No News is Good News

Hi everyone! I realize I have let this go way too long without an update. Landon is doing great since his last surgery. He has now officially experienced over 3 months of the closest thing to a normal life that he had ever known. The only minor complication we have experienced is an external ulcer on the portion of his intestines that is exposed outside his body (used to create the ostomy) and Dr. Levitt said that as long as everything is working okay it is harmless.

Speaking of which, Dr. Levitt has officially moved to Nationwide Children's in Columbus. It's about an extra hour to hour and a half drive past Cincinnati, but we made the decision to follow him rather than establishing with a new surgeon. Cincinnati has been great to us and our entire family has made many fun memories while making the best of the circumstances that brought us there, but I feel like this is for the best. Landon's medical history is so extensive that it's best we go with the surgeon that has operated on him the most, and operated on more Hirschsprung's disease patients than any doctor in the world.

Developmentally, Landon is doing okay. It's always been such a rollercoaster of him looking somewhat caught up and then missing another huge milestone. We are following up with neurology this summer and I'm eager to hear what they think. I have concerns with his balance and how much he still falls down when he walks, and his language delay is becoming more significant. Still, we are thankful for all of the skills he already has that he was never expected to have. When you are at a point where no one expects your child to survive, much less ever surpass a vegetative state, any and every accomplishment is a blessing whether on time (like some have been..yay!) or not.

All in all, I'm continuing to feel incredibly blessed to be Landon's mom. I'm thankful to be out of the state of mind that so many people are stuck in thinking that any of us, whether healthy or not, are entitled to to the next moment from now. I'm thankful know past any reasonable doubt that God has a plan, and no matter how dark the moment seems, He will see us through it. For some reason a moment comes back to mind- the one time I broke down while Landon was fighting for his life. I left the PICU to go for lunch with Carson and Austin, this is when Landon was fairly stable but still on life support with an incredibly poor prognosis. Carson asked when he would be able to give Landon his pacifier again. I yelled "why did this happen to us!?" Me, I can handle anything, but my precious 2 and 3 year olds that have been waiting to be big brothers and have suddenly had the experience ripped away along with both parents that had to go stay in the hospital far away from home- they don't understand. When Landon weaned off the ventilator and was cleared for oral feeds, their speech therapist came in and assessed Landon. She found that he did not have a suck reflex present and was not appropriate for oral feeds and they had to place the first of many feeding tubes. Carson's comment was always in the back of my mind, how out of this entire experience all he wanted was to give his brother his paci when he cried. So this speech therapist racked her brain to remember what she had learned in grad school about swallowing and stimulating a suck reflex in a newborn- which had never had the opportunity to make it into clinical practice- and by the end of the day Landon was sucking a pacifier for short periods of time. I have never felt such a huge victory in my life. Landon still at that point may not have ever been able to do anything else, but Carson could finally give him a paci the next time he visited.

In hindsight, it's hard to make sense of why God wouldn't have given us this child. We couldn't have asked to be better equipped to handle the situation- this includes everyone that has followed Landon's story, helped with the boys, meals, financially, and kept Landon in your prayers relentlessly. Rather than feeling victimized that Landon spent the majority of his first holidays, including his first birthday in the hospital, I'm thankful to have our eyes opened to the fact that both children's hospitals we have received treatment in are full of sick kids. Whether it's Christmas, their birthday, or not, they are there. Many for months at a time, and even farther from home than we were- even in Cincinnati. It gives us a huge reason to celebrate the little things we take for granted- like being at home with our family in one place.

On Landon's first birthday, volunteers at St. Louis Children's brought in a donated birthday gift and hung a banner. I can't put into words how much that meant to us and how much we (and Landon will eventually) cherish the photographs! This year we are looking like we are on track to not spend Landon's 2nd birthday in the hospital, but interestingly enough, we are choosing to. We will be celebrating not being admitted to the hospital by delivering donations to those that are. The goal is to pay it forward x100- so in turn for Landon's birthday gift we will donate 100 gifts. I'll be posting more info to come, but I'm thinking a huge birthday party with cupcakes and balloons galore, and in lieu of a gift for Landon bring a gift to donate to a child- birth to teen- for us to deliver in honor of Landon. Everyone is invited!

On a final note, with Landon in better health we have been able to catch up on many "normal" things like getting family pictures done. They turned out amazing! I'll leave you all with a sample :)

One month post-op update

Hi everyone! It's time for me to catch everyone up with a long overdue update. Thanks to a couple of snow days we have had this week I've been catching up on my to-do list and this was right up there at the top.

