Next Steps - Have No Fear

My last update was pretty long but full of information.  You can read it to get up to date here.  The last few weeks have been spent getting Micah settled into his new room and already we've seen positive outcomes!

• His electric and acoustic guitars are now able to be set up along with his amp and his ukuleles are accessible so he has a little music corner.  He meets with a Portland based musician once a week or so for music therapy which is funded through some folks affiliated with Doernbecher.  He seems to enjoy her company and I hear happy sounds of music and conversation coming from the direction of his room.  He's started practicing everyday and is working on some new songs again.  "insert heart emoji here"  :)
• Moving into the larger bedroom affords him the space of about a coffee table to do some physical therapy on his own.  PT is no longer paid for through insurance so if he wants to continue to gain strength he has to do the work on his own.  Micah has made a reminder chart on his whiteboard to keep him on track (making goals!  A great sign!) and he seems dedicated to regular strength training and muscle endurance.  He has some resistance bands and some small weights. 
• Micah has attended church on Sunday a couple of times over the last few weeks and even gave his mom the elbow when it looked like she was using her phone during church.  I was sharing something the preacher said that I thought was particularly meaningful.  That's allowed, isn't it? 

"FEAR IS THE DARK ROOM WHERE NEGATIVES ARE DEVELOPED."

• Pretty good, huh?  And timely!
• Micah is showing signs of wanting to branch out.  Gaining weight and getting stronger has played no small part in his overall attitude and mood.  He's taken a few short walks outside (Hooray for the great weather!) and since his new room is right off the living/dining room we see him coming out to visit with the family more.

 ABOUT THOSE NEXT STEPS
We started a You Caring account (that's like a Go Fund Me but less expensive) to help raise the funds needed to get Micah to the next level. You can check that out by clicking here.  There's still a lot of research to do and we're all working together (Micah, his dad and I) to prioritize a list of needs to help Micah continue to grow and improve. 

• His Physical Therapist provided him with some resistance bands but he has reached the limit of what those can do for him and it's time to add some aerobic exercise.  We're looking into the best options.  A peddling device of some kind has been recommended.  Space constraints limits us so we're looking at everything from a stand alone peddler he can use from his chair to a full stationary bike.  He's also ready for some heavier weights.
• Micah needs 6 liters of oxygen at all times to breathe easy.  His insurance covers large and small tanks and a large floor oxygen concentrator and a portable bi-pap machine.  This is great and has made all the difference in his daily comfort as long as he stays close to home.  The portable tanks last about 3 hours - depending on how much demand he puts on them.  If  we want to take him out for a lengthy outing, say a day trip to a museum or the beach or shopping, we need to take 10-12 tanks.  You always take twice what you think you'll need to be prepared for anything.  And again - don't get to far from your vehicle where they're stored.  Insurance won't cover a portable concentrator that he could carry on his shoulder so we're looking at purchasing one ourselves.  This could open up a whole world of opportunities for Micah as he looks to add activities back into his life like jam sessions, worship team, college age outings with the church, family trips to the beach, college classes... you get the idea.  The right portable concentrator for Micah would cost in the neighborhood of $2500 - $3000.
• Space - the final frontier. Our house is just too small and older, but not the good kind.  It needs a lot of work (which Herb and I are doing as time and our personal funds allow) but it's clear we will need to either add on a space tailored to Micah's unique needs or move to something that has the space required.  Preliminary estimates put adding on a room with the square footage necessary and a bathroom suited to Micah's fluctuating needs at around $25,000.  That's a tall order.  And there's a lot of steps before we place an order like that. Plans, money, permits, money, contractors, money.  You get the idea.  We'll get our facts together and try to make the best and most economical decision we can.  A work in progress.

I want to write more but I have to go for now.  I plan to give you a glimpse into a day in the life this Friday when Micah has his in-home infusion of IVIG.  Until then thank you for praying for Micah.  If you're not already in touch with him one way or another he would love to hear from you.  You can find him here on Facebook.  Thanks for reading, sharing and commenting.  As always - questions welcomed.  God Bless!

Spring Forward (Some Assembly Required)

Friends on Facebook may have seen little bitty updates on our lives since "the big change" in the Autumn.  This new lifestyle is pretty busy but I owe you all an update.  I apologize for the delay.  So, here's what's happening.

