Monday, February 28, 2011

Helping him along

I had to use the suppository. :( Nikko hadn't had a proper BM in 3.5 days. I saw him straining behind a chair. When Nikko saw me bring over the big jar of Vaseline he immediately started to whimper and cry. Poor boy. But I only used half a tablet and I was quick. It was Nikko who seemed to take FOREVER to push something out. I think he didn't push a darn thing out for over half an hour. And when he did, three times, I wasn't crazy with the results. He didn't have one massive, expelling BM. Instead, it was three medium ones with mixtures of soft and liquid poop, each not at a great volume. So now that I've reset the poop clock, I'll have to watch and see how long it takes Nikko to get backed up again. Is that lactulose even helping?? Saturday was the suppository. Today he had somewhat of a "regular" BM but man it stunk up to high heaven. It (and the small BM after it) was/were FOUL. I'll give it another two days of charting before calling the gastro for plan B.

In other news today, Audrey was a complete and irritable brat from the moment she woke up. Ronin wasn't that cheery either. That leaves Nikko with the sunniest disposition of the three. He didn't give me any problems today. I'll count my blessings on that one!

Saturday, February 26, 2011

Emerging No's

2/23/11 - When handing off Nikki to Lisa this morning [at speech], he took her hand easily. When I got down to his level, he said, "bye mommy!" Lisa and I both praised him for that.

2/25/11 School Report - Speech: Naming things in building, kids names, request by color: red car, etc.

Nikko had speech this morning with Karen. While we waited in the lobby, a little boy named Alex (with his grandmother?) had a bag full of toy cars and shared them unselfishly with Ronin and Audrey. They all played nicely with each other, lining them up in the middle of the room, even cleaning them up and understanding that (with reminders from me) they would not be able to take home Alex's cars. What was great about this was later at night, at the in-law's, I was able to remind Ronin about what a good sharer Alex was, and that Ronin could be like Alex and share his toys with Rex. He did.

As for Nikko's session, it was a good one. He put together a puzzle and was able to easily identify the objects on each puzzle piece. Karen did some verbal prompting but tried to encourage Nikko to use his words for things. Last week, I could hear him crying and protesting up a storm because he didn't want to play with a sleigh and she tried to get him to say No Sleigh! This week I could hear him cry again, but not for nearly as long a period as before, and Karen said she was able to get a No Sleigh out of him much quicker. Progress!

The kids had school and then we went to the in-law's for dinner. Nikko has been carrying around a plastic chocolate ice cream cone, burp cloth and two fish (blue and orange) for a few days now. He brought them tonight and ended up getting into skirmishes with Rex because Rex wanted the fish too. I saw a few instances where Rex was chasing down Nikko for a fish, and vice versa. Unfortunately, I had to intervene on several occasions because Rex needed to know that Nikko would be unrelenting in pursuing his fish back. Rex would lose every time. I tried to redirect Rex from Nikko once, but in the end I broke up one bad tugging skirmish at the top of the stairs and then there were no more fish fights.

Note to add: Today was day three of Nikko not pooping. I called the gastro's office and they told me to increase his dosage to two teaspoons of Lactulose twice a day. It was at one and a half. I asked them if I should unplug him now, even though he is not straining, or wait until he is straining to unplug him [with a suppository]. They told me to wait until he is straining because if I unplug him and he is not straining, then the suppository will only get the stuff out right near the bottom while he might have more poop higher up in the intestines. Gee, fun stuff. So I'm hoping that tomorrow, with the increased dosage, Nikko will strain hard enough to actually pass his bowel movement and I won't have to resort to the suppository. I have not caught him straining per se, but tomorrow since he'll be home all day I'll have the chance to keep an eagle eye on him. I have seen him leaning over a bookcase, but if I see it tomorrow with no result then I will help him push things along.

Wednesday, February 23, 2011

Good day for Nikko

2/22/11 - School Report - OT: Doing lots of altering and body awareness activities. Worked on person drawing at wipe off board. At table - worked with mini chalkboard, printing letters in first name - still very challenging.
Speech: I went with Nikko for vision screening with NSSEO vision therapist. He was sad to leave the room. Cried, said "Oh no." Sat nicely & did a good job! Named Ernie puppet. Did close & distance naming square, house-shape and circle! At one point said "ready to go?"


Either Nikko can recognize the letters of his name OR he knows how to spell it by rote. On a piece of paper today I was writing out his name, pointing to each letter. N-I-K-K, what comes next? He said, "Oh!" I'll try it again tomorrow. The concept of letter is becoming very important for me to show to Nikko as of late.

He had a great session with Kathy today. She told me it was his best one ever. He was very focused, too. No complaints = a good session! I think Kathy is his favorite of the three right now, since he's always chanting, "Kappy coming to play."

I had more interaction with Nikko today. He sat by me a lot, gave me lots of eye contact and keeps asking me/baiting me to play tickle games with him. He'd purposefully say, "LOLL-EE-POP!" and then he knows I will say, "No more lollipop, only....tickles!"

