December 19, 2011: A Day to Remember Forever for the Liningers

What a year for our family.

December, 19th, 2011 :  The day we got the official news about Savanna.  It was a day filled with anxiety and nervousness.  Savanna had been through a lot in the last few days and we as parents had learned a great deal about her probable condition.  We were just waiting in the hospital on a Sunday afternoon, as we were told the doctor(s) were finally going to talk to us.  Then it happened.  Almost out of the blue, a team of doctors came in mid-afternoon.  Leading the way, and the only one who spoke was Dr. Mary Zupanc.  She said to us, “You have to mourn the loss of your normal child.  She is gone.  You need to start to prepare yourselves for what may be a very long and difficult journey.”  She went further to warn us that “90% of all marriages with a special needs child like Savanna, end in divorce.”  We didn’t know anything about anything at that point, and we later learned she was new to the CHOC family.  Her employment was the beginning of a new direction intended to make CHOC a leader in the pediatric neurology field.  The only cases she handled were refractory or intractable (severe & rare) in nature.  I don’t think we fully realized what that meant at the time.  It wasn’t until much later after the ACTH therapy, after the necrotizing pneumonia, after multiple LTM EEG’s, the installation of a permanent G-Tube, that the denial had worn off and we began to grasp the magnitude of our situation with Savanna.

Looking back, we could not have been more blessed than to be admitted when Dr Zupanc was overseeing the EEG monitoring at CHOC.  The Dr. reading the LTM patients EEG results alternate and Dr Z has the 1st and 4th week of every month.  Had she not been there, we might be in a very different situation.  She taught us just how catastrophic the seizure activity was for a baby of Savanna’s age.  More importantly, awareness of how critical it is to arrest seizures in children under 2 by any and all heroic action available.  Not acting aggressively can mean the difference between very different outcomes in development.  If you have read any of my recent posts, you know that this is not a widely accepted principle in neurology.  God was watching Savanna, and while the situation was bad, we could not have been in a better facility in terms of care for her specific needs.

The EEG report from the VTM ending on December 18th read, “possible lesion on left temporal lobe”.  Here we are about 11 months later recovering from epilepsy surgery where a cortical dysplasia lesion was removed from the temporal-parietal-occipital region of her left hemisphere.  For me personally, it is a day of reflection about what we have been through and how far she has come in such a short time.  I have taken the time in the middle of the night to go back through some of the pictures and the emotions of that day 12 months ago and many memories are still very vivid in my heart.  Some memories have faded.  Some memories I wish I could change by having behaved differently at that time.  However, trying to grasp the realities of the situation was difficult, almost impossible until we had a chance to live through it.  It reminds me a lot of the birth of our first child.  Many of you can relate to this.  You prepare, read the books, etc.  But some things you just can’t learn until the baby is delivered and you have a chance to experience it first-hand.  For many, it changes life dramatically.   Savanna has changed our lives by educating  us about how typical life is such a miracle.  A few statistics surrounding her journey from December 19 2011 thru December 19, 2012.

·         57 typical RX scripts filled, total insurance billing, around $25,000

·         14 Specialty Drug RX scripts totaling $164,000

·         Total processed health claims for Savanna, $798,000

·         Total processed health claims for the rest of family was an additional $85,000

·         90+ days in the hospital with Savanna, 14 days with Tristan

·         60+ hours on the phone during the second half of the year with the insurance company and service providers when Anthem’s system began filing Savanna’s claims under Austin when we went onto Cobra.  This resulted in many denied claims, and a waves of collections against us as the bills began accumulating quickly.

·         Gratitude that we have been financially fortunate and were both able to work and save for a “rainy day” prior to this experience.

·         Empathy for the 1000’s of families facing similar situations who cannot possibly be as fortunate as we are.

