Sam has aspiration pneumonia again and worse than it's been for several years. I've got him on oxygen most of the time and he's taking antibiotics. The doctor said to wait 48 hours and if he didn't turn around, I'd have to admit him for IV antibiotics. The 48 hours is almost up and I think he's improved - slightly. I really want to make the right decision here. Going to the hospital might be an important step to saving his life. We don't want to increase the already extensive scarring of his lungs. There are so many parts of his lungs that no longer work.
On the other hand, we both hate going to the hospital. He can't move because of the iv in his arm and I have to sleep on a very cold, hard window seat! A smaller consideration is the fact that the State of Illinois will not pay me for the days he is in hospital because they think of it as time I don't work. Hah! This is a small consideration because they only pay me for 4 hours a day anyway!
It's Lent. You would think this would give me time to reflect and be mindful of my life. But frankly, I'm too sleepy. MY body has never really accepted Sam's habit of sleeping from 4 am to 11 am. I still like to sleep from about 10 pm to 6 am. So when he's sick I only get a couple of hours sleep. Then we both nap in the afternoon on the couch. But the rest of the day I'm giving him medicine and wandering around the house like a zombie and groggily trying to think of all the things that need doing.
Oh and watching tsunami videos.
I heard from my friends in Japan and they are okay but in shock. They are still experiencing several after shocks daily. Tsunami and nuclear explosions are the terror at the core of every Japanese soul and they are suddenly facing both at once. My heart weeps for them.
Want to do something? You can donate to people who seem to be doing a good job with the relief efforts:
American Red Cross
Salvation Army
Crash Japan
Musings From a Life Transformed by Unconditional Love
Showing posts with label cognitive disability. Show all posts
Showing posts with label cognitive disability. Show all posts
Friday, March 18, 2011
Wednesday, March 02, 2011
Sam's Condition (just the bad stuff)
I had to write this for a social worker. It was hard. So I thought I'd post it, because it felt like a challenge like this should be memorialized - or something. Either I'm just feeling sorry for myself or else I'm really proud of my ability to spell arcane medical words.
Sam Forsberg is a 29 year old boy with the mental capacity of about an 18 month old. He is about 4 1/2 feet tall and, on a good day, weighs 80 pounds. If he goes too much below 75 pounds he gets sick from being too thin. He has aphasia (which means he can't figure out how to talk) and dysphasia (difficulty swallowing). He also has a very high arched palate which may be part of his swallowing difficulties. He has bi-lateral choroidal coloboma (which means a hole in the back of both of his eyes) and strabismus and nystagmus (which means his eyes wobble up, down and sideways). The last time we took him to the eye doctor, she said he also has some astigmatism. He has a certain degree of ataxia (which means he shakes or trembles a lot especially when tired.)
All of this is because something went wrong about a month before he was born. Maybe he had a stroke. He was born with brain damage in the back part of his brain. He can't walk because he has damage to his vestibular nerve and so he has very little sense of balance. He isn't very strong, tires easily and has very low muscle tone. He also doesn't have a very good temperature regulator, so I can't take him outside if the weather is too cold or too hot. He has asthma, so I am not supposed to take him outside on "ozone action days".
He can't chew, which means everything he eats must be pureed or mashed. According to the dentist, this means his teeth are MORE likely to decay than if he actually chewed, so I have to be very careful to brush his teeth often. If he swallows something too thin, he chokes and some of it goes into his lungs. If he swallows liquids that are too thick, he chokes and stuff goes up his nose. Sometimes things that he has swallowed half way come back up into his nose and then, we think, go back down into his lungs. He has very extensive nasal polyps because of this nasal regurgitation.
All of his life he has had a lot of congestion. No one is quite sure why. He doesn't seem to have any allergies, although he does have asthma because his lungs are so chronically full. His nose is always running and he often has huge amounts of mucus clogging his nose and throat. He had almost constant ear infections as a child. The muscle that is supposed to help his ears drain is either missing or non-functional because of his high palate. We lost track of how many different ear doctors tried to put tubes in his ears. (I can think of 5 off the top of my head) The tubes never lasted long. But his ear drums have been perforated so many times that he seems to have developed permanent holes in them now, so we don't have as many ear infections. This is good because he is resistant to some of the antibiotics and allergic to others because he's been on them so often. Now we try to avoid using antibiotics as much as possible. He usually gets pneumonia about once a year and we give him antibiotics for that.
