Time-sensitive: Have to make decisions re: 18yr old w/ Megacolon. :-(

aspen8

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I apologize in advance for the length of this post.  

My furbaby Chester is in trouble. We've treated him for megacolon for 3-4 years with cisapride and lactulose.  We were giving him 1.5 ml cisapride 2x/day and 3 ml lactulose 2x/day.  The vet had him eating basic canned wet food exclusively.  No dry at all.  After being boarded at the vet while we had to travel for work, Chester needed an enema - which we'd avoided for nearly a year.  He hasn't been right since.  That was in January.  We ended up having to increase his lactulose to 4.5 ml 2 x per day.  His stools were getting clay-like from all the lactulose and it still wasn't working.  After more enemas maybe a month or so apart, he got backed up again and the vet had to put him under and go in to break up the blockage with an instrument.  He told us at that point that Chester needed surgery to remove his colon.  But he's 18 and I'm afraid he won't survive the surgery.  

As we were checking out and taking Chester home to think about it for a few days, an employee there told us about Fiber Response and suggested we try it.  It was the opposite of the low residue approach we'd been taking but we figured it was worth a shot if our vet okayed it and he did.  The vet also told us to add Miralax to his wet food.  So then we cut his canned food in half and added half his calories from the fiber response.  At each meal, he got 1/6 of a cup of fiber response dry and 1/4 of a 5 oz can of wet food mixed with 1/4 tsp of Miralax.  He was still getting 1.5 ml cisapride 2x per day and we cut his lactulose down to 3 ml 2x per day.  

He farted.  And farted and farted and farted.  Foul smelling farts!  Darn near killed us.  But we didn't care BECAUSE HE WAS POOPING!  Big ole formed but softish poop every day.  Things went on like that for maybe 6 weeks.  It was the best he'd been in YEARS and I was convinced that we'd licked the problem.  But we hadn't.

The farting stopped over time and we assumed it was because he'd adapted to the new diet.  I still think that's the case but I don't know for sure.  But gradually his bowel movements became smaller and farther apart. (Over the course of 2-3 weeks, I'd say.)  Somewhere during this time he started leaving "microturds" behind after he'd gotten up from laying down.  They could be anywhere from the size of a raisin to the size of an olive.  He seemed to have no idea it was happening.  It wasn't producing an awareness of needing to use the litter box as far as we could tell.  They were in his beds, in the middle of the floor, in OUR bed at night...wherever he'd lie down. We thought it was a sign that maybe the cisapride dosage was too high now and on the vet's advice we lowered it from 1.5 to 1.0 ml 2 x per day for a couple of days.  His bowel movements got worse. So we stopped that and went back to his normal dose.  Then he stopped going at all.  The difference this time is that there are no unproductive trips to the litter box.  Usually when he gets backed up we'll see him posture to poop and nothing happens.  This time, he made no effort to posture to poop.  He'd go in, pee, and walk away.  So at that point he was leaving his "microturds" around the house, was clearly backed up, and was making no effort to move his bowels at all.  

I took him back to the vet last Tuesday.  They did two enemas and did get him "mostly cleaned out".  He came home Wednesday evening. He did have another small bowel movement in his litter box that night.  And I've seen nothing since.  It's Sunday afternoon  So almost 4 full days since a confirmed bowel movement.  There's a chance that we missed something as we have 5 litter boxes and 4 other cats. But I don't think so.  He feels "full" to me (I don't mean that I can feel his colon.  His belly always feels so tight and distended to me I'm confused about how people say they can feel that.  I just mean that he feels heavy...like he needs to go.)  The vet told me - based on the fact that the Fiber Response seemed to be helping - that maybe we should cut the wet food down even more (say to 1/8 of a can per meal) to make sure he eats the dry food.  It's not working.  Chester now doesn't really want to eat much of the Fiber Response.  He loved it at first but now he'd much rather have the wet.  His appetite has fallen off significantly in the last few days.  I'm wondering if he's nauseous.  Nothing about this situation is going in the right direction.

