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Showing posts with label GI. Show all posts
Showing posts with label GI. Show all posts

Tuesday, July 22, 2014

We Have Weight Gain!!!

I am singing from the mountaintops over here!

Ramya has officially gained weight and we are NOT headed to GI!  Yeah!! 

Today was her most recent weight check and she gained a little over 2 pounds!  The doctor came in and said (very excitedly), "What have you been giving her?!?!?!?  It worked!!!"  The answer to that is our new little concoction, given once a day in addition to her regular meals (she drinks water other than this drink during the day).  The doctor gave her pediasure, but it hurts her belly and I'm not super fond of the ingredients, so we make our own.  Here's what I put in it...

- 1/2 container of Lucerine protein refuel (She loves the taste, so this way she enjoys drinking it.  It's not organic, and not that great, but it does the trick!)....  150 calories, 2 grams of fat, 10 protein.

- 1 cup raw milk from local organically-raised grass-fed cows.... 160 calories, 8 grams of fat, 8 protein  (it also has TONS of nutrients to help build up her system)

- 4 tablespoons organic heavy whipping cream.... 200 calories, 20 grams of fat, no protein

That give her a grand total of 510 extra calories, 30 extra grams of fat, and 18 grams of protein.  The doctor was happy with this combination and the amount of calories and fat in it.  Since she doesn't eat much, this should help her reach the daily calories she should be consuming.  Hopefully this will keep her growing on her own little curve and help build her body up.  She enjoys drinking it, which is huge!

I honestly think that her last weight check was skewed and she really weighed more last time, but hey, she gained, and that's all that matters!!  She still takes between 1-2 hours every meal to eat, which can be stressful, but my focus really is on trying to get to the bottom of whatever is going on that is keeping her from liking food and enjoying eating.  I want her to be successful and enjoy eating, as I feel that will be the best for her in the long-run.  This buys us a little more time as we continue attachment therapy, and also start cranial-sacral therapy, and hopefully continue to heal.

I'm taking a big sigh of relief right now!  Come rejoice with me! 

 

Wednesday, July 2, 2014

Lots of appointment updates, one not so fun one

Last week we had a few appointments and this week we had lots more!.  The last was a dentist appointment for all three kiddos.  We switched to a holistic dentist, Dr. Butler, and loved her!  The kids really enjoyed their appointments.  Madi's teeth were great, but Conner and Ramya each have a cavity.  Conner's cavity is where a previous filling chipped and Ramya's cavity is a new one.  We also discovered Ramya has double teeth (both her adult and baby teeth in at the same time) not just on the bottom middle two teeth, but also on her tip incisor teeth.  All of the baby teeth are now wiggly, so the dentist is giving her 6 months to get them out on her own, or else she might need to pull them out so that they permanent teeth do not get damaged.  We've been wiggling like crazy and are hoping to get them out soon.  She also already has her 11 year molars, which was quite surprising.  Her mouth is so very very tiny, I'm not sure how all of these teeth fit!  When she got molars shortly after coming home, I had assumed they were her 6 year old molars, when in fact they were her 11 year.  Crazy!  We go back to have both kiddos cavities fixed and then we will also have Conner and Ramya's molars sealed at the same time. 

Dr. Butler confirmed what I have wondered for quite a while now; Conner has a lip tie.  I missed it as a baby, but he had all the signs.  He had a lot of problems with latching, he was very uncomfortable and gassy and spit up a ton, he cried a lot even though I would rock him and bounce him and wear him in a wrap, his top teeth got lots of decay even though he never drank juice, never had a bottle propped (wouldn't even take a bottle when I tried), we always brushed his teeth, etc...., and also had speech delays.  After hearing about my friends kiddos who had lip tie, I started doing some research and my gut feeling was that he had a tie.  The dentist confirmed it and tomorrow we go meet with another dentist who does a laser procedure for the lip tie.  I'm anxious to see what he says.

On Tuesday we had an appointment that was very hard on me.  I took Ramya for her 3 month weight check with Dr. Nemivant, her pediatrician.  Unfortunately, Ramya has lost weight (3 ounces) since her last appointment 3 months ago.  Dr. Nemivant says he is giving her 3 more weeks to show a gain and get back on her own little curve, or he will have to send us back to GI.  He isn't worried about her being on the charts or not being on the charts, but he is concerned that she's not only not gaining weight, but that she's actually losing weight.  He also suggest a g-tube might be the best option for her right now.  This is so not what I wanted to hear.  He thinks if we didn't have to worry about calories and she could just eat for enjoyment that it might help her re-set her feelings about eating.   We've talked about how she may not have developed fat cells as an infant, due to severe malnutrition, about how we don't know the size or weight of her birth parents, about the India growth chart, and all of that good stuff.  He agrees with me about why that would make her smaller, and he's ok with her being on the smaller side and not on the charts, he just wants her gaining on her own curve.  He is very calm and laid back and doesn't worry about much, so when he does, you know he's pretty concerned.

