Olivia's World

Olivia's World Olivia Evelyn Pagano - Follow Olivia's journey and support our family. Encouragement, prayers welcome Olivia, however, has never been ‘typical’ or 'textbook'.

Our beautiful Olivia was born 6 weeks early, weighing 4 lbs. 4oz. via C-section on June 3rd, 2012 (Doctors believe dates may have been out and she was only 32 weeks at birth), and had difficulties breathing. Olivia had an AGPAR score of only 4 at 1 minute after birth, increasing to 7 after 5 minutes. Olivia held her own for the first 24 hours of her life (the "honeymoon" period) but was unable to maintain her sats after this time. Olivia was experiencing periods of sleep apnea and bradycardia. Olivia would switch between C-PAP and a nasal cannula before being trached. Olivia was born with BVCP (Bilateral Vocal Cord Paralysis), bronchomalacia in her left bronchi, and hypotonia (low muscle tone) throughout her body. Unable to swallow, Olivia was fed via a nasogastric tube until she had a feeding tube inserted in her stomach. I exclusively pumped the first couple of months to enable the best start for Olivia. I felt at that time that it was the only thing I could do for my baby and the only thing I had control over. We were hoping Olivia’s challenges would resolve as she grew (premature babies typically outgrow these medical conditions). She was in a lot of danger of aspirating. At just 3 weeks and 1 day old and weighing only 4 lbs, Olivia had surgery: a Tracheostomy, a gastrostomy, and a Nissen fundoplication. Powerless with tears streaming down my cheeks, I watched as my tiny baby was rolled away in her isolette into surgery, and I did not know if I would hold her in my arms again. Olivia was placed on a ventilator post-surgery. It took some time to figure out the correct settings to ensure she had the respiratory support she needed. Olivia spent almost the first four months of her life in the NICU. During this time, we participated in Kangaroo care whenever possible to help with bonding. Olivia’s last MRI before discharge did not come back clear. This was shocking to us, as her first MRI at just one day old was clear. The severity of the damage could not be determined. The neurologist at the time had no bedside manner, telling us, "She may never walk; she may never talk. We do not know. I do not have a crystal ball." Understandably, my husband and I were devastated to receive this news, especially as we had no reason to think otherwise as her first MRI was normal. Olivia finally came home after four long months in the NICU. She came home with 24/7 nursing on a ventilator with a rate, a trach, additional oxygen, and a G-Tube. The last 11 years have been a blur of hospital appointments, doctor appointments, therapies, procedures, hospitalizations, and more. Being far from family here in Orlando, Florida, USA (my family is all back home in Scotland), some days can be tougher than others. Olivia is now 11 years old and is doing great considering her numerous challenges. Maintaining consistent nursing has been my biggest challenge. Now a single mom, with no help from Olivia’s father, financial or otherwise, I must maintain employment to keep a roof over our heads. Trying to keep a job with a child with complex medical needs is difficult. When Olivia requires hospitalization, I must stay with her 24/7. Olivia is non-verbal, and I need to be there for her. She requires constant supervision, and the hospital does not have staff who can stay by her side constantly. Then, when nurses call out, we rarely get a replacement. And then there is my own health to consider. FMLA is not available until one year of employment at the same facility has passed. Trying to get to that year mark is a challenge. I am so happy to report that Olivia is thriving at home. (July 2023) Olivia still has her trach, is vent dependent while sleeping, is G-tube dependent, and still has no diagnosis at this stage. She has global developmental delays, autism, epilepsy, several GI issues, chronic lung disease, hypotonia, myopia, and astigmastism. Extensive genetic testing has been completed for Olivia and has not identified an etiology for her concerns. A microarray identified a 16p11.2 deletion that was paternally inherited. WES (whole exome sequencing) identified changes in two novel genes. Olivia is a happy, strong, brave, resilient, beautiful, content, and adorable little girl. Absolutely enchanting. Olivia takes everything in her stride. She is my Hero! Thank you for continuing to support us on this rollercoaster journey known as life.

My handsome dad, Olivia’s grandfather. 💕How can it be 24 years….Miss you dad. xx🩷
10/18/2025

My handsome dad, Olivia’s grandfather. 💕

How can it be 24 years….

