The first real snow

Minnesota moms, did you feel my pain this morning? Did you wake before the kids, look out your window to find the carpet white and PANIC like I did?

Tonight! The snow was supposed to start TONIGHT! I scrambled to find the boots. "Where is the big box of boots? I know I took it out of storage weeks ago!"

 While Dean was looking for that box, I was looking for the snow pants. Oh my word, the snow pants! I found bright pink pair of 4t's to shove Audrey's size 6 legs into. I found a pair of black 4t's for Amos (thankfully they're perfect for him!) Asher, who is a size 7, got shoved into Audrey's 5t's from last year. They were black, so they work. Well, except for the very feminine snowflake design that runs up the leg.

When Dean found the box of boots I discovered there has been a lot of growth in the house this year. Everyone was put into boots a size or two too small, except for Abel who couldn't even get his foot into them. Hmm Maybe because his feet grew four shoe sizes this year.

After my pre-op exam I made a quick run to the winter clothing section at the local retail place then dropped off appropriately sized snowpants and boots at the kids' school. Guess what! There were a lot of other moms there, doing exactly what I was doing!

When the morning was finally over I was reminded of this scene in "A Christmas Story".

Discharge today!

Angela was admitted to the hospital two weeks ago today, and today she's coming home! Axel and Asher in particular are excited to have her back, and just in time for Thanksgiving! We certainly have a lot to be thankful for this year.

I wish I could say coming home is going to be easy. It will be anything but! Angela has had an insult to her brain due to the high ammonia and glutamine levels. In addition, all her meds were stopped about two weeks ago. The nurses have been struggling with managing her. At this point we really don't know what is "Angela", what is "Brain injury" and what is "I've been in the hospital for two weeks and everyone gives me whatever I want all the time to avoid having a confrontation with me." She is also tired and taking a couple naps per day. I wonder how long that will last?

As for formula, she is now on a combination of two formulas. One gives her amino acids, and the other is free of non-essential amino acids, and has additional nutrients to compensate for the medication she'll be on, along with protein. Everything requires very careful measuring and mixing. Before she got sick we were (per doctor recommendation) allowing her to eat one thing per day by mouth. Usually a pudding cup, apple sauce or other foods she is less likely to aspirate. We will still be able to do that, but need to be very careful that whatever she has includes no protein or we have to compensate with the protein included in her formula.

We're anxious for the long weekend and having Angela home. We have to move bedrooms around again so Angela is closer to us. This whole event started for us on October 6th and we're ready to re-establish our routine! 

Hepathic Encephalopthy; when the liver hurts the brain

The when the urea cycle- which is the process of breaking down protein in the body and removing the waste products into the kidneys - isn't working right, the chemicals glutamate and ammonia build in the brain, which can cause Hepatic Encephalopathy, or HE.

Since Angela's gtube was started on her formula on October 8th, her brain has been swimming in a toxic bath. She displays nearly all of the symptoms of HE. I've marked them in red.

mild confusion
short attention span
forgetfulness
mood swings
personality changes
inappropriate behavior
difficultly doing basic math
change in sleep patterns
decrease in fine motor skills
"musty" or "sweet" smelling breath
slurred speech
marked confusion
severe anxiety or fearfulness
disorientation regarding time and place
extreme sleepiness
slowed or sluggish movement
shaking of hands and arms
speech that is difficult to understand

We don't know if we will get our girl back or how long that will take. The doctors say it can be weeks or months. She has a nearly non-existent frustration tolerance, which makes her aggressive and prone to lashing out in the form of throwing things or hitting. She cries because she is confused by what is happening and she doesn't like how she feels. As her body recovers she has very little energy. She can have one "big" activity in the morning (going to the teen room, doing an art project with a volunteer, 20 minutes of music therapy) before she starts to shut down. The dark mood takes over and she really can't function well. It takes a lot of convincing that she needs a "rest time". Finally the nurses or I will shut everything down, turning off lights and removing attention from volunteers and favorite nurses. After pouting for a few minutes she will curl herself up and sleep.

We just want our smiley, bubbly girl back.

Back in a room

Monday was spent doing lots of labs and watching Angela's ammonia levels fluctuate, but she was waking up a little more every hour. Unfortunately waking up didn't mean being her happy self. Unfortunately the glutamine (neuron protector in the brain) was too high, causing her to have a migraine. Like a person with a brain injury, Angela was extremely irritable, irrational, didn't/wouldn't/couldn't talk to anyone. Didn't want to be touched. Didn't want the tv on. Didn't want her glasses on. Didn't want to get out of her bed. Didn't want to touch anything. Didn't want anything.