Savanna is not free of epilepsy, but seems to be free from the very disruptive seizures the were halting her development and assuring entrance into the contingent of Lennox-Gastaut sufferers.    Dr. Nitin Tandon performed the surgery and his office billed our insurance company $9999.00 for his services – of which his office collected a payment of $3292 from our insurance company.  It is an unbelievably small amount of money for such a far-reaching, life-altering procedure.   Compared to other types of surgeries, the cost versus benefit is off the chart and that is really an unfortunate reality.  That translates long term to surgical talent that is less likely to choose a path of epilepsy surgery expertise when they can make 5 or 10x as much money performing elective spinal fusions for example.  The vast majority of patients like Savanna are misdiagnosed and do not have the opportunity for such a procedure so early in life.

The changes in our lives as a result of Savanna’s birth have been significant.  We relocated our family.  I resigned from the workforce temporarily to manage and guide her care.  Rebecca took a new position in GE, and is dealing with a frustrating work environment that won’t allow success.  We contracted as a family earlier in the year, as we began to face fiscal challenges once foreign to us.  We are contracting again at the end of 2012 in light of the increased tax burden undoubtedly being put on our shoulders.  This situation has altered our financial planning which we once thought was sound.  Action has been  required to stay solvent, and these lessons will be passed on to our children.  Direct medical expenses related to Savanna’s care were a fraction of the total listed above, but the soft costs not directly attributed to Savanna’s condition were and are enormous and never seem to stop.  I have arrived at an understanding of why families earning far less would simply give up and let their neighbors pay for it through a vehicle called Medicaid.  We will never in our lifetime pay in Medicare taxes equivalent to what Savanna’s care cost during her first year of life.  To simply entitle ourselves to this presumed benefit is morally and ethically wrong in our opinion.  Regardless of the schooling, we will without fail teach our children that there are better ways to help those in need than government programs.

Watching our daughter suffer, tested our resolve.  It was so difficult, that I honestly believe death would have been easier to deal with during her most difficult periods.  Experiencing her seizures was like anticipation of imminent death for me.  There was a bit of numbness that developed as at some level you can only handle so much before your body just simply starts to shut down emotionally.  Writing this blog in many ways is one of my few outlets as I work through my personal emotions with words.

December has been a little tough as we had a confirmed case of RSV in the house in early December, and guess who it was, of course, Savanna.  While we were worried about complications, she managed to pull through it well.  Austin and Brandon probably had it too, as they were really sick for about 10 days.  Tristan managed to head it off, but did have a few sickly days.  Rebecca and I both got it too, eventually, but it turned out to be pretty light in terms of effect on us.  Savanna had a swallow function study on the 11th, which is where they determine how well she transfers thick and thin fluid from her mouth to her esophagus.  She did great with no signs of aspiration.  We started to push the post-oral feeds and she is doing well.  Then she developed a UTI, and that was really unpleasant for all of us.  Through this, I undoubtedly witnessed seizures with Savanna.  At some level, it was to be expected.  I increased some of her medication, which slowed the downward titration, but managed to keep the seizures at bay.  As of the 19th, everyone is healthy.

Moving forward, Savanna is doing good with her physical therapy and we will be adding speech and occupational therapy in the coming weeks.  We will undergo another LTM/VEEG January 16th so see if she is experiencing any abnormal brain activity or seizures in a 24 hour period.  Once off the Keto diet, which will be early January, she will have an overnight sleep study to make sure she is maintaining oxygen saturation levels.  We will switch from Sabril to a conventional AED (anti-epileptic drug), which she will be on for at least 1 year post operative as a standard protocol.

So here we are, on the cusp of another trip, contemplating the feasibility of traveling with Savanna.  We have enough drugs to manage almost any seizure related situation.  I have called ahead and know where the diagnostic equipment and expertise resides in Louisville.  All indications are that we are headed back to Louisville for Christmas for a few days.

Our heartfelt thanks go out to all of you who express interest enough to read this and follow her journey.  Your thoughts and prayers have not gone unheard, and God is speaking through Savanna.  From our family to yours, we would like to wish you a Merry Christmas.

