Feb 16, 2020

Every day is a better day than the last; working towards home is looking like a reality for Ev. Her drain is putting out less each day and her strength, energy and stamina increases with each walk she takes. We still are waiting for her guts to wake up, but with pain meds lessening she is beginning to feel more signs of it waking again, a time we will have to “get through” as it often doesn’t feel too good, but is a necessary step in the healing process. There is talk to maybe let her go home with the drain in place tomorrow, as she is finally down to only TPN, antibiotics and antifungals hanging on the IV pole! We’ll see what the morning brings.

Thank you all for the love and prayers.

Feb 13, 2020

Wednesday went well, other than needing a unit of blood because her counts had dropped overnight. She needed an extra IV for this, but she was a trooper and took it with stride. Her ostomy has quieted down again, but this is to be expected after this type of surgery. She has made so much forward progress with healing; going on walks, doing activities, but is also resting well. Her drain output has also slowed which is good. Doctors are pleased at the way things are going and we cannot be more thankful.

Thanks again for all the love and prayers.

February 11, 2020

Evelyn is feeling much better today. Even last night it was wonderful to see the swelling in her abdomen was greatly reduced and she was up and walking today, sitting for awhile in the playroom. We had to convince her to rest this afternoon so as not to push herself too quickly. It is great to see her healing and moving in the right direction. Dr Mercer expects that her drain should slow down in output over 4-5 days and her digestion should slowly resume over this time as well. Already, her appetite is back somewhat and her ostomy has also put out more than it has in days. Little steps forward!

Thank you to everyone for your love, prayers, gifts and words of encouragement during this latest set-back. We’re hoping for a smooth, steady recovery, as God wills.

Continue to remember us.

Surgery Went Well

Evelyn is now in recovery and all went well. Dr Mercer said he theorizes that while placing the j-tube a week ago, the first poke into the space may have over shot, allowing a small leakage into the back area of her abdomen. The drain that was placed was not effective for the area, so she now has a new, longer drain that will flush out any leftover saline that may be left. He placed contrast up and down the inside of her bowel and manipulated it to make sure the leak is gone. He was unable to find anywhere that continues to leak, so it seems that any perforation that was present is healed. This is a huge relief! He also determined that the j-tube balloon was also likely causing obstruction, so he removed it and replaced it with a tiny tube that has no balloon and is stitched down on the outside.

In the end, he was glad that we went ahead with this surgery, as the leakage would likely have been a long uphill climb to recovery and her j-tube is fit custom for her.

She will most likely need rest for 7-10 days to recover in the hospital. We’re so thankful to have answers and grateful for the love, thoughts and prayers on our behalf.

February 10, 2020

Evelyn doesn’t seem to making any progress forward toward healing, so Dr Mercer decided it is time to get more answers for what is going on inside her abdomen. He plans to open up her abdomen, cut out adhesions and scar tissue and wash it out while also assessing the bowel. Depending on what he finds will determine how long the surgery will be. So, we are currently waiting in pre-op, so surgery will be sometime this morning.

Please remember us in your prayers.

February 8, 2020

Evelyn’s night was still painful, and her drain yet again slowed and doesn’t seem to be relieving as it should. A CT scan they did during the procedure yesterday showed that the space in her abdomen looks pretty much the same as it did before, so we are not making any headway with healing. Doctors rounded this morning and wanted to watch for another 24 hours before considering opening up her abdomen and cleaning it out and looking for/repairing any bowel perforations. Please continue to remember us in prayer. God has taken such good care of us and we are so grateful for the physical helping hands who have and plan to come be with us during this time.

Post Procedure

IR was able to replace the drain tube with a larger tube and double check the balloon in the j-tube that it isn’t blocking her intestine. It looks good and her abdominal discomfort has lessened. We are relieved that she is doing much better than this morning and grateful she has some of her spunk back. We are also so grateful for the continued love and prayers on our behalf!

February 7, 2020

Evelyn’s stomach distention has rebounded this morning with little drainage from the tube, so they plan to put her out again in the procedure room to use intervention radiology to reposition and/or replace the drain tube. Her fluid Ins and Outs went out of balance overnight, so they are concerned they havent been reaching the full pocket of fluid that may be leaking into her abdomen. We’re unsure the extent of what they’ll be able to do, but hoping they can find the best outlet for the fluid and relieve the pressure. Thankfully, she was up and able to walk around a bit. From an infection standpoint, it looks like her labs are making progress in the right direction.

We’ll send an update later this afternoon/evening once her procedure is over and we have feedback from the doctor. Thanks for the love and prayers.