I should also say that he clearly has some arthritis in his hips now and some spondylosis in his lumbar spine.  (Is it called "lumbar" in cats?)  The vet has wondered if there isn't a neurological issue arising from the spondylosis or a pain/avoidance issue arising from the arthritis.  However, Chester still makes small jumps like up onto the couch or onto the bathtub to ask for a sink drink.  

Chester drinks a LOT of water.  So much so that I've periodically asked my vet to do blood work looking for diabetes, renal trouble, metabolic issues...so far the values have all come back within normal ranges.  We sent some blood to a lab at Texas A&M and they said he might have IBD so he's on prednisone every other day.  Honestly I'm not sold on that diagnosis and can't say I've seen any difference whatsoever related to the prednisone.  The point is, for an 18 year old kitty, he's pretty darn healthy other than the megacolon.

If he doesn't move his bowels by Monday morning, naturally I'll call the vet again.  But then what?  They're going to tell me that we're back to the point of needing to do surgery and I'll be back to thinking that he won't survive it because he's 18.  He doesn't act like he's in pain most of the time.  He purrs.  He asks to be picked up and gives hugs.  He looks fantastic.  He seems so healthy in every other way.  It's killing me to consider euthanizing him or putting him through a hard surgery that will likely kill him.  I don't know what to do...what to try.  I'm afraid to try to change too many variable at once.  I'm afraid to not try anything.  I love him to pieces. I'm feeling pretty desperate.  He's counting on me and I don't have any answers.   In the last 3 years I've lost a brother, a sister, a father-in-law, 3 geriatric rescue kitties/furkids, and a dog.  I don't want to say goodbye to my "old man" too.  I'm not ready.  And there's nothing about the REST of his condition/attitude that says he's ready to go either.  (I wouldn't be selfish if he was....when it's clear that it's time, I put my big girl pants on and let them go.)  I have to know I tried everything I could before I agree to surgery or euthanasia.  (Just tying that word makes me lose it.)

Again - sorry for the length of this post.  And I'm sure you've answered these questions 101 times in the past.  I'm sorry for asking again.  What would you suggest that I do next?  I have a day to decide what my plan is going to be since I'm probably going to have to call the vet tomorrow morning.  I'm so, so sad.  I really thought we'd found our answer.  :-(  

Thoughts?  Should I try increasing the Miralax from 1/4 tsp twice a day?  Should I try increasing the cisapride from 1.5 ml twice a day?  Should I ditch the dry food?  Should I try slippery elm?  Should I have them do another enema tomorrow and try to start out fresh again?  I'd normally never ask anyone other than my vet about medicines and dosages.  Same vet for over 10 years.  But he seems stumped now.  He just wants to do surgery and frankly I feel like he's given up.  There are "baby docs" there (recent grads from U Penn) and the office has experienced a lot of turnover and the whole place seems to be in disarray.  I don't have the same level of confidence I used to, sadly.  

Anyone have experience with any of this? 

P.S.  Does anyone know if the Yahoo group about cats with megacolon is still active?  I read about it during my manic research stint this weekend and people raved about it.  I found it and joined and posted a version of this novella but so far no one has looked at it or commented.

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white shadow

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P.S.  Does anyone know if the Yahoo group about cats with megacolon is still active?....I found it and joined and posted a version of this novella but so far no one has looked at it or commented.
Well, this one  https://groups.yahoo.com/neo/groups...=1&t=search&ch=web&pub=groups&sec=group&slk=2    is still active, though the 'busyness' dropped from 400 messages in April to 200 in May and so far, only 15 in June (bottom of homepage).

I would email the listowner....right in the middle there....and ask whether/not there's a problem.

One thing though.....in a 'multicat' household, there's only one way to be certain of his output: isolate him with his own facilities.
 
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aspen8

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Well, this one  https://groups.yahoo.com/neo/groups...=1&t=search&ch=web&pub=groups&sec=group&slk=2    is still active, though the 'busyness' dropped from 400 messages in April to 200 in May and so far, only 15 in June (bottom of homepage).

