Expectations of Perfection

I read this post on The Mighty earlier this week about a mother who confessed that she often just doesn't feel strong enough for her son to meet all his needs. I cried through most of it because even though our contexts are completely different, I felt the rawness of this woman's story so completely.

Because I feel it too - completely inadequate more often than I'd like to admit. It irritates me when people say, "I don't know how you do it" or "I could never do what you do." Partially because it's not like there's a choice, and of course they would if they had to. And also at the same time, perhaps somewhat contradictorily, I feel like no one is adequate for any of this. Definitely not me.

About five or six weeks ago, I failed to give Cyrus his evening dose of medicine. This is the only second time we have ever completely missed a dose, but unlike the first time, the fallout was more severe. Basically, the next morning every time he woke up he immediately started seizing. He had four seizures in a three hour period, two of which required emergency meds. And the week after this event, his choreiform movements exploded in intensity as they sometimes do after severe seizures. This makes it harder for him to go to sleep, which in turn causes more seizures.

His seizures themselves have also changed from mild partial seizures to stronger tonic seizures - the first seizures caused by the missed dose could have triggered a cluster. He's now back up to 5-8 seizures per day. And it's hard not to blame myself for all of this. My husband keeps telling me that I can't expect myself to be perfect. That we're both going to mess up sometimes. And the fact that we've only messed up twice in two and a half years is an amazing accomplishment. And intellectually, I can agree with all that. It doesn't change how I feel though, especially when the consequences for messing up even just once have become so incredibly severe. (On the other hand, we now have a pretty good idea how much his meds do in fact help him). How can I not expect myself to be perfect?

And you know, if giving him medicine was the only thing we had to worry about in his care, being perfect might be slightly more attainable, but it's not.

Daddy is still the best!

It took six weeks to go to all the specialists' offices to get all the medical orders we needed for Cyrus to start school. This is a task that apparently has to be redone every year. When Cyrus was shown to have a high level of crystals in his urine we had to take him to a sonographer to check for kidney stones (he's clear!). We also met with the neurologist last week, to see if we couldn't get this latest cluster of seizures back under some semblance of control and she is suggesting that he get a VNS implant, which may require surgery.  A pre surgery consult appointment has to be made to discuss if we want to pursue this. In the same week, his 30-day IEP meeting is taking place and his IHSS hours are up for review which involves a meeting with the social worker from the county.

I've already used up all my personal days this year, so I am unable to go to any of these. I always give Kyle my list of questions, but since I don't hear the answers, I can't write a list of follow up questions. And that just makes me feel insecure and unqualified to make decisions regarding his care.

And then the sales person from the wheel chair calls once a month, and wants to know what progress I've made on getting our very needed wheelchair van funded through the Golden Gate Regional Center (GGRC).

I usually dread this call, as it is a reminder that another month has gone by and I've made no progress at all. But this month, I've actually done a lot, but despite this, I still don't feel any closer to success. The process is long and the GGRC requires that we apply to three different charities, California Children's Services, get denied from my own insurance, and then meet with their OT who will determine if Cyrus actually needs it before I can get funding from them.

The bus has arrived

We've applied to the charities. This was an involved process itself - as for each one I'm basically applying for a grant. The nice thing though, was I didn't have to care if they say yes or no. Either way, I'm closer to my goal. And CCS has a rejection form letter they will just hand you, if you ask for it.

Kyle has tried endlessly to get any kind of response from the insurance company who keeps changing their requirements of what they need from us. First, they wanted a prescription, which we obtained. Then they wanted the code for the piece of equipment in question. We talked to the wheelchair van dealership and they told us there isn't one - that usually when there's no code insurance companies just automatically deny coverage.

Except for my insurance company, Anthem Blue Cross of course - they won't give us an answer one way or another until they have "reviewed" the request, and they are apparently unable to review the request until they have a code. Even when we explained that we really only needed a denial letter from them - that we don't actually need them to pay for anything, they refused to consider it.

"Will you put that you refuse to consider it in writing?"

"No."

After lunch, we go for a walk

I just want to start crying. Why is so hard to get a denial from my insurance? Why is getting services and aid so hard in general?

