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Tiredness

 

At one time during Vera’s first year of life, we talked to a transfer nurse at the Wilhelmina Children’s Hospital. A transfer nurse makes sure that the transition from hospital to home runs smoothly. She listened to all that had been going on with Vera and said: “Vera is a care intensive child”.

letter of our pediatrician about care intensive

letter of our pediatrician about care intensive

Care intensive. That word made sense. It acknowledged what we were feeling, what it was and is like: intensive. And the intensive care and intensive life are making us tired. Sometimes extremely tired. We don’t want to complain or want pity. We have lots of beautiful moments with each other. But life is not the same as it was before Vera was born. We have worries, we have lots of medical appointments and we sleep very poorly. And that is ongoing. The interrupted nights in particular are taking their toll. Some nights are better, where we have to go to Vera 2 or 3 times because she is crying loudly. But there are nights on a regular basis where we care for her in the evening and have to go to her at night every hour or every half hour and then the next day starts early again. In times like that we are extra tired because we also worry, we are looking for the cause of Vera’s restlessness (it’s often not clear at all) and we are looking for solutions. And we are sad because we don’t want to see our child suffer. Thanks to the evaluation by the transfer nurse back then, in 2012, we were assigned hours of Children’s Home Care. During these hours a nurse comes to our house to take care of Vera so we can have a break. Fortunately, these wonderful people also work at night. Two, or in worse times, three times a week, we put Vera in her travel crib in the living room and the nurse sits next to her on the sofa. We get to sleep 7 or 8 wonderful uninterrupted hours in which we don’t have to be alert for sounds and we can have true deep sleep. (Luckily, Mieke doesn’t wake up at night very often). This keeps us going. To paint a picture: life with Vera is not a sprint, it’s a long distance marathon. A marathon in which the strengths have to be divided very precisely to be able to keep walking and not falter. And what else makes it so exhausting to take care of this sweet human being?

Vera with a 3 weeks supply of syringes and food supplements

Vera with a 3 weeks supply of syringes and food supplements

In the past couple of months we fortunately haven’t had any unexpected hospitalizations, but we did have lots of hospital visits and other medical appointments. We have to think about what we want to ask, know and do ahead of time. We have to plan what food and medication she needs (and because of the examinations: which ones are allowed) during those days, the trip there, the exams, consultations and treatments and whether this all is during school time or not and do we need to plan after school care for Mieke or not. And often after a hospital visit like that, we either have to call or make a trip to the pharmacy for new or different medication. Vera uses 4 different medical suppliers! If you ever need boxes, you can come get some at our house, see picture 😉 Which brings us to another issue: keeping track of all of Vera’s medication, which kind, how much, how to administer and at what time (because not everything can be given in combination or with food). And we also have to make sure to order new medicine from the right supplier before the current supply runs out. Every month there is a new schedule on the kitchen wall listing which medicine or food is needed every hour.

medication schedule

medication schedule

Some of the cost associated with Vera’s care can be declared with our tax authority, so we keep a list of number of hospital visits. When we take a look at all the numbers during 2013, we quickly remember why we are so tired so often and that doesn’t even include the lost sleep and worries we have. A couple of numbers:

  • 101: number of medical appointments, not counting phone consultations or appointments
  • 77 appointments were with the hospital or therapy outside the home, 24 were at home (physio, speech therapy)
  • 39: number of nights Vera was hospitalized
  • 2: number of times Vera was picked up at home by ambulance
  • 1: number of times in the intensive care unit, this year ‘luckily’ only 2 days
  • 1.825: number of syringes used for medication
  • 4.963: number of kilometers travelled between hospital and home

And I could keep going. Because even the everyday things take more time and energy with Vera: taking care of her skin, preparing and giving her her food (by tube), (stimulating) communication and play etc.

But I think you get the idea and besides, I am going to relax for a bit because it is now quiet in the house…

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Interview voor KinderThuisZorg

costello-interviewIn het voorjaarsnummer van het magazine van de KinderThuisZorg is een artikel geschreven over Vera in ons gezin! De journalist heeft ons per telefoon geïnterviewd en ik heb zelf de foto’s gemaakt en aangeleverd. Dus de gezinsfoto is in de huiskamer gemaakt met 10 seconden zelfontspanner 🙂

Erg bijzonder om zo een persoonlijk verhaal te vertellen, dat vervolgens in een oplage van 5.000 stuks verspreid wordt. Ook in het ziekenhuis zagen we hem overal liggen en we zijn al een aantal keer aangesproken door andere ouders, met positieve reactie overigens.

Een van de redenen om hier aan mee te werken is bekendheid te krijgen voor het syndroom. Maar ook om andere ouders ons verhaal te laten meelezen hoe we dit ervaren.

Het artikel met ons verhaal is hier te downloaden als PDF

costello-artikel

Daarnaast is voor dit magazine onze vaste kinderarts uit het WKZ geïnterviewd over het Costello syndroom en wat dat is en medisch gezien betekent.

