I have no idea what the title of this post should be!

I have been avoiding updating on here and I am not exactly even sure why.  Everything is so up and down and all over the place that it never seems like a good time to update.  I tell myself that I will update once a decision is made, or we have a better plan.  But maybe this is it.  Maybe things are always going to be up and down, maybe plans our going to always change.  That is a very hard concept for me to accept but I am working very hard at trying to be present vs.  constantly worrying about the future. 

Logan’s sats continually seem to be all over the place.  After his sats being being low 70’s and having the fontan discussion, we had a cardiology appointment last week and his sats were 87.  I talked with Dr. Del Nido on the phone (seriously this man is an angel) and he said that he does not want to do the fontan this fall unless his sats are really low or his valve is giving out.  He said recovery would be a very very long time (I imagine in my mind that this means months).  So this is terrific news.  I am waiting for Dr. Del Nido and Dr. Patel to officially have a conversation about this, but it is now looking like we can wait until the spring for the Fontan.  I am very excited about that news!!!

His last echo showed that his pulmonary artery is still very small.  This means that before he has a fontan they will need to do a cardiac cath to determine if his PA will even allow the extra blood flow that it would be getting after the connect the SVC directly to the PA.  So not being a canidate for a fontan is still a very real possibility for Logan.  I was looking up the statistics and many papers were reporting that only 25% of RAI (right atrial isomerism) babies are canidates for the fontan after the glenn surgery.  Not great statistics but Logan does have a few things in his favor right now.  Fairly good sats, no AV valve regurgitation, and no reoccurrence of PVS (pulmonary vein stenosis).  But his biggest obstacle is going to be his small PA.  I am trying very hard not to think about life if we can’t get the fontan…..I am imagining that this would mean transplant much sooner. 

Logan has been in a great mood for the past few weeks.  Even at his last cardiology exam everyone exclaimed that this was the happiest he has ever been! 

For the first time in his life he didn’t scream bloody murder when putting on and taking off the EKG leads….

He just played!!! He is obsessed with these little foam letters and numbers from Alex Jr.  They stick to the side of the bathtub when wet.  He loves them and even falls aspleep grasping them. 

He has been interested in things and has started letting other people hold him.  He still spends the majority of the day sitting in his swing but he wants to do more now.  Oh, and he officially has rolled onto his stomach all by himself.  Not a full roll yet but we are getting there.  He is now 14 months.  He weighs about 16 pounds and finally is in 6-9 month and some 6-12 month clothes fit him. 

I was shocked that he let me put him in this swing.  Typically that would be waaaay too much stimulation for him, but on this day, he loved it.  Because he can’t sit up on his own I had to stuff his blanket in there to prop him up, but he really really liked that baby swing that day!

He is still on his feeding strike.  Occasionally, we can get him to take 2-4 bites of chocolate pudding or something else irresistible but then he is done.  He wants nothing to do with food.  Nothing. Because of his very abnormal organ arrangement feeding tube placement was deemed too risky by his general surgeon.  So right now it just is what it is….

We did have a bit of a scare this past weekend.  Logan started vomiting on Fri.  and then for the first time I had ever seen he vomited up what appeared to me to be bile.  It was bright almost flouresent yellow.  I got very nervous and called his pediatrician.  Between calling the his ped, his ped card, and the on-call general surgeon they all agreed that it would be safer to have him checked out at the ER.  BIG UGH here becuase, although I have a tremendous appreciation for everything that has been medically done for Logan, the ER has never been a very good place for him to be.  The ER tends to be a place where none of the doctors know anything about him and they tend to love doing intervention after intervention in there. 

(Waiting in the X-ray room.  He always scrunches his legs like that when he is scared. )

(Labs that I was refusing…)

After the x-ray they determined that Logan didn’t have an intestinal blockage but they still wanted to do labs.  I didn’t understand why?  We were there to see if he had an intestinal blockage, once that was ruled out we should be able to go home.  I asked the attending why he would want to do labs now and he looked at me and said….’well, we always order labs.’

Ummm…I need a much more compelling argument than that.  Getting vials of blood from Logan is about as traumatic of an experience that you can have.  His veins are tiny and fragile, and it is very hard to get very much blood from him.  To fill up a bunch of those vials would take hours, probably 15+ pokes, sometimes ultrasound machines, and usually only the pediatric intensive care nurses or the ambulance transport team can even ever get a vein. 

Anyway, we ended up having to just refuse them.  They told me they wanted to check and see if Logan’s electrolytes were off.  REALLY??? He has been throwing up since Fri.!!! I can tell you his electrolytes ARE off.  Well, we want to know exactly how off (they said) my response was, his eyes and his Fontanelle aren’t sunken, and he just had HUGE crocodile tears in the X-ray room. 

My issue with labs beyond how traumatic and painful it is for Logan is that the doctors always find something ‘outside the normal range’ with his labs.  Then they get all worked up and start chasing those numbers.

But we succeeded in leaving the ER with the labs still sitting on the edge of the bed as we walked out…

(Haha Labs…you lose!)

Currently, Logan is still throwing up and not eating much.  Curiously, he has no other symptoms.  No one else in the family is sick, he has no fever, and beyond throwing up he seems to be in a great mood. 

To quote Logan’s cardiologist at Boston Children’s Hospital, “Logan ALWAYS has something up his sleeves for us….”

Next ped card appt. is next week. Most likely just a clinical exam.



The Gastroenterologist.

