Toddling!

Two-year-old with hemiplegia walks!

It is official. We have a toddler! But she is scared. :( Lily Pad can absolutely walk on her own. She does not need her little push walker dinosaur anymore. Our physical therapist has told us we need to hide it so she won't rely on it. Apparently, the push walker has trained Lily's muscles to lean over and falsely rely on it for confidence. So, we start building her confidence by holding on to the back of her shirt as she walks which is working out nicely. She totally thinks we are holding on to her, but she is walking under her own strength and coordination - something we thought we would never see! And it is so very adorable watching her toddle around. We are so excited to finally be entering this new era of parenthood. However, we are not looking forward to the bumps and bruises that come with having a two year old.

And speaking of two-year-olds, Lily has one more week of being one. But don't let her cuteness fool you. When she is not acting like a two-year-old she is acting like a teenager. Such an attitude! If she does not get her way, she complains and gives us her "mad face" which is just her bottom lip poked out. So cute! Not intimidating AT ALL! But she will do it on command.

And when we ask her how old she is, she immediately says, "Two!!!!" I am so thrilled to see more and more of her personality. Our family is so BLESSED to have a sweet and sometimes sassy baby girl!

Drink and Donate

Drink Tabs can be recycled to fund Ronald McDonald House Charities

While Lily was hospitalized shortly after birth, my husband and I stayed a the Ronald McDonald house until she was able to come home with us. Certainly I would have much rather preferred recovering from  the C-section at my home, but the Ronald McDonald house of Durham, North Carolina was a wonderful alternative. Bo and I were so blessed to have a place to stay that was incredibly cheap, close to the hospital, and assisted with meals. As a way to try and give back to the Ronald McDonald House of Durham, we collect drink tabs for recycling. The recycling money goes directly to support Ronald McDonald Charities. The following video was made for the students at Richlands High School in North Carolina to encourage them to also donate drink tabs. The video is being played on the school's weekly student-produced news program. Enjoy and donate to Ronald McDonald House Charities!

Get Reactive and Proactive!

FREE AFOs for Infant Stroke Survivor!

We have good news! Lily will get a new set of leg braces for FREE! How? Because I got reactive and angry and sent a complaint letter to the owner of the company. The brace and limb company that failed to give Lily the prescribed AFOs responded almost immediately to my letter of complaint. I mailed the letter last Monday and they were calling our physical therapist and us by Tuesday. The owner was extremely apologetic for the lack of attention given to our daughter and her needs. The owner wanted to make the situation right and scheduled Lily to be refitted the very next day! Her father took her to the appointment and Lily was casted and measured thoroughly. She will get a new set of articulating braces with derotation straps. Unfortunately we have to wait for another three weeks for them to be delivered, but it will be worth it. Lily will finally get what she needs.

There are a couple of lessons I learned through this experience with the help of a dear friend who also has a child with special needs. When my friend read my last blog post, she became concerned and gave me a call. Her call was exactly what the Lord knew I needed. It can be lonely being the parent of a child with special needs. Finding someone within your own community who is dealing with similar issues is rare, but fortunately God has placed someone in my life who “gets it”.

We discussed the quality of care my daughter receives through a free government program as well as the difference between such programs and privately contracted services. Currently Lily receives physical therapy through a government early-intervention service provided within our county of residence. Because of government regulations, the physical therapist is only allowed to work with Lily a certain number of hours within a week. And Lily does not qualify for occupation therapy under this agency’s regulations because of her age. In addition, I learned through my conversation with my friend that at the age of three, the early-intervention program is “done” with Lily. She will then transition to the school setting and will attend pre-school through the same agency. However, she will only get physical therapy if Lily qualifies for speech therapy. As I have already discussed in previous posts, Lily certainly has no trouble with verbal communication, so I doubt she will qualify. So what happens to Lily after the age of three? This will be our family’s responsibility.

My friend advised me to get Lily an evaluation by a private therapy provider. The private provider will give Lily the physical therapy and occupational therapy she NEEDS and not what she qualifies for under strict government regulations. It is also important that our family begin a long-term relationship with these therapists as it is likely she will need their help for years to come. While the government services are free, which is a plus, they are extremely limited and only temporary. Lily needs something consistent, proactive, complete, and enduring.