As for his bowel movements, I'm tracking them on a daily chart so I can see if a pattern emerges. I called the gastro for our week follow-up and agreed that we should give the lactulose a little longer, to see if a pattern emerges. What I am watching for is more consistency in the hardness of his poo. It's been slightly firmer, peanut buttery as I mentioned yesterday. This morning he had a BM that had some solid pieces, but also watery stuff. No other poopy diapers during the day. That's not great. I wonder if tomorrow will herald more poop, and hopefully it will happen before we go to speech therapy. I wonder if one big blow-out poopy diaper a day is what we're going to get. Hopefully nothing's getting impacted again, but I really need a few more days to see what happens. I think 1-2 poops are considered "normal."

Monday, February 21, 2011

Constipation alert / Birthday Party

********TMI ALERT************
I thought we were in the clear without the miralax. It's been five days off of it and Nikko's poops were becoming the consistency of peanut butter again. The poopy diapers had whittled down to 3-4 a day.

Until today.

Nikko had two diapers that had poop smears, the first one being barely any, the second one at the end of the day being peanut buttery but not a big amount. He had mostly wet diapers today. That's not a good sign right now. It could mean he is compacting the poop and could get backed up. He's still on 2 teaspoons Lactulose a day, so I'm hoping that will help push the BMs along, like the one that produced the last poop diaper tonight. But Nikko also seemed to have gas, and possibly some cramping today. I saw it. I'll describe it in a minute, but the fact that these side effects are happening isn't sitting well with me.

OK, back to our regularly scheduled program.

I took Nikko to a birthday party for his classmate Timmy. It was at the YMCA and it was really busy. The party took place in a gym upstairs with two party rooms, a rock wall (we didn't use that) and a huge tunnel/climbing/slide apparatus. Nikko loved it, even though he initially got stuck and wailed for me so I had to help fish him out. After that, he was all over it. When we first arrived, I noticed that the parents just dropped off their kids and left. The hosts were friendly and the dad told me if I wanted to leave I could certainly come back later. I then explained that Nikko had autism and because he had speech challenges it would probably be better for him if I stayed. The dad was cool with it, and was very friendly to everyone. He even treated Nikko just like one of the boys. I was able to talk to Tommy's mom at length, because she stayed for a bit. When it was time to have pizza, Nikko was pretty hungry and seemed to fit silently at the table. The other boys around him were very chatty At one point I thought I smelled Nikko pass some gas so I tried to subtly check him. He was dry. Then he moved from sitting to hovering over the side of his chair, bent over. I think that he might have had a cramp at this point because he uttered a moan and then his eyes filled with tears. At that same moment, Timmy's dad had walked by and noticed but remarked jokingly about something. Nikko looked like he had a bout of pain, but then the moment passed and he sat down to finish eating. They distributed cupcakes and Nikko ate the chocolate frosting on his. Nikko was eager to get back to the climbing apparatus so I let him. He had shed his socks and then later shed the band-aid that was protecting his heel. All in all, Nikko had a fun time in a gross motor kind of way. However, he didn't interact with any kids. They swarmed around him, some said Hi to him, but Nikko was obviously on his own. It made me sad to see him oblivious to all the kids. He was like the loner kid at a party, or at the playground, or really... anywhere.

I hoped that Nikko's activity would make him tired, but he didn't nap. He went to bed and then around 1a he had a nosebleed. I heard him cough and something about the cough made me go check on him. Sure enough, there was blood dripping from his nose. I wonder what is causing it besides the dry humidity and temperature changes around here.

Friday, February 18, 2011

Lactulose, 2 days

2/16/11 - School report - OT: Good session. Did lots of alerting, movement and deep pressure inputs. then worked on name printing at wipe off board, cutting and drawing at table. Less vocalizations today.
Speech: It's a______, household items, verbs, requesting, verbs.


Wednesdays are our long days. It was also my birthday on the 16th. I had a packed schedule: Speech, home for kids' lunch, then off to mom's house w/Audrey for real lunch, then home before the boys, then ABA w/Rebecca, and finally dinner with everyone. It ended up being a calm day, but a little harried when getting to Speech. Because we arrived just on time, the parking lot was full and we had to trek a ways down the business complex parking lot. Nikko had a good session with Lisa, but was upset when he came back into the lobby and we weren't there. We were in the bathroom changing Audrey's diaper. I heard crying from behind the door and let them in. I guess a change in the routine really upset Nikko, go figure. He was able to sing happy birthday in unison with his siblings at some point during the day. I don't think he napped at all, so he must have been tired by day's end. Rebecca said his session was good, but he's still testing her.

2/17/11 School Report - Bathroom: Nikko had loud and foul smelling gas today. He had a small amount of soft poop. He cried and bent over while on the toilet. It seems like his stomach was very crampy.
Speech: I took him after the bathroom - so was not happy. Crying, screaming. He finally calmed down by singing. Good job with food vocab. 1-step directions.


Ugh.

