Thursday, November 17, 2011

A New Site!!

After a couple of years of intending to, planning to, and even trying to, I have finally (with the generous help of Jean Egan) completely reformatted Abbie's website.  All past updates have been posted there, as will all future ones.

Please, come join us as !

Wednesday, October 05, 2011

A Season of Extremes

I've been looking for my camera cable for two weeks, to download all the pictures and video this update merits  (don't tell my husband, please.)  I'm giving in and will just use words for now, and do a photo update later.

It feels like we have been in a wind tunnel for the past eight weeks.  The high points have been record highs, while the challenges have been more pressing than our "normal".  We are hoping that calmer waters and lighter breezes lay just over the horizon.

The Good Stuff:

Isn't this always the best place to start?

One week after turning 10, on August 23rd, Abbie received her first car.  Well, it doesn't have a license plate, but it was more expensive than my I think it counts.  And she relishes the idea that she got her own car way before any of her brothers did.

Her first power wheelchair is a sight to behold.  As the technician from San Diego was putting it together, I said, "This is like the BMW of wheelchairs!"  He answered, "This is like the BMW M3 of wheelchairs...I've never put one together that was this nice!"   See what I mean about really needing pictures to do this justice?

The seat was custom-molded to her body, and is made of material that passes air through it, so it is really good for both her posture and her skin.  The fine-tuning of both the seat and the chair were no small undertaking, however.  Over the course of three days we spent 20 hours at the rehab department, making adjustments, checking the results, and making further tweaks.  The programming of the electronics alone took a couple of hours.

The head controls on the chair will allow Abbie to drive her chair, but also to control the tilt and recline functions independently.  She will be able to elevate the chair 14" to be at appropriate heights in varying situations, and she will also be able to elevate her leg rests to give her legs and feet a break.

Abbie will be able to use the head controls to use a computer mouse, and to change the channel on the TV (she was excited about that one!).  And, the wiring is in place for a future voice output computer that will allow her to more freely and completely express her ideas, thoughts and opinions (watch out!).

It seemed like a dream, seeing her in the chair.  I guess I worked so hard on containing my hope during the requisition process, that I'm not sure I ever really believed she would get such a wonderful chair.  The seating alone is going to change her life.  Healthwise, it keeps her in a much better position for her spine and lungs.  Breathing is better, alignment is more proper, and she gets all the support she needs not to "droop".

 Socially, though, it's even better.  Instead of sitting in a semi-reclined position in what looks like a stroller, Abbie now sits straight up, looks straight ahead, and looks every minute of her ten years.  She won't ever again have to hear "Mommy, look at that baby" when other children walk by.

It has a joystick at the rear of the chair that allows me to drive it.  Using the chair independently will be a developmental process for Abbie.  She hasn't moved on her own in over seven years, and will have to learn how to maneuver once step at a time.  I must admit, even for me, there is a learning curve to driving the chair.  I am very thankful that the speed is variable, and you can usually find me dialing it to the "turtle" setting!

Loading Abbie, in her new chair, into our van...seeing her looking straight out the windshield at the wide world before her, instead of at the incredible high.

Things began to change the next day.

Emotional Whiplash:

The last day of adjusting the chair was a Wednesday.  Much of it was geared toward programming the electronics, so it involved a lot of just lying around for Abbie.  The flow of the day masked the fact that she was not feeling very well.  She finally got to drive the chair for the first time in mid-afternoon.  She seemed a little tired to me, but was so excited by the chance to roll down the hall that she rallied remarkably.   (I do have video of that first drive...will post it...someday)

As she was driving I noted she was a little flushed, but since she was so engaged in what she was doing, and it was so thrilling to watch, I pushed my concern to the back of my mind.

When we got home, her temp was 101.4.  Rare for her to have a fever.  By 7pm it was 103.  It was a difficult night for Abbie, but around 4am her fever seemed to break, and I was hopeful this was a 24-hour bug I'd been hearing about.

By noon the next day we were at the ER, with Abbie on 5 liters of oxygen and a fever of 104.  We rarely go to the ER, but when we do it's usually a "rule-out" visit.  I want to make sure she doesn't have a UTI, or a junky chest, and get whatever she needs so that I can take her home.   Hospital admission isn't ever really my plan.  This time however, I packed all my things to stay, because I knew, no matter what the diagnosis was, we weren't coming home.

The doc on duty was the one we always see during our "rule-out" visits, and he breezed around the corner like it was another one of those.  Upon seeing Abbie, he stopped, his faced changed, and he said, "Wow...she is really sick."   A few tests and pictures later....pneumonia.  Admission to the PICU soon followed.

Abbie's only gotten pneumonia once independently (2006) and once after a long surgery (2008), so I was disappointed in myself that I'd allowed this to happen to her, but even more so, I felt the ocean of fear lapping at the shore of my faith.  "This is what 'these kids' always die of..." swirled through my brain.  I hate it when people say that -- as if we need reminding, and as if, when the challenges come, the dark predictions are of any assistance.

The intensivist told me she was either going to get a lot sicker, requiring intubation, or she could possible just get better from here.  Not a lot of assurance, but at least a flicker of hope.

Nothing could stop her fever from breaking  through, and it stayed near 104 through the night.  Blood work came back indicating it was most likely a bacterial infection.  IV antibiotics were started, and sometime near dawn they took effect and the fever abated a bit.

I must tell you, though, as a woman generally ambivalent about Facebook, this experience changed my outlook on that and reconfirmed my esteem for you.  I posted updates on FB frequently, beginning in the ER...and I have not experienced anything like the results since Abbie's initial injury.  As friends began to post their prayers, I could literally feel electric shocks starting at my head and running through my body. I would awake feeling it, and knowing we were being prayed for.  I would be praying over Abbie, and feel it, and know we were being joined there.  It was incredible, powerful, and humbling.

Thankfully, our strong, feisty, motivated girl chose Path B:  the "Just Get Better" plan, and never needed intubation.  She was discharged after 10 days, and went home with a new friend, The Chest Vest.  This device, an inflatable band around her chest, hooked to two air hoses that connect to a box with programmed speed, pressure and time settings, has helped her chest become "clearer than it has ever been...ever" in the words of her pediatrician today.  Woohoo.

A great recovery marker happened yesterday.  Abbie finally got to ride Lizzy again.  She had missed "her" horse so much!  Her little body just melted into Auntie Pattie as they rode along, and I don't know who was grinning more.

So, Abbie is in a good place again, with much to look forward to.  I took Kyle to college at Seattle Pacific on 9/22, so it's down to just five of us at home now.  It is strange for us to all fit so easily into the van, but the twins are loving having their own bedrooms for the very first time.

Ray and I are off to Santa Clara tomorrow night for my college reunion.  I absolutely can't wait to see so many special people I haven't seen since graduation...and two nights "off-duty" for both of us, with the added bonus of a visit with Chase.

More to come soon....with photos, I hope.  So sorry for the long lapse.  We were once again learning, in vivid color, about the faithfulness of God in the storm.  I hate the situations, but I do love feeling Him nearer than I can when it's sunny.

May His blessings be upon you today!

Monday, August 22, 2011

Still Here...

I think this may be the longest lapse in updates ever.  This summer has passed in a blur of happy, sad, plans obliterated and then reconstructed, big leaps forward and slippery slides backward.  I can't believe the end of August is near.

The bottom line, after so many weeks (months) is that Abbie is doing well.  She is growing, healthy, happy and eager to learn.  As she matures, there are times I sense  she is processing her differences and limitations in new and deeper ways, and on some days I can see fatigue in her eyes.  But, ever the fighter, those days and thoughts don't last long for her.

A couple of developments that have long been in the works:

Abbie will be getting the bestest, biggest, shiniest, fanciest 10th birthday present I could imagine...a week late.  Her power wheelchair, with all the bells and whistles arrives next week!  We will spend several hours adjusting it to fit her perfectly, and then she will have the chance to gain some independence.  I can barely grasp how much this may change her life.

In addition to the obvious movements forward, backward and turning, the chair will allow her to control the tilt, recline, footrest position and elevation of the chair.  I simply cannot wait until she "tells" someone she is done listening to them by turning around.  Let the sass come forth, I say (in small, measured increments:)

Her therapy team has been working on getting her this chair for almost a year now...I think it's safe to say there may be a few tears shed when Abbie rolls away in it.

And then, on the ABR front:

Recall that ABR is the therapy platform we've learned about that really does provide hope for physical recovery for brain injury survivors.  But, also recall that we would have had to travel to Montreal for a week, and then the mainland US three more times during the first year of ABR.  The costs and logistics of this prompted me to explore creating an ABR project in Hawaii.

The challenge was that there are a limited number of ABR "trainers" in the world, equipped to do the in-depth assessments of the child, and training of the families.  Since meeting the ABR inventor, Leonid Blyum, in April we have been kicking around ideas about how to pursue a Hawaii project.  I made no secret of the fact I wanted a trainer full-time in Hawaii but admitted I knew this may be an impossibility, given the constrains of the trainer corps.

Earlier this month I made contact with a trainer  who:  #1.  has the passion, vision, skills and abilities that match up with my vision for the project, #2 is willing to move to Hawaii, and  (most important) #3, has a wife who is willing to move to Hawaii.

I am working with key stakeholders in the community to ascertain where exactly he will work, how the funding will flow, and other details.  But, it is my deep hope, and firm belief, that we will look forward to welcoming the trainer and his family to Hawaii early in 2012.

It is also my conviction that, once this project blossoms, the work that is done will change the course of the lives of people with brain injuries and their families not only in Hawaii but around the world.  I am finding that as long as you don't give up, even when there doesn't seem apparent reasons not to do so, hope eventually transforms into something tangible.  And, sometimes it is even better than you'd imagined.

Please continue to pray for the success of the Hawaii ABR project.  I told the trainer that last November, I first became aware of Leonid's work and prayed for a way to get him to Hawaii.  Six months later, he came.  In March I began praying for a trainer to come to Hawaii.  Five months later, I was in touch with one willing to move to Hawaii.  To me these are exciting answers to prayer....but what I really long for is the "Big Answer", for ABR to come to Hawaii and start changing the bodies of children and the lives of families.

Tonight we had a special family dinner to celebrate Abbie's last day of being 9.  We shared memories of the day she was born, which included RJ's announcement to the neighbors that "We have a grill!', and each boy now claiming he was positive she was a girl when I quizzed them at the bedside before we revealed whether they had a brother or a sister.

Just before dinner I prayed with thanksgiving for God bringing Abbie to our family, and then remaining with her every day since.  Truly, I know He has....and in the end, that is all that matters.

Thursday, June 30, 2011

The Tooth Fairy's Last Visit

This update is a little past-due because Genevieve has been in the Philippines since early last week.  Writing that makes me realize I've not tied up one huge loose end.  In March I asked you to pray for her mother who had a stroke and was on a ventilator with a poor prognosis.

And then...nothing.  Oops!

Well, her beautiful mother, Irene, is walking, talking, eating, smiling and blowing away expectations daily. But, there is also the reality that she cannot be left alone, for her own safety.  So, with seven sisters in the Philippines, the family decided it only made sense to move her home, where they could rotate care duties rather than having Genevieve's family do it on their own.  A tough trip for Genevieve, taking her beloved mommy so far away, not knowing when  (if?) she will see her again.  But, thank you for your powerful prayers!  Irene is a walking testimony to the faithfulness of God!

A couple of weeks ago, we took Abbie to the hospital for oral surgery.  We are so fortunate that we had an oral surgeon and her dentist that worked hard to coordinate their schedules so that Abbie could get a deep cleaning while under anesthesia before she got four teeth taken out.

All went very smoothly, and she ended up five teeth lighter, as her four permanent bicuspids, along with her last baby tooth were removed.  As has become the routine, the most trying part of the day was getting Abbie to wake up.

She just snoozes, and snoozes....doesn't care about the ice pack on her face.  Uncovering her doesn't make a difference.  Begging, pleading, joking...even subjecting her to my singing.  It took 2 hours for her to crack her eyes open.  She was fine...just making the most of a really good nap.

It was a little bittersweet to realize that it would be the last night we would talk about hurrying to sleep so the  Tooth Fairy could come.  It was an especially generous visit this time!

When I got home from New Orleans I had a very honest conversation with Abbie.  I told her that if any of this ever gets too hard, if she is too tired, or if she has completed everything she had come back to do, that she could go.  I told her that we would be OK...yes, we would be terribly sad, but we would be happy for her to be free, dancing, running, playing, and talking, talking talking.  I told her it was always up to her from now on.

It's strange how when you totally release something, that is when it can come back to you.

That conversation was spurred in large part by the increasing decline in Abbie's respiratory system, and her just looking bound up, uncomfortable and unwell.  In the last two weeks I have seen all of that reverse more quickly than I'd imagined possible.

I have begun to meld ABR techniques Leonid taught me with Tennant Biotransducer treatments on the same body areas.  In addition, I (finally) figured out one key thing about Abbie's body.  Whenever her oxygen saturation numbers dip, her body needs water.  If she begins dropping I give her 120ml of water or so, and within minutes she is fine.  Using this indicator, I have been giving her more water than I ever thought she could possibly need.

The abdomen Leonid called "collapsed" is now filled out.  You can feel the pneumatic pressure (the balloon) when you press on it.  You can no longer see her pelvic bone sticking out.

She was getting two nebulizer treatments a day, and quite a bit of supplemental oxygen.  She is not getting any nebulizer treatments anymore, and supplemental oxygen is rare as long as we give her water when her numbers drop.

Her face is changing as her cheeks seem to move back up her face, if you will.  Not hanging down like jowls anymore, but up where they belong.  And, we are starting to see the emergence of a real neck, not just a weak, bulging ring between her collarbone and jaw.

We've mostly been working on her face, neck and lower abdomen, as Leonid prescribed, but we are also see changes in her ribs, upper chest and back.  The volume in her chest is expanding.  Recall how I likened them to weak hinges that folded easily when Leonid examined her.  The left one now fills my hand, nice and rounded.  The right remains a little folded, but is also expanding.  There are times I see her using the upper portion of her chest to breathe.

I just keep telling her, "Look how STRONG you are becoming, Abbie."  I tell her because it's true, but mostly because I am addicted to the smiles it elicits.

Genevieve being gone has given me some very sweet time with Abbie.  I just cannot get enough of her.  Big things like horseback riding, swimming in the pool, and going to parties; little things, like reading the Psalms together all the way through, even when the day's cycle includes 89 and 119  (a marathon Psalms day:), rocking together, just feeling her beautiful skin and sensing her amazing spirit.

These days are a gift.

Tuesday, June 14, 2011

Sacred Journey

Abbie was injured in the afternoon.  The hours between then and evening remain a blur to me.  The first moment of clarity I can recall is when my friend, Kathleen, appeared around the bedside curtain ( I can still see her coral-colored top and khaki shorts).  She just embraced me as we groaned together.  There were no words, and she didn't try to find any.  She just met me in my pain.

In the middle of that first night, she said, "You haven't eaten anything since need to."  I had no hunger, but she insisted.  I numbly walked to the cafeteria with her at one shoulder, and her husband, Duane at the other.  I met their gentle request by selecting a chocolate Fat Boy ice cream sandwich.  We sat in surreal quiet, entreating our Lord to meet us there because this was beyond us.

Duane, my pastor, basically moved his office into the conference room next to the PICU, and didn't leave for a week.  Kathleen was steadfast, especially in the midnight hours when fear, grief and sorrow gather enormous strength.  The McDaniels laid out their hearts to ferry us across unfathomable depths.

I was sitting at Kyle's graduation on May 21, saving seats, when Ray called to tell me that the stroke Duane suffered earlier in the day was "bad, really bad....Tiffany, it's bad...."  I knew that sound in his voice, even as my soul began screaming in an effort to drown it out.

I couldn't get to New Orleans, where they had moved two years ago, until late on May 25th.  Even with fire-tested faith, I was intimidated by what awaited.  I knew  before my dear friend Sandra, her daughter Keiko, and I landed, that we were arriving to say goodbye to Duane, and to help Kathleen and their four children keep breathing through those first days without Daddy.

I cannot put into words the days that followed.  Each hour seemed a year.  Love so purified, so intense as to wash away every disagreement ever had, every cross word ever spoken.  Truly, the "greatest of these" is love.

To sit with Duane was one of the highest privileges of my life.  One evening I was alone with him, weeping with regret.  I could have supported him better as my pastor, as my friend.  What in the world did I do to be holding the hand of such a man as he lay waiting for his Lord?

In the darkness, a gentle Voice said, "No man feels worthy of me, because he is not.  But, I love you, I seek you, I choose you anyway.  I want you with Me."  I began to grin through my tears as I looked at Duane's face and said, "Even here....even here you are being Jesus to me."

Kathleen, amazing Kathleen, walked through these days filled with the special grace God grants to those at the center of the storm.  I felt it after Abbie was injured, as I was suspended above the maelstrom below.  But, this time I was not given this grace, and experienced the crushing pain of watching people you love suffer.  It gave me insight into how Abbie's injury was experienced by all those who love and support us...the fire you withstood to stick with us, to pray for us, to hurt with us.  I am so profoundly grateful.

I also got to witness the fortitude of Duane's mother, Margery...who can best be described as "concrete coated with sugar."  Her graciousness never wavered, nor did her faith.  But, you know...Mamas are not designed to say goodbye to their children.  It doesn't matter if they are 2 or 54.

So, could you please pray for these two special women; Kathleen and Margery, as they try to find their way in a world that no longer has their brightest star in it.

It was also exquisitely painful to witness four very-loved children (15,14,8,7) begin to process what had happened to Daddy, and what him being in Heaven would mean for their lives.  Please pray for Mallory, Matthew, Keanu and Abby as these days and months ahead will be a maze of emotions, grief and the creation of a new normal.

Kathleen allowed me the honor of walking very closely with her through this journey.  We wept together as Duane departed in the middle of the night.  But, as the sun rose, we truly rejoiced deeply for Duane.  In a quiet moment, I grabbed her hand and tried to croak out the following words:

"Thank you for letting me be here for this, for all of see not only the tears, but the joy.  If, and when the time ever comes for Abbie, I won't be as scared."

The shadow of the monster constantly lurking was trimmed in size by a friend's courage and love.  Just as it was at the beginning of our journey with Abbie.

Duane and his eldest daughter, Mallory

Thursday, June 09, 2011

A long awaited joy

So much has been happening here in the last three weeks that it's impossible to fit it all in one post, so I've decided to write about virtually none of it in this one and concentrate on perhaps the most exciting development, from Abbie's perspective.  She is (finally, finally, finally) going horseback riding each week!

She has been waiting for five years for this...first for her trach stoma to close, then to get past the hip surgery, the broken legs, the hand surgeries....she developed Olympian-level patience, that is for sure.  With deepest gratitude to Maunawalea Riding Center, and their wonderful volunteers, Abbie gets to Cowgirl-up every Tuesday morning.

Auntie Patty, her riding partner, getting her helmet all set

This first time I took her, we didn't know how best to set up the saddle and support chair for her.  In order to get to know her better,  Patty decided to just buddy-ride with her.  This turned out to be perfect! So, for now, Patty will continue to ride with Abbie, who melts into Patty with each lap around the arena.

The week I was in New Orleans unexpectedly, Genevieve and her son John (who took all these pictures) took Abbie by themselves.  So,  I hadn't seen them use this neck pillow before.  Abbie didn't seem to mind it at all, at first.

But, eventually, it was time for the pillow to go, because Abbie and Auntie Patty were about to hit the road!

Not only do they let Abbie ride around in a covered, shaded arena  (Thanks, Lions Club!), but they also let her trail ride down the hill a bit.  A group of students volunteered to build a "Sensory Trail" down there, with fun things to do and experience while on a horse.

Abbie getting ready to throw a ball on the Sensory Trail

Abbie and her riding entourage...all volunteers.  Makes me want to just keep hugging them every time I see them!

The view from the riding arena.  This place is therapy for all of us...if only you could feel the gentle breezes and smell the scent of flowers...aaaaaahhhhhhhh.  Love Waimanalo!

Abbie "getting the mail" on the Sensory Trail.  Usually there is a cute little rubber ducky waiting for her.

Love just oozes out of these horses, people and place.  A tremendous blessing for all of us that instantly became the highlight in Abbie's week.

One quick story to illustrate how kind they are.  Like many ranches,  "Da Ranch", where the Riding Center is located, is multifunctional.  They also do a bit of auto maintenance and mechanical work up there, led by the owner Ben (in the blue, standing by Abbie on the horse).

This week, stricken with the stomach flu, I was unable to drive out there, so Genevieve did it again.  As she was leaving, they asked her, "Why is your van making that noise?"

"I don't know," she answered, "there's no warning lights or anything."

They called Ben over who took a listen, popped the hood, took a look and determined that there was no the reservoir.  Had Genevieve driven home like that, the engine could have seized right in the middle of the windy road next to the ocean, and that would also have been the end of my van.  Yikes!

They put three quarts in to get her home, and sent them on their way.  What a tremendous blessing, in every way!

Much more to come as time allows....all is well here, but please pray for my dear friends, the McDaniel Family, after Duane's homegoing on May 30.  A wife now a widow, four young children missing a loving Daddy...prayers are their breath and life right now.

Tuesday, May 10, 2011

ABR 3: Abbie's Assessment

The day after Leonid's lengthy presentation at the Pacific Rim International Conference on Disabilities, we met him and Mark (ABR researcher) at the rehab department where Abbie receives her therapy.  He was kind enough to meet with Abbie's entire team, who all attended the presentation the day before, to delve more deeply into certain topics, and to assess Abbie.  We were even joined by her orthopedic surgeon for an hour...a stunning amount of generosity, given his very crammed schedule.

We took video of the assessement, but I have not seen it yet - so, this will be from memory.  It won't be hard though, because the highlights (or lowlights) were searing to receive.

I.  The Value of Stillness

Traditionally, we always look for the culprits to "retrain"..those loud, noisy, bullying muscles.  If an electro-myelograph is done, the large muscles literally scream for attention so insistently that it's hard to focus on anything speaking more softly, and impossible to consider those not speaking at all.

Leonid came up with an apt analogy for this:   a foreigner, previously unexposed to the USA hears only the 50 or so congresspersons who hog the media, and adds to that the input of our outspoken stars and starlets, and comes away thinking he understands the whole of what America is about.  That is what we do when we figure out the body by paying attention to those parts that wail for our attention.  Both views are utterly incomplete, inaccurate, and lead us to all sorts of false conclusions.

The connective tissue, on EMG, is silent, going about its tasks in the unassuming way that results in invisibility.  Not only do we listen for the shouts and ignore the silent tissues, but we look for the movements.  If a part of the body is not designed to move, we pay it no heed, never thinking that the stillness may be critical to overall function, and its loss a key barrier to health.

As you sit reading this, place one hand gently on your trachea (windpipe) - then, turn your head to the right and left a few times.  How far out of midline did your trachea move?  Not at all, right?  THAT is stillness, so taken for granted that we don't even notice or appreciate it.

The support structures of Abbie's neck have collapsed so completely that her trachea moves all over the place.  When her head is turned to the left, it is deviated to the right, and vice versa.  The weakness in her neck is apparent once you know that bulging is an obvious sign.  Because her trachea is not anchored by the connective tissue and ligaments, she prefers a head position that makes it easiest to breathe.

Think about gasping for air after a sprint.  What do we naturally do during the initial recovery?  We throw our heads back and gulp in the air.  This is part of the reason she prefers what we call a "nose in the air" position  (the other part will be explained later).  So, when well-meaning people reposition her head to look straight forward at midline, she feels her airway being somewhat restricted and turns her head to the side to relieve it.  I've always been told it's a neurological thing - this preference for head-turning.  Yea...not so sure that's the whole picture now.

Abbie has lost the stillness not only in her neck, but at the upper parts of her thoracic cavity (chest).  She is not using the upper lobes of her chest much at all, which has turned them into a "sewer".  We cannot even start doing ABR on her upper chest until we get other areas strengthened in order to drain the swamp, otherwise she will be overwhelmed.

Understanding the ramifications of stillness, and its loss, made me appreciate connective tissue even more.

II.  The Answer to the Secretion Challenge

Everywhere Abbie goes, her suction machine goes.  Airport security absolutely stresses me out, because they insist on separating the girl from her mechanical pal -- and even 10 minutes can be too long sometimes.

It wasn't always this way.  After she was decannulated, we didn't even turn it on once for 3 months, until she got a cold.  Since then, our constant companion has seen progressively more use.  I have wracked my brain to figure out what I am feeding her that may cause secretions.  What is in the air she may be reacting to?  Reflux meds made no difference.  This has been one mystery that has almost driven me mad.

And then, here comes the simple answer from left field.  Everyone's lungs make copious amounts (30 liters or so) of secretions each day to keep the lungs lubricated.  We have the pneumatic and hydraulic pressures and capacities to pump these properly through the system.  They are partially dispersed by seeping through (under pressure) from the thoracic to the abdominal cavity.

Well, Miss Abbie's pumps are no longer working, resulting in the pooling.  The collapse of her tissue has made it very dense so seepage is not possible (and there isn't adequate pressure to push it right now anyway).  Hence, the only way she can clear her lungs is to excrete it through her mouth and nose...often.  How thankful I am, then, that she has a strong cough  -- which she showed off to Mark and Leonid, resulting in a "cough zone" reminiscent of a Gallagher show.

So, much of her secretion challenge is mechanical....partially related to reflux caused by weakness (I think), and partially related to the "extreme weakness" of her respiratory system.

Those words in quotes were hard for me to hear, as I have felt it coming, but didn't know how far she had sunk.

Leonid had us get on one side of Abbie as she was lying on her back, and then reach to the far side of her chest with both our hands.  We compressed her chest with both hands, and it folded like fragile butterfly wings.  My throat clamped shut and tears came.

Her ribs are no longer oriented parallel to the ground, but are more vertical, so that as force comes up from the ground as she is sitting, she doesn't have the mechanical structure to handle and distribute the force properly.  It's like injury on top of insult on top of impossibility...

Later that evening I overheard Leonid tell someone that Abbie's respiratory system is "hanging on by a thread."  Ugh.

III.  Fake Versus Real

Leonid sat Abbie at the edge of the massage table and held her at the bottom of her ribs.  She was sitting pretty well, and we were happy with that....for just a second.  Then he pronounced, "This is fake."

She was not using strength to hold herself up, but rather was relying on a restriction in her lumbar spine that prevents her from falling forward. all this progress we had been seeing in this area was only her tapping more deeply into the inflexibility of her spine.  Useful, smart...damaging.

It's a great way to keep her from face-planting when seated, but as the restriction deepens through use it pulls down on the back of her skull -- the other factor in her "nose-up" preference.  As the downward pull has been tilting her head back, her jaw assumed a more open position.  So much so, in fact, that location of her of molars drifted so that currently, even if she wants to close her mouth, she can't because her back teeth meet before her mouth closes.

The more we practice sitting with her, the more we enhance the fake and prevent real strength.  What a conundrum.  He made sure we realized that as we progress through the ABR process, there will come a time when that restriction releases, but strength has not been built up yet.  In other words, there will be days of face-planting.  Never thought I would look forward to that, but I do now.

The whole "fake versus real" issue looms large when we think about little ones who may have been born with challenges.  A mother's intuition may be prodding her, telling her something is not right.  But, if her baby "meets milestones" in reasonable amounts of time, she is told her child will be OK.

But, what if a child is holding his head up via a restriction or spasticity (fake) instead of strength (real). What if instead of rolling (real) he is flipping (fake)?  These differences take trained attention and the right paradigm to notice, but ignoring them allows a child's challenges to slip by under the radar until perhaps years of opportunity have drifted by.

I acutely felt the loss of those years when, later that evening, Leonid saw a large photo of Abbie on our piano.  "How long ago was that taken?" He asked.

Hmmmm..I had to think for a moment....three years.

"Wow -- look how much better she looked back then," he said.

Ouch.  The truth stung hard.

Pulled down by the head tilt and let go by the tissue collapse, her face has seemingly slid down her skull...her cheeks are smaller and her jowls are bigger.  It is harder for her to smile.  I did see all this happening, bit by bit, and I felt helpless to stop it.

It's strange to be sad as I look pictures of her as a four-year-old.  It used to be that only pre-drowning photos could stab my heart.  But, now I see how far she has gone in the wrong direction from those early years.  Oh, I wish I had known what I know now.....but I remain thankful that I have learned in time to help her.

There is even more we learned, but I will save that for another post, as I have to go, and I'm sure you do, too.

Just one little "Abbie-ism" I have to share first.  The day of evaluation was all about "weakness, extreme weakness, and profound weakness" all over Abbie's body.  At bedtime that night I could tell she was distressed, and took a chance that I knew what it was.

"Abbie -- I know that today everyone kept saying over and over how weak you are.  But, you know what?  You are strong where it counts!  Everything else can be fixed, but you are strong in your heart, and in your spirit and that is what matters."

A smile came, and  sleep followed soon after.

She always has been, and remains....strong where it counts.

Thursday, May 05, 2011

ABR 2: Stress Shielding and the Vicious Cycle

As we begin to make the mental shift from force generation (muscles) to force transfer (connective tissue) as a target for therapeutic interventions, one of the first things we need to realize is that the body of a brain-injured person, or pa erson with CP, is a mix of strong and weak tissues, often in combinations that boggle the mind.

Traditionally, we have been obsessed with the strong, bullying tissues.  We give medications to relax them, do surgery to release them, inject Botox to paralyze them, but never really give a thought to the other side of the coin.  How do we strengthen the weak tissues?  I envision it at somewhat like the challenges in classrooms today.  Do we keep the class moving along together by holding back the bright children (easy) or strengthening the challenged learners (difficult)?

We've focused on the strong partially because we have had no means to strengthen the weak.  ABR gives us this opportunity, but it doesn't mean the strong tissues are going to give up without resistance.  In fact, they have become so adept at their roles, which in some cases are helpful to the person although ultimately destructive  (like the high muscle tone that may help a child sit,  but will eventually contort the spine), that we must sneak past them to build up the weak tissues.

This is a rough picture of something called "Stress Shielding", where the strong tissues absorb incoming mechanical stresses to protect the weaker tissues, and in the process become even  stronger while the weak tissues continue their decline fomented by neglect.

In a normal body, there is a cycle of tissue remodeling that looks like this, what Leonid has termed "The Virtuous (Sustainable) Cycle":

This cycle can continue in a positive, healthy way  because when mechanical stress enters the body it is sustainably and efficiently distribute by and between tissues that are balanced.  This well-distributed stress is then used to maintain the vitality of the tissues appropriately, so that the cycle can continue.

In a person whose tissue are a mix of strong and weak, the cycle looks like this:

I know the words on the outside of the circle are hard to read, but they are the lists of interventions that are typically applied to counteract the negatives at each of the stations of the circle.  Usually, they are of little to no avail in moderately to severely impacted people, and so their  movement through the vicious cycle continues.

You can jump in at any point on the circle and envision what happens.  Say that you start at "irregular muscle activation" -- this pattern of use leads to tissue remodeling that reinforces this negative pattern...reinforcing the underlying mix of strong and weak.  With the tissue differentiated this way, stress shielding kicks in, as the strong absorb the lion's share of mechanical stress, and deprive weak tissue of the stress they need to get stronger.  The disparities between the tissues lead to internal force imbalances,  with the strong tissues being strengthened even more by the imbalance.  This  leads us right back to irregular muscle activation.

Look, many physically disabled people have a very high "Motor IQ"...being so limited they are endlessly creative and persistent in finding a way, any way, to make their bodies accomplish what they desire.  If "irregular muscle activation" allows them to use a communication device or control a power chair, it's very difficult to say , "Hey, try not to use your body in that way -- it's a destructive pattern."

But, we are not just talking about voluntary muscles, we are talking about all tissues, so halting this destructive cycle is not about "retraining muscle movement".  It is ongoing 24/7, even as a person is apparently still, or even sleeping.  The only way to reverse it is by strengthening the weak tissue, to balance the force distribution and negate the stress shielding response.

A good visual analogy of stress shielding is to align a length of steel cable next to an equivalent length of rubber band.  As you stretch them together, you know that they will only reach the length of the steel cable, which will be absorbing all of the stress.  The only way to introduce stress to the rubber band is to work around (without) the cable.

How can we do this in the body?  Our first instinct, when trying to provide mechanical stress to deep fascia, is to press harder, to make sure the stress reaches far enough.  All we are doing with this approach is activating the stress shielding response and strengthening the strong.

We have to go gently in --- so gently that the movement is almost imperceptible. It truly is like sneaking in under a wire.  ABR aims for a 1-2% deformation of underlying tissue.  To compare, range of motion exercises and fascial release generally aim for 3-8% deformation.  Beside activation of stress shielding, there are a couple of other challenges with this higher range.

Tissue deformation at 3-8% is the introduction of microtrauma to the tissues.  This is how healthy people get stronger.  When we push ourselves at the gym, our muscles respond to the microtrauma by getting stronger over time.  But, recall that people in the moderate to severe range of impact are metabolically broke -- they can't afford to fix microtraumas, especially not on a daily basis  (as range of motion is often prescribed) and in many areas simultaneously.

Secondly,  to achieve gains from range of motion exercises, they must be applied to the very end of the range.  This gets rather technical and challenging, and is a skill difficult to easily and effectively transfer into the hands of parents and caregivers.

So, ABR provides a fortunate confluence of variables:  the 1-2% deformation of tissue sneaks past stress-shielding, doesn't induce physically-expensive microtrauma, and can be safely accomplished by lay people.  And yes, this small window also means that it takes time and repetition.  ABR is not a quick fix, not even a moderately-fast fix.  It is a long-term, one small step at a time approach.

But hey, our brain injured loved ones are never standing still...they are either getting better or worse each day.  So, I am more than happy to take small steps, as long as I know they are in the right direction.

I know this was a really long that I've given you the "why" of the ABR technique, tomorrow I will delve more deeply into the "how"

Monday, May 02, 2011

ABR 1: Lavish versus Thrifty

In researching ABR I watched hours of video, piecing together the theory and application as best I could.  It was a great relief  when Leonid, while visiting Hawaii, framed it in a way that made it immediately relevant and clear.  He introduced us to the concept of “Lavish” versus “Thrifty” rehabilitation.

The most expensive things in the body are the muscles and the nervous system.  They require a lot of effort to use, and the body expends a lot of metabolic energy to meet their demands.  Most traditional rehabilitation focuses on one or the other, or both simultaneously as therapists, parents and aides attempt to stretch and “retrain” muscles, and give sensory and cognitive input in hopes of eliciting output.

A healthy person has adequate reserves to meet the needs of the muscles and nervous system.  Some injured people also maintain enough of a metabolic “bank account” to write the energy checks these systems demand.  But, in the case of the most injured people, a systemic collapse has drained their reserves, and they are unable to meet the demands of these expensive systems.

So, asking a very injured person to use the most expensive means is analogous to asking a girl without money to buy rice, to purchase steak in order to recover.  Not only is it not feasible, but the attempts to use the expensive systems leave an injured person in deeper debt, in worse shape in many ways.

The connective tissue of the body, on the other hand, is extremely cheap, or "thrifty".  It makes almost no metabolic demands on the body, nor any cognitive demands.  It is ubiquitous - found everywhere in the body.  It covers, and actually invests itself, into bones, muscles, and organs.  It is the major support structure within the body.  It is also completely passive, very unlike the contractile properties of muscles.  So, it requires a mental shift to begin considering how to strengthen connective tissue.

To begin this shift, we can observe what happens when it collapses.  A healthy person has two major "balloons" supporting her core, one in the chest and one in the abdomen.  Those balloons are contained by (or even created by) connective tissue.  When a person is subjected to a significant neurological trauma (either in utero or after birth at some point), the connective tissue begins to collapse.

[Side note:  the thoughts within these brackets are mine, not Leonid's.  Not sure if he would agree or not.  Many have asked me "Why does it collapse? The first factor, I believe, is hormonal.  Cortisol is a stress hormone, which destroys connective tissue after prolonged, elevated exposure.  After brain injury, typically a person's cortisol levels go through the roof. Abbie's were still extremely elevated two years after her injury.  There a not any really good ways to bring cortisol levels down, although DHEA supplementation can help.  I have chosen not to give DHEA to Abbie at this point, because she is still pre-adolescent, but she does get pregnenolone.

The second factor is a vicious cycle.  Tissues remain strong and vital by being stressed mechanically -- by moving and bearing weight.  As a brain-injured person becomes locked up by spasticity, healthy biomechanical stresses become difficult to provide.  Tissues weaken, fluids stagnate, and the entire system begins a gradual but steady decline.  When the tissues weaken, the balloons of support act just like balloons that have been pricked, slowly losing the pneumatic pressure needed to support the core of a person.]  

Once the balloons of support collapse, all the joints begin to move into the wrong places.  Stepping back for a moment and realizing this makes the arrogance of our "movement retraining" approach apparent.  Once a body is contorted, the person lives in what Leonid calls the "proprioceptive jungle"  (proprioception is how the body perceives it's position in space and movement).  Because joints are not in the proper places, nor functioning normally, the input given is altered.

We, on the other hand, blessed with healthy bodies and normal proprioceptive capabilities are "urban dwellers".  We then approach the jungle dwellers and attempt to teach them how to hunt in the jungle.  Just because we know from our experience how a shoulder "should" work, we think that helping a jungle dweller is as simple as forcing his shoulder to work the same way, through stretching, assisted movement, and medications.  Helping a starving native tribe by telling them to google "gardening tips" makes about as much sense.

