Thursday, March 31, 2011


I have an enormous headache and not a lot of energy to think all this through today.  Bullet points, it is.

  • After consulting with neurology, radiology, and the cardiac team, we've decided that we will wait to close Keegan's PFO for another year or so.  He is a bit too small for a closure via cardiac catheterization right now.  Although it poses a risk to him, we don't think another event like this will happen.  If we start to notice any clotting issues, we can reassess, but this particular combination of events shouldn't happen again.  We are anticipating that we can have the PFO closed at the same time as one of his annual heart cath/biopsies in the next year and a half.
  • So far, his blood cultures have not grown back anything.  There are indicators in his blood that he is fighting something, but his fever has broken.  He hasn't shown any other signs of something else being wrong, so for now, we wait.
  • We are hoping that this round of antibiotics will not further aggravate his GI issues or bring back the c-diff infection.  We may culture for that tomorrow because we want to aggressively treat it, should it make a comeback.
  • He has been awfully pale and lethargic today, but he perked up this afternoon after a quick trip outside to get some sunshine.  Hoping that's a good sign!
We are praying that it is an uneventful next 24 hours, and then, we can go home for good this time.  Thank you for your outpouring of prayers and kind words.  We really needed to hear them, and you have helped lift our burden.  Thank you, friends.

Wednesday, March 30, 2011

MRI details

Long day today.  Keegan had an MRI and MRA of his brain performed around noon.  He handled anesthesia well and came back up to the room around 2pm, only to be shuttled back off for an echo and bubble study of his heart about 30 minutes later.  He ended up not needing the bubble study because the hole in his heart was clearly obvious on the echo performed first.  Here's what we found out late this evening.

Keegan had a mini-stroke yesterday, a transient ischemic attack, to be precise where an air bubble, not a blood clot, made it's way to his brain, temporarily shutting off oxygen and blood to the part that controlled his left side.  (We believe that his entire left side was actually affected by this event, but we didn't ever stand him up during the episode to know for sure.)  The air bubble then moved on to a more minor area of his brain, where we saw it on the MRI results today.  The neurologists believe that the air bubble will eventually be absorbed by his blood stream, and he shouldn't need further intervention to resolve it.  They don't anticipate that he will have any long-term effects from this event.  However, it does indicate a bigger problem, namely how that air bubble made it to his brain.

I don't have this all down 100%, but this is my understanding so far.  As I mentioned yesterday, we have known since transplant that Keegan's donor heart had a patent foramen ovale (a small, intermittent hole between the atria of his heart).  It usually is not a problem; in fact, almost 30% of the American population has some form of a PFO without ever knowing it.  The main complication of a PFO is a much higher risk of strokes.  We believe that at some point yesterday, an air bubble was accidently injected into Keegan's port while we were trying to save his line.  His port is venous access into the side of the heart that pumps out to the lungs, so in a normal heart structure, this bubble should have gone to the lungs, creating a pulmonary embolism.  But in a perfect storm of events, the PFO hole allowed that air bubble to cross to the other side of his heart, where it was pumped out to his brain. 

God absolutely, positively has His hand on Keegan.  That's the only explanation as to how this large air bubble by-passed the more critical parts of his brain without causing permanent damage.  The bigger question now is what to do to prevent this from happening again.  Obviously, if he didn't need central access, the PFO would not generally be a threat to him.  Since we know that he will need long-term central access for IV nutrition, infusions, and blood for the foreseeable future, the PFO presents a very large risk of this happening again - whether with air, a clot forming on the port sheath and breaking off, a build-up of TPN or lipids breaking off, or a clot from coronary artery disease.  (I have mentioned before that the grafts where Keegan's new heart was patched to his old arteries are extremely prone to plaque build-up.  Heart attacks are the leading cause of death in a heart transplant patient this far out, but strokes are another huge risk.  Keegan's stroke risk is now exponentially higher with the PFO open.)

Tomorrow, neurology and cardiology will consult with each other and with the cardiothoracic surgery about the necessity for and logistics of closing the PFO via surgery.  We anticipate that this can be achieved through a heart catheterization, rather than open heart surgery.  Generally, PFO closures are performed on adults, so we are primarily concerned with determining whether Keegan is even big enough to have this stent procedure. 

All of that would be something we should otherwise be able to do on an outpatient basis.  Except that Keegan spiked a high fever late this afternoon.  Blood cultures were drawn and now the 48-hour minimum waiting period begins.  If the cultures stay clear, we should be able to go home by late Friday evening, unless the heart cath could be squeezed into the schedule faster inpatient.  If it grows back with a line infection, it will be a week or more of inpatient treatment.  Obviously, any surgeries would be delayed until after an infection is cleared.  But honestly, we desperately need them to come back negative. 

I don't know about you, but my heart and my head are about ready to explode.  Why must my beautiful little boy have to go through such trials?  Gray and I feel extremely blessed that this was addressed quickly, that we have an answer, and that Keegan is ok.  But other than that, we are defeated.  I have no more words left to describe what our family is going through tonight.  I just ask that you join us in prayer for Keegan's strength, safety, healing, and courage.  There is nothing more I could possibly ask of you.  Thank you so much.

Tuesday, March 29, 2011


I'm struggling to write this update because I really can't believe we're sitting here once again inpatient.  Yes, inpatient, and I really don't even want to put into writing why.  We are waiting here overnight for Keegan to have an MRI and MRA tomorrow morning to make sure he didn't have a stroke this afternoon or have a blood clot somewhere.

This afternoon, Keegan had a speech therapy appointment at Baylor Our Children's House in Allen at 1:30pm.  His TPN and lipids weren't supposed to finish until almost 3pm.  I was trying to get the kids out the door to therapy and grabbed Audrey's diaper bag (without saline and heparin flushes), thinking what could possibly go wrong in the 45 minutes we would be gone.  (Cue the suspenseful music now.)  Halfway into his therapy appointment, the TPN pump started alarming.  I open "monkey" to find that the pharmacy had underfilled it, and the bag had run dry a full hour and 15 minutes ahead of schedule.  I was a little nervous but figured his lipids were running at just a high enough rate to keep the line open and not clot until I could get him home to properly disconnect him.  But then the lipid pump started alarming that there was a problem on the patient side of the pump, which I still don't understand what would have caused it.  Anywho, this all means that I was about 15 minutes from home and 20 minutes from the Legacy campus with no way to keep Keegan's port from clotting off.