Best wishes

-dad

(Ken Lininger)

Rebecca’s comments and commentary –

As we look back on the words Dr Zupanc chose, and the candid and the direct manner in which she delivered them, we now realize how fortunate we were to have her deliver these messages to us as directly as she did.  We’ve recounted this story a number of times, and those who love us most have had the immediate reaction to have wanted to protect us from the perceived lack of bedside manner.  It was the hardest thing we’ve ever had to hear.  But, truth was necessary.  It was necessary to prepare us for what lay ahead.  It was necessary and the kindest, gentlest decision that Dr. Z made to let us know that we would face a very tough road, and that if we didn’t cling to and look out for each other and our marriage, that we too could easily be one of the 90%.   Over the number of times Ken & I have looked back on this experience as we have gone through the trials of parenting under these circumstances, I believe we found extra patience, kindness, and support for each other, and I am grateful for her wisdom & candor.

As proud patriots and active fiscal conservatives, it has been interesting to face the challenges of health care costs first hand.  Ken is adamant that he would sell everything we owned before we asked a neighbor or stranger to pay a single cent for our health care.  We are fortunate enough not to require assistance at this time.  Commentary:  It’s not the very poor, or the very wealthy that are crushed by medical expenses in our society, it’s those in the middle, making $50K – $300K / year.  The poor receive better medical care than those of us with the best insurance money can buy.  Those in the middle can truly be crushed.  We have stayed on top of every bill and every insurance submission.  We have been adamant that we pay to the doctors what is contractually fair.  Even with this vigilance from 2 masters degree engineers who have held executive positions with top companies, we have seen a number of threatening letters regarding delinquent account status, as the collection companies & the insurance companies figure it out between each other.  Ultimately, it is straightening itself out, but we wonder what the impact on our credit rating of all these mistakes and poor coordination between the insurance companies and the service providers.  We were able to prepare for this, and we made strategic purchases in advance of this step into financial quicksand, but there should be some way to help the average family who faces this experience.

In our liberal government’s infinite wisdom, President Obama has taken away one of the true benefits to special needs families, by far one of the cruelest tax hikes hidden in Obamacare.  He has reduced the amount of money one can save by using a flexible spending account from $5K to $2500 effective in 2013.  This may not seem like much to many of you, but at a 25% federal tax bracket, that’s the cash equivalent of a $625/year tax increase.  To us now, and many of the families we’ve met through this experience, it means the difference between being able to pay for therapy for their child or respite care for themselves or not.  To reiterate the point, the very poor and well-off won’t be affected by this change, only those in the middle who actually implement the shelter.  This is one of many egregious hikes hidden in Obamacare known by many, talked about by few.  Simply put, President Obama intends to pay for his single largest entitlement plan in the history of entitlements in the history of the world on the backs of the very people he claims to be helping or targeting for this entitlement.  It is without doubt the greatest fleecing of America in her history, and very sad to watch it unfold.

We trust that you will continue to place your votes based on your own personal beliefs, but we’ll make a modest request to you to ask that you please look deeper than the marketing hype when casting your future ballots.  Please challenge our politicians regardless of party to address the root cause of expense, waste, & ineffectiveness in our government, whether the issue is health care, social security, Medicare,  Medicaid, education, immigration or other.  We are the greatest nation on earth, and there are Christian solutions to the problems we must solve together as a nation, if we will only hold our leaders truly accountable for being problem solvers and choosing to advocate & implement real solutions vs. just their marketing, lies, & hatred of the opposite party.

When we addressed the meager amount that our neurosurgeon’s office had settled for, we learned more about the healthcare situation in our country.  He indicated that less than 5% of the children who are candidates for radical life-changing epilepsy surgery like Savanna’s ever even find out that they are candidates.  There are only a hand full of pediatric epileptologists in the country who could have diagnosed a case like Savanna’s properly.  The reason for this is that the real money in medicine goes to other specialties like orthopedics and procedures such as spinal fusion.  The insurance companies base their reimbursement rates on Medicare.  Medicare bases its reimbursement rates on lobbying.  Medical device companies & pharmaceutical companies have much stronger lobbies than the epilepsy foundation.  A surprising statistic that he shared  with us is that 80% of back surgeries are unnecessary, and 60% require a 2nd surgery within 10 years after the 1st.  Yet these surgeons are paid 10X for each back surgery than neurosurgeons are paid for truly life changing surgeries.  That is not to say that no back surgeries offer positive, life-altering results.  But, reimbursement rates should be based on successful outcomes, not lobbying.  The most cost-effective healthcare programs in the world work on this basis.

