Wednesday, June 7, 2017

The Pressure is Back

There is more information about my daughter’s vision but as none of it is urgent, I thought I’d take a day off and talk about something else, something mundane, something like water pressure.

My husband and I have had a water mystery ongoing in our house for some time now.   In retrospect it was fairly straightforward, but the order in which events occurred and things were changed caused the facts to be misleading and we were tracking down a problem that wasn’t the problem we thought it was.

We moved into our house in 2010 and at some point in the first year or so bumped up the water pressure in the house higher than average because it was nice getting water faster and harder when you wanted it.

Things went well and without incident for a number of years until we had our annual plumbing wellness check done.   A very thorough technician told us somehow the water pressure was at 120 PSI, or city full pressure.   This was bad, this wouldn’t do, we were going to blow things out if we kept it at that pressure.

So he dropped the pressure.    We also decided to put in a whole house water conditioner at the time because technology had advanced where the system was much less expensive and the consumable cartridges were long-lived and low-cost.   House water now cleaner and milder pressure-wise we also de-scaled the on-demand hot water heaters and ultimately got an imaginary certificate of healthy water and pipes from our plumbing company.

It was after that that things get muddled.   That lower pressure turned out to be potentially nice for the pipes but annoyingly slow for everything else involving humans.   My husband got a pressure gauge a few months later and over the course of the next year we futzed with the pressure, increasing it, worrying about it being too high, etc.

At one point recently we wondered if we had a leak somewhere because the pressure was dropping to very low when there was, say, a faucet on and a toilet flushing.  It was about a week later that my husband was testing pressure with the gauge on the hose bib outside, watching it drop to 30PSI just because one faucet was one when he had an idea…how long did that whole house water conditioner filter last?   I told him I thought it was a five year filter.

He checked and no, that five year filter is for the ice maker, the one for the whole house, incidentally installed just over a year ago, was due to be changed—probably had been needing to be changed for two months.     Today the new filter came in and as it turns out, we didn’t have a pressure problem at all.

We ordered two filters so next year when I start complaining about how long it takes to fill the tub up, my husband will be able to fix the issue over lunch.

The Big Boy Update:  Sometimes on the way to school we’ll play Simon Says.   Today my son changed the game to Batman Says.   He would try to trick us by saying things like, “Robin says…” or “Alfred says…”

The Tiny Girl Chronicles:  We were waiting to board the plane yesterday when my daughter said something to me and I have absolutely no idea where she got it from, “mom, when are we going to sit down?  My bunions are sore.”

Tuesday, June 6, 2017

Blind Defiance

We have a problem with my daughter that my husband and I don’t know how to solve.    We need professional help because we’re just too far out of our level of child development and trauma knowledge.    Here’s what’s happening:

My daughter is almost completely blind right now.   This is a relatively new situation and it’s something she, we think, believes we may have caused because every time a procedure is done, some point in the future her vision gets worse.   As adults we’re terrified and depressed for her and powerless to do more than we’re already doing—everything we can.

What’s happened in the past few days is a level of defiance that’s confusing though.   Let me give an example.    What would you do if your five-year-old child stopped using utensils, played with their food, got a greasy mess on their body, clothes and the surrounding area.    What if they didn’t listen about using their fork, not spilling their drink in the airplane and eating like a child, not a baby?

But, what if the only way your child could find the ketchup was to feel around with her hand and hold it in the ketchup until the other hand found and brought over the french fry to dip it?   What if the only way she could find the napkin or drink cup was to fumble about the table space because they couldn’t see anything on it?

The thing is, these scenarios are both correct in that my daughter has been rebelling and acting inappropriate while eating, reverting to more child-like behaviors.    She is also unable to see and needs to use some of those behaviors to find and eat her food.     But where do we draw the line?    And when we draw the line, is it the right thing to do or do we need to support her more in this time of extreme stress while she’s lost even more of her vision?    

