See what I mean about him being the cutest thing ever? I am not biased at all!!!
I took the above picture of Logan and it reminded me so much of one of my favorite pictures that I took of him when he was a newborn.
The last year has been such a daze…I barely even remember some parts. Like when he was 1-4 months old and he had continual blue spells and I literally had to rock him for 6-8 hours a day trying to calm him down. I remember once I stood and swayed him in my arms for 3+ hours straight because it was the only thing I could do to keep him calm. When he cried he sweat so bad and he turned so blue.
Even his first OHS seems so far away even though it was only 7 months ago. I can’t believe how much we have been thru in the last 18 months, it is truly mind-boggling. In the last year I have prepared for his birth…and prepared myself mentally for his death. We have watched him over come tremendous odds and we have watched barely clinging to life.
So Logan at 12 months old….
Here are the Stats….
Weight: 7 Kilo (15.4 lb.)
Length: 27 inches
Clothes size: 6-9 mo. onsies and 3-6 mo. pants
Strength: Holds head (not indefinitely though, he does get tired) can roll from stomach to back (not vice versa though).
I am super happy about this new skill. It gives me hope that he has some ability to get stronger albeit very very slowly.
Words: Barely talks but occasionally babbles dadda…mamma…and something that sounds like all done.
Likes: Baby TV (its a network on Dish and he it completely addicted), he loves the texture of foam, especially the little foam bath stickers, he loves his Little Giraffe blankets, and his Wub a nubs.
Dislikes: Groups of people, the sun, tummy time, anyone in scrubs or a white coat (except for Dr. Patel, he loves him!) and hats.
Food: He eats next to nothing. The only thing that he will eat is Mum Mum biscuits but they have next to no calories so I don’t even like him eating them. He will also occasionally eat a few cheese puffs. That is it.
I really wanted to take some cute pictures of him today and I guess he just wasn’t very smiley….
I did manage one smile at the end!!!! And then a few more with Momma and Dadda…
I will update on after Logan’s cardiologist appointment on Tues.
While Logan has turned one years old it has left me with much time to think about the last year. When we got the diagnosis, how devasted we were. I think back to that period and I can’t believe how little I understood and how little I knew about what life was really going to be like. And then I think back to our very ugly NICU experience which really opened my eyes to massive problems our medical system has. It opened my eyes to the massive discrepancies between heart centers, cardiologist’s, and other clinicians. It has changed my world view so much. Things that were once important are no longer important, things that would’ve seemed silly to worry about just a year ago, worries me constantly every day. People that you thought would always be there for you….disappear. And complete strangers become your family. The journey our family has been on in the last year is about as far off the trail that we set out on as one can go…but I am okay with that.
The statistics for right atrial isomerism (the specific type of heterotaxy that Logan has) are beyond freightening. I have read studies ranging from 20-40% survival rate at one year old. And at five years this number dwindles even further….and statistically the amount of these children that make it to adulthood is painful to even think about. I try not to dwell on these numbers. Logan has had every single risk factor for death even among heterotaxy kids (right isomerism, asplenia, severe AV valve regurgitation, obstructed pulmonary veins) and he beat the odds. I have so much hope for Logan because I believe we have the right team of doctors. I think we have a brilliant cardiolgoist that has done everything under the sun to keep Logan out of the hospital and to make sure that thru all this he has a good quality of life. And we have arguably one of the best pediatric heart surgeons in the world, who beyond being exceptionally talented, has the biggest heart and is incredibly compassionate. I really feel like we can do this. I really feel in my gut that Logan is going to be one that grows up to be an adult.
The next surgery is going to be a big one and very risky. The surgery is going to attach his IVC (inferior vena cava – the artery that goes to the lower half of your body) to his pulmonary artery. This direct connection will make it much easier on his single ventricle. His first surgery (the Glenn) is when they connected the SVC (superior vena cava – the artery that runs up your neck to your brain) to his pulmonary artery, once the SVC and the IVC are connected directly to the pulmonary arteries he will have complete fontan circulation. This is the ultimate goal. This is so far the best possible way for single ventricle kids to live. But all of this is dependant on one thing. Your pulmonary arteries. Fontan circulation requires children to have a lot of blood flow thru the PAs and Logan’s PAs are small. It is going to be difficult for his body to adjust to the fontan circulation having small pulmonary arteries.