I don’t share this with you to make you hate or judge big pharma, medical device companies, or Orthopedic surgeons.  We passionately advocate capitalism, and we are so grateful to big pharma that they had the money to invest in the many drugs Savanna has needed and will continue to need.  They will never recover their investment in many of these medicines, yet they continue to develop them at a loss, based on their guiding principles.  I share it with you, because it is facts like this that cause our best & brightest not to choose to go into neurosurgery unless they have a driving personal passion to do so.

I’ll leave you with one final thought.  My prayer during this journey has been simply to our Lord to “carry me” and to carry Ken.  This comes from the depth of my soul as I recount a poem that I read frequently as a little girl.  Many of you are probably familiar with the poem / prayer “footprints”, if not, I’ll recount if for you here:

“One night, a man had a dream.  He dreamed he was walking along the beach with the Lord.  Across the sky flashed scenes from his life.  For each scene, he looked back at the footprints in the sand.  He noticed two sets of footprints, one belonging to him, and the other to the Lord.  When the last scene of his life had flashed before him, he looked back at the footprints in the sand.  He noticed that during the saddest and most challenging times in his life, he saw only one set of footprints.  This really bothered the man, and he questioned the Lord about it.  “Lord, you said that once I decided to follow you, you would walk with me all the way.  I have noticed that during the saddest times of my life, there is only one set of footprints.  I don’t understand why when I needed you most, you would leave me.”  The Lord answered, “My son, my precious child, I love you, and I would never leave you.  During the hardest times of your life when you see only one set of footprints in the sand, it was then that I carried you.”

There have been so many times throughout this journey that I haven’t even known what to pray for.  I have simply prayed, “please carry me God”, and He has.  May He carry you, when you need it.  May He send angels to you to guide you and share your path.  May we not question His purpose, yet continue on this journey supporting each other.

Last year, when Savanna was first diagnosed, my sister in law, Kenia, and my parents gave up their Christmas to come be with us.   Dad went to church, and the priest said something that will always stick with me.  He didn’t say, have a Merry Christmas, he said, have a Blessed Christmas.  That is what we wish for you, a very Blessed Christmas.

To leave this post on a lighter note, Mom, Dad, & Kenia joined me for Christmas Eve service with the boys last year.  As we were leaving, Dad pointed up to the sky and asked Tristan if he thought the bright red light up there was Rudolf’s red nose.  I’ll never forget Tristan studying the sky, then looking back at my Dad, Grandpa Squiz, and candidly saying, “That’s an airplane, you idiot”:)  It was rude, but admittedly hysterical.  Ken broke Savanna out of the hospital on Christmas day and we were together.  My friend Thuy visited us shortly thereafter.  If you don’t know Thuy, she’s not the warm, fuzzy, emotional type, but she’s a true friend.  It’s hard to know what to say to someone like us who had just experienced what we had, but she said, “No matter what, Savanna will be loved.”  It was truly comforting, and she was right.  Savanna will always be loved and she’ll be loved more fiercely, and in a way I never could have imagined before this experience.

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Seizures, Seizures, and more Seizures

Savanna was discharged from the EMU at TMC on August 22nd after a bizarre EEG report indicated seizures with an onset in the right hemisphere.  This is not what we had seen to this point, and it was truly devastating news.  If confirmed, this would mean that the issue with her brain was not confined to the left hemisphere, and the surgical option may be off the table.

