We finally made it to the Mayo Clinic in Rochester, Minnesota last week. I must once again thank everyone for the help they sent our way in the spring so we were able to afford to stay out-of-town while our son needed to be in appointments throughout the Mayo Campus for the last week.
We FINALLY have an extensive medical team standing behind us and for us. The level of care and compassion at Mayo compared to anywhere in Iowa was beyond any expectations that we had. We did not get good news but it was news we needed to know and it is never easy to hear unexpected results after your child undergoes his fifth sedated MRI at just over 3 years of age.
In the last 7 days we met with a new Neurologist, Neurosurgeon, a Geneticist, a Genetic Counselor, a Genetic Researcher, a new Developmental Pediatrician, ENT and Sleep Medicine Physician. My son had to endure an MRI with lumbar puncture, multiple blood draws and a 16-point sleep study and another Video EEG in the last week.
They used a different kind of MRI machine on Abram in Minnesota called a 3 Tesla. (You can read about it here.) Basically, this MRI takes thousands of images in comparison to the hundreds that are taken here. Which means a clearer picture of what is going on within Abram's brain, literally.
Sadly, they found that in addition to the Pineal Cyst they have also discovered that Abram's brain has multiple abnormalities. It turns out that while he was developing, some of the gray matter in his brain did not "migrate" out to the outside of his brain. So, he has certain types of brain matter within the white matter of his brain that is not supposed to be there and he also has grey matter within his cerebellum.
These changes are what they feel are causing Abram's seizures causing him nearly all of his issues including his inability to retain language. They are not sure if he will ever be able to speak but they aren't ruling it out, either. So in that way, we will just keep on doing what we have been doing and immersing him with as much therapy and outside help that we can get. We FINALLY have an SCL and Respite Team that we adore and are working TOGETHER to do the best for Abram.
We also have been advised to do a Full Exome Genetic Test. In doing so, it will check all of Abram's Genes and see if there are any abnormalities that the three of us don't share. From there, they can try to narrow it down even more if they happen to catch something. We have joined Mayo's Research Study so any testing that happens after the Full Exome will be covered in full in trade for our DNA.
Many people don't understand the point in doing this sort of testing but this is what they need to understand: Genetic Testing is not to figure our what is "wrong" with our child. It is not to be used to point fingers at which parent a child got handed down a gene from. This is about how to prepare for our son's future. This has the potential of not only possibly catching something to help Abram live the best life but it also has the potential to help other families who come after us. Abram's story, diagnoses and genetics has the great chance of helping another child and another family know what to expect. This is about doing what is best for Abram. If they don't find an answer - so be it. If we find a causative gene - we can help pave the way on how to best prepare a family with a similar diagnosis.
The EEG found that his brain fires all of the time from all over the place, due to the fact that he has grey matter where it shouldn't be. There is no surgical fix for that type of seizure so it is something he was born with and will always have.
In addition, the feel that the pineal cyst is significant and want us to get another scan in 6 months. I was hoping that this would be the last time they would tell me it was "incidental" and "not causing any issues" and we could go on with it. It just sucks is that the reality of it is that it requires constant monitoring. And constant worries about the effects of the Anesthesia on our son.
The best news was that when I shared that my son was on CBD and had been 9 weeks seizure free they all didn't look the least bit shocked and were pleased to see that it was working. It was even referred to as an "innocuous drug" and without side effects.
I was told that there was NO NEED for the change in meds (in addition to his Clonazepam) and that if nothing's broke - you don't fix it.
CBD has given my son the first summer in his life where he was able to enjoy it. He laughed more. He loved more. He got to be a little boy for the first time in his life.
He got to run the first time and get a skinned knee at his Grandpa's. He got to go to the splash pad and have fun with other kids. He got to go to the play area at the mall for the first time ever without hightailing it for the car because it was too overwhelming.
We didn't get the answers we wanted but we got the ones we needed. I officially know that I am doing all that I can for my son. We officially have a TEAM of medical sub specialists who are willing to help us and take care of our medically complex boy.
There is nothing that I can stress more when you are dealing with a sick or special needs child than the fact that if you feel that you have gotten terrible care or that the individual you met with did not answer all your questions - PLEASE get a Second Opinion.
Until I had a son that has had medical issues since day one, I had no idea how different and often times completely opposing views doctors and nurses would have as to what is considered appropriate care for my child. If you are new to the blog you might be shocked to hear we had an Orthopaedic Surgeon tell us that our son may not walk, a Neurologist who told us he was "fine" and a Pediatrician who missed a lot of signs of a serious issue for the first ten months of his life!