I would email the listowner....right in the middle there....and ask whether/not there's a problem.

One thing though.....in a 'multicat' household, there's only one way to be certain of his output: isolate him with his own facilities.
Hi White Shadow.  Thanks for your response.

Yep, that's the group I posted in and I did email the owner earlier today before I posted here to see if there was an issue...may take a while for him/her to see it and respond.

I  realize that the only way to be 100% sure about who's doing what in the litter box is to isolate.  I'm about 90% certain that there was none of his poop in any of the boxes.  I've had other reasons over the years to obsess about poop and I know what everyone's poop looks like .  (I won't bore you with the details but I have one girl who poops rectangles.  Lol.)  It's not impossible that I missed something or that his poop is changing enough that I'd mistake it for someone else's but it's not terribly likely either.  Combined with how his belly feels and his dwindling appetite, I'm pretty confident that he hasn't gone.  Frankly I'm not willing to isolate him too much right now anyway.  If these end up being his last days, that's not how I want him to spend them.  :-(
 

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I can't give you any specific advice other than to weigh quantity of life against quality of life.  Surely continued enemas can't be pleasant, but at age 18, coming back from bowel surgery would not be a walk in the park either.  Between those two, I would choose the enemas as better quality of life as long as they aren't a daily thing.  I've only had a couple in my lifetime and still hold the memory of them being quite terrible and making my tummy hurt in the worst way.  Right now, if he wants wet food, I would certainly give it to him.  That's much more natural to him than a high fiber dry food, and perhaps the combination of the two is ideal.  If you can keep him comfortable and happy for the most part, then that's good, but if you can't, then 18 is a ripe old age and there's no shame in letting him finish his life in comfort.
 
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aspen8

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Hi Red Top Rescue!

Thanks for your response.  Yeah...the thought of taking away all of his wet food just doesn't feel right to me, either from a happiness standpoint or from a moisture standpoint.  I want every ml of water possible in his body!

I so wish they could talk.  I've never had an enema.  I have no idea how awful they might be.  I know the enemas he gets at the vet are a miserable experience for both him and the vet techs who have to deal with it.  But I don't know HOW bad they are for him.  Just HOW much pain does it cause?  If he could say, "Mom, I could do it once a week but that's about all I can stand" or something like that, it sure would help.  

18 is a ripe old age.  You're right.  I realize how lucky I am to have been able to enjoy his company this long and if it's his time, so be it.  My fear is assuming that's the case when it isn't or making a bad decision that MAKES it the case when it didn't have to be.  I guess we've all been there.  And a friend of mine has a 21 year old kitty...and that makes me greedy.  Lol.
 

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Hi Red Top Rescue!

Thanks for your response.  Yeah...the thought of taking away all of his wet food just doesn't feel right to me, either from a happiness standpoint or from a moisture standpoint.  I want every ml of water possible in his body!

I so wish they could talk.  I've never had an enema.  I have no idea how awful they might be.  I know the enemas he gets at the vet are a miserable experience for both him and the vet techs who have to deal with it.  But I don't know HOW bad they are for him.  Just HOW much pain does it cause?  If he could say, "Mom, I could do it once a week but that's about all I can stand" or something like that, it sure would help.  

