difference, but we still needed the restoralax. We are on a break right now, but I find it makes Nick smell like fish for a while. Will probably start it again soon
- Stimulation. I won't describe it, I'm sure you can figure it out.
- Suppositories. Again medication, or just glycerin (which did nothing for Nick) that we have been trying for a while. We've tried it and have found that it is great for preventing him from being constipated, but it just isn't working for getting him clean.
- Enemas. Using liquid (with or without something added to it) to clean out the colon more completely than the suppositories will do. The more comes out at one time with the enema the less that can come during the day. That is how he is clean.
- There are different types of enemas.
- A regular tip enema, but I found that using this (like a fleet enema) doesn't work. Nick doesn't have the muscle control to tighten around the tip, so the fluid doesn't stay in, which is the whole point. So this hasn't worked for us
- A cone enema, is our next step. It is typically used for cleaning out colostomies. And it is cone shaped to fit into the hole of the colostomy, but we are using it for a different reason. The cone shape means that we can create a stopper without the muscle control. So the fluid that goes in, stays in to work, and when the fluid comes out, so does all of the poop in the colon.
- Surgery. This is the final step. But we are not there yet. There are 2 different types of surgeries, which we will explore more when the time comes. But it takes the enema solution and starts at the top of the colon, around where the appendix is, and cleans the colon from that point and down. It seems to me to be the most effective way, but also the most invasive - because it involves surgery.
We have also been doing (for a while) some other things to maximize our results.
Bearing down, have you ever tried to teach someone how to do this? Think about it for a sec, if it doesn't come naturally, what do you say? I feel like I'm at work some days (helping women have babies). Some things that have worked for us is laughing and lifting his bum off the toilet seat.
Positioning. We have him sitting on the toilet (gravity) with a stool to keep his knees above his hips to help.
Timing. You bowels are most active about 20 minutes after you eat. So putting Nick on the potty after dinner has worked well.
So we put all of this together, did a lot of Internet searches, talked to people and got our medical opinion. And we started day 1 of a bowel routine with a cone enema.
There are a number of different websites we used, but the one with the best step-by-step instructions was from here http://lifestyleaccelerator.com/myblog/health/bowel/ and she actually has a video to go with this. http://youtu.be/_hINaZkGWwg
Then I had to figure out what to actually purchase.
We ended up with the product from Hollister and I searched to find the best deal online at Canmeddirect What we needed was a kit with the bag, the tubing and the cone. About $50.
It took over 1 week to determine if what we purchased was latex-free.
Nothing on the packing says anything about latex, which I was very surprised by. And when I looked in the Hollister website, I found their response was very confusing.
The specifications for Hollister ostomy products do not include natural rubber latex as a component. The specification for products and packaging do not include natural rubber latex as a component, and our component suppliers do not add natural rubber as part of their production process.So of course I put the quote on facebook and got every one's opinion. Which is that legally companies are no longer able to say "latex free" so this is the wibbly-wobbly way of saying that it is latex free.
So. With my head full of all of this information, all of my supplies present and accounted for, our bathroom appropriately set up (we put a hook on the wall above the toilet to hold the bag), I printed out all of the directions I could find. Had directions from our nurse for the type of fluid to go in the bag (I have seen a wide variety of different recommendations for fluid).
I also had a bag of toys, a dvd player and some books ready to distract Nick to sit on the toilet for 30 minutes. And we talked about it.
I told Nick that we were doing something different today to help him poop. He was positive about it (which is good considering he hates when I have to help him poop).
And it went well.
It didn't bother Nickolas at all. He wasn't bored sitting on the potty and we got results. It wasn't messy, no leaking around the cone and it was easy.
After 30 minutes on the potty the diaper went back on and we were ready for bed.
I'm chalking it up for day 1 success.
But just because day 1 went well doesn't mean anything. But I'll still celebrate today's success!!
I also shared my knowledge on my "I want to learn about spina bifida" blog too!
Tuesday, April 16, 2013
What's New at SB&H?
You might recognize a face on the home page of the Spina Bifida and Hydrocephalus Association of Ontario.
http://www.sbhao.on.ca/
Or on the facebook group page...
How lucky I am to see that face every day!
http://www.sbhao.on.ca/
Or on the facebook group page...
How lucky I am to see that face every day!
Labels:
awareness,
SBH,
Spina Bifida and Hydrocephalus Association of Ontario,
video,
what spina bifida looks like
Saturday, April 13, 2013
A growing boy
You know how you don't notice something that is right in front of you ever day.
Looking over some pictures from last April something very obvious jumped out at me!
April 2012
April 2013
My little boy is growing up... literally!
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