That was, unfortunately, disturbing to read. I wonder if it was the Lactulose. It's totally possible, and since we have a four-day weekend (School Improvement Day on Friday, no school Mondays) I'll be observing Nikko closely. I remember how he passed gas two days ago and it was horribly stinky, the worst I had ever smelled, and it lingered. The part that makes me worry is the crying due to possible cramping. Definitely listed side effects of the Lactulose.

But...

At lunchtime Nikko decided to eat the Tortorice's pizza from last night. I have to scape off the top layer of cheese, onion and ground beef, and he'll eat it with just the sauce. Maddening, because that pizza is my favorite and not cheap. After I cut him off, after three adult-sized pieces, I had some for myself WITH the toppings. Nikko accosted me at the kitchen table and obviously wanted more. I cut him a small, bite-sized piece and gave it to him. I noted that I gave him a piece with the cheese on top. Nikko really hasn't had a large amount of dairy in a long time, since we started miralaxing his juice last summer. So a small part of me wonders if his reaction today was to the cheese. Well, maybe it's unfounded since he has cheese sandwiches often. Maybe he ate too much pizza. Maybe I'm just hoping it's not the Lactulose. Geez.

Monday, February 14, 2011

Sick (me)

I felt the beginnings of a sore throat last night. I went to bed with a headache, too. For the first time in ages, none of the kids woke up in the middle of the night. However, I proceeded to wake up at each hour of the night because my throat hurt so badly. I think the opening in the back is swollen and when I lie on my back in bed, the tissues get blocked. I had to lie on my side, but I kept waking up and that irritated me so much. I have a temperature and the chills, and I slept so poorly. My parents were going to come watch the kids while I took Nikko to the gastro this afternoon, but Denis kindly decided to work from home today. It was Valentine's Day. He took the kids downstairs to play after breakfast so that I could catch some zzzzz's in the living room upstairs. And when I took Nikko to the gastro, he stayed with the other two. It was a relief for me that he was around, and I am grateful. :)

We arrived on time for our appointment but the gastro was running at least a half hour late. When she finally came in to review our records, she noted that with me changing Nikko's diapers 8-10 times a day (literally from 9-10a until 7p, sometimes twice an hour), she said that it looks like the miralax isn't working for him and that he's not at the state she'd like him to be. That state, when I asked, is having 1-2 bowel movements a day, with sizable poops, not necessarily formed but liquid is ok, too. On the miralax, he was going too frequently and subsequently that's why she said it's not working for him. (Note to add: when using lesser doses of miralax, e.g. 1/2 or 1/4 capfuls, he would become constipated over the course of a few days and then I'd see him struggling to pass a bowel movement. That's when I'd have to use a suppository.) The doctor gave me two choices: mineral oil or lactulose (generlac). The mineral oil was syrupy and she asked if he'd drink something like that, maybe with chocolate syrup or with yogurt. I said no, because his tastes shift so often. She opted for the lactulose, at about 2 teaspoons a day to start. She said we need to start somewhere, to form a baseline, so at the end of the week I should call her office to see how it's working and then we can tweak the dosage for the rest of the month. Nikko ate many lollipops in the office and got whiny when the nurse took us to get his weight and height measurements. He also whined when the doc put the stethoscope to his chest and poked at his tummy. Overall, however, Nikko was a champ.

Saturday, February 12, 2011

Warnings

2/11/11 - School Report - Speech: Worked on household vocab. Very imitative today. Said "I don't know" on his own 2x. Requested "Twinkle" again. We were looking in the mirror and I was trying to get him to say Nikko & Ms. Winters. He imitate Nikko. I said Ms... he said "Kathy!" Too funny. Worked on boy parts, greetings, I see a____. For love item he said "Bow Wow" when I asked the name!

I got a call from Nikko's teacher giving me a heads up that before Nikko got on the bus going home, he had a big blowout in his diaper. They pulled him from the line to quickly change him, and he got upset. This was probably because he didn't understand why he wasn't being put on the bus right away. They were just warning me in case Nikko was still mad when he got home. The bus arrived (it's been arriving ten minutes later than usual because the original bus was in for repairs and this older bus doesn't have five-point harnesses. Instead the straps are over the shoulders and takes more time to buckle in) and Nikko was fine. His eyes portrayed that there were some possible tears but overall he was happy. Nikko has been treading carefully on the pavement lately, avoiding the icy patches and opting to hop from one dry cement patch to another. Safe boy.

This evening I was picked up by Patrick and Jovy and went to see Rory's school play where she had a lead part and a solo. I had prepped Audrey and Ronin about going to the in-law's house to celebrate a birthday and play with their cousins, and luckily they both adapted to my mentioning not being with them tonight. However, Nikko seemed to only hear key words such as "Going. Later. Nice night. Have fun." That all meant the same thing: MOMMY IS LEAVING ME. He was not a happy camper and erupted into tears, trying to put on his socks faster than I could put on my boots. I still walked out the door but knew they would all be all right. When we returned three hours later, we pulled into the driveway right behind the returning Pilot. Everyone was happy to see that I was there, and I aptly put the kids down to bed.