Thursday, March 26, 2020

When a Loved One is on a Ventilator

In any form of media now, it is common to hear talk of ventilators with the COVID-19 pandemic happening. I have heard stories of COVID-19 patients needing ventilators, hospitals demanding more ventilators, and the race to make more to fill the demand. Ventilators aren't some foreign concept to me, and the frequent mention of them is giving me unpleasant flashbacks.

Perhaps, you have never seen a person on a ventilator. Maybe everything you know about ventilators was observed on Grey's Anatomy. I can tell you that, from my family's experience, nothing can prepare you for the reality of it.

Twice my daughter, Jaycee, has needed ventilator support for a common cold virus called the rhinovirus. Jaycee is medically complex and her multitude of lung and heart problems often result in her needing support in the hospital for illlnesses that others can fight off at home.

Back in 2013, Jaycee was admitted to the ICU for breathing difficulties and pneumonia related to that pesky virus. I remember everything about the night she was placed on a ventilator. She was rocking back and forth in bed, hyped up from multiple breathing treatments, when I implored her to go to sleep after settling into our hospital room around midnight. A few hours later, everything changed suddenly, and I was regretting that my last conversation with Jaycee was begging her to go to sleep.

Jaycee went into septic shock and was later diagnosed with ARDS. She went from needing some oxygen upon admission to needing the ventilator quickly. For 3 weeks, I watched my 7-year-old child breathe with a ventilator.

In 2015, the rhinovirus again created havoc in her lungs and a less sudden need for a ventilator occurred. For a week or so, I sat beside my 9-year-old daughter listening to the hum of the machine breathe in and out for Jaycee.

I am not an expert on ventilators, but I will tell you about what I observed as the mother of a patient from these two events.

I was not prepared for everything that came with the ventilator. Jaycee was sedated while she was intubated. One reason for the sedation was that it prevented her from trying to pull out her breathing tube. With her sedated, we found ourselves in a weird mode where she was there but not really there. We talked to her, reassured her, played music, played her favorite tv shows, and held her hand when she was stable, but it was hard to know what she understood, processed, or heard. Tubes did all of the major work of her body while she slept. There were tubes and wires everywhere! It was a sight that was hard to take in and see.

Then there was the noise from the ventilator. It set me on edge all day and night long. The ventilator wasn't a quiet machine that's portrayed on television. It's noisy. It had a constant hum as it inhaled and exhaled for Jaycee. It alarmed frequently for a few different reasons. If she coughed, I jumped at the alarm it produced. Coughing also typically meant she needed to be suctioned. I hated the sound of the suction and the cough that happened as a result. It makes me cringe thinking about it now. Perhaps, it wouldn't bother anyone else, but it was something that I hated hearing and watching. 

The idea of Jaycee being on a ventilator was simply scary too. In other illnesses, Jaycee had been on oxygen, high-flow nasal cannula, and c-pap support for oxygenation needs. The ventilator is the final stop on the oxygen train. To me, it was worrisome that there was nothing left after the ventilator. In the 2013 event, Jaycee was on the highest support on the ventilator and not sustaining good numbers at different points. Other things were eventually tried (like positioning her on her belly, adding nitric oxide, etc.) which eventually led to improvements. It's scary to see someone struggle to breathe and know that there's nothing else that can be done. 

As for Jaycee, I don't know what the experience was like for her. With her limited communication skills, I don't know what she was feeling or thinking during those times or what she remembers. I know there were moments of discomfort and sadness judging from her body language and tears. 

For her sake, I hope she doesn't remember any of it. I hate to go back to those memories. They aren't pleasant. With all the talk of ventilators lately, I have found myself revisiting some of those memories. I feel for all the people needing them right now and their families. It's not an easy thing to live through. 

There are many opinions out there right now regarding what the public can do to stop the spread of COVID-19. I don't know what you should do, but I know without a doubt what I should do. I never want to see anyone I love on a ventilator again. Therefore, if there are some things I can do to put the odds in our favor, I will gladly do them. 

Be safe out there!
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Saturday, March 21, 2020

21 Things I Love about My Daughter with Trisomy 21

It's March 21st! Happy World Down syndrome Day!