I have asked for help from other parents who said their insurance was only too happy to deny them coverage on something. I've also been in correspondence with people who work at CCS who are experienced at dealing with insurance companies specially with regards to equipment, but they seem to completely misunderstand what I'm asking for help on. And I've reached out to our assigned social worker who has not responded to any of my pleas for aid with more than "I'm looking into it" that last few times she even responded to my inquiries.

So yeah, I feel inadequate. Incredibly inadequate.

Then this well meaning new special needs mom friend I made is telling me, "Kari, you have to get help now. You have to get actual respite workers (who we've had trouble finding) in there now before you burn yourself out. And I agree with her, but that's also more bureaucratic fighting, and I just don't want to do it. It feels right now in this moment, so much easier to just do it ourselves. She insists in the long run that this will not be the case.

And intellectually again, I know that she's correct, but it doesn't change the fact that getting help is hard, and yet another thing to do, and another place for me to feel too small to handle all of it.

Having fun with his teacher, Mitzi!

All that being said, Cyrus himself is doing really well. Even though he's having more seizures, they mostly don't seem to be slowing him down. He has been going to school for about a month and has adjusted well. He has a fantastic teacher who he is already smiles to in greeting. She also sends us home a recorded report everyday with an assistive communication device that allows us to send messages back to her the next day (I think they're also using this to train us parents in how to use the assistive technology they are teaching Cyrus). He has a nurse who has already had to care for him through a status seizure and rides the bus with him every day, and he still gets PT, OT, and speech therapy. He's pretty wiped out by Friday, and slept in this morning until ten! Which was positively luxurious for his parents too!

We did find out that Cyrus needs glasses because he's apparently pretty far sighted, and now when they are on we're rewarded with more social interactions such as smiles and vocal play. We will find out at our 30 day IEP this week if Cyrus qualifies for vision therapy as well.

Our random medical tests in an attempt to figure out what Cyrus used to be so unhappy about did reveal that he may be lactose intolerant, or may have kidney stones, but as mentioned before we ruled the latter out already. Since we have removed dairy from his diet he has, in general, been happier and more content again. Yay for small mercies!

He seems to be going through a growth spurt - has put on three pounds since December, and is now 3 foot 4 inches tall. And just the other day, I caught him sucking on a finger in his mouth. He's never done this before! He's actually self-soothing with his thumb or pointer finger pretty consistently now. He'll sometimes even put himself down for a nap!

And I keep trying to remind myself that even when things are not perfect and even when I cannot be perfect, there is much to be appreciative and proud of as well.

Perhaps I should follow Cyrus's example and learn how to self-sooth!
Oh wait, that's why I write this blog. 

Mysterious Mysteries

I saw an adorable meme today: 

And I feel that I understand it and some of what it means today, more clearly than I ever have before. And that I have to become incredibly sensitive to the smallest of signs. And sometimes, even none of that works! I still have no idea what's going on!

In the past, even from a very young infant, Cyrus has always been incredibly chill. Almost impossibly so. I have said on more than one occasion that he spoils us with how calm he is. And I have found in the ADSL literature more than once lists symptoms that include "unusually happy". Of course austistic style tantrums are in there too, but we hadn't really experienced that - except that one time when Cyrus was on steroids for a month.

Let's just say a six month old with 'Roid Rage is NOT an experience I would wish on anyone!

But the point is, having a "chill" or "mellow" baby is not always a good thing, because it means they don't always communicate when something is wrong. And over time, we have become amazingly adept at reading the smallest of facial expressions. There's a flash of a wince or a particular grimace that most others mistake as a smile that let us know that he is uncomfortable. There's a particular noise that he makes that is rather distinct, but it's unclear whether it's a happy sound, or an angry sound unless you're looking directly at his face (particularly the eyebrows I think, but I can't really put my finger on it). Perhaps it's just a "Hey! Pay attention to me!" sound!

But having a calm child, also means that when he does cry - it's not to be ignored. That something is absolutely dreadfully wrong. And I swear this child has been crying since mid January! And I feel so lost as to what the problem is and completely inadequate in figuring it out.

