Showing posts with label Port Wine Stain. Show all posts
Showing posts with label Port Wine Stain. Show all posts

Thursday, February 22, 2018

PDL Treatments #13-17

Yes...delayed this post about 6 weeks because, whelp taking care of two girls is just busy busy busy.  I am trying to keep this up as best I can so I have something to look back on when Sloane is older.  Our dermatologist said it's always nice when they get older and are having trouble with their birthmark to have a "Birthmark book."  I'm certainly not writing a book, so this is the best Sloane will get.  So here I go...

Just when we thought things were done...our Dermatology follow up in February 2017 showed some growth in our short 6 week break.  Our dermatologist mentioned again that the most aggressive treatment shows the best long term effects and is best when finished before the age of 2 years old.  At least that's what I remember.  So we started back up again in March 2017 and did 5 treatments ending the last day of June.  Our dermatologist took a 5 month sabbatical so we got a nice long break over the summer to enjoy no doctors appointments.  Sadly over that time there was continued (yet minimal) growth and we restarted again in November.  

Since Sloane's last treatment in June was pretty bad now that she's older and more aware of whats going on, we decided to do general anesthesia to get a better treatment and more focus on the eye area to help minimize the damage that could be done to the optic nerve as the vessels grow.  

That treatment in the beginning of November went great, she tried to lick the inside of the anesthesia mask and thought the hospital was so much fun with her new best friend Ms. Veronica.  She woke up slowly, much better than her sister when she had versed, but still was feisty once she realized what was going on.  A few weeks between this treatment and the next, Sloane had her seizure episode.  I mentioned in my last post about her treatments, that we were cleared by neurology but since this occurred we get to see them every 3 months.  In December, we were cleared from neurology to continue with treatment as we learned that her port wine statin and seizures were unrelated.  This last and hopefully final (this time better be for real) treatment was tricky as we were coordinating with ophthalmology to get a good visualization of her optic nerve to see if damage had been done.  Sloane had a narly little cough that we were canceled from surgery the beginning of December, but then rescheduled the week before Christmas, getting our Christmas miracle.  We got great news that the optic nerve is un-damaged and this last treatment miiiiight be the end.  Our dermatologist said more treatments may not show much more improvement and to be honest with you....it looks AMAZING and you can barely see it.  We will continue to follow up with ophthalmology every 6 months since the vasculature behind the eye can change at any time.  We don't see ophthalmology and dermatology until JUNE!!!  And we will find out what Neurology says when we go back to see them the March 1.  







Friday, November 24, 2017

Seizure Sunday

The phone call no parents wishes to ever receive is "Come home now, I'm calling the ambulance." Those were the only words I was able to get from Mason as I bolted out of lunch with girlfriends and raced home.  For nearly 10 minutes my mind went all over the place not knowing if it was Mason's heart or an accident with Hadley or Sloane.  I immediately called out neighbors Rose and Stephanie and got a hold of Rose to come get "the other kid" not knowing what was going on.  God was truly watching over our family that day because Rose was HOME and bolted out her front door to find ambulances and fire trucks swarming our house.  The message I got from her was that Sloane was on the floor in the girls bedroom.  Shortly after I ran into the house to find Sloane lifeless looking on the floor in their room surrounded by a team of firefighters, paramedics and whoever else was in there.  Someone greeted me saying "Your daughter was face down having had a 4 minute seizure and we are taking her to the closest Emergency Room."  Mason later describes her lips being blue and fixated eyes.  I begged for them to take her to Stanford (where Mason and I both work and is a pediatric hospital) but they responded "We don't have time."  That's the second time this year, I've heard that statement and let me tell you it SUCKS.  No control.  Mason was not allowed in the back of the ambulance, however road up front.  From what we heard from that ride, she seized again in the back and the main paramedic told them "Get there as fast as you can."  I stood from the street watching them pull away with lights and sirens, yet again, not another good sign.  