WHERE WE'VE BEEN 

The Fall and Winter were spent adjusting, adjusting, oh, and adjusting.  Here's an excerpt from the last blog post dated Nov. 11, 2015 to refresh your memory:

 Micah came home last Friday and is doing so much better than he has in months!  He's helping with his own meds, and coming out of his room to eat at the table and even went out to a movie with his Dad, brothers and myself followed by dinner out!  He was pretty worn out by the end of it but he made it and he felt good about it.  Next Sunday we're going to give church a try.  He hasn't been able to go in a LONG time.

At home Physical Therapy and Occupational Therapy, on-site Pulmonology Therapy (specialized bikes and tread climbers, etc with respiratory support) and hopefully - avoid illness!  Micah's room is quite small and barely contains all his medical equipment and our house doesn't have the extra space needed for optimum physical therapy.  Keeping Micah strong will mean doing the work every day and involves more than therapy.  It means having space to play guitar and rekindle friendships.  We're looking to add a room to our house especially designed for Micah's needs so we're going to be starting a campaign to raise the money, donated labor and materials to get it done as soon as we can.  So far the plan is working and he's getting stronger than he has been all Summer and we want to make sure he has every opportunity to make the most of the time he has left.

-----------------------------------

The first few months were really difficult.  I'm not going to candy-coat it.  He was scared. He felt terrible and weak much of the time even with access to the oxygen around the clock.  He needed me to handle every single aspect of his care and could barely walk to the bathroom right next door to his own room.  Micah often asked me to sit and just be with him because the anxiety was so great.  The bi-pap alarms would go off repeatedly during the night and we struggled to figure out why.  It was a bit like having a newborn in the house again.  Sleep was at a premium and most of my day (and night) was focused on his care.  But that's what we signed up for in order to try to bring Micah back from the brink. Hospice began to visit to see if their services were appropriate for him.  I welcomed them to visit with Micah but I was resolute - we would not be needing them anytime soon.

WHERE WE ARE NOW

Micah did the work.  We all really did the work.  Nurses, physical therapists and occupational therapists came regularly for months working with Micah to help him regain some strength and stamina while I provided him with support with this prescriptions, meals, bi-pap machine, g-tube feedings, insurance paperwork and appointments with all those professionals.  As often as he could - almost daily - he would do the homework given by the therapists. First with just stretches and exercises to improve his balance and rebuild muscle mass. Then adding small amounts of weight.  All of it has worked to bring Micah from terrifying conversations like "maybe we should bring in hospice" to "you look really good!"  Micah went from an 110 lbs average weight, unable to maintain an appetite and often feeling to ill to eat to getting his appetite back and with consistent night calories from g-tube feedings to a whopping, healthier 147 lbs!

We did our best to squeeze all his medical equipment, supplies, physical therapy tools and personal belongings into a 10x10 room.  There are five of us living in this 3 bedroom 1.5 bath house and it can be done but there's no margin for error.  Micah has a folding chair in his room we keep for his visitors (mostly medical personnel) and we can fold it up when not needed making it easier to move around the equipment.  It's like learning to live in an RV.  You get VERY creative with space saving.  Nothing can be left out or laying about.  One challenge we couldn't overcome is Corban, Micah's little brother, doesn't have a room so he has to share with Mom and Dad.  He's 6 so as you can imagine - that's becoming even less ideal every day.  But the worst of it was that there was no room for Micah's guitars.  NONE.  They stayed put away and put up because there just wasn't an inch of room.  This meant he was a LOT less likely to play or even feel like playing.  It was just too much effort to even pull out and open the case.  I think this was a source of much of Micah's sadness.  Just not much reason to get up in the morning.  Nothing to inspire him.

One move we did finally make just this week was to have Micah swap rooms with his sister.  Her room is a little bit bigger in exchange for a smaller closet but the extra floor space was definitely needed. I tried to do this earlier but Micah had his reasons to stay in the smaller room - one of which was the proximity to the half bath - it would be further away which was unthinkable just two months ago. But the move has been made (almost done) while Micah is in the hospital for a tune-up (more on that later) with his approval.  It is going to make it possible for me to set up his guitars in a corner so they're ready to play whenever he feels the urge.  I'll have a little more room to move around his space so he won't feel like I'm about to fall on him every time I move from the oxygen concentrator to the medicine shelf!