This is where we’re at a loss.   Good thing we’re seeing Dhruti tomorrow.    My husband didn’t understand what I was going through the last few days in Detroit until he was at home tonight at the dinner table and saw the fairly extreme behavioral changes I’d been talking about.    I hate to say it, but I was relieved he lost his temper at my daughter, mostly because I’d been feeling like a terrible parent for doing the same thing multiple times on the trip.

So we’re confused, albeit likely less so than my daughter is right now.   She’s resilient, but I want to be supportive in the best way we can be now and not rely on her ability to recover from our misguided parenting today.  

The Big Boy Update:  My son made Robin’s (of Batman and Robin) staff with my husband while his sister and I were away in Detroit.   It’s got a nice grip and has been painted to match the one Robin actually uses.   It was pretty impressive looking but what I didn’t expect was my son to do—with ease—some of Robin’s moves with the staff when I asked him how it worked.

The Tiny Girl Chronicles:   My daughter made a new friend today, Nash, who was on the same flight we were, coming to the area for some specialty surgery.    He and she played with her Paw Patrol characters and when we boarded and discovered we were on the same row, they say across from each other on the aisle seats and played with modeling clay and talked together for the whole flight.    He is apparently her new best friend, she says.  

Monday, June 5, 2017

UES?

This is going to be a long post.   It’s going to be so long I think I’d better start by dividing it up into sections so I can keep it all straight.    This section, let’s call it The Introduction, is where I say today was one of those Monday Detroit Surgery mornings.   We don’t know what will happen until the day of surgery because if you’ve been following this blog for some time, my daughter’s eyes are anything but predictable.   Today we did have surgery on one of her eyes, we now know more about the other eye and we have a plan on what next steps will likely be.    But let’s start with the easiest topic first:

The Right Eye
To sum up the history of my daughter’s right eye: it was the most damaged in the original incident/injury and has had the most work done to it over time.   It has light and dark perception with some ability to discern colors.    There is a chance it can see more, but so far we haven’t seen much evidence to support additional vision is possible.    However, lately (as in the last four to six months) the eye’s field of vision has been blocked by fibrous growth scar tissue that may have been from an internal bleed from a surgery.   Or it may be unrelated, we don’t know.

Today Dr. Trese elected to do surgery on the right eye, leaving the left for next time.   He opened up an oval section in the scar tissue about 3mm vertical and 2mm horizontal in size.  This isn’t much different than the field of vision we have as normally-sighted people, so if the eye can see, this will give her a good chance.    We’ll know more tomorrow when the bandages come off and she adjusts to the light she may be highly sensitive to.

The Left Eye
Here’s where it gets complicated.   To review recent events: the left eye was pretty much all my daughter’s vision but it had declined due to a progressing cataract.   After the recent cataract removal surgery my daughter seemed to potentially see more (even without an accurate refraction) but then had a sudden drop in vision.    Two weeks ago we found out she’d developed a hematoma blocking most of her field of vision.   Steroid drops were prescribed once per hour (fun) and in two weeks (today) Dr. Trese would see how much things had improved and consider surgical intervention if necessary.

Dr. Trese’s Theory is the left eye lost some pressure after the cataract surgery and got bumped causing the hematoma.   This isn’t likely in most eyes, but my daughter has a perfect ocular storm that makes it more probable.   She has irregular vasculature (blood vessels) and hypotony (low pressure).   That, coupled with the potential side effects from invasive surgery like cataract removal made her more susceptible for hematomas.

At this point 80% of the hematoma has been absorbed.   Dr. Trese can see the retina, optic nerve and…the retinal folds.   And this part is the new part—the new wrinkle, if I’m going to try and be literal about it—the retinal folds are back, and that’s not good.  They appear to be new over the past two weeks because they didn’t show on the ultrasound two weeks ago here in Detroit and didn’t show at the one two weeks before at Duke.

