Archives for June 2009

Texas Parent 2 Parent Conference

Wow!  What a whirlwind 48 hours!

We are still in Austin tonight.  The conference just ended a few hours ago, but we decided to stay an extra night so we didn’t have to drive home late at night and exhausted.  Good call on our part, huh? 🙂  I think so!

I’m so glad we came.  I really am.  We went to quite a few informative sessions including legislative outcomes of special needs legislation from the last session, discussing how we all deal with grief, learning how to navigate the MDCP, CLASS, and other financial and equipment assistance that the state provides, and a few others that are slipping my mind at the moment. 

I met SO MANY wonderful new people, all parenting a child (or children) with so many different types of special needs.  I didn’t meet anyone else who was parenting a child with a life-limiting or rare disease, but I still felt a common bond with many of the people I met. 

Ethan and Abigail had a great time in their respective child-care rooms.  They were just suites that were reserved for certain age groups.  Abigail made a “new best friend” for the weekend, this 6yo girl who lives about 3 hours from us.  They were joined at the hip.  On Friday night, at the family dinner party, they were holding hands, and hugging, and just being so girly!  It was adorable.  Ethan didn’t make any “friends,” but he did have a good time. 

Even though neither Ethan nor Abby has made any comments about meeting so many children with so many different types of special needs (including Cerebral Palsy, Autism, Down Syndrome, etc) and different types of assistive equipment (wheelchairs, oxygen, etc.), I know that exposure to these children as just “regular kids” was so good for them.  Questions may come down the line, and we will deal with them at that time.

Tomorrow we are going to explore Austin a little bit, and then we are going to head back home and start getting ready for a jam-packed July!

I can’t wait until next year’s conference!

Feeling down but ready to fight…

I’m sitting here in our hotel room in Austin.  Tomorrow morning is the beginning of the Texas Parent 2 Parent conference that I mentioned last week.  I’m really glad to be here, because I am hoping to learn more useful tools to help us learn to navigate the “system” as well as learn to be more proactive parents to our “special needs” child. 

Funny thing, I still don’t see her as “special needs.”  Yes, I know she is.  My head knows that.  My heart still has a hard time wrapping itself around that concept. 

Even after a horrible occupational therapy today that left me walking out of there somewhat defeated, I still just don’t see her as “special needs” in the classical sense.

Ms. Pat, Hannah’s OT, finally got to see how Hannah eats from a spoon and eats from a bottle.  We tried to do it last week, but Hannah was just starving while we were in the waiting room, so I had to feed her then.

Hannah started getting upset, immediately as soon as I brought out the baby food container.  So much so, that she started having difficulty breathing.   I finally got her calmed down, and I was able to give her about 5 spoonfuls.  Pat was able to notice that Hannah still tongue thrusts, and she doesn’t have the bite, swallow, and breathe reflex that she should have at this age.  So basically, she is choking when she gets spoonfed.  She then said “I didn’t realize it was like this.  This is definitely dangerous for her.”

She wants us to stop spoon feeding for at least another month and just stick to bottles like we are doing.  We can continue “oral play” with the hard licorice and hard pretzles, things that can’t be broken in her mouth.  She then made the comment that “This doesn’t mean she will never learn how to do this the right way,” but my heart just sank. 

I know how this crappy disease works.  It was all I could do to keep my composure together as we left the office.

But for now, we are thankful we can still feed her by bottle.  I pray that she is right, and this is something she will learn.  But honestly, she has been trying to learn this for 7 months now, and we just don’t seem to be any closer. 

But I still don’t see her as “special needs,” I just see Hannah.

Great physical therapy day!

Hannah had a great, great PT day again today!  I tell ya, Ms. Pam, the therapist, definitely knows how to work with Hannah.  Hannah has been using her Surestep orthotics for about a week now, and today was her first day using them in PT. 

We worked on getting on to her knees and balancing and rocking, and you can see Hannah’s is definitely getting stronger in her quads.   We also worked on her getting from a sitting to crawling position and a crawling to sitting position.  She is not there yet, but she is definitely in more control of her movements.