The date 3/21 is World Down syndrome day (WDSD) because it represents the 3 copies of the 21st chromosome that people with Down syndrome have. WDSD matters to me because I love someone with Down syndrome.

Fourteen years ago, I feared Down syndrome and everything it would mean for my daughter, Jaycee, and our family. I felt lost the first couple of years as I processed her diagnosis. I wasted time figuring out how Down syndrome would affect Jaycee. All I really needed to do was simply see her. Jaycee was my daughter. The Down syndrome faded into the background where it should have been all along.

Jaycee is a unique individual who happens to have Down syndrome. She is full of personality, and she gives me reasons to smile daily.

If you haven't had the pleasure of meeting my daughter, then let me tell you some things about her that I absolutely love.

1. She puts things on her head for a laugh. My cup, phone, Bible, and tv remote have all been on her head. Jaycee says, "On my head," as she does it, and then she waits for me to pretend to be mad. I don't know why she started doing this, but it's funny. 

2. "Butt" is her favorite word. It is one of the clearest words she says too. There's worse things to say. 

3. She gives out nicknames that stick. Some of these include: Deer, Daddy Beast, Joel Butt (see number 2), Bubba baby. When I'm mad, everyone refers to me as a mad hippo because of her. 

4. Jaycee has become a savvy clothes shopper. She previously hated shopping in any form. Now, I can't shop for clothes without purchasing something for her. She loves to shop! 

5. Jaycee knows how to use her tone of voice to say 'mom' in a frustrated way. It's funny the things she gets annoyed with that cause this tone to come from her. If I drop something in another room, she will yell out, "Mom!" If I sneeze or trip or make any mistake, she catches it and yells, "Mom!" 

6. She has a "princess pose" for pictures. The pose consists of one hand on her hip and one hand behind her head. 

7. Her memory for some things is completely amazing. She recalls being in certain resturants with people months later. I don't know why or how these memories stay, but they do. 

8. Jaycee has a specific way she wants her hair. Right now, she likes to have a pony tail with a JoJo bow. Her second favorite look is a flower clip in her hair. 

9. Jaycee loves the band Skillet. She hands me the ipod in my van and asks for "illet."

10. She loves Baby Shark too. Skillet and Baby Shark are both pretty important even if they are opposites. These interests show that she has age appropriate ones as well as some developmentally lower interests. 

11. She loves make-up. This developed all on her own, since I don't wear it. She owns more lip gloss, eye shadow, and make-up brushes than I ever have. 

12. Even when things are hard, she carries on. Hospital stays, increases in medications, surgeries, or times of being home bound, she powers through them all. She may have some fears and short periods of sadness, but Jaycee goes through adverse situations like a true champion. 

13. She says the sweetest prayers. Jaycee utters out a mixture of babbles and real words to talk to God every day. She prays for some of her favorite people in these prayers. I feel honored when I am mentioned.  

14. She cares about her friends. She asks about them and is concerned about them if they get hurt. 

15. Jaycee loves to video chat with family and friends. With her limited speech, video chatting is important for the listener to see her gestures and signs. 
16. A few years ago, Jaycee decided she wanted to wear dresses to church. Nearly every Sunday, Jaycee insists on wearing a dress to church. 

17. Jaycee is fearless about amusement rides. While I scream on a coaster, she is all smiles and laughs. Because of her heart condition, she hasn't done the big coasters, but I am sure she would enjoy them if given the opportunity. 

18. Jaycee loves to rub on my fingernails. She takes her hand and gently grazes her fingers across the edge of my fingernails. She has done this since she was a toddler. 

19. My daughter loves to sing. Most people can't make out any of the words that she is saying, but I love to hear her sing. A few years ago, Jaycee was silent, so her singing is such a gift. 

20. Jaycee thrives on routine. This can be good and bad. Honestly speaking, I thrive on routines as well. She gets this trait from her mom. 

21. She loves like no one I know. Seriously, she is the most loving and accepting person. Her loving nature challenges me to do better. I am grateful that I get to be around her love everyday. There are plenty of hugs and kisses in our home. 