February 6, 2020

Evelyn is feeling a bit more relieved pressure-wise, for which we are grateful. The tube continues to drain. Her two insertion sites (j-tube and drain) are most of her complaints now, but the pain is managed well. The culture of the fluid sent last night came back with bacteria and yeast, so they will be adding in an antifungal med along with the antibiotic. They are pretty confident the fluid is gut content, so she most likely has a perforation somewhere along her intestine. Because she ran a fever and her blood counts look suspect, they are wondering if she might have been on the brink of a systemic infection, so they are leaning towards treating her with medicine for a full two weeks. Her line will also be cultured to make sure it remains uncontaminated. Time will tell if we ever find an answer to why and when this happened, but we’re hoping her gut can heal on its own, with best case scenario being that she has the drain removed in a couple weeks. Doctor says to expect to stay inpatient at least until Monday to get a feel for how serious the perforation is.

Thank you to all for the continued love, prayers and words of encouragement. This little hiccup has reminded us yet again how little strength we really have of our own. May God continue to guide and be our strength and stay.

Drain Is Placed

The drain has successfully been placed under CT scan. They were able to remove some air and some fluid that they have sent for culture. They plan to leave the drain in for at least a few days. They also adjusted the water level in the j-tube balloon to be sure it is secure. She is more comfortable now and we’re hoping for a restful night.

February 5, 2020

Evelyn was directly admitted to the hospital this morning. Since the procedure on Monday she has battled with pain and has has not bounced back as expected. She ran a low grade fever last night and is retaining fluids throughout her body. Most of her pain has been due to pressure and distention that seems to only worsen. The doctors expected her to have some discomfort around the j-tube insertion site, but ongoing pain had them concerned.

This afternoon, she had a CT scan done that showed pockets of what looks like air in her abdominal cavity, this has them concerned. Doctors are wondering about a perforation somewhere in her bowel, but can’t be sure until a drain is placed and we narrow down where it’s coming from. It is such a relief to know why she is hurting so bad and we are praying God’s will be done, that she can find relief from the pain soon.

They plan to do a procedure this evening to place a drain into the cavity and to check the J tube that was placed. She is also starting antibiotics to try to keep ahead of infection. The doctor is hoping that if there is a perforation that her bowel can heal on its own. Time will tell.

Please remember us here, that God will give strength for each moment and decision ahead.

February 3, 2020

Evelyn went in this morning to get her j-tube placed and all went well. She now has an 18 cm tube inserted through the abdominal wall just below her g-tube. We hope to start slowly feeding formula through it in the next few days. We’re optimistic that this plan paired with the Gattex will take pressure off of the upper part of her bowel and in time she can wean off TPN again. Time will tell if there is an improvement.

Thank you for the continued love and prayers.

January 15, 2020

It’s been a few months since we updated, we’ve been waiting to see how things progress on Evee’s new medicine (Gattex). Her latest bout of poor motility seems to have advanced to the next level, requiring us to retrace our TPN tracks and restart them daily. Right before Christmas she was able to reduce fluids down to only 1-2 days per week! We were so close to being off TPN, yet not close enough. Soon, it took a lot more to recover for her, no longer could we simply have her drink a hydration drink, but she started emptying her stomach by venting her g-tube more and more often and required more IV hydration. She began to fluctuate weight-wise and her appetite and energy levels began to wane. We’ve now made it the 5 months on Gattex without a complete improvement of her bowels and Dr Mercer has indicated that she must have a motility issue we have yet to find a cause/pattern for and that for whatever reason, her guts seem to like to randomly “go sideways.” Our goal is to minimize the number of bouts if we can and find the happy medium where she is content during the good & bad days.

So, to check up on the function of her gut, we took images of Evee’s bowels with contrast through the g-tube last week and watched it make its way to her ostomy bag. Her bowels were very active and moved the contrast through in a decent amount of time, but curiously enough her stomach refilled with the contrast again after it had already emptied. The radiologist made note that some of her food from the evening before was still sitting in her stomach and that she does have slight dilation of the upper part of her bowel, but not near the amount before her last surgery. So, she wondered if her motility is messy enough that it keeps pushing her stool back into her stomach, the wrong way.

Dr Mercer was happy with the size of her bowel; however, with the symptoms she’s been having as well as the stomach-refill issue, he reaffirmed that there ultimately must be something wrong with her motility at times. One idea that we left clinic with today was to perhaps place a j-tube passed the site where she had previous dilation and see if feeding her this way will bypass any area that could be a potential motility problem. This will ultimately tell us if this area is the sole spot of our concerns or if her guts will be what they’re going to be. We hope to put Evelyn on the schedule for a j-tube placement sometime in early February, that way we all have time to think about it before this next step and cancel if something else is revealed. The procedure would be fairly simple, since during her last surgery he was able to place a few clips on her bowel and attach it to the abdominal wall so that it could be a guide if we ever wished to insert a tube. We hope to see him again in clinic in a couple weeks to make a final decision. We also plan to use IV Zofran for her occasional nausea to see if this helps her avoid emptying her g-tube, that way we can avoid dehydration if possible.