I arrived at the ED to find my daughter, completely lifeless looking.  Pail, eyes glazed over, limp and being poked and tested by a wonderful team of men and women at Good Samaritan Hospital in Los Gatos.  I got a quick report on the events that had happened and gave them a quick history on her port wine stain and treatments.  Meanwhile while getting through all this history she seized, vomited, foaming at the mouth, eye rolling back, full tonic clonic, fists clinched and difficulty breathing.  Sucks again.  Seizure number 3.  After suctioning her and giving her more meds, it stopped.  We stood next to her, played songs our phone and told her Hadley was playing with Addy and Declan.  While sitting there with her we continued to notice weird involuntary twitching like movements, which we later found out were partial seizures.  Then that lead to yet another seizure, same thing, 4th time, 45 seconds.  Sucks yet again.  Another dose of meds to stop it and a quick visit from the team saying they were admitting her to the PICU.  I jumped into momma bear mode and said "No you are not, we need to transfer her to Stanford, my husband and I work there and we want her with pediatric specialists."  I know that was probably the most attitude I've ever given someone in my life, but the doctor was beyond accommodating and understanding.  Mason and I both got on the phone with our co-workers, patient placement, critical care transport and management at LPCH to get the ball rolling.   During all this hustle and bustle to get her transferred, she seized AGAIN.  Five times at this point.  F.I.V.E tonic clonic seizures.  Shortly after we were transferred to LPCH while I went home to get clothes, check on Hadley and get a car.  

While Mason stayed with Sloane and transferred to LPCH.  Meanwhile, let me tell you a little about Hadley.  She witnessed the entire thing.  She's 4.5 years old and was a absolute rock star.  She was sitting right next to Sloane when she started seizing, she ran to get Mason's phone, put Georgia in the bathroom, opened the door for the paramedics and stood in the hallway calm until Rose came to get her.  She stood there in the hall watching the paramedics tend to her baby sister, calm as can be.  Definitely didn't get my genes there.  Amazing reaction.  We have recently been talking about what to do when we need to call 911 and boy did she get to witness a situation first hand at an early age.  Santa is going to be good to her this year.  

Moments later I arrive at the PICU up at Stanford with Rose, my lovely chauffeur and emotional support.  Sloane yet again is just not herself, hooked up to all kinds of monitors but is crying.  Crying!!!  She's not lifeless looking and is getting some spunk back.  Since she was in the PICU, only one parent was able to be with her, so Mason stayed and I went home to provide some sort of normalcy to Hadley.  The report for the evening was that Sloane slept for only 1 hour total and screamed in delirium the rest of the night.  Tough, so tough.  PICU environment, beeping, wires, tubes, IVs is no joke.  I met them the following morning at 7am to find her yet again, angry, biting, telling everyone "bye" and completely delirious.  Her eyes were not quiet right and she couldn't stand on her own.  Her mood though was rather reassuring that she was getting back to herself, so we were transferred upstairs to the acute care floor and waited.  Neurology met with us and mentioned she was in a slightly higher risk bracket for a seizure disorder due to her port wine stain, although her initial MRI at 4 months old was normal.  We made the decision, easily, to do imaging of her brain with anesthesia to determine if this port wine stain has caused damage to her brain, all these seizures had caused neurological damage and if there was signs of epilepsy.  

