Tag Archives: feeding difficulties

The Day Braxton Became a Super Tubie

Since Braxton’s 2nd birthday I’ve been reflecting back on the past 2 years and the journey thus far.  Part of me is re-living every single day all over again and the other (larger) part of me is celebrating every day and the wonder that Braxton is. It’s all very bittersweet. I was also asked to write a guest blog post for another site about our story thus far and I thought it would be a great opportunity to write through many of the emotions I’ve been having lately.  However, when I went to submit my piece I found that the limit was 3 paragraphs and I had written well over 6 pages about the last 2 years.  I’ve been thinking about sharing the piece I wrote here instead, but then I thought instead of sharing it in it’s entirety, I will share it in pieces as I go through each of those early days again.   I didn’t start this blog until Braxton was about 13 months old, so there is a lot about his early days that I barely touch on in most of the posts.  While it will be good therapy for me, it will also be a good opportunity for you to see just how far Braxton has come and get to know him even better.

Logically, I’d start from day 1, but today, I’m remembering the day Braxton had his very first surgery at just 2 weeks old.

2 years ago today Braxton had surgery to have his G-Tube inserted.  I vividly remember everything about that experience.

Here is Braxton with the NG Tube

Here is Braxton with the NG Tube

Braxton had failed several trials with a feeding team who reported his poor oral tone made him difficult to feed.   A swallow study was also done and the test revealed that Braxton was aspirating everything he was drinking.  Each time he swallowed, the liquid filled his lungs instead of his stomach.  As this was very dangerous to his health, Braxton was being fed through a naso-gastric (NG) tube, which is a tube that goes from his nose straight to his stomach.  This of course made sure his food was going where it was supposed to.  Within his first week Braxton was able to regulate his blood sugars since he was getting his nutrition through the NG Tube. He was also gaining weight since he was actually getting everything he needed, and he was regulating his body temperature on his own as well. Each of these a critical step in Braxton being allowed to go home.

One morning, we walked in to see Braxton and the nurse stopped us almost immediately and told us the doctor needed to speak with us.  She paged him and we visited with Braxton as we waited.  When he arrived, I remember the doctor explaining to us that Braxton had reached 3 key goals that had to be met before his release.  The final piece was feeding.  Due to his failed feeding trials and the aspiration revealed on the swallow study, the doctor sat us down and discussed our options about feeding so that we could finally take our son home. The first option was sending him home with the NG-Tube and bringing Braxton back to work with the feeding team.  He went on to say that he really didn’t think this was ideal because an NG-tube was only meant to be temporary and based on reports from the feeding trials, Braxton was really going to need a lot of work.

The doctor showed us how the button would be placed through the skin to the stomach.

The doctor showed us how the button would be placed through the skin to the stomach.

Then, he told us about the Gastrostomy Tube (G-Tube). He drew a picture to explain it to us and told us this would be the best option so that Braxton could get the nutrition he needed and be released to work on feeding at home.  If the NG-Tube was temporary, in my mind, the G-Tube meant permanent.  I remember the fear we both had thinking Braxton was going to need this forever. It was also the first instance of realizing that Braxton would be different forever.

We went home that day and I researched G-Tubes and tried to wrap my head around it all.  I could not grasp the idea of a feeding tube.  What would it really look like? How exactly would we feed him? I felt it would all be so cumbersome and we’d never be able to go anywhere and if we did, everyone would see his tube.   I was mortified.  Would we look like failed parents? What would people think? What would they say? How would he be treated? I think those thoughts scared me more than the thought of the tube itself.  I could not find a single reason NOT to have the tube placed, and if it was really what would be best for him, it felt like it was the only thing to do.

The next day, we returned to the NICU and spoke to the doctor and had him explain everything again. One of the nurses also called someone to come and give us more of a hands on demonstration.  I remember the nurse bringing in “G-Tube Gina.” It was a doll they put a feeding tube on.  The nurse showed us exactly what the G-button was and the extensions and explained the procedure.  We felt a little more at ease about moving forward with the procedure, but still  we were scared about having to handle it all.  Within a few days, everything was set with the pediatric surgeon to come in and do the surgery.