Logan saw Dr. Patel last Tuesday and had an echo done. He has grown a lot of collaterals because his pulmonary arteries are small and blood is finding other routes to go down. He is going to need a cath in the relative near future to coil more of these collaterals off so that all that oxygenated blood is forced back into the PAs and reaches his lungs instead of just getting lost in collateral viens. His O2 right now is low 70’s. He will most likely need a cath in the next 6-8 weeks unless his oxygen levels drop futher sooner. We will be going to Boston for that cath and more discussions will happen at that time about the timing of the fontan. We have heard that most likely he will have a very early fontan. Most kids have this surgery between 2-4 years old. Logan will have his at the latest 18 months. This is because his heart will not be able to function well on just the Glenn connection for that long. If we do the fontan too early we deal with having small pulmonary arteries and the procedure is risky….if we wait to long there could be too much resistance and his pressures in his heart and lungs could be so out of whack that it wouldn’t take to a fontan either. Timing is going to be everything here….and just like with life, every person with a set up lips has a different opinion. Dr. Patel is going to see Logan in two weeks from last Tuesday.
I would also like to wish a Happy Father’s Day to daddys around the world and especially the ones dealing with children of special needs. Logan’s Dad said his biggest fear about having a baby was that he would have one with severe medical problems. It is so interesting because even though his worst fear came true, I think if you saw the way he cuddles Logans, and watches him sleep you would see that his worst fear has grown into the biggest love of his life.
So after being very confused about how Logan can be doing so great heart wise and yet still be blue and breathing heavy, I pushed Dr. Patel to do an echo sooner rather than later. For my own piece of mind I just couldn’t wait another 2 weeks. My biggest fear was that he had pulmonary vein stenosis once again. This is what caused us to have the last pop-up open heart surgery. unfortunately, if this does happen to Logan again we will most likely have to put him on the transplant list. I was A WRECK waiting for this echo. I mean really a complete nervous wreck.
Luckily Dr. Patel was able to squeeze us in fairly quickly. Once we got there the nurses immediately commented that he looked bluer (thank you this is what I have been saying – Mom’s know these things) and once his pulse ox was taken it became very apparent, his oxygen is now around 72-73 instead of 80.
(watching Elmo while getting his echo done)
Long story short Logan heart still looks good. There is NO pulmonary vein stenosis that is visible. His last sutureless repair on his pulmonary vein stenosis still looks excellent, his Glenn looks great, his valve is still holding up. The only thing is that he still has relatively small pulmonary arteries. So most likely because his pulmonary arteries are on the smaller side blood is finding alternative paths to travel down i.e. collaterals. Heterotaxy kids are known to have abnormal vasculature so this crazy collateral growth is more common in kids with heterotaxy. But keeping in mind the perspective that he could have had pulmonary vein stenosis, I was hugely relieved. I mean collaterals….come on, that’s just a cath fix.
So the plan right now is to do nothing until Logan’s PO (pulse ox or oxygen saturations) drops further he is going to need a cath to coil more collaterals off. This poor baby’s chest is just full of platinum (that is the metal used in coiling) his chest x-rays look really bizarre with over 25 metal coils in there right now. I can’t imagine what some doctor one day is going to think when they do a chest x-ray and they don’t know about him.
And then there was the G-Tube drama. I just can’t get over how something that is typically no biggie in 99% of population quickly becomes so complicated and life threatening to a child with heterotaxy. It was a one situation that clearly illustrates what Logan is going to have to struggle with for the rest of his life. So to begin with, the pediatrician (who by the way- should we win the award for best pediatrician EVER!!!) had set up a conference call between Dr. Patel (cardiologist), our GI doc, myself, and him to discuss the big picture plan for Logan and to go over different contingencies (this phone call was one of the most helpful things we have had during Logan’s care and with a whole post in-an-of-itself) but one of the unanimous decisions that was made was that Logan needs a G-tube put it to help him gain weight.
You would think that this would be a pretty straightforward and simple task to get accomplished. Well, not for a heterotaxy child. As it turns out his mixed up abdominal organs make placing a G-Tube much more risky. Because Logan has a small misplaced stomach and a hiatal hernia he is at a very high risk for aspirated milk into his lungs. Because Logan is asplenic and any major infection could kill him the last thing we want is milk sitting in his lungs and causing an infection. So to avoid this risk a fundiplication surgery would also have to be done.
Basically wrapping the top half of the stomach around the the bottom half of the esophagus.
