Same old, same old - Daisy has infection, Daisy recovers from infection, gut becomes inflamed again, feeds not tolerated - and on and on and on we go.....next month it will be 10 months since we first were admitted to hospital........

Daisy is clear of the last line infection but her gut is clearly still inflamed so she will definitely have an endoscopy next week and I'm hoping they will be able to get some more biopsies this time to give us some more answers. She is still on IV antibiotics as they are all so twitchy about taking her off them and opening the floodgates for another infection. Her consultant came around today and he did refer to Daisy as a miracle child given all that she has been through, he said the plan is to get her stable enough to get home and then try and work towards - if at all possible- a cure.....yes he said cure so maybe he has something in mind??? One of the last resort treatments for Daisy's gut condition is a Bone Marrow Transplant, maybe he was thinking of that??? The problem is with us parents of chronically sick children, we hang on every word our consultants say looking for a little source of hope, they do not realise how much we churn over the conversations we have had with them, pinning our hopes on maybe just one word...

As always in the plate spinning world that is Daisy there is a problem, and this week it's back to her old problem of blood sugar regulation. One of the reasons she is on 24 hour iv fluids is that she cannot tolerate any time without sugar and we cannot get enough into her tummy to keep her blood sugar up. In fact if there is any delay in her IV being changed her blood sugars drop and she goes "hypo". Fortunately Daisy's endocrinologist also covers this ward so he will try and work out what we can do to try and maintain her blood sugars without this dependency on a constant supply of glucose into her bloodstream. The reason he had originally diagnosed for her problems was insufficient growth hormone, as this plays a role in blood sugar regulation. However Daisy has been having Growth Hormone injections for quite a while now and while she has grown to nearly 90cms the sugar regulation problem remains.

In herself she is really happy and enjoying the benefits of staying at GOS as it is so well geared up for long stay patients - she has a visit every day from a teacher who is actually able to use sign language, and she also goes to Singing Hands sessions and Music Sessions in the hospital school as well as spending time in the activity centre playing with other children. Then there are the visitors to the ward - neither Daisy or I are very enamoured with the Clown Doctors finding them deeply unfunny but we did enjoy a recent visit from the living legend that is Sir Terry Wogan.

So on we plod - Daisy has had a few tests this week, a video fluoroscopy which had to be abandoned as she refluxed up all the contrast fluid used to show up her gut, the outcome of which confirmed what we already knew, her tummy is now redundant and cannot be used at all. She also had a DMSA scan of her kidneys today to check for scarring following lots of urine infections as this may be the cause of her elevated blood pressure. We restarted feeds into her jejunostomy today, slowly, slowly as always at a rate of 5mls an hour, so it will be a while before she is on enough volume to take her off daytime iv fluids. Of course all of this delays us getting home, TPN training has been delayed and now it is getting really close to my deadline of the long school holidays to be home. I am reaching the end of my tether - I don't mind hospital when Daisy is acutely unwell, she is safe there, but as her condition is chronic, Andy and I can manage her at home. I hate that she is referred to as a patient and that we are so institutionalised, I don't enjoy my goldfish bowl existence or this complete lack of privacy, I crave the chance to sit on the sofa, cook food in anything other than a microwave and shut the door to the rest of the world. Most of all I am fed up of our family not being together - I want to be able to help Theo with his homework face to face, not via the phone, I want to make sure that Xanthe is remembering her Irish Dancing shoes on a thursday, not texting Andy to remind her and I don't want to miss any more of Jules growing up....

Snakes & Ladders

A friend of mine in a similar situation once described this life as like a game of snakes and ladders - you climb a ladder and make some progress towards your goal then when you least expect it you hit one of those pesky snakes and back you go again.... Over the past few days we have been climbing some big ladders, Daisy was managing 10 hours off TPN, she was enrolled in the hospital school and loving it, Andy and I were enrolled in TPN training school and feeling one step closer to bringing her home, we had even discussed a date of 24th June to discharge Daisy back home for good - I use the past tense as when we least expected it we hit that great big snake you get just before the finish line, the one that sends you all the way to the bottom of the board again....

Daisy started vomiting on Thursday evening and by Friday evening it was clear that her gut had gone on strike again (technically called pseudo obstruction) just as it had when she was first admitted to hospital all those months ago, her temperature also shot up and blood cultures show that once again she has a line infection. The bottom line is that she has had another flare up of her gut inflammation which has caused her to gut to stop working again, this has meant that we have had to stop anything going into her gastrostomy or jejunostomy. She is back on 24 hour IV fluids/TPN plus IV antibiotic infusions and her immunosuppressants have also been switched to IVs. Her consultant came to see her today and confirmed what we already knew, Daisy will be on TPN for the rest of her life. The plan now is to try and manage the inflammation again and then she will have another scope (where a camera looks at her gut to see what is going on), she may have to go onto even stronger immunosuppressants which would definitely only be IV infusions and at this stage we really don't know if getting back onto feeds into her jejenum (top of her intestine) is a possibility. All we can do is hope that in the same way Daisy has suprised us with the sudden turn of events she will suprise us by picking up and getting back to where we were before.