On World Down syndrome day, I celebrate my daughter, her life, and the wonderful person that she is. I hope her Down syndrome fades away for other people too, and they can see her. 

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Monday, March 9, 2020

Things I Don't Know about my Daughter

I recently returned home from a lovely 10-day vacation with my family and parents. We had a wonderful time in Florida and enjoyed spending time together.

During one of our meals at a restaurant, there was a heated discussion about bacon. Bacon is pretty important, especially if you are doing the Keto diet.

I like my bacon thoroughly cooked. My husband says I eat it burnt, but I disagree. I don't like it blackened, but I do like it hard and crunchy. On the other hand, my husband eats it chewy and soft. I  struggle to cook bacon for him as I feel I am serving it to him partially raw. He hates "overcooking" the bacon for me. This is one of the many trials of our marriage.

During our discussion on the proper way to eat and cook bacon, my son chimed in regarding his preference. It appears he likes bacon cooked somewhere between my husband and I's crispness.

Then it hit me. I have no idea how Jaycee, my 14 year with Down syndrome and language delays, likes her bacon. Jaycee is a great eater, so she will eat bacon nearly any way it is presented. Yet, I wonder what her preference is. I cook her bacon the way I like it, but maybe she hates it that way. It's hard to know exactly her thoughts on this important subject.

On the last night of our vacation, there was another conversation where Jaycee's contribution was missing. We reflected on all of highs of our trip and debated about which Disney park provided the most enjoyment. We talked about the different rides that were our favorites. Jaycee, with her limited speech, listened to us and smiled.

I asked Jaycee what her favorite part of the vacation was. Her response was, "Gabby."

Her answer didn't make sense because Gabby is her cousin who wasn't even on our trip. Questions are generally hard for Jaycee to comprehend and answer. She does better with questions that require a yes/no response or questions that contain specific choices. I tried that tactic with her but still got no good answer.

I don't know what her favorite part of the vacation was. Who knows if it was meeting the princesses, walking on the beach, or riding coasters? She seemed pretty excited to meet Gaston and has watched the video of their meeting a few times. Was that her favorite part?

Despite these unknowns, there are plenty of things I do know about Jaycee. She shows me her preferences by her actions, behaviors, and words/signs. She asks to call her cousin Gabby like any other teenager. When I gave her some options for her birthday lunch, she answered "spaghetti" consistently. She tells me if she wants to go home or if she doesn't want to go to school. We can talk to each other about many subjects.

I'm thankful for the things she can communicate. I appreciate what we do have in this life. Sometimes, I do wish there was more. There are things missing from our conversations, and certain times (like vacations) remind me of the gaps. Perhaps one day, the gaps will be fewer and fewer.

Maybe in the future Jaycee will pick up her perfectly cooked, nearly burnt bacon and tell me it's horrible. That would be a really amazing day!
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Tuesday, February 4, 2020

The Art of a One-Sided Conversation

I have been monopolizing conversations with my daughter for years. I'm not rude. It is done out of necessity. At age 13, Jaycee is saying more and more words. Still, we can't have full conversations that most mothers and daughters do.

For a good 8 years, Jaycee was nonverbal. During those years, Jaycee communicated with a few words, sign language, and a communication device. During that time of her life, our conversations after school were something like:

Me: Did you like school today?

Jaycee signs: School

Me: Was it fun?

Jaycee: Grunts happily (I interpret as yes.)

Me: I missed you while you were at school. Mommy had to work.

Jaycee signs: Work

Me: We're going to go home and make dinner.

Jaycee signs: Home. Eat.

Jaycee signs: Pizza

Me: No, we aren't having pizza tonight.

There were few questions Jaycee could answer back then. There were no stories she could offer on her own. Getting information from her was next to impossible. Jaycee often repeated back words she heard me say. She wasn't able to express many things out of the blue. If she did, I struggled to understand what she was talking about.

There is an art to having conversations with a child who doesn't respond with many words. You have to know ways to keep the conversation going when words are few from your communication partner. It is possible to converse, but there's not much depth. 

Progress is a wonderful thing. Now, I can have better conversations with Jaycee though they are still mainly one-sided. A typical after school conversation is now:

Me: Was school good or bad today?