We have seen this mood before. Years before. It is when she would have sudden, unprovoked aggression. Our neurologist said she was either having simple partial seizures or migraines, and the treatment was the same: Topiramate (a seizure drug that also treats migraines) When she was treated with the drug the aggression improved about 90%, having breakthrough episodes about every 4 weeks. (ahem!) When this mood returned this week, Angela's ammonia level was hovering around 80. This would cause her glutamine level in her brain to rise, causing the migraine and this very dark mood. Now we know when we see this mood, Angela's ammonia levels are on the rise and we need to get her into the hospital to have them checked. For now, it can take several weeks for her glutamine levels to come down and her mood to improve.

Let me go back a bit and explain the Urea cycle, at least in my limited understanding. Maybe this graphic will help? Or confuse you more?

Here is a brochure for patients and families to better understand Urea cycle disorders. Somehow I need a different type of graph because I still don't really get it. Stuff goes into the liver, stuff comes out of the liver. Somewhere in there the body creates the waste product ammonia, and breaks it down with agrinine. Originally it was thought that Angela had OTC Deficiency, which is a deficiency of Orinithine (its in green in the graphic above.) For her to be deficient in that, she would have to be deficient in Arginine. 

Back on Saturday Angela's blood was sent down to Mayo for genetic testing. On Weds her tests came back to show that her arginine levels were actually high. If she had OTC her arginine level would have been low. This means she is more likely to have HHH syndrome (hyperorinthinemia - Hyperammonemia - Hypocitrullinurea)  which is caused by a mutation in the gene SLC25A15, or a condition called LPI (Lisinuric Protein Intolerance) New bloodwork was taken on Weds and has been sent for molecular testing. This will take 2-3 months to come back. In the meantime, we need to get Angela healthy again.

On Weds we started the slow process of finding Angela's protein threshold - the limit of protein she can have before getting into another crisis situation. The fact we found her in a coma - twice - scares me to death. That is the last step in the urea process before a person dies. We don't ever want her getting to that point in the process again.

Angela is now off TPN and on a continuous formula drip. This is a very specialized formula, created just for her, that she will be on the rest of her life, along with daily medications. It is a very fine dance between amino acids and protein to keep her urea cycle functioning properly.

Understanding the whole Urea process has been overwhelming to me. I need to make a model of it in order to understand all the steps. We're talking steps that take place at the molecular level. Mostly I'm just glad we didn't lose Angela last week. I'm thankful for doctors who didn't give up looking for a cause for the comas. Those same doctors have come to visit Angela every day, even when they don't have a medical reason to. This is the first time this hospital  has treated this type of disorder because it is extremely rare. (which is why only 6 doses of the rescue drug were available in the entire 5 state region!) Angela is a bit of an enigma there. This doesn't surprise you, right?

Playing catch up

Now that I have borrowed a computer from the hospital's family resource center (thank you Geek Squad!) that I can keep in the room during our stay, I can also update the blog. Typing on the phone is so not fun. Its probably not fun for you to read through the typos either!

So...back to last week...

On Saturday we were finally given the possible diagnosis of OTC Deficiency. This is an x-linked Urea process disorder. Of course it is very rare, but of Urea Processing disorders it is the momst common. Angela's body is missing the enzyme needed to process ammonia in the body. Isn't it crazy that our bodies produce ammonia? I knew that, but..yeah...didn't really need to know that.

It was urgent that Angela receive a rescue drug called Ammunol, which is in class of drugs called "scavenger" drugs. It does just as it sounds, runs around the blood stream eating up the protein based molecules and converting them to products that can be excreted through the urine. The problem is there were only 6 doses of the drug in the 5 state region, and of course not where we are, St. Paul Children's Hospital. The drug was flown up from Mayo.

Because this hospital has never administered this drug before, all the staff was in a tizzy. A bit excited, really. Oh boy! We get a new drug for the first time! I wasn't really feeling it, since this drug has some potentially very harmful side effects, is caustic, and CANNOT mix with anything else!

Angela got a PICC line put in, then was moved to the PICU. The drug arrived around 1:00 am. All the nurses in the PICU, along with the doctors, went over the protocol given by Mayo on how to administer the drug, the signs and side effects to watch for, etc. Everyone was hyper-focused and I just stayed out of the way. Finally the Ammunol was started at 2:00 am, and would run for 24 hours. She had 5 other drips running at the same time: lipids, D10, electrolytes, arginine and I forget what else!