Monday, July 11, 2011 we arrived at the NICU to see Braxton before his surgery.  We met with the pediatric surgeon and he again took the time to explain the procedure.  He would make a small incision below Braxton’s belly button and insert a small camera to guide him.  He would then have to cut through his belly to his stomach and insert the button.  It was a relatively simple procedure, but to a frightened mom and first time dad they may as well have been cutting off a limb.  I remember sitting with Braxton after he received the anesthesia and not being able to hold him.  The nurse told us he needed to be relaxed and that we could only hold his hand and no soft strokes or gentle touches.  We sat with him until it was time to go. I wasn’t able to go with him.  He was again wheeled off away from me and I just had to sit and wait.

The G-button

The G-button

The surgery really didn’t take very long at all.  The doctor came back up and reported that Braxton had done well with the procedure and the team was brining him back up and we’d be able to see him in just a bit.  I remember going back to the NICU room and seeing Braxton just waking up from the anesthesia.  The nurse showed us the button and went over some instructions on how to use it and how to clean and care for the button.  We were handed a folder with pictures, information and instructions.  Braxton’s feeds had been slowed down and with the new placement of the button we had to work our way back up to full feeds.  He was only given a very little amount every couple of hours to make sure he was able to tolerate the food plus the balloon taking up space in his tummy. The recovery time was 2 weeks.  However, instead of keeping Braxton the whole time, they told us they would keep him for the first week and then let us finally take him home.  The first week was critical in the healing of his stoma (the hole in his stomach around the tube) and it was very important the tube did NOT move at all or be wet.  The nurses were able to keep an eye on him and keep him from getting infected and the surgeon was easily able to come over and check him out each day.

Every day we visited they should us how to set up the feeding pump and how surprisingly simple it would be to feed Braxton.  A few days after surgery a representative from a medical supply company came to the hospital to actually give us the equipment we would take home and show us how to use it.  I was so nervous and scared learning about everything.  Joseph had already gone back to work so I really had to pay attention because I was going to have to teach him too! The learning curve was steep, but fortunately I did learn what I needed in that first week to be able to take Braxton home finally.

Looking back as my present self I can’t help but chuckle a little bit.  If I could go back to that time knowing what I know now I would laugh at myself and all the worry and stress that I had during those first couple of weeks.  Yes, it’s very scary when people start throwing terms around that you don’t understand, but it is really all going to be ok.  If I had told myself then that in no time you will be an expert I would have never believed it.

Braxton just hanging out with his tube

Braxton just hanging out with his tube

Braxton’s tube is now such a NORMAL part of our life I don’t even give it a second thought. When I run down the list of medical symptoms and equipment I often forget to mention his feeding tube because his tube is as much a part of him as his arm or his leg.  It’s funny when we see a different doctor at the pediatrician’s office and I have to run down a quick summary for them and then they lift his shirt to listen to his chest and say, “Oh, he has a feeding tube?” And I’m like “Ohhhh yea I forgot to mention that…oops” I forget that it’s different. As worried as I was about Braxton being different forever, I’ve now come to see absolutely no difference it all.   It’s just the way life is.  It’s our normal. His feedings have become second nature to us now and I never would have thought that sitting there in that chair 2 years ago as the doctor told us Braxton needed a G-Tube.

2 years later, we are pretty much experts with using his G-tube, caring for it and troubleshooting when necessary.  We’ve come a long way as parents since then and Braxton…well, Braxton is a completely different child than that little boy I held in the NICU.

Braxton began to really thrive after having his G-tube placed.  He gained weight a little too well and there were lots of adjustments in the beginning trying to find the right amount to feed him.  It was a little different trying to get the right sense of what he needed.  Typical kids will tell you when they are hungry and they eat until they are full.  A tube fed child doesn’t really know what it means to be hungry because they are kept on such a schedule.  There were days we had many appointments and we were an hour or two late with his feed and Braxton was just content.  No crying or fussing from being hungry or anything.

I didn’t realize it then, but his tube saved his life.  Without a feeding tube we would have taken Braxton home and continued trying to bottle feed him without success.  He wouldn’t have gained any weight.  Worse, he probably would have swallowed so much in to his lungs that we would have lost him.  I know now, his tube saved his life then and continues to help him live every day.  We are working very diligently with a speech therapist to get Braxton eat or drink anything by mouth, but having little success.  If he didn’t have his tube he would be completely malnourished and who knows what would happen. The alternative is definitely not something I like to think about.  Instead, I see a happy little boy who is indeed superhero like in every way since his first day in this world.  Braxton is a Super Tubie. A term coined by the Feeding Tube Awareness Foundation for all tubie children surviving and thriving thanks to their feeding tube.