Meanwhile her foot that was bothering her seemed to get better, but then got worse again. We are thinking that it is a musculoskeletal issue because she is favoring her foot due to a plantar’s wart that is growing quickly. We’ve been treating this as well, but she has missed some school due to the pain. Thankfully, in the last few days, it has started to feel better again.

Traveling long distances is still difficult for Evee; even just 6 hours in the van during our Christmas travels seemed to have caused decreased motility. Her motility seems to be better when she is more active or laying down. We are taking the precautions with her guts being upside-down that she may be more susceptible to line infections, and it is more imperative to limit her distance from the hospital. Keeping a balance between spending time with friends and family to keep us going and her health is a continual challenge. We certainly cannot be so sure of anything, but this we do know: God is guiding and we are so fortunate to have the continued love and prayers of our dear friends and family.

Please continue to remember us weak ones here, that God will continue to be the giver of all that we need in the days ahead.

Update 11/11/19

With several months behind us since starting her new medicine, it has yet been difficult to get a full grasp on how much it will help Evelyn in the long-run. After only one dose of Gattex, she definitely showed signs of less dehydration and a lot more energy. Over the first few weeks, her stool output decreased while her appetite went up and her need for IV fluids lessened. We were very optimistic as we were able to taper her TPN relatively quickly; she went from needing 1700 mLs daily to only 600mLs in 3 weeks! Since then she has tapered further to 400 mLs daily, and has transitioned slowly over the last month to cutting out two nights a week. With this has come the pressure for her to get the calories in that she needs, as she doesn’t seem to require as much fluid-intake, which has been a relief for her. We used to think that if we could just get her fluid needs taken care of, she could enjoy eating and do fine.

But, every day has not been perfect, as she seems to continue to have her gut-upsetting days. With her slowed motility, there are days that her stomach doesn’t empty as well. Her TPN taper has stalled because she has the occasional need to vent her g-tube of extra fluid buildup that just didn’t want to digest that day. This slows her eating as well, so her weight has come down in the last few weeks. She went from having the occasional bad day to every few days having set-backs, and this last week she is back to only the occasional bad day again (maybe 1-2 a week). Because Evee isn’t the typical “short-gut” patient that they give Gattex to (her small bowel is actually a decent length) we are still experimenting and learning what this new drug can do for patients like her, and given the initial progress she made, it is obvious she is benefiting somewhat. Dr Mercer told us that as the Gattex is changing her bowels, her body has to adjust to the new square-footage that brings this feeling of “fullness” with it. It is hard to say at this point if it is Evelyn’s underlying motility issue trying to shine through or just the adjusting. They like to give the patient a full 5 months on the drug, as this seems to be the amount of time it takes to max out the benefits of the drug. So, we try to be patient and wait for her body to make the changes, if it will.

On the plus side, she hasn’t needed any hydration fluid at all since we started the medicine; this is great, since during a gut-episode she usually will need supplemented, sometimes daily. We are hopeful that even if the Gattex hasn’t “cured” any underlying issue, it has at least helped her recover much quicker and if a bigger “storm” is to come in the future, we can perhaps lessen the need for IV fluid.

Throughout her life we have tried unsuccessfully to manage the ups and downs with no idea what her intestines have needed to succeed; they’ve usually recovered on their own to a mediocre state that enabled us to “get by” until the next storm, whether it was a line infection or gut-motility flare. We cannot forget that only 9 months ago after her recovery from surgery, she was totally line-free and thriving wonderfully, without the need for Gattex. So, it seems we may not have a full picture of what her guts need and the medicine may be the bridge to be less dependent on IVs, for now, but doesn’t seem to be the cure-all. Time will tell. Meanwhile, in the last week she has an ankle that is giving her grief, this time the left foot, and we are praying that it is a simple muscle problem and not a brewing storm. May God continue to guide and give strength. Please remember us in prayer, that we could be given strength to not weary in this journey and accept with patience the ups and downs as they come. Thank you for all.

New Medicine!

It has been a couple of months since we’ve updated. Last post we were optimistic that Evelyn’s guts were moving in the right direction and that perhaps we would make progress on g-tube feedings and be back in the position to cut out TPN again. Unfortunately, she experienced a lot of stopping and starting with her feedings and with the beautiful, busy-ness of summer, we felt that to allow her to coast for a few months would give her guts more time to sort themselves out. Mid-summer she started to eat more by mouth, tolerating most everything she put in while still avoiding hard-to-digest foods, yet she still required TPN. She was maintaining a mediocre balance of nutrition and hydration; not great, but not awful. Our family was thankfully healthy throughout the last few months, so this was a break for us for sure.