Het artikel waarin onze kinderarts uitleg geeft over het Costello syndroom is hier te downloaden als PDF

 

[this blog is not translated; the articles are in Dutch too, about our family and about the Costello syndrome in a Dutch magazine]

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Operation successful

Lead up

We have known for about two months now that Vera would need an operation. We have been anticipating this with mixed feelings of looking forward to it and dreading it at the same time.
We were looking forward to it because the operation would solve and prevent issues. And when we knew it had to happen, we just wanted to get it over with as soon as possible. Preferably at a time when Vera was doing well, so she would withstand the operation better.
We were dreading it because it is not a nice experience for Vera and for us it means chaotic and tiring times ahead. This week it was go time. We received a phone call on Tuesday and were asked if we could report to the hospital at 8:00 AM the next day; the only time slot available where all physicians involved would be present at the same time. It wasn’t even that bad to know with such short notice. Thankfully, grandpa and grandma de Zwarte were able to watch Mieke, things could be arranged at work (like always, fantastic employer!), bags were packed and we were ready to go.
Three specialists were needed in the OR. First, a port (portacath) was placed, second, the throat-nose and ear doctor placed ear tubes in Vera’s ears and last, the dermatologist removed a wart from her cheek. The ear tubes are needed because Vera has a narrow ear canal and has had several bad ear infections, which led to sleepless nights because of pain lying down. The ear tubes will prevent future ear infections.

Port (or portacath)

The port requires some explanation: schematische weergave PAC
a port (portacath) is the main form of a central venous access device. The term: totally implantable venous access system (TIVAS) is also used. ‘Port-a-cath’ is a brand name. A port (or portacath) is a small medical appliance that is installed beneath the skin, in Vera’s case on the side of her chest right under her left arm. A catheter connects the port to a vein. Under the skin, the port has a septum through which drugs can be injected and blood samples can be drawn many times. schematische weergave PAC The reason Vera needs this is because Vera’s veins are very hard to find and starting an IV-line has been very troublesome. During her last day treatment for her porous bones, Vera ended up needing general anesthesia to get an IV-line in (see this blog post). General anesthesia is not desirable because it is not without danger for Vera because she has a narrow trachea. Every time Vera needs treatment and a vein cannot be found quickly, it is risky. With the port this risk is taken away, there is always direct access. And since Vera needs an IV-treatment for her bones (with so called bisphosphonates) several times a year, it is a good thing that the port was placed. So, it was an unpleasant procedure once to make it possible to give her medication through an IV or even take blood more easily and repeatedly in the future in a much more comfortable way. In the future, when treatments are no longer necessary the port can be removed.

Vera ready for the operation

Daddy takes Vera to the OR

Operation successful

The operation went well. Although sad to see that the doctors had ‘poked’ Vera everywhere to find an IV-line for the general anesthesia: little holes in both hands, feet and on her head were visible. Another confirmation that placing the port was very necessary.
In the OR the doctors noticed how irregular Vera’s heartbeat is, a known issue for our pediatric cardiologist, but to a doctor who sees this for the first time it can be quite unnerving. Her blood pressure also dropped at one time, which is not usual for her. During recovery the anesthesiologist wanted to keep her a little bit longer in the recovery room to monitor this and to adjust her medication accordingly. It is known that children with Costello Syndrome react differently to pain medication and experience pain faster, so more is needed. Several hours later we were out of recovery. Vera’s breathing was quite noisy which was worrisome to us and the doctors. They were the same noises that landed her in Intensive Care several times due to breathing problems. At the same time, it wasn’t so bad when she was calm. We had a very good consultation with the pediatrician where our experiences with Vera were taken seriously in consideration. Because Vera has responded well in the past to the anti-inflammatory drug Dexamethasone and we figured she could have an inflamed trachea due to intubation for the anesthesia, it was decided to give her this medication. In the meantime, the ICU was notified just in case, which made us nervous.  room in hospitalBut soon Vera responded very well to the medication. And ended up sleeping better than ever that night (with me next to her, see photo of our nice room). And, like so often with Costello-children, the next day she had improved tremendously. A true miracle and big difference with the day before.

Let’s go home

Because we heard Vera’s normal breathing sounds again the next day, we consulted about taking her off the Dexamethasone again. They agreed, took her off and things went well. Vera started babbling again. When we were moved to a different ward with other children Vera was highly interested in the other babies.
At the end of the day we were released with some instructions on how to care for her further at home. Because, when it’s medically possible, home is where you recover best.
When Vera realized we were going home she started signing (thanks to the children’s sign language DVD’s from ‘Lotte en Max’) enthusiastically. She signed the signs for: ‘go outside’, ‘car’ and ‘home’ with a twinkle in her eye and her familiar ‘yyyyyes!’
And so we did. Go outside, into the car and home. Yes!


 

logo WKZ
In our eyes, the type of care at Wilhelmina Kinderziekenhuis (WKZ) (Wilhelmina children’s hospital) is fantastic. The fact that 3 procedures were possible for us in one hospitalization for instance. We always get solid preparation and explanation ahead of time, which gives us a lot of trust. Doctors welcome all questions and respond very well so that you feel very involved as parents. And during hospitalization they are always alert and take effective action. A top-class hospital!