Our family is preparing for the additional cost of private therapy as it will be a financial commitment. We do have medical insurance, but there will be co-pays of around $60. While that might not sound like a lot to some, it is an additional monthly medical expense. However, we are certain our money will be well invested.

I am extremely grateful for my friend who is guiding me through this process of being a parent to a child with special needs. I am always surprised at how much I do not know about the ins and outs of therapy, insurance, and referrals. Everything is complicated, but I do know that Lily has no greater advocate and fan than her mother!

It Ain't Right!

The prescribed AFOs were not given and these ain't right!

It has been a loooong time since my last blog post and I greatly apologize. From the last time I posted up until about a week ago we have waited for Lily’s AFOs. And she has not walked, has had no desire to walk, until about a week ago. J But the minute we put the AFOs on her, she stood up and attempted walking. What a change in her we have seen! She seems to be getting the hang of this walking thing, but our experience with the brace and limb company have tested my patience and Christian attitude.

I am MAD because my AFOs just ain't right!

My husband and I recently used a local brace and limb company for Lily’s AFOs. The company came highly recommended by our physical therapist. She not only specifically requested we use a specific orthotist, but also prepared us for a custom fitting appointment in which our daughter would have to be casted and measured for her lower leg braces.

When we arrived at the office, the orthotist welcomed us and began to measure Lily’s foot. As he measured, we talked about the prescription physical therapist had sent over. I became concerned because he did not mention the “hinged AFO” phrase or the de-rotation straps my husband and I had discussed with the physical therapist. I immediately tried to call our PT to get clarification. While I waited for the physical therapist to call me back, I was bothered that the orthotist did not make a cast of Lily’s legs and feet nor did he measure her leg length as the PT had said. In fact, the whole office visit took about 5 minutes. The orthotist gave us little details about how the AFOs would look or function.  I wondered how he could give our daughter Lily custom fit and function AFOs with only a foot measurement. However, I did not question him as I considered him the professional. In the meantime, the PT called the orthotist directly and discussed with him that Lily’s braces were to have hinges, be custom fit for her, and include de-rotation adaptation.

Three weeks after Lily’s fitting, her AFOs were finally ready. When I reviewed them, they did not have hinges, de-rotation strap capabilities, and were not custom fit for her. The AFOs were much too long for her feet, missing a top Velcro strap, and ill-fitting around her ankles. My husband was told by the orthotist that the strap was left off so that the unhinged AFO would allow for a motion similar to what the hinged version would have provided. Upset, I called our PT and requested she review the AFOs the next day.

Upon assessment, the PT and myself felt that the orthotist had done a very poor job of meeting the needs of our daughter Lily. Instead of what was written on the prescription and discussed with the PT, Lily received “stock” AFOs that could have been ordered online by my husband and I. While I am certain the orthotist is a consummate professional, he failed to give our family the time and effort because of the age of our child, our inexperience, and the underestimated intelligence of our physical therapist to know the difference between custom-fit AFOs and “stock” AFOs.

Unfortunately, we are forced to use the AFOs because our insurance will not pay for another set of AFOs so soon after the delivery of the current ones. Overall, our experience with this orthotist and company has been unsatisfactory. This is disappointing as I am certain Lily will continue to need AFOs and we will eventually have to get the current ones replaced with ones that follow the therapists orders and prescription.

This situation is upsetting mostly because I feel like we had the wool pulled over our eyes. And the AFOs we have received are ok for the job, but they lack the capabilities the prescribed ones could have provided. Because our insurance won’t pay for a replacement so soon and because of how expensive they are, Lily will have to use these for now and she seems to be adapting well. Unfortunately we cannot fix her in-toeing problem right now because her AFOs do not have the de-rotation strap capability. Instead, we will have to use a special tape used by athletes and have to wait until the weather cools down a great deal as the tape is sticky and painful in the late summer heat.

