He Did It!

I've been half-heartedly trying to potty train Noah for a while now. I never put much effort into it thought because no matter how many times we sat on the potty, he would never go. He never acted like he could feel the sensations. His therapists told me that kids with sensory issues tend to train later so this didn't surprise me much.

But for the last several months, every time I changed Noah's diaper, I would tell him that we don't pee or poo in our diapers. We go in the potty. Then I would ask him, "Noah, where do we go pee pee?" And he would always say "In the Potty!".

Well, the other day Noah came up to me and said (for the first time ever) he needed to go potty. So I took him to the bathroom and he sat down. And nothing happened. I decided to go ask Shane to come in and maybe he could "show" Noah how big boys use the potty but when I came back I found it wasn't necessary. He had gone pee pee in the potty for the first time EVER! I guess he just had a little stage fright with Mommy in the room.

We made such excitement over this. We jumped and clapped. We high-fived and danced. We ran outside to tell Daddy "I did it! I pee in the potty!".  Miracle One...Check!

Miracle Two? He has gone pee pee AND poo poo in the potty all on his own, EVER SINCE! I kid you not! He goes in and sits on the training potty and then dumps the pee pee in the big potty, ALL ON HIS OWN! When he needs to go poo poo, he sits down on the big potty and goes. It absolutely blows my mind. Uhm, hello? He went from ZERO, NADA, ZIP potty training progress to BAM! No accidents.

This is, most definitely, a tender mercy to weary mommy. It also gives me hope for all of the things to come in the future and what this kid is capable of.

It seems Noah just makes awesome leaps in developments around the time of his birthday. Last year, when he turned 3, he finally started talking a little bit. He would make sounds that were the beginning parts of words instead of just grunting and screaming. Since then, he's made tremendous progress. And, just recently, he did it again. With his 4th birthday, he potty trains and starts saying his first FULL words consistently without having to see me say it first.

It's just absolutely amazing.

Progress and a Plan

My sweet little man.

Noah has done some amazing things since he was born. I still get amazed when I think about how sick he was and how close we came to losing him so many times and yet now he's the most energetic little man I have ever seen. His capacity to love is extreme. His tenderness is unmatched. He teaches me so much, every single day. I am truly honored to be his mother.

Right now, Noah is coming to the end of his first year of preschool. While he's made tremendous growth during the past year, I can't really attribute any of it to his schooling. Most if his progress is from things we have worked on at home or in private speech therapy. This has left me with some concerns over how I should address his education in the future. Homeschooling has been very much on my mind but I worry that I'll have enough time to really focus on it while also working full time.

In preparation for his next year of preschool, Noah had his IEP (Individualize Education Plan). For those of you not aware of what an IEP is, it's basically a plan put in place with the school to address Noah's personal needs. It lists his goals and what items or accommodations he might need to reach those goals. After considering what might have contributed to this past less-than-stellar year, I decided that Noah's original goals, and how they were addressed, was the underlying problem. They had been working on basic low level goals and when he wouldn't participate due to sensory issues, disinterest, or even just because he's 3 they  assumed he couldn't do it and never pushed for more.

This year, I went in prepared to really lay out what I felt he needed to be successful. And also some items that would help me track his progress and work. I suggested his ultimate goals be age appropriate based on requirements for starting school in an average kindergarten class. Even though these goals will push him, I am much more comfortable with a 50% attainment of something that is a challenge than 95% attainment of something easy.

I now feel much better about the whole thing. While I still have a few reservations about how much the teacher is actually involved in the class, at least now I have a legally binding contract to help get Noah what he needs. It also addresses his personal learning style. See, he is very HIGH-INTENSITY! He needs positive reinforcement. Lots of cheers and high-fives and screams when he gets something right. Without it, he quickly loses interest and shuts down. He also needs sensory integration assistance like jumping on a tramp, swinging, throwing balls. Without it he can't focus or pay attention.

But all in all, I really am amazed at all this kid can do. He knows his entire alphabet. He can recognize all the letter. He can count to 12 all by himself. He can count items (not just saying the numbers). He's almost got all his colors memorized (this has been a hard one for him. I've often wondered if he had some colorblindness going on).