There is another thing they were able to see today via ultrasound and that’s the choroid, the layer directly behind the retina, the thing from which the retina detached, is thickened.   It is upwards of three times as thick as it should be in some areas.    This indicates the choroid has been strained for some time.   And that’s where the title of this blog post comes into play.

Dr. Trese said there’s a possibility my daughter has Uveal Effusion Syndrome (UES).   It’s a very rare  condition characterized by choroidal fluid collections, often in association with serous retinal detachments.    Hold on, did you hear that long-time readers—“serous retinal detachment”?   That’s how this whole thing got started, well, that in conjunction with inflammation and ciliary body damage, but that was the main thing that damaged her vision.

So for now the UES is a question, not necessarily a diagnosis of something my daughter has.   Also, don’t mistake UES as the possible suspect for an overall diagnosis either, there’s not just one overarching thing causing all the havoc in my daughter’s eyes.   Dr. Trese will investigate the possibility of UES further as we move forward.   One thing that would be nice is that UES can potentially be managed medically versus surgically with drops.    Less surgeries would be nice.

And while he didn’t perform surgery on the left eye today, he did add Healon to it to increase the pressure because he said there is a possibility the pressure was artificially reading higher than it actually was due to the blood in her eye.  

Today
My daughter will need to sleep sitting up or propped up for at least a few weeks.   She has to wear shields over both eyes, with tape that in order to keep the patch on overnight, sticks to her hair and tears it out the next day and leaves adhesive residue on her skin, so that’s fun.   We have drops in one eye every hour while she’s awake and three drops I’m not sure how many times per day in the other eye (I’ll find out tomorrow).

Oh and one other thing, Dr. Trese said my daughter is a, “Fibrant Former” which means she forms fibrous scar tissue very easily, hence some of the issues we’ve had in her right eye.   The frequency and regularity of the steroid drops will help prevent this process in her eyes.

Next
We return in two weeks for another surgery in which Dr. Trese hopes to be able to do something more therapeutic to the left eye.   This will likely be a vitrectomy with added silicon oil and possibly PFO, the heavy substance that helped lay down the retina in her right eye.   There is also a second option to address the potential UES.   Surgically he could open some scleral slits to help drain any fluid buildup.

And what about that refraction I keep going on and on about?   Well, things have changed yet again and as Dr. Trese so aptly put it today, “we’re a ways away from a refraction at this point now.”   Those retinal folds make it hard to refract light in a regular manner and you need that in order to get an accurate prescription.    But there might be one small upside to this and that’s the right eye.    Back in 2015 when my daughter had her first eye surgery, they removed the natural lens in her right eye.   Since that time she’s never had a strong enough pair of glasses on her eye to correct for that lack of lens.  

I’d like to say we might find out what she can see (if anything) when the gauze comes off her eye tomorrow, but I’m going to hold off on that hope for now because she has two small stitches right slam in the front of her eye, just exactly where you personally would least like to have stitches in your eye.   She’ll probably be light sensitive and may, like before, choose not to open the eye for five days or until the stitches start to dissolve.  But I’m patiently hopeful for now.

The Big Boy Update:  My son isn’t getting a present from his sister when we return home tomorrow.   There was nausea after surgery we didn’t know about which culminated in lots of vomit all over the rental car, car seat and my child.  She was still nauseated come dinner time and we just didn’t make it to the store in the mall to get him a present.   When I told him on the phone he was understanding.   When I told him we had a multicolor volcanic rock we’d taken from the Red Robin parking lot for him instead, he was surprisingly chipper, asking if it was heavy and being even more interested when I told him volcanic rocks weighed less than regular rocks.

The Tiny Girl Chronicles:  My daughter was waiting to go into surgery today.   She usually walks back and they give her the gas mask and she goes right to sleep.   I’ve never been there with her before though but I knew what she meant when she said in frustration, “I’m hungry I want to do the smelly nose thing now.”

