Wednesday, May 21, 2014


So Q had the procedures in March (lateral releases on eye muscles, botox for upper extremities, and removal of hip hardware), and they went well. I opted to skip the post-op Ativan, which seems to have been a good choice: he still woke up mad, but was distractible. The orthopedist prescribed diastat for muscle spasms, which I wish we hadn't had. Fortunately, the duration of the dosing was short enough (because I called the neuro office the next day and asked for a titration plan) that it only took us four additional days to get off of it. It was still enough time to mess up the sleep issues, and yes, per the neuro visit today, it was the diastat that did it. Dagnabit.

Going forward, we will avoid Ativan and diastat, substituting something like Flexeril if muscle spasms are a concern. In a few weeks, we'll revisit the issue of effectiveness for the sleep meds. A slight dosage increase would be fine, if needed. There've been no breakthrough seizures, so no dosage changes to those meds, for now. When he asked for updates on Q's therapies, I was reminded again why we drive so far, with traffic, and often wait a long time to see this doc: he went positively mooshy.

Q often does his power chair driving practice with a friend who is practicing driving a car that he operates with a switch pad and one thumb squeeze. The first time they were driving together, Q bumped his friend, who seemed fine with the initial bonk, but cried at the second bump. Q has since learned to approach his friend slowly (no mean feat with a head switch), getting within a couple of inches, while trying very hard to be careful so he can chase his friend again when the friend is ready to take off (his car goes faster than Q's chair, so Q has to pay attention and really work to keep up).

Since beginning to work with an AAC (speech) device, Q has shown a preference for things that are funny: games, stories, jokes, riddles. I described this to the neurologist today, mentioning that Q will go to the "HAHA" button if the audience is too slow responding to his knock knock jokes. And he'll skip straight to the punchlines if he thinks you're not paying attention. I swear the man had a tear in his eye. He said, "This is what we've hoped for, isn't it? That Q isn't just an observer or recipient of the world around him, but that he initiates social interactions, and is effective, despite being non-verbal and having motoric limitations. This is him working around things to develop cognitive opportunity."

Why, yes.

Also this week, Q sees the ophthalmologist for the two month check-up. I'm so hoping she'll say that what she did worked. "Stuck," if you will. The bleeding into the whites of his eyes looked atrocious, and I'd hate for him to have to undergo the same procedure again too quickly. Immediately following the ride home from the outpatient procedures, Q was using his eyes more completely, experiencing a greater range of motion, if you will, so he's not looking so wobbly about the head.

The botox also seems to have gone exceedingly well. The most obvious feature of this is that Q's easier to dress - all the teeny adjustments necessary as one wrangles arms into and out of sleeves are just a little more  gently made, in most directions. He can more easily isolate his index fingers, hold utensils, and hit targets. Yay!

I'm so glad this day is over. It was incredibly full of frustration, based on logistics and production issues, but the pieces came together effectively and voila! We survived, and with a little good news, to boot.

More later, lovely people.

Saturday, May 17, 2014


I hope more of this happens around the country, and quickly. I'm grateful for perceptive attendings who cut through this and other subtle biases, to institute this kind of progress. It's a small investment for medical staff, in terms of training, but has a significant impact on the outcomes for patients who will already face unusual obstacles to wellness and comfort.

Tuesday, May 13, 2014


Could you take a few minutes and pray for sweet Ben and his family? And then go hug your own.

Peace be with you, friends.