Hannah’s ABSOLUTE favorite thing is the yellow peanut therapy ball.  Ms. Pam sits behind her, and Hannah focuses on standing up with just using her hands to hold herself in a standing position.  We would put a toy on top of the ball, and she would actually start being able to balance with just one hand while grabbing the toy!   She would also work on walking with her hands on the therapy ball while Ms. Pam and I would continue to move it forward.

But the thing that made the entire therapy room laugh was Hannah’s pure joy on being rolled on this ball.  Ms. Pam would roll her up so she would be balancing on her stomach with her feet in the air, and then Hannah would work on putting her feet in the right position each time she would land back on the ground.  She was just hysterical doing this and had such a blast!

Actually, my goal now is to see if I can find one of these peanut therapy balls for the house.

Greyson’s Law celebration and a bit of a scare last night!

Even though we have only known each other about 6 months or so, I really feel like I have connected with Nicole, Grey’s mom.  We met via blogs back then, and then we met in person last month.  She is more awesome in person than she is online!  

It was also a celebration of her a-bit-younger-than-I-am birthday.  When she was able to do a backflip on the trampoline — TWICE — I was just in awe!  I sure as heck can’t do that!

So when she invited us to celebrate the signing of Greyson’s Law (Texas Newborn Screening Law), we didn’t hesitate, even though it was a 3-1/2 hour drive!  It was great to see her again, and I got a chance to meet her husband and good friend, Misti (who “introduced us” online), who is just fantastic!   It was an honor to be there to celebrate this great occasion with their family and friends – such an important law for Texas children!

Hannah

Hannah

Hannah was just not herself completely yesterday, though.   Usually she loves meeting new people and “hanging out,” but she just wasn’t in the mood this time.  I think it was a combination of the heat (it was over 100 degrees) plus the lack of afternoon nap (only 15 minutes) and being cooped up in a car for the long drive there.  Daddy kept bringing her inside the house in order to keep her cooled off.

However, on the way home last night, she just started getting really upset on the ride home, about 90 minutes in.  We aren’t sure what started it. Because she has dimished lung power when she gets excited, she started hyperventilating.  This was the first time this had ever happened with her.   Because we were on the freeway in the middle of nowhere, and it was dark, it took about 5 minutes before we found an exit with a lighted gas station.  Until we got there, I just reached over the chair and kept trying to keep her paci in her mouth, hold her hand, and stroke her face (though she couldn’t see mine).  It seemed to help only a little bit, but it did help some at least.

Once at the gas station, I pulled her out of the carseat and just cradled her, trying to calm her down.  She started bubbling a little bit from her mouth, and that freaked me out a bit.  Daddy and I handled all of this really calmly because we didn’t want Abigail and Ethan to freak out, but I was truly scared.  Yet, we knew we weren’t anywhere near any medical facility, so I just did my best to calm her down by holding her and stroking her face.  Finally, about 10 minutes later, she was calm enough that I could put her back in her carseat.  I ended up sitting next to her in the middle row (we have a minivan) and holding her hand the entire ride home.   She didn’t take her eyes off me nor did she take her hands off my hand or arm. 

Even though she was a bit calmer, she was taking quite a few shallow breaths, as if she still hadn’t completely been able to catch her breath yet.  This lasted about 30 minutes.  By the time we got into a major city, she was pretty much back to normal, thank goodness!!!  She finally fell asleep about 10 minutes after that.

So now we know… we have to make sure she takes her afternoon naps when we go out, keep her out of the heat more often than not, and take more breaks on long car rides.  The combination of the three is pretty dangerous for her, it seems.

This morning?  She is just fine and completely back to her normal self.

Worsening eye movements

We met with Dr. B., Hannah’s pediatrician, on Friday for her monthly check-up.

Her head circumference growth seems to have leveled off and actually didn’t change in the past 3 weeks.  This is good news in hopes that she does not have hydrocephalus!  We will still probably be doing an MRI of the brain at the National Institute of Health in July, however.

Hannah’s spleen really is starting to shrink now.  Before it went 5 cm below her costal bone (rib), and Friday, it is almost at the 3+ cm mark!  What a big difference!  Her liver is also starting to shrink a bit now.  Her platelets, however, went down just a bit to 147,000 (we were hoping for a raise since the spleen is shrinking).

Everything else was what we already knew except her worsening eye movements.   Daddy and I have been noticing it for the past few weeks, but Dr. B. saw it and mentioned it, so I knew it was true. 

