Thursday, November 13, 2008
Kira is now a member of the gym. She signed up on member appreciation day, so she got 13 sessions with a personal trainer for the price of 10. One of the personal trainers has special training and experience in stroke rehab so that is the trainer that Kira will be working with. The trainer will contact us to set up her first session. Baby Ross will be able to make some friends in the Kid's Club too!
Kira's right arm is really making some great progress! Her muscle tone and strength have improved dramatically over the last 2 weeks. Experts say that the arm wakes up starting at the shoulder and then works it's way down. The hand is the last to "come back". When she was first able to move her arm it was because she was moving it at the shoulder and none of the muscles in her arm contracted. She can now open the frig with her right hand and when she does I can feel her entire arm muscles tense up just like one would expect. Very exciting.
Her left vocal cord is still paralyzed, although every once in a while we can tell that it's moving because her volume level will increase. Last night I heard her loud and clear from an adjoining room in the house. That was the loudest I've heard her. We're going to arrange to see a specialist to assess her vocal cord. Even though the vocal cord and her aphasia are completely unrelated, the vocal cord problem does add to her frustration level and seems to be counterproductive to aphasia progress. So we'll know more on that later.
Thursday, October 30, 2008
We'll be picking out some new flooring and getting it installed before Christmas.
Kira continues to improve. She absolutely never wears any leg braces and walks around in tennis shoes, flip flops, or sandals. Her walking needs some fine-tuning to be real smooth, but she has great balance and control. Her right arm is starting to come around, but it is a slow process. It starts with the shoulder and the fingers are the last to wake up. I attended one of the therapy appointments and learned something very interesting - therapist said that exercising after a stroke is completely different than exercising after any other type of injury. The brain has to connect to the body part that is being rehabilitated and much of the energy it takes to do this is in the concentration. I was amazed to see how much more she could move her arm when she really focused on it.
Kira's speech is also improving. A lot! The left vocal cord that was paralyzed from the operation is slow to recover, so there isn't much sound, but she is doing so much better getting the right words out. We aren't needing to guess at what she is saying anymore and only need to ask for clarification once in a while. She does need to spend more time doing more deep breathing exercises to get her diaphragm working more efficiently and help with tiredness.
Still going to occupational and speech therapy twice a week, but her physical therapy has been cut down to once a week.
It is so exciting to see the tremendous amount of progress that Kira has made in less than 2 months! Full recovery can't come too soon for her. You know how impatient these "youngins" are - wanting immediate results and all.
One of the most amazing things to witness is the way that Kira is coping with all this. She has her moments (and certainly has every right to have them), but she has her eye on the prize and knows that if she weakens and gives in to self-pity she won't progress. What a gal!
Monday, October 13, 2008
The shower chair has been cast aside and it is keeping the cane company.
Grandpa and I went to Babies R Us a couple of days ago and left with a bouncy thing. Some assembly required. Baby Ross really took a liking to it and he's literally a bouncing baby boy.
Here's another pic from today:
Sunday, October 12, 2008
Kira has been home now for a week, and it is so wonderful for all of us that she is here. The hospital discharged her with several pieces of equipment as follows: Wheelchair, cane, walking leg brace, night boot, and bedside commode.
The wheelchair is being used regularly – not by Kira, but Ross enjoys playing video games from the chair and has also mastered several daring wheelchair tricks. It is very entertaining. We also have a scooter at the house that we’re test-driving for possible use by my mom one day, and we put on some amusing family parades from time to time.
Kira used her cane for the first 4-5 days she was home, but it became more of a nuisance than a help, so it has been cast aside.
The walking leg brace was custom made for her and it is hinged at the ankle. The purpose of this brace is to keep her foot and ankle positions stabilized while walking to reduce the risk of damaging her ankle and/or foot. Her foot muscles have a tendency to turn her foot inward and the brace corrects this. She wears the brace all day and it has helped her walking tremendously. The night boot is a soft blue stabilizer that she wears while sleeping.
The commode is being utilized as a shower chair and she is showering all by herself.
Kira has a number of prescriptions also. The least favorite is Heparin, which is a blood thinner that has to be injected into her abdomen every day for 2 weeks. Only a short way to go and she’ll be done with that.