Jaycee says: Good (She also gives a thumbs up.)

Me: Who did you play with at school?

Jaycee says: Hope, Mikayla

Me: I'm glad you got to see your friends.

Jaycee says and signs: School. Friends.

Jaycee says: Bubba?

Me: We're going to the pharmacy first. Then, we'll pick your brother up from school.

Jaycee says: Uh-uh (as in no). Bubba!

Me: He's still in school. We have time to go to the pharmacy first.

Jaycee says and signs: Bubba. Home.

Me: First, we'll go to the pharmacy. Then we will get bubby. Then we'll go home. (I hold up a finger as I say each item, so she knows we are doing 3 things.)

Jaycee: Imitates holding up three fingers and babbles in an attempt to repeat what I said.

This is how we converse now. It's not the typical exchange for most teens with their moms, but it's our way. I am happy she can speak more now and not be so reliant on gestures or sign language. I'm thrilled she contributes her own thoughts to our conversations. Our talks aren't completely one-sided now.

When Jaycee was little, I wanted nothing more than to talk with her. I wanted to know what she is thinking and what happened during her day. Even now, I still want these things. However, I am grateful for the progress she's made. I'm happy to get glimpses into her thoughts.

I am also extremely grateful that there are several people in her life that know how to speak to her too. Grandma, cousin Gabby, Aunt Steph, and a host of other people have also mastered the art of the one-sided conversation. Jaycee has opportunities to converse with other people besides me. I'm grateful these people have figured out what questions to ask her and know how to pull information from Jaycee.

After all, Jaycee does have something to say. She doesn't need 30 minutes of non-stop talking like so many of us do. Sometimes, a short sentence and a big, firm hug can speak volumes.

Maybe one day Jaycee will be monopolizing our conversations. I would be thrilled to have that experience!

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Monday, January 27, 2020

Language Delays, Church Inclusion, & Information You Need

Picture this:

There's a young boy with an Intellectual Disability sitting in a children's church. He only says a few words. The teacher at church wonders how he can participate more while he is in class.

There's a young teen with Down syndrome who is very social and enjoys church. The teen is verbal but struggles to understand and answer questions. The teacher at church wants to make sure the teen is understanding their lessons to encourage spiritual growth but isn't sure what to do differently.

While the other children in Sunday school sing in worship, there's a student with little verbal speech standing quietly. The church volunteer would like to see the student participate in worship, but she doesn't know how to encourage participation.

It is a beautiful thing to see people with disabilities attend church. Much like in a school setting, churches often need to make accommodations to make sure these members can learn, participate, and grow in their faith just like anyone else.

At a couple of different ministry conferences last year, I presented a workshop called "Supporting and Teaching Children who are Language Delayed, Minimally Verbal, or Nonverbal." As a pediatric speech-language pathologist and the mother of a child with minimally verbal speech, I was excited to share some ideas and knowledge I have collected over the years.

After my presentation at the Inclusion Fusion Live conference in Cleveland, Ohio, I wrote a few posts for Key Ministry highlighting portions of my presentation. These include:

Tips for Starting Sign Language in Your Special Needs Ministry

How to Develop Prayer in Children with Little Speech

How to Help Those with ID/DD Understand Baptism

On April 24 & 25, 2020, I'll be back at Inclusion Fusion Live. This conference is perfect for ministry leaders, families, and those caring for individuals with disabilities. My topic this year will be "30 Ways to Include the Person with Severe Language Delays." The title sort of sums up my talk, but I'll be sharing ways we can include people with more severe language delays at church during prayer, worship, lessons, fun & games, etc.

As a bonus for reading this today, I'll share with you two of those ways to include those with severe language delays that will be further discussed in April.

#1. Consider having live music for your students. 
A guitarist or pianist is an excellent addition to your worship time (as opposed to CDs or videos) because the musician can adjust the tempo of the music to better fit your students' needs. People who are minimally verbal or struggle to put sentences together can benefit from music played at a slower pace. Individuals with Intellectual Disabilities may process information slower and therefore benefit from a slower tempo. 