Happy Tubie-versary, little man!

Super Tubie, Braxton

Super Tubie, Braxton

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More Blending Fun

I am very amazed at how well this Blenderized Diet is going for us.  Braxton is tolerating the new diet SO WELL! All of our issues with his vomiting have truly stopped.  I’ve accidentally fed him a little quickly and made him throw up, but I’m pretty sure that was a too much, too fast kind of thing and not an intolerance issue.  And call me crazy, but I really do think his hair is growing and getting thicker and shinier.  I read that that could happen, but I did NOT expect to see it so quickly! It’s been about two weeks  and there is already some positive differences.  I’m so excited for Braxton! It’s still a lot of work, but it’s getting easier and taking less and less time to get everything ready for Braxton’s feeds.  Seeing the amazing differences it’s made is all the motivation I need to continue forward with this.  I’m all for whatever makes my kid happy. 🙂

Since speaking with our dietitian I have tried a few other recipes for Braxton’s blenderized diet.  I’m still trying to find one that works for us – mainly making sure we have enough calories and all the necessary nutrients in a blend to maintain a healthy weight gain for Braxton, but we’re close! All of the blends are pretty similar and I’ve just changed out the kinds of fruits and veggies we use.  I still want Braxton to be able to try a variety of foods.

We’re also still working on oral feeding, since that IS the ultimate goal here.  Braxton is much more tolerant of feeding attempts now.  I’ve been able to get him to eat anywhere from half an ounce to a full ounce at one feeding, and he’s even taking some milk from a sippy cup!! Yayyy Braxton! Progress is definitely being made.

Braxton always reaches out to the bottle when I shake it so I let him hold it and he put it right to his mouth!

Braxton always reaches out to the bottle when I shake it so I let him hold it and he put it right to his mouth!

I put a little milk in a sippy cup and let him try it

I put a little milk in a sippy cup and let him try it

Braxton drank about half an ounce of milk from a cup!

Braxton drank about half an ounce of milk from a cup!

The dietitian sent me a few different recipes to try since she felt the initial one we were using had a little too much cereal for Braxton, so I tried out a couple that sent.

For our first few trials and recipes, see this post.

Trial 4

  • 12 oz Organic Whole Milk
  • 7.5 oz Happy Naturals Chicken w/ Gravy Baby Food
  • 8 oz Happy Naturals Carrots & Peas Baby Food
  • 4 oz Happy Naturals Peach, Rice & Banana Baby Food
  • 1/4 cup Sugar
  • 2 Tbsp Vegetable Oil
  • 1/4 tsp Salt

This recipe made about 36 ounces, which is enough food for one day.  We tried this recipe for a few days changing out meats, fruits and veggies but it was very thin and I think the added Sugar aggravated Braxton’s symptoms of Dumping Syndrome, because we did have some gagging and retching with this recipe. And he vomited once, so I added corn starch to the feeds and he did ok after that, but some gagging still.

Nutritional Facts for Trials 4-6 which used this recipe

Trial 4 Nutrition Facts Trial 5 Nutrition Facts Trial 6 Nutrition Facts

For the last trial I doubled the recipe to try to cut down on the amount of work for myself.  Also, my mom was reading our first posts on starting the blenderized diet and about needing a high speed blender (we weren’t ready to invest in one yet since we were just starting out), but she and my dad decided to go out and try to find one for my birthday/Christmas present [joys of having a birthday near Christmas].  She went to Sears, but when she asked for the Vitamix or Blendtec, they told her they didn’t carry it, but offered the Ninja Kitchen System, which they said was comparable. It has a similar design to the Blendtec Blender with the four sided blending container. It came with a 72 ounce container so I decided to test it out and make a big batch.  I still used already pureed baby foods, so maybe not a real test, but volume wise it worked great!!

Thanks mom!

Thanks mom!

Large capacity container

Large capacity container

Since Braxton was gagging even with the Corn Starch, I decided to try a different recipe suggested by the dietitian.  She gave us a spreadsheet with one recipe based on different daily calorie needs.  I started out with the 1,000 daily calorie recipe.

