Month: February 2004

On Saturday, after a fair few delays we returned to PICU at St George’s. It felt like we were coming home!

Massimo has unfortunately lost 500 grammes in the last 2 difficult weeks – the nurses noticed and decided to weigh him to check! And all his “normal” regime is back in action – feeding times, quantities, drugs, etc etc. It is also because he is better that all these things can in fact be changed back, but it is also a testament to how well he is known here at St George’s, and how important they think it is to get him back to as much normality as possible. Also all his intravenous drugs have now been replaced by oral drugs (I think this is only possible now because the quantities of the intravenous drugs have been reduced sufficiently) and today he was on oxygen and no CPAP for 4 hours in the morning and 4 hours in the afternoon. He was only on about 0.1 – 0.2 litres of oxygen which is an incredibly small amount, but in the morning he was on no oxygen at all! What a star!
Continue reading “Back at PICU St George’s”

Every day since the meeting we outlined in the earlier entry, we have discussed with people: a) whether it is appropriate to continue to put Max through the trauma of repeated ventilation, and b) how we would like to handle the inevitability of his final episode of tracheal collapse. We are sitting down with people and discussing how we would like to handle the death of our son.

It is so unbelievable that at times it just doesn’t seem real. You can’t help but imagine, over and over again what it will be like. Are we really going to sit and watch our beautiful little boy draw his last breath, and be able to do nothing to prevent it?

However awful, this is the increasingly likely reality that we are having to come to terms with and, as this truth sinks in, it just gets harder. Thank you all for your messages of support, they mean a lot to us, even though we haven’t got time to respond to you, we are very appreciative.

The good bit first. Massimo’s ventilator settings have been reduced all through yesterday (from a Peep of 10 to a Peep of 6 in one day) and this morning he was put on CPAP. He seems to be coping well and they are planning on slowly weaning him off his sedation. Apparently coming off midazolam is much like giving up heroin with all the side effects. As we know that in October he did suffer quite badly with withdrawal they won’t be weaning him at any great speed.
Continue reading “The future is bleak”

We saw one of the doctors on PICU at GOS yesterday afternoon and he said that they had hoped for a much better result from the steroids and that they can see no benefit from them at present. The infection seems to have gone and that is good. The main results from the bronchoscopy is that it is tracheal wall and as such cannot be removed. Further, neither a change of tracheostomy tube nor dilatation will help. The doctor was really quite pessimistic and basically it is up to the wee man to breathe properly and for himself.

His muscle relaxant was stopped yesterday morning, as much because he has been on it for too long and needs a break as to see how he breathes himself. He is still heavily sedated and on lots of morphine. He started to move and twitch last night and trigger a few breaths himself – this is when he starts the breath and the ventilator does the rest. Apparently he has opened his eyes this morning so we are off to see him now. We are also due to see the doctors again today.

On Friday as Massimo’s infection was under control and his ventilation was settled, the ENT surgeon decided that it would be a good idea to have a look down his trachea to get a better idea of what is actually going on. The plan was that if the “tissue” that Justin saw on Monday turned out to be granulation tissue then they would laser it off, but if it was tracheal wall or tumour they would just take a few pictures and send Massimo back to PICU.

The wee man went into surgery at around 5.15 pm, but he was back very quickly as the obstruction was seen to be tracheal wall. The tumour is pressing on the windpipe and causing it to weaken. The tissue that Justin saw on Monday is something we still have to clear up. We are hoping that the steroids have reduced any swelling that there was thus reducing the size of the obstruction. We really need to have a chat with the ENT surgeon and the other consultants to have an idea of what THEY think is going on.

Massimo’s ventilation requirements have increased slightly since the investigative bronchoscopy as any kind of instrumentation causes trauma and therefore swelling. However he is still very stable, albeit still paralysed and sedated.

Massimo’s ventilator settings have been changed a little but nothing much else has changed. He does seem imperceptibly better, and his night nurse who has looked after him for the past three nights, agrees with me. His heart rate is the lowest it has been for a long time which is a really good indicator but unfortunately his upper right lung isn’t inflating well and therefore although his breathing is OK his carbon dioxide levels are still quite high.

We had a brief chat with a consultant who made it very clear that being neutropenic and on a ventilator at the same time is a VERY bad combination – being on a ventilator generally means that it is only a matter of time before you get an infection. Neutropenia means an inability to fight infection. Unfortunately, the best chance of getting Max off the ventilator is a large dose of steroids, which brings with it more susceptibility to infection. With the balloon dilation now not possible until March 1st, steroids seem to be his best bet. He has responded well to steroids in the past, so we are keeping our fingers crossed.

