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Vera going for a walk

As promised in our previous post, we would like to share some more of the positive things that have been going on in Vera’s development over the past couple of months.

Since March Vera has been on sleep medication. While this doesn’t mean our nights are completely smooth, they are certainly much better than they have been! It’s absolutely wonderful that we ourselves are much better rested. But we particularly notice a big difference in what this means for Vera and her quality of life. She now has the energy to learn. And Vera likes learning. At her therapeutic preschool (from Sophia Revalidatie) she gets praise for her eagerness to learn and for her perseverance.

And we realize once more how hard Vera has to work at things that may come natural to typical developing children. She has to work hard because she is a heart patient, her entire body works differently, has lower muscle tension, limited vision, different proportions and feet that are quite bent. But she is making strides in development.
In the past couple of months she has learned (with the help of the physical therapist) to get herself to a seated position from lying down. She can climb into her (low) chair by herself.
And she has a walker that she is getting more and more confident with as we practice going for small walks outside. Vera loves anything with wheels; she has her little red scooting car, a wonderful pink scoot bicycle, her blue walker and whenever she sees a pedal car or small bike, she is very keen on trying it out, even though she is often too short.vera-schoenen
And Vera likes to walk without her walker as well. She can’t quite do it by herself yet, but is doing better and better while holding hands as well as along the table or wall. Her custom shoes are quite literally of great support in this. And she has discovered climbing! The small kitchen stepladder has become a playground, as well as the open staircase in our living room and small stoops in shops. The beauty of Vera is that she teaches us to celebrate what she CAN achieve. So we don’t focus on the extra effort we have to put in (paying more attention to where she is wandering about) but that we are happy for and with her when she accomplishes something new.
We also notice that while we can think of goals she should aim for, she certainly has her own agenda as well. We were trying to work on playing independently for longer periods of time for instance. But instead, Vera decided to put her energy into developing her motor skills further. And because she can now get to the places she wants to be more easily, her play has improved as well.

It may sound as though Vera is walking and biking and playing all day; but we do notice that her energy levels are definitely limited. We are noticing improvement in her energy levels over time, but it is still something we need to take into account when planning our day or week so she doesn’t get overloaded. Or overstimulated, such as being around large groups of people (at birthday parties, in shops, at church etc.) after which she kind of shuts down and often has a restless night. So we are still trying to find the balance between what we can and cannot do during a day or week. Oddly enough, we currently have to watch out we don’t overestimate what she can do because she has so much more energy than she used to…

And so a new goal we have come up with is: how can Vera have some down time between all these developments so she can keep up with herself?
Boy, 3 years ago while sitting next to the incubator at the intensive care unit I certainly could not have imagined that I would have to slow down this little girl.
A big hand of applause for Vera!

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Positive developments

“Have some leniency with her”, Vera’s eye doctor said at the beginning of her life. What he meant is that we needed to be patient. That she really would develop, but that it would take time. More time than with a typical developing child. And he is right, slowly but surely we can see an upward trend with Vera.
One of the main characteristics of Costello syndrome is developmental delay. Everything is very slow (or in some cases doesn’t develop at all) and we see this in Vera also. But if we look at all the facts, we can see several jumps in her development.

The first jump was early in her life, it was the moment she was no longer in intensive care and came home with us for a couple of weeks. During those weeks we saw progress, until another hospital stay followed and things halted again.

Vera met sonde

Vera met sonde

Sonde Vera er uit!

Sonde Vera er uit!

A real jump came the moment the feeding tube came out of her nose because she received a PEG (feeding tube in her stomach). The negative sensations in her nose and throat were gone. This really benefitted her, in particular in making sounds for instance.

On vacation in the summer of 2013 we noticed she was feeling well and that her development continued. Being outside often with nice weather and always having people (without white coats) around to smile at were exactly what she needed and are things that she enjoys.

Zomervakantie met Vera

Zomervakantie met Vera

There have not been any more hospitalizations since October 2013 and a new development in play and discovering the world is taking place.
And then the biggest step to date; this February we made a change in her food. With tremendously positive effects. In the past there were problems with her bowels, she had cramps and ongoing diarrhea. A real solution had not been found. She would often spit up food and mucus several times a day; for sure in the mornings, but also often in the middle of the night so that we had to change all her bedding.
From our closed Facebook-group for parents with a child with Costello syndrome we got the tip that the special tube formula for children who are lactose intolerant caused problems in some children when used for a prolonged period of time. It is unclear why. After all, it is the most allergy free food in liquid form that contains all necessary nutrients. In consultation with our main pediatrician we stopped the special formula for a couple of days as a test and substituted with pure soy milk as her main source of nutrition.

The effect was that within a couple of days she stopped spitting up her food, produced less mucus and for the first time of her life had a solid stool. Her skin calmed down, was less splotchy and even somewhat softer.

Naast medicatie geven we ook groentensap via spuitjes over de sonde

Naast medicatie geven we ook groentensap via spuitjes over de sonde

A week after, she even slept through the night for the first time in her life. Unfortunately, the latter was just the one time.

It made such a big difference that we have switched to our own food. In the USA a so called ‘blended diet’ is used: you puree your own food in the blender so it can be administered through a feeding tube.
And so now we are in the kitchen for an hour every day weighing grams, calculating the calories, taking notes in a food diary and pureeing with the blender or the slow juicer (thanks to donations!). Grinding up sunflower seeds, mashing avocados, pureeing cooked rice, juicing vegetables: it all turns into beautiful porridge.
Instead of using the food pump with a very slow drip of two hours so she wouldn’t spit up, feeding her now only takes 20 minutes per feed.
Only the first and the last feeding of the day are still by food pump (soy milk with baby cereal), but we no longer have to get up out of bed in the middle of the night to turn the pump off and rinse all the equipment out…

slowjuicer

Slowjuicer zodat groente en fruit vloeibaar over de sonde gegeven kan worden

slowjuice

voeding-koelkast

 

 

 

 

 

 

 

 

It seems like making your own food would take more time, but not having to change her bedding and not having to change her clothes at least twice a day due to her spitting up actually saves us time. And above all: it gives Vera so much more quality of life that we gladly do this for her.
And because she no longer has diarrhea and is no longer spitting up, she is even more cheerful and likes to explore more. She is even more interested in solid food. So with every meal, she joins in and tastes, sometimes she chews a little and sometimes she even swallows a little. And, at two years of age, this is a very good development for someone with Costello syndrome.

Video food therapy: