More strokes, surgery, and hospitalization

I'm writing this blog post on my cell phone while snuggling with my Ellie in a hospital bed so the chances of me proof reading it are even more slim than normal so please excuse any mistakes....

My last blog post was titled positive results and we did feel that the left side of her brain looked minimally affected by the Moyamoya disease.  But we also knew she was potentially having some symptoms.  The symptom we were monitoring was her eye blinking. But what happened a week later we never would have predicted.

Tuesday, September 23, 2014 (exactly 2 months after her 1st stroke) started as any other day.  Ellie didn't have an appetite and hasn't had one the night before but otherwise she didn't seem ill.  I dropped her off in her classroom at school and then spied on her from the hallway.  I could tell she was pretty upset. A part of me wanted to go back in and hold her but the other part told me she was okay and that I needed to give her time to get used to school.  And while I stood there questioning what I should do Miss Trisha, the assistant director of the school, went into the room and held Ellie which seemed to calm her down.

From there I went to the store to get groceries for the week.  When I was about to check out, Miss Tricia called to tell me that they hadn't been able to calm Ellie down so I told her I would be right there to pick her up.  I took Ellie home and even at home there seemed to be nothing I could do to calm her down either.  She wasn't interested in eating lunch and so I held her in my lap  because she was so upset while I ate my lunch.  Ellie has had plenty of days like this so I just gave her Tylenol and figured she had a bad headache.

I put the girls down for their naps around 1 p.m.  At just before 2:15 p.m. I heard Ellie screaming and went into the room to get her up from her nap.  When I saw her I knew immediately she had suffered another stroke.  She was lying on her stomach trying to sit herself up but couldn't.  I brought her into the living room and quickly assessed her, noticing that she couldn't sit independently and didn't appear to be able to move her right arm.  So I called 911 and explained that my baby has a disorder that makes her prone to strokes and that I felt she had suffered a stroke.

An ambulance arrived at pur house quickly.  I told the EMS that I also had a 3 year old who was sleeping so he took Ellie to the ambulance while I went to wake Payton.  I felt so bad telling Payton, "Hurry, get up, an ambulance is here to take Ellie to the hospital, she's very sick!  Sit down so I can put your shoes on!"  Payton is not one for being woken up suddenly and she was upset that her nap time clock was still on red not green (her clock turns green when she can come out of her room after nap time).  A couple minutes later, Payton and I joined Ellie in the ambulance.  Ellie was very upset so I sat on the stretcher holding her and they buckled Payton in to a seat behind us.  Payton looked like she was about to cry so I kept saying things like, "Yaaay!  Look at you riding in an ambulance!"

When we got to try hospital they rushed us in and they had to keep telling everyone coming up to asses us, "It's the baby who we think has had a stroke, not the mother".  I guess because strokes in children are so rare they figured everyone would assume I was the one who had suffered the stroke.

They moves us from one room to try next and eventually down the hall for a CT scan, with Ellie and I on the stretcher and Payton tagged along behind us.  I kept saying, "Follow us, Payton" and felt concerned about her well being in all this chaos as well.  Payton was such a trooper and I'm so thankful that she is the type of person who just takes things in strides.   Eventually Charles was able to get to the hospital (he works an hour away) and could help take care of  Payton.  And then around 6 p.m. my mom arrived from central Texas and was able to take Payton home.

While at UTMB, Ellie was pretty upset and besides the paralysis on the right side of her body and the lack of head support, we also noticed that she was nonverbal.  Around 5pm Ellie started having seizures which was really scary.  The first several seizures were the worst because her eyes went hard to the left, her face would twitch, she would drool.....  Later the seizures presented themselves as a consistent arm twitch.

From the moment we arrived at UTMB the plan was to have her transferred to Texas Children's Hospital.  But we had to wait for hours for TCH's "Kangaroo crew" to arrive.  Around 8 p.m. they arrived to transport us to Houston.  They had me ride in the front seat of the  ambulance and I couldn't see how Ellie was doing so the trip was petty nerve racking for me.

Once at TCH they took Ellie to MRI pretty quickly.  They didn't want to sedate her so they had Charles stick his body into the MRI machine to hold her down.   From the MRI they could tell that she had indeed had another stroke but that this one was much larger than the stroke she had 2 months ago.  It took up 2/3rds of the left side of her brain and blocked 2 major arteries.  This explained why both her arm, leg, and speech had been affected.  Unfortunately they warned us that with a stroke of this size the swelling might cause things to get worse.  So after getting the MRI results, Ellie was taken to PICU.

