Denial? Reality? What do I say to strangers?

It is almost like I have been in denial about this disease for so long.  I mean, I knew she had it, obviously.  But after looking at all the symptoms that she is developing all at once, it really got me very down and pretty depressed today.  Especially now that there is this probability of communicating hydrocephalus, which apparently is common with those Gaucher patients with the D409h mutation.  That is really scary. 

I can see that my baby girl is falling farther and farther behind where she “should be” for her age.  Dealing with orthopedics and brain MRIs now… geez. 

When I was at TCH yesterday before PT, I met a mom with a 10-month-old boy who was walking (assisted) all over the waiting room.  She asked me how old Hannah was, and I told her 9 months.  She made the comment “Oh, I bet she is crawling all over the place, huh?”  Nope, not even close.  But I just said “She’s getting there!” 

What am I supposed to say when people make these assumptions?  They are becoming more and more frequent now that Hannah is getting older.  I’m not going to tell them the truth, they are strangers.  Besides, could you imagine their face if I did?  “Oh, she isn’t on track because she has a fatal disease that is killing the neurons in her brain, but thank you for commenting!”

Anyone who sees Hannah could not tell that she was “sick.”  Right now, if you didn’t already know she had GD23, and you saw us somewhere in public, you would never guess she was ill.  She has no obvious tell-tale signs except her eyes.  But most people wouldn’t connect her eyes with a serious condition like that, especially since you really wouldn’t notice unless you were looking for it.

I just hate being approached with questions that I can’t answer honestly to…I really don’t know what to say.

Putting all the symptoms together

Hannah had her monthly checkup with Dr. B., her pediatrician.   I realized after this visit that more and more symptoms are starting to come to the surface now…

* Lack of blinking.  I have no clue how long Hannah has had this issue, but we were only made aware of it by someone noticing in an elevator this week.  “Your baby doesn’t blink!”  Sure enough, I have watched her for up to 10 minutes at a time without her taking one blink.  Dr. B. tried it today too, and he was surprised that she was still was acting normal, playing, observing, interacting, etc., yet not blinking.  So, we know it isn’t a seizure or sorts.   After talking to Dr. Sidransky at the NIH, this is not a normal symptom of Gaucher 2/3 kids, so we don’t know if this is related to her Gaucher’s or something completely different.  She WILL blink when she is really tired, however.  I have to call her Dr. Edmund, her neuroopthalmologist, about this.

* Head circumference growing too fast.  For the past couple of months, Dr. B. has noticed Hannah’s head circumference is growing much faster than the rest of her body.  He was a bit concerned about it last month, and after seeing it still growing today, he wants to watch it for one more month.  I contacted Dr. Sidransky about this as well (there was talk of an MRI at her NIH visit but we decided against it because of sedation), and she made the following comment:  “We were interested in doing an MRI of the head because sometimes subtle hydrocephalus (enlargement of the brain ventricles) has been seen in children with Hannah’s mutation. That is why we discussed the sedation with you. It is not necessarily a common finding in neuronopathic GD, but with this observation regarding her head circumference, I feel that the study is clinically warranted, and we can do it when she is here. However, if other symptoms like vomiting or signs of pressure develop acutely and your physician becomes concerned, don’t delay because of the NIH visit. ”

* Motor Delays.  Dr. B. made the comment to me that from this point on, Hannah’s motor development, especially gross motor development, is going to go much slower than the normal child.  We are already seeing that with her hypotonia (low muscle tone) in her lower extremities and the need for orthotics. 

* Breathing issues.  This isn’t really new, but it is something we have been watching.  Basically, Hannah doesn’t cry like a normal baby.  She doesn’t wail, and she can’t scream because she just doesn’t have the lung power.  It is a combination of her lungs being smooshed for so long because her liver and spleen were so big and the hypotonia in her lungs and throat.  She also gets pretty winded after being active for about 5 to 10 minutes (like in therapy or playtime).  Unfortunately, this is where the possible trach would come in if things become more severe.  We just got to hope that they get stronger now that her liver and spleen are getting smaller.

* Ocular Motor Apraxia.  Nothing new to report there.  She has it, and she has supranuclear gaze palsy.  She is learning to thrust her head to get her eyes where they need to go quickly.  For example, if she hears something on the side of her, instead of just turning her head or her eyes like a normal person does, she thrusts her head and neck pretty hard to get her eyes there.

* Food issue.  Yes, we know she has neurological issues with her tongue.  She doesn’t know how to use it to eat solids.  We are working on that.  We are slowly seeing some progress, and when she is “on a roll,” she can finish a jar of baby food in about 45 minutes.  It just takes her a LOT of work to figure it out.  Dr. B. wants us to go to the 9-month+ formula in addition to the baby food.  We are still working with OT on this (actually, they are coming today!).