18 is a ripe old age.  You're right.  I realize how lucky I am to have been able to enjoy his company this long and if it's his time, so be it.  My fear is assuming that's the case when it isn't or making a bad decision that MAKES it the case when it didn't have to be.  I guess we've all been there.  And a friend of mine has a 21 year old kitty...and that makes me greedy.  Lol.
Hi, I'm so sorry that you and Chester are going through this.  I know the struggle and the fine line you have to walk when bodily functions aren't quite right.  It's like a juggling act, isn't it, trying to give them just the right thing at just the right dose?  I agree that he should be given all of the wet food he wants.  At this point, eating what he enjoys is the most important thing.  I allowed surgery on an 18-year-old cat because of a resorptive lesion on one of his teeth.  He made it through the surgery, but he was never the same.  Before you make a decision to do that, I have a suggestion.  Do you have a holistic vet in your area?  Or a regular vet who practices acupuncture?  Since he has some arthritis and some spinal problems, acupuncture might work very well on him.  When those nerves coming out of the spinal cord are pinched or inflamed, it can greatly impact motility.  My daughter's cat has been diagnosed as being "suspicious for cancer," and has been taking Buprenex, which, like other opiates, can stop the colon from moving.  She was given an acupuncture treatment by her oncologist and it worked very well.  Other than that, she is on Miralax, Slippery Elm syrup and Nordic Naturals Omega-3's mixed into her wet food.  She too has the little "accidents" you described above, and is seemingly not even aware that she's leaving something behind.  She has swelling in one leg and we think the discomfort of that may be impacting her litterbox behavior.  Another supplement she is taking that seems to be really helping her is Animal Essentials Plant Enzymes & Probiotics, sprinkled on her food.  Since Chester seems to be very healthy otherwise, and you don't sound as if you're sure who to trust at your current vet's office, you might want to get a second opinion and/or seek out a holistic vet or pet acupuncturist.  I know how hard it is to lose yet another loved one.  But Chester doesn't sound to me like he's remotely ready to go yet.  You're not greedy, sweetheart.  You love him.  And everyone here totally understands that.  
 
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aspen8

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UPDATE:

1.  The Yahoo feline megacolon group IS still active, which is terrific.

2.  He pooped!  Late last night he had a small bowel movement.  It doesn't change the fact that we have a very rough situation on our  hands but it's very good to know that he WAS able to feel the urge to move his bowels, was able to posture correctly to induce a bowel movement, and that his stool isn't too hard to pass at the moment.  That means that we haven't - yet - reached the point where there is absolutely no motility in his gut.  And THAT means no enema today at least and no need to have any life-or-death discussions with my vet today.  I may have time to talk to the folks in the yahoo group and make some tweaks to his treatment plan and see what happens.  It's definitely one day at a time but this time yesterday I didn't know if I had an extra day, so....I'll take it!  :-)
 
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aspen8

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Hi, I'm so sorry that you and Chester are going through this.  I know the struggle and the fine line you have to walk when bodily functions aren't quite right.  It's like a juggling act, isn't it, trying to give them just the right thing at just the right dose?  I agree that he should be given all of the wet food he wants.  At this point, eating what he enjoys is the most important thing.  I allowed surgery on an 18-year-old cat because of a resorptive lesion on one of his teeth.  He made it through the surgery, but he was never the same.  Before you make a decision to do that, I have a suggestion.  Do you have a holistic vet in your area?  Or a regular vet who practices acupuncture?  Since he has some arthritis and some spinal problems, acupuncture might work very well on him.  When those nerves coming out of the spinal cord are pinched or inflamed, it can greatly impact motility.  My daughter's cat has been diagnosed as being "suspicious for cancer," and has been taking Buprenex, which, like other opiates, can stop the colon from moving.  She was given an acupuncture treatment by her oncologist and it worked very well.  Other than that, she is on Miralax, Slippery Elm syrup and Nordic Naturals Omega-3's mixed into her wet food.  She too has the little "accidents" you described above, and is seemingly not even aware that she's leaving something behind.  She has swelling in one leg and we think the discomfort of that may be impacting her litterbox behavior.  Another supplement she is taking that seems to be really helping her is Animal Essentials Plant Enzymes & Probiotics, sprinkled on her food.  Since Chester seems to be very healthy otherwise, and you don't sound as if you're sure who to trust at your current vet's office, you might want to get a second opinion and/or seek out a holistic vet or pet acupuncturist.  I know how hard it is to lose yet another loved one.  But Chester doesn't sound to me like he's remotely ready to go yet.  You're not greedy, sweetheart.  You love him.  And everyone here totally understands that.  
Yes!  A juggling act on a high wire without a net.  In the rain!   Lol.  I've never looked for a holistic vet in my area but I'm in a suburb of Philadelphia - about 40 minutes outside the city - and I've got to think the chances are good that we have one or two or ten within driving distance.  That sounds like a great suggestion and I'll definitely look into that tomorrow.  I'm making an action list.  (It turns out that the yahoo megacolon group is still active and they're giving me some great information too.)   Someone else suggested a probiotic.  I'll look up the one your daughter's cat is taking.  I bought some slippery elm capsules but am considering returning them in favor of loose powder if I can find it.  Do you make the syrup yourselves?  Do you mix it with her food or give it separately via oral syringe?  How well does the kitty tolerate it?  I've read some hate the taste.  I've loved this veterinary office for nearly a decade but things just aren't the same for the last six months.  It's too busy and chaotic.  Too much change.  Too few staff.  I hope things return to normal soon.  In the meantime, I need to turn wherever I need to and get all the info I can and make the most informed decisions I can, right?  I do love him.  Thanks for understanding.  It helps a lot.  And thanks for the excellent suggestions!  xo
 