His speech is AMAZING! The other day, when I told him we were going to a movie and would get popcorn, he said "Pa cor?". I about died! Yes, he still dropped the last consonant but he said a double syllable word which is really hard for him. The day before he said "Happy" when usually it's just "Haa". A typical conversation with him goes something like this:

Noah: Give Da Hu (I want to give Dad a hug)

Me: Okay, when Dad gets home from work you can give him a hug.

Noah: Da hoe wor hu me? (When dad gets home from work he'll give me a hug?)

Me: Yes, When dad gets home from work he'll give you a hug.

Noah: Okay, nie ma. (Okay, goodnight mom.)

Uhm... hello!! That is absolutely AMAZING!! Even in just the past few months he's made tremendous progress with his communication. There are still many times and circumstances when communicating his hard for him. If he's upset, embarrassed, sad, tired etc. he may not even be able to get any words out. He relies on gestures but sometimes even that doesn't work. It can be very frustrating for him. But he's learned ways around his mouth not working. For instance, there are certain sounds that his mouth just has a hard time making. But he's learned that if he plugs his nose, it helps the right sound come out. So now, every time he says Shoes, he plugs his nose. Sure enough, instead of saying "Goo and socks" and plugs his nose and says "Shoes and socks". Just goes to show that even though his brain and mouth had a hard time communicating, he is a very smart and resourceful little guy.

But one of my greatest joys with his development is his interaction with Lilly and Allie. He follows Lilly around like a little puppy. They play games and even argue over whose turn it is to pick the movie. He's sweet and gentle with Allie. Gives her kisses and always asks me if Allie is sleeping so he knows he needs to be Ky-It (quiet).

I think about how much desire Noah must have had to be here on earth and experience life to get him through the pain he experience during the first year of his life. Of how much he continues to fight to be here and learn and grow. Things haven't been easy for him by any means. And yet he keeps fighting. He keeps trying. He never gives up. I am in awe of his strength and determination. And I'm humbled by his sweetness and tenderness. It's impossible to be around him and not know that he's someone very special. I am truly blessed to be his mother.

 

Mr. Magoo Update

Man, I love this little guy.

I look at him and I'm just amazed at how far he's come, the odds he's beaten. I'm so blessed to have him.

Noah's thing right now is all about kisses. He won't leave my side without giving me hugs and kisses a couple times then he blows me kisses as he walks away. When I'm in feeding the baby he will pop his head in and blow me kisses. Then, when Shane is at work he tells me over and over that he wants to give Dad a hug. "Da hu?" "Yes, you can give dad a hug when he gets home from work." "Hoe wor?" "Yes, when he gets home from work." "Yay!" Then he kisses my arm and blows m kisses as he runs off to play. This repeats about 60 times a day.

He also is getting more confident with talking. He may not be saying full words yet but he's trying to communicate and that's progress. This morning he started pointing to everything and telling me what it was. It went something like this...
"Tay."
"Yes, that's the table"
"Be"
"That's the love sac but you can call it a bed."
"Be"
"That's the couch."
"Cow?"
"Yes, couch."
Pointing to the couch, "cow" and pointing to the other couch "Cow. Two cow.?"
"That's right buddy! Two couches! Good job!"

Then he counted the windows too. The other day he was counting in the car and he counted to 12 all by himself. He also knows his letters and the alphabet. When driving, he spells out the words he sees from the car. He doesn't know what they spell but he recognizes the letters. Last Sunday he shocked me by saying T..E...X..I...C...O... when we stopped near the gas station.

He's still working on his colors. He knows the color names but doesn't quite get the name for the right color. He loves to say yellow. It comes out like "yewweee". Too cute.

His tantrums are getting better. At least for me. He gets so excited playing with dad that he ends up having major breakdowns when play time ends or if he thinks Shane isn't paying him enough attention. Or heaven forbid Shane try to use the restroom and shut the door.

The other thing he does is ask me if we're going to the dr's every day. "We go da daa me?" Or if we are going to school or staying home. He's very interested in what we are doing.

He still couldn't survive without vanilla carnations but he is growing and getting bigger every day.

He has also started playing with Lilly and wanting to do everything she is doing. I wondered if that day would ever come and I'm so happy to see it here.

Yesterday Noah had an echo to check up on that precious heart of his. Its beating strong and looking healthy. And once again I'm reminded of the amazing gift that has been given to us. I hope his donor family knows how greatful we are.