I don’t know what the medical term is for it, but she seems to have trouble moving her eyes to where she wants them to go.   For example, she was in her exersaucer today, facing away from me.  I called her name, and you can see she got really excited, jumping up and down, and with a huge grin.  However, even though she started moving her body towards me, she couldn’t seem to get her eyes to unlock from straight ahead where she was. 

It is like we go through days where everything seems great, but then we get hit with these reminders that she really does have this progressive nasty disease, and it breaks my heart.  Now that it is more often and more noticeable, these reminders happen more often now.

Mutations for Gaucher disease linked to high risk of Parkinson’s disease

http://www.phgfoundation.org/news/4676/

What’s the connection between Gaucher disease, a rare single gene disorder of metabolism that appears during childhood, and Parkinson’s disease, a common multifactorial disorder of the nervous system that occurs late in life? The answer lies in just a single gene (glucocerebrosidase or GBA), which encodes an enzyme required for lipid metabolism and storage within the lysosome. Numerous pathogenic mutations in this gene have been characterised, which result in Gaucher disease if present in both copies of the gene; these recessive mutations are generally assumed to be relatively harmless to the carrier.

 
However, numerous studies have linked pathogenic mutations within GBA with increased susceptibility to Parkinson’s disease. In perhaps the most definitive work to date [Mitsui J et al. (2009) Arch Neurol 66(5):571-6], researchers resequenced the GBA gene in over 500 cases of Parkinson’s disease and matched controls; whilst only 2 of the control subjects had any of the pathogenic mutations associated with Gaucher disease, 50 of the cases were heterozygous for one of 11 mutations in the gene. Having one of these mutations therefore confers a substantial and significant increased risk of developing Parkinson’s disease of nearly 30-fold (OR = 28.0, 95% confidence intervals 7.3-238.3), though individual mutations may be associated with various lower risks [Gan-Or Z et al. (2008) Neurology 70(24):2277-83]. In addition, patients with mutations in GBA were significantly younger at the age of onset of Parkinson’s disease than those without. In contrast, there was no statistically significant association between non-pathogenic mutations in GBA and Parkinson’s disease.
 
Comment: This research is important for three different reasons. First, by combining numerous pathogenic mutations in the GBA gene in a relatively large study, the work unifies various earlier and smaller studies linking the gene with Parkinson’s disease.
 
Second, it highlights a general paradigm shift from the common disease-common variant hypothesis within human genetics, which underlies the recent plethora of genome-wide association (GWA) studies, to the common disease-rare variant hypothesis. If the majority of genetic risk for common diseases is actually located in rare variants, not common polymorphisms, conducting resequencing analysis of specific susceptibility genes is the logical next step in the hunt for the genetic basis for all common diseases. Adopting such a strategy could therefore be substantially more fruitful than conducting ever larger GWA studies.
 
Third, and perhaps most significantly, the work raises serious ethical concerns over carrier screening for Gaucher disease, particularly within the Ashkenazi Jewish population (see previous news). According to the National Gaucher Foundation, the carrier status may be as high as 1 in 15 amongst Jewish people of Eastern European ancestry (and 1 in 100 amongst the general population). The current policy of the UK National Screening Committee is that carrier testing for Gaucher disease should not be offered, as it is treatable and can be relatively mild. However, those who are considering getting tested privately prior to becoming pregnant may now want to think again; a relative risk of ~30 is one of the largest genetic risks known, and may even have predictive ability (though further research is needed here). As Parkinson’s disease has a UK population prevalence of around 1% in the over 65’s (based on data from the Parkinson’s Disease Society), such information could potentially have enormous personal and societal consequences. Additionally, authorities face an even greater challenge – should people who have already had carrier testing be informed of the associated risk of Parkinson’s disease, or not?
 
Such ethical conundrums are only likely to increase as more and more genetic susceptibilities are discovered that have relevance to multiple diseases. To date, this has been a relatively small problem, as most of the susceptibilities discovered through GWA studies have been associated with extremely low risks (OR<2) and have very limited predictive ability. However, if the common disease-rare variant hypothesis is correct, we can expect significantly more issues of this nature to surface over the coming years. Policymakers and clinicians will need to bear this in mind when forming national guidance regarding genetic testing and screening.