To All Our Prayer Warriors

We could use your help tonight. Please join us in praying for Ava. She is having some extreme nerve pain.

Typically, Ava does not have pain that interferes with her daily living. However, yesterday I noticed she was chewing on her unaffected hand some. I would describe it kinda like a teething toddler trying to cope. Today, I noticed she had chewed her nails down and then switched mouthing her affected hand.

Photo courtesy of Ava’s aunt, Tae, with Main Street Kids.

Lots of Sunday afternoons, we will take her swimming to our YMCA pool. It is an incredibly nice place and we often even have the whole pool to ourselves. As I was helping her in the locker room when we arrived, it occurred to me that all these things could be nerve pain. She hasn’t experienced jolting nerve reconnections for months, so I think that is why it took me a while to piece it together.

Since her surgery 3 years ago, she will have certain stretches where she feels the nerve reconnections happening. When it first started in her upper arm 4 or 5 months after surgery, it was like somebody was shocking her shoulder and she was trying to jump away from it or shake it off. It has happened since then every now and then, usually lasting for a few days or a week.

However, this pain today is the most INTENSE yet. The pool (perhaps because of its conductivity?) intensified it. Made for a quick swim for all of us. At home, she writhed on the couch bicycling her legs, holding her arm behind her back. The particular area of pain is in her palm. She couldn’t eat supper and is in bed sleeping now. It took Joe a very long time to calm her down, and he is a pro.

So, two things: pray for her comfort. Also, we PRAISE God because this is ironically such wonderful, wonderful news! New connections. Ava has essentially no hand function at this point but the team at Cincinnati Children’s insist that this healing after surgery takes 4 years and that the hand is last. It is hard not to give up hope but this pain is encouraging that perhaps more healing is happening!!! So we praise God even in the midst of pain and ask you to pray for our sweet little 7-year-old.

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No load of silage is worth that

As the sun sets of 2018 corn silage season for us, I am incredibly thankful for the safety of everyone on our crew and well, anybody on the roads.

Corn silage should be all done by midnight tonight. We have some earlage to make yet, but it is a little more low-key. Photography by my son, Vince.

My husband always reminds his crew every year:

Don’t EVER roll through a stop sign…no load of silage is worth that.

Don’t EVER drive 60 miles per hour on a gravel road…no load of silage is worth that.

My husband bears the burden of Ava’s accident every day. He tries very hard to have one extra semi on a crew all the time so that people don’t have to feel rushed. Whenever something breaks on his chopper (forage harvester), a tractor or a semi, he always says, “At least nobody got hurt.”

I urge you to be extremely cautious as a person on the road this harvest season. Farmers will bring out their combines very soon.

Put your phone down.

Never pass if there is any possibility a farm vehicle may be making a left turn.

Forget about the time clock you want to punch.

We were terrified when we had heifers out all over the highway last month. There were so many cars that blew by cops with their lights on, heifers running across the road….none of us could believe the incredible hurry that cars were in. I honestly think some people were so engrossed with their phones that they didn’t even see that they were incredibly close to an accident. Or in such a hurry to get to work on time that they weren’t willing to slow down or stop for a minute.

Please be patient this fall harvest season. Your safety is worth so much more than a text message or a time clock.

4 tons of salt, no pepper

On Tuesday, we were in the middle of making our corn silage pile which we feed to our cows for the entire next year. That day, we received two inches of rain. There is no way a silage semi can drive in fields that were already wet beforehand, for at least 3 days. That left us with a few options:

1. Leave it sit, knowing that all the exposed silage starts to lose a lot of value while in the presence of oxygen.

2. Cover it with a plastic tarp and old tires, wait for fields to dry, uncover it, finish adding more silage to it, and then splice plastic pieces together when covering again. Expensive (lots of man hours) and not fun.

OR A BRAND NEW IDEA…

3. Salt it. Well, maybe it’s not a brand new idea because it makes me think of Laura Ingalls Wilder times and how they use to salt stuff to preserve it. This idea came as a brainstorm when Joe called our nutritionist. I’m not sure if it was Joe’s idea or the nutritionist or some other dairy farmer’s, but my father-in-law thought it to be smart, so a LOT of salt was ordered.

