Monday, 16 June 2014

Nate's Next Stepping Stone On The Path To Speech

Nathan will be starting the extended school year program in just a few weeks.  He will go back to the same site he went to last year (but not the same school he goes to during the school year) and that got me thinking.  How will these teachers and therapists, who likely worked with him last summer, view his progress?  I mean, I have a hard time gauging it myself, but I see him every day.  These people have gone almost a full year since they last saw him.  What will they think?
And then I smiled.  This year, for the first time, I would like to go in and see the looks on their faces.  This year, for the first time, I know that they will be looking at a child that has made progress- and it will be my son!  Is he still stimmy?  Ummm, yeah he is!!  Is he distracted?  Oh yes.  Does he notice the other kids?  Rarely.
Did you notice I just said rarely?  Last year that answer would have been NO.  I have caught him looking at Jack lately- especially when they are swinging together.   He will watch Jack’s face while he swings.  And he smiles.  OK, that makes me teary.  This is one of their first positive interactions.  John and I noticed it the other day, and we were both like “look, look!!!”  HUGE for him. 
And the words, oh the words!!!  He can say anything he wants to.  He can repeat any word that I tell him to.  He can say mama, hi, bye, go, open, all done, eat, drink, no, I want, bath, I don’t want, “Lawrence”, “gwen”, night night, gra (for grammy), chicken, chip, cookie, pi (for pizza), meat, dog, fish, watch- and many more.  And he gives the most incredible hugs and kisses.  They will be stunned by all of this.  I am stunned by all of this.
There is a much needed next step for Mr. Nate.  And that is USING these amazing words that he can now say.  At this point, if he wants something, he will still say “more”.  And we have to go through a list of possibilities.  If we say “eat” and that is what he wants, he will respond with “eat”.  But when we get to the cabinet, he just says more again.  If I say “cookie” and he wants cookie he will say it- if not, he literally pushes it away.  Same with any other food.  Now we have to get him to use these words spontaneously.  It’s a big transition and can use his pecs as a tool- so he can hand us the picture of what he wants, or even point.  Sometimes that works.

And like all autism parents there is that paranoid part of me.  Is this going to go away?  If I stop feeding him the words, will he lose them?  He has lost so much so many times before.  I can’t take watching it happen again.  So it takes a lot of strength to withhold a word from him. His speech pathologist at Cisco Center, Miss Carla, will stand at the door with me and I want to say “open door” and make him repeat it.  She wants me to just stand there and wait, or state “open door” and not do what I do, which is  say “say open door Nate”- which then makes him do it.  It is a very small difference and those of you with regular old verbal kiddos may be reading this and saying why the heck does it matter?  I say to you- I totally get it!  If someone had talked about this when Jack was my only child I wouldn’t have gotten it either because Jack would have stood at the door shrieking “open door” like 5000 times and interrupting our conversation.  It is a totally different world.  Carla is 100% in the right.  She can view it from an objective angle.  I on the other hand cannot.  I view it from a fearful, anxious, maternal angle.  I want him to make this leap so badly.  But it took him sooooo long to get to where he is, and a bigger part of me wants to just continue to hear these words even more.  I prayed for these words, I begged for these words.  I sat in front of him saying them over and over and cried so many days because I didn’t hear these words.  And now- because I am a good mommy and I love him- I need to stop trying to get him to just repeat what I am saying- I need to work on functional speech.  Deep breath…ok, I can do this.  It will have to be in small steps.  I do not want to take away his current, relatively new, ability to communicate, even if it involves my assistance.  We can start with areas where he is super motivated- food (he is our kid, ha).  And we can take the next step.

Wednesday, 11 June 2014

Depression, Anxiety, and the Autism Parent

I read many autism blogs at this point- the autism "blogosphere" is very much so a community and I like to keep up with certain families.  I read blogs by both moms and dads and something struck me the other day.  In both of the autism dad blogs that I read, the dads are very up front about the fact that they suffer from depression.  They are both on antidepressants and don't hesitate to talk about it.  I have not seen many autism moms discuss this, which doesn't mean that it hasn't happened, I just haven't seen it.

