What Not to Say to a Mom with a Seriously or Terminally Ill Child

I came across this article today by Rachel Carpenter http://www.associatedcontent.com/article/1645757/what_not_to_say_to_a_mom_with_a_seriously_pg3.html?cat=25 and it is so true. These are things you should not say to a mom of a seriously ill child.
#1 "No matters what happens. it's God's will. [sic]"
#2 "I just know he/she will get better."
#3 "Are you needing help?"
#4 "I know exactly how you feel. My baby was in the hospital with RSV last year."
#5 "I had a friend go through this too. It was really tough for them, and now the child has lifelong disabilities."
#6 "I just don't know how you do it."
#7 "You need to relax. You need to be strong for your other children."

I definately get #6 a lot. I don't know how I do it either. Many days I want to stay in bed and pull the covers over my head, but I can't. There are feedings to do, appointments to make and go to, and kids to feed. If I looked pulled together it is because I rely on Diet Dr. Pepper and try really hard not to cry in front of my kids.

Occasionally, I get #3, and as the article points out, it is difficult to say 'yes' to the phrasing of that particular question. YES! YES! I always need help. It is horrible dragging 3 kids to an appointment, especially to offices that aren't kid friendly (most), have small rooms (many), it is an appointment where I actually need to hear what the doctor is saying (typically), or they run a couple of hours behind schedule (much more than one). I could definately use someone to cook us a meal that is low lactose (O), kiwi-free (M), peanut, egg, nut-free, etc. (Talli), low protein & low fat (Talli), and high protein & low carb (me). Meal planning is enough to want to crawl under the covers as mentioned above. ;).

A reminder to always check...

I know that everything should be checked with Talli: verify medicatins are correct, the right formula is given, packages of food are checked for allergens, IV fluids are correct, etc., etc.,

A couple of years ago, she was in the hospital and TPN had been ordered. It was a non-modified amino acid version, the kind anyone else would get. Some visitors were leaving when the IV bag was hung and as I walked them to the door, I checked the bag. The protein count on the bag wasn't what I had expected, so I alerted a nurse. The pharmacist had made a mistake and 24 hours worth of protein was in a bag to run for 4 hours. I am sure that no long term damage would have been done, but it likely would have prolonged her stay. Everyone was very nice and apologetic over the mistake and a new bag was sent up within the hour.

Yesterday, Talli got her delivery of some Energy Options candy bars. She has been eating a lot lately and we had run out of the mint and while chocolate versions. Energy Options candies are made to be completely protein free and are peanut and tree-nut free. To foster her indepenence, we usually have the bars in a designated place for her. Instread of having the imprint of "Energy Options" on the bar, it said "PhenylAde". Appled Nutrition makes both Energy Options candy and a bar called PhenylAde that is an amino acid modified food to replace formula for someone with PKU. The bar contains 10g protein equivalant, lacking only phenylalanine. So if Talli ate one, she would be getting 100% of her protein for the day.

The bars are getting sent back to the manufacturer, so they can verify where the problem lies. Is this actually a PhenylAde bare that got into an Energy Options package and box or an Energy Options bar with the wrong imprint. It was a reminder that everything does needs to be checked before it goes into Talli to keep her as well as she is.

I did check all of the mint ones by pressing through the wrapper to read the imprint on the bar.

Education Resources

I came across this information and just needed to share!

Baxter makes a couple of formulations of IVIG. Talli was going to start on one of them, but we found out they contain glycine. Talli's glycine level is already very elevated, which is a complication of PA. Baxter provides the following at no charge at www.mygardian.com/gardian/living-with-pi/resources.html

The blue bear, named IGI V, is included in the Therapeutic Play Kit. It contains the bear, medical supplies to give the bear and IV and remove it. There is a notebook for the child to record how the infusion went, a guide to theraputic play for parents, and a story book for kids. Even if the child just goes into the hospital occasionally and doesn't receive IVIG, this would be an excellent tool kit in helping them to cope.

We used IGI V during Talli's last hospitalization. She put an IV into the bear, including talking about how it was important not to get it too close to thumb for video game playing.

IGI V's Medical Records is included in the Theraputic Play Kit or you can order it separately.

The ABC's of Kids Like Me is an ABC picture book and some of the pages are medical related. For example, 'D' is for Doctor. The second half of the book is blank so you can create your own personalized ABC book.