In the weeks and months after a brain injury, much investment is made in the lavish methods of rehabilitation.  For those fortunate enough to have the resources to utilize these investments, recover comes in differing stages and depths.  However, for those not so fortunate, the lavish efforts produce nothing worthy of comment nor celebration while in the meantime, the connective tissue collapse pushes them further from health.  This points to the need to differentiate between degrees of injury -- "brain injury" is far too broad of a stroke to adequately address the varying needs.

The graph below was produced by a group in Hamilton, Ontario Canada who followed children with Cerebral Palsy for 21 years to see what levels of motor function they were able to achieve.  Although this is geared for CP,  I think it is instructive when we talk about motor recovery in brain injury in general.

Prognosis for gross motor function in cerebral palsy: Creation of motor development curves. Journal of the American Medical Association, 288 (11), 1357-1363 Rosenbaum, P., Walter, S., Hanna, S., Palisano, R., Russell, D., Raina, P., Wood, E., Bartlett, D., & Galuppi, B. (2002). 

As you can see, "Level 1" is the least affected, while "Level 5" is the most affected.  Lavish methods may be effective for Levels 1 and 2, but for Levels 3, 4, and 5 they are increasingly less effective.  It is often tempting, after seeing progress in a Level 1 or 2 person, to replicate the approach in a Level 3, 4 or 5 person, while thinking, "Well, we may not achieve as much, but at least we may gain something."

Unfortunately, since the lavish approach bankrupts the Level 3, 4 and 5 people, not only do they not achieve gains, but they make things worse.

The collapse of the connective tissue has great impact on the respiratory system, the digestive system, as well as posture.  I can tell you that every parent of a spastic quad child is dealing with challenges in all these areas.  Normally we are given medications  (nebulizers, inhalers, anti-secretion,  anti-reflux, digestive motility aides, anti-spasticity) and all manner of splints, braces and supports.  What we are not given, unfortunately, are solutions.  Our children continue their declines at rates that seem to accelerate over time.

I sit here typing on the first Monday in May....the day Abbie drowned seven years ago.  Through these challenging years I have often comforted myself by saying, "My daughter is not an oncology patient.  I am not beating back something trying to kill her."  But, in the last six months, I have realized that comfort is an illusion.  She is dying, more rapidly each day, as her respiratory system begins to cave under increasing strain.

Leonid's in-depth evaluation, which I will describe in a separate post, was exquisitely painful for me, as he confirmed my fears, and shone a bright light on things I'd only seen as shadows.  I try not to regret only learning about all of this now, avoiding thinking about the beautiful, strong body that has disintegrated over these years.  It will be a long road out of this valley in which we find ourselves, but we are walking anyway....only, now I have confidence that perhaps we can change the direction.

More to come on typical results of connective tissue collapse, how to strengthen it, and the physical barriers we have to work around.

Sunday, April 24, 2011

Risen Indeed!

Holding the precious lei presented to her by her beloved (and lovely) Auntie Merle at church today.  I only wish you could smell it!
I really, really, really LOVE my dad!

...and my puppy really loves me!

Easter 2011....the boys still hate taking photos!

With 3/4 of my sons....we missed you Chase!!

Easter provides me, at last,  respite from a week that has left me feeling like I've lived through seven days of spin cycle.  I don't think it a coincidence that as I celebrate the sacrifice that has led to new birth (Oh, Death...just where is your sting???),  the birth of new insights, paradigms, outlooks, and plans with regard to Abbie's body is calling us to somber recognition, determined sacrifice and faith-based rejoicing.

I met Leonid Blyum, the inventor of ABR, and researcher Mark Driscoll, at their hotel one week ago.  I was slated to introduce them at the Pacific Rim International Conference on Disabilities  the next day, so I wanted to touch base to see if there were any particular things they wanted me to highlight.

OK -- that was part of the reason.  The more honest explanation is that I wanted to check them out.  I had invited numerous people to the conference to hear them, and wanted to know ahead of time if I'd made a huge mistake.  Within five minutes, those concerns evaporated, and I knew I was in the company of men who were going to stretch my mind, and hopefully, change Abbie's path.

I have learned so much this week, and feel compelled to share it with other brain-injury families.  So, I will break it into installments.  Yes, it is about Abbie, but from the beginning, where possible, Ray and I have committed to make this journey matter for ALL children who are in Abbie's position.  Thankfully, what I learned about Abbie this week translates very easily to all children recovering from brain injuries.
I will be writing about:  The "Lavish" versus "Thrifty" approaches to rehabilitation  [which explains the basis for ABR, and also why traditional rehab doesn't work for severely impacted people]; the differences between CP and acquired brain injuries in regards to physical rehab; the value of stillness; why we can't solve the secretion problem;  Abbie's biggest challenge (which is not unique to her), "Fake Strength", and where we go from here, as a family and as a state.  So, stayed tuned for all that.

On this day, though,  our thoughts go to our families spread out on the mainland, and to friends we've been blessed to have far and wide. With such a profound reason to celebrate, we wish we could all be together today....but, that Day is coming!!

God Bless.

Friday, April 08, 2011

A New Throne

I just received pictures taken of Abbie while we were making the mold for her new wheelchair.  They give a good idea of what she will look like when she does get her new throne, eventually.

In this first picture, the therapist's hand at the back of Abbie's head is doing the job of a head rest, so this is how Abbie will look from the side when seated:  

 The mold will have full contact with her back, pelvis, ribs, and legs, so she will just need a lap belt to help keep her safe, most likely.  Quite a difference from the lap/lateral/chest strap contraption we have to use now!

Being seated in a position that allows her to look straight ahead rather than at the sky, as her current chair positions, results in much more visual engagement from Abbie.

Once we had a good shape around her, we took her out and they filled the whole mold with plaster.  So, a perfect copy of Abbie's little okole is sitting right now in the rehab department, waiting for the green light to be sent off to the seating company.

Here's a snapshot of Abbie right before we went on our very short walk in the woods during out trip to Washington:

Abbie and Genevieve, at what ended up being our turn-around point.  Notice how different Abbie looks seated in this chair opposed to the mold above.  She's tired of looking at the clouds!!

Please continue to pray for Genevieve's mom.  They have been able to extubate her, she has spoken a few words, but it extremely weak, very disoriented, and it the very early stages of what is going to be a challenging journey of recovery.  If she is anything like her daughter, though, there is MORE than enough fight in her spirit to make it back.

Monday, April 04, 2011

Living With an Enlarged Heart

Many times, as I meet someone, or as someone I know first learns about the details of Abbie's journey, one of their first sentiments is, "I could never make it..."  Before it happened to our family, I thought the same thing.  But, one of the things I've learned is that extreme trauma, grief and challenge don't have to break your heart permanently, but they do change the shape of it forever.

The basement expanded by the flood of tears is matched in scope by the altered top floor with improved views of grace, joy, and love.  Nothing is ever the same -- and for that, in fact, I am utterly grateful.  The lows are truly lower than I can describe, but are matched by equally unfathomable highs.  Living with an enlarged heart means that each day may include volleying back and forth between the two several times.  That was certainly the case this week.


Abbie's adventure has led our paths to cross with the most amazing, kind, compassionate people, and I'd like to introduce you to a group of them I met this week.

This photo is the second-semester carpentry class at Honolulu Community College, with their instructor Dean Crowell (blue shirt with white stripes).

A couple months ago, when a group of six families was working at warp speed to bring the ABR therapy to Hawaii, we were trying to figure out how to build special ABR "benches" for each of our kids.  We could not proceed with the pilot group without them, but there wasn't a carpenter in our group.

One of the moms, Shari, had the brilliant idea to call HCC to see if it would be an appropriate project for them.  Immediately, James Niino, of HCC asked for more information, and within a couple of days said, "Sure, we would love to do it!"