This summer we will take a trip back to Denver for Noah to have a heart cath. They will take biopsies and make sure there is no rejection on a cellular level. I can't say I'm looking forward to that but the kids are excited to go to McDonalds work again (the Ronald McDonald House).

All in all.... I'm pleased with the progress Noah is making. I love his sweetness and adore his toothless smile and I always remember how lucky I am to have him one more day.

Germs Are Not For Sharing

It's that time of year again.

So I'm sending out my plea to all our family and friends... PLEASE get a flu shot and help us keep Noah healthy. Getting the flu is never fun for anyone but it can be especially dangerous for Noah. If you get the FluMist (nasal spray) please let me know. That is a live virus and can be considered contagious. If you get the FluMist instead of a flu shot, we will need to avoid contact for 2 weeks. So please help me protect Noah by letting me know.

Also, it's not just flu shot time. It's that time of year when germs are in abundance. Stomach flu, fevers, even just snot filled noses, coughs and general feelings of illness. At our house, they aren't just an inconvenience. Please be mindful of Noah's special health care needs during this time. As his mother it's my job to try and make the best decisions regarding his care, this includes weighing the risks vs benefits of activities and outings. Sometimes we won't be able to make it to planned activities and outings for the sole reason that I'm worried about the risk of being exposed to illness. Some may think I'm being over-protective and cautious. But that's okay. I'm still new to this life. Noah's only been transplanted 3 years. I'm still learning whats okay and not okay. Regardless, it should be my decision and I sincerely hope that my friends and family understand and respect that.

That said; if you ARE sick, HAVE been sick (even if you are now feeling better), THINK you are getting sick, or have been in CONTACT with someone who is sick... and will be at the same get-together as Noah, PLEASE call me, text me, email me, or pass along the message and let me know. As Noah's mom, I will decide if it's a risk we are willing or can take. Either way, I will be extremely grateful for your thoughtfulness and consideration.

I know this request is straight and to the point. I really don't mean to offend anyone at all and I hope I haven't. It's just a very important topic to me; one that I have to take seriously for Noah's sake.

So before the situations arise, THANK YOU for being considerate of Noah's specials needs and for getting a flu shot to help stop the spread of germs before they even begin. I really appreciate all that you do and I'm grateful for such wonderful family and friends who understand and help me do what's best for my little man.

All Things Noah

It's been a month now, since Noah started preschool and he is finally adjusting to it. He still acts worried when I drop him off and he says "Momma sit" over and over hoping I will come in his class and sit with him. But he hasn't cried in a bit and now when I pick him up he's happy and excited. You know he's having fun when he has to say "byyyeeee" over and over and even yell it from across the parking lot. His teacher/aids say he's doing much better. He's trying the snacks, playing and participating, and he is NOT falling asleep. Today I was informed that he's yelling outbursts for no reason and throwing things. I was happy to hear it knowing he's finally opening up and being his true self.

His speech is coming along. He hasn't made any huge break throughs but it's a work in progress and he's trying really hard. I feel so blessed that he has such a fabulous therapist who is familiar and knows how to treat Apraxia. The fact that the service is free through the Scottish Rite is even more of a blessing since my paycheck can't seem to keep up with all of expenses these days.

One new therapy we just started is feeding therapy. I've always figured this was in store for Noah since he is by far the worst eater I have ever seen (the kid does NOT eat anything besides cheese). I've kept him on Soy Milk (since milk aggravates his diarrhea) mixed with Carnations since he loves it and it gives him the nutrition he wouldn't be getting otherwise. The only problem with that is that he only drinks it in a bottle. Yes, my 3 1/2 yr old drinks several bottles a day. O-well. It's just not a battle I want to fight right now. I'm more concerned with his nutrition than the bottle dilemma. I've tried refusing the bottles for almost a week before and he still won't eat. Lately, I've been following him around the house feeding him bites of food. Its helping him eat but not really solving the problem. Anyways, now that we have started therapy for it, I hope to see improvement. Instead of a sensory approach like I suspected he would need, we decided to do a behavior approach. It's very similar to what his speech therapist does (which really works) so I figured it was worth a shot.