I called the transplant coordinator once we were in the car and was told to go straight to the ER.  Of course, let's add insult to injury I'm getting Keegan and Audrey out of the car in the rain, his g-tube extension gets caught on the carseat and pulls the whole thing clean out of his stomach.  Now we have blood and stomach contents everywhere, getting rained on, Audrey's crying, Keegan's crying, yadda yadda.  At least we were already at the ER! 

(**Quick aside: Anyone who has ever had a child on a feeding pump will be amused to know that in my haste, I did not stop or clamp the pump.  I just ran/shuffled into the ER carrying a 30lb child, a 16lb child in an infant carrier, a diaper bag, and the monkey roller bag full of pumps.  It wasn't until a good 10 minutes later that I realized the feeding pump was now covering my car floorboards in yummy, elecare formula.  Yeah.)

Long story short, we got a new g-button in without having to dilate the stoma.  His line wouldn't draw back blood or flush, so we reaccessed his port with a new needle.  It had blood return, so we thought all was well.  Gray met us at the ER, was able to take Audrey to my mom, and we all breathed a sigh of relief.

The ER attending told us she was going to get our discharge papers ready and walked out.  I handed Keegan's clothes to Gray, asked him to get Keegan dressed, and stepped out to use the restroom.  As I walk back in, Gray is telling Keegan, "come on, just put your arm in the shirt!"  He then realizes that Keegan can't move his left all.  We ask him to clap, and he weakly slaps his right hand at his useless left hand.  We ask him to do "touchdown", and only the right arm goes up.  At that point, I run out and call the attending doctor and nurses that we need help.  They start testing him in different ways and still nothing.  After about 6 minutes or so, he slowly started to regain use of his hand.  No one bothered to look at his face or legs because we were too freaked out about his arm.  After a few minutes, he seems to be perfectly fine again, but everyone in the room looking at him was clearly not ok.  A quick portable chest x-ray shows his lungs are fine, so what the HECK just happened??

One phone call to the neurologist on-call, and we're told that Keegan needs a full stroke work-up immediately, which includes a head CT and a full MRI.  The CT can be done at Legacy, but because of Keegan's cardiac history and the need for general anesthesia, he will need to be transfered downtown for the MRI.  Again.  The head CT was done quickly and seemed clear.  We arrived downtown onto the neurology floor (seriously...I think this child has a secret agenda to test out every floor of this darn hospital!!) by 6pm.  Other than being thoroughly exhausted, he seems pretty normal to us.  We've finally gone over everything with everybody, and Keegan will have the MRI done tomorrow, along with an echo of his heart and a probably a bubble study of his line.

It's pretty unlikely that he had a mini-stroke.  It's also pretty unlikely based on the anatomy of his line that he has a clot that broke off.  HOWEVER, his donor heart did have a small hole called a PFO.  It hasn't been noted on his echos for the past year, but it may still be present intermittently.  (Since Keegan's heart is not his own, it's REALLY unlikely that the PFO closed on its own.)  Again, it's all unlikely but still a possibility.  And let's be honest.  If there is going to be a bad or rare complication, Keegan is going to get it. 

We are truly just blessed and relieved that this happened in the ER with so many people around to witness it and act quickly.  I was exhausted living through this afternoon and now, I'm even more exhausted typing it all back out.  So if you could, we'd love for you to join us in praying for the following:
  1. Clean MRI results, and if anything, a clot that can be easily dissolved.
  2. A quiet, restful night for Keegan.
  3. Peace and resilience for Audrey.  She was so confused being rushed into the ER, nurses descending on Keegan, him screaming, Gray rushing in and rushing her out, and once again, being shuffled off to my parents' house.  It's just all a lot for a little girl to handle in the last 5 months.
  4. Strength and patience for Gray and me.  I hate to even ask for it, but I don't think I can deny it anymore.  This afternoon was probably the scariest thing we've dealt with since seeing Keegan go from completely normal to complete kidney failure in 48 hours just 3 short months ago.  It's all just getting to be a bit too much.
We do not have a time for the MRI yet, but we will update throughout tomorrow to Twitter and Facebook.  We just can't thank you enough for your love, prayers, and support.  We don't know why Keegan is being tested once again, but we have faith that He will make it glorified in His time.  Thank you for joining us in that prayer.

Now faith is the assurance of things hoped for, the conviction of things not seen.
Hebrews 11:1

Monday, March 28, 2011

Heart Walk

Information from Aunt Alex on our team, K's for Keegan, for Keep the Beat, the 1st annual It's My Heart walk to raise awareness and funds for congenital heart defects:

Hello Friends,

It’s My Heart is a non-profit organization created to provide support to and advocating for those affected by Acquired and Congenital Heart Defects. Through awareness, resources and education, It’s My Heart creates alliances and networks among families, groups, hospitals, and the community.

Lake Dallas High School is hosting a 5K on Saturday, April 2, to raise money for It’s My Heart. My family and I aren’t going to be able to walk the event, but we formed a team of "cyber walkers". This basically means we register for the race and can fundraise, but our shirts will be mailed to me. I would then, obviously, forward them on to each of you.  You can help in one of three ways:

1.  If you want to cyber walk, you can sign up under our team, K’s for Keegan.  You can register online with our team as a regular walker HERE.  Then, be sure to email me at to let me know you registered as a cyber walker and with your tshirt size.  I will let the race contact know to send me your t-shirt.  Please note that there is no actual option to "cyber walk".  The race administrators are doing this just for us.  You will be registering as a walk participant online, and then, we will forward our list of cyber walkers to them.  **Great idea from our friend, Lauren: Register as a cyber-walker, then go out and walk 3 miles in Keegan's honor on Saturday morning wherever you might be! 

2.  You can also just donate to our team. Click HERE to make a general team donation that will go towards reserach for congenital heart defects and support for children battling them.

3.  Go get some exercise and actually WALK the 5K!  We hope that maybe by next year, Keegan will be well enough to come out, so we can have a real team of walkers.  Again, you can register online via the same link above.  And please do let us know if you are going to walk! 

We've barely even started fundraising, and we're already the second biggest team!  You can help make a difference!  As always, my family greatly appreciates all the support you have shown Keegan and us! Please feel free to email us or call with any questions you might have.  Let's log some K's for Keegan!!

Thanks again,

Sunday, March 27, 2011


Technically, we've been home since last Wednesday evening, so I suppose this update is about four days overdue.  Trying to adjust our schedules and keep up with Keegan's medical issues has kept us pretty busy since we arrived home. 