It's hard to describe what a relief this was.  James would have the carpentry class build the benches, and then the families would only have to upholster the padding and sand and finish the bench.  The plans we'd received from Montreal were not completely clear, so Dean Crowell used his expertise to fill in the blanks, and we planned to pick up the benches on April 1.

In early March, James called and said...."You know, as we look at these benches, the upholstery is going to be pretty tricky.  So, I've talked to our upholstery instructor, Donald Frost, about it -- he is going to donate the foam and vinyl and they will do the upholstery."

Another big sigh of relief!  All we would have to do was sand and finish -- that, I felt pretty confident, we could do.

Kyle and I went to pick up the benches on Wednesday, and got to meet the whole class.  As I looked at the benches, I noticed they were pretty shiny for unfinished wood. wasn't.  They had finished them for us, too.

I was pretty overwhelmed by their thoughtfulness, and tried to explain to the students what their work meant.  I failed utterly at eloquence, and just said the benches were for a special therapy for many children who used wheelchairs, in the hopes that one day they wouldn't.

It was a humbling experience where my spirit just drank in the compassion of others.  Hawaii is a very special place, and as one of the students told me, "This is what we do for each other.  We are ohana..."

Mahalo Nui Loa to James Niino, Dean Crowell, Donald Frost, and their students -- you've built more than six benches, you have bolstered the spirits of six families who are each on a very long trek.

Joyful Anticipation

"Always for a reason" is what I've learned about delays.  I try to hang on to that lesson when frustration and impatience creep in.  Many hours this week were spent in appointments about Abbie's future wheelchair.

On Tuesday I met with a local vendor, Frank, for almost three hours to talk about Abbie's seating needs and the right power base for her.  The most powerful insights came when Frank let me drive a couple of power chairs down the hall to experience the difference for myself.

Observation #1:  driving a power chair is not as easy as it looks.  In fact, I was pretty horrible at it  (which in no way relates to my car-driving ability:).  It gave me a lot of empathy for what faces Abbie as she learns to control one with her head.  Generous amounts of time and patience will be needed; avoiding expectations of her hopping in and taking off in a matter of weeks.

Observation #2:  the seating Abbie needs cannot be made by anyone in Hawaii.  The insurance company does not agree yet, but we're working on it.  In very good timing, the vendor from San Diego, Kevin, was here again this week.  We took a new mold of Abbie's body, since she has grown since the last one was taken in December and we have no idea how long the approval process is going to take.

The mold we got this time was even better than the first one, and seeing her sitting in it was a joyful moment...truly, she looked like a big, smart, independent girl.  The word "baby" didn't cross my mind. It often crosses the lips of other kids who see her being pushed in her wheelchair, which is one reason I am hoping Abbie will get a power chair soon.

We're still working through the process, but truly covet your prayers, as we haven't even made it past the administrative review yet....they won't start picking the request apart for medical necessity until we're past the admin hurdle.

At the same appointment, we took a mold for a custom-fit side-lyer for Abbie to sleep in. Honestly, I was a bit ambivalent about this equipment, because it will be big and bulky.  But, once I saw Abbie relax as the mold closed in around her...well, I don't care if it's a baby elephant if it will help her sleep well and get her spine into the best position!  This will be a boon to our effort to prevent scoliosis.

An enlarged heart captures rays of joy that may fly above houses not yet renovated by trial!

The Volley

As we walked out of the mold appointment, I saw my little friend, Hailey, sitting in the hall.  Her mom and I have struck up a hallway friendship over the years, as we are both Rehab frequent fliers.  Hailey had an aggressive brain cancer, and required a surgery from which most children don't recover their speech or ability to walk.

Hailey's mom burst into tears of joy when I told her about Abbie's power chair.  I did the same when she told me that Hailey's port was being taken out, and we marveled at her pink cheeks, regrowing hair, and ability to run down the hall, sporting a little chub around her tummy.  What a far cry from the wan, weak, silent girl I met as she leaned on a tiny walker.

Hailey was struggling to open her milk, so I sat down to help her.  "Hey!" I said, "You got your port out, didn't you?"

Now distracted by opening the straw, Hailey didn't really look up when she said, nonchalantly, "Well... I was going to, but before the surgery they had to do Xrays, and they found a tumor on my spine."

I tried not to shriek or cry in front of her as the air was sucked from my lungs.

Her brother, Zachary, came bounding down the hall, eager to spring April Fools' jokes...which included telling the staff he didn't have school that day.  April Fool's!  Followed by his sing-song voice saying, "But, Hailey really didn't have school - she had chemo instead."

My head was spinning as I realized it was all starting again for them.  Fortunately, I suppose, Hailey's dad was with her, as I think I would have dissolved upon seeing her mom.

An enlarged heart, knowing by name what lurks in the basement, does suffer more acutely as those they care about are called to descend the staircase once again.  Please, please pray for sweet Hailey and her family.

The Promise

As we were finishing up our Spring Break trip last weekend, Genevieve got a very strange message on her phone.  Her friend, Maria, was calling to check on Genevieve's mom because she was expecting her hours earlier.  Maria lives in Ewa, which is quite a ways from Genevieve's home in Waimanalo.  Her mom had been riding the bus to Ewa when she fell asleep.  After she'd been riding for four hours, asleep, the driver tried to rouse her.  She was unresponsive.  Genevieve's mom had a stroke at some point before she reached Ewa, but hours had passed since then -- critical time for stroke treatment.

Genevieve's mom has been on a ventilator since last Sunday.  Although it seems that perhaps the imminent threat of her passing has abated, the picture remains very unclear.  Would you join us in prayer for her healing, and for comfort for Genevieve and for her seven sisters and brother in the Philippines?

An enlarged heart knows that it knows that it knows that all His promises are true, and we cling to these with both determination and trust as new storms come.

May the Lord bless you, and may you welcome heart-renovation, even if it comes in overwhelming, painful packages.  The Contractor can  trusted, and the results will be worth it!

Monday, March 14, 2011

Wishes (Come True) and Wings (Of Her Own)

I am delving as deeply as I can into my soul to find words to describe Abbie's theater experience yesterday.  As you can see above, she made a lot of new friends....but if we start at the end and not the beginning, you may not understand why I was taking that photo through tears.

Keiko is the eldest daughter of our precious friends, the Oda family  (she is the blue fairy above).  Her mama, Sandra, invited Abbie to the Friday morning production of "Wishes and Wings", a play about a young fairy hoping to get her wings.  Unfortunately, Friday morning found most of Hawaii shut down due to the tsunami warning the night before  (pray for Japan!!!)

 I thought we were out of luck, and was so thankful that after many iterations of disappointing my daughter, I'd learned the lesson...I didn't tell Abbie about the play, so she wasn't sad.  In fact, she was still grinning on Friday from getting to sleep in Daddy's spot on the bed, since our bedroom is upstairs, and Daddy had to work all night during the emergency.  What an adventure.

Sandra emailed and told me there was another show on Sunday...woo-hoo!  She also mentioned that Abbie may get to meet some of the cast after the play -- what a treat.

The entire day was perfect.  We pulled into the parking garage, and immediately found plentiful handicapped parking.  You fellow drivers of rampvans know what a huge deal that is!  As we entered the theater, we asked for handicapped seating, and each usher was so kind.  They initially seated us in a very nice section about 3/4 of the way up the theater, with lots of room in front of us.  As the usher looked at Abbie, though, she noticed that her chair positioned her head to make her look up, not straight ahead.

"You know, we could seat her in the front row, so that as she looks up, she will be able to see everything."  What compassion!

So, to the front row we went, to what turned out to be the primo spot.  Abbie could see each of the radiant fairies, with their fantastic make-up, we could laugh with the silly turtle and seal, and she jumped a little at the scary spider.  Best of all, at the point in the play when the bubble machine kicked in, I think most of them landed on her.  She was thrilled!