Ross and Kira went on a little road trip yesterday. They drove up to Boomtown and had a great time. Here's Kira right before they left:
Thursday was Day 1 for outpatient physical, occupational, and speech therapy at Mercy here in Folsom. Several staff members remembered Kira from last year when she was caring for my mom and taking her to the same place for rehab from her stroke. She was pregnant at the time so they were excited to see Baby Ross when I picked her up. The occupational therapist asked that the baby attend her next session so she can get some pointers on caring for him until her right arm “wakes up” all the way. She will be attending therapy sessions twice a week.
Progress is being made all the way around. We’ve been doing a lot of massaging of Kira’s right arm and hand and she has very recently begun to move them a little bit voluntarily! Prayers and well-wishes are so very much appreciated and they are helping. It is so exciting to see the progress that she is making, and it is an honor to witness her strong will and her outlook on what she has been through. Being proud of her doesn’t even touch it. My daughter is my hero!
Monday, October 6, 2008
Thursday, October 2, 2008
Sunday, September 28, 2008
Today she was walking unassisted, and without a cane! She even walked up and down some small flights of stairs. The doctors are giving her an anti-spasmodic medication and keeping her right foot in a brace to help keep her foot stabilized while she is walking. She hasn't been eating much, probably because the pain medication (fentanyl patch and Norco) decreases her appetite. But, her need for pain medication is decreasing and that is a good sign.
Kira's therapy has been stepped up a bit so that she is working hard enough to get tired. The therapists were emphasizing how important it is for her to rest in between sessions, but she wasn't getting tired enough to rest.
Baby Ross visits his mom at the hospital every day and she has been changing him with her left hand. Kira's mom reports that the baby is very calm with her and can sense that something special is happening. For now Kira is requesting that her visitors are limited to only her immediate family, but she knows that we are all thinking about her and anxious to visit with her when she is ready.
Thursday, September 25, 2008
- Kira is speaking in complete sentences. She is getting bored and then sad between therapy sessions, so they are looking into increasing the amount of therapy she receives.
- Discharge from inpatient rehabilitation should be in one week.
- Yesterday she changed the baby using only her left hand and did a good job.
- Today Kira squeezed her left index finger with her right hand.
Sunday, September 21, 2008
Kira is getting physical therapy (PT), occupational therapy (OT), and speech therapy every day. Her therapy schedule changes every day. When she first arrived at Mercy, they had some major difficulty getting her pain under control. Now that they've figured that out, Kira is able to work hard on regaining her strength. The therapists are great! They are young, energetic and encouraging. They are working on stretching exercises on her right side, so that when her muscles "wake up" they will be ready.
The wound care specialist came by. Yikes!!
Yesterday Kira had a wonderful visit with Baby Ross. Her mom says when he was in his mother's arms they were just looking at each other and he knew he was with his mommy. One of the therapists came in to do a session and saw the baby and said she knew how important this time was and would come back later. We think Baby Ross is a critical part of Kira's therapy and great motivation to keep her working hard.
Saturday, September 20, 2008
Before leaving Stanford:
After the long trip - now settled into Mercy Sacto:
Wednesday, September 17, 2008
- Kira was able to have a phone conversation with her mom today. She said one word for every breath she took, but she is getting some sound back.
- Kira will be transported back to Sacramento tomorrow, to Mercy General's acute inpatient rehabilitation. Doctors are estimating she will spend three weeks in rehab as an inpatient, then continue being seen as an outpatient.
- The clot in her brain has dissolved and she is not in danger of having another stroke. She will have follow up appointments with cardiology and neurology in two weeks.
Tuesday, September 16, 2008
Check these out:
Sunday, September 14, 2008
Kira was proudly showing off pics of the baby to the nurses. Foley cath was removed. Kira was moved to a private room at the end of the hall. It has room for a cot in there. It's perfect. She was sucking water from oral swabs and said she was hungry. She has a feeding tube like Baby Ross had (ng tube). The IV in her neck was removed and her only IV is now on the top of her right hand. She sat up in a cardiac chair for a long time during the day. Therapist staff is at a minimum over the weekend, but we tracked down a speech therapist who gave us some information on aphasia. She did say not to go out and buy flash cards because Kira is going to get better and we won't need them. So nice to hear.
Saturday, September 13, 2008
Kira is out of ICU finally! One of the several tubes in her neck was removed. Ross got to watch. He said it was about 4-5 inches long. We don't know how many more there are.