I love how creative people can be at coming up with ideas to spread 4 tons of salt, at a rate of 2 pounds per square foot. My father-in-law used a fertilizer spreader. He even took a picture for me and came up with a title for this post. Lots of creative juices flowing! Typically, corn silage is a yellowish green and very bright. It really does look differently with all the salt.

Our nutritionist is always pulling feed samples throughout the year to send to the lab, so he will just have to adjust the mineral package our cows receive to account for this extra salt. I always feed my family lots of real salt (and pepper!) and encouraging adding as much as they want to what they eat. I know most people think salt is terrible for you, but a lot of the latest research shows how good it is for you to use as much as you crave. I certainly am on board with this, and some of it is probably from watching how much our animals appreciate a good salt block lick.

Anyhow, food is on my mind because well, I’m pregnant. And also, because the big item on my to-do list this time of year is to provide food for our crews making corn silage. I use a lot of salt in everything to encourage them to stay hydrated, and they even get some pepper to go with it.

We Found Them All But One

We Found Them All But One

Not quite two weeks ago, about 150 of our 229 heifers escaped their pasture in the middle of the night. They all headed north a mile and crossed Highway 60, a 4-lane road with a railroad beside it.

We have had heifers out many times before, but never this many and NEVER across the highway. Also, they split into 20 different groups which is unusual for Holsteins.

The most entertaining story is that the first group of 20 that we found in town were in the backyard of some church friends of ours. They live on South Shore drive, which is the road that goes around the lake. If they had started crashing through people’s backyards, a lot of damage could have been done. But, thankfully, the heifers waited right there. This family used to run the auctions at the local livestock sale barn, so they were very familiar with cattle on the loose and were understanding. They said that next time they needed fertilizer, they would just call us.

Here’s some answers to some questions I have heard:

How is it possible for them to escape?

I consider my husband a good fence maker, and typically a dairy heifer finds a single strand of electrified barn wire as a good enough reason to stay in the pasture. Working against us this year though, was the fact that it never quit raining long enough for us to put them in the low area that we use as pasture. So, when we finally put them on pasture two weeks ago, the electric shock wasn’t as strong due to lots of grass growing up as tall as the wire. It is impossible to say if something spooked them overnight or coyotes started chasing them or whatever. We had watched the sunset on them the night before they got it and they were all content at the time.

The ideal situation is this one — a dirt bike on each side and a side-by-side behind. Also nice if someone is ahead clearing an intersection.

How did you find them?

For the first 4 hours of so, we just kept getting phone calls from people or police. We had 2 side-by-sides, 3 dirt bikes and a bunch of pickups. We just kept responding to the calls by splitting up as we saw fit. The police helped us a lot in the morning with stopping traffic on Highway 60.

After mid-morning, we were no longer getting calls but still missing about 25 heifers. Joe’s friend took him up in a helicopter to go search some cornfields. They found a large group near a drowned-out area 2 miles west of our farm. After we brought those home, we slowly got more phone calls for the next 3 nights about heifer spottings. They were usually just 1 or 2 heifers at a time.

Did you find them all?

Maybe, maybe not.

I did a full inventory that first afternoon. Then, as we continued to find more lost heifers, I kept track of their numbers. We are still missing one heifer, 7591. However, keeping a heifer inventory is like herding cats or fencing goats. No matter how hard one tries, it is tough.

There is a possibility that she was not on our pasture that evening. See, we move heifers to our farm on the day that a veterinarian confirms them as pregnant, with new heifers arriving every two weeks. Then, about once a month, we move heifers OFF of our farm and into the barn where they will birth their first calf. So, there are always heifers moving here and there, and humans aren’t perfect(especially me!). Mistakes are sometimes made. There is a possibility that 7591 was a mistake on our inventory.