We are officially a month (plus almost a week) post-op from Landon's second colostomy surgery and everything is going really well. He finished the 10-day course of Cipro, and since then it has been smooth sailing. This is the first time in his 19 months that he has been able to experience a normal life free of antibiotics and irrigations. Plus it's wonderful for everyone else in our family because without the irrigations we have an additional 2-3 hours of time in our day. It's an extra hour to sleep in every morning (getting up at 4:45 was no good.. I am NOT a morning person) and an extra hour at night to catch up on chores or enjoy quiet time with the boys all put to bed.

The colostomy care is still a night and day difference from last time- in a good way. I'm still able to get 4 days out of each bag before we have to do a change. During the week I only let it go 3 days to reduce the risk of having a leak while I'm at work, so we only go through 2 bags in a full week. The only issue we have had so far is gas. Sometimes his bag will fill with gas every hour or two and I have to open the pouch and let the air out. I'm sure this is related to diet and could be better managed with some dietary changes if I monitored it closely enough, but I hate to place dietary restrictions on him again when for once in his life he can eat anything he wants...

Which brings me to the next piece of good news. He has turned into such a good eater since his surgery. If anyone is considering making their own baby food, I highly recommend it! It may be a coincidence, but Landon is such a good veggie eater compared to his brothers. They would only eat baby food veggies and still barely touch vegetables without bribery of some sort. I decided to make Landon's baby food to give us more options since he used to have so many dietary limitations and organic baby food is so limited in choices anyway there was next to nothing available for him to eat. Everything that he ate pureed he also accepts in its original form- peas, green beans, carrots, spinach, etc. He has been eating so well I've cut his Pediasure intake down from 3 bottles per day to 1.5. I mix it 50/50 with coconut milk. He goes on the 17th for a well check with his pediatrician and if his weight looks good we will try transitioning to 100% coconut milk. He still takes Klaire labs therbiotic complete, 2 capsules of S. Boulardaii, 3 drops of grapefruit seed extract, and a multi-vitamin with iron daily.

As some may know, Landon's surgeon, Dr. Levitt, is moving to Nationwide Children's Hospital in Columbus, Ohio in April. It's only an hour and a half further away than Cincinnati, but at 6.5 hours each way I don't see it being feasible to do one day round trips for clinic appointments and so this will be a bit of a challenge. We have the option of staying at Cincinnati Children's and going with another surgeon, and they all have a wealth of experience compared to anyone available locally (and by locally I mean St. Louis 2 hours away), but it would be hard to make it this far and then compromise after everything we have been through to get Landon to the best colorectal surgeon in the world. We are most likely only looking at one more surgery to resect another segment of his colon, and after already having 8 surgeries it makes no sense not to follow Dr. Levitt and have him do number 9.

Dr. Levitt said that we could do the second pull-thru at least 3 months after his colostomy surgery up until as late as we choose to wait. He recommended that we potty train Landon to urinate in the toilet before going in and doing the surgery, so I have started on that. I have just been putting him on the potty during diaper changes when we're home and he has already peed in the potty 3 times! I plan to wait until this summer around his second birthday when I'm home all day with him to really start hitting potty training hard. His brothers potty trained at 26 and 25 months, and so fingers crossed he will be in big boy undies when I go back to work next fall. Even though life can be very unpredictable (as we have learned the hard way numerous times!) if everything stays semi-on-track I'm looking at June of 2015 for his next surgery. That way we could avoid sending him to school with a colostomy if he starts pre-k after his third birthday.

Everything is going so well I'm in no hurry to rock the boat again, but I'm also unsure of what it would be like for him to need extra care while he was in school and how his peers would react to him being different. We have already dealt with disgusted looks from adults when I change him in public, but fortunately this has not affected him in any way. It would be a different story if he goes to school and other children are negative about it because pre-k will be his first social experience with kids his age. I don't want him to be remembered in high school as the kid that had the "poop bag" when he was young. At the same time, we finally have a working system with the colostomy diverting away from the hypertrophic segment and it is expected that removing the additional section and reconnecting will be successful. The colostomy is free-flowing, though, meaning that Landon has no control on his output- when it reaches the site it is expelled from his body. Once we reconnect to his rectum we may have to deal with his anal sphincter acting up again- he might need more Botox treatments, we might run into him voluntarily withholding or the biggest fear of them all- incontinence. With half of his colon gone once it's all said and done, obtaining bowel control won't be easy for him. The colon absorbs water (and some nutrients) from stool as it passes through, so the less you have= less water that gets absorbed= less formed your stool is. Less colon also means less tract for it to pass through which equals less warning that it is coming. If you have a total colectomy, or the entire colon removed, your stool would be the consistency of water- pure liquid. With half gone, about the best we can hope for is about a pudding consistency and we are really going to have to push the fiber to get that because right now his ostomy output is very loose. I try not to worry though, he has already shown so much strength and resilience there is no doubt that he will conquer whatever comes his way.