*Excerpt taken from WebMD.com
How Well It Works
Studies show that laparoscopic fundoplication improves GERD symptoms in about 6 to 9 out of 10 people who have the surgery (depending on how experienced the surgeon is). But no studies have proven that laparoscopic fundoplication surgery is effective in maintaining healing of the esophagus over the long term.1
- A successful surgery does not guarantee that you will never have symptoms again. Some studies show that only about 1 out of 10 people who have fundoplication surgery done by an experienced surgeon have symptoms come back in the 2 years after surgery.2 But there isn’t much research on how many people have symptoms come back after more than 2 years.
- About 2 or 3 out of 10 people who have surgery to relieve GERD symptoms have new problems (such as difficulty swallowing, intestinal gas, or bloating) after the surgery.2 These new symptoms may or may not respond to treatment with medicines.
- Difficulty swallowing because the stomach is wrapped too high on the esophagus or is wrapped too tightly. This complication may be more likely to occur in people who receive fundoplication surgery using a laparoscopic surgical technique.4
- The esophagus sliding out of the wrapped portion of the stomach so that the valve (lower esophageal sphincter) is no longer supported.
- Heartburn that comes back.
- Bloating and discomfort from gas buildup because the person is not able to burp.
- Excess gas.
- Risks of anesthesia.
- Risks of major surgery (infection or bleeding).
All I can say to the above information is NO THANK YOU. Logan has enough problems as it is. And to do a surgical procedure for aspiration which may or may not even happen and potentially end up with a child who can’t swallow? Not to mention the fact that some studies are showing only a 60% success rate? And these risk are actually very minor in comparison to the major risk would be how Logan’s heart would handle such a large operation. So needless to say, Dr. Patel and I had a long talk about this and decided very quickly this is not the path we are ready to embark on. So after countless hours on the phone talking and discussing and go back and forth between the pediatric general surgeon, the GI doc, Dr. Patel, the pediatrician, and myself. We all settled on the fact that the once unanimous decision to have Logan get a G-Tube is now a resounding NO.
We are very lucky to have such an experienced and insightful pediatric general surgeon on our team. He was a surgeon at CS Mott’s in Ann Arbor MI (one of the nation’s top Pediatric Heart Centers) before coming to the Cleveland Clinic and has tremendous experience with him. He has experience with heteortaxy kids and has seen how quickly things can ‘get messy’ with them.
A little side note here on second opinons……GET THEM. This whole situation clearly illustrated the importance of finding a surgeon with actual experience with the type of illness you have. I have spoken with 2 general surgeons and 3 GI docs to get a team I felt comfortable with.
So after I had finally excepted that Logan was going to get a G-Tube I began picture him growing, and starting to sit up, and develop at a much increased pace and I started to get excited about the idea….until it was pulled out from under me.
As Logan is quickly approaching the one year mark, I have been particularly emotional. It is so much to take in, where we have been in this last year, and the road ahead as well. The other issue with his 1 year mark coming up, is that I have been avoiding calendars, timelines, charts, ect… in hopes of not having to worry about the comparison. The comparison to where he is and where the average child is. It is heartbreaking to see a baby almost a year old just start to have enough strength to hold his head up and for my own piece of mine I block out all the comparison charts and just accept him for him. With his birthday looming it pulls me out of my world and into The 1 Year Old World. The world of 1 year olds is crawling, walking, talking, waving, peek-a-boo, babbling, clapping, eating, sitting in a high chair, ect…. Logan can’t do any of those things. In terms of physical strength Logan is a 3 month old. This has been so tough on me that I have even considered canceling his B-Day party.
I have come around though and accepted that Logan is very special and been thru a lot and it would be a shame not celebrate his life, because even though he is very small and weak, he has fought battles larger than most of us fight in our life.
Logan’s birthday party is open to anyone in that would like to celebrate his life with us. If you are interested in coming on Logan B-Day Party which will be on Sunday June 5 please leave a comment with your email address and I will give you the details. I look forward to meeting some of my fellow heart Mom friends that I only know thru words.
We had a crazy emotional up and down insane week with Logan.
So emotional I haven’t even had the energy to write about it here.
But I wanted to wish everyone a
Happy Mother’s Day
especially to my fellow heart Moms and other Mom’s of special needs kids because it is a bumpier road and a much trying path we travel as Mom’s. I also want to thank my heart Mom friends for their unbelievable amount of support they have giving me this year.
I know I have said it before but TRULY I don’t know how I would go on without you!!!
Love you all so much.