Sunday, June 4, 2017

A Constant Hazard

My daughter and I are in Detroit tonight.   We flew up today so she can be seen by her retina surgeon tomorrow morning.   He may remove the hematoma in her left eye, hopefully giving her the ability to see something again.     He may wait and work on the right eye’s scar tissue or he may do nothing at all.   

I’m personally in favor of him doing something.   My daughter is just a hazard to herself all the time. Her cane training isn’t far enough along for her to keep a cane for general use, although my husband and I are thinking she might need one over the summer and, well, now if her vision stays the way it is.   The reason she doesn’t have one yet is because they are very easy to misuse and once bad habits are made, they’re very hard to break. 

Our travel today involved a lot of holding my hand as we went through the airport, car rental, hotel, swimming pool, restaurant, etc.   I got a better sense of how very bad my daughter’s vision is right now—she will run into anything and everything.   I had to yell, “STOP!” multiple times to prevent her from walking straight into something right in front of her. 

She can’t see colors either—she wanted to play with some of the rocks out in front of Red Robin where we ate diner.   The rocks were volcanic and very vibrant in color but she couldn’t tell a white from a black from a red rock.   

There was one game on her iPad she was able to do reasonably well, Toca Boo, which is a black screen with a white ghost on it.   You control the ghost and try to hide behind furniture in the dark in rooms and scare your family members (you’re really a child wearing a sheet).    She was doing fairly well finding and moving around the white blob on the black screen.   But seeing walls directly in front of her?   That’s another story. 

My daughter is apparently coping well with the loss of vision if her wish as the threw a penny into the airport fountain is any indication.   As she launched the penny high into the air she said, “I wish we could have a pterodactyl right now!”

The Big Boy Update:  We called my son when we got her and the first thing he said is, “what did you get me for my present?”   I explained how that made me sad that he didn’t miss me, all he wanted to know was if we’d gotten him something.   I think he understood, but I know it’s hard when you’re six-years-old.

The Tiny Girl Chronicles:  My daughter told my husband this morning, “okay, dad, you do not look great when you do not have a shower.”   

Saturday, June 3, 2017

The Now List

We have two types of children in our house: the one that wants everything and the one that doesn’t really care about anything.   The one that wants everything, my son, has his wish list.   He’s on and off with the wish list mostly because he’s figured out wish list items are for some day, eventually, when someone has a reason to get you something.   Since my son’s birthday is  close to Christmas, most of the year his wish list seems more a “some day eventually, maybe” list.

My daughter doesn’t have anything on her wish list.  She has a few things my husband or I put there because we had an idea something might work well for her or someone suggested something, but other than that, my daughter is happy with whatever she gets.    I don’t know if she’d have more of a wish list if she could see, it’s hard to tell.    I don’t think she’d have the same length of list my son does though.

My son has come up with a new stratagem to get the things he wants.   Today he explained that <insert super hero thing he told me about this morning> was being put on his, “Now List”.   This list, he explained, was for now, not for later.  What that meant, he explained to me, was that I could go right out now and buy it for him.  

The Big Boy Update:   My son had some work he brought home from school that included something he’d written (apparently a song) and a some notes colored in on sheet music on the lower half.   I asked him what the writing was and he read something about snow to me.   Then I asked what the part at the bottom was.   He looked puzzled and then said, “it’s the alphabet that begins with C and ends with C”.   “Musical notes?” I asked.   “That’s it”, he replied.

The Tiny Girl Chronicles:  We had been talking about magnets and electric cars the day before.   The next day my daughter remembered the conversation and kept talking to me about the ‘electromanic’.

Friday, June 2, 2017

Pliers and Cardboard

Children like to bust things up.   They like to knock block towers down, push over someone else’s hard work and definitely, without question, kick over that sand castle another child’s been working on.    I’m not sure why destruction is an important part of child development, but we try to nurture it when we can.