Just sucks… don’t know what else to say…

National Institute of Health visit almost set!

We have a date for our NIH visit to meet Dr. Ellen Sidransky and her team, including Dr. Ozlem Goker-Alpan.   July 13th through July 18th. 

We’d have to leave Monday evening since Hannah has her Cerezyme treatment at TCH that morning, and we USUALLY get out of there by 1:00 PM, but after last week’s delay, we didn’t get out of there until 2 PM because the pharmacy was late.  So, we want to make sure we have time to make it.  We would return home that Saturday. 

They had first mentioned keeping Hannah in the hospital during our 5-day visit, but I asked if we could please stay at the Children’s Inn there so we could be more comfortable and have freedom to just move around.  I can’t imagine keeping her cooped up in a hospital crib for five days, especially if she isn’t being treated for anything!

I’m really looking forward to meeting Dr. Sidransky, as I have talked to her on the phone a few times.   She sounds like a very impressive and passionate doctor.  She has been studying GD2 and GD3 for many, many years.  They really want to see Hannah since she this new mutation is pretty rare and never seen in combination with the 84gg.  Because the D409H carries cardiac problems associated with it, she agrees that we need to have an echocardiogram for Hannah as well as check for minor hydrocephalus.  They also want to do the skin biopsy to see if they can tell type 2 or type 3 as well as a couple of other studies.

As I mentioned before, my aunt and uncle live a block away from the NIH, so we will have family close by, which is great.  Daddy is really disappointed he can’t go, but he just can’t take any more time off of work.  Also, we just can’t afford to bring Abby and Ethan with us (even though me and Hannah would be paid for), so Daddy will stay home with them. 

What is interesting is one week after we get back from the NIH, Hannah will be turning ONE YEAR OLD!  What a milestone we hit!

Physical Therapy, SureStep, and Supramalleolar Orthosis

We started physical therapy at TCH yesterday. During her assessment last week, she was found to have “scattered skills,” meaning that her skills ranged from the 4-month level to the 8-month level. She has incredible upper boddy chest strength but incredibly poor abdominal and trunk strength, which is what is possibly causing most of her skill setbacks because she is using the wrong part of her body to do certain tasks.

Common sense tells us that because her abdomen was so huge that she compensated by using her upper body and her shoulders to get done what she wanted to do. Explains why she can sit, but she can’t get to a sitting position or crawl.

Today, Pam, her therapist, also noticed that she has low tone in her lower legs and ankles as well as no arches in her feet. When she stands, she rolls her ankles or angles out her feet to try and balance.

Mommy and Hannah’s homework:  The homework for this week is:  1) positioning Hannah in sitting with her hips leveled with or slightly higher than her knees to facilitate weight bearing through her legs ; 2) encouraging Hannah to lean her trunk forward when moving into the stance position so that her body weight is shifted anteriorly onto her forefoot, bilaterally, instead of her heels; and 3) encouraging Hannah to stand while holding on to facilitate balance reactions in the stance position.

So, she wants Hannah to get orthopedic high-top shoes called Supramalleolar Orthosis (SMOs) from SureStep.  They are similar to the picture on the left.   “The SureStep system is designed around the child with low muscle tone. It is a truly remarkable early intervention tool to help stabilize and align the lower extremities of children with hypotonia.”

The cost of these custom-fitting orthotics?  $1300 A PAIR (made by a local company because they are “custom”)!  And she would probably need a new pair EVERY 6 WEEKS until she figures it out on her own.  I hope our insurance company will cover it because there is no way we can afford these.  Pam is going to write a medical letter of necessity and ask Dr. B., our pediatrician, to write a prescription for them.

We’ll see how that works out…

10-year-study solidifies strong link between Gaucher’s Disease and Parkinson’s Disease

Today is an INCREDIBLE day in the world of Gaucher’s Disease!  Two very important studies came out in the past day or two that have not only proven the strong link between Parkinson’s Disease and Gaucher’s Disease, but they will also open the eyes of many Parkinson researchers and biopharmaceuticals towards Gaucher’s Disease!  

Is GD23 similar to a “childhood Parkinson’s Disease?”  Now that this genetic link between PD and GD is here, it is time for researchers to realize that researching the babies of Gaucher’s disease with the neuronopathic type is critical to understanding Parkinson’s disease.  Gaucher’s Diseases types 2 and 3 share so many of the same symptoms as Parkinson’s disease such as supranuclear gaze palsy, balance problems, fine and gross motor problems, fatigue, and swallowing problems.  It cannot be just a coincidence that these two disease share so many of the same symptoms!