Keegan is doing okay.  Could definitely be better, but I know it could be worse.  I know one day he'll die of humiliation from me talking about this, but it's the truth.  His diarrhea is becoming even more of the clear mucous that we saw a week ago and more frequent.  He has an appointment with his GI doctor tomorrow, and I'm 99% sure that at least the c-diff will come back positive tomorrow, if not the rota too.  (If you have to ask how I know that, your child has never had c-diff.  Consider yourself lucky.)  Keegan is still getting only 10cc/hour of half-strength elecare through his g-tube, approximately 8 ounces per day, and he gets 16 hours of TPN and lipids per day.  He is only taking water by mouth during the day.  Until about 2pm everyday, this is what he deals with:

Formula in the pack on his back.  TPN and lipids in the rolling backpack (aka "monkey").

Keegan is getting pretty good at keeping "monkey" with him at all times.  Probably has a little to do with me yelling, "take monkey with you!!" about 1500 times per day.  Today was much better than Thursday, but he still forgets it too often.  If you're not paying attention, you'll find him stretched to the limit of the curly tubing and paralyzed by how tight he's gotten himself wound up.  Remember that line goes directly to a needle in his chest.  Not exactly comfortable.  He is a resilient, strong, smart little guy though, and each day, he has figured out ways to do what he wants despite the limitations.

I wish I had the energy and clarity of mind to fully express everything that I'm dealing with and feeling lately.  Frankly, I just haven't come to grips enough with it to put it in writing and out for the world to see.  I'm tired...physically, mentally, emotionally.  I'm angry, disappointed, and full of grief.  I want Keegan to get a break.  Heck, I want a break.  I can only imagine how he would feel if he knew the extent of all he is dealing with on a daily basis.  Yet, that one thing, above all else, helps me move forward each day.  The fact that Keegan has no idea what he is missing.  He has no idea he isn't perfectly normal.  He knows that he is home, surrounded with the love of his parents and sister, and that for now, he has a few extra pumps to carry.  But he's not going to let it get in the way of his fun.  My son is amazing.  Stronger than I could ever hope to be.

I have a lot to catch up on here.  Audrey had her 9 month doctor's appointment.  Alex has an exciting opportunity for us to help raise awareness and money for congenital heart defect research.  Keegan has more appointments and therapy this week.  We are getting in a groove here, and I will try to be better about updating this blog. 

This life is a marathon, not a sprint.  We might be hitting a wall, but we'll keep running.  And we appreciate your continued support and prayers that we can keep going day in and day out.  Thank you so much.

"Let us run with perseverance the race marked out for us,
fixing our eyes on Jesus, the pioneer and perfecter of faith.
For the joy set before Him, He endured the cross, scorning its shame, and sat down at the right hand of the throne of God.  Consider Him who endured such opposition from sinners, so that you will not grow weary and lose heart."
Hebrews 12: 1-3

Tuesday, March 22, 2011

Wrapping up

It looks like we're wrapping up this inpatient stay, although not nearly in the positive way that we would like.  Ideally, the doctors don't like to send patients home on TPN, but we're not really in an ideal situation here.  Gray and I said over the weekend we would push to go home at 12 hours of TPN.  The attending physician said this morning that Keegan could very well be on TPN for another month or more.  We were simply not willing to wait that out within the confines of this little room.  We are very capable of working with our team outpatient to adjust and wean Keegan's feeds and TPN as necessary from home. 

The main reason we are doing this at home is because the team here has run out of ways to actively treat his infection.  The drugs that were supposed to have helped him heal and shorten recovery time all but failed miserably.  He will stay on the anti-parisitic for another 2 weeks to see if it has any help whatsoever over the long term.  I mentioned yesterday that Keegan's output increased dramatically yesterday, and it did not stop after I posted that.  He had several dirty diapers overnight, which hasn't happened for over a week.  He had just as much output today during the day as yesterday.  Given that we haven't changed his feeds at all from the minimal drip, we have absolutely no idea why he is suddenly "getting worse".  But the only way to compensate for it at this point is to support his hydration and nutritional needs with TPN and wait it out.  Which, of course, we would prefer to do from home.  We are hoping that more time to recover is what he needs.  What we can't answer right now is at what point we consider his symptoms due to his general intenstinal issues versus due to the virus(es).  That will have to be determined over the course of the next few weeks. 

After some research by the nutrition department, we were able to tweak his nutritional needs and concentrate his current dose of TPN to 16 hours.  It looks like he will be at that rate for some time while his intestines continue to heal.  For those of you keeping track, Keegan will be on a very tiny drip of diluted formula through his g-tube 24 hours per day and on TPN and lipids for 16 hours per day.  We are trying to think of some creative ways to allow him to still be mobile with three different pumps.  This could get interesting.  He will carry his formula pump in his backpack, as always, but the TPN and lipids are a different story.  We're looking for a kid-sized rolling backpack that he might be able to pull along with him.  Thank God for dear friends who have gone before us to come up with these ideas!  Thanks, Avery!

Most of the day was spent once again trying to keep Keegan entertained.  He had some great visitors!

I am SO excited to see my Bubba again!!

Hey!! Wake up!! Play with me already!!

Annoying little sister wins again!

And music therapy too!  I think this is quickly becoming his favorite thing to do inpatient.

Looks like guitar lessons are in our future.

I am cautiously optimistic (ok, no, really I'm not) that we will get everything ironed out for a discharge tomorrow.  It's really just too much to do in one day.  If it's not all set and ready to go by 3pm, we'll look to Thursday for home.  No more stressful discharges for us.  Either way, it will be good to be home as a family once more. 

I would once again ask for your prayers.  Y'all have been so faithful for the last several months, and I simply can't put into words how much we appreciate it.  Being that this illness was contagious, it has been a pretty lonely inpatient stay, but knowing that so many people were out there following up on Keegan and lifting him up in prayer helped immensely.  Thank you.  I will probably post more specific prayer requests tomorrow.  For tonight, we would greatly covet your prayers that Keegan has a restful night with no diarrhea.  We had to change the dressing on his port right before bed, and he is just beyond exhausted.  And of course, we would welcome prayers for a smooth discharge, whether it is tomorrow or Thursday.  Thank you again, y'all.  More tomorrow.