This all felt so hard to believe.  How she could go from having an MRA the week prior where her Moyamoya had been seen as very minimal to suddenly having a massive stroke?!   So just like the first time we went through this, it was very hard to come to grasps with.  The thought of, "I can't believe this is happening again!" kept running through my mind.

Once in PICU it was a comfort to have doctors and some nurses immediately remember us and who we felt comfortable with.  ICU is one of the few places where you don't take offense when someone says, "I had hoped I would never see you again!"  We had certainly hoped to have never had to be in PICU again either. 

The following day Ellie continued to act in pain and her only comfort was having me lie by her side.  I was glad that even though she seemed very out of it, she was always aware of if I was with her or not.  The next morning Ellie underwent a sedated MRA.  The MRA showed a bit more swelling than what was seen the previous evening which was to be expected.  Otherwise, just like the MRA taken the previous week, it didn't indicate a progression of the Moyamoya disease. When I asked her neurosurgeons what could then explain the massive stroke they flat out told me that they didn't know. That even though the brain still looked rich in oxygen on MRA that it must not be a sufficient amount.

Like the last time we went through this, the plan was to give her a few days to recover from the stroke and then consider going with surgery.  Because of the size of the stroke and the potential for serious swelling, Ellie was kept in PICU under close watch and high doses of sodium to help reduce the swelling.  She was also placed on seizure medicine that stopped the seizures she was experiencing.

The evening of our second night in the hospital was a scary one.  We were sharing a PICU room with a tiny 2 month old baby.  A nurse went in to check on her and then called for another nurse to come see how purple the baby's coloring was.  As the other nurse came into the room, one of them yelled, "She's not coming back up!  She's not coming back up!  Pull the code!"  Suddenly no less than 15 nurses, the PA, and doctor ran into the room.  You could hear the fear in their voices as they instructed each other on what to do.  The mother, who was there alone, went into the hall and started crying.  Charles and I just sat there paralyzed, whispering things like "Breath baby! Dear God please help the baby!"  Holding Ellie and realizing how easily that could be her, I just melted down.

They kept trying to get a breathing tube placed but the baby was so tiny that for some reason it kept slipping out of place and the fear and panic would happen all over again.  Each time that they would think they had it in place, they would need to take an x-Ray.  Being pregnant I would be asked to leave the room.  And there in the hallway was that poor mother. She had told me she doesn't speak English but I still gave her hugs and told her how I was praying for her and her baby.  That Jesus was watching over her baby and she was going to be okay.  I just didn't know what else I could say or do.  I felt so helpless and so shaken up myself.

They continued to work on the baby for hours, asking me to leave the room numerous times.  One of those times I went into the waiting room for a cup of water.  It was now the middle of the night and old lady there surprised me by taking my hand and saying, "What's going on?"  So I told her about the 2 month old who wasn't doing well and that I was also scared for my baby.  She said, "My granddaughter is in bad shape too and they aren't holding out much hope for her but I know Jesus can heal her."  Then she asked if she could pray with me and holding my hand she prayed for healing for the 2 month old baby and for Ellie.

After working on the baby for over 5 hours, they had a breathing tube in place and she was stable again.  At this point it was about 2 a.m. and we were finally able to go to sleep.  Around 4 a.m. I woke to our nurse leaning over Ellie telling her to wake up and take a deep breath.  Having just woken up, I didn't register what was going on at first.  Then I heard Ellie's alarm going off and realized her oxygen levels were dropping.  The nurse yelled for another nurse, who rushed in, and she kept encouraging Ellie to breath.  The whole event lasted only a minute but minutes like that are terrifying.  Ellie then went back to breathing normally and was okay after that.  The nurse reported that Ellie was twitching and it appeared she was having a seizure.  Because she was already on seizure meds and the seizure had stopped, they didn't change anything.

The next day the teenage girl across the hall from us coded.  It was a terrible sight as the nurses traded off giving her chest compression trying to restart her heart.  Finally after a long effort to save her, they stopped their efforts.  The girl was the granddaughter of the woman who had prayed with me the night before.   You don't know these people and yet you feel so heartbroken seeing what the families around you are going through.  Sometimes I would find myself being so thankful that although Ellie was clearly in bad shape, she was doing better then the children around her who were on ventilators.  Other times I would feel paralyzed with the fear that if this was happening to those around me, it could happen to us too.  Obviously you have to quickly push those thoughts from your mind but sometimes even still the fear has a way of remaining.