Also, Kira stood up yesterday with the help of the doctor. Great news!
Kira, Daddy Ross and Baby Ross had a wonderfully long visit yesterday. Kira was moved out of the ICU an Baby Ross was going to visit her again. Leona wanted to let you all know how much your encouraging replies mean to them, so please keep posting.
Thankyou to all!
Friday, September 12, 2008
Thursday, September 11, 2008
I called ICU this morning and was told that Kira was talking (whispering) more this morning. She also communicated to the nurse that she wanted to see the baby. The nurse told me she was crying earlier. I asked if Kira could get her hair washed and we'd bring the baby to see Mommy after that.
Big Ross has been a wonderful caretaker for Kira. He spends hours sitting at her bedside and whenever she wakes up he is so attentive and positive. He is going to help her any way he can. With her loving husband and amazing son, Kira has so much to get better for.
Last night therapists showed Ross how to help exercise her right arm and leg. The therapist said that Kira feeling Ross' hands helping her would do more good than therapists' hands. They are trying to stimulate her nerves.
Today Kira was sitting up in a chair! They said that she could balance herself when she sat on the edge of the bed. She looked SO much better. Very alert and very responsive. The occupational therapist was with her and Kira was feeding herself ice chips with her left hand. Each and every step of this was very deliberate as all the muscles we take for granted when we eat are having to re-learn their jobs. She did very well.
Tuesday, September 9, 2008
Kira is mostly unresponsive, her face is expressionless and she can't talk. If you ask her a question she can nod her head. She can't move her right arm and can barely move her left arm. Her family is not sure if it is because of the heavy drugs she is still on or due to the stroke. She will be having another CT today. Her mom is bringing her an MP3 player with some music to listen to and a poster board with some pictures.
The family would love to receive cards. If you would like to send a card to Kira please mail it to:
1720 West El Camino
Mountain View, CA 94041
Monday, September 8, 2008
Sunday, September 7, 2008
Kira had the CT scans (heart and brain). There is a little swelling in her brain which is to be expected following a stroke. There is a little blood at the site where the patch was placed on her aorta, but nothing of concern.
Kira wanted to make sure that her mom took pictures of her after her surgery and that I posted them on her blog. So here are some pictures from the last few days.
Right After Surgery:
Saturday, September 6, 2008
Kira was able to move her right leg today, but hasn’t moved her right arm yet. She is still intubated since she will be needing a CT scan & MRI tomorrow. Good news is that there is minimal blood flow to the brain, rather than none. The doctors have said she will definitely need physical therapy and there is a possibility of brain damage, but they won't know until more tests are done. When she does wake up she can nod her head or move her eyes to communicate.
Please be praying for Kira.
Kira's surgery lasted six hours. The doctors came out to talk to her family and said that the surgery went well. The aneurysm was the size of a baseball. The removed the dacron patch and replaced it with a stent. They were able to go in through her side.
Some concerns are that there may be some paralysis of her left vocal cord and diaphragm. The phrenic nerve (which controls the vocal cord & diaphragm) had grown onto the aorta so the surgeons had to peel it off. Kira was stable until about 3 am and the doctors think she may have had a stroke. Her right side was not responding, but this morning she moved her right foot a little bit.
That's all I have for now. I will post again when I hear from Leona.
Friday, September 5, 2008
I just spoke with her mom, Leona, and Kira went into surgery around 2. The surgeons this morning told them it would be a four to six hour surgery. There was some confusion as to whether they will be going in through her sternum or through her side and how long the whole thing will take. Leona said she'll call me when Kira's out of surgery and I will let you all know.
Right now Grandma is helping to take care of little Ross and the family is waiting at the hospital. Thank goodness Leona is feeling better today after her first ambulance ride yesterday.
Thursday, September 4, 2008
I called my dad, and he left his work, and drove here. I arrived at Kaiser and she was still doing better, and very drugged up still. Anyway, long story and I'm SO tired, but lots of tests, ct's labs, and they found 2 kidney stones above her bladder. She just now got back to the hotel, and she has to pee in a stainer every time she has to go. She will pass these, and it will be very painful. My mom was saying how sorry she was the whole time the paramedics were here, and I kept telling her to stop, because it is not her fault.