Why aren't we talking about this more?  Because guess what?  I AM depressed, and I have been for quite a long time.  I know my husband experiences depression as well.  I know my autism mom friends are depressed.  Hell, I was having a horrible anxiety attack last winter, and one of my mama friends offered to pop by with some ativan.  It's just like that.  There are multiple studies and a bazillion articles about it:
Autism is associated with burden and stress for parents/caregivers of the affected child. The demands placed by the disability contribute to a higher overall incidence of depression and anxiety among parents/caregivers.
Most parents of children with disabilities or chronic health problems suffer a great deal of stress. There is evidence, however, that parents of children on the autism spectrum suffer the most stress of all. 1There are several reasons why the stress of those parenting children with an autism spectrum disorder (ASD) is so high. All parents of children with disabilities must cope with grief, worries about the future, and the struggle to find and obtain appropriate services. Parents of children with ASDs face some additional stressors. First, they often live with uncertainty about what caused their child’s autism, as well as possible guilt (no matter how undeserved) over whether they did or failed to do something that led to their child's ASD.  Second, the core disability associated with ASDs is a social one. Most parents hope for a warm and loving relationship with their child. It is bewildering to find you have a baby who does not like to be held, or a child who will not look into your eyes. Parents adapt, learning to love the way their child loves, but usually not without having passed through some confusion and pain.  Third, no matter what their specific ASD diagnosis or IQ, children on the autism spectrum often have problem behaviors, from refusal to sleep to intense and frequent tantrums to extreme rigidity. These behaviors can make living with them day-to-day very trying and lead to another variety of guilt: the kind you experience when you are not feeling loving toward a difficult child. In addition, such behaviors strain the entire family, impacting sibling relationships and marriages.
Autism is an emotional roller coaster ride that begins before diagnosis and continues throughout life. According to a study published in the journalPediatrics, mothers of children on the autism spectrum frequently rated their mental health status as "poor" or "fair." They had a much higher stress level than the general population.
In addition to the higher stress level, many parents of children with autism experience the following emotions:
  • Feelings of being overwhelmed
  • Relief at having a name for the challenges their child faces
  • Anger at their spouse, the doctors, or themselves
  • Resentment of the child and guilt for that resentment
  • Despair at the incurable nature of the disorder
  • Guilt that something they did may have caused their child's challenges
  • Frustration that the parenting experience they have is not what they envisioned
  • Feelings of social isolation
  • Embarrassment at child's behavior in public

Physical Impact

Autism also has an indirect impact on the physical health of family members. Anxiety, depression, and exhaustion all take a toll on the physical health of families with children on the autism spectrum. Stress can lead to lowered immunity, and sleep deprivation may result in difficulty concentrating, memory impairment, and other health complications.  This one describes our family right after diagnosis to a T:
Parenting a child with ASD requires an inordinate amount of time and energy and may have detrimental effects on marital relations (Piven, Chase, Landa, & Wzorek, 1991), attention devoted to other children in the family (Holroyd, Brown, Wikler, & Simmons, 1975) and career opportunities for caregivers (Gray, 2002). Parents may find themselves withdrawing from social relationships and recreational and community events (Boyd, 2002; Sanders & Morgan, 1997), the very activities that may serve to buffer the stress associated with caring for their child.
The literature suggests that certain resources reduce the stress parents experience in caring for their child with ASD. Financial support has been reported by parents to be among the most influential resource for reducing stress (Dunlap & Fox, 1996; Freedman & Boyer, 2000). Adequate funds allow caregivers to enroll their children in interventions that most appropriately target their children's needs and enable the parents to purchase respite care as needed (DeMyer & Goldberg, 1983; Freedman & Boyer, 2000). Support of one's spouse and relatives has also been associated with lower level of parental stress 

I could go on and on and on....I won't, but do me a solid- please click on at least two of these links, especially if you do NOT have a child with autism, or if you have a family member who has a child with autism.  It is so important to understand that this issue is very common- this is based on large, legitimate studies (even NIH tackled this one).  The stigma has to go- the issues we deal with on a day to day basis are not typical and it is not surprising at all that we are depressed and/or anxious.  It would be really weird if we weren't!!!