If you think finding a musician may be difficult, think outside the box. In our church's special needs class, my 10 year old son plays his guitar a few Sundays a month. He isn't the perfect guitarist since he's young. However, the kids look past his mistakes and enjoy his music. His acoustic guitar isn't too loud, so even those with sensory processing disorder have enjoyed it. He's adjusted the songs so that we sing them slowly. This has allowed singing to occur for the students who were struggling to sing along to videos.

Live music allows you to sing a song a few times in a row. Repetition is helpful for those who need more time to process or learn the words. A musician can also play choruses of songs and omit verses that have verbiage that may be too hard for our students. In short, you can customize your worship to fit the needs of those in your class.

#2. Compile a list of conversation starters for the volunteers. 

Sometimes, the most seasoned volunteer just doesn't know how to begin a conversation with a child who is nonverbal or minimally verbal. At our church, we have a communication chart for volunteers to reference. It lists some things the child is interested in so that volunteers can start conversations and find common ground. For my daughter, Beauty and the Beast, Disney Princesses, pizza, and her cousin Gabby are all listed. Even though she can't have full conversations, a new volunteer can make comments that can connect with the her interest. ("You're coloring with yellow. Princess Belle wears a pretty yellow dress.") 

You may be wondering how to gather this information. When a new student attends our special needs ministry class for the first time, we have a one page paper of various questions to ask parents in order to know how to best support their child. One of the questions is about the student's interests. This is a great thing to know for reward systems and to understand what topics a child may enjoy talking about. Some children may not be able to respond to general questions ("What video games do you like to play?"). But, by making a comment or asking a simple yes/no question about an interest, we may have better success at connecting with the child ("My son loves Minecraft. I like the chickens on it. Do you like the chickens on Minecraft?"). If I know a child likes animals, I may pull up a picture of my cat to show them and start a conversation. Getting the information from the caregivers takes the guess work out for the volunteers. 

At the conference, I'll be giving about 30 more of these tips for churches to foster inclusion of those who are nonverbal, minimally verbal, or language delayed. I really hope to see you there in April!

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Monday, January 6, 2020

2019: The Year I Prayed Differently

Happy 2020!

Like many people, I tend to reflect about where I've been and where I am going when a new year begins. I usually make a mental to do list for the upcoming year that seems attainable. In the past, some of items on my list were: take a vacation, deep clean my house, grow closer to God, make an effort to reach out to others, etc. 

Last year, I felt compelled to do something different. Rather than having a task to complete, I had a "word" to focus on. "Ask" became my focal point in 2019. 

You may feel like 'ask' is a strange selection for a word, but I knew exactly what I was being challenged to do when I got the idea through prayer. First, you have to understand what happened the previous year that preempted everything. 

In 2018, Jaycee, my daughter with Down syndrome and other medical conditions, was in the hospital five times for respiratory issues. The hospital admissions were hard and the recovery at home long. It was a draining year. It wasn't the first year that she was hospitalized so often, which only exacerbated the feelings of stress and anxiousness over her health. 

During 2018, my prayers for Jaycee were mainly, "God, please keep Jaycee from getting sick." Sicknesses like colds or influenza were major threats to Jaycee's lungs. If she could keep the germs at bay, then she would be fine. My prayers reflected that line of thinking. If God could protect her from getting the germs, all would be fine. Once Jaycee became sick, I felt there was little hope that her lungs could fight anything off. Caring for someone with chronic health conditions can lead to that type of thinking, especially when you have consecutive months of health trials. 

My faith was only strong when Jaycee was healthy. I had seen Jaycee in respiratory distress too many times over the span of a decade. It made me fearful and shook any sliver of faith I had when she was ill. We had exhausted all the pulmonary tests and treatments (or so we were told by two hospitals at the time). 

When Jaycee was symptomatic, I spent little time in prayer. You may think that odd, but I was busy. I was managing multiple medications and treatments, calling doctors, and trying to stay on top of her care. I didn't ask God for much help during these trials; I simply lacked the faith or the energy. 