As always we hope to save her hickman line but the infection is pretty bad as it is also around the entry site in her skin as well as in the line. It's just a waiting game to see what the next few weeks bring. Andy and I are continuing our TPN training and all the equipment we need is being delivered to the house so at least we will have everything in place although it is looking likely that the hospital will have to bend their own rules and allow Daisy home with minimum breaks from the TPN.

The rest of the children are really disappointed - I was supposed to have brought Daisy home for the day on Saturday to have a belated birthday party for me (it was my birthday on the 10th) - instead I came home on my own and then spent most of the day catching up on sleep as I had spent the previous night up with Daisy.

I guess I was a bit taken aback when the hospital were talking about a discharge date of the 24th - always in my mind I had imagined that Daisy would get home to coincide with the rest of the children breaking up for the end of term so perhaps if I keep that in mind then I won't be disappointed and we really will get home in time for the summer holidays.....
So we got Daisy over her latest line infection and managed to save the line and life was ticking along, with the big focus on her next admission to Great Ormond Street. I had a call early last week saying that we were booked into a 5 day bed for her to have two procedures on two separate days under general anaesthetic. In complete frustration at the slow progress in moving Daisy from 6 hours off TPN to a regime where she would be able to come home I phoned the nutrition nurses at Great Ormond Street and basically said that Daisy, all of us, needed a life and we need to find a way to get her out of hospital and home.

Cue a second phone call from Great Ormond Street late last week, can we bring Daisy in that day, in fact asap, as a long stay bed had become available. Sometimes you have to be careful with what you wish for – one minute I was plodding along enjoying the few hours freedom in the day with Daisy and gearing up for a short term stay at GOS , leaving hopefully with a date to start TPN training and bringing her home, next minute I am frantically rushing around, phoning friends to pick up the children, ironing clothes and sorting out the million and one things that need to be sorted out when you have a family of 6 so that Daisy and I could transfer from Queen Mary’s to GOS quickly enough not to lose the bed. We arrived last Thursday at 8pm, not really knowing why we were there…

The first thing that needed to be sorted was another blood transfusion. Daisy has been chronically anaemic for a long time now and while she copes well with a haemoglobin level well below target levels every now and then this drops very low and she needs a transfusion. The levels of immunosuppressants are currently low in her body and the doses are needing constant tweaking and changing. The most exciting thing is that following my call to the nutrition nurses Daisy became the priority for home tpn training and set up and we arrived her to find there was actually a plan to get her home!

For the past few days we have been weaning down the hours Daisy spends on TPN – it’s early days yet but so far so good as she needs to be 8-10 hours a day off TPN to be allowed to go home on TPN. The dietitian has been keen to try and increase the amount of feed that is going into Daisy’s jejunostomy, however sometimes an increase of even a couple of mls and hour can upset the applecart with Daisy and for the past two nights she has vomited so we may not be able to push these feeds too much. However she is now allowed a two hours break from her milk feed pump which means for two whole hours a day she is completely free of tubes and wires and skips around like a little spring lamb – it’s the best sight in the world!!!!

The plan for the week coming is for Andy and I to start TPN training, fitting this around the two general anaesthetics that Daisy needs this week plus any thing else she throws our way (another transfusion is a possibility). Given that this is the first week of Andy leaving his old company on a redundancy package and starting up his new business this is a huge commitment on our part as he has had to completely rejuggle everything to fit this in. We have also had to completely rejuggle the children’s schedules to take into account Andy and I both spending all day at the hospital. But to get Daisy home this has got to be worth it.

So as I said at the beginning, be careful what you wish for.........I am so excited at the prospect of having all my family under one roof, but at the same so daunted, not by having to do the tpn, we will do whatever it takes to give Daisy quality of life and both Andy and I are dab hands at changing gastrostomy buttons, checking blood sugars, placing ng tubes....It's more the fact that for the past 9+ months we have been cocooned in this world of hospitals, desparate to get out and reclaim our role as parents, and reclaim our daughter. Now this is about to happen we realise how much we have depended on nurses and doctors being round us all the time, providing us with a security blanket, now it's over to us. I guess the thing I am dreading more than anything is night-time. Children with Costello Syndrome are notoriously bad sleepers, add into that reflux, tummy pains, beeping and leaking pumps, itchiness from excema, oversensitivity to noise and you get the recipe for broken nights. Theoretically we are entitled to some sort of night respite package but whether that will be forthcoming in the short term is another matter. And then there's the twitchiness about line infections and illness - we have seen Daisy go dangerously downhill very very quickly, this makes you very overprotective as parents and it will take me a while to feel safe without the comfort of a resus trolley outside her door and a picu down the corridor. The children will have to adjust too, they will get a full time sister back and parents who need to focus on her needs while in the house. The time we need to put TPN up is the worst time of the evening for parents - 6pm -7pm, right in the middle of tea time, activities, homework, bath time - our already very self sufficient children will have to become even more so. It will be so good to get back to being a full time mum to all of them, we are realistic in knowing that we will still get stays in hospital but nothing should ever be as long as this stay, who knows, maybe next year I can even get back to work!!!!!! (those who know me well will know this is only half a joke, watch out, maybe I will sign up for med school!)

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