Fast forward to hours upon hours of being NPO, not being able to eat, restricted inside a hospital and not being able to walk independently.  She was a mess.  Hot mess express.  She had moments of calm and distraction getting stickers from the library, playing in the playroom and riding in the wagon around and around on a scavenger hunt for hand sanitizer.  We saw all our friends, screamed, waved hello and avoided every elevator with someone with food or drinks.  It was tough, after enough was enough we bathed her, changed her hospital gown and laid her down.  She slept.  Praise Jesus, she slept for 12 hours!!! We even were able to wake her up to give her the anti-seizure medications orally and she fell right back to sleep.  I stayed with her this night while Mason returned home to Hadley.  Tough having to separate, but yet we needed to give Hadley the much needed attention and tell her how Sloane was doing.  Hadley was telling her teachers at school that Sloane was sick and she wanted Abuela to buy her a milk and muffin at Starbucks.  She missed her sister.  :( 

Fast forward to the MRI...so strange and sad to be bringing your child to the department you work, yet so much respect and gratitude for my team.  So much love I have for them.  The anesthesiologist was able to mask induce her while she was asleep on Mason's chest and Sloane didn't even wake up.  Another blessing from God!  By the time we saw her in recovery, she was smiling, asking for juice and we seemed to have our girl back.  By the time we made it back to the room we had already heard "Her MRI is NORMAL, you are going home." Shortly after Neurology came by to meet with us explaining that there was no sign of Sturge-Weber Syndrome (the problem with her port wine statin), no signs of epilepsy, and no neurologic damage from all the seizures.  Blessings, prayers answered and smiles all around.  

The ending diagnosis is febrile seizures, although she presents as a complex case and atypical as she is on the upper age of a typical febrile seizure and since she had so many tonic clonic seizures and partial seizures.  Also since she had so many seizures, there is a higher likely hood she will seize again, therefore we are home now with anti-seizure emergency medications.  We sit and wait with lots of anxiety for another seizure.  I watch her eyes and body movements like a hawk and buy new baby monitor chargers to keep an eye on her at all times.  I feel like I'm sitting on a land mine just waiting for he next.  

While the 48-56 hours we were going through this, we had an outcry of support.  Thank you to the Engine 9 fire team, Rose and Mark for saving the day with our girl Hadley and driving me around, and all the endless texts/visits from friends and co-workers at LPCH.  It is so so tough to be on the other side and is something I hope nobody has to ever experience but I'm grateful we have our girl back, dancing with her hands on her hips, discovering the magic of Christmas decorations and playing with her sister.  The moment of proud-ness we have for Hadley is something I just can't describe.  Her bravery is just amazing.  

This is Chapter 1...hopefully there is not a Chapter 2.   









Friday, December 16, 2016

PDL Laser COMPLETE

We are done! We are done! We are done!!!!!  Well to be realistic...we are done for now.  There is a high likelihood that we will need to do treatment later in her life when we notice growth in size, color or texture.  Or since it affects her eye lid, if it starts to hinder her vision, we may have to do treatment then too.  But let's live in the present and be excited that our recommended treatment plan of 10 treatments before her first birthday are DONE!  We've had this date on the calendar for months and I couldn't be more excited.  We are cleared from Neurology and Ophthalmology and we don't go back to Dermatology until the end of February for a follow up.  Let's continue to hope and pray that it has minimal growth over the coming months and years.


I have posted before and after pictures of each treatment.  Yes, she didn't like them and yes they give her topical numbing cream, but really it was the swaddling and eye protection stickers she didn't like the most.  We are sooooo thrilled with the progress and hope that she grows up to embrace her little "strawberry mark" which is what Hadley likes to call it.

Newborn 1 day old


Days 1, 2, 3, 4
January 28-January 31st
 Pre & Post Treatment #2
April 13, 2016
 Pre & Post Treatment #3
May 19, 2016
 Pre & Post Treatment #4
June 16. 2016
Pre & Post Treatment #5
July 16, 2016
Pre & Post Treatment #6
August 11, 2016
Pre & Post Treatment #7
September 26, 2016
 Pre & Post Treatment #8
October 28, 2016
 Pre & Post Treatment #9
November 17, 2016
Pre & Post Treatment #10
December 15, 2016

Of course I had to make a cute little "Thank You" basket for her wonderful Dermatology team.  They loved our baby girl so much every month.  Everyone knew Sloane...everyone from the girls at the front desk, so the nursing assistants, volunteers, nurses, residents/fellows.  They asked several times if Child Life would come help their clinic, but since we just don't have the staff for it, I made them a Child Life basket with little distraction items.  