He still needs some major Occupational Therapy intervention to deal with his sensory issues - I'm not sure if I've mentioned it before but Noah has Sensory Integration Disorder. I've been working with him as much as I know how. Doing lots of jumping, swinging, throwing, etc that seems to help him cope but it's fairly obvious from his behavior and aggression that it's not enough. I'm trying to get him in a program that will be a bit more affordable for us but if this doesn't work out I will be setting up the therapy through the hospital. He will be getting an OT eval and most likely services through the school district and his special education classroom but those services are so limited (and usually a group setting, not one-on-one) that he really needs a more personal program. But since I've spoken with his teacher about these needs, she found him a trampoline to use and allows him to bring a ball to throw which has made all the difference in the world. He started opening up and enjoying school more once he was able to do this.

The final update about Noah is his psychology appointments. He's been through a few hours of evals now and has been accepted into treatment. What type of treatment, I'm not sure about yet. Those decisions will be discussed at the next appointment. After the last eval, his therapist told me that while Noah doesn't fit any one group of issues, he does seem to be in a large classification of the Autistic spectrum. I guess what it's called is PDD - Pervasive Developmental Disorder. It's where you have some characteristics of Autism but not all. (Although, I am anything but an expert in this field) This is kinda tricky. I do not believe he has Autism. And really, neither does his therapist. But since it fits, and we don't really have all the answers just yet, giving him that diagnosis will help him get services and will also give us an idea on what services he needs. I'm hoping that Noah's behavior and aggression are due to his speech issues and his sensory problems. That seems to me to be a bit more plausible (and likely to outgrow) than Autism. Either way, we are figuring out what he needs.

Noah is still the sweetest little man; giving hugs and kisses. He's playing more with his Dad and was very concerned when Shane was out of town visiting his family. Noah couldn't have been happier when his Dad came home. He has also started playing WITH Lilly more. Hearing them giggle and interact does this Momma's heart a lot of good. One things for sure, he may be a handful but I am his biggest fan. Not a moment goes by that I am not full of gratitude for that little booger.

Health Update

Noah's recent blood tests revealed he does NOT have Celiac or CMV. YAY! We still have to do his stool sample and a follow up panel in 6 weeks but we are that much closer to solving the mystery of Noah's chronic diarrhea.

But it has been confirmed that he does NOT manage his body temp. He doesn't seem to have a hard time making heat (and staying warm in cold temps) but he can't get rid of heat. This causes his internal body temp to raise when he is in hot temps. For example, he was outside in the shade just walking around, nothing strenuous, when it was about 85* outside. After an hour, he seemed really warm and when I checked his temp it was 100*. Normally he is about 97* when playing inside.

So we have to do more tests and possibly see a Neurologist to figure out what the cause of this might be. He will also need to have restrictions on how long he can be outside or in hot conditions. I also need to get him a cooling blanket and other tools to help keep him cold.

If you have any idea where I can get a medical cooling blanket please let me know. My initial searches online have not been fruitful.

It Was Our Home Away From Home

This is a video that shows the magic of The Ronald McDonald House's in Denver.

How We Got Here

We've come a long way in the past three years. Today Noah is a spunky three year old who loves to throw balls, jump on the tramp, swing for hours, and watch Curious George. He loves his Nanny and Poppy and asks to go to their house every single day. There were many times since he was born when I wondered if we would ever get to this point though.

I had been induced 4 weeks early due to some worrisome results after a stress test. It was suspected that preeclampsia was causing my placenta to shut down. What started out as a normal induction quickly became serious when Noah wasn't getting enough oxygen. I was put on oxygen and told to lay on my side and when that didn't help the room was filled with Dr's and nurses within minutes and I was told that I had to push him out now, even though I was only dilated to an 8 or I would have to have an emergency c-section. I pushed him out in just a few pushes and I thought all was well because they let me hold him for several minutes. What came next was a whirlwind.  I can still remember going into the nursery to see Noah for the first time after he was born and seeing the Neonatologist, from the children's hospital next door, listening to his heart. "Your son has a heart murmur and its not the normal kind of heart murmur. We are going to take him over to Primarys and run some tests. Don't worry Mom. We'll take good care of him." Then I watched as the Life Flight team wheeled him away. That night, after many tests, Noah was diagnosed with Critical Aortic Stenosis. The next day specialist tried ballooning his aortic valve and when that didn't work we waited to find out if any doctors would agree to perform a Ross-Konno procedure. No one would.

Noah was very sick. His Billirubin level was lethally high, his oxygen level low, and the pressure in his lungs climbing every minute. My grandparents came to see him one day while Shane and I were meeting with the Doctors. The nurses told them that he was one very sick little boy.