I am lucky to have had a nurse friend advise me on what to do when no one else was listening. So, if you are reading this because you have a sick child and no one listens... find someone who will. Since my son was born we have seen Nephrologists, Orthopaedic Surgeons, Neurosurgeons, Neurologists, Ophthalmologists, Cardiologists, a handful of Pediatricians, Orthotists, Physical Therapists, Occupational Therapists, Dieticians, and almost any other kind of "ist" there is out there. Once I finally got his first Pediatrician to admit that something was off with my child, there hasn't been a day that I haven't fought like hell to do everything that I can for him.
After my last post, we decided to travel to Iowa City to see another Nephrologist. She concurred that he does have abnormal kidneys but that the scans weren't exactly the best. It appeared that they are almost on top of one another, so she doesn't believe them to be horseshoe kidneys per se but said that there was flesh where there shouldn't be any and that they definitely aren't where they are supposed to be. So, she recommended that he get a nuclear test (Mag 3) to check his kidney function and to make sure that everything is working properly. They were going to try to schedule it the same day as his next MRI (in three weeks, eep!), so he only has to be sedated the one time. Sedating your child is risky and scary but sometimes it is a necessary evil.
In addition to the Nephrologist, we also managed to get the Sleep Study conducted over mother's day weekend. We took our own supplies and showed the sweet nurse how we prevented him from ripping off the sensors during his three day EEG. They managed to get the information they needed from the very little time that he slept (he woke every 60 minutes the entire night) but I am hoping that it is enough to show the Pulmonologist what is going on in Abram's sleep. We have already ruled out Aspiration but are still waiting to hear if he has sleep apnea or RLS before chalking his sleep issues 100% as an affect of his chromosomal disorder and the mass on his pineal gland.
The Geneticist also called back to report that Abram's test for Noonan Syndrome came back as "normal" but that the test only catches 60-70% of the cases so a normal result doesn't necessarily rule out Noonan Syndrome but it makes it less likely. That was a $4,700 test for a maybe? So, now we are still waiting on the results of my husbands blood work to see if he is a carrier of the Chromosome 7 Deletion. If he isn't, then they will be testing for Fragile X Syndrome.
We also have had a follow-up with our Neurologist who upon walking into our appointment was convinced that he would start medication for Abram's seizure-like activity but after seeing him and how much he'd improved socially and physically since our last meeting changed his mind entirely! That was a big relief. The less medicine the better because most anti-seizure medications make kiddos very sedate and his entire personality could change.
Next month is another huge month with appointments and follow-ups but I am hoping that July will bring fewer doctors appointments and more fun! This is officially Abram's third summer and I plan to make it the first memorable one for him. He deserves to be a kid. If the Fragile X comes back as "normal" too, I think we'll be taking a break from the hunt for a diagnosis or a name of a syndrome for our son's affliction. Life is too short to spend it in a waiting room!
The month of February has been an unkind one. As I am writing this I am waiting to go to my Grandfather's wake. Lyle passed away early Saturday morning in Hospice House and tomorrow is his funeral. Saturday also brought the sad news that my husband's cousin was murdered so he will be Pall Bearer in two funerals this week - both in SW Iowa.
Things with Abram seem to be progressing for him both with diagnoses and his abilities. He STOOD for the first time last Sunday and has been pulling to stand all over the house now which is amazing. Since he is hyper-mobile and he has hypotonia, his knees lock and his legs overextend so he has a really hard time getting back down unless he's on the couch where he knows he's got a cushy landing. He is also becoming more vocal and is saying 'ah ah' and 'mum'. He loves the sound of his own voice and is thrilled if he is anywhere it echoes. Haha.
We have also gotten to finally meet a Geneticist. I had no idea what to expect but it was a lot of information. He confirmed it is a rare case and didn't have much new news that we hadn't already learned from Unique. After them taking thirteen vials of blood out of my little baby, there are still a lot of other things to rule out including metabolic issues and two Syndromes that they are checking him for including Noonan Syndrome and Fragile X. So far all but two of the metabolic tests have come back abnormal but we are waiting on two more.... one for copper and one for a word that sounds like a sneeze. If both of those are negative they will test for Noonan's (a$1700test) and then on to Fragile X. After that.... I guess we just might not get an answer. Basically, whatever Abe goes through now is being followed by Genetics and Neurology so his case can help someone else in the future, so that's good.