Savanna was not on phenobarbital, but now on Keppra, and still on Sabril.  She was still having complex partial seizures, but no cluster episodes or events that required intervention.   We were in a wait, watch, and see period again.  We were given a script for the diazepam rescue medication, to be used when she won’t stop seizing.  This in and of itself was a bit scary.  Her doctor was on her way out of the country to France for about 2 weeks.  We were told of her limited availability and the reins were handed over to her Fellows with oversight coming in the form of overnight email communication.  No back-up partner or pediatric epileptologist on staff meant few people available to make the difficult decisions to help her in crisis.  We had no idea how much of a headache this would be for Rebecca and I over the next 2 weeks.

On Thursday, August 23, the situation seemed manageable.  She was very sleepy from all the activity and this was normal presentation after EEG equipment is removed.  We witnessed a few seizures, and at that time it was of great concern to us but we couldn’t do much about it.  Rebecca and I were already contemplating the future, second guessing our decision to be in Houston, trying to re-engage her doctor in Orange County, CA.  I was the lead on choosing this particular doctor, and I was feeling like I made the wrong choice.  Internally, it was really starting to bother me.

Friday the 24th, Savanna had a really great day.  Her demeanor was wonderful.  She smiled, laughed, and was engaged at times.  Then she would have a seizure and our hearts sank as it took our breath away.  We were very concerned, and wondered if this may really be the new normal.  We were not ready to accept this paradigm shift.  We noticed as the afternoon progressed, she became increasingly agitated.  That night, this agitation grew to inconsolability and we were up with her the most of the second half of the night.

Saturday the 25th, she just would not stop crying and screaming.  It was exhausting for everyone involved.  We clinically could not determine if she was even having seizures due to her extreme fussiness.  When she would finally tire out and sleep, the big kids wanted to play or do something that Rebecca and I had little energy for meaningful participation.  We noticed Tristan’s level of comprehension had increased as we tried to explain Savanna’s condition.

Sunday the 26th, was a really difficult day.  Savanna would just not stop crying.  She was rigid with her body, would not take feeds anymore, and was completely non-responsive to Tylenol or Ibuprofen.   We were not even able to hold her she was so upset.  She had to stay in her crib, in a bouncing seat, or on the floor.   We contemplated the next direction with respect to her care as we did not feel it was going well.  For a moment, we were lost.  Our natural instinct was to take her to an emergency room at a hospital.

[Sidebar:  It was Sunday, and we knew we could not to go to any emergency room as they were unable to help her due to the complexity of her case.  Emergency departments exist to stabilize a patients with immediate life-threatening situations.  Despite the catastrophic damage happening to her brain in terms of development, Savanna was not in an immediate life-threatening situation (as long as she wasn’t in status).  As parents, we felt her future capabilities were being threatened by her continued uncontrolled seizures.  This is how it was explained to us in the beginning of this journey.  Her condition and presentation was changing rapidly.  Without the presence of our doctor who could directly admit her to an EMU, the only way to permeate the membrane surrounding in-patient services is through the Emergency Department.  But, many people use the ER as their primary care, and thus it can be a concentration point for a wide variety viruses.  Illness can greatly reduce the seizure threshold for someone like Savanna.  This is a subject I have thought a great deal about, and there should be another ‘way in’ for someone like Savanna.  Recognizing these factors, we decided to manage the situation at home with the medications we had on hand – right or wrong.]

Monday, August 27, we consulted with the Fellows on her team, and the conversation resulted in re-starting the phenobarbital as they felt she may be experiencing symptoms of withdrawal.  We administered the medication, watched, and waited.  Monday night seemed to go better, but by Tuesday midday, we felt confident that phenobarbital withdrawal was not the problem.   Under their advisement we, took her into the ER on Tuesday afternoon.  I was told she would be a direct admit (meaning we would check in to ER and then move immediately to the EMU). Tuesday afternoon, I packed our suitcase and headed for the hospital feeling anxious but relieved that we were going to get help managing her situation.

Once there, a fiasco ensued.

