8.27.21 More of the Same

Aimee is happy. 

That is what matters most right now. Aimee is home and happy and fairly comfortable. 

Things haven’t really changed in her health. She is still relying on her bipap most of the time. She is having more muscle spasms than typical. She is at about 70% of where we would like her to be hydration wise. Not optimal. One issue that we are having with the lower hydration level is some challenges in clearing thicker secretions. This causes more difficulty with maintaining oxygen levels and a risk for sticky mucus plugs, which can lead to pneumonia. It isn’t severe currently, but we would like this to not be her maintenance level. It is less comfortable for her and gives no buffer at all. 

Monday we had our first visit with the Palliative/Hospice Care nurse and social worker. They will be coming back again on Thursday and every week or two going forward as long as we choose to continue. I am excited about their role. They will help us to keep Aimee home and provide comfort care options while still allowing us to seek curative care. They will assess her health trends with us, get us prescription changes, help our family process, make sure we have resources, connect us directly with specialists, help us decide when interventions are in Aimee’s best interest, train us on emergency care, ect. They will help us respond to emerging problems to avoid crisis care/trips to the hospital. I don’t think we quite understand all that this service could mean for our family going forward. Right now they are trying to get to know us and Aimee. Currently they will be specifically helping us with pain management, adjusting meds, and dosing CBD oil. 

Yesterday I spoke with Aimee’s GI specialist again. We are making more changes. Apparently the Imodium medication can increase urinary retention. Last week when we communicated, the doctor was concerned that the medication was causing low urine output. She didn’t realize that we are already on a cathing schedule with Aimee. Now knowing this, she is re-increasing the Imodium over the max dose with the willingness to even double the max dose next week if we still don’t see improvement. Please let there be improvement!! 

Walking the fence, tracking her numbers each day and hoping for improvement and worries about bad days becoming a new trend… well we would be fine with this all settling down so that we could feel secure at home. :) This is where Aimee wants to be too. 



8.21.21 Home Update

Today it has been 3 months exactly since Aimee’s ileostomy surgery. The first step of this extended journey. More than 2 of those months we spent in Children’s. The weather is shifting in the opposite way it was when we started. Summer is ending and we missed it.  
 
Aimee has continued to have issues with increased output and lower urine the past several days. She has shown some other signs of mild dehydration. We communicated with her GI specialist yesterday and we have made even more adjustments. We actually decreased her Imodium dose back to our discharge level, but tripled the fiber/prebiotic. At discharge she was at the max Imodium dose for her weight, but with our continued output troubles, her specialist pushed her to 50% above that level. As we have had more thickened secretions, ect she decided to pull back and try a different approach. I am hopeful that we will see improvement over the next few days to avoid needing to go back.  

Aimee’s energy level has remained mostly where it was at discharge. She has had 3 amazing days while home with 9-11 hours awake and off of bipap. Most of her days though she has only been awake for about 6 hours. This shift actually has some significant positives with it. As we allow her to use the bipap as much as she needs or tolerates it, her reserves are built up, and those 6 awake hours are energetic and engaged. I would much prefer fewer quality hours than a large quantity of meh hours. 

I am not sure where to go from here. When we came home in June for those couple days after her spinal fusion, I made a recovery plan. That didn’t pan out. I want to make a plan again, but am also nervous that this time won’t last. How can we go forward and reset ourselves in a healthy way? We have survived. We have eaten take-out and meals from friends/family and prepared meals. We have tried to sleep, though Aimee needs more care throughout the night right now with meds, positioning, and respiratory adjustments. At some point I hope to return to healthy living… for now we still feel on edge and hesitant to try for normal. I hope as we settle into these new routines, as Aimee hopefully plateaus, that we will find our new rhythm with healthy habits soon. We are so grateful to just be together. Even exhausted together. As one never knows what is ahead, we will savor this time for now.

Ps. I hope soon to individually thank so many of you for the different ways you have been on our team. It has been truly beautiful to have your help in the different unique ways. The errands run, the meals purchased, the cleaning up, the childcare, the messages, the farm help, the funds sent, the prayers and encouragement. We don’t want to do this by ourselves. Thank you for being with us. 

8.20.21 16 Year Anniversary



16 years married to you today. 

The more I know you, the more grateful I am. 

Our love is not fancy. 
Our life rarely picture worthy. 
Our hopes are simple and few. 

Yet, we are peacefully together in daily tasks, in deep messes, in middle of the night alarms, in quiet waiting rooms, in uncertain outcomes, in someday project daydreams, in afternoon cups of coffee, in raw conversations, in moments of true delight. Through it all I am thankfully here, in it all hand in hand with you. 

Here is to many more years of making any time, any place together a date. 




