The Geneticist told us the biggest concerns with this are Epilepsy, Heart Valve Defects, Kidney Issues and Bone Density Issues so now we are being scheduled for an echo cardiogram, a renal sonogram and a full body x-ray. In addition, having small stature is also a concern so if he has another dip in his growth chart he will need to see an Endocrinologist to get him on growth hormones. The Geneticist also said that he felt the pineal cyst is a separate issue than the genetic disorders and could not offer an answer or advice on why Abram's soft spot is open still at 19 months, mentioned hydrocephalus and asked if we'd been to a Neurologist! (sigh and ugh)
In addition, we had a check-up with our Neurologist who finally told us the results of the EEG which was disheartening. He said that he saw three spikes in Abram's 3day EEG in December indicating seizure activity but he doesn't feel comfortable in drugging him to prevent seizures at this point. He also admitted that he'd never heard of Abe's deletion and that he is learning from us.... that people will be helped by what we are discovering so at least maybe this journey won't be so hard for the next family.
The Neurologist feels that the soft spot issue, the cyst and all of Abe's other issues are attributed to something genetic while our geneticist feels that the cyst and soft spot are neurological and not related. I just want to scream! Alas, our Neuro is going to measure the open fontanelle with a head ultrasound once our Title 19 kicks in and then Abe will get his third follow up MRI to check for growth in that cyst.
Next up is the new Opthamalogist next week and just more waiting on more tests...... but regardless.... things are moving forward and my little man is gaining skills and brings me so much joy. I just hope that someday he can just be a little boy and not spending his days and weeks on a full schedule of appointments and therapies.
In other good news, Abram qualified for the ID Waiver... which means we can get in-home respite care with people we choose so we will finally have the much needed help we will need and when he turns two we will have a community service that will help teach him life skills and give me a break. The wait list is 2-3 months but once we get in and get an hours worth of respite care, Abe will get his Title 19 back which will help immensely with medical bills.
Well, that's all for now!!!! As always, thanks for reading and for caring. Your support means the world to us!
<<< That is Abram during his EEG when his Gramps called him to check in on him! He got so excited!
I haven't put an update on here in a little while. Life has been insanely busy and hectic.
The Short Version is: we are still waiting on the results of Abe's most recent EEG as well as the results of the first MicroArray test we did at the beginning of November.
(If you want to hear all the Blah Blah Blah...)
The Long Version Is:
We are hoping that with the results of both tests we will be on the right track as to what we can do to help Abram the best we can. We are hoping that the results from the MicroArray Test will give us some answers and guide us in answering why Abram has Hypotonia along with Sensory Processing Disorder, Macrocephaly and a host of numerous physical markers that our Developmental Specialist pointed out. From what I have learned though, Genetic testing is a long long road to find an answer and we may never be able to FIND an answer... which makes it a daunting task.
I've had a lot of folks ask why we chose to go ahead with genetic testing since there is nothing we can do to "fix" it even with a diagnosis. So, I just want to sort of explain that even if there is no "cure" or way to "fix what is wrong" the point of the testing is to rule out certain other genetic defects and syndromes and to know what to look out for in the future. Knowing what "it" is will help us to know whether our son faces other serious ailments we would need to know to watch out for (like heart defects) or to know if his life span will change. I honestly had to STOP reading through all of the Genetic Defect information because almost all of them are scary, have heart issues and shorter life spans.
To the mamas reading this who are going through this same thing - I'm just starting on this journey but your help, kind words and advice have been so helpful and have meant more than you will ever know. Not many people know what we are going through and it seems like every single mama I have met who just KNEW something was "off" about their babies were deemed crazy by friends, family and even their doctors. It has been a non-stop confrontation to even get the help we needed from certain hospitals but having this little boy to fight for has changed me entirely as a human being. I am now aggressive about our needs and expectations when it comes to our son's medical care!
To the mamas reading this who may think there isn't something right with your child trust your gut. Go with your instincts. You know your child the best. My son had a rough start but even after he was deemed healthy enough to go home from the NICU, I knew the first night home that something wasn't right and I haven't stopped fighting since. If your Pediatrician isn't doing their job, get another one and ANOTHER ONE until you have someone that sits down and listens to you and looks at your face when you are telling them what is going on. Film anything you can that shows any behaviors or things that you may think are a little strange. Document everything. If they still don't want to help you - file a complaint. These are all things that I have had to do and have done in the last five months. I had to become a pest in order to get the care my son deserved to get in the first place!
In addition to waiting for the blood work to come back from the Geneticist we are also waiting to hear back from our Neurologist regarding the results of his most recent EEG. Two weeks ago we were admitted to the Children's Hospital for what I thought would be a 24 hour ordeal and we were unable to leave for three days. It was a loooong three days too. Poor Abe didn't know what to do all connected to a little machine and he did not sleep much so by the second night he was a wreck and officially traumatized by all people in scrubs or white! He still won't let me touch his head and there is one patch of glue left but sometimes you just have to pick your battles. Our Neuro saw him the second night and was concerned because of how he looked and kept repeating he wasn't himself. In the three days he was there he had five of his episodes and when they occurred, we were to hit a button on his equipment so it would mark the video and the EEG on where to look extra closely so we can try to rule out seizures.