BOTTOMLINE

The effort has been worth it.  Selling our business, moving Micah in with us and making his care our primary focus has brought about the improvements we were hoping for. so Micah is now more stable and ready to take on what's next.

Micah is ready for the next level.  He's reached a point in his recovery where he can take on more aggressive physical therapy. This means exercise equipment (read special pedaling devices) and weights.  Insurance doesn't cover this and they no longer cover the cost of physical therapy so that's on us.  I've come to learn that insurance is meant to keep people from dying but it doesn't have any interest in helping you be as healthy as you can be if you're disabled.  So once you're "stable" their work is done.  We're grateful for all that has been provided and the effort of the therapists and nurses but now that they've completed their assignments it's time for the rest of the work to be done - to get Micah from patient to having a life again - to contributing and being involved in the world again like he wants.  

It also means he'll need more space for this equipment.  We expect Micah to be on oxygen for the rest of his life and this means a concentrator, bi-pap machine, filters, tanks and more tanks, hoses, jugs of distilled water and more. Plus his IV pole, two pumps, IV supplies, refrigerated medicines which means he needs a refrigerator and the space to keep it nearby.  Then he can also keep his specialized high fat/ high calorie diet nearby as well and out of general circulation (if you know what I mean).  Cases and cases of formula for his g-tube feedings.  Ideally he would have a room with a private bathroom with a specialized tub/shower made to support people like Micah and a kitchenette because there is equipment that has to be sterilized every day and a frequent need for water and rinsing and washing.  I carry a lot of "stuff" back and forth to his room several times a day.

This disease is insidious.  Micah may continue to improve with all this effort.  We've seen good results so far.  Or the next illness may be the one that causes his one partially good lung to collapse.  I don't want to talk about worse case scenarios or planning for what that looks like here.  Currently, we want to focus on providing Micah every opportunity to have what we all have - a chance to make a life.  Who knows - maybe if we keep pressing on Micah will be able to take on more and more of his own care and feel the sense of independence we often take for granted. For as long as he can.

 Micah has been in the hospital for a quick tune up the last few weeks.  He started to feel poorly and then he had three wisdom teeth start to come in but they were impacted!  TERRIBLE pain.  Poor guy.  There was no relief. No oral surgeon wanted to take him on with all his underlying condition so the docs admitted him.  While waiting to get his teeth pulled as an inpatient (OHSU has an oral surgery department!) they started treating his illness but the delay from the oral surgery gave whatever it was in his lungs a chance to dig in so a longer stay was needed.  He looks great now and is coming home TODAY!  :)

Thanks for reading.  I've written so much but of course there's always more.  Please feel free to contact me with comments or questions.  Part of my goal here is to educate.  The world of disability is a mystery to some and I'm happy to answer your questions.
Thank you for your prayers and kind thoughts. You make a difference!

Hope Deferred Makes the Heart Sick

Last week was seriously busy with meetings tests and new ideas. It was really overwhelming.  Here's a quick update.  Apologies to my grammar junky friends. I wish I had the time to be a good writer but I'll have to settle for just getting it on virtual paper.

It all started with the care conference with Micah's doctors and other specialists on his team early in the week. Here's what we talked about in that conference:

• Micah's most recent CT scan it appeared to show his left lung was not getting the blood flow that it should so the team wanted a nuclear scan of his lungs to get a better picture of the blood flow on both sides of his lungs. 
• This was important because there has been discussion by his otolaryngologist about trying to open the left main stem to increase Micah's access to that lung which is basically almost completely shut down due to the main airway being narrowed at the top. There's a few ways they could do that:
•  Putting a stent in that upper left bronchus might hold that airway more open than it is now but means Micah would have to agree to putting in the trach which you can read about in my previous post. Both the stent and the trach introduce new opportunities for infection on a regular basis.  There's also the risk that because the airway is already so narrow and the stent has its own thickness perhaps the scarring wouldn't allow the stent to stay in place.  It could shift.  Or the additional scarring could grow up around the stent making the airway worse not better. Not a small thing to decide.
• Using special tubing and a balloon to go in and stretch that narrowed area. But the scarring is pretty severe and very stubborn. The risk here is that the area could tear causing irreparable damage to his airway which would be fatal. 
• Going in with the laser to try and cut away some of the scarring to open up that airway. I'm sure you can figure out all on your own how dangerous it is to put a laser inside of an airway. One wrong move and the laser could cut right through the airway wall and believe it or not there's also the potential for the patient to catch on fire. (Terrifying.)