I'm going to be honest, this was a huge blow for me.  There is just no way for me to convey how hard I work on eating with her, and I just feel like a failure right now.  Each meal with her can easily take 45 minutes to 2 hours.  The 45 minutes I don't worry about, but when it takes her 1-2 hours to eat a small meal, it's hard.  At that point, she's burning more calories eating than she is taking in.  She really does not like eating, even though she eats food she choses, a large variety of foods and textures, foods from India, foods from the US, etc....  It doesn't matter if she picks the food, it doesn't matter what the food is, it doesn't matter if I feed her or she feeds herself, she just doesn't like eating.  She will tell me the food is good, but she still doesn't want to actually eat the food, or at least not past a few bites.  Sometimes, like tonight, she does well and she eats a good amount within about 45 minutes, but that's not usually the case.  It's especially bad if she has had to share my attention that day because I babysat, or if she feels like she's not in control.  She gets very jittery at the table and she does anything to avoid eating (itching, looking around, asking a million questions, squirming all over, not chewing and pocketing the food in her cheek, etc...) past the first few bites.  I try so hard to make her food she enjoys eating.  I give her food choices.  I sit with her and we listen to music and I talk with her.  I put so much work in to trying to make sure she eats a decent amount and that she likes what she eats.  I add fats and calories to EVERYTHING to try and help her gain weight and help make every bite she eats nice and healthy and full of good fats for her.  I literally spend HOURS a day.  It's really hard.  Oh, and I will offer her a treat after eating, and she will say "no" most of the time.  She loves icecream, but tonight after dinner, she didn't want to eat any.  And yesterday, when we made homemade cookies together, she didn't want to eat any.  This is pretty usual for her.   She also rarely wants a snack.  When I give her one, she usually just kind of picks at it or doesn't touch it at all.  On a very rare occasion she will ask for a snack I always make sure she gets one, and also offer often. 

At this point I don't know what else to do to help her.  I love her so very much, and I just really wish she enjoyed eating.  It makes me sad to think it's so hard for her and I just want to be able to fix it.  I was so stressed out yesterday I got a migraine and felt sick to my stomach, and it was just no fun.  I have a call in with an attachment therapist so we can try and deal with the emotional side of eating for her and I can get tips on how to best help her.  I am also getting her referred for a feeding therapy evaluation so that I can make sure there is nothing muscular or structural getting in the way.   I found a protein shake she will drink that has 300 calories in it, so I am having her drink one a day (spaced out so she enjoys it) in between meals for extra calories.  I'm also trying to get some raw milk in her, because that has good fats too.  Oh, and I am starting a new mineral supplement with her to try and build up her body, as I am sure she is still depleaded from the years of inadequate nutrition.  I'm doing all my normal tricks as well, like adding both grass-fed butter and nut butters to her pancakes and waffles (which are homemade so there are none of her allergens in them), in addition to the powdered sugar she loves, having her snack on nuts when she will snack, adding lots of butter to veggies and quinoa and rice and the such, having her dip her chicken in smashed avocados or a dressing she likes, etc....  Her OT suggested having her hypothalamus looked at to make sure it's functioning properly, but she wasn't sure how to go about that.  She has an appointment next month with the endocrinologist, so I plan to discuss that with her. She has an MRI she can review, and maybe that will shed some light there.  Other than that I'm praying really really hard that we can get over this set-back and back on to her own little curve.  We have an appointment set in 3 weeks, so I'm praying she can get back on track by then.  If not, I do want to try a new GI doctor, as I didn't feel the last one was a good fit for us.  If we need to go that route, hopefully the new GI doctor will have some good ideas we can try. 

We also got a new panel of food allergies run on Ramya yesterday, but with her naturopathic doctor downtown, instead of at the pediatricians office this time.  Her last test through Sonora Quest didn't test some big things, like dairy and soy, and I feel it's important to know how her body reacts to those.  This time we are using Biotec labs to get a better picture of her IgG and IgE reactions. I hope to have the results within the next few weeks. 

Today we headed back down town for our 2nd appointment downtown this week (it's actually our 3rd appointment, just the 2nd one downtown).  Madi was in desperate need of an adjustment on her wheelchair and is excited to have it fitting well again.  They were blown away at how much she has grown this past year.  She has had the chair just a little over a year, and already she has almost outgrown it!  We even ordered it big on purpose so she would have lots of room to grow!  There is still room for another adjustment or so before we will need to order a new one, so that should buy us another 6 months to a year at least.  Ramya's wheelchair (which is Madi's old wheelchair) still fits fine.  She wasn't needing any adjustments because she hasn't grown much, so it's still long enough and wide enough for her.  Eventually I hope to get her a new chair, but this one still fits her really well so there is just no need right now. 