Honestly, when I was having extreme anxiety a few months ago I went to one of the practitioner's in my PCP's office who I don't normally see- I told him I was feeling really anxious, and he asked me what was going on.  I started my story, I have two sons, both on the autism spectrum, I work full time... he stopped me.  Shushed me really.  And told me he would give me a prescription for xanax.  Oooookay.  I mean that's fine, but then I looked at the script and the man wrote me for 80!!!!  Seriously- what does this say to you?  Your life sucks.  It is not going to get better.  Don't bug me.  OK, well that's what it said to me.  Who the hell prescribes 80 pills to someone who doesn't normally take a controlled substance?  And how much could I have gotten for it on the black market?  Kidding, kind of, autism therapies are really expensive in case you haven't heard.

I just felt like he was saying, ummm, yeah, this is expected, don't look for it to get better.  Not really the best bedside manner in my opinion.  Luckily, the anxiety eased up, and I have been ok.  I have also talked about my migraines here in the past.  I finally made it to the neurologist about a month ago.  When he asked about my stressers (yes, I snorted), he of course said, well duh, of course you have a headache.  What's with these practitioners- I feel like my health is being written off because of my kids' conditions.  I mean, I get it, I should have some headaches, but 20 days a month?  He agreed, not ok and we tried a maintenance medication, which also happened to be an antidepressant- effexor.  I will tell you, I have been on wellbutrin for several years now for my depression (I know, you are shocked, right?)- and we decreased this when we added the effexor.  This mama has been a freaking mess- and as an added bonus, effexor gave me heart palpitations- I couldn't get to a therapeutic dosage for migraine prophylaxis because every time I attempted to increase like I was supposed to, it felt like my heart was literally in my throat. And my depression has been much worse.  Enough of that.  Unfortunately, because I live the life I do, there is no good time to be a mess.  I mean in the past month, we lost a pet, I attended the birth of an amazing new family member, Jack had surgery, we had many appointments, I have been trying to cope with a very complex new treatment plan for the boys, apply for the stinking DDA wait list in 5 days or less, secure funding for the boys' summer know, the usual.  But this month I find myself crying in a corner at the end of the day.  That's not acceptable.  And it annoys the crap out of me that it happened because I was finally making the time to address my headaches, which are also debilitating just in a different (easier to manage if you can believe that) way.

I guess my point is that it is really important for all autism parents to be open with each other about their struggles with depression and anxiety.  I think it's imperative that we know we are not alone, but I also think it's vital that those around us know that we are experiencing this stress (and apparently we need to educate OUR practitioners).  It is a big deal, and we all need help.  I think it's our responsibility as parents really, to address our depression, with whatever means necessary.  Whether it's therapy, medication, or both.  We are literally trying to move mountains for our kiddos on a daily basis- we need to be at our best.  We owe it to our kids to be at our best.  When the boys were early in their autism journeys, John and I would use the excuse that we had no time for marriage counseling.  How much pain and time could we have saved if we had made the time right from the start?  Right?

Feeling depressed, in any setting, but especially in these circumstances, is nothing to be ashamed of.  It's nothing that needs to be hidden.  But it does need to be dealt with.  Our kids need us.  

Tuesday, 10 June 2014

My Son Jack, AKA, the Charmer

Everywhere we go....well almost everywhere anyway, Jack makes friends.  The only other person I know like this husband.  When we were dating we would be doing something mundane like walking through Macy's, and some random person would just come up and start a conversation with him.  Now that we are married of course, he doesn't come to Macy's anymore (I guess he was trying to reel me in, hahaha) so it's not an issue.  It still happens when we go out though, he is easy to talk to, and people like him.