I was transfixed by the lead fairy, "Blossom", a young one trying to get her wings.  Yes, I was impressed by her voice and poise, and was drawn in by her character.  But, mostly, I could not get over how much she reminded me of Abbie....very spunky, a little sassy, beautiful curls, and a sense of adventure.  In the end, she got her wings because she chose love.

One song that Blossom sang went something like this:  "When I get my wings, I am going to do a hundred thousand things."

I wondered how often Abbie serenades herself with a chorus similar to that.

We clapped and cheered as the colorful cast took their bows.  And, then Sandra came to me and said, "Doesn't Blossom remind you so much of Abbie??"   I had to smile at the validation.  My heart was pretty full by this point, so I was unprepared to hold back tears as the cast began to encircle Abbie.

They all knew her name, and were giving her lei!  Oh my!  Not only were they taking the time to greet her before they went outside to greet all the other patrons....but they had known she was coming.  Not just some little girl in a wheelchair, but Abbie.

And, then Blossom stepped forward...

Having just earned her own wings, she wanted to present Abbie with a pair of her own, too.

Here is sweet Blossom, and her newly-winged sidekick:

Abbie was then presented with a beautiful flower by one of the "Boy Fairies" as we called him:

They made such a beautiful fuss over her that I felt completely incapable of thanking them, and only hope that they have an inkling of how deeply their thoughtfulness, time, and attention meant to Abbie and her mommy.

As we walked to the car, we stopped to give Abbie some medication.  As I moved the lei on her lap, I noticed that one, composed of easter eggs, had a heart-shaped card attached.  I flipped it over to read this:

To Abbie - The girl who can fly,

"I can do all things through Christ who strengthens me.  Phillippians 4:13"

Love, the Fairies

The girl who can fly -- how much that touched my heart.  I know in her dreams she does, and I pray fervently that the freedom she finds in the hours of slumber see her through the daylight hours of restriction.

After receiving it so abundantly yesterday, I can say yet again,  "Love Always Wins!"

Abbie and Keiko

With our deepest, from the tips-of-our-toes thanks to Abbie's beloved Auntie Sandra, who is always thinking of ways to include her and make sure she has a big life.

Monday, February 28, 2011

Full Steam Ahead

Today was another big day for our driver-in-training.  At therapy, we seated her in the power chair, headed to the elevator and went downstairs, to a broad, uncluttered hallway.  Then, we said, "Go!"

And boy, did she.

She controlled the forward motion of the chair with a sensor placed directly behind her head.  As she was almost down the entire length of the hallway, I began to wonder if she either didn't understand how to stop, or couldn't do it it.

Has she taught me nothing?

Of course she knew how to stop, she just didn't want to.  Once we assured her that she could stop and start whenever she wanted,  she showed off her stopping skills.  As the minutes of practice added up, she became able to start and stop in rapid succession.

I played a game with her, by standing in front of her a ways away, and letting her drive up to me and stop before she hit me.  Let's just say that it's still a work in progress, but I did tell her that it was the best "first day of driving" in our family so far  (no offense, Chase and Kyle).

At one point we all stepped away and let her really feel independent as she drove.  I was in front of her, and an image from several years ago flashed in my mind.  A couple of years after Abbie's injury, we were in the hall waiting for our therapy session.  A young girl and a therapist emerged from a room, and the therapist placed large, colored plastic dots on the floor.  The girl, an emerging walker, had to practice walking from dot to dot while keeping her balance.  Oh, how deeply I longed for Abbie to progress to doing therapy in the hall, from dot to dot.

I felt again today, that our prayers are often answered in ways we could not have imagined.  Would I rather have Abbie walking?  Of course.  But, I realized what I truly desire for her is independence, and I saw a glimpse of it today -- doing therapy in the hall at long last.

As far as her power chair request goes, I was notified last week that the insurance company had contacted a local vendor to see if they could put together a chair like the one we had requested, and they replied that they could.  This is not possible, because there are only four authorized vendors for the seating system Abbie needs, and none of them are in Hawaii.  The seating is critical to making everything else work, so I became anxious when I heard this news.

Then, I thought,  "Wait...back up for just a second."

If the insurance company is negotiating about what vendor is going to supply the chair, and they haven't pushed back on any components of the chair...well, it sure looks like the actual request has been favorably reviewed.  Wow!!  I am still holding my breath until I hear something officially, but I am very encouraged.

One other update, regarding the ABR therapy I wrote about recently, and for which we continue to raise money.  The original visit from the ABR team was scheduled for later this week, but at the beginning of February it became obvious that there were too many loose ends and too little time to ensure a successful initiation of ABR in Hawaii.  So, we have postponed it.  But, we are thrilled to be welcoming the inventor of ABR, Leonid Blyum, and the principle investigator (lead researcher), Mark Driscoll to Hawaii, for the Pacific Rim Conference on Disabilities, April 18-19.  We will also be conducting follow-on meetings with stakeholders in the community to see how we can best launch a community template for ABR in Hawaii.

If you are in Hawaii and interested in learning more about ABR, the presentation will be on Monday, April 18, 8:30-12 at the convention center.  There will be special pricing of $85 for family members wanting to attend only  the ABR portion  of PacRim.  Professional registration is $165 for one day.

You can register here:

Note:  the family special is not yet available at the PacRim website.  If you are interested in the special pricing, please email me at

May God bless you!

Tuesday, February 15, 2011

Pray for Abbie's Friends

I have dreaded opening emails and checking Facebook this week because so many of my near-drowning mom friends are describing very challenging, threatening situations with their children's health.  Some of the kids are sicker than they have ever been since their initial injuries.

Could I ask you to specifically pray for:

***  Caleb:  He had a very long febrile seizure the other night, ended up with collapsed lung(s) (?), and is in the PICU on a ventilator today.  He is very, very sick and the doctors have not been optimistic.  It seems from a recent update that he may be stabilizing a bit today, as far as blood pressure, but he remains extremely fragile. It appears he has a very bad pneumonia.

Caleb and his family are precious to us because they are here -- we see them at therapy, around town, and it's nice just knowing we are not alone on this island.  He has a baby sister who is not quite three weeks old.  I cannot imagine balancing everything that is on Kehau's plate right now, so please pray intensely for her, too.

***  Luke:  Our little buddy in Tacoma was able to narrowly avoid the PICU this week, but remains hospitalized today, also with respiratory challenges.  His mama, Sue, and I have traveled this road together almost from the beginning, and she has become a very special friend and encourager.  Please pray that Luke continues his suddenly-speedy recovery, and is able to be discharged today.  There is a birthday party  tonight for his older sister, Natalie, and I know they so want to celebrate it as a united family.

***  Aiden:  I got to meet Aiden's exceptionally creative and crafty mom, Erin, at the near-drowning retreat in November.  He is the eldest of three, so I don't know how Erin finds the time to out-cake-decorate Martha Stewart and crochet masterpieces, but today finds her running to the pharmacy and caring for a very sick little boy.  Again - respiratory.  Ugh.  Please pray for his quick recovery!

***  Santana:  another little boy suffering from respiratory challenges, with another truly talented and creative mom who focuses on film production.  He is the middle of three boys, and I have missed hearing from Lindsey lately as Santana has been too ill for her to be online much.  I don't know the details, but I do know that prayer changes things, so please lift him up.

One common theme (and's not the gender)...what stalks our fragile children is respiratory infection.  Each of our families know too well that what our children usually die from is these infections that get out of control.  The stress, fear, and worry can be overwhelming as things begin to take a wrong turn.  I have felt this weight even just praying for these families, so I am asking you to join me, as they just cannot bear it on their own.

God  bless you!