Thursday they decided to put Ellie under anesthesia to insert a PICC line to make blood draws and IV usage easier.  A PICC line is like an IV only it has a line that goes up her vein towards her heart making it more reliable than an IV.  The following day they did a swallow study on her which came back fairly inconclusive because she was really upset.  Ellie has no interest in eating or drinking so they had to force the foods down her throat so it's no surprise that it was upsetting to her.

By Saturday Ellie hadn't had anything to eat or drink since Tuesday morning so they inserted a NG tube (a feeding tube).  She started receiving PediaSure through the feeding tube and they were able to cut back on some of the IV nutrition and fluids.  They continued to pump her full of sodium to help reduce the swelling in her brain.  As long as the swelling wasn't excessive, the plan was for her to have brain surgery on Wednesday.

Tuesday morning Ellie had an MRI to see how her brain was healing from the stroke and to ensure surgery could proceed the following day.  They decided to do a quick MRI without sedation.  Ellie was hysterical during the procedure.  When they brought her out of the MRI she was still screaming and crying.  In the middle of the hysteria I watched as her eyes opened really wide, became fixed in place, her mouth opened in a strange way, her back arched up off of the bed, and her immobile arm lifted up.  I said, "I think she's having a seizure!"  The nurse said, "Let's just get her back up to ICU".  On the elevator she had another one and once in her ICU room her seizures were coming approximately every 2-3 minutes and lasted for 7-10 seconds each.  They gave her a dose of emergency anti-convulsant medication and when that didn't help they gave her an increased dose of the preventative seizure medication that she was already taking.  She continues to have the seizures so they gave her another dose of the emergency medication.  Finally the seizures became less intense in nature and eventually stopped all together.  Because of the high dose of medication they had given her, they had to put an oxygen cannula on her to monitor her oxygen levels since some people have breathing difficulties after such medications.  Thankfully she was just really out of it for the rest of the day but didn't experienced any breathing problems.

Soon after the seizures, Ellie's neurosurgeons came to us with bad news about her MRI results.  Not only was the swelling worse in her brain but they could see that she had experienced 2-3 new small strokes in the last week.  These new strokes had occurred on the same side of her brain as the initial massive stroke but in a location they aren't used to seeing strokes in Moyamoya patients.  And they admitted they had never had a patient who continued to have new strokes after the initial stroke.  The initial plan had been to postpone surgery if there was still a lot of swelling and wait until the surgery could be done when her brain was more recovered from the stroke.  But given the new strokes they said although the surgery would be more risky, they dared not wait seeing that she was continuing to get worse.  Since they'd never run into this situation before, they agreed to call their friend Dr Scott of Boston Children's Hospital, who is considered one of the leading Moyamoya surgeons in the world, to see what he has done in this kind of situation.  Unfortunately Dr. Scott said he had only had 1 patient who after the initial stroke continued to have additional strokes.  In that patient he made the decision to wait until the strokes had stopped and the patient had time to recover before proceeding with surgery but sadly the patient ended up passing away before surgery could be attempted.  Hearing this was the nudge we needed to make the decision to go with surgery even if the surgery would be considered risky.  Ellie's neurosurgeon told us that during the conversation Dr. Scott had said, "I am so sorry!" to which Ellie's neurosurgeon said, "Don't be sorry, you would never know things were this bad if you saw how well this child is doing".

The other thing we had going against us is that surgery isn't a quick fix.  The intent of surgery is to provide the brain with new blood vessels to start transporting the blood in the brain in place of the diseased vessels but it takes weeks to months for those vessels to grow and start to transport the blood.  Although neither Dr Dauser (our neurosurgeon) or Dr Scott had done surgery on a patient continuing to have strokes, they both agreed that for some unknown reason patients who were experiencing repeated TIAs (mini, non-permanent strokes) prior to surgery tended to stop having them immediately after surgery.  So the hope is that Ellie will have the same results and will not suffer additional strokes following surgery.