I thought we were headed to the EMU, but the ER personnel didn’t get the memo and started a complete work up for infection and injury.  They had plans for a lumbar puncture and CT scans with contrast of her head and neck.  Complete blood panels were drawn, despite the fact that this was just done a few days ago.  I thought we would be admitted to the EMU, and she would get help right away.  Wrong.  Once again, nothing I said mattered.  Patients like Savanna are few and far between.  I could hear the conversation out of the room simply dismissing my assessment and presentation of her history and physical condition.  They were actually going down a path that Savanna was having febrile seizures, which meant provoked seizures brought on by high fever – not epilepsy.  She didn’t have a fever.  She hadn’t had a fever in months.  There was one particular attending physician, who recognized us from the visit during the prior week.  He was the only one who knew even a little bit of the magnitude of the situation and finally stepped in to change the course of care.  After two attempts, one of the nurses was successful at installing an IV.  But, Savanna was clearly altered and in state of wild hysteria.  I simply could not hold her or control her at this point.  She managed to get the end of the port in her mouth, and with only 2 teeth on the bottom jaw pulled the IV out, tape and all.  Yes, blood was everywhere.  She was having seizures all the while during this activity.  Finally, they decided to install ambulatory EEG equipment, and they observed complex partial seizures, but she was not in status.

While they attempted a 3rd IV start, she started a cluster of seizures that lead to one seizure where she simply did not come out of it.  She laid there limp, almost like she was dead.  After 4 minutes, I told the nurses we had to stop for a moment – they agreed-, and I administered my first dose of diazepam.  I was sweating at this point.  She remained in a state of seizure for a solid 2-3 more minutes.  A nasal injection of versed was administered.  Finally she came out of it.   By now it was around 8 pm and the on-call neurologist made his way to our area.  I felt like he understood the situation better than most as he had a lot of experience with babies even though his focus was on older children now.  After a consult with her previous neurologist in CA, the plan was to optimize the Sabril dose, and sedate her in a controlled and scheduled manner.   It finally felt like she was being helped.  Then, like releasing a fish back into the water, he vanished.  I was never able to talk to him again that night.  She was finally admitted to the in-patient ward at around 12am.  The plan was to administer scheduled Ativan for sedation.  Initially, they were going to give her .5mg every 8 hours.

We went up to the ninth floor of Memorial Herman Hospital in downtown Houston in the middle of the night.  This is not where you want to be as a parent of a patient like Savanna.  We might as well have gone to another hospital.  After an hour of presenting her life story, again, to the attending pediatrician on the floor, they attempted to start another IV.  They failed.  Then I was told that without the IV, they would not administer the Ativan.  I found that really inconsiderate with regard to Savanna’s care given what we had been through and her condition.  The Valium (diazepam) was wearing off, and she was really inconsolable now.  Padding had to be added to the inside of the crib to keep her from hurting herself.  After another hour or so, I could sense another large seizure episode and when it started, I did not wait to use the diazepam this time.  I administered it quickly so she didn’t have another 10 minute seizure.  I also provided relief from the seizures for about 4 hours.  After being berated by the attending pediatrician for administering it myself 5 hours after the previous dose, I knew it was time to go.  Help just seemed far away until the pediatric epileptologist was back on the case.  The attending pediatrician was intent on letting her seize for at least 10 minutes before helping.  They didn’t even have diazepam prepared on the floor.  It was completely negligent in my opinion.  This was simply not acceptable to us after what we had learned that past few weeks.  Her presentation during her complex partial seizures was a-tonic and for a baby that simply looks like she is sleeping.  I actually had heated exchanges with that attending about the seizures and she simply didn’t want to listen.  Savanna had seizures while I was talking with that doctor, and she simply did not agree.  I knew we had to get out in order to get help which seems completely counter-intuitive.  But, we had more ability to get medication outside the hospital in this case.  Our plan was to get her home, get the Ativan, and administer it at home and deal with consequences.