Life would be boring if things went as expected..

In case you can't tell from the title, things once again did not go as planned- some good, some bad. We just made it home tonight (actually, for the second time) after conquering the 5 hour drive in the aftermath of a snowstorm and negative degree wind chill. Here is what went down:

On Sunday (the 29th) we arrived back up at Cincinnati. We checked in at same day surgery on Monday morning for Landon's ileostomy surgery. Once we started getting checked in, we realized that it was down on the schedule for an ileostomy OR a colostomy. This was the first I had heard of the possibility of doing another colostomy and I did not agree with that plan and so I requested to speak with Dr. Levitt. If you are wondering why I did not want to do a colostomy again, refer back to July 2012-December 2012. It involved recurrent enterocolitis and having to irrigate through the ostomy. Dr. Levitt was very understanding, but explained that if we could get away with doing a colostomy it would save Landon a surgery because it could prove that the section of colon used was functional, and then when we go to do another reversal/pull-thru he would pull thru the site of the colostomy and remove the rest of the colon. He showed us three possible sites of the colostomy, two in the left colon and one in the right colon. He wouldn't know for sure where it would be placed until he got inside and did an exam and another full-thickness biopsy.

Before Landon went back to surgery, I asked about something that has been on my mind. Something very controversial in the colorectal surgery world- intestinal neuronal dysplasia (IND). Hirschsprung's disease occurs when a portion of the intestines is lacking ganglion cells, IND on the other hand, is thought to represent a spectrum of neural-crest malformations rather than a distinct disorder, but diagnosis and treatment are controversial. I stumbled across it while researching complications and reasons for a "successful" pull-thru (by successful I mean that biopsy confirms aganglionic segment is removed) to not be functional or truly successful. The events over the summer (reference July 6th blog entry) reinforced my suspicions that Landon had another segment of colon that was not working. My experiences doing frequent irrigations that seemed like stool was "stuck" in a particular location and two contrast studies which showed a narrowed segment led both our St. Louis surgeon and myself to believe that another segment of colon was aganglionic. But then we received confusing biopsy results from both St. Louis and then confirmed in Cincinnati that ganglion cells WERE present. Here is a review of what we thought we were up against before the biopsy shocked us all:

Now that I've backtracked, I will get back to what went on last week and how it relates. After finding out that what seemed to be a dysfunctional segment of colon DID contain ganglion cells, I wondered if it was affected by IND. Dr. Levitt explained that he did not feel that IND was separate from HD, he feels that it is simply just "transition zone." I thought that my hopes of getting some type of diagnosis to explain why Landon is going through what he is were crushed. Soon after, Landon went back to the OR.

The surgery went well, and Dr. Levitt came out to talk to us. He explained that for nerves to be functional in the colon, they need to be 40 microns or less in size. The biopsy they took during surgery showed that Landon's were hypertrophic in another section of colon, meaning that they are too large to function properly. It's a mystery how this has been missed in the 3 biopsies that have been done in both St. Louis and Cincinnati, but we were relieved to finally have an answer. Approximately another 7 cm or so is affected, and so once it is said and done Landon will have about half of his colon left. For now, he has a colostomy in his upper left abdomen. Dr. Levitt was able to use the same scar from his previous surgeries, and so no more cosmetic damage.

Recovery was a breeze, except for an unwelcome, disturbing odor that came along with the return of Landon's bowel function. The odor was absolutely horrible, and quickly filled the entire colorectal unit every time we emptied his bag to the point where we overheard people outside the room commenting on the smell. This bought us a ticket to isolation and a stool culture with the suspicion of c.diff. Fortunately, the stool culture was negative for c.diff or any other type of growth. They discontinued the Flagyl and we were discharged on the 3rd. We made it home late that evening.