Cyrus comforting himself with cuddles

Then there's this face.

We have thought we had it figured out several times.

In January, he was behaving like he was teething - lots of grinding of teeth, shoving his face into the floor, a bit of soft sobs, and lot of angry utterances that I can only describe as exhaling watery hard k's at the back of his throat. Almost like he's hissing like a cat, except with a k instead of an h. But we knew it couldn't be teething anymore because he has finally finished cutting every single one of those awful molars (plus the other ones too). One of his teacher suggested that it might be an ear infection. Since he had no fever, I never would have thought of this.

We took him in! And sure enough - ear infection! It may be silly to be happy to discover that your child has an infection, but there's also a certain relief in understanding what is happening so you can do something about it!

He starts taking antibiotics and I give him some children's ibuprofen and things are better for a few days. We finish the course, and take him in for a follow up and the ear infection has cleared up! So, I stop giving the ibuprofen, and suddenly he's exactly as he was before - grinding and not happy.

And over the next two weeks it only gets worse. For huge chunks of time each day, he will just have a meltdown  - where he's thrashing about on the floor, slamming his hands down onto the ground, and cannot be consoled with cuddles, swinging, or food (Our trampoline birthday party was sadly pretty much a wash). And he won't take a nap even when we try to set him down before the meltdown (not that they are predictable at the moment).

Cyrus mostly winced and needed cuddles at the trampoline park... 

But the ibuprofen still works. Forty minutes after a dose, he'll be calm for hours!

And that kills me because doesn't that mean he's most likely in pain the rest of the time? I know I can't give the painkillers every day indefinitely. That doing so is not good for him in more ways than one. But I have no idea what hurts and he can't tell me, and it seems that arching his head and grinding his teeth are general complaints - not isolated or specific to his actual mouth or face.

At the beginning of February, our IEP team suggested we get Cyrus's ears checked as they hadn't been assessed since he was born. This took awhile to set up, but we did get Cyrus into an audiologist. The doctor had this awesome contraption that determined whether the inner ear was registering/responding to sound. But in one ear - his right ear - he had abnormally high pressure in his middle ear. This makes it difficult to get a reading of hearing ability out of this ear, and we were told that in adults, this condition is incredibly painful.

Ah ha! This explains everything! And is something we can do something about!

So we contact our pediatrician, and quickly get referred to an ENT (Ear Nose Throat Doctor, which is actually supposed to be called an otolaryngologist, but who knows how to spell that - let alone pronounce!)  It is another week or so before we are seen. Cyrus's tantrums, for lack of a better descriptor, have increased both in frequency and severity where at times he is actually crying with actual tears down his face (which again, is a big deal because it never used to happen!)

The ENT takes a look and insists his ear is fine! That if he did, have increased internal pressure, it's gone now. He thinks (listening to Cyrus's grinding) that it's probably a dental issue. We go back to another audiologist just to be sure because this was supposed to be the answer to everything! And yup, the pressure has cleared up completely. At least we now have a clean hearing test that shows both ears work correctly.

So we make our way to a pediatric dentist. Usually, there's a dentist that comes to Cyrus's school, but they weren't going to be there again until late March, so we make an appointment at a local pediatric dentist. And this guy is awesome! If only because he works so well with Cyrus and he removed the medicine induced stains on his teeth that I've complained about before. But yeah, there's nothing wrong with his teeth (though he does have grinding sites), but there's nothing indicating he would be in any pain with anything related to his teeth.

Feeling frustrated at the shuffle, I start wondering about other things. Could this just be a cognitive growth spurt where he suddenly understands new things and is frustrated at things he can't do or can't communicate or just is overwhelmed by all the sensory inputs going into his brain?

Could this be because of his latest trend in seizures? Where he doesn't fully lose consciousness in a giant grand Mal seizure, but rather is having mild partial seizures a lot more often? Perhaps, these alter his perceptions, and make it difficult to make sense of things around him and he's scared and stressed?

Or perhaps, it's not one thing, but all of these things, plus who knows what else? Perhaps it was ear infections and middle ear pressure, but now is mental emotional stress. I don't like that answer as how am I ever going to figure all of it out?