• That said if the nuclear scan shows the blood flow is inadequate to the left lung, opening up that airway could cause more problems that it would solve. The demand for blood which had never been there before would be too great and would create another set of problems.

Some of the other interventions were more basic and less scary.

• Micah has diverticula in his windpipe (potentially dangerous but stable thank God) which they've determined have worsened somewhat overtime and this could be the source of some of his pain. They decided it was time to bring in the pain team to help Micah manage his pain better for the long term rather than Band-Aiding with short-term pain management. (Finally!) I didn't even know there was a pain team. 
• Anxiety has been a real ongoing issue and rightly so. Imagine feeling air hungry all the time. They decided to consult with psychology to see if there were some better solutions for Micah.

RESULTS

The Bad: The nuclear scan came back showing Micah's left lung has only 18% of the blood flow it should have.  The Otolaryngologist consulted with his colleagues in Cincinnati and it was unanimous.  There are no surgical options left for Micah at this point. This was a real blow to Micah and he took it very hard.  Opening up that airway could have made a big difference in how he feels every day and he was holding out a lot of hope for what that could mean.  I'm sure it felt like all the hope was suddenly taken from him.  This is as good as it gets. I can tell you as his Mom I've never seen him so low or angry.  He's not an angry guy - if you know Micah you know that.  But this was more than he was able to bear.

The Good: Psychology and the pain team definitely had some ideas.  Some adjustments were made to anxiety medications that deal with air hunger and a new longer acting pain medication was prescribed.  So while Micah grappled with the bad news about any operative solutions for his lungs the new medications were kicking in.  By the end of last week Micah was no longer asking for additional meds for break-thru pain and/or anxiety. He was starting to spend more time off the bi-pap machine and on regular oxygen from the tank and for a few minutes here and there - off the O2 entirely.  He started getting out of bed more, going for longer walks and doing more things for himself.  It has made a significant difference in his day to day which has in turn had a very positive affect on his attitude.

And Now: Micah came home last Friday and is doing so much better than he has in months!  He's helping with his own meds, and coming out of his room to eat at the table and even went out to a movie with his Dad, brothers and myself followed by dinner out!  He was pretty worn out by the end of it but he made it and he felt good about it.  Next Sunday we're going to give church a try.  He hasn't been able to go in a LONG time.

What's Next:  At home Physical Therapy and Occupational Therapy, on-site Pulmonology Therapy (specialized bikes and tread climbers, etc with respiratory support) and hopefully - avoid illness!  Micah's room is quite small and barely contains all his medical equipment and our house doesn't have the extra space needed for optimum physical therapy.  Keeping Micah strong will mean doing the work every day and involves more than therapy.  It means having space to play guitar and rekindle friendships.  We're looking to add a room to our house especially designed for Micah's needs so we're going to be starting a campaign to raise the money, donated labor and materials to get it done as soon as we can.  So far the plan is working and he's getting stronger than he has been all Summer and we want to make sure he has every opportunity to make the most of the time he has left.

Thank you everyone for your prayers and support.  We are confident that your prayers have made all the difference.

POST CT SCAN UPDATE:

Micah did great. We don't know the results yet - or even if they got the pictures they need to determine if Micah is a good candidate for a stint in his upper left main bronchus but the experience itself was fairly uneventful. They had all the right supports in place and there were no surprises. So thank you for all your prayers and kind thoughts. As soon as we know more about the results from the scan we'll let you know.  But here's a little info on why this CT Scan is so important:
We (his medical team, Micah, myself and his step-dad) have run out of ideas to improve his lung function and he's been getting increasing worse.  A new doctor was invited to have a look and attempted a procedure meant to try and stretch open the nearly completely shut down left main stem bronchus.  It didn't work well.  His instruments were too rigid and couldn't really get into where they needed to go to get the job done. He agreed to meet with some other colleagues of his and see if any other ideas could be discovered and they were.  There are other more flexible instruments  that may be more effective.  It was also thought that it might be possible to put a stint into that stretched opening to force that airway to stay open.  If so - it could mean improved over all breathing for Micah.  BUT (there's always a but - isn't there) he would have to agree to having a trach placed because the stint would need regular maintenance and easy access to the stint would be needed.  A trach would offer that access.  It could make a big difference for him and how he feels on a day to day basis.  But all of this possibility rests on the mechanics of his upper airway which is already in pretty rough shape and THAT is why he was having a CT today.
At this point this is the last idea on the table that is curative.  Any other efforts at this point are aimed at comfort care.  Some have asked if Micah is eligible for a lung transplant and the answer is no.  His doctors have asked twice and twice been turned down.  It's not the sickest people who get transplants.  It's the sickest people who have the best possible chance of the transplant actually working who get transplants and Micah's disease and physiology make it impossible.  His airway (trachea) is to damaged to accept new lungs and there's no way to know if the new lungs would be damaged by his disease since they have no idea what has caused it in the first place.