It is time to reach out to organizations such as the Michael J Fox foundation, the National Parkinson foundation, and the Parkinson Disease Foundation and say “Hey, our kids may hold the key to understanding your disease!”  

Not only that, but the pharmaceutical companies that make Parkinson’s medications such as Sinemet, Stalevo, Parcopa, Cogentin, Artane, Eldepryl, Zelepar, and Azilect need to be looked at more closely to see if there is something within those medications that can be reformulated and used to possibly help our gaucher kids!

Association between Mutations in the Lysosomal Protein Glucocerebrosidase and Parkinsonism
A body of work has emerged over the past decade demonstrating a relationship between mutations in glucocerebrosidase gene (GBA), the gene implicated in Gaucher disease (GD), and the development of parkinsonism. Several different lines of research support this relationship. First, patients with GD who are homozygous for mutations in GBA have a higher than expected propensity to develop Parkinson’s disease (PD). Furthermore, carriers of GBA mutations, particularly family members of patients with GD, have displayed an increased rate of parkinsonism. Subsequently, investigators from centers around the world screened cohorts of patients with parkinsonism for GBA mutations and found that overall, subjects with PD, as well as other Lewy body disorders, have at least a fivefold increase in the number of carriers of GBA mutations as compared to age-matched controls. In addition, neuropathologic studies of subjects with parkinsonism carrying GBA mutations demonstrate Lewy bodies, depletion of neurons of the substantia nigra, and involvement of hippocampal layers CA2-4. Although the basis for this association has yet to be elucidated, evidence continues to support the role of GBA as a PD risk factor across different centers, synucleinopathies, and ethnicities. Further studies of the association between GD and parkinsonism will stimulate new insights into the pathophysiology of the two disorders and will prove crucial for both genetic counseling of patients and family members and the design of relevant therapeutic strategies for specific patients with parkinsonism. © 2009 Movement Disorder Society

Researchers believe they have found genetic cause for Parkinson’s disease
A team led by Shoji Tsuji of the University of Tokyo, and Tatsushi Toda of Kobe University discovered that those with a mutation in a gene called GBA are 28 times more likely to contract Parkinson’s disease. They now hope to use their finding to explain exactly how the disease is caused, and develop a treatment.

There are an estimated 150,000 cases of Parkinson’s disease in Japan. In 90 percent of the cases, however, they are the only members of the family to contract the condition, and the genetic component of the disease has never been identified.  However, the team noticed that the GBA gene, which is responsible for causing an unusual condition called Gaucher’s disease, also showed a mutation in those with Parkinson’s disease. They examined 534 Parkinson’s patients and 544 healthy people, and found that 9.4 percent of those with the mutation suffered from the disease, and just 0.4 percent did not. They also discovered that those with the GBA mutation contracted the disease around six years earlier than those without.

“It’s the first time that a risk factor has been this clearly identified,” said Tsuji.

Happy Mom’s Day

This Mother’s Day is bittersweet for me. I’m so glad that I will be able to spend it with my hubby and my three children. Hannah is still stable, thank goodness. We will be adding more therapies into her routine due to developmental delays, but she is still a very happy and smiling baby!

But I reflect on this holiday, and I can’t help but wonder what next Mother’s Day is going to be like. Will Hannah even be here with us? Will she still be stable? Will her condition progressively deteriorate?

As a mom, our “job” is to prepare our children for the future. I do that with Ethan and Abby. I admit that I don’t do that with Hannah, as I don’t think my heart will allow it. With Hannah, I just love her as much as I can and give her all the cuddles, snuggles, and kisses I can. The same rules just don’t apply when you are faced with losing your child to a horribly debilitating disease like neuronopathic Gaucher’s disease.

But I am now finding that I am not alone fighting this disease, as I have found 10 other families with children still fighting this disease as well as a number of families who have lost their children to this disease, including little Josephine who passed away a couple of months ago at the age of 9 months old with Gaucher’s type 2.

Hannah is 9 months old…

You can meet some of the other families with children fighting this disease by clicking the GD23 link at on the top bar.  Their stories are so important. Hannah is not alone. I am asking your help to continue to fight for Hannah, but also to join the fight for the other children.  Fight so that other moms can have their child home with them next Mother’s day and not worry about losing them.

Please help my daughter live. Please help the other children with Gaucher’s type 2 and 3 live.   Please help me fight to keep Hannah here and as healthy as possible for my  next Mother’s day.