Wednesday August 29th, Savanna was discharged and had a significant seizure event that required intervention.  I did see the Fellow on her case, and he indicated they were going to give us a script for Ativan that we would administer at home.  He also agreed the situation was less than ideal.  We received a seven day supply of .5mg pills (one pill per day).  Friday night we got the script filled and used it for the first time.  We were nervous about using them at first.  They did seem to provide Savanna some relief to the agitation and anxiety she was experiencing.   [Over the next 2 weeks, when her epileptologist was back on the case, we would give her 9mg per day and some days 18mg in an attempt to manage the seizures.]

Thursday into Friday September 1st, were all about the same.  Savanna was not happy, and having at least 75 seizures per day.  We started charting each event, looking for a pattern.  I was spending at least 30 minutes out of every hour sitting and watching her.  It was overwhelming.  I felt like I couldn’t do anything unless she was right there in visible sight.  Andrea’s capability was reduced to simply just sitting and watching her for about 6 out of her 8 working hours.  Frequently, we would see a cluster pattern, and have to administer diazepam.  It became a very intense situation.

Saturday September 2nd, she was the same, but Rebecca really got a chance to witness big events.  It was devastating to her.  The situation seemed completely out of control to us.  We decided to take her to the ER, against all out loud conversation about what we thought would happen.  We were banking on our doctor being reachable by phone now, as she was supposed to be back in the country.  It turned out to be a bad bet.  Anyway, once at the ER, another idiotic waste of time began.  I actually had a conversation face to face with a young neurologist, whom I asked this question, “If your child was having five to ten uncontrolled seizures per hour with the history of my child, would you sedate your child heavily?”  He responded, “Yes, but I won’t sedate your child. It is not in our protocol.”  At that moment he walked away, and I knew again we had to leave if we couldn’t get into the EMU.  It was a waste of time to be there.  I was communicating with Rebecca during this, and we could not have felt more lost as parents at that moment in time.  Out daughter was having 5-10 seizures per hour, and we could not access services that would be helpful.  It wasn’t just perplexing, it was unbelievable.  Meanwhile, Rebecca’s Dad was on an airplane coming to help us.  After further consultation with Rebecca, we decided as a last resort to try Texas Children’s ER and see if we could get some traction.  I got Savanna out of the Memorial Herman ER and drove the 1/2 mile down the street to the Texas Children’s hospital. (Yes, they are all in one place in Houston.) After 4 long hours, it became clear that they were not going to help either.  They didn’t even have a neurologist attending, only on-call.  That went nowhere.  Rebecca and her Dad arrived in the ER around 1am, and a near argument takes place between Rebecca and I about Savanna’s care.  These are really difficult times and we each have our moments where we think we know what is best.  Once we heard the on-call neurologist recommend no changes to her care and to come see him in a month or so, I knew we were definitely in the wrong place.  Waiting overnight to see a neurologist that was only going to say the same thing in person the next day, wasn’t going to help either.

At this point, what do you do as a parent in this case?  I invite all of you in the medical field to chime in and tell me where we went wrong.  Tell me how to getting help for our daughter would have been easier.  We are on our knees begging for help, yet no one is listening.  We seriously contemplated catching the next flight back to CA to have her original epileptologist take her care back over.  We called CHOC and they said they would admit her immediately, but strongly advised against flying, as she could die if she went into status, and emergency care was not immediately available mid-flight.  We asked if it was possible for our former epileptologist to direct her care from CA at a hospital here, but that’s just not the way these things work (due to the potential for liability).

We were exhausted and desperate.

Admission to the EMU on Tuesday September 5th, could not come soon enough.  Savanna’s doctor is back in country and on the job and we could be more relieved. I knew we just had to gut it out until then.  These are really difficult learning moments in life.  I commend Rebecca’s Dad for stepping in to help, but it takes time to absorb seeing a baby in such a condition.  While we know it was overwhelming at times, he was very helpful and we thank him for his sacrifice.