I've had a lot of scary moments lately and Ellie's brain surgery that took place on Wednesday, October 1, 2014, was definitely one of them.  We knew how risky the surgery was going to be.  The plan from her neurosurgeons was to open her skull and assess the amount of swelling on her brain.  If the swelling didn't look excessive then they would put in a drain to drain off some of the fluid and then go ahead with the dural inversion procedure.  If there appeared to be too much swelling and the procedure would be considered too risky then they wouldn't do it and would close her back up.  They said with the entire surgery they were going to try to do it fast to get her off the operating table as quickly as possible.  Of course what they consider fast (2-3 hours) feels incredibly slow when you are sitting in the waiting room without knowing how she is doing. 

When surgery was complete and the neurosurgeons called us into the consulting room, I could see smiles on their faces and when they said everything had not only gone well but had gone better than expected, I breathed the biggest sigh of relief.  It had gone better than expected because when they opened her up they found the swelling not to be bad at all and didn't even need to put in an external drain.  She also had no issue with anesthesia and woke from surgery able to breath on her own.  So many people were praying during Ellie's surgery and we know it was through those prayers and God's grace that surgery went so well.

The first few days after surgery were tough.  Initially we were dealing with trying to manage her pain and keep her comfortable.  She had a high fever that lasted several days and didn't respond well to Tylenol.  They felt like it was her brain having trouble regulating her body temperature which is a problem she had off and on after her first stroke too.  She also started having trouble focusing her eyes (they would dart to one side repeatedly) which we feared was a sign of another stroke or seizures.  An EEG, which was hard for her to endure, indicated they weren't seizures and our neurosurgeons reassured us that it could be caused by brain swelling and should resolve itself as the swelling decreased.  They seemed to have been right as it did resolve itself.

We dealt with ongoing high blood pressure issues.  Ellie's blood pressure always runs high but there were times following her surgery where it would get scary high for extended periods of time.  Her doctors are very hesitant to medically treat her high blood pressure since having her blood pressure drop could be very dangerous for someone with Moyamoya.  But after hours of her systolic pressure being in the 160s and 170s, they did end up treating her.  Just as a side note, a systolic number in the 90s is what is common for someone her age while a good number for Ellie is in the 120s.

About 5 days after surgery, we noticed Ellie's stomach had become extremely distended.  We tried monitoring it for awhile and gave her laxatives and stool softeners to get things moving since they felt the distention was gas trapped in her stomach but nothing was working.  Then one day she pulled her NG tube out.   This left Ellie without receiving an NG tube feed for over 4 hours.  And yet when the nurse drew back residuals (they pull the fluids back out of the stomach to evaluate how much is there and then they put it back), she drew back 150 cc which was 4 hours worth of food.  Meaning she wasn't able to digest the formula they were giving her and was backing up.  We remembered back to when she was about 3 months old, having blood in every stool, and was diagnosed with a milk protein intolerance and we wondered if that's why she was unable to digest the formula.  After trying a couple different formulas, she ended up on a hypoallergenic formula called EleCare which she seems better able to digest.

Also at about 5 days after surgery, a physical therapist came to work with her and she put Ellie on her stomach to encourage her to use her arms to support herself.  Ellie became hysterical and yelled/cried what sounded like "Mama, Mama!"  This was the only time since her stroke that she has spoken and we unfortunately haven't heard it since.  I can't wait for the day I hear her say it again!

The first several days after Ellie's stroke she did not smile, laugh, or really focus on anything said to her.  She simply rested and when anyone tried to mess with her she cried.  This included if I tried to show her a book or a toy or anything.  Everything was just too overwhelming for her traumatized brain at that point.  A day before surgery she started smiling and squealing again when I did things like kiss her neck and played peek-a-boo with her.  But after surgery she went back to not feeling well enough to play or smile.  But after about 5 days, her little personality emerged again and her smile returned.  She thought it was funny when she stole the glasses off of my face and I put them on her and then showed her what she looked like on my cell phone. 

After spending 12 nights in PICU, on Sunday October 5, 2014, Ellie got moved out of PICU and to a regular hospital room on the neuro floor.  Our nurses and doctors during our time in PICU had been phenomenal and while we will miss them, I can't say that we will ever miss being in PICU.  Being in a regular hospital room feels like such a luxury after being in PICU, with our own bathroom, shower, and couch for Charles to sleep on.  Although we are also very grateful for the access we had to the Ronald McDonald House during our time in PICU which gave us a place to shower and a bed for Charles to sleep in so that he only had to spend one night in the PICU waiting room. 

