Guillain-Barré Syndrome {part 2}

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January 30, 2013

Left you all a couple weeks ago with some of the most grueling parts of our family situation. I am currently back home in Huntington for a couple days, catching up on chores, taking care of myself (MOPS, The Wild Ramp, River and Rail, Studio 8, bike ride, friends, food, sleep) and my other three children. Brent is with Avery in Columbus. You can read the first part of our crisis here, and continue on with the saga below.

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Avery, our six year old, was admitted to Nationwide Children’s Hospital February 5 near midnight. He was met by a team of doctors, nurses and therapists and sent to the neurology unit. Without having my journal in front of me at this time, I estimate he spent another five days with intense pain, extremely high blood pressure and other very misaligned autonomic systems. The pain team was able to do their best, but cautious to using heavy narcotics which could cause respiratory suppression.

In order to confirm/deny the diagnosis of GBS, the doctors ordered an MRI of Avery’s spine. A couple days later, there was a nerve conduction study/EMG. Both tests confirmed inflammation of the nerves and disruptions in the nerve communication. The EMG also helped identify this as a second isolated case of GBS, not a flair up from the first case. This case presented very differently from his 2010 episode. In 2010 his motor neurons were heavily effected, in 2013 it was his sensory nerves, which led to the frightening pain.

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EMG
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Taking his own vitals.
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Controlling pain and sensations through cold compresses and massage.

Given all this data, the progression of the illness and the introduction of Bell’s Palsy on the left side of his face…and a slew of other symptoms, we accepted the GBS diagnosis and added to it the Miller-Fisher Variant. Following the week and half period of pain, which included two additional treatments of IVIG (first was at our home hospital), he was assessed for rehabilitation. He was slowly taken off many IV drugs, transitioning to oral, and monitored for stability with respiratory function. When we had gotten clearance from our insurance company (a story in itself), we were moved from neurology to the inpatient rehab unit at Children’s on February 14.

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Nationwide Children’s. Avery room is the left side, third from the upper floor.

A couple days prior to the rehab move, Brent went home to Huntington with my sister and two of our other three children who came up to Columbus for several days. The hospital has a very strict, protective visitation policy during influenza season. The 2012-2013 winter was especially difficult for the flu, so children under 14 are not permitted on patient floors, and we can only have four visitors to his unit the entire duration of his stay. Those spots were taken by a couple in laws, my sister and a dear family friend (at Avery’s request), leaving my own parents, and other family unable to visit. This of course made it exceptionally difficult to have our children with us in Columbus, unlike the 2010 GBS case, where we felt we could be together more often during Avery’s hospitalization, despite having a new born.

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We understand the restrictions, and if it wasn’t for the grace of Avery not being under any type of contact restriction, it would have been even more challenging. On the Sunday before they left town, Avery had been fitted for a wheel chair and granted 30 minutes to visit with everyone on the lobby level. This was his first transition out of bed, into an upright position. He was unable to do any of the moving himself, but once upright, with proper harnesses and belts, was able to remain so for short periods of time. His duration of chair time has gotten long with time.

Such a bitter sweet moment in our journey. Avery was finally able to be with us all, and they all had to leave. Thirty brief, precious minutes.

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Insisting on waiting on the washer to finish in the family resource (Blue Jackets) room.

With Brent, my sister Shannon, and the three children in Huntington, and Avery and I transitioning to rehab in Columbus, there was a lot of texting, phone calls, email researching, and a little FaceTime. It was during all this time that people were filling countless needs on our CareCalendar (Id: 139535 Code: 4009). We simply could not function without the work of dozens of friends and community members. I am continuously surprised and impressed (when I really shouldn’t have been, b/c everyone is always so selfless and amazing).

Brent and I switched places the weekend of February 16th. It’s a 150 mile drive each way, without any interstates until you reach each city. The parking has been covered by the social worker, due to our long term stay, and free when we utilize the Ronald McDonald House across the street. We have three family/friends in the Columbus area who have come to our rescue with groceries, special clothing and activity/book requests for Avery, and some child care. This has made being with Avery, and caring for him around the clock, a manageable task. Our other needs, outside of the need for being together as a family, and desiring Avery to be healed, have all been met with love and efficiency. Thank you.

When I returned to the hospital February 18th at 8am, Brent immediately left for work. He managed to fit in a week of classes, then the family returned to Columbus together, utilizing the RMH once again. Brent, Shannon and the children returned home on Sunday night, February 24, then this weekend Brent and I made a swap once again. I leave for Columbus in a couple hours, Brent comes back to Huntington Monday morning. And back and forth we go.

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“Boots” for flexing his feet to 90degrees. Worn while sleeping.

During Avery’s stay in rehab he has developed new symptoms. He had something called a convergence insufficiency with his eyes. He became incontinent. The sensations in his limbs went from pain to feelings of intense tearful itching or sharp grains of sand between his toes. There was the feeling of things in his eyes, the sudden onset of cold sores. He lost the ability to move his ankles and toes completely. Many of these things would disappear, and some of them would reappear. Some remain gone. His vitals slowly became normal. With medication they have been able to bring his blood pressure down (to slightly above normal). He is taking three doses of neurontin everyday and a dose of elavil before bed.

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The view that Avery narrated to me.

The facial paralysis spread to both sides and has recently subsided. This affected his respiratory tests and his ability to swallow. The first barium swallow test showed aspiration on thin liquids so he was placed on a nectar thickened diet. A second test on Friday showed aspiration on nectar thicks and he was elevated to honey thickeners. This morning he was given a chest x-ray for wheezing that may have been caused by aspiration, but it was clear.

We are often, as you can imagine, asked how is Avery doing. Everyday has been so different from the one before it that it was difficult to say if he was better, worse or the same. We just told people he was different. We were also cautious to say he was better when in a couple hours he might not be. Since I have been home this weekend, Brent reports he is getting better. He is making progress in his therapies, as you will see in the following videos. His ability to write and control his hand was improving, his endurance is increasing, his attitude is brightening, he is sleeping for longer periods at night. Some of his symptoms are worse, like the swallowing, the return of incontinence, and no changes in strength. I don’t wish to downplay his progress or over represent it either. The information sharing is a delicate thing.

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Tilt table to help with weigh baring.
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Family time in the Blue Jackets room.
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Using the knee stabilizers.

Check out these clips from this most current weekend. He was fitted for special ankle to calf braces on Friday, so he could stop using the knee stabilizers he was utilizing for the previous week. The clips show the very first “steps” and other firsts I wasn’t able to be present for. These are tremendous improvements and I do wish I had video of all he couldn’t do prior to this for comparison.

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A frozen yogurt treat before I left this most recent time, in the “magic forest,” lobby level.
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