Who would have thought that a company whose purpose is to help the disabled would take advantage of such a tiny patient needing their help? Today’s lesson parents: If your gut says it ain’t right, IT AIN’T RIGHT!

A New Hope: Hinged AFOs

I know it has been awhile since our last post, but it is summer time and we have been on vacation! Myself and my kids Lorelei, Lucas, and Lily went to Birmingham, Alabama to visit family. We had a wonderful time celebrating my mother’s birthday and my sister’s birthday on July 4^th and 5^th. The kids took a trip to Desoto Caverns, Zimora Park swimming pool, The Summit shopping center, and Vulcan State Park with their grandparents. We all came back tired, suntanned, supplied for school, and filled with the love of family!

After two weeks off, Lily had lots of physical therapy to make up. So we have been doing two to three therapy sessions a week since the second week of July.  The PT has been working on her heal-toe technique with the left foot and stretching her interior leg muscles to improve her hip turn-out. The muscles on the top her legs are not strong or coordinated enough to lift her toes. As a result, she drags her left foot and toes. To compensate for this weakness, she lifts her legs at the hips by rotating them inward. This improper rotation and lifting is hindering her ability to walk correctly.

Butterfly kisses from Daddy.

After three months of working on these issues and providing opportunities for her to walk and stand, we have seen no improvement in her strength and coordination. Lily has plateaued in her motor skills development before, but never for such an extended period of time. So, this week the PT and I decided it was time for Lily to get hinged leg braces and hip derotation straps.  I am so ready for Lily to walk, and ideally I would like to see her do this on her own without any assistive devices, but I am willing to do what it takes to get her walking.

While she seems to have stopped improving in motor skills, her language skills continue to spring forward. I know I have said this several times before, but she really does repeat everything we say! Her newest words are cracker, cup, brother, sister, banana, and all gone.  And she even does hand motions with her words and pretends to brush her teeth, rock a baby doll, and answer a telephone. Lily has completely caught up with her age group in areas of cognition and language development. What a wonderful blessing!!

As I was telling friends and family about Lily Pad’s upcoming braces and straps, I had an individual say to me, “So does this mean you are giving up on Lily being able to walk?” Absolutely not!!! The braces and straps are designed to build Lily’s walking muscles, not as replacements for the skill.  This person’s question shows me that change and situation is all about perspective. If you perceive something as negative, it will be. But I see Lily’s new devices as an opportunity to give her the confidence to take her first steps. God is providing us with the resources to help Lily and he is blessing me with a positive outlook and a new hope.

The Eye: Gateway to the Brain

Last week I took Lily Pad to the eye doctor to check on a persistent problem she has had since birth. As a result of the strokes, Lily’s eyes lack muscle control. Both eyes turn in and out periodically when she is tired or when she is looking at objects from the point of view of an odd angle. In addition, her eyes turn in and out when they focus for an extended period of time however the problem is more prevalent on her left hemiplegia side. To correct the problem, the doctor prescribed a patch for the right eye in order to strengthen the muscles on the left. But patching the eye of an infant is not easy or extremely successful.

Lily learned very quickly how to remove the patch. So, we switched to adhesive patches, but these eventually caused irritation to the skin around the eye. Finally, we found the perfect combination! By patching her eye during mealtimes, we were able to redirect her focus on eating rather than the annoyance of wearing the patch. Using this technique we were able to fit in the hours of needed patch time.

And Lily’s eyes have made huge improvements due mostly to her physical therapy. As the physical therapist focuses on the left side, Lily’s eyes slowly begin to improve. The more strength and coordination she gains on the left side, the more strength and coordination she gains with the left eye. I was not expecting these results, but this does make quite a bit of sense. As she uses her hemiplegia side, she slowly builds hand/eye coordination, which in turn benefits the eye muscles.

Lily’s eye doctor has been seeing her every three months since her birth to monitor the progress or regression of the eye muscles. The eyes, I have learned, are the gateway to the brain. If there is a problem within the brain, the first area to be affected will be the eye. Also, the doctor is able to see if there has been any damage to the optic nerve because of pressure or bleeding. Lily’s optometrist has not observed any damage, which is excellent news! It indicates that the shunt is working properly and that the strokes have not decreased the size and function of the optic nerve.

