6 Minutes

Our day began as all Saturdays do: kids get up at the crack of dawn and Derek and I pry ourselves out of bed, barely functioning. Luckily today, I decided it would be a good morning to clean the carpets and then go outside to plant flowers and do some yard work.

Around 8:00, I began some laundry and steam cleaning the living room carpet. Derek was starting breakfast for the kiddos and it seemed like a typical morning. Until it wasn’t.

I take steam cleaning very seriously, so I was concentrating on making sure I was getting every spot of the rug. Roslynn was on the couch watching The Phantom of the Opera: Live at Royal Albert Hall for the 500th time and Derek was still in the kitchen, starting pancakes for the kids. When I run the vacuum or steam cleaner, Greyson is typically running around and stimming on the sounds of the machine, but this time he wasn’t. I looked around and noticed Duke (the dog we got to train as a service dog but then definitely was too hyper for that) was laying on the dining room floor nudging Greyson with his nose.

Mr. Duke

Duke typically is not one to be all over the kids, so I thought it was strange that he was so close to G. I took a closer look and noticed that Greyson was face-down on the dining room floor, convulsing and unresponsive. I turned him on his back and noticed he was foaming from his mouth pretty heavily, so I gently rolled him on his side and made sure the area was safe. THANK YOU WELLSPAN FOR FORCING CPR AND FIRST AID TRAINING ON ADMINISTRATIVE STAFF! I knew what to do and felt confident in the situation because of the training I have received through work.

I yelled and got Derek’s attention and told him to call 911 immediately. I noticed that Greyson’s lips, hands and feet were starting to turn blue, so I checked for a pulse and breathing. I found a heartbeat, but no breathing, so I gave him an emergency breath, like I learned in CPR class. After a breath, I checked his chest again and he was still not breathing. I gave another and he finally gasped for air. This was all happening while he was still stiff and convulsing. I administered his emergency seizure medicine, as I was shown how to do when we first were prescribed the medicine in March 2018. After a minute, the convulsions stopped.

Derek gave the 911 operator our address and explained the situation, while I tended to Greyson, who was still not responsive. From the time the seizure started until the ambulance arrived, it was a total of 6 minutes. The longest 6 minutes of our lives.

Once the paramedics came inside, they took over. They checked his vitals and I informed them of the situation and what exactly happened, including a list of his prescriptions. Derek hopped in the ambulance and rode to the emergency room with Greyson. I grabbed his medicine, medical records and threw some shoes on. I had called my parents to let them know what was happening and that I needed them to watch Roslynn so we didn’t have to take her to the ER too.

Greyson woke up in the ambulance as soon as it was turning into the LGH parking lot and was drowsy and annoyed that people were bugging him. They took him back to a room and I met up with them about 15 minutes later.

The next two hours were a whole lot of waiting. They got him some juice, which he was happy with, and he fell back asleep. The doctor came in and informed us that Greyson has a break-through seizure, which is common in children with epileptic brain activity. The type of seizure he specifically had was a Tonic-Clonic Grand meal seizure, which included tense muscles and convulsions. The entire episode lasted about 10 minutes and because of our CPR and First-aid training, we were able to control the situation and get him the help he needed.

Greyson is ok. Derek and I were shaken up, obviously because he has never stopped breathing like that. The next 48-hours will be a lot of monitoring, but he should be back to his normal self once his diazepam wears off.

The most important thing I have learned from this situation, is that first aid and cpr training seems repetitive and boring, but it really can come in handy when you least expect it. I am extremely grateful I work in the medical field, because otherwise, I would have had no idea how to handle this situation.

And for Duke…..he will get an extra large bone tonight after his dinner. I might even let him sleep in my bed tonight, too. 🐶❤️

Advertisements

40% vs 1%

Today we headed down to Baltimore again for our genetic testing results and a neurology follow-up. Again, another early morning commute down I-83 aka the construction highway, to an appointment that we may or may not receive answers or recommendations from.