Monday, March 21, 2011

Monday update

Well, try as we might, we couldn't keep Monday from coming again.  Funny how it always seems to come around this time of week.  Bummer.

Evidently, Keegan's tummy is not fond of Mondays either.  We stayed the course.  We made no changes, and yet, today was much worse than yesterday as far as output goes.  If nothing else, it made me very glad that we advocated for not making any more changes in Keegan's feeds until he shows continued, sustained improvement.  Keegan's cardiothoracic surgeon stopped by, and she wholeheartedly agreed.  She said there was no way to expect he would recover if we kept "letting the bull into the china shop."  I couldn't agree more.  Our plan now is to hold his tube feeds at 24 hours per day of 10cc/hour for the immediate future (a week or more?).  That's such a small amount for his body weight that it's considered just enough of a basic drip to keep his stomach and intestines "alive" as he heals.

Keegan's labs are fairly stable now.  The IgG trial is over tomorrow evening.  I won't say I'm wholly disappointed in that one, but I do wish it had been the golden ticket we'd for.  His stool cultures came back negative for rotavirus finally today and negative for c-diff too.  The c-diff isn't surprising.  It's so prone to false negatives, that you aren't even given the all-clear until you've had consecutive negatives over the course of three 24-hour periods.  We were excited to see the negative rotavirus.  If you remember, it should come back negative while on the anti-parisitic drug, but Keegan's was still coming back positive after two full courses.  This is definitely an improvement, but we will continue the drug treatment for the next two weeks to be sure.

Where does that put us?  Working on advancing Keegan's tube feeds and weaning the TPN (IV nutrition) for the most part.  Generally, the doctors would like to see him on full tube feeds and off the TPN completely before sending him home.  Gray and I initially said we'd push to go home on 12 hours of TPN.  Right now, he's on 20 hours of TPN and just enough tube feeds to keep his stomach from atrophy.  It could be a month or more of sitting in this room on contact and neutropenic isolation before that happens.  We're not okay with that.  We've asked for Keegan's nutritional needs to be revevaluated and determine into just how few hours we can concentrate his TPN.  We're hoping for 16, but I'd be okay wtih 24 if it meant going home. 

So, long story short - barring any other issues cropping up, the next two days will be filled with getting our home health situated.  We're hoping to bring Keegan home by Wednsday or Thursday.  This is going to be an extreme challenge for us at home.  The demands of Keegan's line, TPN, meds, and tube feeds, all while keeping him mobile, entertained, on time to appintments and therapies (and don't forget Audrey) will be daunting at least.  But it is worth it to be in our own home as a family again. 

We would greatly appreciate your prayers as we get the ball rolling on this.  We are ready to be home.  Thank you so very much.

Sunday, March 20, 2011


After yesterday's set-back, the decision was made today to hold Keegan's tube feeds at 10cc/hour for the next few days.  It will take another variable out of the overall equation, so we should have a better idea how the drugs are/aren't helping him.  The more things we change everyday, the harder it is to tell what is hurting or helping.  Hopefully, holding his feeds steady at a very, very small rate will put less stress on his GI tract and give him more time to heal.  Advancing his feeds should be easier once his tummy is more ready to deal with the increased volume and calories.  It is fairly evident that at this point in time, his intestines just simply aren't ready for the job.  I use the word "should" cautiously here, as absolutely anything is possible with Keegan.  All that being said, today he had less overall output, but we have yet to see any improvement in "quality".  Less output is a step forward though, so we will certainly take that.  I am hoping that by tomorrow or Tuesday we will have more of a plan for where to go from here.  At the moment, we are taking each day as it comes and waiting for signs that Keegan has healed enough to go forward.  I would anticipate that once we feel comfortable advancing his feeds again, we will go home once he is down to 12 hours of TPN again.

The IVIG has at least worked to give his bone marrow a boost.  Still neutropenic but climbing.  Full labs will be drawn tomorrow, so we'll have a better idea how his kidney is acting.  We will also resend off stool cultures for the rotavirus and c-diff to see if at day 12 of the virus/day 8 of the anti-parisitic/day 3 of the IVIG has changed anything.

Other than that, it was another day of trying to entertain Keegan in his room during his energy spurts (still nowhere near 100% but just enough to be too much for this little room).  So, today we broke out the window markers, and let him decorate the room.

This kid never ceases to amaze me.  To see that smile from the simple pleasure of coloring on the window after all he's been through, makes my heart burst with pride and love, even if it's tinged with a hint of sadness and disappointment that this is his life.  He sure makes it easier to endure the trials.  And so do your continued prayers for his strength and health.  Thank you is so much less than y'all deserve! 

Saturday, March 19, 2011

Saturday Fun (and Not-so-fun)

In order to refocus my energy this evening, I'm going to start this post with the FUN parts of our Saturday.

After 10 LONG days, we finally got to see this little beauty today!

Miss A is definitely cutting those top teefers.  Poor thing, she's only pushed one just barely through the gum.  That didn't keep her from sharing some smiles, hugs, waves, "mama", and "dada"s with us today though.

We sure needed some fun time with our little Ladybug today.

Thanks for bringing her up today, Mamie & Aunt Alex.  Sorry Keegan slept through your visit!  I can't wait until she can see her brother again.  Now those will be some big smiles!  Once Keegan was up this afternoon, we got special permission to take him down to the hospital garden for some fresh air after being stuck in bed in his room for 10 days.

It took awhile to convince him to walk on his own, and when he did, it was pretty awkward.  We took quite a few breaks to watch the clouds, count flowers, and admire the glass fish in the relection stream.

There isn't a lot of time for moments like these in life in general and especially when you're inpatient.
So when you can steal away and be still together, that's when memories are made.

Well, that was a nice beginning to the post.  Now for the not-so-fun part.

We tried to increase Keegan's tube feeds to 20cc/hour today (that's about 2/3 of an ounce over an hour).  It did not go well.  At all.  Since we switched him to half-strength elecare formula on Thursday, the volume of diarrhea hadn't increased, but the "quality" (for lack of a better term) wasn't improving either.  We had been saying he was "tolerating" the feeds mainly because of the volume aspect.  Since there wasn't any improvement (and you can't really get worse) in the quality aspect, we started the IVIG trial.  Yesterday was about par for the course with an increase from 10cc/hr to 15cc/hr.  So with the IVIG on board today, we decided to try for the 20cc/hour increase.  I tried to ignore the fact that the volume was increasing as the day progressed.  I tried even harder to ignore the multiple accidents that occurred.  But by the time I was changing the sheets (despite multiple layers) and Keegan's tshirt for the third time this evening, we cried mercy.  We gave him an hour break completely and then restarted him back on 10cc/hour.