We spent 8 days on the neuro floor.  During that time we continued to deal with her digestive issues.  Her appetite finally returned (prior to this she absolutely screamed if you tried to offer her anything to eat or drink) but when we would give her baby food we would then hear it in her chest which meant she was silently aspirating it.  Her stroke had weakened her swallowing muscles so some of her food and drink were going into her lungs rather than into her stomach.  This can be a dangerous problem so we continued to give her a few spoon fulls of food per meal so she could practice swallowing but otherwise didn't allow her to eat or drink. 

Overall we could tell she was starting to feel better and becoming more alert and interactive.  The occupational therapists, physical therapists, and speech therapist started coming in to work with her daily.  Initially therapy was terrifying to her.  She had been caused pain by so many people that she immediately assumed anyone coming to mess with her was going to hurt her.  Also doing things like being in a sitting position was very scary to her.  Her head support had mostly returned but she had little core body strength so she required a lot of help to sit upright. 

After a few days on the neuro floor we noticed her core body strength returning and all she required was one hand on her back to help her stay in a sitting position.  Also, when held in the standing position, she would sometimes stiffen her weak leg to help her stand. 

The weekend of October 11-12, after not seeing Payton for a few days, she and my mom stayed in a hotel across from the hospital.  It was fun to be able to spend time with them and for Payton to finally get to see Ellie again.  Ellie enjoyed being held in our laps, watching Payton cruise up and down the hospital hallway on a little tricycle. When Payton would ride by, we would stick Ellie's hand out so she could give her a high five.  One evening I said, "Payton, stand by Ellie for a picture".  Payton did and Ellie reached out and took her hand.  Ellie had not been wanting to be touched at all and yet when it came to her sister, she wanted her touch.

We wanted to make Payton's birthday week special so that Sunday Charles took Payton to a trampoline place to have some fun with her.  The following day, my mom stayed with Ellie while Charles and I both took Payton on the metro train to Hermann Park.  She was able to play at the park for a little under an hour when it began to rain so we then spent another hour riding the train for fun.  Payton had a great time and so did we.

On Tuesday, I went back to Galveston and took Payton to school.  I had an OB appointment which my mom joined me for.  The baby I am carrying had a good, strong heartbeat and everything else checked out fine as well.  After the appointment we went to Academy to pick out a "big girl bike" for Payton's birthday present.  Payton has only seen the movie Frozen once but she has a couple of the books and she likes to play Frozen with her friends so we picked out the Frozen bike for her.  We then went to her school where we celebrated her birthday with her classmates.  Payton had Jake and the Neverland Pirate party favors and Hello Kitty cupcakes to share with her friends.  She and her friends seemed to have a fun time.

While I was in Galveston, Ellie got transferred from the neuro floor to the inpatient rehabilitation unit.  Charles was with her for the room transfer.  We had been anticipating this move and have been told that they estimate she will be here for approximately 3 weeks.  But that it is based on her progress and could be up to 5 weeks.

Wednesday, October 15, 2014, was Payton's 4th birthday.   In the morning she and my mom took her to the Houston Zoo which is conveniently located just down the street from the hospital.  It was a beautiful fall day!  We started by taking a train ride around Hermann Park.  After that we asked Payton what animals she wanted to see and she said the flamingos.  After finding the flamingos we saw a few more animals before ending up at the petting zoo and playground.  Payton loved petting the goats and playing on the very crowded playground.  She kept going back and forth between the two activities and didn't want to leave them.  Eventually we left that area and went to ride the carrousel.  After that we ate lunch by the giraffes, rode the carrousel one more time, and then returned to the hospital. 

Charles reported that Ellie's first day of rehab had gone well.  That she had stayed in a sitting position unassisted for a couple of minutes and she ate pureed food well for the the speech therapist without sounding congested.  Ellie seems fairly comfortable going to the room that they call the "gym" for therapy and is getting more comfortable with having therapists work with her.  She still often gets upset when they try to get her to stand and walk with assistance and when they try to force her into positions to be weight bearing on her immobile hand/arm.