My son has this thing he’s come up with which makes a lot of sense if you’re the parent of a Montessori-educated child.   If you’re not, this might sound like a bad idea, bordering on negligent parenting.    But bear with me because it all turns out okay at the end of the story.

My son likes my pliers.   I’ve done a lot of jewelry making and I have a drawer with over thirty pair of pliers.   They do different functions in the jewelry making world but in general most are pointy or sharp in one or more direction—which is why they’re so enticing to my son.

What my son wants to do is get the pliers and see what he can tear up with them.    After some negotiation a few years back, we settled on cardboard (typically from broken down boxes) for his plier-based attacks.   My son would see just how much carnage he could exact on the cardboard and I would see how much calmer he’d be afterwards.

He’s done this repeatedly, when the need would arise, for a long time now.   Yesterday he brought two other friends into the process, inviting his next-door-neighbors saying, “you can pick three pair of pliers and then get a piece of cardboard from the garage”.

I had the children meet on the front porch and sidewalk, saying they could do whatever they wanted with the piers and cardboard, but the house (including the sidewalk) was to be protected from damage and hey, didn’t the grass look like a great place to do this fun work?

My neighbor’s son, Whitaker, came up with the best plan, putting his cardboard over the doormat and jabbing down again and again into the cardboard, through the standing bristles of the mat, making lots of satisfying holes in his cardboard.

All three children had fun and no one was injured.   I didn’t get arrested because the children were having fun responsibly.   But what if there had been an accident?   Then there would have been an ice pack and a bandage and most importantly a lesson learned in safety from the child.   I’m okay with a little injury to teach a lesson.   We can’t effectively learn without making mistakes.

The Big Boy Update:  My son has been more and more kind to his sister lately.   Don’t get me wrong, he can still be a serious jerk to her, but when he realizes she’s hurting or she’s going to miss out on something because of a poor choice she made, he’ll step in and offer his help or some of his reward.   This is new—very new.   My son is exhibiting signs of empathy, something he didn’t understand until relatively recently.

The Tiny Girl Chronicles:  Not only is my daughter managing her hourly drops schedule, she’s putting in the drops herself some of the time.   She’s not always hitting the eye directly, which is causing a decent bit of wastage with the drops, but heck, I am so not complaining.   My daughter, instead of fighting and crying about the drops that sting and are an annoyance, is helping and doing the job herself.   It is important at this point that I point out she is clearly her father’s child because I would never be so understanding and helpful.

Thursday, June 1, 2017

Two Thousand Posts

I pressed the ‘Publish’ button last night and noticed I’d just completed blog post 1999.   I know it’s been a while since I’ve been doing this, namely since my five-and-a-half year old was only a month old, but two thousand posts?   Hard to believe.

I was going back and review some of the posts but I ran out of time today making lunches, doing laundry, facilitating conflict resolution and helping out with pliers and cardboard—something I’ll try to explain in more detail in tomorrow’s post.

Ideally this blog would be mostly about boring things happening in my life here and then a cute little story or words my children said in the lower sections.   But that’s not how it’s netted out recently.   My daughter’s eyes have dominated a lot of this blog for some time.   I don’t mind so much in so far as it’s a good way to communicate what’s happening to friends and family and it’s an excellent way to document over time what’s happening.    But it’s not fun.

So here’s to more fun posts in the next two thousand.   At the rate my children are coming up with things to say and do, I’m fairly sure we’ll have some good stories ahead.

The Big Boy Update:  My daughter took her glasses off to have them cleaned this morning.   My son. who has said this before, said to her, “you look beautiful without your glasses.”   I’m not sure how my daughter takes this.   He means it, but she knows she has to have her glasses to see.    I was happy he had something so kind to say to her though.

The Tiny Girl Chronicles:   My daughter was in the tub doing something unusual.   She had her head pressed up against the side of the tub while it was draining.    She shushed me when I asked, telling me, “I’m hearing the water going through the sewers”.