Tomorrow we head downtown again to see the dentist about Conner's lip tie.  Please pray for wisdom and guidance for us there, and pray that if he needs it corrected, it will be quick and painless for him with a fast recover time.  Please also be praying for Ramya to gain weight and get back on her curve.  I think that's it for now!  I'll update when I know more about Conner's lip tie.   

Wednesday, March 5, 2014

Oh Me Oh My Today I Hate GI


Today I brought Ramya to her 3 month GI follow up.  When we put her on the scale, I noticed she really didn't gain any weight at all since her last appointment.  The doctor brought up her chart, and she's back to not following her curve any more.  She's been home for a year and she has gained about 4 pounds (the average for kiddos is 5-7 a year I guess) and quite few inches, but for a kiddo who now has great nutrition and consistent meals after not having them for so long, they really expected better weight gain.  I would think the fact that she is gaining, though, and not losing weight, is at least a good thing.  She turns 7 tomorrow and currently weighs 32 pounds.

The doctor started talking about g-tubes and all kinds of not so fun stuff.  Bleh.  That's something I really didn't want to hear.  We are just not going there (of course I would if it was really, really, realllly necessary, but for now, we are just not going there).  We really need to get to the bottom of it.  There are just so many factors going on with her, it's hard to know what to think or what the best approach is.  First off, you have a body that isn't used to consistent food and nutrients.  She doesn't have those automatic responses she should.  She rarely says she hungry, and doesn't love to eat.  She eats a good amount, but because that is the expectation, not because that's what she wants to do.  If it was up to her, she'd eat a few bites and be done.  She also can take a long time to eat because she doesn't love it.  There have been days I've sat with her at the table for 1 1/2 hours per meal, multiple meals a day.  Then you have the RAD stuff coming in to play.  Ramya displays pretty much all of the classic RAD symptoms, though thankfully many are not to a large degree.  You can tell when she's starting to feel out of control, and boy does she like control.  She starts getting this nervous energy and just starts spiraling.  This usually leads to trying to control food by not eating.  I can usually spend time feeding her and giving her attention and we work through it, but it's a dangerous practice.  I really try to make eating fun, give her lots of choices so I can make sure that she likes what she is eating and feels in control of her food, and try to give her appropriate choices with food.  She eats a wide variety of foods, which is great.  She also is learning how to eat and enjoy consistent meals in appropriate portion sizes, which is a big adjustment!

The hard thing that I just do not understand, though, is why she isn't gaining more weight.  Maybe she just has a high metabolism, or maybe this is just the way she is, who knows!  It's hard because I'm still trying to learn who she is in so many ways.  I do feel like she should be at least staying on her own curve.  I try everything with her.  If I make a protein shake, she gets chia seed, flax seed, and avocado in it for extra fat.  If she wants chocolate milk, I make it from full-fat coconut milk (we are dairy free, and dairy seems to bother her tummy).  I try to get her to snack on nuts.  I mash avocados for her to dip things in for extra fat.  I cook everything for her in lots of extra organic unrefined coconut oil.  I don't just give her pancakes, I put butter, peanut butter (or sunflower nut butter), and syrup on her pancakes.  Her oatmeal gets coconut oil and walnuts in it.  I feed her sausage, bacon, hot dogs (nitrate free, natural ones, but still!) often, even though I'm not a big fan of processed meats.  I put butter on peanut butter sandwiches for extra fat.  And when she eats chicken, I load her up with skin and fat, which she loves.  I just feel frustrated because I don't know what else to try.  The doctors watch her so closely, which is awesome and I'm thankful for that, but at the same time, I don't want to make problems where they may not be, nor do I want to ignore something that may be a problem.  It's hard!

Ramya has a pediatrician appointment coming up soon, and I plan to talk to the doctor about underlying things that might be slowing her weight gain.  There may be things we can test, like her growth hormone, food sensitivities/allergies, etc..., and try to find some answers that way.  I know that her thyroid functions fine and she was negative for celiac (though we eat gluten-free anyhow), but there could still be other things going on.  I also want to chat with him about feeding therapy and attachment therapy to see if he thinks those may help at all.  Other than that, if any of you have any recommendations, please let me know!!  You can always e-mail me at jamie_lugo@hotmail.com or comment here :). 

Please be praying for wisdom and discernment (I know I say that often, so you can just keep repeating that prayer for me ;)) for us as we try to see if there is even a problem, and if so, what it is. 

