Synagis with Emla tomorrow

Tomorrow afternoon Wren is scheduled for his Synagis shot. I have a tube of prescription cream from our pediatrician which is to be used an hour before the shot so it does not hurt.

The information I received from the pharmacist was "apply 1 hour before the shot".

Ho hum.

I read the online instructions and it appears to be more complex. I am to apply ONLY to the spot that will be used for the injection. I should apply a dollup and then seal the area with an occlusive dressing so Wren does not mess with it. I should not allow the medication to be in contact with the skin for more than 4 hours - so effectively once the time for the shot comes I should wipe it off and clean the site so the cream is removed.

The shot is scheduled for 2.30pm-3.30pm

Wren naps from 12.30pm - 2.30pm

When can I apply the damn cream?

I guess I should try and get him to nap early, ask the nurse to confirm her arrival time around midday and then put the cream on based on the most current information. I also need to aquire a big bandaid that seals a bit better than our scooby doo ones.

Ugh. I wish it was a bit easier.

Wren had the shot(s)

Nurse Penny came to our house yesterday and gave Wren his Synagis shots. He weighs 27lbs 9oz which means he needs 1.8ml which is two shots. After reading Jeanette's (Grace's Mom from our support group's) articles on pain management I am asking our pediatrician for a prescription for the topical pain reliever to minimize discomfit during the shots. They are particularly large ones.

The Synagis protocol takes about 30 minutes. They have to weigh the child, check vitals, draw the vials, administer and then wait 15 minutes in case of a very very rare anaphylactic reaction. Wren had no reaction other than to check it was "all done!" Then he was happy. Last night he gave his bandaid to dinosaur at bathtime. New Dinosaur is Very Long Dinosaur and since the bandaid had a little blood on it from the shot "new dinosaur has owie on neck. Has BLOOD!!!!" The "has BLOOOOOD" was repeated a few times until he was "all better".

Do it like a crane
Wren really impressed me this morning. Not only did he sleep through the night for the first time ever... (8pm till 6.15am) but he helped himself to a drink from a sports bottle by his bed. When I went in in the morning he told me "I get it [the water] like a crane" and demonstrated with his arm how he reached over the rails to get it. I shall have to leave it there in future and hope he doesn't splash it around the crib. He always makes sure snuggle-bunny gets a drink when he does.

Mommy is in Therapy
I went to see 'my' therapist this morning. She is a buddhist 'psychotherapist' so we focus on ways of being and identifying what is arising. I haven't been to see her for over a year and it was nice to pick up again. My hope in going to see her is that I can figure out how to get from being a full-time mommy to having some of my own needs met by working part-time. My homework for the next few weeks is to do "open-ended" research into local non-profits with an international focus which is where I would like to work next. She helped me identify lots of reasons why I find it hard to start AND some ways to overcome them by making this into a research project [=happy and exciting] rather than a test of self-promotion [=bad and tiring].

Playgroup for Wren
I am very excited to have some offers of playmates for Wren. I am going to see if we can work out a time to play with some friends from our heart support group and perhaps a couple of toddlers we knew from our old playgroup. Wren is not going to know what to do with children under 4 years old!

Synagis or No Synagis?

I drove through the remains of last night's snow to take both boys to the pediatrician today. Frost had a plantar wart frozen off and Wren had his 2 year check-up. Wren is doing well in all the Normal Baby things. He is developing normally in all areas and was ahead of the curve in his ability to jump up and down on the spot. He also understood all the pediatrician's instructions to "lie on your back", "roll over" and "take big deep breaths now" which pleased her a great deal.

Stats:

• 36.5 inches long = 90th percentile
• 27 lbs 9 oz = 45th %tile
• 19 7/8 " head circumference = 85th %ile
• hematocrit normal (11.8 up from 11.3 pre-surgery)

Here is Frost having his wart frozen while he squeezes Wren's raccoon.

Shots
On the way to the pediatricians Frost was begging to have a shot himself. He said that if he could have a shot he could show Wren it was OK and how to do it. I was a bit taken aback by this but when we came into the doctor's room he asked again. She checked the chart and found he did need a shot - his Hep A booster and Hep B (one of those I refused early on).

Frost had his shots first and managed not to cry, just to say "ow" rather plaintively while sucking vigorously on a candy-cane I gave him as an incentive during the nitrogen-freezing of the wart.

Wren received Hep A & B and varicella (another I had refused for Frost until Wren's CHD). Wren was very sad afterwards and said "go home, all done, get dressed" in one breath. Thankfully it was all done.

The Synagis Question
On our cardiologist's recommendation (Dr Olson) we had asked our pediatrician to order Synagis this year. Apparently the recent surgery and the ongoing haemodynamic disturbance meant that Dr Olson feels "he could get pretty sick" if he contracted RSV. Synagis is made from immunoglobin and each shot (for a 2 year old) costs around $4,000. He would need 4 doses this year.

This is the status of the application:
1) December - applied for insurance coverage for Synagis.
2) Cover REFUSED (December 10th)
3) Appeal placed by pediatrician (on my request). Cardiologist submitted requested evidence.
4) Insurance said approval on appeal UNLIKELY. Ped notified cardiology about refusal and asked "how far to push the appeal."
5) Card responded that since he is now 2, we need not push all the way.
6) Discussed with us and we decided no Synagis - Wren would be OK without it. Ped suggested we avoid big crowds of children and regular LARGE playgroups to reduce risk of RSV and respiratory problems.
6) Today, insurance faxed APPROVAL for 4 months of Synagis. Ped very surprised.
7) Ped notified Card about what to do. He said emailed "good. He should get it "he could get pretty sick if he gets RSV."
8) Ped notifies us and asks what we want to do.

So, my question is "Shall we order Synagis for Wren?" Its been approved but he may not need it. He IS 2. It is painful. It is very expensive [for insurance]. I shall have a talk with Joshua and make a decision. I think our insurance will cover home-help doing it (which means they send a nurse to give him the shot at home rather than visiting a clinic) which is much less stressful for all of us.

Socialization
Apparently the one area our pediatrician would like us to do something is in Wren's social life. She noticed that he is very social and wants to make sure he has some interaction with peers (other toddlers). He tends to run around with nerf guns and knows Indiana Jones, Transformers and Batman so she is probably right in asking if he has babies to stack blocks with. She suggested we set up a small playgroup at home rather than join a preschool playgroup to avoid the germiness of big playrooms. I shall see what I can figure out. Any toddlers want to play with Wren? He plays well and we can put away the shark guns.

Dentist
We have also been asked to set up a first dentist visit for the next 6 months. I have an amoxicillan prescription for a prophylactic in case of a tooth cleaning. Its to avoid endocarditis. Apparently early cleanings are a good idea to reduce build up of the kind of bacteria which can cause heart infection later on.

PS.
Here is the snow last night!