I try another day with ibuprofen, you know, just to see.

Damnit! The ibuprofen still works! So, he probably is in pain. What are we missing?!

Cyrus after a dose of ibuprofen...

This past Sunday evening he had the worst meltdown - one that felt both heartbreaking and puzzling. He was angry at first - screaming and vocalizing his complaints, but not really crying - more the Cyrus equivalent of yelling. He did this for two minutes or so, and then out of no where he was laughing so hard!

Where did that come from?!

Don't question it! He's happy now right?!

Then another minute or two pass, and he's crying - his whole form wracking with crushing sobs, tears pouring down his little red cheeks. He couldn't be consoled. And this goes on for another ten minutes - where he's just changing instantly from one extreme emotion to the next - until he finally cries himself to sleep.

This is not normal. This is incredibly weird - like neurologically weird! Could this be a different type of seizure? Like seriously, what is happening in your little brain dude?

So we call the doctors again, this time basically just crying out for help. I explain that we've been shuffled every which direction, and still have no answers. And thank goodness for our wonderful pediatrician. She gets back to us so quickly, and she admits that she's shooting in the dark, but at least she takes me seriously, and suggests a few other tests we can try.

Thankfully, Monday was significantly better, but he seems to gradually ramping it back up each day that goes by. It's definitely time to run some tests! I don't know if any of it will pan out, but it feels better to be doing something.

And in the meantime, I guess we will have more snuggles on the couch. Maybe binge watch something. I didn't want to grade those quizzes or labs anyway!

Subtle Changes and Big Transitions

Many of my friends and families will refer to "cognitive leaps" in describing the explosions of development they see in their children. I can't say that I have truly witnessed these sudden bursts of growth in Cyrus because development happens so slowly and subtly that I often don't notice any change at all. But occasionally, it will hit me and I will ask my husband - have you seen him do this? Is this new? I have to ask because I'm not completely certain the behavior is new or if I just didn't notice it before.

Cyrus just turned three last week, and as always, I find myself reflective and taking stock of what Cyrus has gained this year. Just recently, he seems to have become responsive to touch - and by that, I mean he likes it! You can ruffle his hair or touch his temple and he'll sometimes smile! Before he would turn away or make an irritated sound. He's gotten better at giving hugs - they seem more intentional in any case.

He has opinions! He will take that first big gulp of a baby food that we know he doesn't care for, but that we can get him to eat anyway, except now he'll make a face of disgust - like there's this whole "Ew!! I don't want this one!" and he'll still eat it, but he will take his sweet time with it in a way he didn't used to. He's gotten a lot better at avoiding taking his medicine, employing strategies such as gurgling to prevent him from swallowing it. Though I admit this is a talent, I'd have sooner wished he hadn't developed, it's still good to see him complain!

He vocalizes so much more often. Kyle recently said that Cyrus makes five distinct sounds and he knows what four of them mean. But in general, there's a more consistent call and response pattern that takes place so we can have "conversations"! And I am finally confident that he knows his own name because when someone says it he turns towards them for a second. He even knows some of his peers' and teachers names as he will look towards them when they're names are used as well.

As of his third birthday, Cyrus is 3 feet 3 inches tall and 30 lbs! Three is apparently Cyrus's magic number at the moment! And three is also an important birthday in the education world.

A few weeks past we attended our first IEP meeting to make the transition from early intervention services into the school system. Our first meeting was a very positive experience where our concerns and goals for Cyrus were heard, and as a bonus I got to learn about language assessment for young non verbal children. Cyrus has mastered all communication skills of about a 3 month old, and has scattered communication skills from 3-12 months old. And has demonstrated no verbal communication skills beyond that point. Cyrus was placed in a sheltered special needs school and he will have six classmates total. He will continue with OT and PT, and have Speech Therapy added into the mix. And he will spend his day on motor development and learning alternative communication strategies as before only now he will be spending multiple hours on it each day. Cyrus also qualifies for a 1:1 nurse who will accompany him on the bus, administer medication, feed him, change diapers, and of course watch for and respond appropriately to seizures while he is at school.