At 3 a.m. I woke up to the sound of heaving. Landon's crib was full of vomit, so I changed his bedding and cleaned him up and put him back to bed. I went back to sleep for about 30 minutes and we repeated the same routine. We did this a third time and I was out of clean bedding and so I threw everything in the washer, woke John up to take over, and I went back to bed for a few hours. When I got up it was time to do a bag change. When I removed the bag, we found something very disturbing looking. ***WARNING- This is absolutely disgusting. I'm sharing this for anyone else that is weird like me about cool medical stuff or for any HD parents whose child might be getting an ostomy and could have this happen. Side view and front view. (Trust me though, I did not find it cool at the time. I can only look at it now in hindsight without freaking out!)

If you viewed the images you have saved me the pleasure of brilliantly selecting adjectives to describe the way it looked. If you did not view the images I will put it this way- it looked dead and/or infected. That appearance combined with the vomiting was enough to get us back on the road to Cincinnati only 18 hours after arriving home. After a wonderful ER experience (no sarcasm, really.. we got straight in and the attending physician didn't waste any time- he called for a surgery fellow right away!) we were admitted back to the colorectal floor. They did an abdominal xray which showed possible ileus, but no big deal and it seemed to have already corrected itself. They repeated the stool culture, and while it was pending they put him back on Flagyl. Now we get into the fun of what happens on weekends/holidays when residents are the ones running the show. I hate to be mean, but we have had A LOT of bad experiences with residents in Cincinnati.. like say... being told Landon had c.diff TWICE when he really didn't, being literally shouted at for taking a bad photograph of Landon's first ostomy which was "misleading" (I reported that incident!), and a few other incidents with that same perpetrator as the shouting incident being catty with me about a variety of things. Anyway, on this occasion the stool culture came back negative (whew!) but the nurse came in with his next dose of Flagyl. I asked why he was still taking Flagyl since the culture was clear, but could not get an explanation. In case you have missed this in just about every entry I've written- I DON'T LIKE GIVING LANDON FLAGYL! The best explanation I could get was "it's in the orders" and "it's probably a precaution." Great. So we waited out the weekend and finally this morning came around with the return of Dr. Levitt. Come to find, Landon's first stool culture from the 1st actually did grow something. It was not c.diff, but I did not find out what. I was too distracted trying to process what was happening to ask any specific questions. They had left him on the Flagyl all weekend because of what had shown up on the first stool culture, which I guess we never would have found out had we not returned. Here's the kicker, though, Flagyl does not even cover that particular strain of bacteria. Dr. Levitt switched Landon to a new antibiotic, Cipro, and sent us home on a 10-day course.

That brings us to right now- Landon has had 2 doses of Cipro and is sleeping peacefully in his room. I'm getting ready to go to bed in my own comfortable bed with all 3 of my children under one roof and right now all is perfect and right in the world. The foul odor has already cleared from Landon's ostomy output, so it seems like the Cipro is what he needed. Here is the best part- the ostomy bag that Landon has on right now has been on for 4 days! Woohoo! We switched to a Hollister two-piece system, added an ostomy belt, and got some great tips from a very experienced ostomy nurse and this is already night and day from our last experience when we were lucky to get 24 hours out of a bag. Thanks to everyone that has kept our family in your thoughts and prayers!

Taking a step back

"Optimist: Someone who figures that taking a step backward after taking a step forward is not a disaster, it's a cha-cha.” -Robert Brault

Thank you to everyone that has been asking about Landon. Unfortunately, the reason I haven't been updating on him online the last few days wasn't because things got better, it was because we were plotting our next move.

The random vomiting spells are only getting worse. It has happened every day since Tuesday- 4 consecutive days now. Landon's GI system is so out of whack there's no point in even trying the botox. We are over a year post pull-thru and it seems that things are getting worse instead of better. Some may remember this past summer when we were entertaining the thought of going back to an ostomy. I felt pretty strongly about doing it to get him off the Flagyl (which he has had to take over a year total now) and to improve the quality of life for Landon and the rest of the family. Landon should not have to deal with 3+ hours of irrigations a day, and it takes away time from our other kids. He shouldn't have to deal with projectile vomitting all the time, the belly aches, not ever wanting to eat and pretty much being force fed. But despite all that, having an ostomy stinks for him because it makes him "different." So we tried the Botox, and it helped. Just not enough. Landon spent his first Christmas eve and first birthday in the hospital.. but he is not spending his 2nd or his 3rd. After the way the last 3 months have played out, I have complete confidence now that going back to an ostomy is the right thing to do.