So, everything is ok now, except my mom who will be suffering when she passes these stones. OUCH!!! They said kidney stones are worse than labor. No wonder she was in so much pain. I had to remind her to breath, because she wasn't doing that.
As for my surgery appt today, Dr. Hanley will be going through my left side like my last 2 surgeries, which means to sternal incision! BUT, because of all the scar tissue on my left side, they said it could take up to 4 hours to get through it all, and if it's not successful, they will open me up through the front. This means I have to heal from 2 incisions. The other news is that I will be for sure recovering on the adult side. This is because I refuse to be rescheduled. I would go NUTS if I had to do this reschedule thing all over again. Dr. Hanley would rather me be on the peds side, but he is ok w/ this. His team (fellows) will come to the adult side to treat me, so it is really just the location that is a difference, not the care. Also, I am the second case, so I have to be there at noon. Surgery at 2pm. BUT, if there is no room for the morning case, who is a kid, then they will call me to come in at 8am for surgery. Does that make any sense??? SOrry, i'm tired, and on valium. I'm on valium because I started to NOT want this surgery after the surgical consult today. All the risks just started making me sick, and I'm just so scared of dying. I have to be here for baby Ross. He needs his mom. But, if I don't get this done, it will rupture, and I will die. My life stinks right now. I try so hard to stay positive, and strong, but today was my weak day.
Alright, gotta get some sleep, or try.
Tuesday, September 2, 2008
We're off to Stanford in the morning. Thank you everyone for all of your comments, it means a lot. I am nervous about this, and I just want to be ok for my baby. I'm so used to being in control over medicines, baths, feedings, diapers, dr. appts, bills, all that stuff, and now I will be relying on my family. I know they will do a good job, but it's hard on me. I have my certain ways of doing things, and I guess I'm kinda particular about things, maybe too much. I might be slightly over-protective? But, can you blame me? Having a heart baby might do that to people. He's just so precious to me, and I've seen him go through the worst things, and keeping him healthy, safe, happy, and away from GERMS is so important to me.
Ok, enough of that..here is a video of him LOVING the paper stuff from the doctor's office. He does this at every appt, but this time I took a video. He gets a determined look on his face.
Sunday, August 31, 2008
Baby Ross is doing great. He doesn't appear to be sick. =)
That's it for now!
Thursday, August 28, 2008
Ok, he's getting fussy =(
So, hours later, no word. I asked the nurse if the doctor looked at the xrays yet, because his meds were already late, and I didn't bring them. He said "yeah, he just looked at them, and he said he's gonna think about what to do." That didn't sound very good. The doctor came in and told us he has a "questionable" right side pneumonia. He prescribed antibiotics, and told us to come back if he has trouble breathing, or runs a fever. He consulted w/ Dr. Juris, who was on call. He was OK with that. The E.R. doctor said if he was heart healthy, he would just send us home, and keep an eye on it. Since he has a complex heart condition, they have to be aggressive. I'm happy about that.
I'm so glad he was seen, because pneumonia can get life threatening, and left untreated with his condition is just asking for a hospitalization!!! We DON'T need that!
We got home after midnight, and we're doing good today. I called Dr. Wright, his cardiologist. We will get another xray Tuesday, and hand carry the film to his office, and that way he is seen right before we head off to Stanford. He also has an appt. with the pediatricians office in the morning, recommended by the E.R. doctor.
That's about it!
Monday, August 25, 2008
Anyway, everything looks good, and Dr. Wright is very impressed w/ baby Ross. =)
My surgery is coming up, September 5, in Stanford. I should be there 5-7 days. My mom said she would update the blog, and post pictures. I'm going to let her take pictures of me right after surgery, and post them. I'm sure it will be different seeing a heart mom be the patient! =) I'll let you know what it was like.
Here are some recent pictures. Baby Ross is developing so quickly! He's trying really really hard to sit up on his own. His back muscles are really strong. He is eating baby food (when he really wants to). So far, it's a hit or miss if he'll eat it. He loves his bottles a lot. He is doing really good on his tummy. He holds his head up high, and now he just wants to move. He loves to kick his legs all the time. SO active~and such a good baby. He only fusses when he's hungry or tired. I think he's getting a tooth pretty soon. There is drool EVERYWHERE!!! It runs down my arm when i hold him, he loves to chew on my fingers (and his), so I think it's a sign. I'm new at this stuff, but I think I feel a little swelling on the front bottom gum line. He will be 6 months September 5. =) He's growing so fast.