The eye doctor is so impressed by Lily’s eye function that we are now released from patches and three-month optometrist’s visits. We are now on the every six-month plan!!! Yay! Not only does this reduce our doctor’s visits, but it also shows how far sweetest Lily Pad has come and the bounty of God's blessing in her life.

Walking Up that Hill: A Baby with Hemiplegia and Hydrocephalus after In-utero Stroke Tackles Walking

20 Months Old June 19, 2012

Today, Lily turns 20 months old! And she is doing so many wonderful things! She can say many new words such as "that's daddy," "all gone," "good girl," and "cup." She truly is a miracle and her ability to finally communicate with us and tell us what she wants is refreshing. We continue to work with her on her language development and especially her fine and gross motor skills. Walking is still a challenge, but she is oh so close...

I can stand with my push walker!

Instead of fighting us when we encourage her to walk, Lily is now taking off on her own! She grabs her dinosaur-shaped push walker and does laps around the kitchen and living room. She is able to pull herself to a standing position and take off. And some of the issues she was having before now seem to be resolving themselves. For example, Lily's left foot, which is on her hemiplegia side, turned in quite a bit when we began walking exercises. The Physical Therapist was quite concerned and the Developmental Therapist recommended a brace for the left foot. The PT did not want to add a brace because the brace limits the ankle's ability to flex and extend. And since our goal was to get her walking, the PT said the brace may cause more problems by limiting her range of motion in the that foot and ankle. But as Lily continues to use the push walker, her left foot has slowly turned straight. It no longer turns in when she walks. I did bring this to the attention of the PT and they said that often times the foot will turn in on the hemiplegia side in an effort to compensate for the weakness. Now, as her left side becomes stronger, she will not over compensate by turning her foot inward.

Nothing can stop me now!

How wonderfully amazing is the brain of child! When no pathway exists, the brain creates new ones, repairs damage, and changes to overcome obstacles.  Sometimes I am reminded of how much work we still have to do.

Doing laps in the house.

Another concern we have is Lily's size. She is incredibly small for her age. At her 18 month check-up, she only weighed 20 pounds. Her weight is not even registering on the standard growth chart; it is below it, off of the growth curves. In fact, Lily had lost weight since her 15 month appointment! As well, her height is only on the 10th percentile curve. Her head size is stable at the 20th percentile curve. These numbers were quite concerning for our pediatrician and he asked if she ate well. Lily Pad eats everything in sight! She loves to eat so this is not her problem. I did talk to other parents of children with stroke, hydrocephalus, and hemiplegia who all confirmed that their children were tiny as well. One  parent reminded me that, unlike a normal child's brain, our children's brains have suffered a good bit of damage where tissue was destroyed, blood flow compromised, and CSF restricted. Not only will these present developmental and cognitive delays, but also delays regarding glands in the brain. The pituitary gland, located in the brain, is responsible for growth and therefore may not function as well because of damage.

Also, it takes Lily and other hemiplegic children twice the effort to do normal motor functions as it would take a child with no muscular or sensory problems. Lily will burn twice the calories reaching for a toy, pulling to a standing position, cruising the furniture, walking while holding hands, and crawling on the floor. It will also take her twice as long to accomplish these tasks which in turn burns more calories. It is no wonder she eats often and a lot. She burns the calories as quickly as she can consume them.

I am a happy baby!

One afternoon I was watching Lily play. She was playing with her baby swing, pulling up on it and trying to connect the buckles in the seat. She lifted her left foot and put it on the ground while the right knee reminded on the ground. Lily tried to push up with her left foot and knee to a standing position. Sweetest little Lily Pad tried so hard to push up with her left side and could not do it. She struggled with it for a few minutes before finally giving up and switched to her right foot. It very much hurt my heart to see her struggle and to see how weak that side is. We still have lots of work to do, but Lily is trying to use her hemiplegia side and that is a huge improvement!