Miss you dad. xx

🩷

10/16/2025

Absolutely gutted to hear that our surgeon—the wonderful Dr. Adele Evans—has resigned from Nemours. She is not only a highly skilled and dedicated surgeon but also one of the most compassionate and inspiring women I've ever met.

I had such high hopes for Olivia’s journey with Dr. Evans by our side, and truly believed she would play a significant role in shaping her future and prognosis.

In only a short time with her, I’ve come to admire and appreciate her more than words can say. I’m so grateful for the care, expertise, and kindness she’s shown us. Dr. Evans made a lasting impact on our lives, and we were incredibly lucky to have had her—even briefly.


Look who’s off to school!! 🎒✨Exactly 2 weeks post-op and Olivia couldn’t be more excited!She’s not cleared for PE just y...
10/09/2025

Look who’s off to school!! 🎒✨

Exactly 2 weeks post-op and Olivia couldn’t be more excited!

She’s not cleared for PE just yet, but she understands why and is happy to cheer on her classmates from the sidelines. She also can’t eat anything by mouth right now—so we’ll see how that part goes. 😅 I’ve explained the rules clearly to the school nurse... but if you know Olivia, you know she might still try to bend them. She’s smart and totally aware of what’s going on, so I’m hopeful she won’t push it.

In the pic, she’s wearing her PMV (Passy Muir Valve), and I’ve sent some HMEs with Nurse Marcia just in case she starts to dry out.
Sunday was her first full day wearing the PMV during the day, and she did great! But Monday night was rough. Her oxygen sats dropped and wouldn’t hold—we tried repositioning, elevating her, suctioning her trach (bone dry), gave extra O2, saline treatments... eventually she coughed up a ton of secretions, and we were able to clear what we think was a small mucus plug deep in her bronchioles. Scary night, but we got through it.

I kept her home from school Tuesday just to be safe. The good news: Tuesday night went smoothly, and last night she slept like a champ—satting 97–98% without any extra oxygen! 🙌

Here’s to a smooth first day back! 💪💛

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Olivia is getting better day by day. She is still on round-the-clock medication for pain management. Today is the first ...
10/04/2025

Olivia is getting better day by day. She is still on round-the-clock medication for pain management. Today is the first day we haven’t seen any bleeding, which is great—bearing in mind it’s only 10 a.m. here, but fingers crossed!
If she continues to improve at this rate, I’m thinking mid-week next week for a return to school.

We do need to transition back to the Passy Muir valve, though. Right now, Olivia is using the HME. I chose this to ensure she was receiving enough humidification and to prevent the wounds from drying out. Also, with the HME, air is inhaled and exhaled through the trach, which I felt would give her wounds time to heal. With the PMV, air is inhaled through the trach but exhaled through the nose and mouth.

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Olivia is getting closer to her regular self. 🩷We’re still seeing some bleeding, but it’s much less now and less frequen...
10/01/2025

Olivia is getting closer to her regular self. 🩷

We’re still seeing some bleeding, but it’s much less now and less frequent. It’s mostly blood-tinged mucus rather than straight blood.

Nursing has been irregular, as Olivia is usually at school during this time and has a school nurse there, rather than a home health nurse. My work has been very understanding — they’re allowing me to use FMLA and work flexible hours where I can. I need to go to work though to make $$$$$$!

Mum and Norman are back home in Scotland now; they left yesterday. I was so happy to see Mum before she left — it meant the world to me. She had started feeling better on Monday and was able to come over to spend some time with Olivia and me, which was incredibly special.

09/28/2025

Olivia is recovering steadily at home. We were finally able to clear the excess blood that had collected in her lungs, which has brought significant relief. Her breathing has improved, and she seems more comfortable overall.
She is still experiencing some bleeding from her nose, but it’s now manageable. We no longer need to use dressings—just cleaning the area gently every hour. So far, there’s been no sign of heavy bleeding.

Emotionally, this week has been incredibly difficult. What happened on Thursday was really scary for me—something I never expected to face after surgery. I was already anxious, but nothing could have prepared me for the severity of that moment. It was supposed to be an outpatient surgery, we should have been home by 4pm that same day. It’s taken days to feel even a little bit grounded again. Even the smell of blood lingered for so long that I could still sense it around me—thankfully, that’s finally starting to fade unless I get very close to Olivia.