DROOL, everywhere...never stops!!!
The shirt had to come off...
Tuesday, August 19, 2008
Monday, August 11, 2008
Here are some recent pictures of baby Ross being home. He is doing great, and Dr. Warden said his color is amazing. He doesn't hear a murmur, and also told me if he didn't have all the scars, he wouldn't think anything is wrong with him...even listening to his heart! Now, this is the pediatrician, not a cardiologist, but still good to hear.
We saw Dr. Warden because the baby's eye was looking infected. He was also born w/ clogged tear ducts. This happens to 5-10% of babies. His right eye is better, but the left eye is still blocked. This caused a secondary infection. Not pink eye. So, we have eye drops, and we need to massage his eye area at every diaper change. It's not a big deal, and should resolve by 9 months. His eye looks a lot better this morning.
Tuesday, August 5, 2008
Tuesday, July 29, 2008
Monday, July 28, 2008
I met a cute little boy, who is 2 years old. He is here waiting for a heart transplant. His mom kept telling his pediatrician that something wasn't right, and the Dr. kept saying, "you're a new mom, and you're just being paranoid." She knew something wasn't right. She took him to Fresno Children's hospital, and they took an xray. His heart looked like Mickey mouse. His atriums are enlarged, and getting worse. He has some rare heart defect restricting mylopathy? I can't remember, but this was a total shock for the family. They tried for 3 years to get pregnant, and now, their precious 2 year old is on the 1A heart transplant list. He is so adorable, and his mother is the sweetest thing. I'll be thinking about them. The doctor who kept telling mom that nothing was wrong flew here twice to apologize, and was crying, offering money. She denied it, and said, "please, just don't tell new mom's that they are paranoid." We know are kids better than the doctors do, and I hope that opens up his eyes. Maybe he can spread the news of this unfortunate situation, and more doctors will start listening to us.
I saw Drew's picture on the board here in 3 west. He's so cute. He really stands out on that board. Smiling little guy. I don't know how Andrea did it here for 7 weeks, and Drew, having chest tubes in for so long. He's a tough little man, and I admire their family.
Sunday, July 27, 2008
That's it for now. He also got a visit from his other grandma this morning, so that was nice. My mom left, and so did Grandma Lou. Baby Ross is resting, and I'm still wearing a mask, as I'm still a little sick. Nyquil, rest, and a very hot shower seems to do the trick.
I'll post pictures later.
Saturday, July 26, 2008
His xray looks good. The heart echo they did yesterday shows no changes from his pre-op echo (as far as heart function goes.) It's on the normal-low side of function. This is what they expect for his HLHS. They will, however start him on a new med. Not digoxin, but something else, and I can't remember the name. He will be getting only 10% of his dose, so it's a very small amount.
We are to be discharged Monday!!!!! I cannot wait. This dry air/germy hospital is making us sick, and I have a feeling he'll feel better once we're outta here.
That's it for now. My mom came to the rescue, by coming here in rush hour traffic to give us a break. Thanks mom!
Friday, July 25, 2008
Thursday, July 24, 2008
Then, the little guy wanted to scare us some more..He has been stuffy in the nose since we came to the 3rd floor. We've been using the nose suction, and saline drops. I kept asking nurse after nurse, N.P. after N.P., even doctor after doctor....nobody would help, or even care. Finally, a blessing. Our nurse tonight actually did something about it. I told her about it, and also told her that I woke up this morning from a sore throat and stuffy nose. I then noticed the vent in this room is filled w/ dust! Nasty!!!!!! I know that I can get sensitive at times w/ dry air, and dust. So, maybe he is too. So, he got some benedryl, and I put saline drops in his nose. He seems to be better now. Actually, big Ross is at Safeway getting me some benedryl because I'm not feeling so good.
Baby Ross decided about 45 minutes ago that he just needed some hot nurses in his room. He was starting to desat to the high 60's..so after our nurse tried increasing his oxygen, moving the probe from foot to foot, another nurse came in. She tried the same thing. Then, a third nurse came in, and baby Ross was struggling to poop. My trick at home is a rectal thermometer. So, there we were, sticking that thing up there, and he poops! But, his sats were the same. Finally, they put the probe on his hand, and HELLO, 90%. All of these nurses were just telling him how cute he is, and making him smile. He was loving it. He's a ladies man.