Payton went home to take a nap and then late that afternoon Charles drove to Galveston.  Payton opened all her birthday presents and then they went out to eat at her favorite restaurant, the Rain Forest Cafe.   The Rain Forest Cafe has a frog mascot named Cha-Cha who walks around the cafe while you are eating.  Payton has always loved Cha-Cha so it was really funny when they arrived at the Rain Forest Cafe and the cafe was hosting a birthday celebrating for Cha-Cha.  When Cha-Cha came to their table, Payton excitedly told him, "It's my birthday too!!!"  Because it was Cha-Cha's birthday, Payton got all kinds of fun little toys and she couldn't have been more happy to share her birthday with her favorite frog!   After eating they went back to the house and had Hello Kitty birthday cake with candles and singing, of course.

The next day, Payton and my mom came to the hospital to visit during Ellie's nap time.  It might have been bad timing except that the store Spirit of Halloween was throwing a Halloween party at the hospital for patients and their siblings.  Payton got to attend the party where she picked out costumes for she and Ellie.  She announced, "I want to be a princess and Ellie wants to be a bad witch!"  Thankfully the bad witch costume is really adorable.  I already have Jake and the Neverland Pirate costumes for both girls for Halloween because that's what Payton had requested but my girls love to dress up in costumes year round so I know these new costumes will get lots of use.  Spirit of Halloween also gave out all kinds of fun hats, socks, and toys.  And Payton got to paint a pumpkin and decorate a mask. It was such a cool event!

So that leads us up to today.  This Tuesday will mark 4 weeks since Ellie's stroke.  For the first 1 1/2 weeks after Ellie's stroke she remained like a newborn.  Unable to support her own head or body, uninterested in things, unable to communicate beyond just crying, unable to eat, etc.  Now I would compare Ellie developmentally to about a 6 month old.  She can now sit unassisted but you still have to watch her because if she gets tired or distracted she will fall over.  She is doing a lot better with eating purees and has started to be able to chew puffs.  She is still on a feeding tube because she isn't yet taking enough orally to fulfill her nourishment and hydration needs.  The main issue with this is that we think she is likely to still silently aspirate liquids so she can't drink water or anything other than some thickened juice and would likely have a very hard time taking oral medications.  

When one person supports her trunk from behind and another person holds her hands and guides her, she will sometimes move her legs in a walking motion.  This is as close to walking as she is right now and doesn't have the balance, coordination, or strength to be close to independently walking at  but we practice this several times every day.   Her leg does have the ability to stiffen to help her stand as long as someone is supporting her.  Her leg and foot are beginning to stiffen in an unnatural way so they are having a brace made for her leg to help prevent this.  Her right arm and hand remain completely paralyzed.  She does occasionally have a little involuntary movement in her arm (when sleeping) but has no intentional movement of her arm.  It stays limp by her side.  Her fingers at times are showing signs of spasticity (curling up in a tight fist) so she wears a hand/arm brace to keep her fingers straight.  In general, she acts as if she doesn't realize her right arm, hand, or leg even exist so much of her therapy is designed to try to bring awareness to that side of her body.

She currently has no speech.  She will squeal and laugh when happy and cries when upset.  She seems to understand some of what we say but generally doesn't follow basic instructions.  She doesn't accurately identify basic objects.  By this I mean if you hold out a ball and a car for her and say, "Which one is the ball?" she is just as likely to grab the car instead.  She doesn't point, shake her head yes or no or communicate in other nonverbal ways beyond smiling or crying.  And yet if you ask her, "Do you want to eat?" you had better give her food immediately or she will start fussing at you.  She also finds things like pulling my hair to be hilarious, enjoys playing peek-a-boo, and laughs at us when we are acting silly.
 
At times it's really hard to see her like this but at the same time we continue to see her improve and are so thankful that she continues to head in the right direction.  It's just really hard to watch someone you love go through so much pain.  We are very grateful for all of the prayers she has received and we believe she is doing so well thanks to those prayers on her behalf.  As long as she doesn't suffer another stroke, because she is so young her prognosis is good.  Her young brain should continue to heal and create new pathways to compensate for the damaged areas of her brain.  It's just going to take time.  Because the surgery isn't a quick fix, Ellie does still remain at an increased risk of having another stroke so we appreciate all the continued prayers for her.  She has been a rare and severe case of Moyamoya disease and on MRI her brain looks very damaged.  And yet she is here and alert and has a sparkle in her eye again.  She is gaining strength and making progress in therapy.  She is doing well, is oftentimes happy, and we have high hopes for her future.  She is a fighter but most of all she has a whole lot of people praying that God would show his power and glory through her healing.  God clearly has a special plan for her life and she is one of the greatest blessings in our lives.