I will tell you Micah did have some nice visitors today after his CT.  He felt good for a few minutes and the timing worked out for some Super Heroes to stop by at that time.  :)  Wonder Woman was jealous of Superman because he could land anywhere and she always has to submit a flight plan - even for her invisible jet.

Micah's next homework assignment is pain management and sleep. They're trying something different and it's on an as needed basis which often means he waits too long to take it ("I don't feel good I should get some meds." Takes 30 minutes to get it and 30 to kick in now I feel like garbage) and he's always chasing the pain instead of staying on top of it. So we've made a chart to help him know when he can ask for it to help him anticipate his needs instead of react to them. And sleep has been elusive. Tonight? Praying for good, restful, sleep.
‪#‎blessings‬!

Turning Point

It's time to pull this blog off the shelf and dust it off.  This summer has marked a turning point for Micah with twists and turns and new challenges so I'd like to start sharing his story again.

 I stopped blogging for lots of reasons mostly time related.  If I made a list of all the things you would be tempted not to believe me.  Mostly, however, Micah leveled off for quite a while and managed to find some independence, a girlfriend, and a home of his own.  I moved to the background as far as his day-to-day care was concerned and with his permission moved on to other projects like my other kids, the Donald Hazelnut Festival board and planning committee member and helping care for my husband's mom who had been diagnosed with dementia.  Those are different stories not meant for this blog.  This blog is about Micah.  So here we go... I'll write as often as I can.

Bumpy Summer / Autumn of Change

Micah was home only a week after his 1 and a half long hospital stay and it was back up to the Emergency room at 2 AM on Tuesday morning.  I had two molars pulled only 12 hours earlier and was a bit distracted with the pain and swelling but we bumbled along because we had to.  He was de-saturating on his home oxygen set up and dipping towards the upper 80's fast.  We spent the night in the ER and the next day in pediatric ICU catching naps in-between the hospital staff visits.
He was moved from ICU Wednesday to the regular floor in Doernbecher and seemed to be tolerating it fairly well. He looked tired and uncomfortable to me much of the day with a few highlights of a fun physical therapy session and a visit from Great Uncle Steve and Great Aunt Diane.
Today is an important CT scan of his upper airway which, for Micah, is less fun then the average CT. He doesn't lay on his back - it's too hard to breathe. So it comes with added anxiety to perform this task.
Today's prayer request:
His CT is scheduled for 1 pm. He needs to have everything go smoothly. No technical difficulties, and competent staff and support staff. It needs to be relatively on time because the not knowing and good timing of anti-anxiety medication really makes it easier.
He needs calm breathing and no coughing during the CT so they get the important images they need the first time.
A sense of peace and safety for Micah.
Then tonight? Sleep. He needs long, uninterrupted sleep.
I thank God for you all and your love, support and faith extended on Micah's behalf.
#blessings

Raw

This post will probably have a lot of 'I' statements in it this time. If you think that might sound selfish and you won't like it you should stop reading and go back to scanning facebook posts about funny cats.  It's OK.  It's what I do when something makes me uncomfortable.  Like posts about my friends' son's birthday who would have been 14 today if not for a terrible accident when he was still very young. I only read the first three words and I burst into tears. Losing a child is the worst and heaviest burden of them all.  I am sure of it.

Even now as I type these words, my hands shake from the effort of trying to contain the powerful emotions that threaten to stop this day in it's tracks.  My son is sick.  It's unlikely he'll die in an accident.  He'll just wake up everyday a little closer to death.  Some days he finds he has taken just a few sidesteps - it doesn't feel closer.  Other days we can clearly see that he took 3 giant steps forward.  There's nothing for it.  It's coming.  Like a fin in the water pointed straight for you and no land in sight.