Over the course of the next 24 hours her blood glucose levels taken every 30-60 minutes. If she moved over 150 she was started on an insulin drip until she came back down. In addition, her ammonia levels were checked hourly to make sure it was trending down. For the first 12 hours Angela mostly just slept. Then she started complaining of her PICC line and arm hurting her. A couple hours of that and it was full-out crying that her arm hurt. Poor baby. I couldn't do anything to make the hurting stop at all. She was just miserable. It was the longest 24 hours.

Finally at 2:00 a.m. Monday morning the dose was complete. She complained about her arm a bit more. But the worst was that her Ammonia levels jumped right back to where they had started. The doctors thought she was needing to go back on the Ammunol for another 24 hours! Then the metabolic geneticist got back to them and said no. What has happened is she has gone into a catabolic state. Meaning her body was creating its own protien by attacking her own muscle, then converting it to ammonia again. So she was started on TPN (nutrition that goes right into the veins) so her body didn't feel starved and could stop attacking itself.

Finally on Tuesday, when her ammonia levels were consistently sitting at 80, we moved her back up to a regular room.  While she was out of imminent danger at that point, there was still a lot to do.

Update from ICU

Posting from my phone so please excuse the million typos.

I cannot begin to tell you how confusing the last 48 hrs have been. Let me recap:

10/06/15 walked into the hospital for surgery her normal chipper self. Had gtube placed. Normal grogginess after surgery.

10/08/15 had first gtube feed with Nestlé Complete.

10/09/15 med supply company delivers our preferred formula (Liquid Hope - amazing stuff!). Nurses prepare discharge papers. Angela is very quiet. We go home.

10/12 she goes back to school but is still not herself. Quiet and tired. She doesn't make it a full day.

10/12-10/31 Angela gets more tired every day. Her blood pressure plummets multiple times. Ambulances are called to school. In general she is not right but nothing we can put our finger on.

10/31 she is very tired and has tremors but really wants to go trick or treating with the little kids. We only do a few houses because I can see she is fading. She is not answering questions and I would call her mental state  a "stupor". We go home, get her last feed for the night as she sleeps on the couch. She is very difficult to wake up to move to her bed.

3 am I wake up and check on her. I find her on the basement floor unconscious and unresponsive. Ambulance is called. On the way she becomes combative, but still unresponsive. She is admitted to ICU in a coma. I am asked about 20 times if she could have gotten into anything or if someone could have put something in her gtube. Over the next 48 hours she gradually wakes up and is more awake than she has been in a month. She is chatty and chipper, although she has these odd tremors.

11/03 she comes home mostly herself again. She starts back to school but cannot make it a full day. She is moving from lethargic to sleepy.

Through all this there were countless conversations with doctors. But she is just sleepy. Not much to do. I decide there is a connection with the formula. Too many calories? Not enough calories? Too much water? Not enough water? She sleeps most of every day.

11/05 we normally give her 4 feeds per day. Our schedule was thrown off and she only gets 3. In the morning she is easier to wake up but very irritable. She is awake all day for the first time in several days. In the evening she goes to a disabilities dance for a couple of hours but does not make it the whole time.

11/06 I email her doctor. As long as we can wake her and her blood pressure is ok we can keep her home. I wake her every hour and give her feeds while she sleeps. Get her to the bathroom every 4 hours.

11/07 repeat of the day before.

11/08 call the doctor first thing in the morning. We agree if she is still sleeping on tues to bring her into clinic. I wake her several times during the night to make sure shes ok.

11/09 wake her up for dr appt. She has been sleeping for 14 straight hours without really moving. I am able to get her out of bed and to the bathroom but with a lot of support. She is not talking or answering questions. I get her to sit down at the table. Her eyes are only 1/2 open when she slumps her head to the table. Dean calls 911. She is able to walk to ambulance with 2 person support but her eyes are closed. After about 2 minutes in the ambulance she is unresponsive.

In the ER they do all the same bloodwork and tests. This is named coma #2. There is nothing they can find. They again ask Dean and I who has access to her gtube besides us. Since she hasnt been in school there is nobody. We make it clear we will not bring her home again until we know whats going on

11/10 observation and tests. She is getting perky.

