More from cardiology

Wren was very anxious about the clinic visit today. I am not sure whether it was due to his experience of getting shots at the doctor last week but he was teary and anxious going in. I explained that he could ask any doctor or nurse to stop if he was unhappy about something and must tell me if he was feeling worried so I could help.

Immediately, he said "I am feeling anxious." I asked him what he felt anxious about and he said he was worried about his snack. I reassured him I had snack and then he said he was anxious about going to the doctor.

Anyway, we survived. Once we entered the echo room and lay down to watch Thomas the Tank Engine Wren asked me to lie on the bed with him (as I used to do when he was a baby). I promptly fell asleep on the bed in the warm dark while I heard occasional Thomas music between episodes. Josh and Frost arrived toward the end of the echo which was good timing since Frost had nothing to do but ask questions in the dark and was trying to read Foxtrot by the light of the ultrasound dials.

One interested comment by Dr Lewin has made me feel better. Apparently by this age Wren should be symptomatic if his condition gets significantly worse. In other words, if he is completely asymptomatic there is a chance of relatively stable obstruction. I am not sure I believe this (I want to) but its good to start to think that I could observe any significant deterioration through outward signs.

Nurse Nancy (?) was very kind with Wren and explained how they do "arm hugs". Wren asked "but is it a BLOOD PRESSURE THING?" and she said "yes, but we call it 'arm hugs' because some kids are worried when we call it blood pressure."

They sang the alphabet song to count out how long the machine would take. Wren sang a lot more forcefully once the cuff was released.

About the leg pains which we think are scooter fatigue or growing pains, Dr Lewin agrees. However, he did investigate closely because children with coarcs can present with sore legs due to decreased circulation to the legs. He does not think that is the case for Wren because his arm-> leg pressures are within normal range and his coarc repair looks completely open. He complained of sore legs again this evening and we gave him Tylenol. He has grown 5cm in 6 months so 'growing pains' or at least some muscle aches are a good excuse.

Height: 38.5 inches (75th)

Weight: 15.1kg (67th percentile because they use a different chart to the ped who says hes 50th)

BP arm: 104/50

BP leg: 120/?

I can't recall anything else now. I am trying to read Siblings Without Rivalry but really want to read Regency romances. Its shameful, really. I know. When I read them I don't watch TV so its doing that vegetative thing with my brain. Still, the bathroom is doing well and I can now relax for a few months about cardiology.

Next appointment is in 6 months. Until then, hypnotize your child if they have to lie on a hospital gurney. Don't stand to attention if you hear the national anthem. Your hypnotized child may then leap off the gurney and FALL!

Quick version

Things went well at cardiology clinic. We had the shortest appointment yet - usually 2 hours but this time it was a bit over 1 hour and no EKG was needed.

The main point is that Wren's heart problems are stable. There has been a very slight increase in gradient over the aortic valve - like 44 to 47 but it could be measurement error. Being a bit jaded, I wish measurement error occurred in the improving direction but since it all looked as expected I was pleased.

He has three issues that we will watch. Any one could lead to surgery and Dr Lewin said it is just unclear or unknown which will change first. They are:

• the mitral valve (mild, mod regurg),
• sub-aortic stenosis (tunnel type, no significant turbulence but narrowed
• aortic valve - stenotic, moderate.

Nobody knows how these will change but we remain stubbornly hopeful that he can make it till later childhood for a valve replacement if that turns out to be what he needs.

We ate dinner at Blue C and shared a mango mojito. Those things should grow on trees, really. The tree should be near cardiology clinic.

More later.

Snap

Value Village: $14.95
He wears it better.
Making pasta for dinner. Wren does it HIMSELF!

We realize the new bath is a bit deep :) No fixtures in yet but its been seeing some use.

The custom boxes at the head of the bath: toys, shampoos, magazines [to be cut] and vent.

To distract us from Clinic - Magnuson Walk

Yesterday morning the boys and I joined Tara and her kids for a walk/scoot along the shores of Lake Washington. We parked at Magnuson, near the new wetlands, and walked as far as the off leash dog park (where their pug, Pablo, enjoyed a frolic).

Frost had a fabulous time - Alex was on the Razor 360 bike he got from Santa, which really spins - and Wren managed to go almost the whole distance under his own pushpower.

At the dog park Wren was very anxious but also fascinated. Neither of the boys have had much exposure to dogs and almost none to big dogs. Alex met a friend of Fred's at the park and the boys tried to throw a tennis ball for his dog, a purebread American bulldog. The dog loved the ball being thrown into the lake and swimming to retrieve it but once it was in his slobbery jowls he was loathe to relinquish it.