On January 1st, 2019, I prayed something different. I asked God to make Jaycee healthy (as opposed to not getting sick). I must admit, I had trouble even saying the words at first. My thoughts told me it was a crazy thing to even say. It seemed like it would be an absolute miracle for Jaycee to be healthy- without sickness- without hospitals. I prayed her lungs would be healthy. I wrote out a little page and stuck in on my bathroom vanity as a way to keep focused. 

On January 25, 2019, we rushed Jaycee to an emergency room as she suddenly turned blue. Jaycee was discharged after a few days, a relatively short amount of time in the hospital for her. We continued to intensely care for her at home. However, a couple of days later, Jaycee needed to be rushed to the ER again. She had developed pneumonia from RSV, which wasn't caught at the first hospital. (Yes, 12 year olds with crummy lungs can end up with serious repercussions from RSV too!)

Did I want to stop asking for her to be in good health? Yes and no. I knew I would face opposition by praying this way simply by knowing Jaycee's health history. I wish I would have had at least one full month to pray peacefully and develop some faith before the obstacles. However, I knew I needed to go forward. I knew I needed to stretch my faith and speak life over her lungs, now more than ever. I made an effort to pray for her when she was sick instead of going into full "mommy-nurse" mode.

RSV has a long recovery time. By mid-February, Jaycee had more sick days than healthy. Yet, I chose to keep asking on Jaycee's behalf. The more I said it, the easier it became. It also helped me develop faith and look long term for her rather than the current crisis.

The year of asking and having faith for Jaycee started out rocky. She would be hospitalized once again in May. There were a few other illnesses too when Jaycee endured several days of interventions at home. There was no magical end to her health problems. But, a few things happened in 2019 that were game-changers. 

I asked one of Jaycee's specialists about enrolling her in outpatient physical therapy in the spring after she fully recovered from RSV. Low muscle tone is part of Down syndrome and every illness seemed to make Jaycee weaker. I didn't realize just how poor Jaycee's endurance had gotten because it happened slowly over time. I became accustomed to using the wheelchair for most public outings. I accepted the fact that she couldn't lift her legs for more than 30 seconds to shave. After a few weeks of therapy, there were noticeable changes in her. It didn't change her lung status, but it made a huge difference in other aspects of her life.  

In 2019, we made three trips to Mayo Clinic where Jaycee's lungs were extensively tested by them for the first time. As a result, new treatments were added as well as new diagnoses. In some ways, I struggled after our second Mayo Clinic trip in late July. Knowing exactly what was wrong with Jaycee's lungs was frightening. She was prone to pneumonia and we knew why. The best thing for Jaycee's lungs would be for her to have long stretches of health to give them time to heal. It seemed like an impossible task. I was hopeful for the new treatments but also fearful from the information we learned. I continued to pray for her health, but it was harder knowing the condition her lungs. 

In September, I listened during the pre-service prayer to my pastor who challenged us to pray for supernatural miracles. He asked, "Are we praying baby prayers that require no faith or miraculous prayers that only God could answer?" As he spoke, the worship team sang, "Great are You Lord." The lyrics to this song often run through my head during a health crisis: It's your breath in our lungs, so we pour out our praise. The combination of these things happening were a sign to me. Don't fear the future. Continue to ask for Jaycee's health. Step out, be vulnerable, and ask. 

Much can happen in the course of a year. Some things are easy and good, and some are hard. These events can sway our emotions and our prayer life if we allow them. Other events happen that seem small or a shot in the dark. However, they turn out to be exactly what needed to happen. Opposition may come in life but God can also raise people up to provide encouragement if we are willing and available to receive it. Situations in our lives can change. That's why we have to decide how we are going to believe. Our faith shouldn't be changed by events. Our events are meant to be changed by our faith. 

In 2019, I made a choice to ask God for health for Jaycee. I really believe that by changing my prayers I have been able to see a healthier version Jaycee. The 8 weeks of physical therapy helped Jaycee's endurance and activity level tremendously. Deciding to go to Mayo Clinic provided us new insight into Jaycee's pulmonary problems and better ways of treating them. We ended 2019 on a 6 month no hospital admissions streak. Six months! 

Last night, I said a prayer for Jaycee before kissing her good-night. Want to guess what I prayed for her?

Friends, what do you need to start asking God for again?

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