8.16.21 Output troubles

Still having trouble with ostomy output the last few days. Aimee is producing less urine and more stool than she should. I was able to communicate with her GI doctor and she asked us to increase her medication significantly, as well as, doubling the fiber doses. Hoping we see quick improvement from that. 

Aimee is having a lot of fun being home with family. Lots of smiles and laughs. It has been an overwhelming contrast to the isolation we were feeling in the hospital. We are soaking up time together. 











8.13.21 Family







We brought Aimee home in the middle of our annual family camp. When we pulled in at home, she was surrounded by family. Her cousins and siblings were chanting “Aimee! Aimee! Aimee!”. It was so overwhelming and so beautiful. 

When we put her back in her bed for the first time she immediately began looking back and forth with a great big smile on her face. So happy being home. It is wonderful to see her light up. We brought her outside to be with the family in the evening and she smiled and laughed for hours. It was like taking her from a nightmare to her dream come true. So precious and priceless she is. 

We did have the most ostomy output yesterday she has had in weeks. Please pray with us that it immediately settles so that she remains hydrated. In great news, she was awake and off of bipap for 8 hours yesterday! 

8.11.21 Home

We did it. What a ridiculous day of roadblocks, but we made it. Aimee is home.



8.10.21 Inpatient 44

Well my dear friends, Aimee has done it. 24 hours without episodes of hypothermia. Tomorrow we will have our training with homecare, get new equipment, pick up meds, and move out of the hospital that has been our home for most of the past 3 months. 

I have been intending to share this exciting news with you all evening. Yet, here it is past 11... I can’t describe my hesitation. I am numb. I should feel thrilled, but somehow I can’t feel anything. This has been a difficult journey for all of us. Many lows and too many false highs. Maybe we rode the roller coaster of emotions too many times. Maybe we have been too detached from real life to remember its joy. Maybe we are just too weary to feel. Maybe the sorrow of it all is finally settling into me. Perhaps the elation is tempered by how tenuous it feels to take her home after these recent experiences. 

Aimee will go home. She will be with her family. She will sleep in her own bed. She will be outside. She will take a shower. She will watch movies on the couch. She will listen to audiobooks with her brothers. She will dance with her sister. She will feel the sun on her skin and hear the crazy sounds of life around her. I am so grateful that she will be experiencing life again. I am so grateful for her life. 

8.9.21 Inpatient 43

Lots of good news tonight. The ultrasound showed no abscess or excessive swelling of her kidneys. Her temperature just this evening came all the way up to normal for the first time. I am hoping that she will keep it up on her own tonight. If she does, we should be able to discharge on Wednesday. 🤞 We can’t leave until that is resolved. 

We asked the team to operate under the optimistic assumption that she would keep her temp up, so they are working on updating prescriptions, orders, and getting us the last of the equipment. Hoping to finish up our training on Wednesday morning. I’ve met with GI and Pulmonary to get their orders and their sign off on discharge. 

We literally could be taking her home in 2 days. I’m honestly getting used to this life. It will be weird to be in the real world again. But, such a good weird. 


8.8.21 Inpatient 42

Aimee has needed the bear hugger heated blanket all day today to keep her temperature up. The doctor ordered a renal ultrasound this morning to check just in case there is an abscess or anything else more serious. We had the technician here earlier. I have not heard any results yet, which I take to be a good sign. It is possible that Aimee is just taking extra time to respond to the antibiotics.

I spoke with the pulmonologist today about discharge and what our new home routine for respiratory care should be. They will send us home with the tools to add Chest Percussion Therapy with a handheld wand and hypertonic saline through her bipap. We haven’t been able to get her right lung to open up more, but these tools do seem to be keeping her more clear. He is leaving it up to us when we feel safe taking her home, when we feel that she is stable enough. None of the teams are satisfied with where she is at, but I am hopeful that getting her home will improve her situation. She is having extra secretions and a higher heart rate, but pulmonology believes it is a respiratory response to her kidney infection rather than a respiratory cause. 

So, as soon as we clear up the hypothermia and infection, we will gather our new supplies, take her home, and give her the same respiratory routine that she has been on this past week here. We will re-evaluate her status in a week or so of being home with the help of Palliative Care. The Medically Complex Care team is writing up a care plan and then essentially transferring their care over to the in home Palliative/Hospice team. This, I believe, is making everyone more comfortable with her going home. In great news, the few hours that she is awake each day, she is alert and engaged. If it wasn’t for that, I would be much more concerned. 

I will update once I have the ultrasound results. For now we will continue with the IV antibiotics and monitor and hope. 