About 6 years ago he had a very bad bout of pneumonia and had to be hospitalized. At that time we met Dr. Mutlu. He has been caring for Sam's lungs ever since. He discovered that Sam also has Central Sleep Apnea which causes his Co2 levels to rise. Sam is in compensated respiratory acidosis. This means his body is working overtime to compensate for the extra Co2 in his blood. If the Co2 rises too much, he dies. So bringing down the Co2 has become a central focus of our lives the last 6 years.
We tried for about a year and a half to get him to wear the bi-pap machine, but finally gave up because I wasn't getting any sleep and started to see snakes in the corner of the room! Instead, I keep a close watch on his blood oxygen level with a pulse oximeter. I try to keep it between 87 and 95. If it gets too low, I have an oxygen condenser at home and I can give him oxygen. It never gets too high naturally, but sometimes it can get too high with the oxygen condenser. If it gets too high, the sleep apnea gets worse and his Co2 levels rise.
He has always seemed to sleep best between the hours of about 4 am and 11 am. I used to dress him in his sleep and take him to the car to get him to school or program. He was always late. I would feed him in the car when he woke up. Dr. Mutlu said this should stop. It is vital that Sam sleep whenever he can. When he sleeps deeply, he breathes deeply and this is the best way to bring Co2 levels down. So we let him sleep. He often takes a nap in the afternoon as well. This means that he has been unable to attend Esperanza very often. When we have a very good day, I bring him to visit for a few hours from about noon to when they close at 2:15.
In addition to letting him sleep and preparing all his meals carefully so he won't choke or regurgitate, there are also his breathing treatments. I give him chest PT with a chest vibrator 2 or 3 times a day. This takes 30-45 minutes each time. I also give him a nasal irrigation twice a day and nebulizer 4 times a day with medications prescribed by Dr. Mutlu.
I have three recent examples of how necessary all this is. First: in December my husband had surgery for prostate cancer. He came home with a catheter and was very weak. I spent a great deal of time taking care of him. I skimped on Sam's treatments. Sam got pneumonia. Second: whenever I fail to keep all the food and sleep and treatments in balance, Sam is up all night whimpering. Third: When we went to see Dr. Mutlu on February 22 of this year, Sam's blood gasses were stable! After 6 years of rising blood levels, and all my efforts to slow the rate of rising, we have finally stabilized him! His blood levels are still much higher than normal, but this is a great victory.
So, in summary, a brief list of his many diagnoses would include: profound mental retardation, ataxic cerebral palsy, chronic hypercapnic respiratory failure, bronchiectasis, central sleep apnea, asthma, dysphasia and aphasia. There's probably a several more, but that's all I can think of at the moment. Dr. Mutlu speculates that he has Joubert's Syndrome. His small stature is due to failure to thrive in his first year.
Sam Forsberg is a 29 year old boy with the mental capacity of about an 18 month old. He is about 4 1/2 feet tall and, on a good day, weighs 80 pounds. If he goes too much below 75 pounds he gets sick from being too thin. He has aphasia (which means he can't figure out how to talk) and dysphasia (difficulty swallowing). He also has a very high arched palate which may be part of his swallowing difficulties. He has bi-lateral choroidal coloboma (which means a hole in the back of both of his eyes) and strabismus and nystagmus (which means his eyes wobble up, down and sideways). The last time we took him to the eye doctor, she said he also has some astigmatism. He has a certain degree of ataxia (which means he shakes or trembles a lot especially when tired.)
All of this is because something went wrong about a month before he was born. Maybe he had a stroke. He was born with brain damage in the back part of his brain. He can't walk because he has damage to his vestibular nerve and so he has very little sense of balance. He isn't very strong, tires easily and has very low muscle tone. He also doesn't have a very good temperature regulator, so I can't take him outside if the weather is too cold or too hot. He has asthma, so I am not supposed to take him outside on "ozone action days".