11/12 she is the life of the party. More questions, along with a list of drugs that would not show up on a toxicology of blood or urine. Do we have any of those in the house? Do Dean or I have prescriptions for any of them? We are asked again and again.

11/13 we start the feeds back up. I insist she is fed the same formula she gets at home so her reaction can be observed. I refuse to do the feeds myself or to do anything with her cares. I won't even go near the beds during feeds. This needs to be all them.

Evening of 11/13 I bring Axel up to the hospital. Angela's hands and arms are trembling. She has feed #2 while we are there.

11/14 she has her morning feed. Dean goes to visit at the hospital. She seems "fine" but I call and insist she get out of bed and walk around. Oh, surprise she can barely stand without support because her legs are too shaky. Dr is seeing the pattern with feeds. 11:00 am she calls me. I told her with the next feed Angela will start to get drowsy. They stop her feeds, contact metabolic specialist who orders an ammonia level. Normal is under 15-45 Angela is at 221. Suddenly there is urgency.

Genetic testing is ordered to test for the x-linked enzyme OTC Deficiency. It is a rare and deadly disorder. She cannot process protein. This amazing formula has given her more protein than she's had in her entire life.

A special rescue drug - Ammunol - is ordered. There are only 6 doses in the entire 5 state region. Coat is $100,000 per dose. One is flown up from Mayo clinic. 11:00pm Angela has a picc line out in. The nurses are all in a tizzy because this hospital has never administered this drug! 12:00 am she is moved to the PICU. This drug requires her blood sugar be tested every 30-60 minutes. Insulin is kept on hand. She needs lipids, dextrose, fluids..everything all at once.

The drug arrives. It should be encased on gold the way everyone is acting
 The nurses and doctors meet outside Angela's room. They go over all the side effects to watch for, when to declare emergency response, blood glucose every 30 minutes, ammonia level every hour, insulin as needed for high sugar levels, watch for burning of tissue because drug is caustic, patient will complain of burning throughout duration because it burns inside. It is a 24 hour continuous drip. 48 finger sticks, 24 ammonia draws, 1.5 liters of fluids per hour. Watch for coma. The drug was started at 2:00am Sunday morning.

We found the zebra, she wears a pink tutu!

Some of you have known Angela for years in the DS community. Others are more recent additions to our circle, either via the adoption community or connections through friends.  For you lad timers, you remember the days when Angela kept everyone guessing, either due to erratic behavior or unusual medical symptoms. Yesterday we received a diagnosis that now makes sense of all the oddities of previous years.

Partial Ornithine transcarbamylase deficiency

I'm going to post a link to information for you to read at your leisure. Wrap your brain around it a bit. Pick your jaw up off the floor, then come pack and I'll explain how this all came about. I'm sure you'll notice as you read that many features associated with Down syndrome masked the symptoms of POTCD.

http://path.upmc.edu/cases/case335/dx.html 

zebras in parks

Nobody seems to know what makes a teenager sleep for days on end, getting deeper and deeper until she is not responsive. Sleep through an ambulance ride. Sleep through getting an IV placed. Sleep through hetting a catheter placed. Sleep through the eight different doctors in the room, poking and prodding.  The first thing asked is always the most obvious- could she have gotten into anything? Were meds dosed correctly? Blood test after blood test rules out all those things. Everything is normal. Carbon monoxide poisoning at home? New carbon monoxide detectors rule out poisoning from invisible gas. The sleep lab gets involved to look for obscure things like sleep disorders. More bloodwork to investigate further. Search for the zebras in central park,right? It has to be a reaction to something based on the timing of when she starts to wake up. Tonight we stopped everything. No food. No meds. IV fluids only. Tomorrow we will start over. One change at a time. Find the reaction. Sounds so simple. 

If you could

Angela is in the hospital again. Praying we get this figured out. 

Random stuff

Playing catch up here a bit. You know, since I was awol from blogger! So here are some random pics and videos from the last few...ah...months.

We're working hard with Audrey and Amos on table manners. We have a long way to go, but we're getting there. My main goal with Audrey right now is to keep her hands out of her food. She's coming along! (for those who know where Amos was when he came to us a few months ago, he has bypassed Audrey in this area. His hands are out of his food AND his face is significantly cleaner. YAY Amos!) 

Abel has a new favorite job! 

This morning at 8:30 am. he turned 

on the vacuum ....again.

Axel loves to organize various areas of the house.