Three steps forward, two steps back.

If only this hospital had a padded room available for parents.  I guarantee you there would be a line to use it every hour of the day.

I'm not sure I am even capable of putting my exasperation with Keegan's intestinal issues into words.  And I'm only concerned with Keegan's tummy.  I can't possibly imagine how these GI doctors deal with this in so many kids every single day.  I know they don't have any more answers for me than I can give myself or you tonight.  I don't know what we will do tomorrow.  I'm even less sure of what to fight for at this point.  Back off more?  Stay the course with trophic feeds?  We can't sit here and wait forever.  That's simply not an option.  But I'm not sure what is anymore.  I know we have to at least give the IVIG a fighting chance, but how we do that over the next three days is yet to be determined. 

My comfort for today comes from Keegan's resilience through it all.  He is so used to his tummy feeling like this that it rarely seems to bother him.  He has his moments where he curls up in a little ball, buries his head in the pillow, and shuts down for a minute.  But in the next minute, he's bouncing up and down on the bed, mimicking every word on his episode of Curious George.  He has no idea that this is not normal, and he refuses to let it interfere with his fun.  And for tonight, that's enough for me. 

Friday, March 18, 2011

Friday Update

I'm going to make this short because it's Gray's night at the hospital, and I'm very much looking forward to crawling into my own bed tonight!  Ironically, I had to download a white noise app on my phone because the stark silence of an empty house was too unnerving to allow me to actually fall asleep.  Unfortunately, I wasn't able to find one with "hospital monitor" noise.  Guess that wouldn't be too appealing to the general population!

Keegan's day was pretty much status quo, in that he didn't throw us any curveballs or changes or really any improvements either.  He still is having bad diarrhea (way worse than even his baseline), little change in his labs, kidney still happy, and energy still good for two good spurts morning and afternoon.  He tolerated the half-strength formula well enough with only slightly more output than on the pedialyte.

Sometimes status quo is a good thing when you're inpatient, but frankly, we would rather be seeing more improvement from him at this point in the course of this virus.  So, today we started him on IVIG given through his g-tube four times a day and will do so for the next four days.  IVIG is usually given in an IV form (in case you couldn't tell that from the first two letters of the name).  If you want to argue semantics, IVIG stands for intravenous immunoglobulin.  We're just giving the same immunoglobulin through his gut instead of his line.  Our hope is that it will give a boost to his bone marrow, help heal his GI tract, and shorten his recovery time.  Of course, the last drug we started him on (still on it) was supposed to shorten recovery and pretty much did nothing, and the virus in a healthy person would have been gone several days ago.  He just received his second dose, so the real test will come over the weekend.

That's the biggest news of the day.  No pictures today.  A pretty quiet Friday on the floor for us at least.  It appears that Spring Break is coming to an end because the floor literally filled up with new admissions by this afternoon.  No one wants to be sick over Spring Break, I guess! 

I know I say it every day, but we really feel blessed and are beyond grateful for your prayers for Keegan.  He is a fighter, but we know that he is strengthened daily by those of you who intercede on his behalf.  Thank you so much!  More tomorrow.

Thursday, March 17, 2011

Day 9

By the end of today, Keegan had rolled into day 9 of this current illness (a week inpatient).  Starting off with the bad news for today.  His platelet and hemoglobin/hematocrit continued to drop today, but at least his ANC (baby white cells) were up just a touch, although he is still severely neutropenic.  The bigger problem today was again what to do with his gut and feeding him.  This morning, we agreed to trial him on half-strength elecare at the same rate of 10cc/hour.  It didn't get started until about 1pm, and it hasn't been too much worse on him than the pedialyte.  He is starting to show signs of discomfort and cramping though, so hopefully, the deluge is not about to hit. 

The most interesting thing from today was that Keegan still tested positive although he is (1) on day 9 of a virus that usually has a life span of 5 to 7 days and (2) is on day 5 of what is usually a 3-day strong anti-parasitic drug that should result in a false negative test.  A virus that, by the way, rarely rears it's ugly head until the middle of the summer.  Normally, the doctors said they wouldn't even bother to retest because of the false negative, but we didn't see a harm in sending it today.  Lo and behond, positive still.  The attending doctor came in the afternoon and it seems tomorrow is the day to start trying some of the more "creative" treatments we discussed over the weekend.  We shall see how that pans out tomorrow.  Until then, I'm praying he at least is comfortable enough over night to get some sleep.

Good news for today: Keegan's kidney is much, much happier, and so is Keegan!  He still is having two good energy spurts and shared lots of smiles.  He even walked from his bed to the bathroom for a bath today. 

Why did he need a bath?  Oh, just because of this...
Fingerpainting in bed.  One of the extremely few perks of being in the hospital!

He was painting this bird house and kept dumping more and more paint one one side.
A swimming pool for the birds, perhaps?

 I have paint where?

Good thing Mama didn't have to wash any of that stuff!

The aftermath. 

We pretty much only agreed to this because it was that time of week where we had to pull the needle from Keegan's port and reaccess him, which gave us a very short window to give him a much needed bath.  That was one big morning between crafts, bathtime, and a dressing change, so much of the rest of the day looked like this:

Thanks once again for your daily support and uplifting prayers for our little family and our sweet Bug.  Most of the family has recovered from the tummy madness, and our pediatrician thinks Audrey is just working on two brand-new, sparkly upper teeth.  More tomorrow.  Time for this Mama to get a few minutes of sleep before midnight vitals and meds! 

Wednesday, March 16, 2011

Update & Visitors

Once again, I don't feel like I have much new to report from the GI floor today.  Kidney and bone marrow function are not improved but not declining.  We started him on a pedialyte drip yesterday afternoon (10cc/hour; that's 1/3 of an ounce an hour, so virtually nothing).  He's not doing too well with that, but we're going to reassess tomorrow morning.  The question is whether we (1) go back to complete gut rest, (2) give him more time on this little bit through his tummy, or (3) try to push him further.  The problem is that Keegan is so far from the normal kid that gets rotavirus and/or c-diff that no one really has a plan.  The new drug they put him on a few days ago was supposed to be a 3-day course, but we've decided to continue it for the foreseeable future until the team is more comfortable that Keegan is showing consistent improvement. 