However, if we received a phone call this fall when combines start to roll through corn fields, that a yearling heifer with yellow tags was spotted, we would go look. I have a feeling that the dispatchers from our county will be calling us for years if lost cattle are ever reported. I’m not sure if we will ever have the guts to let heifers on that pasture again.

We are just thankful that nobody was hurt, especially considering how many times heifers had to cross the highway to come back home. So many people were probably not as attentive or concerned about their own personal safety as they could have been.

If you happen to spot 7591, give me a call!

Heifers out, using that mom voice

Some of our 230 heifers broke down the pasture fence in the middle of last night, and hightailed it across 4-lane Highway 60. Police called my father-in-law, and within minutes we had 4 trucks, 3 dirt bikes and 2 side-by-sides ready to round up our rogue pregnant Holsteins.

The fun began at 5:30 this morning. We started on the southwest side of town on a patio that borders the lake. We started walking those 10 heifers down the road that leads to our local elementary school and is about 2 miles north of our farm. We kept splitting up as more calls of more groups of heifers kept coming in.

Our local police and employees did an awesome job. It took a lot of team effort to get all these groups of heifers back across the 4-lane! We are terribly sorry for any inconvenience and confusion this caused people on their way to work. I am headed to town soon to visit people’s yards and access any lawn damage. We did everything we could to keep them in the ditches.

My husband and I have endured much in our marriage, and have learned that the most important thing in the end is….NOBODY GOT HURT. All stuff is replaceable but people are not. We are so very grateful for safety.

At this point, we have 203 heifers at home. I should have 230. We think the remaining 27 have settled down in a corn field for today and will start to move tonight. So, if you see a 1,000 pound heifer that has yellow tags with a number starting with a 7, either call police or contact me through my blog or Facebook.

Again, a huge thanks to our local police and community members that helped. Way too many people to mention. I would call them, but my voice is pretty hoarse from sternly directing heifers all morning. I can’t wait to go to my OB appointment tomorrow, and have them ask me if I have been exercising.

Until skeletal maturity

When we began this journey 3 years ago after Ava’s accident, the head surgeon at Cincinnati Children’s informed us in a very serious tone that these kids are not of the “in and out” type. He said that his patients need to be cared for by the team until skeletal maturity. I suppose for a girl would be somewhere in her teenage years. For Ava, at least another 6 years.

The prognosis from yesterday’s appointment was this: wait another year. Tough news to hear. This recommendation came after they had Ava show them her full range of motion and how much strength she had within those various movements.

Boonshoft Museum Of Discovery in Dayton, OH.

It works like this: every appointment, the whole team (like 5-6 of them plus a few students) comes into the room. It gets to be a pretty big party when our whole family is in there too! The head therapist gives Ava a sucker and has her try to hit it here, swing at it there, etc. The therapist and surgeons start using terms like “maybe a 2 for triceps, moderate abduction”, and the nurse, Melissa, is typing furiously on her keyboard. The team has tried the last couple of times to get a feel for sensation in the different areas of her hand, but Ava doesn’t cooperate with that at all.

After their observations, they recommended waiting another year. I think they know me well enough by now, to know I wasn’t going to start packing our things up and allow them to leave the room so quickly. I think they secretly refer to me in the hallway as the “Million Questions Mom”.

I wanted details about what things are likely in store, and when these things will happen. They told me they normally wait 4 years after the initial surgery with babies, and may wait five years with Ava since she was older at the time of her nerve transfers, and her nerves have to regenerate across a greater distance. At that point, they anticipate 3 procedures. They said they haven’t for sure decided yet if they prefer them done in one day or at separate times, but another year of operating and they think they will know what is best for Ava.

The first is a forearm osteotomy which involves cutting one or both of her bones in her forearm and resetting the starting point from which she pronates or supinates(like rotating her forearm upside down and right side up). She wouldn’t get more range of motion, just a new starting point — that is why I am always stretching this muscle, even in public. I don’t want her to even lose half an inch of rotation. Her supinators have kicked in big time and overpower her pronators so, right now, her right hand is always palm up. We live in a pronated, palm -down world when one considers driving, deskwork, anything. Risks with this operation are high for infection, and if done too early, the resetting can be “outgrown”.