This is My IVIG Book is a children's story book about getting IVIG. It includes a blank book (you could easily customize the cover by covering up IVIG with hospital or doctor), paper and stickers.

The last thing is for parents. There are 2 Notebooks in the Wellness Kit with divider pocket folders and blank pages to keep track of medical information, bills, etc. You could also customize for your metabolic child with the Care Notebook that the Propionic Acidemia Foundation put together. It is available under 'sites of interest' at http://www.pafoundation.com/. It is available in English and Spanish.

PA Consensus Conference

Tomorrow, I fly out to Washington, DC for a PA Concensus Conference sponsored by Children's National Medical Center. There will be a small group of metabolic doctors attending, as well as liver transplant experts, a neurologist, and representatives of parent groups. I will be representing the Propionic Acidemia Foundation, along with my dear friend, Jill Chertow Franks.

We hope to make great progress in creating documents with recommendations on screenings and monitoring. It is expected that the information gathered and discussed will be published.

Mucinex mini-melts for Kids! not compatible with feeding tube

Talli has a pretty nasty cough. Her pallative care nurse suggested Robitussin DM, however, the pharmacy only had adult Robitussin DM, so the pharmacist suggested using Mucinex mini melts. She indicated that it is like Prevacid Solutabs, so would fit into her feeding tube.

We did try it last night. Unfortunately, Mucinex completely clogged up her tube AND her button. Changing a button is anxiety provoking to Talli, so I try to avoid it as much as possible. After cleaning out the extension set while not attached to her, I realized that her button was indeed clogged. I found a bamboo skewer and gently used the tip to unclog the button. The one way valve on the button was already shot, so I didn't have to worry about breaking it.

So Mucinex mini-melt for Kids! doesn't work with a feeding tube, so stick to the liquid version. Prevacid Solutabs and Tylenol meltaways DO work in a feeding tube.

Hospital Beds

Hospital beds, what can be done to get a good night's sleep in one? I don't mean the electronic beds that raise and lower, fold, and weigh patients. I mean the ones that the parent or significant other sleeps in to be near the patient.

The hospital that Talli usually stays at has 3 different types of beds, the worse being a hide-a-bed type, that folds out from a chair with a thin, likely spring mattress. The better ones in my opinion are more like day-beds that a couches and may have removable pillows or pull out slightly from the wall. My dorm bed in college was this latter type.

Over the weekend, I spent the night with Talli in the hospital. For the past 3 years, my husband has taken the honors on almost every night (40+ nights), however, he was sick when Talli was admitted, so I stayed with her. Unfortunately, she was put in a small room that will only accommodate the worst of the parent beds. I tried a couple of things to help make my attempt at some sound sleep-
1. sleep with your head at the foot of the bed. While initially, it felt an though I was laying downhill, a couple of pillows remedied that. The mattress was less worn at the foot.

2. layer a couple of blankets. I folded 2 blankets in half under the sheet. This gave more support and evened out the feel of the springs, so one wasn't poking me in the knee or some other random place.

3. Sleep in the parent room or "quiet room". I didn't do it this time, but I have in the past. The beds seem to the newer and more comfortable in there. Even in our hospital with about 15 peds beds, there is a lounge-type room with an extra bed in it. At larger facilities, we have used their parent suite that had several beds and a full bath with sitting area.

4. Trade beds. Talli loves to sleep in the pull outs, so often she and my husband switch (with the nurse's ok). When O had surgery a few weeks ago, the nurse gave me the option of just having a hospital bed in the room to sleep together, instead of a crib for him. However, with that option, I would have needed to stay with him ALL of the time and I knew at some point I would need a crib to just use the bathroom.
When Talli was younger she also liked to sleep in the wagon they had in the unit, so that freed up her bed. When she had pneumonia once, she would only use the oxygen if she could sleep in the wagon.

Please post a comment if you have other ideas on how to get a good night's sleep in the hospital.

Soft Clothing

A few months ago, I posted about SOFT Clothing. I got some this week that I had ordered for Talli. I got the demin pants and a khaki pair. I ended up ordering a little bit too big for her, so will have to get a smaller size. I think they are true to size. She is short and a bit pudgy with a spinal dimple, so she needs something with a high rise and short legs. I think the next smaller size will fit her perfectly.

They are incredibly soft!! She is able to get them on herself, since they do not have fasteners. She only wore them for a sort period of time, since they were too long, but in that time she didn't get any hives. They do have flat interlock seams, similar to Hanna Andersson's infant clothes.