 

Friday, December 20, 2013

A Quick GI and Orthopedic Surgeon Update

Ramya saw Dr. Silber, her GI doctor, a few weeks back.  Though she is still not even close to being on the growth charts, she has gained a little weight and is following her own little curve.  YEAH!!!  I am not worried about her being on the charts, I was just worried about her lack of weight gain at all, and am so thankful to see she is gaining on her own little curve.  She is officially up to 32 pounds (at 6 1/2 years old)!  This is great news!  Dr. Silber is pleased with her growth and

On Thursday, Ramya saw Dr. Segal, our orthopedic surgeon.  He is very pleased with how the muscles in her core and legs are developing.  He thinks if we continue to work with her and help her get stronger, she should be walking with AFOs (instead of her KAFOs) within a years time or so. 

We are still working on getting her to use her legs for walking.  She wants to do it all with her arms, and not use her leg muscles at all.  We are also working on balance and core strength.  It is slow progress but she is really coming a lot way!  She has a very deeply ingrained fear of being dropped, which makes the walking thing a bit harder, but we take it a day at a time.  Her trust is growing and her muscles get stronger and stronger every day.  Right now I focus more on standing and sitting exercises with her, instead of walking, but I know once those care muscles are built up, the walking will come right along.  I am very proud of how far she has come! 

Here are some updated photos of my beautiful girl.  I can't believe she's almost been home a year now.  It's such a blessing to get to be her momma!




 

Wednesday, September 4, 2013

Oh Me, Oh My We Saw GI

Yesterday was our appointment at PCH's Scottsdale office to see GI.  We saw Dr. Silber because we had heard great things about him from a friend.  Our main goal was to talk about Ramya's bowels because we are still trying to see if she will need a cecostomy in the future, or if she can adequately manage them on her own.  The general surgeon, Dr. Bae, believes that she will likely need the cecostomy, and I agree. I can clean her out just fine, but she has many accidents.  Though she doesn't care right now about them, I know eventually she will.  The cecostomy would help keep her from having so many.  Before we decide on that, though, we want to exhaust our non-surgical possibilities. 

Dr. Silber asked us a lot of questions to find out as much as he cold about her history, what we've seen during her 6 months (AH... 6 months!!!) home with us, where she is at developmentally, etc...  He spent quite a bit of time with us.  I went in prepared to argue why I don't want to give Ramya miralax.  I know that miralax is the go-to for bowel issues, however, I find probiotics, George's Aloe Vera Juice, and Senna when needed, works very well.  I don't like that long-term use of miralax in children has not been adequately studied, and I do not like putting PEG in my kiddos bodies, even though it is not supposed to cross the blood/brain barrier.  Anyhow, I was told by Dr. Bae that she would likely need to try miralax, and most of what I read is that kiddos with SB take a daily dose of miralax, so I was anticipating a struggle.  Thankfully Dr. Silber was totally on board with our approach and saw no need to try and change it.  The only thing he would like to do differently, though, is to give Ramya Ducolax suppositories (well, half of a suppository) once a day to see if we can clean her out a bit more in one setting, and therefore keep her from having so many accidents. 

We talked about her weight gain, as Dr. Bae had put it in the notes he sent over, and he asked me if I wanted to put Ramya on an appetite stimulant.  I told him that Ramya had grown about 3 inches taller in the past 6 months and has also gained 2 pounds recently.  I am thinking she's just one of those kiddos that grows up, and then out, and then up, and then out.  First came the height, and now a bit of weight gain.  I told him I'd rather wait and just see how she does, and he agreed that we could do that. 

Dr. Silber noticed that Ramya's iron levels are pretty low so he'd like Ramya to take iron supplements for a few months.  He thinks because she was so deficient for so long, her body is still struggling to catch up, but that after a few months, it should be fine and stay fine.  He doesn't see it being an ongoing problem and doesn't think that she will need supplementation past a few months.

It's hard to add another doctor to our list of frequents, as Ramya now sees the pediatrician, orthopedic surgeon, neurosurgeon, endocrynology, and GI frequently, and Madi now sees the orthopedic surgeon, pediatrician, urologist, neurosurgeon, and neurologist, but I can't complain because my girls get AMAZING care and have doctors that truly care about them.  I am so very thankful for that! I can't wait until the day when they can see the doctors at the same time, and at the same place.  That will be a life-saver.  Right now Madi is on our insurance and also long-term care and can only see her doctors out of CRS.  Ramya is on our insurance, but we can't apply for long-term care for her, as we are still waiting on everything to be 'official' in Arizona so that she can be give our last name.  Until then, she sees the exact same doctors (for the ones that they both see), but at PCH.  So, for now, we can't coordinate.  The good news, though, is I can sneak in questions to the doctors about the kiddos they aren't seeing, and save myself a call in to the office. 

In other news, Madi got her new HKFOs today.  She was sooooo very excited.  I'll post about that soon, and show some pictures :).