Our Neuro did mention that the one we marked the first night did NOT have peaks on the EEG so I am hoping that Dr. Shahinian (the Skull Base Surgeon) is correct in thinking that the vision disturbances he has are due to the cyst in his brain and not seizures at all. I obviously don't want my son to be having either but it would be a relief to know for certain that his episodes are not seizures just so we can check that off of his list of symptoms.
So that's where we are! STILL MORE WAITING!
Two weeks ago we had our big Developmental Assessment at the CDD in Iowa City. My husband couldn't go with us, so my mom drove up the night before and went along with me since the appointment was right at 8:15 in the morning and from our house it's an almost two hour drive to get to the University Hospital!
I didn't realize that there would be "campus traffic" at that time in the morning and got a little lost but hey... we found the place and they had free parking and we got there right in time, so I can't complain too much.
We were admitted immediately and we were put in a huge room with lots of toys and space for Abram to crawl around in. We immediately met the Hospital's Social Worker (who tells you about the help you may qualify for and gives you information on how to go about getting it). Then we spent the next five hours talking to Occupational Therapists, Speech Therapists, Physical Therapists, Dieticians, Nurses, Audiologists and then finally the Developmental Specialist who performs a thorough exam and tells you what the professional opinion is and what to expect next.
The Developmental Specialist told us that she believes our son has a Genetic Chromosomal Abnormality. She pointed out a variety of physical things our son has going on including his far set eyes, the shape of his eyes, his wide nose bridge, small chin (with tongue-tie), hypotonia, the creases in his hands (he has a single transverse palmer crease), his Macrocephaly (his soft spot is large/not closed on his forehead) and showed me that his feet are not in line with his ankles.
Obviously it was not the best news to get because there is no cure for a genetic abnormality. The only thing you can do in these scenarios is to prevent and/or treat the symptoms that the syndrome causes. It was definitely hard news to hear but I was slightly relieved to hear the Doctor say that she knew something was wrong and there is likely a name for it. The only step we could take at that point was to start our journey into Genetics.
Before we left that day, they took Abram's blood and are sending it off to do a Chromosomal Microarray which will test his chromosomes for certain markers and will which in turn will hopefully be able to tell us which Chromosome may have the genetic abnormality. I believe we will be waiting quite a while to get the results back from that but IF it comes back with something we will get into a Geneticist ASAP and won't have to wait until our appointment in February which is the only good thing in this scenario. I am certainly not happy that my son may have a genetic abnormality but I am going to relieved to be able to refer to it by name, help improve the things I can and work my hardest to prevent any issues that this syndrome may cause. The doctor warned me about possible heart defects and after reading up on many of the symptoms my son has vs the possible syndromes it could be, I have learned that many of these syndromes also come with shorter life spans.... but I cannot even bear to think about that right now at all. Even if that is true there is nothing I can do but what I am doing... and that just means being the best Mama I can be.
With that, I have had a lot of people ask if this Chromosomal Abnormality has anything to do with his Cystic Lesion of the Pineal Gland and the answer is a resounding, NO. Unfortunately for us, these two issues are separate problems for our family to deal with. Ironically, our Neurologist called us back in (earlier than our expected appointment) due to the fact another toddler in the city (who has the same thing as Abe) became symptomatic (when the medical field keep telling us that these cysts rarely cause syndromes and that they are typically "slow growers".) Unfortunately, if they do become symptomatic the only solution is to have your child go through the most invasive brain surgery there is due to the fact that the Pineal Gland is located precisely in the middle on the underside of the brain! Ugh!
Anyhow, I updated our Neurologist on all the information we received at the CDD and he agreed that Abram may have a syndrome and/or disease that needs to be dealt with in addition to the issues he has from the lesion on his pineal gland (sleep disturbances, possible seizures). He also informed us he that he has decided to refer us on to a local Pediatric NeuroSurgeon to get a second opinion, "just to make sure" to which I am relieved. After our experience with the last NeuroSurgeon I am looking forward to meeting a local NeuroSurgeon that came at the request of a Neurologist who sees that my son has some major issues and is trying his best to help our family! Luckily, we got in right away (this coming Thursday) and I am anxious and nervous to hear what this man will say. He will be the third NeuroSurgeon to look at his scans so I am hoping that the third time's the charm in getting a consistent answer. Please!?
So, that's where we are! Genetic Testing and a Neurosurgery appointment, which is exactly where I wanted to be so that is good. With more appointments come more questions but I do finally feel like we are going in the right direction to getting our son the help he needs the most! Yay!
Hi! I'm Erin. I'm Abe's mama, a tireless advocate for UBE2a Deficiency Syndrome and a fierce proponent for medical cannabis.
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