Second is a Green transfer. I guess the neat thing about inventing a surgery is that it may be named after you! The Green transfer would hopefully provide her with wrist extension. That means the ability, if her arm is resting on a table, to draw the hand up against gravity. Currently, Ava has no need for this ability as gravity naturally extends her wrist, but if she had the osteotomy, she would really need this. Lastly, the Zancolli procedure is a tendon transfer to also help with pronation and maybe finger flexion. I have lots of reading and researching ahead of me!

To be honest, part of me wants to contact Mayo and Wash U in St. Louis (two places we initially visited but decided against in favor of Cincinnati Children’s) and visit with their hand surgeons again for better options or at least reassurance we are on the right track. I honestly think if I quit being in contact with our team in Cincinnati that I would walk into my home sometime and they would all be sitting around my dining room table, ha reminding me of the importance of following through with them, not just for Ava’s sake, but for future patients that have traumatic brachial plexus injuries! I do feel in my heart that I can be confident in our current team, but I don’t like the idea of missing anything.

Carol Ann’s Carousel in downtown Cincinnati.

The head surgeon when we began this journey was Dr. Yakuboff. He has since retired and I miss him. The team now laughs that retiring was the hardest thing he ever did. I guess when he started cutting back on his hours at Children’s that he couldn’t help but to spend those extra hours volunteering at the Shriner’s hospital with burn victims and brachial plexus kiddos. I am certain he remembers Ava but doubt that he remembers the exact conversation when informed me that this recovery would take years and years. I think I should send him a card with a photo so he can see her progress. It can be hard for me to see in the day-to-day how far she has come, but I am sure it would make him smile to see her now.

In person

“They” say a picture is worth a thousands words. I agree. I also think that meeting someone in person in way way more valuable than just communicating online. Our 3-year-old’s latest way of communicating a lot is “a google million”. So, meeting someone in person is worth a google million words.

We packed light! In true Vander Kooi fashion, we showed up just in time to grab one snack and then board the plane. No waiting around.

And, today, we get to do just that! Cincinnati Children’s brachial plexus center found sponsors and today, they offer a free day at YMCA Camp Kern for all current families. We flew direct from Minneapolis to Dayton, Ohio yesterday. Sometimes flights to Dayton are cheaper than Cincinnati and this time they were. The camp is equidistant. We spent last night in our first-ever Airbnb and it’s been great.

Liv making some morning tea. Dayton is just an hour north on Cincinnati and is home to the National Air Force, so lots of that aviator decor in our half a house that we are renting through Airbnb for a few days. So nice to have yesterday’s laundry done!

So, today, we will get to meet families from all over that have a child with an injury similar to Ava’s. The severity differs greatly among patients, but as families we can all relate. I am so excited to see how all these kids have adapted to this world as they eat, play, craft, and swim.

In the 3 years since Ava’s accident, I have spent hundreds of hours researching all things brachial plexus. I know more about these 5 nerves that give sensation and function to an arm than I could have ever imagined.

I feel very fortunate that my degree in animal science and my work on the farm have taught me so much about how to research an issue. Joe is the same. Very few people travel to 3 different hospitals specializing in this injury to compare surgeries, teams, nerve transfers and options but we did it, assuming that was the ONLY thing a parent would do. Because of this research, I have been able to offer guidance to hundreds of parents in online forums and support groups. There are so many good things that have happened since Ava’s injury and I am incredibly proud to be able to help other parents cope and make a plan. My goal is to make sure a parent or caregiver never leaves a doctor’s office visit until they have the correct questions asked. So many times, a parent doesn’t even know what they need to know, and I really try to help them build that bridge between their child and their medical team.

Here’s a snippet from today. This lady is in India and just had a orphaned 9-month-old come to her. He has lots of hand function but no shoulder movement.

After today, we will go into full-on vacation mode for a few days, and then we have Ava’s check-up on Tuesday. We fly home on Wednesday. There is never an easy time to get away from a farm, but I thought we just had to make today and this trip happen. It’s going to be a great day!