We have learned that agreeing what was needed was a lot easier than actually getting it all set up so he can start! Before Cyrus can start, we have to have reports and orders from all his specialists with instructions for his nurse. And while I am great at filling out paperwork in a timely fashion, getting other overworked pulmonologists and ophthalmologists to fill out their portion so that my child can go to school is a slow and frustrating process... Our neurologist was fantastic - she wrote out a seizure action plan within twelve hours of my request! The pulmonologist however feels unqualified to comment as Cyrus hasn't seen him in over a year and is completely booked for the next few months. Guess it's time to get a new one! Ophthalmology never responds to my voicemails, messages, or requests for an appointment. May need a new one of these as well. And we didn't even have an audiologist (but we fixed that! Turns out Cyrus can totally hear, but has excessive pressure in his left middle ear, that has probably been the source of his irritation for the past few months...). Oh! And the school needs to actually a hire the nurse, and who knows how long that will take.

Needless to say, it's been a slow process, but the school principal and especially the school nurse (she came to my school during my prep period when I couldn't meet with her at hers to answer all my questions!) have been absolutely phenomenal in offering guidance and support! So while it has been an overwhelming and daunting task, we're making progress and truly excited about Cyrus's new placement.

The only bittersweet part of our transition so far has been having to say good-bye to Cyrus's teachers. His Early Interventionist (EI), Linda, came for her last session the day before Cyrus turned three. She is the therapist that gave me hope again when Cyrus was only five months old by showing me that he could see and discovering what he could do, rather than everything he was missing. She was the best at reading him and being just endlessly patient with him. We are going to miss her so much! 

And today, Cyrus graduated from his non-verbal pre pre-school class. They did the adorable little ceremony (video linked here) where they gave him a graduation present, a graduation hat, and then sing their normal good-bye song except the normal lyrics of "We'll see you again next time," turns into "We'll see you again some day." And yes, that simple substitution is enough to make me cry. Nicole is his favorite teacher - she communicates with him. She asks him questions and lets him make choices. I have no doubt that he loves her so because he doesn't have to struggle quite so hard to tell her what he wants the way he has to with the rest of us. That around her he feels seen, heard, and understood. She is a difficult person in his life to say good bye to. And he has other aides and therapists here as well he's connected with - Jenny, Elizabeth, and Vicky who have played with him, found new ways to make him laugh and smile, and helped his develop that critical core strength and head control. It has been an amazing class for Cyrus, and I hope he finds as good of a niche in his new one.

We've been a little behind in his actual birthday celebration, but we plan to take him to the local Rockin' Jump Trampoline Park this weekend rather than throwing a party as we figure he will just love all that extra bouncing.

An Ode to Medical Professionals

There are so many people who have taken care of me in the last few years of my life. Friends and family definitely, but today I want to talk about a more specific group of people: Medical Professionals. And I mean like all of them!

This group of people has seen me at my absolute worst multiple times in my life. The very first day I met my new OBGYN after discovering I was pregnant for the first time, the first news she had to give me was that I had blighted ovum - that my pregnancy wasn't viable. That was not news that I expected or wanted. And she was some perfect combination of warm patient compassion and calm serious professional as she explained my care options moving forward.

And when that same pregnancy failed to result in a miscarriage on its own, I had to get a D&C. I remember there was this nurse who managed my care after the procedure. How I cried to her about how I wanted this baby that had never existed. And I remember feeling so awkward that I was spilling my feelings to this complete stranger and she listened and empathized as if it was the most natural thing in the world.

When I went to the hospital, finally in labor, I was lucky enough to get a nurse who was a former doula! She coached me so excellently through transition, and I remember feeling so lucky. In fact, all the labor and delivery nurses were fantastic! Over the course of the first day, it was so easy to make mental notes of their names and all the individual things I appreciated about them. They were so different from one another. I had planned to make thank you cards for all of them.

By day three, I realized I needed to starting writing names down as we had already had seven or eight different nurses taking care of us, and three different On-Call OBs each night. And after a C-section, we were going to be there for another four days, and there was a whole other fleet of nurses and pediatricians, not to mention all their assistants!