For an otherwise healthy kid (or even a transplant kid) with severe enough rotavirus to be hospitalized, the benchmark for going home is normal stools and tolerating a fairly normal diet.  And Keegan doesn't usually do either of those things.  I'm getting a little tired of the doctors coming in and asking me what I think we should do.  Yes, I'm his mom, and yes, we've been dealing with his GI problems for 3 years.  But sometimes, I want to scream at them, "I don't know! You're the doctor, darn* it!" (*Or something...)  In the same vein, I certainly want them to heed my warnings about making changes slowly with Keegan.  I certainly don't want to be stuck in the "1-step-forward, 3-steps-back" tango that we spent months and months doing two years ago.  Taking one step over two days, still puts us ahead in that equation.  Having Audrey at home definitely puts a new urgency in treating Keegan than it did before, but we know that pushing to get him home too early will just put us right back in here.  Can you sense how incredibly frustrating this is?  Sheesh.

The biggest change is in Keegan's energy and attitude.  The last two days, he has had a good energy spurt morning and afternoon before crashing.  It's been nice to see some smiles and energy from him, although he doesn't seem ready to get out of bed yet.  He tolerated sitting in the chair for a little while again today while I changed the sheets on his bed, but that's about it.  I'm hoping that by the weekend, he'll be willing to go to the playroom for a little while.  I can never say enough good things about Child Life at this hospital.  Today, they brought Keegan a dress-up knight costume, complete with shield and sword, from an event he wasn't able to attend at the hospital.  And they are committed to keeping him entertained, even if he doesn't have a lot of energy to leave his bed.  Tomorrow there is talk of finger painting and crafts.  Oh boy!

As Keegan's gotten older, he's now more apt to participate with some other forms of therapy offered by the hospital.  So the last two days, he had some visitors.

Warming up to the idea of music therapy

Puppy needed to participate too.

Now that's a happy face I hadn't seen in awhile!

Funnyatrics at your service!

He's always been a clown.  Now, he just has the nose to prove it.

Monday, March 14, 2011

Monday Monday

Not much to report today from Keegan's room.  Little urine output, still tummy problems despite nothing in his stomach since Tuesday of last week, all blood counts still trending downward.  We had to adjust his TPN today because his labs showed he wasn't quite getting enough nutrients.  Keegan's tolerating the new drug pretty well.  We're not sure how effective it is/will be, but he has developed some kind of dry mouth from it.  It doesn't seem to upset him, just seems bothersome.  As the dose wears off, it seems to go away, then comes back in force with each dose.  He had very little energy until 4pm today, but at least he perked up some.  He also received his immunosuppressant infusion and his breathing treatment. 

Unfortunately, this plague has officially spread to the rest of the family - Audrey, my parents, and my mother-in-law.  Audrey evidently started feeling bad Saturday night and was somewhat sick all weekend long.  My parents didn't want us to worry because she wasn't too sick, so they opted not to tell us.  I wasn't too thrilled about that, but I understand their intent.  It came out today when both my parents fessed up to being sick themselves.  I guess Big Daddy got sick first and is starting to feel better this afternoon.  My mom is in the thick of it now.  I have felt pretty puny all day but haven't gotten sick yet.  Maybe I'll be the one to dodge the bullet.  I really hope so.

Tomorrow is John Christopher's funeral, and I'm beside myself that I might not get to go.  I would hate to wipe out the entire Heart Center with this nastiness.  I hope I am able to slip away and celebrate the life of an amazing young man and be there for his loving family.  He touched so many lives and gave such inspiration to so many of us that a heart transplant doesn't have to rule your life.  He gave us hope that Keegan would see many milestones and live to his full potential for many years.  Funerals are an inevitable part of our lives as a transplant family.  I just wish it wasn't for a young man that was so dear to so many of us.  When it's our turn, I will find comfort in the faces of my fellow heart moms who have lived through the same thing.  I hate that I might not be able to be that for Cindy, but I know she will be surrounded by the loving arms of so many in this fight.  We love you, Mama Cindy, and we are praying unceasingly for your family.

The Lord is my shepherd; I shall not want.
He makes me lie down in green pastures;
He leads me beside quiet waters.
He restores my soul;
He guides me in the path of righteousness for His name's sake.
Psalm 21:1-3

Sunday, March 13, 2011

Sunday Update

Positives for today:
  • Albumin and IV lasix pulled a lot of fluid off of Keegan. 
  • Fever has been gone for over 24 hours.
  • Several periods of improved energy.
  • Blood drainage has almost stopped.
  • Blood cultures all came back negative at least 48 hours.
  • Stopped both IV antibiotics.
  • Got his TPN and lipids started back up for 24-hours a day. 
  • Gray felt much better by this morning, and he was able to come back up to the hospital this evening.

Not so positives for today:
  • Keegan didn't get a lot of sleep last night.  He seemed to be in pain, but we're not sure what was causing it.  It appeared to be the urination in response to the lasix, but we aren't sure.
  • By late this morning, Keegan's urine output had greatly decreased again.  We are trying to avoid giving him too much lasix.  His diarrhea can cause dehydration, so we don't want to contribute to that by pulling too much fluid off.  He's already starting to swell back up though.  His poor little kidney is probably just stressed to the max after the last few months.
  • In addition to the rotavirus, Keegan tested positive for c-diff this afternoon.  It's an opportunistic GI infection that affects those on antibiotics and the immunosuppressed.  C-diff is just as bad as rotavirus, so the combo is bad news.  Again, I doubt I have to say it, but this is some of the worse GI stuff we've ever seen....and we've seen alot from Keegan.  We have started Keegan on a new drug that has only been tested in a few studies, but it has been shown to be somewhat effective in shortening the duration of the contagious period for c-diff and possibly rotavirus too. 
  • His bone marrow response hasn't improved yet.  Could be worse though. 
Hey, at least there are more positives than negatives.  Even if the negatives were pretty awful.  Thank you so much for your prayers for Keegan.  We really do appreciate them more than you know.  For tonight, we're praying for some good sleep and for his kidney to not go into hibernation again.  That's all for now.  A new week starts tomorrow....a new attending physician, new residents, oh boy. 

Saturday, March 12, 2011

The Force is with him

Keegan perked up for a bit this afternoon.  He colored, played with some cars, and played a memory game on the phone.  It wasn't too long of a run, but it was nice to see.  I think the fever breaking really helped.