Trial 7

  • 1/4 Cup Gerber Mixed Grain Infant Cereal
  • 5 oz – Happy Naturals Beef w/ Gravy Baby Food
  • 4 0z Happy Naturals Carrots Baby Food
  • 4 oz Happy Naturals Applesauce
  • 1/2 cup Simply Orange Orange juice
  • 2 cups Organic Whole Milk
  • 1/4 Cream Half & Half
  • 1 Egg Cooked Scrambled – VERY important that the egg is cooked well!
  • 2 tsp Vegetable Oil
  • 1 Tbsp Karo Syrup

This recipe includes the infant cereal like our very first recipe, but it’s significantly less so hopefully easier on the tummy.  With Dumping Syndrome, Braxton does better when his foods have more complex carbs/sugars that take longer for his tummy to digest, so I decided to try this recipe.  This recipe made about one days worth of food and the calorie per ounce was less than previous recipes, but it still ensured 1,000 daily calories.

Nutritional Facts

Trial 7 Nutrition Facts

For the next one, I made a double recipe because we had a couple busy days ahead and I didn’t want to be up too late mixing food.  Basically the same recipe, but here’s what those nutrition facts look like.

Trial 8 Nutrition Facts

And finally, yesterday’s mix I decided to try out the 1,200 calorie mix.  Braxton had his 18-month checkup and he weighed 25 pounds 15 ounces, which is slightly less than he was when we started this diet, so I need to increase his calorie intake to make sure he’s gaining weight.  Here’s what the 1,200 Calorie recipe looks like

Trial 9

  • 1/4 cup Gerber Mixed Grain Infant Cereal
  • 2.5 ounces Happy Naturals Turkey w/Gravy Baby Food
  • 2.5 ounces Happy Naturals Chicken w/ Gravy Baby Food
  • 6 ounces Gerber Turkey w/ Rice & Veggies Dinner Baby Food
  • 4 ounces Happy Naturals Prunes w/ Apples Baby Food
  • 1/2 cup Simply Orange Orange juice
  • 2 cups Organic Whole Milk
  • 1/3 cup Cream Half & Half
  • 1 Egg Cooked; scrambled
  • 1 Tbsp Vegetable Oil
  • 2 Tbsp Karo Syrup

This recipe made about 42 ounces and is a little closer to the calorie per ounce goal we are aiming for.  Braxton really needs to have a blend that is about 30 calories per ounce since that is what the Pediasure was.  I’m thinking we my need to add in a feed daily, or find some more calorically dense foods to blend in.  The increased calories here only really increased the volume and not necessarily the calories per ounce.

Nutrition Facts

Trial 9 Nutrition Facts

When I started with this recipe, I blended the egg with a little milk separately in our Baby Bullet Blender just because I wasn’t sure if the Ninja System blender would blend it up smooth enough and I didn’t want chunks of egg floating around. WELLLLL, my grandma came in to show us how to make tamales and when it came time to shred the pork and chicken, I decided we could use the Ninja System blender and holy cow! It was amazing!! It blended a little TOO WELL for tamales.  I’ll definitely be buying whole pieces of chicken and putting this blender to good use blending up chicken and portioning it out in our stash of baby food jars we are starting.  Pureed baby food meat is close to a dollar a jar and although it’s not much, it adds up quick!! Some of these recipes call for 2-3 jars! That’s almost $20 bucks a week! I’ll try out some homemade meat blends and get back to you.  Until then….happy blending!

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Beginning a Blenderized Diet

Yayyy, Everyone is on board with Braxton starting a blenderized diet!  We saw his GI last week and spoke with him and a dietician about making the change and the doctor felt it was a great idea to change Braxton to a Blenderized Diet since he was having so many problems with the formula.  GI is also sending Braxton to have another abdominal ultrasound and Upper GI Scan to make sure that nothing in his anatomy has changed that is causing the vomiting and also to be sure he hasn’t developed a hernia because he has been vomiting so much.  We’ll do that next week, for now we are working on the new diet.

What is a Blenderized Diet?

A blenderized diet is essentially blending up REAL food into a liquid consistency so that we can still feed Braxton through his G-Tube.  With this new diet we could basically blend up anything we are eating and feed it to Braxton instead of that icky formula.

Why a Blenderized Diet?