By the end, being overwhelmed with recovering form surgery, and learning to take care of a newborn baby I never did write any of those thank you cards.

Since then, we have had unfortunate cause to become familiar with the staff at Lucille Packard's Emergency Room, PICU, NICU, Radiology, and Imaging Diagnostic Departments! And at this point I don't know how many doctors, nurses, assistants, EEG techs, social workers, and orderlies, (not to mention all the people doing work behind the scenes that I never directly interacted with) that have been involved in Cyrus's care over the years. I certainly don't remember hardly any of their names, and honestly would not recognize most of their faces.

There was even one occasion, where the sister of a friend, greeted Cyrus by name at a social gathering. And I was taken aback, thinking we had never met this woman. But it turns out she had indeed met Cyrus! She was a nurse that had taken care of him when he was recovering from anesthesia after one of his MRIs! And she remembered him because she loved his name!

Needless to say, I am profoundly grateful for this group of people! They have coached me through so much from surviving miscarriages to changing diapers as quickly as possible to tricking infants into swallowing medicine they don't want. They have placed and flushed IVs and reset alarms when Cyrus had pulled out his O2 sensor more times than I can count. Even when I didn't have the best rapport with some of these nurses and doctors, I always appreciated them.

It is winter again, and Cyrus has been ill for the last week or so (but seizure free during this time!!). And despite not making it to any of his therapy sessions or to school, he's had a fairly eventful week. On Monday, we visited his neurologist to discuss his pharmacology treatment, which was followed by lab work to test his medication levels and his liver function because one of his medications is known for causing issues in this area. He was mostly fine this day - definitely congested, but awake, alert, complaining about teething - all the normal unhappy Cyrus bits.

But as the week progressed, he kept sleeping more and eating less. He has had reoccuring fevers in the late morning and afternoon (but still no seizures!), and a somewhat low body temperature (96 F) at night. On Thursday he had only eaten 3 oz of food (he normally has about 40 oz a day), and was boasting a fever of 102. Kyle took him to the pediatrician's where he learned Cyrus's lungs and ears were both clear - that Cyrus was most likely fighting off some kind of viral infection.

On Friday, he hadn't eaten anything. In fact, he wasn't waking up at all. Even when we tried to wake him up, he wouldn't do more than slit his eyes open, crumple his face in objection (crying with no sound), before falling right back to sleep!

Seeing as Cyrus struggles to drink thin liquids unless we give them to him with an oral syringe, he gets most of his fluids through his pureed food. And when he's not eating, I get worried about dehydration. So when I got home and discovered he hadn't wet a diaper all day, I pestered him - gave him four ounces of pedialyte (rehydration solution) 10 mLs at a time.

He showed his appreciation by throwing it all up on both of us fifteen minutes later. Liquid vomit is the worst. It just soaks through everything instantly and is just unpleasantly warm and still a bit slimy. We took a bath together, which he tried to sleep through.

While he slept I looked up dehydration - when to worry and what to do - that kind of thing. I learned that when someone is dehydrated you have to give them fluids slowly. If you do it too fast you just make them throw up!

Oops.

Well, no worries, we can go slow next time. Give ten mLs, then wait ten minutes before giving more. We gave him his 40 mLs of his usual meds over the course of thirty minutes. He wasn't a fan, but it got done.

Until it all came back up a few minutes later, followed by a lot of dry heaving. It being the Friday before Christmas it felt prudent to try to get him checked out before the holiday weekend. We tried to call the pediatrician's office again, which was still technically open, but they didn't answer and we hadn't made it to the "On-Call" schedule yet. So, we drove him over to the local urgent care to see if they thought we should take him into the ER, only to find they were closed due to holiday hours.

Luckily, I have friends with more than a bit of medical expertise who were able to offer advice.

We did end up going to the Emergency Room. And I must say, as far as hospital visits are concerned, this was one of our most pleasant! It probably helps to be familiar with the system and process, and that for once we were coming in with something that is far more typical, rather than rare beyond understanding. But it also helps to have an excellent care team.