Anyway, like father like son.  Today was Jack's same day surgery for his dental issues, and Jack now has a fan club at AAMC.  It started right when we went to check in, the chairs in the lobby had dragonflies embroidered on them.  Seriously??  Jack's current favorite insect! So he schooled the intake coordinator on dragonflies- and also informed her that he was a common green darner, I am sure she walked away with quite a few fun new facts.  When they took us back to preop his first tactic was to fake being asleep and snoring (while simultaneously saying- see I don't need the mask, I am already asleep).  I was sitting there thinking, trust me buddy, you want the mask.  The tech couldn't stop laughing at him, and said to me, I haven't seen a kid this cute in a loooong time.  When his nurse came in to check him out, he casually started a conversation with her..."hey, have you ever been to the the Sonoran desert??"  Because isn't that how all 7 year olds speak?  And the good news- she had!  Jack had an involved discussion with her about the different animals- rattlesnakes, gila monsters (which he corrected her pronunciation of), you know, the usual.  Dr K, his dentist tried to join in the conversation, but really her knowledge was quite limited- I like to think she has been busy focusing on teeth.

The anesthesiologist also loved Mr. Jack, although, the two of them had to have a long discussion about what she would be doing, and he tried to convince her also that he didn't need "the mask".  Things moved along nicely, he was the first case of the day, and before I knew it, I had my little OR suit on, and was walking back with Jack.  Jack refused an OR hat, as they are only for girl hair.  If you are a parent who is lucky enough to have never taken your little one to the OR, you may not know that they have the parents actually go into the operating room to help the child get situated and feel more comfortable.  Or that they have YOU hold the anesthesia mask on your child's face, and if they start to struggle, they take over and have you hold your child's arms down.  It is traumatic for all, but apparently, less traumatic than without mom.  My favorite is when they tell me Jack won't remember any of it.  I call bull____!  Because the first thing he said when I told him he had to go to the hospital was "I don't want the mask!"  Hmmm....if he doesn't remember, then, where did he come up with that?  Either way, he did ok, and I didn't cry, which is a big accomplishment.  

The procedure lasted over 3 hours.  The nurse came out and talked to me midway, because they had to do x-rays while he was out, and until they did that, they weren't positive what needed to be done.  For those of you with neurotypical kiddos who you "think" have trouble with the dentist- oh no, I promise you, we are in a different stratosphere!  No awake x-rays, fillings, anything.  He is too sensitive- and he is the easy one.  Nate is much much worse with oral stuff.  When she told me exactly what was going on, I will admit it, I did cry.  They had to extract 4 teeth.  Now one of the teeth is a little one to the right of his two front teeth- all I can say about that one is that it had literal lines in it when it came in- it is right in the front, and has always been brushed well, even when his oral guarding has been bad, this has nothing to do with oral care whatsoever, and frankly I am surprised it lasted this long.  But the other 3....well this made me really REALLY angry.  They were all teeth that were filled when he went to the OR last time, at age 4.  They were filled (with mercury anagrams- and yes they knew he had autism) and then had crowns put on them, thus "protecting" them from further decay, right?  Apparently not.  They all three had abscesses under the crowns.  There are two possible reasons for this- either bacteria was left in the tooth when the crown was placed or the crown was not sealed properly or the seal somehow broke.  I have my own theories- I think it was done in a rush and not as thoroughly as it should have been.  This is based on the fact that in about 2.5 years, one of the crowns had already fallen off of a tooth on it's own (they stuck it back on), and another tooth with a crown spontaneously fell out way early about 2 weeks ago.  Neither of these things should have ever happened.  I can't go back and change what was done, all we can do is move forward- they sealed all of Jack's remaining baby teeth and all of his new permanent teeth, did a fluoride treatment, and took care of the affected teeth, as well as gave him IV antibiotics.  He had some trouble with bleeding where the extractions were done, likely due to the infection, and ended up with some serious stitches.  This prolonged his recovery room time of course, but better he have the issue there than after I brought him home.  