Everyone needs a teenager like Axel! He also loves

to clean the kitchen, fold towels, feed the dogs 

and take out the garbage. For real! 

Axel comforting Angela shortly after being discharged

after she had her feeding tube put in. He felt so bad for her. 

About 1/2 our house is still in storage and I refuse to 

move it all back in since we're going to put

our house back on the market in the spring. 

However, I finally bit the bullet and pulled 

out all the winter gear. Asher was excited to find his favorite hat. 

We did actually make it to a pumpkin patch! 

It was an unseasonably hot day, which isn't so great

for Angela. We were only there about 30 minutes 

before she faded and we had to leave. We did get pumpkins though!

This picture is from the top of the observation tower, 

which is about 25 feet high. Can you guess

which of the kids weren't happy to be up there? 

Hint: They're hanging on tight! 

Evidence that Audrey got into the kitchen. 

This is why we're working hard on feeding skills. (and not stealing food, as this

was contraband chocolate!) She's still cute as can be!

Back in August, walking the trails near our house. 

We bought this cheap pool late in the season and it never did warm up. 

The three older boys didn't care. They still lived in the ice cold water!

Axel and Angela get to stay up later than everyone else

on the weekends. One night Axel went to bed and hollered up 

the stairs. "Mom. Dad. Abel no!" In other words, Abel 

did something. We walked in to find Abel's pillow had

"somehow" exploded all over the room. Hmmm

Could it be because of the bite marks in the corner seam?

What you can't see in the picture is that Axel's bed is

covered too. It took a long time to clean up those feathers!

August 6th Angela started her first day of 

her Transition Training program. She was SO excited! 

Asher has started taking selfies!

The last couple of years winter has been tough for me. I normally

spend all my time outside in the summer months, soaking up

the sun's warmth and re-energizing myself. The year I needed the sun the most I 

found out I had cancer. How I craved the sun even more! Only when summer 

finally rolled around chemo happened, which means staying out if the sun and heat. 

When winter rolled aroundagain it dragged on forever and ever and ever. 

Surgery after surgery, infections, hospitalizations and just B.L.A.H!!! 

With the growth of our family and a few other needs, 

Dean and I decided it was time for a fresh start 

in a new house. Since showings require we vacate the house, we 

spent the summer in the van with 6 kids, 2 dogs 

and sometimes the cat! We did almost nothing fun because we always 

had pets with us. And when we didn't have showings we didn't feel like

leaving the house. I feel like it was the summer that never was. 

This last picture, taken in July, is a reminder

for myself that summer will come again. The summer of 2016? 

WE WILL ENJOY IT JUST BECAUSE IT IS! 

Fall Clean Up

Its a beautiful weekend here in Minnesota. Well, in our part anyway. I hear my parents are getting snow way up north. I personally dread winter so that white nastiness can keep its distance as far as I'm concerned!

We spent a lot of time in the van this past summer, killing time while strangers walked through our house. I cleaned out the van whenever I could, but it has really needed a thorough cleaning. I got new tires on my van today and was a bit embarrassed that someone was doing to actually see inside! Ugh! Abel and Axel love a job so I put them to work.

Asher gave it a try too. 

But he mostly just wanted to climb trees. This boy, he is 

all about climbing and being up high as he can possibly get! 

Can you find some of the other kids in the background?
Audrey and Amos are on the trampoline and Abel is on the swing. 

What do we do with our rotting jack o'lanterns? The deer LOVE them so

we put them at the tree line for a snack as they pass through the yard. 

Axel decided to rake the back patio. As you can see, the little

kids were a huge help said.nobody.ever. 

Amos was the most help of all. LOL

A funny story: 

I wear orthotics on my feet and it can be difficult to find 

shoes that fit right with them. About a month ago I 

wrecked one of my tennis shoes. I was in a hurry to

get out the door and saw this pair of shoes. I thought

they were Deans. They're about 1/2 size too

big for me, which is what I need for a good fit 

with the orthotics. They are the most comfortable 

shoes I've owned since getting them. Only I was mistaken!

They are Axel's old shoes that he has outgrown. 

Yes, "little" Axel's feet are now about 2 sizes bigger than mine. 

Even more shocking? Abel's feet are even bigger! 

Axel is now wearing a size 8 mens, and Abel is wearing 8 1/2. 

(Yes, Angela is missing from the pictures. She came out to help with the van cleaning up, climbed into the back seat and promptly fell asleep. She went back in the house after a few minutes. I wish I could get her to sit outside with us. She just avoids outdoors lately. We're working on it. ;-) 

She's HOME!