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Yes!  A juggling act on a high wire without a net.  In the rain!   Lol.  I've never looked for a holistic vet in my area but I'm in a suburb of Philadelphia - about 40 minutes outside the city - and I've got to think the chances are good that we have one or two or ten within driving distance.  That sounds like a great suggestion and I'll definitely look into that tomorrow.  I'm making an action list.  (It turns out that the yahoo megacolon group is still active and they're giving me some great information too.)   Someone else suggested a probiotic.  I'll look up the one your daughter's cat is taking.  I bought some slippery elm capsules but am considering returning them in favor of loose powder if I can find it.  Do you make the syrup yourselves?  Do you mix it with her food or give it separately via oral syringe?  How well does the kitty tolerate it?  I've read some hate the taste.  I've loved this veterinary office for nearly a decade but things just aren't the same for the last six months.  It's too busy and chaotic.  Too much change.  Too few staff.  I hope things return to normal soon.  In the meantime, I need to turn wherever I need to and get all the info I can and make the most informed decisions I can, right?  I do love him.  Thanks for understanding.  It helps a lot.  And thanks for the excellent suggestions!  xo
I agree, it is a total nightmare/high wire act to try to keep them balanced!  I was SO excited when my daughter's cat left a small "gift" on the floor at the vet's office.  I actually felt like celebrating!  lol  Success!  Here is some info about slippery elm and the syrup recipe that I use:

Slippery elm soothes all mucus membranes and can be used for IBD, colic, vomiting, ulcers and diarrhea. It contains vitamins and minerals and has a pleasant mild taste. It is also readily accepted by most animals young and old, even by the most picky cats and ferrets.

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Recipe

Put 1/2 cup of cool purified water into a glass or stainless steel saucepan. Add one slightly rounded teaspoon of slippery elm powder (or you can open and empty the contents of 5 capsules into the pan). Whisk with a fork until the powder blends with the water. Note: Always blend it in the cold water first. If you add the powder to warm or hot water it will be lumpy.

Bring the ingredients to a simmer over a low flame, stir constantly. Simmer about two minutes or until it slightly thickens to a syrupy consistency.

Cool the mixture then refrigerate in a glass jar with a tight fitting lid. With proper storage the syrup will remain fresh for 7 or 8 days.

Even if you just add the dry powder mixed to an animal's soft food it can help soothe the digestive system.

Suggested Herbal Doses for Cats: 1 teaspoon slippery elm syrup  given before each meal.

---------------------------------------

I have only used the capsules and I buy mine at Swanson Vitamins online because I trust their quality.  It's also a good idea to taste the Slippery Elm yourself.  It should taste slightly sweet.  If it is at all bitter, don't use it; bitterness means the manufacturer harvested the wrong part of the bark.  I've given it to all four of mine and they don't seem to object to the taste at all.  