One day a Fellow assigned to Noah's case informed us in passing that there was nothing left to be done, they were out of options. He gave us the impression that we would have to let our son die. We were devastated. We rushed to the waiting room where my family was and cried in each others arms. Soon after we met with the Attending Cardiologist who gave us another option. Noah would need a Heart Transplant to live.

The Transplant Cardiologist at Primary Children's Hospital had transferred to Pittsburgh the Friday after Noah was born, leaving the transplant program at Primary's on hold. If we wanted to try and get Noah a new heart we would have to go to a hospital out of state to get it. We were given two options to choose from. We could either go to Loma Linda in California or to Denver, Co. I called around and talked with their on-call transplant coordinators, I even spoke with a local family whose son had a heart transplant at Loma Linda. I did research online and everything we saw said Loma Linda. We tentatively made up our minds that we would go to California. The next day we sat in a secluded corner of the hospital and prayed together. the most overwhelming feeling came over us that we should go to Denver. We went over it again; Denver was harder to get to, rougher weather if we had to travel in the winter, we had never been there and they hadn't been doing pediatric heart transplants as long as Loma Linda. But when I had called the transplant coordinator, Alison, had been so much kinder and was more helpful. They had less babies waiting with the same criteria and most of all, it felt right. We rushed back to the NICU and told them we were going to Denver.

We quickly packed up some stuff and drove through the night to meet up with Noah who went ahead of us by Leer Jet transport. We met with the Transplant Coordinators and got the necessary testing finished up to get Noah put on the UNOS waiting list. The next twelve days were so hard. Noah wasn't doing well and he had some complications. He was so sick that we were given a few other options than just a "routine transplant". He was also listed as ABO Incompatible, meaning that instead of only being able to get a heart with his blood type, he was sick enough and young enough to be able to get a heart with any blood type. TCH was also part of a study that allowed them to offer DCD (death by cardiac donation). Then, on Thursday July 5th Noah had a Heart Cath to put in a stent and even possibly have a Hybrid. The process was long and took a lot out of Noah.  I was so worried and lonely that I called Shane and asked him to come out that weekend even though his next planned visit was a week away.

Back in the CICU Noah was headed down hill. His tummy was swelling, his vitals were bad and he was losing strength. I knew we didn't have much time.

Friday came without much progress. Everyone was worried and all we could do was wait. I spent the day at the hospital then headed back to the Ronald McDonald House to pump and eat dinner before heading to the airport to pick up Shane. I was sitting on the floor against the door of our little room, pumping, with my phone on one side and the pager from the transplant team on the other when my phone rang. It was Alison, she had come back on call that morning for the first time since we had arrived. Noah was getting a heart.

It was divine intervention that made it possible for Shane to be there that night. I know without a doubt that I was prompted to have him come when it wasn't in the plans. I am so grateful for that. Noah went into surgery at 8:30 am on July 7th, 2007. I waited in a private family room while Shane waited at the Ronald McDonald House with Lilly. Alison gave me updates every hour. I was surprisingly calm. I tried really hard not to think about what was happening and I felt strengthened with a strength beyond my own as I did the entire time I was in Denver. At 3:55pm I was brought into the CICU to see Noah for the first time with his new heart.

He had the corner bed and every space was busy with someone doing something. Dr. Campbell paced at the foot of his bed whistling "Downtown" by Patsy Cline the entire time. His tubes were draining and the pacer leads were keeping his heart beating while he was drugged and sedated. I had been warned about what he would look like when he came out after the transplant. I expected to see all the wires, and tubes, and the incision down his chest. I was glad I had been prepared, it made it a bit easier but at the same time, it was so awful.

It took Noah a long time to recover enough to be transferred out of the CICU (Cardiac Intensive Care Unit)  to the CPCU (Cardiac Progress Care Unit). I knew it would since he had been so sick before. When the day came, I was scared. A new set of nurses and Doctors who were taking care of several patients at once. He wouldn't have one on one care anymore and because I had Lilly at the RMH with me, I couldn't stay at the hospital night and day. Luckily we were blessed with many loving nurses who took very good care of Noah and when I wasn't there and they couldn't hold him there were many volunteers who came and loved on him.