Not to mention we loved this girl and Sloane started to reach out to have Jennifer hold her at month!  She really coated Sloane's face with numbing cream each month and made sure it stayed on for 20+ minutes.  We LOVE Jennifer!  


I will post a newborn photo and side profile closer to her first birthday to see the before and after from day one to one year old!  Until then...Happy Holidays!  

Monday, April 25, 2016

Pulse Dye Laser Treatment Update

We are changing the face of beauty over here at the Ybarra house hold.  Little Sloane has completed 2 of her estimated 10 PDL treatments and we are already seeing a big difference in the appearance of her Port Wine Stain.  You can see how it looked when she was born at the bottom of this post.  You will notice that there is a big difference in the color already!  

They continue to put the lidocaine cream on her face, which she's always so confused about what they are doing.  Trying to keep those little hands off her face is tricky and I'm sure will be more and more of a challenge as she gets older.  People have asked what the machine and laser looks like so I snapped a quick photo while playing her favorite lullaby music in the room.  The more she cries/screams the better the outcome of the treatment as is brings the capillaries to the surface and Dr. Teng can see the stain better.  I know it sounds sad, but it's really done soooo fast.  This treatment was a little longer, maybe 35 seconds, as she covered a larger area and ramped up the strength of the pulse.  

The bottom picture is the before and after photo of this treatment.  See!!! The redness has already decreased a lot since she was born!  I know the after picture looks narly with all the bruising, but it does not bother her AT ALL.  She calms down immediately after we are done with the 35 seconds of treatment and just wants her bottle or to be unswaddled.  The bruising lasted about 5-6 days and we kept her covered with a little wide brimmed hat by iPlay, which I of course want to get her name embroidered on it :) To be honest I don't see much of a difference in the color from the first and second treatment, but hey, we are only done with two treatments.  The biggest changes are by her hairline.  They still are unable to laser the area by her eyebrow and eye lid, which will probably remain the darkest since it can affect her vision.  Maybe when she's 6-9mo we will have to do the eye lid, but that's a whole other ball game as they have to add protective inserts into her eye.    We did learn that the appearance of the stain will remain stable after all these treatments and will start to change it's texture/color/size when she hits puberty.  By doing these treatments early, we hope that the changes when she is older are very minimal.  

We follow up with Ophthalmology at Stanford Children's Hospital this week to get a baseline on her vision as Port Wine Stains can cause eye involvement or glaucoma.  We are confident she does not have any of these additional problems, but we need to make sure we only have to follow up with dermatology for the treatments.  





Monday, April 4, 2016

Where Have We Been?

Well, it's been about two months since little Sloane joined our circus and a circus it has been.  We now are settling into a little rhythm, getting a routine down and tackling challenges head on.  Since I last posted, Mimi and Grandaddy came to visit.  It was so helpful to have an extra pair of hands here to entertain our little Elsa, cook us dinners and babysit so Mason and I could go out!  Hadley sure loves having her Mimi here to play with her, read her books and take her to the playground for extra 1:1 attention.  We went to Frozen on Ice, which as you can imagine was a HUGE hit.  She did.not.move the entire show!  We go back to Charleston Mother's Day weekend for more Mimi and Grandaddy fun at the beach.






Mimi thinks the bottle drying rack is a great place to also dry her wine glass.  It is very effective and cute, so why not?!


Mimi and mommy's photoshoot of Sloane when she was 1 month old. 




Hadley has done very well with Sloane, much better than we all expected.  It took her several weeks to really interact with her, however now she tells everything "That's my baby."  She has nicknamed her Sloane-y, which has really stuck.  Poor girl will be called Sloane-y her whole life.  She's also very observant of what we do with Sloane.  She buckles up Penny and Perro in the swing, tries to balance the bottle on her chin so she could grab her snacks, puts her stuffed animals in Sloane's pajamas, oh the list goes on and on.