I understand exactly what you're saying.  My own vet's office has recently become rather chaotic.  My vet owns the clinic and I will not go to any of the other doctors he employs.  Every time I go, it seems busier and at a certain point, I'm sure that they too will be unable to care for my babies as I wish.  I've gone there for 15 years and I hate the thought of finding another vet, but you have to do what's best for them.  Finding a vet you trust is a rare and wonderful thing.  I believe you can find a good holistic vet in a city the size of Philadelphia or in its suburbs.  I live outside of Memphis and you would think we would have one in the metropolitan area as well, but I haven't found one yet.  The search continues....  Please keep us updated on Chester's situation.  I will keep him in my prayers.
 

red top rescue

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WONDERFUL NEWS!   I'm so glad you are located in a fairly civilized area where you should be able to find a more naturopathic vet and I'm glad @MaggieMay has joined in this thread because she has some good experience and knowledge on this subject.  Since you mentioned your manic research, you might be interested in another site dedicated not just to megacolon but to everything GUT.  I will give you a link to the middle of Gut102, where they discuss what goes wrong.  Maybe this will add to your research..  http://www.felineconstipation.org/whatgoeswrong.html and http://www.felineconstipation.org/acutetreatment.html

One day at a time with your cat's quality of life at the forefront is the best way to fly.  Wishing you many more years with him.  Do keep sharing anything and everything you find out.  A friend of mine also has an 18-year-old who is having issues, but they don't think it's megacolon, just a hydration problem.  But I am sharing things I find on this site with her in hopes they will help.
 
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aspen8

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Maggie May -

Thank you for all of that information on SEB!  That was hugely helpful.  I'm hoping to be able to use that info soon.

Sorry I sort of fell off the face of the earth for a while.  We had a family emergency...nephew fell down a 25' embankment and hit his head and was in a trauma unit ICU on a ventilator.  We thought we were going to lose him but things have turned around dramatically in the last few days which is wonderful.

On a sadder note, long story short I had to take Chester to the vet again today and requested that they do a full workup with labs, x-rays, and urine analysis.  He's been losing his appetite and exhibiting other symptoms for the 4-5 days that I just couldn't ignore of put down to the megacolon any more.  Anyway, the diagnosis is acute renal failure.  They're going to try IV fluid therapy for a couple days to see if they can get some improvement and get him stable.  If so I'll bring him home and try to manage it with sub q fluids here, though I admit I'm nervous about adding CRF to megacolon and balancing both.  I love him more than words can say though and I'm not ready to give up yet, so...we'll see.

Thanks again for everything.  You all have been such a big help!
 
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aspen8

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WONDERFUL NEWS!   I'm so glad you are located in a fairly civilized area where you should be able to find a more naturopathic vet and I'm glad @MaggieMay has joined in this thread because she has some good experience and knowledge on this subject.  Since you mentioned your manic research, you might be interested in another site dedicated not just to megacolon but to everything GUT.  I will give you a link to the middle of Gut102, where they discuss what goes wrong.  Maybe this will add to your research..  http://www.felineconstipation.org/whatgoeswrong.html and http://www.felineconstipation.org/acutetreatment.html

One day at a time with your cat's quality of life at the forefront is the best way to fly.  Wishing you many more years with him.  Do keep sharing anything and everything you find out.  A friend of mine also has an 18-year-old who is having issues, but they don't think it's megacolon, just a hydration problem.  But I am sharing things I find on this site with her in hopes they will help.
Thank you for that link.  There's some WONDERFUL information there!!  Hugely educational!  Just the idea that inside the GI tract isn't inside the cat was an eye opener.  Thank you, thank you!

I'm still researching but as I explained in the post I just left for Maggie May things have changed a bit.  Chester was diagnosed with acute renal failure today and we're holding our breath hoping that they can help him get over this hump and settle down into a more chronic and less acute condition.  Managing the two together is daunting as heck but considering the alternative, I'll take it!  I'm going to do manic CRF research now and add it to the megacolon stuff and see if I can find people with experience balancing both.  Hopefully my "old man" will come home and I'll be ready.  

Sorry I went radio silent.  Don't want to fill this thread with repeat info but we had to shift into bedside vigil mode after my nephew had an accident that nearly killed him.  ICU in a trauma center is not where you want family members.  Although...he's darn lucky to be alive and able to move all of his fingers and toes so again...I'll take it!
 
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