One

Shirley is one today! We could write for hours about the past year but we won't. 

We are so blessed to have Shirley in our lives. It has been a wonderful year! 

Please continue to pray for us and our little girl as the years go by. The support we received over the past year has been unbelievable, thank you.

Shirley's heart will never be perfect and she will need other surgeries to keep it beating, but we look forward to the days, months, and hopefully years to enjoy our little girl.

There are some exciting things coming up for us and Shirley. We will be doing some work with the American Heart Association this year as we continue to spread joy, hope, and awareness to those who find themselves in similar shoes.

Please enjoy these pictures we took for Shirley for her first birthday.

-Joseph

Reflux Sucks

Cardiology

Shirley's heart is pretty much the same as it has been. Her medication doses were increased after her last appointment because of her growth (12lbs 3oz!). She will have another echo at her next appointment. If all goes well, Dr. Penalver mentioned that they will be toying with the idea of weaning her off some more of her medications. Obviously, it would be ideal for her to be weaned from all of her medications, but we would would be excited about even a slight decrease.

GI and Feeding 

Shirley is still not feeding much better than she was before. She has good days and bad days. Although my milk supply has come back up, she is still not interested in breastfeeding. We've had two visits to SCH GI clinic in Federal Way with Dr. Len. She thinks Shirley looks too good, and feeds too well, to justify placing a G tube. Since Shirley has no oral aversion, and she's a chubby baby, Dr. Len wants to exhaust all options before ordering the procedure. She is quite convinced that Shirley's issue with feeding stems from chronic reflux, and not low energy or a physical inability to feed. So now we're trying to tackle her reflux before trying anything else.

At our first appointment Dr. Len noticed mucous in Shirley's stool, so she suggested we cut cows milk protein out of Shirley's diet (which meant my diet too). Since Shirley has been on fortified breast milk, they switched her to a peptide based formula that's more broken down and easier to digest (still derived from cows milk... which confused us a little). She also prescribed a reflux medication. It's been about 4 weeks since that first appointment and we haven't noticed much of a change in her feeding, but she is spitting up much less. At our most recent GI appointment, Dr. Len was glad to hear that about the decrease in spit up, so she switched Shirley's feeds to plain breast milk, but added about 7oz total per day. This is a huge step! Especially since the new formula tasted horrible and Shirley wanted absolutely nothing to do with it. Although we are excited about Shirley being fed straight breast milk, the increase in volume will give Shirley even more catching up to do in terms of oral feeding... but we'll celebrate our small victories when we can!

Looking Back 

People are always asking me how Shirley is doing. My most common answer is some form of "she's fine, but she still won't eat anything." I say this partly because I'm too lazy to elaborate, and partly because I've been totally obsessing over her feeding issues, so it's really the only thing on my mind. What a bummer of an answer! Although it's essentially true, it's not the whole story. 

Shirley is doing remarkably well. We are all doing well. I have to keep reminding myself of this fact. I am often so frustrated and worried about the slow, almost non-existent, improvement in her feeding that I forget how far we have come. I'm so busy wishing for at least a semblance of normalcy, when I should be relieved that oral feeding is my largest concern. I constantly have these thoughts bouncing around in my head "What if I'm not trying hard enough? If only I had pushed her more when she was younger! Is she too old to learn to breastfeed now? Will she ALWAYS need a tube? What if some other woman were her mother? Would she have been able to get Shirley off the tube and feeding by now?" They repeat themselves over and over, one thought leading to the next. I know they are not healthy, but they are my thoughts all the same. Before writing this, I spent an hour or so reading over our past blog posts when Shirley was in the hospital. Most of the posts brought me to tears... and it helped me to see just how well Shirley is doing these days. She is growing, she is happy, she is deliciously chubby, and she is loved. 

Joseph and I have come a long way as well. Dosing and administering medications has become second nature, prepping her food and feeding her isn't an ordeal that takes an entire hour anymore! We're no longer jumpy and overly anxious whenever Shirley is unhappy, we know that she is a baby... and crying doesn't always mean something terribly scary is happening. We have come so far, and there is still a ways to go. We are learning, we are growing, and I am so thankful for that.

I constantly feel inadequate. I believe I am always going to feel inadequate, because the truth is, I am. Nevertheless, for some strange reason God chose me to be this sweet little girl's mother and I am confident that He will equip me to do the job.

-Brianna

Cute photos below!

These Days

A New Normal

With Joseph being back at work and a lot busier than he was before, I (Brianna) thought I'd take the time to post an update. I know you have all gotten used to Joseph and his writing style, but we're probably going to tag team the updates from here on out. His posts are going to be a tough act to follow... so bear with me. 