Frost approached confidently saying "DROP" but its owner pointed out that he had never had any success with that. Frost rose to this challenge, pursuing the dog, demanding it "DROOOOP, drOP, and DROP!!!" without any better results. In the end the owner stuck his hand in its mouth and extracted the ball, time after time.

Here are the boys climbing the tree. Wren was wondering whether the tree "falled down last night?" I said it had fallen down long ago.

This picture shows the ball being extracted while the dog does his best to resist. Wren was fascinated by its testicles, asking "what is that stuff coming out of its tummy?" They were very large and wobbly and will be put to good use this month when it is mated with another pedigreed bulldog!

The boys wait for the dog to return with the ball. At this point they remain hopeful that it will drop it at their feet.

After the walk we stopped at Top Pot Donuts for tea/coffee and sugar+fat. Frost ate his entire chocolate bar donut (which was an exhibit from supersize me) and Wren ate most of his chocolate feather boa cake donut. It took Joshua two days to finish his Bavarian creme but it is now all gone and he is eating Reeses Pieces (sp) instead.

Last night Frost and Josh went out to see some live music at an all ages gig at the Kew Cafe on Magnolia. They were invited by Shawn and Sarah who took London. Frost loved it and told me he read Foxtrot, listened to live music, danced like crazy and ran around (with the lead singer's) kids and London's friends.

I read the nook.

A good night all around :)

Cardiology Clinic tomorrow afternoon

Wren has clinic tomorrow afternoon. As always its a worry. I would hope that his obvious wellbeing and health are an assurance that all is going well with his heart. However, even at his well child checkup I could not dream it was all fixed. His pediatrician let Wren listen to his heart and described it to him as "like someone sawing, ghee ghaw." Wren said he heard it.

An ER Resident once called a colleague to listen, saying it was "like a washing machine."

That's not normal. Right?

Anyway, I am hopeful and its in the afternoon so there is no point in getting all freaked out yet. For our new friends, cardiology clinic is for routine follow-up of Wren's heart defect. Almost all kids with CHDs have cardiology checkups at various intervals. If you have annual checkups you are considered pretty stable. Post-operatively they can be monthly but we have gone from month one, month two, 4 month and now 6 monthly.

At cardiology clinic they do a general well-child check (weight, height, nurse asking questions), an echocardiogram (a long ultrasound of the heart in a dark room while Wren watches TV high on the wall). After that they do blood pressures (all four arms) and sometimes an EKG showing the electrical impulses of his heart.

Finally, there is a nasty wait while the echo technician confers with the cardiologist to ensure that they have the right views and agree on what they are seeing. After that the 'team' comes in to tell you what they have learned. The team includes our cardiologist, the medical student(s) he is training, his nurse and generally another junior nurse. The rooms are not large so its pretty crowded.

We have a talk with the cardiologist and I try and scribble notes and make sense of things in a way that allows me to ask questions and assess whether this is something I should panic over. The big question is always "if and when Wren will need surgery again" probably for his aortic valve.

Wish us luck.

I will post an update tomorrow night while Mum (worrying with us) is on the plane to South Africa for my little brother's 40th birthday! Bon voyage.

Josh will be come to clinic with me but will be late to be here to fetch Frost from the school bus.

Uh oh. Slight weight reduction

Apparently Wren's pediatrician made a mistake on his weight percentile. He is actually 50th percentile for age 3. They had forgotten to enter in his last weight so put the current weight in the wrong age column. He's still doing great being utterly average.

We walked to the coffee shop with Laurie for lunch and I am now readying myself for grouting the window box. I am starting to feel I must get everything possible done with Bill and Judy still here. They are wonderfully handy in everything. There is nothing that has not been done or heard of.

Tonight we are going to Tara and Fred's for "Family Game Night" & pizza. Wren and Frost are excited. I think we will take along pictionary and not one of the more arcane favorites. Frost and I are really enjoying Smallworld which I gave Josh for Christmas.

I have also talked to Laurie about coming for Sunday Roast in February. Perhaps Itea and Courtney could come too - although that would necessitate a rather larger meat alternative.

3 Year Well-Child checkup

Wren had his annual visit to the pediatrician this morning. It was all good news.

In all things not cardiological he is a normal 3 year old.

Weight: 33.5lbs 70th percentile!!!!

Height: 38.5" 75th percentile.

Head: 85th percentile

He has normal eyesight and vision, liver is not enlarged, meets or surpasses all milestones and is a happy chappy.

I was encouraged to Make Friends with some other 3 Year Olds so he has his own friends and not just Frost's. This arose after Wren told Dr L that he liked to play Dungeons and Dragons with "my brother Frost and probably with my friend Alex."

She felt this was not typical play for a 3 year old but sounded fun.