I cry more now.  Some days are unbearable.  Other days I manage to function like life is "normal". But you have to know most decisions I make are run through the filter of, "Will this interfere with Micah having as much chance at a normal life as I can give him?" I hate it.  I HATE IT. It robs everyone I know and care about. Bethany has to grow up faster.  That's not all bad - but it means less time to attend volleyball games or basketball tournaments. She is often the other Mom around here. It means I can't help build sets for Rebekah's plays or chaperone field trips. It means I can barely pay attention when Herb is trying to tell me about his day. He needs me - and I'm mentally unavailable. Herb's Mom, Lenora, lives with us and she's disappearing from this reality as Alzheimer takes over - I'm running out of time to give her good experiences before the hallucinations are all she has.  Corban is only 3.  He doesn't really understand how much he's not getting but I know. It's like Paul, my first husband all over again.  All the good things were poisoned by his death which was the same shark that stalks my son Micah now. And because of the needs of my littlest son and his Grandmother I can't be with Micah at the hospital as much as I should be supporting him and learning about his care and treatment. He's isolated, unable to visit other patients with mostly only nurses, and RT Specialists as friends. Adults are nice - and can be so kind.  Micah's youth pastor has taken the extra effort to be there for him so much more than I think he has time for.  The music pastor has tried to reach spend time with him but Micah isn't always well enough. But he needs friends. People his own age. Peers. The friends were the first to fall away.  It's always like that with long term illness. But the loneliness is so hard to watch.  I can't fix it.  I'm a mom.  Mom's are great. But a person wants to be loved and missed and pursued  by their peers.  It's what we all want.  I can't make that happen for him.  How does a mom go scrounge up friends for her son?  If you know - please tell me.

Before you jump to conclusions - I know how this sounds.  I can't and shouldn't say any of these things.  In fact I rarely do - even to those closest to me. I only do it now because of how much care people have expressed.  The questions I get asked that I politely answer in as balanced way as I can so I don't lose all my friends who can't deal.  But if Micah hears or sees these things he might get the idea that I resent him or blame him on some level. Which of course is just ridiculous and not true.  But our hearts are so soft and we often perceive our fears as true if there is any evidence, real or imagined, to back it up. But I think people need to know, need to understand the million tiny ways something like this effect every single area of the lives of those attached to it.  Don't you think I want to volunteer to make that casserole or attend that meeting or help in the nursery or be on the worship team? I feel judged but really -  I judge myself. How do I reconcile all these things I think I could and should be doing when the only ministry I am have time for is my own family.  I could help.  But I can't. Be all you can be?  Whatever. I'm trying to shut my ears to the requests that are everywhere.  It's very, very hard. If you have a "normal" family that gets up, goes to school or work, comes home and spends their evenings and weekends however they decide cherish it.  Hug it close and thank God.

In the end all I want is for Micah to have as many chances to squeeze into his shortened life so many of the things we take for granted because we have DECADES for things to happen to us by chance. But life is very demanding and dinner still needs to be made and I really can't put the rest of the family's lives on permanent hold because of this, can I? Should I?

I wish there was a miraculous cure but there isn't
one. So there it is - for those of you who are still reading.  The truth is there is no cure.  They barely understand the disease he has. And a lung transplant is all but ruled out. If he doesn't die suddenly from some kind of massive pneumonia they can't fix then this thing will go just like his Father. Slow - long - the disease will take him to the point where he is bed ridden and on a ventilator and tube fed exclusively because it's too dangerous for him to eat. Until his heart fails.  This is our future. How can I care about anything else? Teachers? Policemen? Politicians? Bosses? Friends?  Debts? How can I care about anything else? There IS nothing else.
I try to redeem anything negative I say or write with something up. But sometimes there just isn't one. I don't need any comments.  Don't feel obligated to cheer me up.  But if you are in a position to do something for someone who is in shark infested water - do it. DO. IT.

 

do

verb (used with object)

1.

to perform (an act, duty, role, etc.): Do nothing until you hear the bell.

2.

to execute (a piece or amount of work): to do a hauling job.

3.

to accomplish; finish; complete: He has already done his homework.

4.

to put forth; exert: Do your best.

5.

to be the cause of (good, harm, credit, etc.); bring about; effect.