So the 30th we will head back up to Cincinnati, but instead of doing the botox, Dr. Levitt will be giving Landon an ileostomy. We will then have to stay in the hospital for a week and possibly a few additional days. This time we know what to expect post-op. We already know how to do bag changes, and even though they are no fun for us, Landon had a much better quality of life with an ostomy. I'm looking around for the coolest pediatric ostomy belts that I can find to conceal it. I learned from our last go round that many, if not most people are very freaked out by the appearance of it. After all, it is live human intestine hanging out of the abdomen, and even I had a hard time looking at it and touching it at first. But Landon is completely aware of what goes on around him now and I don't want him to experience any dirty looks or unnecessary rude questions. He will just have some sort of cool belly band he wears around his waist barely peaking out of his pants.

Since it is another temporary ostomy we know that he will have to undergo at least one additional surgery eventually. I want to emphasize the word eventually. We are leaving things alone for at least a few years. There is a good chance he will go to kindergarten with an ostomy. Personally, I'm tired of making decisions that affect his quality of life. I can't even explain how bad I feel when I think that we could have done something differently thatmay have stopped him from going through even a little bit of the adversity that he has faced. I hope that we can leave things in place until he is old enough to want to reverse the ostomy, and to understand the risks and challenges that will come along with it. Who knows, maybe within the next few years modern medicine will catch up to these complex HD kids. There is some promising research going on in Boston right now where they have found that injecting cells from the intestines of healthy mice into the intestines of mice with HD caused the aganglionic segment of the intestines of the HD mice to gain ganglion cells and function. That's terrific news, especially for the children affected with total intestinal aganglionosis. In Landon's case, that particular study may not have much use since his affected segment has already been removed and he continues to have poor function of his colon for unknown reasons.. but hey- at least they're getring somewhere!

I hope everyone has a Merry Christmas! I will update soon on how the surgery and recovery goes. As always, please keep Landon in your prayers.

The night I poured my 17-month-old a Coke...

I'm sure you can tell by the title that this is going to be an interesting post. I really don't know what else to do, though. Landon is sick- he has been having a horrific vomit fest all night. Our closest children's hospital is 2 hours away. On one hand, I don't want to let this go to the point where we miss Carson's birthday and Christmas Eve because we are in the hospital. On the other hand, it is late at night, the other boys are in bed, we would have a lot of packing to do, and the roads are icy and expected to get worse. We don't want to take Landon in unless it is completely necessary, and the key to that is to keep him hydrated while we hope and pray he responds to things we can do from home. It's safe to say at this point that his last round of Botox is completely worn off, and even the full dose of Flagyl and 2 irrigations per day isn't keeping enterocolitis away. Why does this have to be the weekend? If I call Cincinnati they will put me on the line with a resident and he or she will tell me to take Landon up there. Unlike Dr. Levitt, the resident will not be aware of how much experience we have with enterocolitis, irrigations, and managing this stupid disease while doing everything we can to keep him hydrated.

Which brings me to the title. A little background: we are a very healthy lifestyle family. We eat mostly natural, organic, and unprocessed. Carson and Austin have never tasted a caffienated soda. Maybe twice a year as a special treat we will let them order a rootbeer or Sprite when we're out to eat, but that's it. Unfortunately, though, my title is a true event. I poured Landon a Coke in a sippy cup and he drank about half a can. What else is there to do when your son is vomitting profusely and you desperately need to get clear liquids in him. And he refuses Pedialyte. And he refuses water. And he refuses apple juice. You bet he guzzled down the Coke though. Thank God he did because it was my last resort.

Please keep Landon in your prayers the next couple weeks. He has another round of Botox scheduled for the 30th and so we need him to hang on through the holidays without landing in the hospital AGAIN. This poor child spent the better part of his first 3 months of life in the hospital, and his 1st birthday, and as most probanly remember we had to rush him to the hospital on Carson's 4th birthday last year and missed Christmas Eve and drove all night just so we could be back for the boys to get their gifts from Santa Christmas morning. I want nothing more than not to have a repeat of last year, so please keep him in your prayers!

Update

Everything is going pretty well with round 2 of Botox so far. It has been nearly 2 months and it seems to still be working. About a week ago there were some irregularities that made me think that it had worn off (enough that I started the process of scheduling round 3 for the end of next month) but everything seems to be working pretty well again. We haven't been successful in getting Landon off Flagyl this time around. We are getting ready to wean him off and try again starting next week.