After seeing the pediatrician he had two shots and was full of dread, pain and recrimination. When we returned to the car he asked tearfully whether the nurse had left "those prickles in my arm I think they are still there!"

I assured him they were not but when I lifted the bandaid to prove it he saw BLOOD so that was just as bad.

He is now having a late nap.

Nightus Interrupticus

We had an odd night last night. First, Josh had trouble putting Wren to sleep because of his "sore leg". He has been complaining of a sore leg for a few days. He has had Tylenol at bedtime for the past few nights to help with what we suspected were growing pains.

It was not growing pains but I am going to leave you in suspense for a moment.

At 2am Frost woke us saying he had a very sore tummy. He had been awake since 1am, tried to sleep on the couch, tried to walk around but it was still too sore.

I asked him where it was sore but he was ambiguous - showing various areas on his lower left side and flank. I gave him Tylenol and snuggled him in our bed for an hour but he was still unable to sleep (and so was I) so I got up to google side pain. Because I am neurotic I was thinking appendicitis, obstructed gut, arthritis in the hip etc.

DrSears.com suggested constipation or stiffness from vigorous exercise and recommended a warm bath. Due to the construction and tiling debris in the new bathroom a bath was not possible. I asked Frost whether he might need to poop.

"Oh, yes, I do actually."

At three am we clomped downstairs in the dark, no doubt interrupting Corinna who was sleeping in the basement. Then Frost spent a long time on the toilet complaining that it would not come out. I got the giggles thinking that this was a ridiculous experience and that I had not imagined parenting would look like this when I was single. I think I was in a sleep haze because I only went to bed at 11.30pm due to Nookitis.

Also, part of the reason Frost had this issue was our bathroom upstairs is unusable so he avoids going downstairs because it is time out from playing or reading Foxtrot comics. We are all going through bathroom-absence pathologies. Last night I actually peed in a bucket. I could not be bothered to walk downstairs [if you are not part of my audience able to cope with the idea of peeing in a bucket you can just pretend it didn't happen and is in there for dramatic effect.]

Frost felt better immediately after our basement excursion reached its goal and fell asleep in his bed.

I was unable to get back to sleep. My 15 stitches hurt and I drifted in and out of those strange dreams when you are conscious and 'awake' but the world is subtly altered - for example I had the most gorgeous bird sculpture made out of popsicle sticks hanging from my ceiling and twirling and twirling. Dreaming it turn was keeping me awake.

While lying half awake I realized Dr Sears was right about Wren too. His leg is sore because he has been scooting so much! It is only the leg that pushes the scooter!

Well done, Dr Sears.

The Scooter Movie (at last)

After failing to export the AVI file I have made a movie from the clips and exported via youtube. The boys and Josh are watching a new Simpsons episode while eating the mint infused vanilla icecream Joshua made over the holidays. It is his best icecream ever, by far. I am restraining myself from eating more by eating chips, instead.

The Christmas flowers have wilted and we have dismantled the Christmas Tree and chopped it up for yard waste collection. I always feel a bit sad putting away the decorations and taking down the tree. There is so much excitement and anticipation in the holidays that its sad to feel that we must labor through a year of life before we get to have the cold again. Also, even the slightly milder weather we've been having is reminding me that it will one day warm. I am not ready for sunlight and warmth AT ALL. I have been dreaming of storm watching on the coast and I need many more months on the couch with this Nook thing before summer. I guess I have some time left in the gloom :)

Magnuson Park - Scooters again

Yesterday Wren and I went scootering at Magnuson Park while Frost scooted to U-Village with Elias and Lauren. At Magnuson, they have opened a new area of wetland trails by the playing field construction and I was glad I remembered my binoculars because the area was full of tweeters with spotter scopes and camouflage gear. The object of their attention was a suspected garganey - a rare vagrant from Asia. There was much debate among viewers who thought they saw a band indicating it could be an escapee from a collection. Complicating the issue was the question of identification. Was it a garganey or a green-winged teal variant?

I include the discussion from the Tweeters List at the end (for those ornithologically leaning).

Meanwhile, Wren could not believe the quality of the newlaid bitumen trails. He thought they were paint. He kept getting off his scooter and kneeling down to touch the ground saying "it is paint?" He didn't believe me when I said it was not and kept saying "Its paint? Its PAINT!"to himself as he scootered along.

Scooters have brought a new vocabulary to our mouths. Wren says "I am a good scooterer." I am not sure that is a word but what is better? I am a scooter rider? I am a scootee? I scoot well? None sounds as precise as scooterer so I have entered it into popular parlance by responding "Yes, you are a great scooterer."

"Amazing." Says Wren as he scoots off into the distance.

