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.

12/20/2025

Today is my Christmas miracle! My mandatory Saturday at work got cancelled. This means I have a Nurse for Olivia and therefore time for MMMMEEEEEEE!!!!

Baby girl sick though so won't be gone from her too long.

Positive thoughts please for Olivia that she works through whatever is going on super quick in time for Santa coming.

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And this is what I’m thankful for. 💗My baby beside me in a beautiful hotel, listening to the sound of the ocean. Olivia ...
11/28/2025

And this is what I’m thankful for. 💗

My baby beside me in a beautiful hotel, listening to the sound of the ocean. Olivia is satting at 100%—you can’t ask for more than that. 💗

I’m missing my family back home as much today as always.

I’m grateful for the life I’ve made for myself here in the States, and I’m also thankful for my framily here. My first Thanksgiving as a U.S. citizen. 🦃






Feeling like Delia this morning before work! “And here’s one I prepared earlier.”😆
11/24/2025

Feeling like Delia this morning before work!

“And here’s one I prepared earlier.”

😆

Olivia’s speech therapist goes on maternity leave today, and she’s going to miss her so much!She decorated and wrote her...
11/21/2025

Olivia’s speech therapist goes on maternity leave today, and she’s going to miss her so much!

She decorated and wrote her card beautifully, and was so happy to give her flowers and a card.

So proud of my girl. 💗

11/16/2025

Suggestions please?!
10/27/2025

Suggestions please?!

10/26/2025

THIS!!

This.is.perfection

My girl — happy and healthy. 🩷

Olivia is happy and babbling away to herself while practicing her writing. I don’t ask her to; she just loves to write. She looks up all the Disney character names on her phone and writes them down.
This scene makes my heart complete.

Today — no doctor’s appointments, no labs, no therapies, no work (for mum), no insurance authorizations, no medical supply orders, no pharmacy calls, no scheduling or canceling appointments, no transportation requests, no insurance conferences, no virtual meetings.

Just peace. And that is everything. ✨

🩷💞💕

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

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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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