Unfortunately, his little energy spurt was about the only good thing.  He continued to not have any urine output at all throughout the day and got really puffy again.  Right now, we think it is a different type of swelling called "third-spacing".  Fluid has leaked out of his veins and cells and into surrounding tissue.  We are running another infusion of albumin and IV lasix right now, hoping to pull that fluid back into the veins and that his kidney will wake up and drain it off.  He is still draining blood from his g-tube, and his blood counts aren't great.  He is on 24 hours of lipids and TPN (IV nutrition) again.  We're hopeful that getting some nutrition in him will help his bone marrow perk back up.  I doubt I have to note that the GI output is beyond horrible, but at least he's not throwing up anymore.

In worse news, Gray is now sick.  We were really hoping that the rest of the family would get lucky and stay healthy.  Gray went home this afternoon, so it's just me for awhile.  We're praying Gray can fight this quickly.  It's always better to have both parents here.  There's no opportunity for breaks when you're by yourself.  It's hard enough to entertain a kid stuck in bed and on contact isolation all day with two...nearly impossible with one.  I'm sorta hoping Keegan's energy doesn't come back in full force until Gray is well again!  And in case you were wondering, Audrey is still doing fine.  This virus has a 2-day incubation period, and she hasn't been around Keegan since Wednesday.  That should mean she dodged the bullet, although stranger things have happened in this family.

On a fun note, right when Keegan was at the tail end of his little energy spurt this afternoon, he had a surprise visit from some special dudes who came a very long way to meet him:

"Um, Mom? I know I'm on neutropenic and contact isolation, but this is taking it to a new extreme."
(I apologize to those of you non-medical peeps reading this blog who don't get the humor of that caption!)

First Tony Romo, and now Darth Vader.  The power of Keegan's "touchdown"!

One day, he'll look back on these photos and get it.  He might even find it cool or amusing, but today, he just found their visit exhausting.  That's okay though.  We are always so grateful for any group that takes the time to come visit the kids.  I'm sure it made some little preteen boy's day somewhere in the hospital!

Morning update

  • Keegan got some much needed sleep overnight after we aggressively treated his fever.  By 6am, it seemed to have broken.  That's a big step forward in his comfort levels for sure. 
  • He is bleeding from his stomach or upper GI tract.  It's not wholly unexpected, but the volume is a little unnerving.  He has filled up a bile bag already this morning with it.  At this point, we believe it is irritation related and not a bigger bleed.  They've started him on some new drugs to help "coat" his tummy to reduce the bleeding.  We are watching his blood counts even more closely and will intervene if needed, especially since his platelets are dropping consistently.
  • His neutropenia is worsening quickly.  We are starting him back on TPN today, so hopefully, some nutrition will help his bone marrow start to put up a fight.  If not, we can restart the bone marrow stimulant he was on before.
  • The head of the GI department is the attending this weekend, which was very helpful.  He doesn't get excited easily, but he takes Keegan's unique history quite seriously.  He told us this morning that he is ready to get "creative" with treatment if necessary.  He also said that an otherwise healthy kid hospitalized with rotavirus was generally looking at 5-7 days inpatient; a transplant kid longer than that, and "who knows" with Keegan.  Yippee.
  • His albumin is low and dropping, contributing to his puffiness and "third-spacing".  Until we can pull that fluid back into his cells, his kidney can't clear it anyway.  Tomorrow we may need to replace some of that albumin to help him along.
  • He is still on broad-spectrum antibiotics while we wait for his neutropenia to resolve and until we are sure there is no blood infection the rotavirus is masking.
  • We did an echo of his heart this morning, which showed his function and pressures are fine.  There was a blip of an area where the muscle might not be getting enough flow.  We are triple-checking it against old echos to see if it is new or not.  If it is, we will simply follow up later in the week.  For now, we are ecstatic as always that his heart remains strong.

Enough info for you yet?  It's as much for us to document his history as it is to update our family and friends, so I apologize if there's a bit more jargon than is necessary for most.  The good news is he is stable and has a bit more energy today.  He really was talking to Curious George this morning and sat up a few times on his own.  He has interacted more with the medical staff also, which is always a relief to see.  I will probably post another update tonight with any additional information we find out.  There are some labs we are certainly waiting on the rest of the day. 

Thank you for the millionth time for your prayers and support.  I really don't know how we would do this every day without y'all. 

Sitting up and watching George makes for a happier Keegan. 
He says "tank you!" to everyone for their prayers.

Friday, March 11, 2011


Where to start?  Well, the good news is we have an answer as to what Keegan is fighting - rotavirus.  It's a nasty stomach bug for normal, healthy children.  I suppose you can imagine how bad it is for Keegan.  He is stable but struggling.  (Where he might have picked this up is the strange question, as he is still on strict lock-down.  Neither Keegan nor Audrey were allowed to have the rota vaccine, as it is a live vaccine and too dangerous to Keegan.  If the vaccine, which is a miniscule amount of the live virus, is dangerous, that says a lot about what the full-blown thing can do to him.)

Keegan had a really rough night.  Lots of pain, high fever, lots of tummy problems.  We tried pedialyte through his g-tube, and he couldn't tolerate it at all.  As soon as his morning labs were drawn, the attending at the Legacy campus came into the room and told us Keegan needed to be transferred to the main Children's campus downtown.  At that time, none of the cultures were growing back anything.  They didn't know what was affecting him, and they were highly concerned about his kidney function.

We finally got the details of the transfer ironed out and a transport team to take him by ambulance downtown around 2pm.  Lo and behold, the rotavirus culture came back positive in the 30 minutes it took to drive him down here.  His bone marrow and blood counts have tanked under the stress of the infection, rather than mount a response.  His poor kidney has suffered the shock of dehydration, followed by fluid overload.  He is extremely pale and very puffy.  He is still in quite a bit of pain and lethargic.  He frankly looks terrible.  His fever is not responding to tylenol, and we may have to put him on a cooling blanket soon to try to break it.  The team has started him on two broad-spectrum antibiotics because his immune-system has sunken so low; it puts him at a much higher risk of developing secondary infections.

The worst part of all this is that Keegan's GI system was in a really bad place before this hit.  We are not anticipating that this will be an easy recovery for him.  He will go back on TPN (IV nutrition) tomorrow, and he is on complete gut rest (absolutely nothing in his tummy) for the foreseeable future.  We have no idea how long it will be before he can come home.