So even after all of that, when they brought me back to the recovery room, they were already all in love with him (a completely new team mind you).  The nurse said he just told them exactly what he needed- turn that light off, make that noise stop, etc etc.  She said to ME "you just don't know how hard it is when they can't communicate with you!".  Smile, nod, smile, nod.  She didn't know anything about Nate, and hey, she is right, it is hard.  I was struck by how grown up Jack was acting in many ways, answering questions appropriately about how he was feeling (ie pain rating), telling us that he felt nauseated and needed medicine....he never would have done this the last time we were there.  Jack was also really drowsy, which is so different than the other two times he has had to be put under.  Both of those times, he woke up violently and didn't sleep a wink for nearly 24 hours after (this is likely because they jinxed me by telling me he would probably nap all day).  Today was more of a typical response- he was cute, and saying some kind of nonsensical stuff.  He insisted on looking in the mirror to see what was going on in his mouth, and calls his stitches "stitchies".  The recovery room was just one big open room, and no curtains were pulled since he was the first case for the day.  At one point he looked at me, serious as can be and said "mom, am I dead?".  The nurses almost fell over from laughing so hard.  Oh my sweet boy!  But I know what he was talking about- waking up from anesthesia is such a weird feeling, losing time is so disconcerting, I get it.  But the way he expresses himself.....just love him.

Friday, 6 June 2014

A Day With Jack- Ups, Downs, and Tear Provoking Progress

Yesterday was action packed.  I took the day "off"(insert the usual laughter here).  I did actually have from about 9:15 to 10:30 all to myself-  took a shower, put on real clothes- good stuff.

Jack had two doctor appointments yesterday- one with his pediatrician- for preop, and one with the pediatric dentist, also for preop.  Jack has had dental issues since the day his first tooth can in- well, let me rephrase- I could see abnormalities in the enamel right away.  By age 3 he needed 6 fillings and crowns on his back teeth.  It was not a pleasant experience at all- we were asked all of those "irresponsible parent" questions such as- how often do you brush his teeth (twice a day), how much juice does he drink (not much and it's always diluted 50/50), did you give him a bottle in bed?  Well no doctor, because my son refused all bottles after the age of 6 months, he solely nursed until he was 22 months old- a former babysitter was reduced to trying to squirt water into his mouth with a bath toy while I was working. Try again.  And of course, because of the extensive nature of the work needed, and jacks oromotor guarding he had to be under general anesthesia- so about $7000 later...out of pocket...we were all set.  Except that one of his crowns fell off, and then last week one of his crowned teeth fell out??

Anyway- one of his teeth has always been malformed- they tried to reshape it (I am guessing with white filling material) when he went to the or, but it keeps decaying- it's his enamel again.  And he had swelling in his gums around one of the crowned teeth.  We took him to our dentist, who tried to extract the tooth in the swollen area (after an x-ray showed infection)- but jack almost kicked HIS teeth out in the process.  So he sent us to a new pediatric dentist- who wants to extract two teeth, put in spacers, and potentially fill two more. It sucks. But it has to be done

I was looking at the treatment plan yesterday while we were in the office and noticed one of the teeth to be filled was one of his NEW molars- ie in for about 5 months!!! What. The. Heck???? The dentist asked if I had any questions and I was like ummmmm yes.  I told her how concerned I was and she went on to explain that about 10 percent of people are born with this issue.  He has very weak enamel, the fact that any type of decay could happen that quickly just further proves that.  She recommended getting every one of his current teeth sealed, and then, as soon as a new tooth erupts, bringing him in to have that one sealed as well.  This stinks, but at least she is not blaming us and wants to be proactive.  I am thankful for that.