So, now he is sleeping, and that was our night tonight.
Now for the not so good news..yesterday, I noticed that some creamy looking stuff was coming out of his right chest tube. I told the N.P. about it, and she wasn't concerned. Another N.P. looked, and wasn't concerned. But, I knew it wasn't right. Finally, they took a lab sample, and it came back w/ a name called cholethorax. I know I'm spelling it wrong, but it's like fatty tissue's from the stomach emptying into the chest cavity, or something like that. So, the remaining 2 chest tubes need to be in another day. He might have to go on a low fat formula for awhile. The drainage is SO much better though. It's really not that bad, and the creamy stuff was only once. It might just have resolved on it's own, but we'll have to see what tomorrow brings us.
His only I.V. blew last night, so he's taking everything by mouth. He's on Tylenol codeine. He is so sleepy today, and I think it's from that. He just seems really tired.
Other than that, just sick of this place already, and it's only post op day 4! Ugh..........
Wednesday, July 23, 2008
Tuesday, July 22, 2008
In the CVICU, puffy eys are better!
On the 3rd floor, and starting to act more like himself
Smiling...warms my heart
We're in a private room, and baby boy is feeling better. He actually smiled a few times tonight. He's such a trooper. Here are some pictures, then we're off to bed.
Monday, July 21, 2008
That's about it for now. I just want him to be comfortable. Watching him suffer is heart breaking.
Sunday, July 20, 2008
Other than that, vitals are stable, and they plan to extubate later tonight I think. His color looks really good. He looks darker to me. They have him in an upright position because of the increased blood flow to the head and upper extemities (from the glenn), and i guess this can cause a headache for a short period of time. this is standard procedure. He also got a tylenol suppository, which i thought to be interesting..
I'll update when we get more news!
I'll update later, after i get enough time w/ baby boy. =)
The doctors today said that he's the biggest HLHS post norwood baby, and one of the healthiest. That was so nice to hear. We hear it so much from doctors, but it doesn't get old. Baby Ross is such a blessing to us, and he is so strong. I told him that he's gonna be stong like last time, and that I'm so proud of him.
Daddy Ross is doing ok. He just went to get some food. I got my starbucks, and I found a good spot to wait. They usually don't do surgery on the weekend, so it's pretty quiet over here, which is nice. I'm going to take a nap.
I'll post when we see our little man.
Saturday, July 19, 2008
Maybe we'll have better luck for the 5th try..
Friday, July 18, 2008
We are just hanging out at our very nice hotel, that Stanford will be paying for...=)
I will update as soon as I can in the morning.
I'll post more when we know something.
Tuesday, July 15, 2008
Since Ross' surgery got rescheduled, Dr. Wright (his cardiologist) wanted to see him once a week until surgery. Everything checked out great. Dr. Wright was really impressed that I got his surgery up to this Friday. I told him that I just used profound language, which I NEVER do, especially to the medical staff. He was shocked, and said, "you're always cool as a cucumber". But, he agreed that when it comes to your children, you have to speak up.
Nothing else to report today. Here are some more pictures. I've been camera crazy since we got home.
- ► October (6)
- Walking unassisted
- Some updates from the last few days
- Doing Great!
- No news...is good news
- Day 12
- Post-Op Day 11
- Sunday update
- Day 8
- Update all good!
- Good News!
- Update to Day 6
- Post-Op Day 6
- Post-Op Day 5
- Post-Op Day 4
- Post-Op Day 3
- Update to Day 2
- Post-op Day 2
- A little good news and some pictures!
- Update to Day 1
- Kira-Post Op Day 1
- Kira is in surgery
- Could things get ANY worse for our family?!?!?!?!
- Busy day today!
- ► August (8)
- We're home!
- We're going home tomorrow!
- Post op 6
- Germs are in this hospital........
- Tube free!!!!!!!
- post op 4 news
- post op 3 news
- On the 3rd Floor!
- 2 days after sugery
- day after surgery
- He is doing good
- Dr. Reddy came out smiling!
- 45 minute call
- He's in the operating room!
- Nope..not today
- surgery tomorrow???
- No surgery today..........
- Cardiologist appt
- Some more pictures from the weekendGrandma Lou and...