First social smile March 21, 2016



Our first trip to Barre class.  Hadley turned our single Bob Stroller into a double stroller, apparently, by making herself a little seat on the front.









Breastfeeding...breastfeeding...breastfeeding.  Well, it's not for everyone and it surely wasn't for me, again this time.  But hey we really gave it a try and I can truly say we tried hard this time.  For 3 weeks, we saw the Lactation Consultant, Joanna Koch at PAMF.  Early on things were going fabulous, she was latching very well and feeding great.  Buuuuut when my  milk came in, boy oh boy did all our problems start surfacing.  I tried EVERYTHING.  Yet again, I have a craaaaazy oversupply producing 70 ounces a day.  Now I have weaned down drastically but at the beginning I was producing enough for multiples.  We tried cabbage leaves, weaning, pumping to soften so she could latch, nipple shields, bottle feeding until everything healed, various medications and hospital grade pumps.  After trying soooooo much, Sloane was feeding about 1.5 hours at a time and it seems she was not feeding effectively because after a hour and a half of feeding she would be super fussy about 30 minutes later and would feed for another hour and a half.  We just weren't able to get things done and she was able to feed effectively with the bottle.  So now I am exclusively pumping again, have a deep freezer almost full of frozen milk (probably over 1,000 ounces stored) and I'm borrowing a wireless small Medela (Freestyle) pump from a friend, which has been a lifesaver, I can now get Hadley a snack, pick out clothes and we can even eat dinner as a family while I pump.  Hadley has really adapted well to pumping as she likes to help hook up the tubes, turn on the pump and play pretend with the clean bottles.  Oversupply and pumping may seem like heaven to a lot of people, but I am not on my FOUTH round of mastitis!  All this milk just sitting in the milk ducts has been a breeding ground for infection, which I have gotten really good at detecting the symptoms early on to get it treated.  Having this many infections truly sucks and is so painful.  I am so beyond thankful to Mason for supporting me as I call him at work in pain, frustration and everything else that comes with breastfeeding/pumping.  Thank you to Susan Booras and Sheridan Ross for also helping me at the beginning as I was trying to navigate how to breastfeed, latch and figure it all out.  Although it didn't work out, I am truly thankful for your help.  

Something I read on a blog while I was going through all this, crying during each feed and on the way to the doctor every week really hit home.  

"We don't talk about postpartum pain, bleeding, stitches, not being able to stand upright, or easily walk around.  We don't talk about struggles of early breastfeeding: cracked and bleeding nipples, mastitis, and worries about producing enough milk."  



And a final update on little Sloane and her Port Wine Stain.  Her first treatment the beginning of March went VERY well and we now have 1 out of 10 treatments behind us.  The lidocaine cream (which you can see in this picture behind the saran wrap) worked wonderful.  The only challenge was trying to keep her hands off her face for 30 minutes.  The treatment was FAST, there were only 50 laser pulses, which only took about 20 seconds total and we were done! Dr. Teng said at the beginning "When I put these protective eye shield stickers on her eyes she will start to cry" as she would not like them.  Whelp, she didn't move or fuss!!! Mason was able to hold her, swaddled in her little lemon blanket and we all got to wear stylish goggles.  She did not react at all to about the first 20 pulses, which were near her hairline/ear and then she started to notice what was happening and started crying, but by that time we were done!  She stopped crying immediately when they stopped and she was so content taking her bottle in the waiting room as we packed up to leave.  We pray the next 9 treatments will go as well, which we go back next week April 13th for our next treatment.  We go to Ophthalmology the end of April to follow up regarding the possibility of eye involvement that sometimes accompanies Port Wine Stains.  So far so good, so we are thankful!!!  "We can't promise to fix your problems, but we can promise you won't have to face them alone."