When both appointments, which were obviously quite stressful and stimulating for jack, were over we headed back to his school.  His end of year party was scheduled for yesterday afternoon, all the parents come, and I didn't want to miss it. (Even though if I'm being honest, I would have loved to miss it).  The kids write a book each year, and at the party they share their book with the class- it's a really big deal to them, and I knew Jack really put effort into a story he was very excited about (this year the children were sharing an experience they had had)- although the whole quietly waiting his turn and listening to others first concept is still extremely difficult for him.  Anyway, off we went  As we walked down the hall, his class was coming back from art or music from the other direction- another transition on top of like a million others yesterday.  This is one of Jack's biggest challenges btw.  Then we walk into a classroom full of parents and with lots of food that he couldn't have yet.  It was loud, it was different, and Jack was discombobulated to begin with from the appointments.  And he was really having a hard time.  Now in the hard time department we are actually pretty lucky.  No violence, no self isolation, nothing "unpleasant".  But his little arms start flapping, his whole body stiffens, he starts shouting (louder than normal) and running from person to person, asking them about planes, locusts, dragonflies, etc.  You can immediately tell which parents and children are good with this (some of the kids just LOVE him and it is very apparent) and unfortunately tell those who are not just as easily.  Someday I SWEAR I will stop caring, but yesterday wasn't that day.  When jack has a hard time, I have a hard time.  I just wanted to grab him and wisk him awake from the few disapproving looks.

Turns out, I didn't have to.  His special ed teacher happened to walk into the room, she took one look at Jack, walked over to me, and before she opened her mouth, I said "this is way to much for him.".  She agreed, and asked Jack if he would like to have a chance to read his book to just us.  At first, Jack protested, he said he would have nothing to eat (or, if you want to know his real, scripted answer, he said, "but I'll have no food, no water, no communication"), but then she asked if he would like to fly into the other classroom and he was game.  If you look below, you will see that Jack's teacher has a shelf of vehicles with propellers, all there for one very special Jack, as rewards.

She handed him a plane and we "zoomed" next door to read his book.

I have to say this.  I am so incredibly proud of my boy and his progress this year.  Looking at this book drove it all home, not just his progress with reading, but his ability to coherently tell a story, his follow through, and his willingness to do fine motor activities.  I know that they had a long period of time to work on these books, but even so, compared to last year, this was fantastic.  Not to mention that last year, getting him to go through his book was like pulling teeth (no pun intended, ha).  This year, he just, read it.
This is about when my waterworks started.....

But here is where I really started blubbering.  This little boy could barely write his name at the end of kindergarten.  If you asked him to draw a picture, he would likely try to run away or literally scribble a few lines and say that's it.  I know that the drawing above looks very very basic- I know that "most" first graders' pictures look very different.  Don't care.  If you look- the blue is my CRV, the little guy with the big smile is Jack, wearing his favorite color, orange.  The big person in the front is me, also with a huge smile.  This took thought and planning, and most importantly for Jack when it comes to fine motor, motivation

And look at his colossal squid (I commented to his teacher that the person who helped him with this probably had to look up how to spell humboldt, ha)!  It looks completely awesome!    

I wrote this (other than the typo that reads Max- guess he had his typed up right before Jack's, ha).  I LOVE this picture of Jack from Easter, it is so him.  

He continued to have a pretty rough time when we returned to the class for snacks- he had a hard time waiting in line, actually what he yelled was "I DO NOT want to be the line ender".  Guess what, a little girl in his class who was done with her snack came and stood behind him, not to get more food, but to be the line ender so Jack wasn't.  That is a nice kid, right??  I was still trying to keep him calm for the rest of the "party" (or trial by fire for autism families), but I was also in a bit of a bubble- no matter how hard of a time Jack was having, all I could really think about was the book, and his teachers and classmates that are always looking out for him.  Forget those few snotty looks- for the most part, he is surrounded by such positive people every day.  And look at how he is thriving.  I am one happy mama.  