Sunday September 3rd, was more difficult.  We got a much needed refill of diazepam at the local CVS and felt like we could make it to Tuesday.  We had a conversation with our doctor and she was prepared to admit her to the EMU over the weekend, but also said she would not be there to manage her care.  Tuesday September 5th, was now the scheduled admittance, as Monday was a holiday.  We have come to dread the holidays, as these seem to be the times when Savanna needs the most help, and yet the resources to help her are least available.  Savanna was to start the Keto-genic diet that week as a last resort to control her seizures.  Rebecca and I were contemplating our choices and what would be best for Savanna.

[Looking back, I made a mistake.  Not having all of her official records in one place, and ready for review wherever we went, was a mistake.  A person at the Hospital in CA recommended we do that, and while I had many discharge notes from hospital stays and pediatrician notes, they really did not tell the entire story.  Since then, I have acquired all of the official neuro output notes, lab results, test results, EEG reports, MRI reports etc.  I have parsed them into separate PDF files and make sure they go with us everywhere.  While this may or may not have altered the course of history, it could not have made it worse, that is for sure.]

She was not stable and traveling was against all doctor’s recommendations.  Her doctor was still away in France and just not reachable in a reliable fashion.  We mulled the decision on ‘what to do’.  Starting over with another group was more or less out the window after a lot of discussion.  Diagnostically, they would accept the records, but would without doubt want to run their own sets of tests.  Rebecca and I started to realize that Savanna may need surgical action sooner than that schedule would allow.  We spread out our medicine on hand, even if just mentally, and I told Rebecca I felt like I could make it back to CA with what we had in terms of rescue medicines (assuming I could get her on the plane).  Savanna was having 5-10 seizures per hour now, and we felt completely helpless.  This was when we really realized how special her doctors were, and how few of them were spread amongst the population.   We decided to gut it out, watch the seizures, and go with the advice of our doctor here in Houston.  Formal second opinions would have to wait until she was stable.

We did our best to stretch the medications, but Tuesday around 1am, we administered our last dose of diazepam.  We were out of Ativan too.  We had exhausted our medication cache, and we were out of options.  The only responsible place to could go was to the EC at MH.  I packed her up and we took off for the emergency center downtown.

Once there, even though we were on the list for admittance, I still had to go through the EC.  The poor nurse taking triage information had no idea what was coming.  I was so infuriated after 30 seconds of answering her check box questions that we got into an argument.  After I told her that I just gave her 1mg of Ativan and 5mg diazepam to stop her seizures 2 hours ago, she proceeded to ask me if Savanna had ever had seizures.  Steam was coming out of ears, and thank goodness a doctor intervened, and moved us to a room, because I was about to unload on that poor person.  It was such a pointless act of futility but one that must take place during each EC visit.  You are at their mercy and they know it.  The doctor understood, and once we had a 1 minute conversation with him about what we had been through, the amounts and types of medicines she had been given (at home), that was the end of our hassle in the EC.  No other person bothered us with the exception to make sure we didn’t need more medicine, until it was time to move to the EMU.  I thanked that doctor for simply listening to me and taking me seriously.  Even though he himself was not a parent, I think there was genuine empathy for Savanna’s situation.  His professional common courtesy and respect for my knowledge of Savanna’s needs was refreshing.  I am certainly not a doctor, but I have become an expert in her general daily care and management.  At 3 in the morning about 2 weeks after the start of this ordeal, I finally felt like we were on a path to getting some help.  It had been a really long and difficult period in which our respect for pediatric epileptologists grew immensely.

We really just didn’t take a lot pictures during this period.  But, I do have a couple of iphone videos that are interesting.  One shows our oldest boys, Tristan and Brandon, as Daddy is at the house in the morning getting ready to head down to the hospital and take over for Rebecca.  We were sending Mommy a video text to let her (and Savanna) know we are coming.  The second is a rare moment during this time period when suddenly she seems ‘okay’ or at least a little happy.  We are in the EMU, 2 days into the Keto diet and on 9mg of ativan per day (that is a lot for a little baby) in this video.  It doesn’t entirely fit with this post, as I have not written about this stay just yet, but I have to put up something 🙂

-Mom and Dad

Ken and Rebecca Lininger