8.7.21 Inpatient 41

I came down to switch with Ed this afternoon and to bring Aimee some fresh flowers from the garden.
Aimee is doing well. Sleeping most of the time, but awake about 5 hours a day total. Still having trouble keeping her temperature up so the doctor is switching her to the IV version of the current antibiotic in the hopes that it will be more effective. If this does not work, we may need to do an ultrasound to rule out an ulcer. 

We were able to take her up to full calories this morning, so we will track her hydration over this weekend to see how she does. Working on getting her prescriptions, her orders, and her plan all updated over the next couple of days in the hope that we will be able to discharge soon. As long as Aimee doesn’t throw any more curve balls and responds well to the above, we hope even for Tuesday or Wednesday. 🤞 

A few pictures from my time at home with the fabulous four:












8.6.21 Inpatient 40

Infection cultures came back this morning and it appears that Aimee has a significant kidney infection not a bladder infection. The antibiotics have been shifted from a general first line type to a more tailored prescription and we hope to see the hypothermia stop tonight/tomorrow after the first few doses. Hopefully her heart rate will come back down as well. 

Ed has been keeping really busy between the different departments coordinating Aimee’s care. The Medically Complex Care team is working with us to write a new detailed care plan for Aimee and working with Pulmonary to get us a new respiratory plan for at home, including a some new equipment to give Chest Percussion Therapy and inline Bipap Saline/inhaler doses. Rehab is going to help us oversee the new medications for pain and muscle spasms. 

He has also been talking with Palliative care about at home services either on a semi-monthly basis or possibly even a semi-weekly basis hospice style care. At least for the next few months we are accepting their offer to come provide service in our home on a regular basis. 


Throwback photo to Ed caring for Aimee after her peg surgery 10 years ago today. 😍 Always there to defend his girls. 

8.5.21 Inpatient 39

Warning *Guest blogger* Ed DeVoe. I know you all enjoy reading Rosa’s blog posts, but she needs a break every once in a while. So I’m gonna do my best to fill you in on what is happening with Aimee. (Editor notes: Ed is a great communicator and this post made me cry.-Rosa)

Yesterday, due to Aimee’s continued hypothermia, we did another urine sample that this time turned up positive for a urinary track infection. We have started her on an antibiotic to treat it. Her temperature has still been below normal requiring the use of the Bear Hugger, which is an air inflated heated blanket. She used this almost all night in order to keep her temp around 96 degrees. 



We finally got training on our new Astral BiPAP/ vent. It is quite a bit fancier than our old BiPAP, but one of its biggest features is that it has a battery back up allowing us to bring it along with us no matter where we go with Aimee. This is exciting and also a little nerve-racking thinking about all of the extra equipment and care that Aimee will need away from home. It reminds me a little bit of when we switched from having Aimee fed through the G where we could do intermittent bolus feeds and then switching to the J where she was fed continuously. Things just seem to progressively get more and more complicated as we care for Aimee. Along with the training, they also brought the bag and other parts and pieces to allow us to go mobile with it. One sidenote that was discussed is that we can’t leave the room with Aimee on BiPAP due to Covid restrictions. So somehow we will need to leave the hospital at the exact moment when she is awake and not needing the additional support. 

Yesterday we also met with neurology, palliative care, MCC and got a new attending for Aimee’s medical team. Although it is great to have all of these teams watching over Aimee and doing their part in her care, it is a little crazy to think about all of the facets that are involved and how one affects the other. When we see these clinics outpatient we may get one or two in a single day and we know leading up to the appointment who are going to be talking to and when, but at the hospital any one of these teams could walk in at any given moment. They almost seem to stack on top of each other and, at times, will show up at the same time as someone else is already in the room. Their intentions are good and they want to help Aimee with her care, but at times it’s like a rapidfire question and answer with each one of these teams. It gets pretty overwhelming and draining. I always feel so inadequate during these times, because I know that Rosa has a much better grasp on Aimee’s care and history. Yet I also know how draining it is for Rosa to be in the room not knowing when someone might come in to discuss Aimee’s care. You almost have to sit at the ready knowing that it any moment someone could walk in from basically 6am to 6pm and that doesn’t include respiratory therapists and nurses that come in 24/7. I am grateful that Rosa is willing to let me give her a break here at the hospital and I think it’s good for the kids to have Rosa at home and not just have me full time. 

None of the teams that we met with yesterday really had any concrete direction or guidance for us. Aimee has left a lot of them scratching their heads trying to figure out what her new baseline is going to be. We are hopeful that the UTI treatment will eliminate these hypothermia issues that have been cropping up, but continue to try to figure out the added sleepiness and increased respiratory requirements. Yesterday, Aimee was off of BiPAP for six hours which seems to be on the better end of her time awake and off BiPAP. 