He can't chew, which means everything he eats must be pureed or mashed. According to the dentist, this means his teeth are MORE likely to decay than if he actually chewed, so I have to be very careful to brush his teeth often. If he swallows something too thin, he chokes and some of it goes into his lungs. If he swallows liquids that are too thick, he chokes and stuff goes up his nose. Sometimes things that he has swallowed half way come back up into his nose and then, we think, go back down into his lungs. He has very extensive nasal polyps because of this nasal regurgitation.
All of his life he has had a lot of congestion. No one is quite sure why. He doesn't seem to have any allergies, although he does have asthma because his lungs are so chronically full. His nose is always running and he often has huge amounts of mucus clogging his nose and throat. He had almost constant ear infections as a child. The muscle that is supposed to help his ears drain is either missing or non-functional because of his high palate. We lost track of how many different ear doctors tried to put tubes in his ears. (I can think of 5 off the top of my head) The tubes never lasted long. But his ear drums have been perforated so many times that he seems to have developed permanent holes in them now, so we don't have as many ear infections. This is good because he is resistant to some of the antibiotics and allergic to others because he's been on them so often. Now we try to avoid using antibiotics as much as possible. He usually gets pneumonia about once a year and we give him antibiotics for that.
About 6 years ago he had a very bad bout of pneumonia and had to be hospitalized. At that time we met Dr. Mutlu. He has been caring for Sam's lungs ever since. He discovered that Sam also has Central Sleep Apnea which causes his Co2 levels to rise. Sam is in compensated respiratory acidosis. This means his body is working overtime to compensate for the extra Co2 in his blood. If the Co2 rises too much, he dies. So bringing down the Co2 has become a central focus of our lives the last 6 years.
We tried for about a year and a half to get him to wear the bi-pap machine, but finally gave up because I wasn't getting any sleep and started to see snakes in the corner of the room! Instead, I keep a close watch on his blood oxygen level with a pulse oximeter. I try to keep it between 87 and 95. If it gets too low, I have an oxygen condenser at home and I can give him oxygen. It never gets too high naturally, but sometimes it can get too high with the oxygen condenser. If it gets too high, the sleep apnea gets worse and his Co2 levels rise.
He has always seemed to sleep best between the hours of about 4 am and 11 am. I used to dress him in his sleep and take him to the car to get him to school or program. He was always late. I would feed him in the car when he woke up. Dr. Mutlu said this should stop. It is vital that Sam sleep whenever he can. When he sleeps deeply, he breathes deeply and this is the best way to bring Co2 levels down. So we let him sleep. He often takes a nap in the afternoon as well. This means that he has been unable to attend Esperanza very often. When we have a very good day, I bring him to visit for a few hours from about noon to when they close at 2:15.
In addition to letting him sleep and preparing all his meals carefully so he won't choke or regurgitate, there are also his breathing treatments. I give him chest PT with a chest vibrator 2 or 3 times a day. This takes 30-45 minutes each time. I also give him a nasal irrigation twice a day and nebulizer 4 times a day with medications prescribed by Dr. Mutlu.
I have three recent examples of how necessary all this is. First: in December my husband had surgery for prostate cancer. He came home with a catheter and was very weak. I spent a great deal of time taking care of him. I skimped on Sam's treatments. Sam got pneumonia. Second: whenever I fail to keep all the food and sleep and treatments in balance, Sam is up all night whimpering. Third: When we went to see Dr. Mutlu on February 22 of this year, Sam's blood gasses were stable! After 6 years of rising blood levels, and all my efforts to slow the rate of rising, we have finally stabilized him! His blood levels are still much higher than normal, but this is a great victory.
So, in summary, a brief list of his many diagnoses would include: profound mental retardation, ataxic cerebral palsy, chronic hypercapnic respiratory failure, bronchiectasis, central sleep apnea, asthma, dysphasia and aphasia. There's probably a several more, but that's all I can think of at the moment. Dr. Mutlu speculates that he has Joubert's Syndrome. His small stature is due to failure to thrive in his first year.