We decided that we always try to show you the “good” pictures and so here are a couple of pictures of when things are not so good.

This morning’s meeting was a bit of a mixed bag. We were afraid that we would be told that there was nothing that could be done. That was not so.

There are a range of options, the simplest is to use a balloon dilation to try and push the tissue growth out of the way, squashing it to a size where it does not interfere so much with his breathing. Next was the possibility of fiddling with the size and length of the trachy, which is what we have done in the past, and which does work, but past experience shows that this is only a temporary solution as eventually either a granuloma forms at the end of his trachy or he has tracheal collapse beyond the tube if it is too short. Another option is to surgically remove the offending object. The possible problem with that is that it may be part of the tracheal wall, being pushed in by the tumour, and if it is removed, that would obviously pose problems later on when/if the tumour regresses.
Continue reading “A few options”

We had a largely uneventful day at GOS today. Having arranged to meet up with the specialists at 1.00pm, we were called first thing by the ENT registrar who had had a look down Max’s trachy with a flexible bronchoscope, and I am guessing on the strength of what he saw, decided that a rather more in depth discussion was required involving more of Max’s specialists.

On Monday afternoon, when everyone had a look down Max’s trachy, the SGH ENT reg felt that the growth we were looking at (I had a look, along with the PICU consultant and Max’s respiratory consultant) was not the usual granuloma tissue caused by the end of the tube. The others felt that, on balance, it was more likely to be granuloma than tumour.

Although he didn’t say it, the impression given by the GOS ENT reg was that it doesn’t look like a granuloma and that therefore what was required was rather more than simply the use of a laser to remove it, hence the delayed meeting with more specialists.

We are off to GOS first thing tomorrow where we are, frankly, more than a little worried about what is in store.

Verna had an extremely difficult night as Massimo never actually settled. They tried several things to try to improve the situation but nothing seemed to work. By about 4 am Verna was very unhappy and eventually, after waking doctors and ward sisters and making quite a fuss, Massimo was transferred to PICU at 7.30 am.

It took the doctors and nurses on PICU 3 and a half hours to stabilise him as they could NOT get him ventilated. In the end they put him on an anaesthetic ventilator in the hope that the gases that they use to anaesthetise might help his wheeze and open his chest a little. This helped, but only temporarily.
Continue reading “Another difficult day”

Yep, the wee man was here for only two days and today we ended up taking him back in! We had a quiet day on Friday and Saturday morning. Then at around midday he started getting rather agitated and his breathing didn’t seem great. We removed his tracheostomy dressing and gave him a dose of paracetamol. His breathing seemed to improve as did his temperament and a lovely afternoon was had by all. His gums are very swollen and we just assumed teething.
Continue reading “Only two days at home …”

Massimo is home as of around midday today. He is still on a little oxygen and has managed to develop a cough between PICU and home, but he seems well enough. We have had plenty of smiles and are all set for a quiet weekend at home just enjoying being a family.

Yesterday we had our meeting with the oncologist. It was a long and pretty grim and difficult discussion. Firstly she told us that she had presented Massimo’s case at the UK Children’s Cancer Group as mentioned in our entry on 15th January. There were lots of people there and the response she got ranged from one extreme to other. Some doctors felt that she shouldn’t be treating Massimo at all. Their feeling was that the quality of life that Massimo could expect should the tumour disappear, shrink or otherwise be effected, would be such that it would be kinder and better to allow Massimo to enjoy what life he has left without further intervention. At the other end of the spectrum there were plenty of doctors who felt that she was doing the right thing and that we should give the chemo he is on a little longer to have an effect and take it from there. We were therefore asked what we wanted to do, whether withdraw treatment or continue.
Continue reading “What the oncologist said”

On the Monday (2nd February), Massimo was due his cocktail of Actinomycin D and Vincristine chemo drugs and we were supposed to be going to Great Ormond Street to have these and to have a chat with his oncologist. As he was still on CPAP and still in PICU, we decided, along with the PICU doctors that Justin and I would go to GOS on our own and Massimo could to have his chemo on PICU on the following day. On the Monday, after various conversations with GOS, J and I were about to head off up there when we received another call saying that of course we were more than welcome to keep our appointment but there would be more to discuss the following week and could we make an appointment for then.
Continue reading “A prolonged apnea”