Things have settled down and we've begun to feel like we are living a new kind of normal. We have gotten pretty good at packing everything but the kitchen sink when we go out (you'd be surprised by how quickly we can load up and go!). I've even gotten comfortable taking Shirley out alone, on a walk, to coffee or lunch with a friend, things are just getting a bit easier. We've gotten used to strangers asking questions about her NG tube. Although these questions can be repetitive, they have been the start of several surprisingly meaningful conversations with people we've never met before. 

There are moments I find myself forgetting about Shirley's heart condition entirely, which is something I did not think possible just a short time ago.

Struggles 

We are having a difficult time waking up for her middle-of-the-night feeds. Shirley sleeps through them, so we don't have a crying baby to wake us up. We have accidentally slept through them right along with her more times than I'd like to admit. I usually wake up frantically pawing around in the dark for my phone, only to find that it's right next to me and that I must have silenced my alarm several times in my sleep. Then a wave of guilty thoughts rushes into my mind "she's probably starving!" "Do I not care about her enough to wake up for her?!" Although powerful in the moment, these thoughts are fleeting and usually do not last until the morning. 

Shirley has not been improving with oral feeds. For a while she was very interested in breastfeeding, but she has recently decided that she doesn't like it so much anymore. The fact that my milk supply has been rapidly dropping ever since her discharge from the hospital is probably a contributing factor. Bottle feeding is slow going as we work with the feeding therapist to find the right flow rate and nipple shape for Shirley's comfort. We want feeding to be a positive experience for her, so we can only push her so far before she gets upset or overtired. We give her as much as she will tolerate by bottle, and then feed the remaining amount through her NG tube.

Appointments

Shirley doesn't have as many appointments as she had the first several weeks after her discharge. She has in-home physical therapy and feeding therapy appointments that rotate every Monday. The therapists are wonderful! They have been so encouraging to me and I can tell that they truly care about Shirley.

We had a cardiology appointment last week with Dr. Penalver at the Tacoma SCH cardiology clinic. I had seen him once before when I was about 30 weeks pregnant, so this was the first time he officially met Shirley. The appointment went well overall; Shirley was a champ, smiling at everyone! Although she is still quite small, she is healthy and gaining weight (11lbs now!). She had both an EKG and an Echocardiogram done; both had positive results. Her heart hasn't changed much, and any slight changes have been for the better. 

Because of Shirley's difficulties with oral feeding, both Dr. Penalver and her dietitian (Tran) mentioned the possibility of getting a G tube placed instead of her NG tube. A G tube requires a small surgery to place a tube from the outside of Shirley's abdomen directly into her stomach. It has a small button that can be opened for feedings and closed when not in use.

Initially, this would seem like a step backward, but it really isn't. There are several issues that could be resolved by switching the NG tube out for a G tube. First, the NG tube holds Shirley's esophageal sphincter open, which causes reflux and throat irritation; both make it more difficult and uncomfortable for her to feed orally. Second, the NG tube also causes Shirley to have a heightened gag sensitivity, since the tube is hovering at the back of her throat; this also makes oral feeding more difficult. Third, the adhesive used to keep the tube in place on Shirley's face really irritates her skin. It is an obvious discomfort for her, and the older she gets, the better she is at ripping it off and pulling her tube out. For the past several weeks we have considered ourselves lucky if we could keep a tube in for more than 3 days. Although we don't like the idea of Shirley going through another operation (albeit a very minor one), the NG tube has been such a headache for all three of us that the idea of a G tube is beginning to appear like a breath of fresh air. Also, selfishly, I would like to see Shirley's beautiful face without that pesky yellow tube getting in the way!

We have not made a definitive decision to move forward with the G tube yet. We're going to see if her oral feeding improves over the next couple weeks and then make a decision.

Meds and Labs

The other positive thing that came from her cardiology appointment was that she was taken off digoxin. She is now only taking three medications multiple times a day. Digoxin was never meant to be a longterm treatment for Shirley's heart failure and because it is by far the most dangerous drug with the least benefit, we were all itching to be done with it. If you don't remember digoxin is the drug synthesized from foxglove. Shirley also had her blood drawn last week and this revealed even more positive news. If you recall a post a while back about BNP you will be glad to hear that Shirley's BNP levels are at 63. Thats down from about 3500 at its peak in the hospital. It is still high, relative to the average child, but its not that bad for a child with heart failure! It also confirms that she really didn't need to be on digoxin anymore and that her current meds are doing the job just fine.

Shirley is still the happy, chubby, sweet baby she's always been. See pictures below:

-Brianna

Home Sweet Home

Home

We are finally home! Our wonderful family and friends cleaned our house from top to bottom. There will be a lot of adjusting but it will be good. I could go on and on but I think that keeping it short is best.

We are thankful to have Shirley home. Thank you all for your continued prayers and support. This is only the beginning of Shirley's Grand Adventure! 

Tonight we will sleep in our own bed with Shirley under the same roof. 

-Joseph