There’s no definitive you HAVE to do this for your child answer out there.  Every parent has the right to choose how to feed their child.  We decided to give a try because Braxton has such a hard time with the formulas we have tried.  For one, how would you like to be on a liquid diet? It just didn’t make sense to continue to make Braxton stay on a completely liquid diet.  We want to maintain some sort of “normal” with him, and “normal” 18 month olds are already eating hamburgers and hot dogs! While we aren’t blending up hamburgers and hot dogs just yet, you get the idea.  We want Braxton to start having REAL food.  My research has shown me that several other parents started for the same reasons we have: formula intolerance, vomiting, gagging, retching and so forth – almost all of those parents said those issues stopped almost completely on the blenderized diet.  It also helps kids to be able eat by mouth faster.  A lot of parents have said their children are more willing to try oral feeding once they start with a blenderized diet, and at the end of the day, THAT is the goal! We want Braxton to learn to eat by mouth so we can eventually take the G-Tube out.  Other reported benefits include faster hair growth, healthier skin and nails, and better intestinal health.

Getting Started

There is a TON of information out there! Here are a few sites I checked out to gather some information:

  • Blenderized Food for Tubies – They have a fb group and website with a searchable forum. Lots of getting started tips and recipes from other parents.
  • Feeding Tube Awareness– All things tubie! They have a page of links and info on getting started as well
  • You Start With a Tube – A man WITH a feeding tube started this site and has a book “Complete Tubefeeding” Which is another great resource  Complete Tubefeeding
  • Mealtime Notions – “Homemade Blended Formula Handbook” Everything you need to know about homemade formula

After reading everything and talking to our GI and Dietitian I decided on a simple recipe to begin with until I’m comfortable moving up to more elaborate recipes.  Also, many will mention that you need a high speed blender like the VitaMix or BlendTec Blender (both companies offer discounts if you are purchasing for medical reasons). We do not have a high speed blender, so we are currently using our regular blender or our hand blender.  So far it’s worked just fine since we are using already pureed foods.  If this is something that works well and we have success with we’ll look into the high speed blenders.  No point in spending $400 for something if it might not even work! The point is, don’t be discouraged to try if you don’t have one of these blenders.

Here is the starter Recipe I used: (Said it was a 1,000 cal recipe, but I came up with a different figure) Following this recipe exactly also yielded about 60 ounces of food! o_O I’ll explain more in the next post about adjustments

  • 2 Cups Mixed Grain Infant Cereal
  • 12 oz Vegetable Baby Food
  • 8 oz Fruit Baby Food
  • 3 oz Pureed Meat
  • 16 oz Water
  • 4 tsp Olive Oil
  • 1 Tbsp Karo Syrup

With any of the recipes you find, you can use any fruits and veggies, but you have to follow the regular guidelines for “normal” oral feeding babies. You should introduce one food at a time for 3-4 days before switching to the next just so that IF there is a food allergy it’s easy to rule out what food caused the allergy. Since we’ve already gone through that process when Brax was eating by mouth, we have been able to mix foods pretty easily.

Our trials will be a separate post, just wanted to put out some info on the new diet we are trying.

Happy Blending!

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Something’s Gotta Give

I’m really getting tired of reporting Braxton’s tummy woes.  It’s the absolute worst to follow everything the doctor tells you do, only to find that it is still not best for your little one.  Seems like we find a solution and it works for a couple weeks and then BAM! back to square one.  I was really excited when we added corn starch to Braxton’s feeds and were able to run his feeds over 30 minutes instead of an hour, but alas, the vomiting has returned.  I’ve documented everything, but can’t pinpoint exact cycles, so I’m not sure if I’m dealing with Cyclic Vomiting or if it’s simply all part of the Dumping Syndrome.  Everything I’ve read on CV though is pretty severe and a lot of kiddos end up in the hospital for it, so probably not that.  It’s just so frustrating! Even moreso when I can’t get a doctor to return calls while I’m dealing with a child who can’t keep his food down….if that’s not an emergency or at least worthy of a call back I don’t know what is! Possibly time to find a new doctor.  Yes, I know they have other patients and are very busy, but certainly not everyone who calls is vomiting uncontrollably! I’m just at my wits end and feeling like somethings gotta give; my sanity being most likely the first thing to do so.