For now, we would just humbly ask that you continue to pray for Keegan as you always have.  He just can't seem to catch a break, but he is so very strong.  He has not let this break him, and we are trying to let him be our guide and inspiration.  We are so weary on so many levels; I can only imagine how he must feel.  Thank you so very much for your support and prayers through every trial.  You give us strength for the day and endurance for the journey.  The Lord alone knows the mysteries of Keegan's body, and we place our trust in Him daily to provide relief, comfort, strength, and hope for our little boy.  We would also love it if you would keep Audrey in your prayers.  She is okay so far, but this could be dangerous to her as well at her age.  More tomorrow.

Waiting on the transport team to take him downtown this afternoon.

Praise be to the Lord, to God our Savior,
who daily bears our burdens.
Our God is a God who saves....
Summon your power, God.
Show us your strength, O God, as You have done before.
Psalm 68:19-20, 28

Thursday, March 10, 2011

Inpatient again

Keegan was admitted at Children's again this morning.  The night before last, he once again stopped urinating and had some nausea and vomitting.  We drew labs at the Center for Cancer and Blood Disorders and came home.  Things progressively got worse overnight, in an eerily similar way to the first night of kidney failure in the fall.  This morning, we brought him into the ER at Children's Legacy.  We knew he would need fluids at a minimum and were anxious to see if his kidney function was worsening.  It was, just a bit, but not drastically, as it had before.  It was still unclear (and still is for that matter) if this is some kind of infection or the beginnings of something bigger.  He spiked a fever while we were waiting in the ER that has not yet broken. The fever in, and of itself, would have necessitated an ER visit and possible admission, since he has a central IV line.  Luckily, our team agreed that he could be admitted here at the Legacy campus, which is literally right across the street from our house.  We miss our team downtown dearly, but the convenience of being this close to home is comforting.   

Keegan's heartrate and respiratory rate are much higher than we would like to see, while his blood pressure and oxygen saturations are lower than we'd like.  He finally peed a little bit, although it is not consistent and nowhere near what he should be producing.  None of the cultures have grown back anything yet, but he is stable.  We are certainly praying for a better night than last night and that this admission is short.

I hate sitting here.  I hate that we do so much to try to "protect" Keegan.  We have taken away just about everything, and yet here he is, once again.  I hate that we still don't have an answer to so many of the things going on in his little body.  I hate that he has endured so much intense pain in his short life.  I hate that he has to be poked and prodded, under the guise of trying to make him feel better.

But I hate, more than anything, that he could fight this fight day in and day out and still lose the battle.  This morning, yet another of our precious transplant friends found his perfect healing.  John Christopher was 21 years old.  He fought tirelessly his entire life and had been waiting to be clear of rejection and relisted for transplant.  This morning, his body had endured enough of the fight.  My heart breaks for him, his amazing parents and family, and our entire transplant family.  Each one of these blessed warriors becomes part of our family, one of our own, and it cuts to the core...every...single...time.  And unfortunately, it reminds us that every day, in every single breath, it could be us.  It could be Keegan.

So, there will never be "just a bug" or "just a fever".  Every thing could be the one thing we dread most of all.  And we will never stop fighting for him.  We will never stop being vigiliant.  And we will pray fervently for his health and protection and for that of every one of our transplant kids.  But tonight, we grieve for JC and his family.  We pray for their comfort and peace, and we really hope you will join us.

Sunday, March 6, 2011

9 Months

Look who is already 9 months old!

I honestly can't believe that my little girl is going to be a year old in just 3 short months.

Audrey is such a fun, easy-going, little girl.  She reminds me so much of Keegan at this age.  Every day is an adventure to her, even though most of them are just spent at home or the hospital.  She loves Keegan's nurses in the clinic and at home, and they just adore her too.  Never a shortage of those who want to play and cuddle with her!

I love watching her learn, seeing her figure things out on her own.  Audrey wants to crawl so badly, and I can tell she will figure it out soon.  She gets just about anywhere she needs to go by sliding backwards on her tummy or scootching around on her booty.  Audrey can get up to a sit from her tummy or her back almost all the time.  She babbles all day long (Bubba and DaDa are new favorites, although Mama has snuck in there a few times).  She loves to give hugs and kisses, jump in her jumperoo, take "airplane" and laundry basket rides, and play with any toy that is not hers.

But the one that can make her smile the most is still her big brother.  Keegan can make Audrey laugh, smile, or just calm down simply by walking in the room.  Her favorite time of day is absolutely bath time.  She splashes with Keegan, watches every move he makes, and watch out if you try to take the sugar shaker from her bathtime tea set from her!

Nine months ago, I was so worried about how a little girl would adjust to such a crazy family, but Audrey has truly showed us how to weather a storm.  She has brought more smiles and laughter to our lives, and she brings a bit of normalcy that we so desperately needed.  I hate that at her age, she already has to live a sheltered life to protect her brother.  No play dates, no Mother's Day Out, no runing errands or lunches out.  But I pray that our family is stronger because of it.  I know that we are more sane with this little beauty in our lives. We love you, Ladybug, and we are so happy to call you ours.

Wednesday, March 2, 2011


Recent photos of K & A... These two have tolerated "lock-down" so well together.  I hope it is just a small glimpse of their future bond as siblings.

Watching these two play together makes my heart smile like nothing else in this world.

You know it's love when you let your little sister play with Buzz and Tato.

There's nothing Audrey loves more than being the one to wake Keegan up in the morning.  Correction...there's nothing Audrey loves more than pulling on the tubing from Keegan's various bags hanging from his IV pole in the morning.  When I took the pole away from her this morning, she decided to hang from the guardrail.

Keegan couldn't resist joining her.  (For the record, this is the gesture we get most often when asking Keegan to "smile for the camera".  Any ideas as to what it is would be appreciated!)

A much better way to start the day!

Keegan taking "pictures" with his old hand-me-down 35mm camera of me taking pictures of him.
(There is film still in that camera, and I'm dying to know what's on it.  The battery is dead, and I am struggling trying to decide whether I should go seek out the specialty battery to retrieve them.)

Audrey thought she was the coolest sister in the world when Keegan let her play in his ball tent.

Aunt Alex's friend had some little chicks at her house, and we brought Keegan over to meet them.  His interest lasted a few seconds, but it was a great opportunity nonetheless.

Audrey was so very gentle with the chicks.  Thanks, Monica, for letting us visit.