Noah was finally released toward the end of July. I brought him over to the RMH on a Friday morning and we celebrated Lilly's 2nd birthday. By Sunday he was screaming not stop. When I took him back on Monday for his first clinic appointment I could tell Alison was not pleased. It was decided to readmit him. He was put back on IV antibiotics for a suspected infection of his incision. He was having a lot of ectopy (missed heart beats, fast heart beats, etc.) One day while I was holding him his heart rate spiked. A nurse rushed in but it had returned to normal. A few moments later, he went into Vtac. His heart rate spiked to almost 300 bpm. The CICU team was called up and when several different tricks to return him to a normal sinus rhythm failed, he was given a drug to stop his heart. After a few days back in the CPCU, his nurse Ben reported his color off and a low crit level so a blood transfusion was started. That night I received a call about 3am. Ben was calling to tell me Noah had a bad reaction and was taken back to the CICU.

When I got there the next morning nothing could have prepared me for what I saw. Noah was back in the same bed he was in when we first came to Denver. He was on the ventilator and was swollen and red from head to toe. The Dr was digging around in his arm to get a central line and it wasn't working. His lungs were filled with fluid and he had hives inside and out. He was dying.

He ended up having a lung collapse twice and after a few days of no answers he was taken to the cath lab to take some biopsies and check for rejection. What they found was that Noah's blood pressure was dangerously high. Too high for even an adult. He was being taken down to get an MRI of his brain. Dr. Pietra told me that with pressures that high he would be surprised if there wasn't a brain bleed.

That wait was awful. Noah had already been through so much and had come so far... I felt sickly composed on the outside and frightfully out of control on the inside. Much to everyones surprise, the scan came back normal. The next day it was decided to treat Noah as if he was having rejection. The high dose steroid would also help the suspected TRALI (Transfusion Related Acute Lung Injury) that was attacking his lungs. He slowly began to improve.

The ectopy improved and his blood pressure went down and eventually he was released again. Once he was off all the sedation he did cry... a lot. I had to give him large doses of Benedryl to knock him out every single day. He also had really strange diarrhea. Other than that, he was doing well. We continued clinic appointments several times a week and counted off the days until we could go home. Shane visited every other weekend and my parents and sisters even came out to see us once. While they were visiting Noah almost had to go in for another cath to check for and repair a suspect CoArch of the Aorta. The pulses in his feet were faint and at one clinic appointment with another coordinator they couldn't be felt at all. I was so nervous I was nutty. The day of decision I took Noah up to the CPCU to find Dr. Pietra so he could feel for a pulse and make the decision. He grabbed his foot and called off the cath.

The day finally came when we were discharged and sent home to Salt Lake. Now that the day had come I was scared. But it was time. I arranged for enough oxygen canisters to get us through the 8+ hours of driving and I packed up the room that had been home for the past 4 months. We brought Noah home for the first time on October 30th, 2007.

Over the next few months we adjusted to home life again and tried to find a new routine. It was much more difficult that I would have expected. But we were finally together as a family and having Shane in the same house was all Lilly and I needed. Being apart was so much worse than I can even describe.

Noah had lots of clinic appointments and continued to do well other than his strange poop and crying fits. One day he pooped white curds and after several ER visits and insisting on seeing a surgeon we finally figured out what was going on. Noah had gall-stones. He went in for surgery on December 10th to have his gall-bladder removed and his appendix taken out (since Shane had his taken out it was a precautionary measure).  I saw his gall-bladder after, it was about the size of 3 M&Ms and the 3 stones filled it to capacity. It was scarred and shriveled and it was a good thing it was removed. While his diarrhea has never gotten better, he did stop screaming and has never had white poop again.

It was sometime after his last surgery that things started to calm down. We found a routine and eventually life went on. It took a long time for me to deal with all of the buried emotions I had been suppressing. They expressed themselves in the form of panic attacks and eventually took a physical tole on me. But through faith and prayer and many several spiritual experiences I have worked through the trauma. And here we are, three years post transplant. We go to clinic every 4 months, sooner if he gets sick. He is active and lively and preparing for preschool in the fall. His speech is getting better and he is learning to express himself. He's growing and learning and loving and living life. Many people and all of his doctors always say you could never guess he had a heart transplant by looking at him.

The road has been rough but he made it through. And while there are days where he wears me out and in true three year old fashion tries my patience, I am so very grateful for every single moment of every single day.