Tuesday, 3 June 2014

A Weekend Of Contrasts For Our Family- Life, Death, and Coping

Oh my, has this past weekend been intense.  I will give my usual disclaimer that this post is “not about autism” per say.  It is, however, about our family.  In a 3 day period, our family has experienced an extreme low, and an incredible high.  Particularly this mommy.  At this point I am so emotionally exhausted that I am happy and thrilled one minute and literally sobbing the next.   We lost a best friend and family member earlier this Friday, and gained a precious, perfect nephew/cousin yesterday.  And I was very much so “down in the trenches” for both.
I will start with the bad.
We have had our dog Riley since about 3 days after John and I got back from our honeymoon- so around 10 years.  My old nurse manager at Hopkins gave him to us after her dog had puppies- he was a black Labrador, something John had wanted his whole life, and when I found out the puppies were available, I knew it was the perfect thing to gift to my new husband.  We went together in October and chose Riley because he had such expression and soul in his eyes- it was like we already knew him.  He has been an integral part of our family since day one.  He was our first baby- we made up songs about him, gave him a million nicknames, took him everywhere.  When the kids were born, Riley became more of John’s partner in crime, because well, I was a mommy.  That being said, I work from home, so I spent every single day with him, he was such a constant that I didn’t even think about it half the time. 