Our nurse was warm and friendly - I imagine she is excellent at putting a nervous family at ease. As she was placing topical numbing gel and heating pads all over Cyrus's vein sites (such luxury!), she asked if he had ever had an IV before. I couldn't help but laugh at that question.

Yes, so many IVs, and once even an IO (when they can't place an IV as fast as they need to and so they just drill a hole into your bone), and never before with any numbing preparation. And boy did she know her way around a needle! She was quick and efficient with the tourniquet (the only part Cyrus actually complains about) and she had that IV placed so quickly and so cleanly even with his tiny butterfly veins. Really, every time she came to check up on us, she made a stressful evening far more pleasant.

And our resident physician simply inspired confidence. He first commented that he had read Cyrus's chart, he admitted he was unfamiliar with ADSL (but he said it out loud before I did) showing immediately that he was transparent. I assured him that no one else on the planet had heard of it either. Throughout the visit, he patiently heard us out, asked appropriate follow up questions, explained what was happening with Cyrus and our treatment options, and what we were looking for in response to said treatments. He was very open about what he was thinking and treated us like collaborators in Cyrus's care, which I always appreciate.

I learned from him that children have less reserve water on hand in their bodies than adults so it is easier for them to get dehydrated. And that once they are dehydrated, it causes nausea and vomiting, so it becomes difficult to get them rehydrated without intervention (anti-nausea meds help or an IV does wonders!). He was very friendly and was probably the source of the only time I laughed the whole evening.

Dehydration is scary. Your child just becomes completely lethargic and listless - almost completely non responsive! But it is amazing how quickly they perk up once you get those fluids into them. We were only there for a total of five hours! That's our shortest hospital stay ever!

Awake and irritated!!

Today, Cyrus still has been tired, but he has kept down a whopping 28 ounces of food, taken his pedialyte and his medicine both, had two three hour windows of wakefulness and activity, and has had five wet diapers! He's once again also complaining about teething. So we're not quite back to his normal self, but we're moving in that direction once again.

This is probably not how I would have chosen to spend my first day of vacation, but it also went better than I honestly was anticipating at seven pm when we made the decision to go to the hospital.

At the end of the day, I'm writing this to say thank you to all the medical people who have watched out for us over the last three plus years that we've needed it constantly! I may not always say it when we're there because if we're there, I'm probably really tired and stressed, but I promise I'm gushing about you when we get home to anyone who will listen! And I'm truly grateful you have chosen the profession you have because you have literally helped save my son's life on more than one occasion. Thank you!

Happy Holidays everyone!!

...

General Update: 
We've had a few fun developments in the last few weeks.

First, Cyrus is cutting the center of his last two molars - the four pointy corners are all through!! The dentist said three weeks ago, that his last two teeth would probably be completely erupted within a month. So we might be done with teething in just a week or two! We're going to celebrate this day!!

His head control has gotten to be a lot more stable with far less wobbling. He's gotten to the point where I can prop his elbows up on his knees when he's sitting with crossed legs, and he won't immediately fall forward, and pretty much now never falls to the side.

Cyrus also received his first haircut courtesy of the San Mateo Zoo Barbershop who was giving away free haircuts to special needs kids a weekend or two ago. Pictures below show before, during, and after the cut. His hair hasn't been matted all week! This means he's happier with me for not having to work out the knots.

His seizure control has been all over the map. November was awesome if you will recall, but quickly turned into three status events in one week - the first week of December was only slightly better. But we went up on a med again, and the duration of his seizures has cut in half.

We had some lab work done on Monday to check Cyrus's medication levels, and to check out his liver function. We have found that he has macrocytosis (enlarged red blood cells), which is a potential side effect of one of his meds - depakote. He's luckily not anemic yet, but this is not ideal, so we're going to probably wean this med. In the meantime, we went up on Sabril again and we've not had a seizure since! Though he's also been sleeping a ridiculous amount this week, which always helps to reduce seizures, even with a few fevers, he's remained seizure free this week!

We're excited that he's doing well enough that we will be able to continue with our Christmas plans, even if we're leaving a day or two later. We still get to see all the grandparents, aunts, uncles, and cousins even if not all at the same time. We hope that you too, are spending some time with the ones you love!