After a lot of research, sleepless nights, and just misery watching my poor baby, I’ve finally decided it’s time for a change.  We’ve tried several different formulas, medications, and other remedies and they have all failed.  So, I’ve decided to tackle a Blenderized Diet for Braxton.  Just doing the research and trying to wrap my head around it all has me feeling a bit overwhelmed.  Brings back NICU memories when we were being released with endless discharge instructions and appointments to be made. But, we made it through that and we’ll get through this and hopefully it finally brings relief.  All of the research shows that a Blended Diet is healthier and has several benefits, so in the end, if it’s better for Braxton, then I’m all for it.  I’ll do whatever it takes to help my little man.  Many people who have tried Blended Diets did so because their child had several GI issues which included severe vomiting. Almost all who made the switch report that the vomiting stopped within the first week of switching, and many have said their child even started tolerating oral feeding as a result. [ I sound like an infomercial! Possibly still trying to convince myself here….who knows] If we could get Braxton eating by mouth again I would be ECSTATIC!! [So would our Speech Therapist!] There are still some conversations that need to happen before we can forge ahead, but some of the important ones have already happened.  Our Speech Therapist and Occupational Therapist are on board with this decision which is a blessing.  We need to talk to our GI doctor when we see him Thursday to get him on board, and a nutritionist so that we make sure we’re still getting Braxton all the vitamins, nutrients, calories, and everything that he needs to stay healthy and continue growing.

It’s all a little bit scary and very overwhelming, but I’m confident in moving forward with this decision.  I’ll definitely be keeping detailed journals on everything that we try so that we can come back and post here what worked for us.  I can only hope any of the information I write here might help anyone out there in the same journey.  I’m open to suggestions/advice too so if you have any helpful info on getting started, things to do/not do, recipes etc. use the form on the “Contact Us” page and send it over! Thanks in advance!

/// On a brighter note! Braxton took pictures at daycare a few weeks ago and we received our prints today of our handsome man!

Sweet little boy :)

Sweet little boy 🙂

Brax's little smirk like he's too cool for the camera

Brax’s little smirk like he’s too cool for the camera

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Baby Steps

It’s been a pretty good week for us and little by little Braxton is continuing to make progress.  He’s crawling like crazy! One minute he’s at my feet and the next he’s in another room. He’s fascinated by everything around the house. He loves to go to the windows and pull the curtains back and forth. I’m constantly moving him back so he doesn’t pull them down! These days sound something like…”Braxton, get down – Braxton don’t touch that – No sir! – Braxton come here!” Hahaha we’re really in for it. He’s starting to really try to pull up on things to stand. He can get to a kneel and he pushes up on his feet but can’t quite stand up yet. It’s only a matter of time though!

We continue to work with our speech therapist to get Braxton eating again.  The periactin seems to have at least gotten Brax to be able to tolerate a full 8 ounce feed every 4 hours and he’s eating a little by mouth.  We’re really trying to work through the aversion he’s developed so just little by little introducing things by mouth. Basically starting over like we did when we started solids several months ago.  He’s making some progress though.  We started using a Z-Vibe with our therapist which has been working great! We decided to go ahead and purchase one ourselves to continue making forward progress.  The Z-Vibe is a vibrating handle with interchangeable tips to help with feeding and oral motor stimulation.  One of the tips is a textured spoon and with Braxton still teething he’s done really well with it.  He definitely likes the vibration and the texture against his gums and is eating with it too.  Our personal Z-Vibe came in today! I tried it for his afternoon feed and got him to eat a little less than an ounce! Considering we’ve only been able to get him to take about 5 bites, this is really exciting!! He’s taken about half an ounce or a little more with the speech therapist too, so it looks like we’re making progress.  🙂

Also trying to get a handle on the Gastric Dumping, so we’ve started to monitor blood sugar levels throughout the day too.  We went last week to to see the Endocrinologist to get a Glucose Monitor and learned to use it. Just one more step in his feeding process.  Didn’t think I’d be able to poke him so much to get his readings, but he doesn’t seem to fuss about it too much thankfully. We also followed up with the Audiologist this week to get new ear molds made for Braxton’s Hearing Aids as he is continuing to grow. She adjusted the volume levels on the aids too and it seems like he’s already responding better!

Baby steps add up to giant leaps. May not seem like much now, but with every step Braxton makes he gets closer and closer to every goal in place.

Today was picture day at daycare 🙂

Always so serious

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