I’ve found myself crying more than I usually do. I’m someone who’s become quite desensitized over the years, so this has been unlike me. To add to everything, my mum is here on vacation—something we’ve all been looking forward to for months—but she became unwell shortly after Olivia’s surgery and hasn’t been able to leave her hotel bed. It’s been devastating not being able to see her, especially during such a vulnerable time. Unfortunately, Olivia still can’t leave the house, and without a nurse, I haven’t been able to leave her side. I haven’t seen my mum in two and a half years, and it’s been nine years since I last saw my brother. This is just so very upsetting.

We're taking things one day at a time. I’m beyond grateful Olivia is stable, and I’m hopeful the hardest part is now behind us.

💗

I can’t believe my wee mum is here — and I haven’t seen her in almost 48 hours. 😢It’s been a rough couple of days for al...
09/26/2025

I can’t believe my wee mum is here — and I haven’t seen her in almost 48 hours. 😢

It’s been a rough couple of days for all of us. Hope you feel better soon, Mum (Evelyn). ❤️

Just dropped my brother off at SmackDown (wrestling event). Now I’m going to get dinner and soon be heading to bed after nearly two days without sleep.

Meanwhile, my girl’s getting a bath — trying to wash off all the dried blood, even from under her nails. But no matter what I do, I can’t get that smell of blood out of my nose. It just lingers.

Goodnight my friends.

💗

Look who’s going home!!!I promise I’m excited — I’m just exhausted!Olivia’s bleeding has significantly decreased, and it...
09/26/2025

Look who’s going home!!!

I promise I’m excited — I’m just exhausted!

Olivia’s bleeding has significantly decreased, and it no longer appears to be active bleeding from the original site. She aspirated a considerable amount of blood into her lungs yesterday, so the blood we're now suctioning from her tracheostomy is likely residual from that event. Nasal bleeding has also improved — we’ve gone from changing gauze under nose every 5 minutes to just once an hour. Big progress.

We already have everything we need at home — oxygen, ventilator, suction machine, nebulizer, CPT vest, emergency equipment and all the medical supplies — so we can manage the bleeding and keep things stable from here.

Meds are being administered around the clock.

We’ve got this.

💗🙏

09/26/2025

Olivia maintained her sats through the night without needing any extra oxygen, which is a relief.

Neither of us got much sleep.

Bleeding from her nose seems to be slowing down. Yesterday, we were changing her dressing every 2–5 minutes because the gauze would get saturated so quickly. It was relentless.

The respiratory therapist (RT) says the bleeding from her trach during suctioning hasn’t improved. They’re trying to avoid irritating things further by removing the ventilator briefly and letting her cough instead of suctioning her trach. When she does, she’s coughing up a lot of blood — enough to cover her entire chest.
Her trach cuff is inflated at this time (while on ventilator) so the blood is likely coming from her lungs — maybe from yesterday and still making its way out. Honestly, it’s hard to tell. We’re both just... so tired.

Olivia is getting nebulized Tranexamic Acid every 12 hours to help control the bleeding, and she’s on around-the-clock Celebrex and Tylenol for pain.

My poor girl. She’s enduring all of this with her usual grace and strength — just without a smile on her beautiful face right now. 💔

They just did labs as concerned about her iron levels due to all the blood loss.

Will continue to update.

💗🙏

My baby is almost asleep. What a long day for her.She is due another treatment at 2am to help her blood clot. Hoping she...
09/26/2025

My baby is almost asleep. What a long day for her.
She is due another treatment at 2am to help her blood clot. Hoping she can get a quick nap in before then.

💗

09/26/2025

We transitioned from the OR to the PICU a few hours ago. Olivia is stable and doing better thankfully. I’ll provide a more detailed update when time allows.

She has experienced significant postoperative bleeding and is now receiving medications to help control it.
Fortunately, she is now maintaining her oxygen saturation levels and is currently on room air, without the need for supplemental oxygen.

Thank you all for your kind thoughts and supportive messages — they mean a lot.

💗🙏

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