We scooted all along the waterfront from the boat launch to the bathing area. I also saw a huge flock of greater scaup on the Lake with some bufflehead and common goldeneye mixed in. We have decided to keep a family bird list for the year. Our list yesterday while scootering was:

bald eagle

bufflehead

common goldeneye

merganser

greater scaup

golden crowned sparrow

american widgeon

garganey

american robin

american goldfinch

bushtits

Wren is back at preschool this week. Today he went in his pajamas. It is one week until cardiology clinic and I am starting to veer towards the maudlin with thoughts like:

"Poor Frost, to have a brother who is in such peril. If only he could have a normal healthy brother who would be with him his whole life." [note: Wren acts like a normal brother in all respects.]

"Maybe Wren has paler greyer poop due to liver damage which means his heart is in trouble."

We also have Wren's 3 year "well child" visit in the next week [checking] on THURSDAY and I have a mammogram this week too so we are into all things medical for a bit. I hope all are uneventful. Last year at my mammogram I was alarmed when the technician asked me if I gained weight. Apparently I needed "larger plates". I am now going for a run so as to ensure plate shrinkage this year. If my goal is reached they will be chasing me with little postage stamp plates a year from now!

On a more thrilling note, we had our first BATH in the new bathroom this weekend. It is unfinished but the cabinets have been delivered and the grouting and installation should proceed quickly this week. We all love our bath although I think we slightly overbought (in terms of size). Wren's head is barely visible over the bath rim when he sits upright in the bath and it easily fits myself, Frost and Wren in a shared bathe. I fear our water consumption will not trend in the right direction. Even Josh has been bathing!

Picture later. Run now.

----------------  TWEETER STUFF ON GARGANEY ---------------------------

Tweeters mailing list Tweeters AT u.washington.edu http://mailman2.u.washington.edu/mailman/listinfo/tweeters

Subject: garganey/teal at Magnuson Park
From: "Eugene and Nancy Hunn"
Date: Sun, 3 Jan 2010 11:02:31 -0800

Tweets (long),     Brien Meilleur and I relocated the alleged Garganey (referred to as the "Garganey" hereafter) this morning about 9 AM in the big pond near the playing fields at Magnuson Park and are busy backtracking.     It was certainly the same bird we saw December 29 and that Brien saw on the 31st. It dove repeatedly, was very active, and kept to itself as before. The speculum was conspicuously visible at all times as the bird swam and on several occasions climbed out onto the bank. However, the upper speculum border was not pure white but showed some buffy white toward the body. The face pattern and bill size and color were as we had noted before, but there was a distinct, though quite restricted whitish border to the base of the tail on the outside edge, where on a Green-winged one would find a whitish patch, perhaps formed by the under tail coverts. The throat appeared pale, as is said to be a Garganey feature.     We then went looking for some Green-winged Teals for comparison and found three females on a pond to the east. On these three the speculum was never visible as they foraged, nor did they ever dive, as the "Garganey" did nearly constantly. The face patterns of these female Green-winged Teals lacked the dark shading below the pale bar beneath and behind the eye that is said to be characteristic of the female/eclipse male Garganey face pattern. -These female Green-wings also seemed to lack the pale throat. Two of the three female Green-wingeds showed much more conspicuous white patches at the base of the tail, though the third closely approximated the "Garganey." We also noted that the flank and rump feathers on the Green-winged females seemed much more coarsely patterned than on the "Garganey," and the back feathers showed rusty centers and pale rusty margins, while the "Garganey" seemed much plainer and grayer overall on the back and rump and more finely patterned on the flanks.     At this point we went back to have another look at the "Garganey." We first noted a male and female Green-winged Teal where the "Garganey" had been, but while studying them as they foraged on the far bank, the "Garganey" climbed up beside them and engaged the male Green-winged Teal in a beak wrestling match. During this agonistic encounter we could see the "Garganey's" belly well and it appeared to show a decided contrast between the white belly and the patterned breast, said to be a Garganey feature. The "Garganey" then swam off by itself and resumed diving, the speculum conspicuous as before.     So we are no longer certain about this bird being a Garganey but don't find that it fits Green-winged Teal all that well either. A hybrid is perhaps possible. Green-winged features on the "Garganey" include the buffy coloration on the upper border to the speculum and the pale base to the tail. The inner wing panel is not pale gray like a male Garganey but rather evenly dark gray like a female Garganey or Green-winged Teal, though the upper wing panel seemed pale gray on our first encounter. Garganey features include the face pattern (though it is less conspicuous than most) and pale throat, the conspicuous speculum visible at all times, the odd behavior, including constant diving and an aggressive encounter with the male Green-winged Teal, and details of the breast, flank, covert, and rump feathering and perhaps head and bill shape.      Go figure. I have some more photos which I will have a closer look at shortly but don't expect they will resolve the issue. An odd duck, to be sure.