A few weeks ago when we were meeting with the head pulmonologist, he acknowledged that Rosa would be a good candidate to work with a team that is looking at how much of the day is spent caring for medically complex kids during day-to-day life at home. What they are trying to quantify is how much time is being asked of the parents every time a doctor adds a new sequence or prescription to her care. If they really give the doctors some data they will be better able to acknowledge what they are asking the parents to do for these kids. I didn’t think too much of it at the time because we’ve just slowly added more and more care for Aimee over the years. After thinking about it and being at home with only the other four kids, I’ve started to realize how much time it truly takes to care for Aimee. Not that caring for four kids at home by yourself is an easy task, but I feel almost a bit of freedom to be more flexible and do things that we just can’t while caring for Aimee. I’m not upset by the amount of care that Aimee needs. I feel honored and privileged to be her dad and care for her the best that we can, but I just didn’t realize how much of what we do on a day-to-day basis is scheduled around Aimee’s care and needs. Because this care has just been added slowly over time, almost like a frog in a tea kettle with the temperature slowly being turned up, you just don’t even realize how hot it’s getting and all that it takes to care for her.

8.4.21 Inpatient 38

Good news, we have the new lower density formula back in hand and now the hospital has decided to carry it. That is great reassurance for us that this same mishap will not be repeated. Aimee’s output has been perfect the last couple of days requiring no IV replacement, but we still have to get her up on full calories on the new formula to know for sure it will stay. She was started on an additional dose of probiotic along with the the prebiotic fiber supplement and they added a new rotational antibiotic to treat her Small Intestine Bacterial Overgrowth. We already had her on one every other week, but will now rotate with a different one for other bacteria. All of this concoction in addition to the new medication given throughout the day will hopefully be enough to keep her hydrated. We have to give it a bit more time to tell for sure. 

Aimee had another hypothermic episode last night that required several hours with a warming machine. We don't understand why this is happening. All of her labs came back normal, no infections evident. She does have difficulty regulating temperature sometimes in less controlled environments (IE. in the heat outside, she rarely sweats, and will usually allow her internal body temperature to rise), but in a very controlled environment to drop her temperature so dramatically without an infection? We are scratching our heads. 

Yesterday I met with the pulmonology team. We discussed all of our options, including a tracheostomy procedure. We would like to hold off on that agressive measure for now. I am hopeful that if we get Aimee home and she is able to have less trauma that she will improve her respiratory function to a more consistently stable level. If not, we will revisit the idea in a couple of months. We want to do whatever we have to do to keep her safe with the goal of her being healthy and at home with her family, but adding a trach would also add 1-2 months more in the hospital.

So, we are hopeful to get a bit more respiratory rescue training and to make sure she is stable overall through this week. If all goes well, we are very hopeful that everyone will sign off on her coming home early next week. 

8.3.21 Inpatient 37

The hospital is highly overwhelmed right now. There are so many patients that there isn’t room for them to wait in the ED for a room (like we did). Our nurse yesterday discharged one patient and before the room was even cleaned the next family was waiting in the hall. They are discharging whoever they can and cancelling surgeries. Many kids coming in with RSV and other “winter” bugs that were delayed, plus the typical “summer” sicknesses of flus, ect. 

What this means for us is that the staff are all stretched much more thin. They are working many more shifts in a row than they typically do. Especially the RTs, RNs, and CNAs. Even the Environmental Services has been lacking compared to normal. 

We are feeling this stress particularly right now as we just found out that they do not have more of Aimee’s food. We started reminding them a couple of days ago that they had only brought us 5 days worth, so we were almost out. Somehow there was nothing done about it. Last night they told us that it would be a few days until they have more. :( We are moving her back to the old formula that we personally have on hand until they can get the new for her again. Grrr. This is unfortunately going to set us back several days here. We will have to re-transfer back to the new food once they have it and increase again. :( Disappointing. 

8.2.21 Inpatient 36

Aimee is very tired again today and her temperature is low again, though not quite as bad as Friday. She was only off of bipap for 1 hour yesterday and for 2 so far today. After I posted last night, she had several profound desats. 

Her ostomy output was down into the right range for yesterday! We hope to see that trend continue as we up her calories this week. We are trying to stop IV replacement to see if she can stay hydrated by herself. 

Ed has been keeping the kids busy at home this past several days. :) I’ve heard tales of nerf gun fights and DQ blizzards. I have much to live up to when we switch back tomorrow! 
















8.1.21 Inpatient 35


Aimee has slept the day away. No profound desats. 

Unfortunately, her medical team and the current GI on rotation did not feel comfortable going up on her med dose more before re-discussing it with her specialist. So, we wait. Today we increased her calories a little bit, which has caused some choking and discomfort. Otherwise, no news for tonight. 

I have to admit, this feels unbearable keeping her here. Yet, we must continue forward hoping for up and up, stronger and stronger.