And he’s gone.  And it was so sudden.  About a week and a half ago, we noticed that his right paw was swollen, and that he was limping.  This had never happened before, and we were both concerned, so a week ago this past Saturday, John took him to the vet, where they x-rayed his leg.  They said it was a soft tissue injury, that we should restrict his movement and give him some pain meds they provided.  And he got better- very quickly the swelling went down and he was barely limping at all.  He had some diarrhea, but that was one of the listed side effects of the medication, so we didn’t worry about it too much.  Wednesday and Thursday nights, he woke us to go out in the middle of the night- but once again, we figured it was GI upset.  On Friday morning, I had him shut in our laundry room, which I had been doing to keep him separated from our other little guy Darby, so he didn’t reinjure his leg.  I opened the door to let him outside around noon, walked into our laundry room, and slid and fell, (sorry) in vomit.  Riley had been sick.  I cleaned it up, and left him out so I could watch him and make sure he was ok.  He lay down next to me while I worked, which was pretty typical for the next hour or two, but he went to get up and I just heard this thump.  He had fallen onto his side, and then he got back up.  He walked around for a minute and lay back down.  I called John at work and told him I was concerned.  He had a recheck appt at the vet coming shortly, so we were going to wait for that.  When I got off the phone, I looked at Riley more closely, he was panting- I got more water for him and he wouldn’t drink.  I called him and he didn’t lift his head, he barely even looked at me.  He eventually tried to get up again and fell down.  I immediately called the vet and told them what was going on- I told them I was bringing him right away.  I called John’s work, called him out of a meeting (which I have never done), and asked him to come home and get Jack off the bus.  I had to take Nate with me, as his daycare was closed on Friday.  I managed to get Riley up and onto his leash and he walked outside with me, but he couldn’t get into the car.  I picked him up- he weighs 78 lbs., but my adrenaline was going to the point where it just felt like nothing.  The 10 minute drive to the vet was excruciating- Riley is usually foaming at the mouth, drooling, barking, and generally freaking out when we go somewhere in the car.  He lay on the front seat with his mug on my lap.  I just petted him the whole time and told him over and over that it would be ok.  When we arrived, he managed to get out of the car on his own.  He was walking so very slowly, but damned if he didn’t stop on the grass, sniff the other dog smells, lift his leg and mark his territory.  Then he lay on the vet floor and let other dogs come up and sniff him without even flinching.  When the vet went to examine him, we had to lift him so she could listen to his heart- she said it was very muffled and wanted to get an x-ray, as whatever was going on with him was very acute.  He was panting, using accessory muscles, in distress, his gums were so pale.  As they went out to set up the x-ray, he crawled into a corner and quieted down.  Most people would have thought he was calming down, but being a nurse I recognized the change in his breathing pattern immediately- he had gone agonal and was basically about to die.  I screamed for the vet and they literally dragged him out of the room to try and resuscitate him.  I texted John and told him to tell the neighbor to get Jack- that I needed him NOW.  That our puppy was dying.  He made it in record time, right before the vet came in and told us to come see Riley right away because things were really bad.  We walked to the back (Nate was there the whole time, poor thing- although he seemed pretty oblivious) and you could just see he was almost gone.  Almost the second we got back there, he stopped breathing, and they tried to intubate him, and we retreated back to the exam room.  Within 5 minutes, they came to tell us he was gone.
Gone.  Chasing squirrels in the morning, and gone by 4:30.  All the vet could really tell us is that they managed to get the x-ray and nothing was visible in his gut, but his heart was enlarged.  We could have requested an autopsy I suppose, but it wouldn’t change the outcome.  She said it was likely a tumor that ruptured, a neurological event, or a cardiac event.  I keep thinking that the swelling in his paw could have been a clot that broke free and went to his heart.  But I just don’t know. 
Friday was the day that I was slammed with the realization that no matter how much more I felt like I loved my “human babies”, Riley was my baby too, that it never changed when the boys were born, even though at the time it felt like it did.  Both John and I are devastated.  Even Jack, who was overwhelmed by Riley most of the time and somewhat scared of him (for his size solely, as he was the gentlest dog you would ever meet), is having a difficult time.  We are working hard to help him understand and cope with a sudden loss like this.  We are working hard to cope with it ourselves.  I am still trying to process what I saw, and my reaction.  I have always had a tendency to blame myself for everything- did I miss something? Was there something more I should have done?  The vet tried to reassure me that in something this sudden, most owners wouldn’t have gotten their pets to the vet in time, they wouldn’t have recognized the signs.  I try to find comfort in that fact.  I also try to find comfort knowing that Riley’s last memories were of me trying to help him, and petting him, and telling him that I loved him.   That he didn’t have a long drawn out illness.  But it’s just going to take time for all of us. 
In the meantime, my little sister was 41 weeks pregnant, the poor thing, and scheduled for an induction yesterday.  Her body finally saw the writing on the wall and she went into labor on her own Sunday evening.  So I found myself hauling ass to Pennsylvania as she had asked me to attend my nephew’s birth.  What an honor.  I was freaking out, because it was a two hour drive and I had these visions of walking into her room and her holding the baby because I missed the delivery.   Didn’t happen- lucky for me, not so much for her, ha.  I was able to be there for most of the process, give her the lo-down on certain happenings, and just encourage and love her in general.  It was one of the most wonderful experiences of my life, and she was so incredibly brave and strong.  He was born around 9am on Monday; about an hour after her induction was scheduled to begin.  She is taking to motherhood like a pro (not that I’m surprised) and her son is beyond gorgeous.  I already have such an intense love for her son- he is just perfect and I can’t wait to introduce him to Jack, who is just going to lose it!  I have been very involved in this process, from the text I received with the picture of a positive pregnancy test and the question, “am I reading this right???”, to finally seeing this precious child (and I do mean finally) born and placed on his beautiful mama’s chest.  There is nothing more extraordinary in this world.  I mean, I was a labor and delivery nurse for a while, it made no difference yesterday in the way I felt.  I cried like a baby. 

Then I drove back home after being up for 36 hours.  Riley wasn’t there.  My kids still needed me.  I needed to pick up right where I left off on Friday morning.  And it is so stinking hard.  THIS is when I know I am really a grown up, really a mom, who has earned her stripes.  When I feel like death on wheels, and still haul myself downstairs at 6 to get the supplements made, and let our remaining puppy out.  When I finally get the second child on the bus, come home to work and our suddenly incredibly quiet house and finally completely break down and cry for an hour, because it was my first down time since Friday.    Then, I started making calls- it was time for “work” (note intense sarcasm).