As I type this, Angela is sleeping peacefully on the couch next to me. She wasn't super thrilled about coming home. You know, at the hospital she has complete reign of the TV, and the nurses love coming in to visit with because she's so adorable. Yeah, I am immune to the cute. Totally over it. ;-)

 Admittedly, they don't often have patients on the PICU who are quite so active and chatty, so I guess Angela was a welcome change. Errr maybe not! She was awake all last night, finally falling asleep around 6:00 a.m. She slept for two hours and was wide awake until 8:30 tonight when she finally crashed. When I arrived at 11:00 am the PICU doctor said it was a "rough night" because Angela was quite wound up. Hmm maybe because she had essentially slept for the last month, and then there was that deep coma-sleep for her first 24 hours in the hospital. She was feeling the best she had in ages! Why would she want to sleep? LOL

The ultimate conclusion is Angela's gtube has changed the way she's absorbing meds, probably because we're dissolving them before putting them through the tube. Slow release meds are being absorbed immediately. Since they got to see first-hand what Angela is like when she's NOT sleeping, the doctors didn't like the idea of her being completely off one of her meds so wanted to start it back up, but at a half dose. I reminded them she's been off all but her seizure meds since Saturday, but they still wanted her back on the one medication. 

I'm just thrilled that our chipper Angela is back. Of course, she is anxious to be back at her transition program but they're on a break through next week. It might be a looooong week keeping her busy! 

ICU Update 3

Well, this will be my last update from the Intensive Care Unit! Angela was actually moved to the medical/surgical floor around dinner time, but they don't have a bed available so she is still in ICU, but her level of care has been significantly reduced!

Angela is fully awake! She has been awake and talking, talking, talking  all day long. She has been more awake today than she has been since October 6th.

This morning we were told her EEG showed slightly decreased activity on the right side so they ordered an MRI+MRA. Those tests showed no change from her last scans done in 2007. The doctors had a pow-wow in her room, and the conclusion is she just cannot be on all her meds anymore. Her medication blood levels were within normal ranges but for whatever reason that seems to high for her. This is most likely due to her "sustained release" medications no longer being slow to release when they are crushed and put directly into her stomach via gtube. As I mentioned in a previous post, the neurologist said he has seen this a couple of times over the years, but the ICU staff had never seen it. Nobody has any ideas other than the medications. When asked about the left-sided weakness this morning I was reminded that she has had hemiparesis since she was an infant. Normally the only time its noticeable is when she's swimming. She isn't able to kick her left leg very well, and her left arm doesn't have full range of motion. But this event left her very weak, making that left-sided weakness more apparent.

I am home to help Dean tonight. Now that Angela is awake and mostly herself (she's not walking without help yet) she and I were both comfortable with me going home. She will likely be discharged tomorrow.

Thank you so much everyone for your prayers and support. They mean a lot to us as we navigate this very scary event.

Now, I shall go change out of the pajamas I've been wearing since Saturday evening! 

Update 2

Dr just came in and said neuro says her EEG shows slower activity on the right side of brain. This is the side at risk of stroke so she'll have an MRI done to check for a small stroke that couldnt be seen on CT when she was admitted. It could also be she had seizure on that side. We'll see what the tests show. 

ICU morning update

Last night Angela had several moments of being able to answer simple questions. Things like "Do you want a blanket?" Or saying hi back to someone. All with her eyes closed.

About midnight I went to a parent sleeping room. I prayed for a miracle overnight. That I would come back to find my girl awake. The nurse told me that at about 6:00 this morning she very clearly said, (eyes still closed) "Its Monday. I need to brush my teeth. The bus is coming." The nursing staff frequently tells her that she is in the hospital, that mom is here, what day it is, etc to help her reorient every time she wakes up. The nurse went to get her a tooth brush and when she came back Angela was out again.

Meanwhile at home Dean is managing with the other kids. He truly is the most amazing dad. The kids woke him up early this morning (gotta love daylight savings time!) So he had everyone up, dressed and breakfast done by 6:45. All that was left was to brush teeth and comb hair, then wait for those beloved buses to come!

Praying we continue to see her wake up. And that she is able to start opening her eyes. She's in there somewhere, trying hard to get to the surface.

2014 was.the year of cancer and Audrey. What label should we give to 2015?