On Tues we saw Logan’s gastroenterologist.  I was NOT excited about this appointment for two reasons.  One being I felt very blown off by him in the last couple weeks and the second reason was that his main area is NUTRITION.   Thank goodness I got Logan to gain that pound when I did because ever since his last respiratory illness he has completely refused ALL food.  I keep trying about 3-4 times a day to feed him hoping he will just snap out of these aversions….nope.

Not a chance. 

He lifts his hands to his mouth, squeezes his lips closed, and whines.  He wants nothing to do with eating. 


If only he knew what the alternative was…..

So we started off by clearing the air, and I told him that he was a very hard man to get ahold of.  I explained what happened and he kind of shook his head  “from now on you call me, don’t talk with Fellows or a nurse you call me.”  We worked out a plan for future  situations and moved on to the next big elephant in the room.  Logan’s weight. 


Logan is way below the 1% mark for weight.  If you can picture this I would say he is about

-50% on the weight chart.  (Thank god, I packed that pound on him when I did.)  After going over various options he said he wanted to speak with Dr. Patel.  So while he spoke with Dr. Patel I met with his preferred dietician.  She did all the calculations that they do, ideal body weight, calorie consumption, daily needed calories, ect… Turns out for Logan to just get on to the weight chart at around 1-2% he needs to weigh over 2 more pounds.  I told this nutritionist all of the things we have tried and failed at…. increased calorie formulas, thickeners, rice cereal, ect… I explained how there was a one two-week period where he ate and I fed him very rich food and he gained a pound.  She had one more idea that we hadn’t tried yet….

Supposedly this ridiculously expensive can of overpriced cornstarch, is supposed to add undetectable calories to formula.  It is not supposed to change the flavor or texture but it is supposed to ass 14-28 per bottle feeding.   Then the doc came back into the room with this….

It is ALL TO familiar to us heart Mom’s but to those of you that have the privilege of not knowing this an NG tube.  A nose to stomach feeding tube.  He said that he really wanted Logan to just have one now but the hospital policy has changed and now it is very complicated to give a child an NG tube.  The nurse has to do, and then a chest x-ray must be done, home health care must be set up…. So instead he said that he would give the nutritionist 2 weeks to work her magic on Logan but at the end of that two weeks if Logan had not gained 4 oz per each week his recommendation was going to be a feeding tube.  He said that he wanted to start with an NG to make sure that his stomach and GI abnormalities could handle the increase in amount and if it does then he wants to put a G-tube (a surgically placed tube in the tummy).  He said that at Logan’s age and NG tube was not a good long-term solution anymore. 

We also discussed Logan’s rectal prolapse and his rectal bleeding.  He said the prolapse is just a nuisance but nothing serious and that the bleeding was not concerning unless it was dark-colored, had clots in it, or was happening very often.  I showed him the big tear and he just grimaced.  Poor Logie….

So we are now on a frenzy to get him to gain weight.  I do have to say that  I am getting a second opinion from another GI specialist this coming Tues.  This was a doc that was recommended by the pediatrician so I thought I would give him a try too.  I am sure that he will have similar recommendations but if I like him he would be more convenient to get to.  Going to the Cleveland Clinic is a hassle.  Parking is so expensive, traffic is horrible, and the hospital is just Mammoth, its like its own city. 

The thought of putting Logan thru another surgery right now is just gut wrenching.  I am really hoping that he puts some weight on.  I don’t understand why he won’t eat??? Its so simple…. Please baby just eat….

Today we are off to see Dr. Patel (the cardiologist).

Rectal Prolapse…Ugh.

So after a few days of SEVERE constipation and some rectal prolapse, Logan began having fairly significant rectal bleeding.  I called his GI doctor and his pediatrician and they wanted me to take him to the emergency room.   I  was so angry because you can’t just take a baby like Logan to the ER.  Everytime we have ever gone to the ER it turned into a COMPLETE disaster.  There are so many things that can go wrong with Logan (heart, asplenis, intestines ect…) that everyone overreacts and panics about every little thing.  I thought that it would be in Logan’s best interest to have a doctor just take a look at him and if it really was an emergency he could then be admitted to the hospital.  But, it isn’t that easy and nobody has time so I put my foot down and said that I wasn’t taking him in.  Most likely Logan was having bleeding from the severe constipation, when he wasn’t pushing he was completely fine.  Smiley, happy, ect…It was only when he was pooping was there any problem.  There was some fear that he was having Intussusception (telescoping of the intestines) but it wasn’t very likely given that intussusception is painful even when not pooping.  So we stopped his diuretic and gave him some pedialax and there was very little blood the next time he went and then the next morning there was none.  It was very stressful though none-the-less because I had to pick the lesser of two evils.  I didn’t know what was the bigger risk for him…the ER or the rectal bleeding. 

It turned out to be the right thing to just be conservative he hasn’t had any bleeding although he is still having rectal prolapse and pain.  For some reason when he goes he keeps going until the insides come out.  I am not sure why he can even feel them but sometimes there is nothing even there.  So I will be calling the GI to make an appointment tomorrow morning. 

This is what I have always heard about with Heterotaxy.  It is so much more than just the heart condition.  Hopefully there will be an easy fix to all these problems although, I have heard that many children with heterotaxy suffer from severe constipation and are prone to Hirschsprung’s disease.  Much like malrotated kids are prone to the interssusception.  I am just really hoping this isn’t a whole big can of worms.  Logan just doesn’t need any more problems or any more surgeries to deal with right now.