Dr Mercer recommended starting a new medication called Gattex that was just recently approved for children by the FDA. In short, it is a synthetic hormone that healthy bowels produce to expand the absorbing abilities of the gut. Many folks with short or unhealthy bowels do not have or make enough of this hormone. The hope is over a few weeks time we should see a decrease in the amount of fluid loss from her intestine as well as an improvement in the nutrition absorption. We are hopeful that this will be the bridge Evee needs to cut out most if not all of her TPN while her guts are stable. We’re hoping her fluctuations will be less drastic when she gets ill as well. We will have to watch out for any signs of overgrowth that may cause obstruction.

So, we received approval from insurance relatively quickly and today was her first dose! We will see what time brings and hope that this helps her feel better over the long-run. May God’s will be done. Continue to remember us in prayer that God will continue to guide and keep us all in His care.

Update 6/20/19

We’re so happy to share that Evelyn’s anti-fungal treatment seems to have set her intestines onto a better course for now and she has had no horrible days of dumping since she was discharged from the hospital. She has continued on an oral regimen of anti-fungals to help keep her flora in check and hopefully assist her immune system to fight yeast on a daily basis. With stool outputs down and her appetite returning, experimentation with food has started…with success! She can eat a decent amount at a time, not only tastes, and she is excited to finally have the luxuries of eating without causing her stomach to be upset for days. We’re hoping to start g-tube feeds soon, and with this, to ween off of TPN as she tolerates.

Continue to remember our family in prayer, as we travel forward with God’s strength and grace.

Recovering 5/28/19

Ev is doing better than yesterday. She still had some low blood pressures that improved with a fluid bolus and no need for medication. They want her to stay in ICU for one more day to watch her pressures. Her blood counts are low but doctors say this is a normal side effect of the anti fungal medication she is on. She was able to get up and go for a walk this morning. The plan is to get a new central line later in the week if the peripheral lines last that long.

Thank you for the continued prayers.

5/27/19

Evelyn’s blood pressures overnight were rocky, dipping low at times, to a point that doctors decided she needed to start a blood pressure med to help bring it up. Her blood pressures seemed to respond to the medication. As the morning progressed, they weened her off of the blood pressure med. Her line was taken out at bedside with sedatives early this afternoon. They hope to make it a day or two before placing a new central line unless maintaining peripheral IV access becomes a problem. God’s will be done.

Thank you all for the prayers.

Back In 5/26/19

Evelyn was admitted into the hospital in Delaware with septic shock this evening. She started with a low grade fever as soon as we arrived in Maryland on a trip to see family last night. As the day progressed her fever worsened, so she was brought in to AI Dupont Children’s Hospital. Due to low blood pressures she was sent to the ICU. Thankfully, her pressures have improved some since getting admitted. Preliminary results show yeast is growing in her blood stream. She is feeling relatively well considering what’s going on.

Remember to pray God’s will be done with our little Ev.

Home!

Evelyn was discharged from the hospital last night (5/16), and although she has some recovering yet to do, she is feeling much better! We are thankful this hospital stay was relatively minor compared to other times and that she was able to keep her line. It’s a good reminder for us that we don’t know what is ahead and need to leave all in God’s hands while trying our best to do what we have been asked.

Thank you for the continued prayers and love. We are such fortunate people!

Update 5/15/19

Ev is feeling much better. Doctors were able to pinpoint the bacteria that grew; it seems to be a relatively easy one to clear from her line, so we are remaining hopeful that the line can be salvaged and not pulled. Her blood counts were still low today, so she will stay inpatient until we see them rise again. Her blood pressure has stabilized again as well. She is full of energy this evening and it is so good to see our Ev back!

Thank you all for your love, prayers, and words of encouragement. We are so grateful for them! Continue to remember us.

May 13, 2019 Update

It has been quite awhile since we have updated on Miss Ev, mostly because there hasn’t been much to report, other than the slow progress uphill from her illness in February & March. It took her many, many weeks to get to a point where she could begin tube feedings into her stomach, and once this was started, it was still very slow advancement. It took us about a month to get 1/3 of her total needs comfortably settled into her gut routine, but then recently she got sick again with a significant cold virus that had her back to square-one again. So, for now, she continues to get full TPN and will not have formula through the g-tube until we see good signs that she is maintaining her electrolytes well. It doesn’t seem surprising that Ev’s old ways are still with us & we have fallen into an accepting routine that is familiar. We even took a trip to the East Coast in April for a quick weekend trip and it thankfully went very well!

Unfortunately, Ev took a turn for the worst. She started feeling icky early yesterday morning and ran a fever throughout the day yesterday, despite ibuprofen & Tylenol. She was admitted to the hospital and today, blood cultures are positive for a bacteria; it is yet too soon to tell which specific bacteria it is and if it will clear the central line with antibiotics. We will attempt to treat her line with antibiotics for now.

Remember us here, that God will continue to guide and give strength.