Landon still takes 15 mg of Senna (one Exlax square) along with Klaire Labs Therbiotic Complete probiotic (adult dose), one capsule of S. Boulardii, a gentle iron supplement, multivitamin, and extra fiber with built in probiotic support. We no longer see the natural medicine specialist due to the cost and very little observable difference now that things are working more smoothly with the Botox injections.

We are still very careful about what Landon eats. Constipation doesn't seem to be an issue, more of the opposite. Laxative foods tend to run right through him and so we are now limiting most of the foods that Landon originally was living off of. He drinks 2-3 Pediasures a day for nutritional support and extra calories, which for right now is all he drinks aside from an occasional sip of water. Fruits and vegetables are the most difficult foods to get in because they often pass undigested and cause mild obstructions- which thankfully at this point we have been able to dislodge during rectal irrigations. Landon can eat peaches, apple, carrots, and sweet potato.. as of right now that's it. It's unfortunate because he is a very good veggie eater, but we have had some close calls with everything else. We have been lucky that Landon does fine with small to moderate amounts of cheese (which I love and add to most dishes that I make in some form!) He eats everything I serve for dinner which includes chili without beans, various pasta dishes made with pasta with extra fiber, meatloaf, chicken breasts, and sloppy joes on whole wheat buns. Other foods that he does well with are scrambled eggs, Applegate chicken sausage, plain Almond yogurt, peach-applesauce, thin-sliced deli turkey, and any kind of chicken- but especially nuggets and tenders. We go on Monday for a check-up with his pediatrician to confirm this, but Landon appears to be growing and gaining weight very well. At 16 months old he is outgrowing 18 month clothing.

We are doing one rectal irrigation per day. We do this before bed every night. Landon tolerates this very well and isn't at all bothered by it, despite how terribly invasive it is. My first goal is to get him off daily antibiotics for good before we worry about discontinuing the irrigations. If he doesn't come off of the Flagyl this time, I want to discuss either trying a super low maintanence dose or possibly giving Rifaximin another shot. We are approaching the one year anniversary of Landon's pull-thru surgery and so things should be regulating as much as they will within the next few months. Thoughts and prayers are always appreciated!

I'll leave you today with a picture of Landon at the park yesterday with his brothers. He loved this ride and although I was afraid he was going to get a brain injury and/or broken bones, his brothers couldn't make it go fast enough for him!

Round 2

After 4 weeks of absolute perfection with Landon's health, the botox wore off. Before there was even a noticeable change in his bowel function he already had a low grade case of enterocolitis. They had hoped that we would get at least 3 months out of the last round, but Dr. Levitt said they could go in for another round after 2 months. So basically for the past month Landon has lived off of Flagyl, frequent irrigations, and Pediasure since his appetite is nonexistent when things aren't moving along very well.

Today we were finally able to repeat the botox injections. Landon did great and we were in and out of the hospital in under 3 hours. Dr. Levitt recommended that we start putting him on a potty chair to encourage him to push more on his own, but other than that didn't have any suggestions other than repeating the botox treatments and treating enterocolitis as needed. I asked about the possibility of doing a myectomy- a surgery to permanently remove some muscle in the sphincter to create the same effect as the botox permanently. He said that he doesn't like doing those surgeries due to the risk of incontinence later on. For now I'm fine with trying a few more rounds of botox to buy us some time, but if things don't improve and Landon continues to experience recurring bouts of enterocolitis we will definitely weigh the pros and cons and reconsider.

Now we wait and hope for similar results from this round of botox as we experienced with the last. Other than our continued Hirschsprung's related struggles, things are going really well with Landon. Big news- he is officially walking! He took off walking 2 weeks ago and has made great progress becoming more stable ever since. He is also saying and repeating more words every day. This weekend we came up to Cincinnati early to visit the zoo and children's museum with the boys, and during that time Landon was around a lot of children his age. I noticed two wonderful things- compared to his peers, Landon is 1) big! and 2) equal. He talks, walks, and climbs as well as other children his age that we saw. No one would ever guess there is anything out of the ordinary going on with him other than the slight clue that I'm holding him down pretty much force-feeding bottles of Pediasure just to get calories and hydration in him.

I'll update with results of the botox soon. I hope everyone is enjoying the start of fall. The weather is absolutely beautiful here right now!