Intensive care

*note this post was written on my phone over the course of 8 hours. Lots of typose and time lapses I'm sure.
....................

I'm sitting in the intensive care unit with Angela who is unresponsive. I'm a bit stunned we have come to this point.

I recently said to someone that Angela has not been right since the day of her surgery on October 6th. She was her usual bubbly self as she walked herself into the OR. But something happened that day, and it now seems as if its more serious than any of us were aware.

She has been so off. So lethargic. Struggling to stay awake more than a couple of hours. Falling asleep everywhere and generally jusy struggling to stay awake. Ambulances have been called to school when they couldn't get a blood pressure on her, and just yesterday the blod pressure monitor I ordered arrived. I was able to get accurate readings on everyone in the house, but no reading at all on Angela.  Just a week ago I told someone I feel like she's slipping away from us. Like we're somehow losing her. Like she was swimming underwater and couldn't get to the surface.

We went trick or treating. Angela participated but still in her fog with a few moments here or there when we saw flashes of the girl we know so well. We even let her have a few bites of Ashers birthday cake (mostly frosting that would disolve) but she was too sleepy to enjoy even that.

She had her evening food and about 10:00 I moved her to her bed. But she was sooooo out of it. I told Dean if she was still like this in the morning I was taking her into the ER. Remember, she went trick or treating with us just a few hours before.

At 3:00 am I rolled over in bed and heard very clearly in my ear, "go check on her." I sleep very soundly from my own cancer related drugs. I rolled over and thought I will. In just a few.minutes I will. But again, louder, "No, check on her NOW."

I  went downstairs to her room.her mattress has been on the floor because we packed up all the beds thinking our house was sold. She was on the other side of the room, face in the carpet, arms and legs all contorted the wrong way. I couldn't wake her up! I ran to get Dean to call 911. She was completely unresponsive, breathing but with a horrible croupy sounding cough (later I would be told the cough was because her airway was too relaxed.)

The paramedics came and still no response. It took a bit but they finally loaded her into the ambulance. She became VERY combative but could not follow directions. I followed behind in my van. About 1 mile from home they turned on lights and sirens and took off. Another mile and they pulled over. I was trying not to freak out but my sister was on the phone with me. Finally one of the crew came back to tell me they were trying to get an airway on her and to stay in my car. Then another ambulance came, and that crew ran from thier rig to the ine Angela was in. It seemed like there were 20 people in there! Finally they came back again, saying they weren't going to do an airway. That they were going with lights and sirens with both crews and to just meet them at the hospital.

She was so very combative at the hospital. Thrashing and rolling but unresponsive to anything but deep pain stimuli. Nobody could figure out what was wrong. All i could think of was omg this is the big stroke we were warned about years ago, when she got her make a wish. She had a CT that thankfully ruled that out.

She was moved to ICU. A million labs were drawn including her medication levels, looking for infections, organ functuon. Really anything they could think of. Finally in the afternoon the neurologist came in he said they were all grasping at straws be he felt this was all neurologocal and not organ related. One thing he has seen, only a very few times, is kids who were switched to gtube, and went from oral meds to gtubed meds. Oral meds you dont get 100% of the dose in your blood stream, plus what goes to the stoach is disolved and subsequently absorbed at different rates. But when you switch to gtube you disolve the meds first so 100% of the dose goes to the blood stream. Angela has always been hypersensitive to meds, so it could be for the last month we have inadvertently been over dosing her on the meds! That would make sense that my saying she has been off since she woke up from surgery because she got her meds right on schedule that night, but disolved in the gtube!

She has been hooked up to the EEG all day to rule out seizure activity. It has shown that she has been in the equivalent of a drug induced coma and is just sleeping. The deepest sleep ever. Unresponsive. At about 6:30 tonight she 1/2 opened her eyes. Over the course of an hour she was able to wiggle her toes on command, but not open her eyes. She could not squeeze my hand but shook her head no when asked if she wanted a blanket. I put the ohone to her ear so she could hear Dean talking to her and she managed to mumble "I got a IV Dad." And was back to sleeping.

The doctors here are stumped. The neurologist said he has seen this once or twice before in his years of practice. It is highly unusual, but if you know Angela, that is her norm, to not follow the rules. The nurses keep saying "this is so odd. This is how you give meds to a gtubed person!"

So that is where we are now. She is in/out of consciousness, with "conscious" being a very altered state. We hope to see her continuing to wake up iver the next 24 hours, then can evaluate what if any damage has been done