Tuesday, November 16, 2010
Parenting a Child with Cognitive Issues
I was just watching part of a movie called "A Child is Waiting". I didn't see much of it because my child was waiting for me to change the channel. But I did hear this angry parent instructing his autistic child's caregiver to "just give him everything he wants and make him happy" because he is has a cognitive level of a five year old.
I just have a few things to say about that attitude.
First of all, if your child has the cognitive level of a five year old, I envy you. You can talk to your child and get an answer.
But seriously, if your child is "stuck" at 5 years old that means that he or she is going to be 5 for a very, very long time. So you probably want to look into what are the best parenting techniques for a 5 year old. As far as I know, "giving them everything they want" is light years removed from "making them happy"! Practically no one enjoys being around an over-indulged 5 year old! An over-indulged 5 year old in the body of a 50 year old is a big problem.
5 year olds need boundaries, security and new challenges. They need to know that they can make mistakes and someone will still think they are terrific. They need to know how to obey and cooperate and help to feel important.
But really, people with cognitive disabilities are never "stuck" at any age. That's just someone's short hand method of describing a person's limitations. Who wants to be described by their limitations? Raise your hands. What? No one?
I thought not.
People continue to change throughout their lives. It's nice if there's somebody around to notice. Sam, for example, has the "cognitive level of an 18 month old" whatever that means. But he has been at that level for about 28 years. In that time there have been so many changes and delightful discoveries. He has met and loved so many people and grieved their loss. He has been depressed and elated and everything in between. He is curious about everything and loves to investigate. He is a precious valued member of whatever community he enters. And he needs me to take care of and challenge him.
I need him. I think everyone needs to be needed and Sam thrives in an environment where he knows he is needed. He is part of a family and he is part of a community and he is wise and funny and precious.
Which brings me to what the caregiver in the movie said in response. "The child does not know he is a tragedy. Maybe the tragedy is in you." Some people with cognitive disabilities are smart enough to know they are not like "other" people, but that doesn't mean they are tragedies. "Normal" is kind of a myth anyway. We are so much more than what we know. Getting an advanced degree in college and a high paying job are not guarantees of a happy life.
Tragedy is a society that has upside down values. We should celebrate the people we love and delight in discovering their unique abilities. That doesn't mean life will be easy. Most lives are not. That's something we can call "normal".
I just have a few things to say about that attitude.
First of all, if your child has the cognitive level of a five year old, I envy you. You can talk to your child and get an answer.
But seriously, if your child is "stuck" at 5 years old that means that he or she is going to be 5 for a very, very long time. So you probably want to look into what are the best parenting techniques for a 5 year old. As far as I know, "giving them everything they want" is light years removed from "making them happy"! Practically no one enjoys being around an over-indulged 5 year old! An over-indulged 5 year old in the body of a 50 year old is a big problem.
5 year olds need boundaries, security and new challenges. They need to know that they can make mistakes and someone will still think they are terrific. They need to know how to obey and cooperate and help to feel important.
But really, people with cognitive disabilities are never "stuck" at any age. That's just someone's short hand method of describing a person's limitations. Who wants to be described by their limitations? Raise your hands. What? No one?
I thought not.
People continue to change throughout their lives. It's nice if there's somebody around to notice. Sam, for example, has the "cognitive level of an 18 month old" whatever that means. But he has been at that level for about 28 years. In that time there have been so many changes and delightful discoveries. He has met and loved so many people and grieved their loss. He has been depressed and elated and everything in between. He is curious about everything and loves to investigate. He is a precious valued member of whatever community he enters. And he needs me to take care of and challenge him.
I need him. I think everyone needs to be needed and Sam thrives in an environment where he knows he is needed. He is part of a family and he is part of a community and he is wise and funny and precious.
Which brings me to what the caregiver in the movie said in response. "The child does not know he is a tragedy. Maybe the tragedy is in you." Some people with cognitive disabilities are smart enough to know they are not like "other" people, but that doesn't mean they are tragedies. "Normal" is kind of a myth anyway. We are so much more than what we know. Getting an advanced degree in college and a high paying job are not guarantees of a happy life.
Tragedy is a society that has upside down values. We should celebrate the people we love and delight in discovering their unique abilities. That doesn't mean life will be easy. Most lives are not. That's something we can call "normal".
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