Ready for the road trip

I was exceptionally nervous today for the appointments. We have been waiting for genetic results since December 2017, when we began the genetic testing process. Fully anticipating not getting any real answers, I didn’t want to get my hopes up that we were going to find out what has caused Greyson’s disabilities.

I drove down I-83 with countless thoughts in my head. What if they did find something? What if they didn’t? Should we pursue more options or tests? What else could we be doing for him to make him the most successful? I attempted to keep my mind off of the “what ifs”, and tried to distract myself with vacation discussions with Derek.

Once in Baltimore, it was the same routine: drop the car off with vallet, check-in at security, then with the outpatient clinic, then finally the nurse brings us back to start the appointments. The moment we stepped into the consultation room, G started crying and throwing a tantrum. I thought we were well prepared for the trip, fully equipped with snacks, juice, books and toys, but nothing seemed to calm G.

Finally, Dr. Julie Cohen, the genetic counselor came in the room and after a very brief greeting, cut right to the chase. My leg was shaking as we waited for the answers to all of my questions I frantically thought about on the drive down. When we had the samples taken from Derek, G and I in December, we knew the odds were not very good for getting an answer- a 40% chance of getting an answer, to be exact. Julie said that we “sort of” fit into that 40%, but not really. What does that mean?! We have an answer and a reason “why”, but it’s not a 100% today.

The entire exome sequence analysis showed only one variant in Greyson’s DNA makeup. Gene STAMBP, specifically variant p.R78X, which is responsible for MIC-CAP disease: Microcephaly-Capillary Malformation Syndrome. This variant is a heterozygous, autosomal recessive gene that was inherited from a carrier parent, and a “likely pathogenetic variant” contributing to G’s symptoms.

In people with microcephaly-capillary malformation syndrome, microcephaly begins before birth and is associated with an unusually small brain and multiple brain abnormalities. Affected individuals develop seizures that can occur many times per day and are difficult to treat. The problems with brain development and epilepsy lead to profound developmental delay and intellectual impairment. 

In G’s case, he only had one variant, which means only one parent was a carrier, often leading to a non-effected child. Because this disease is so incredibly rare, less than 1% to be exact, it is extremely difficult to detect. Because the exome sequence only looked at the overview of the chromosomes, there may be more variants that he has, that are currently unfound or undetectable with current technology. This all said, Julie did not feel that it was something that is too concerning, however, she did find that it was interesting that G presents many of the symptoms, but only had one variant. Because technology and genetic discoveries are everso changing, the lab will store our samples and retest them in two years when more information may become available.

That, in a nutshell, was the first appointment of the day.

Tempted to Google and self-research, I refrained and read the generic report that we were provided with. The nurses then came in to get Greysons vitals, which was difficult because he had fallen asleep after his 45-minute tantrum. About an hour later, Dr. Comi came out to bring us back to our appointment with her. We updated her on his development, behaviors, seizures and migraines and similar to what Dr. Stein stated earlier this month, confirmed that G was stable on his current meds and dosages.

She then pulled up the genetic testing report and connected the dots between the STAMBP variant and Greyson’s current symptoms. Commonly, children with MIC-CAP have one or more of the following symptoms:

    Severe Microcephaly (G does not have)
    Congenital Cutaneous Capillary Malformation (His Port-Wine stain)
    Infantile-onset epilepsy (He has)
    Profound developmental delays (He has)
    Whorled hair pattern (He has)
    Dysmorphic Features, such as cleft palate, thin lips, low ears, flat hairline and extra webbed fingers and/or toes (G doesn’t have any of these)
    Loss of normal protein function (He doesn’t have)
    White matter brain loss (G has)
    Thin corpus collosum and other non-specific brain abnormalities (He doesn’t have)

Coincidentally Greyson shows several of these symptoms, but because only one variant was found and research is extremely limited on MIC-CAP, Greyson is considered a carrier but not effected. Though not effected as of today, there have been cases that show a child to have MIC-CAP that has been inherited from only one parent and not both. This is extremely rare and not common, but we seem to hit the genetic jackpot everywhere else, so why not this too? The report goes on to state that:

“We interpret R78X as a likely pathogenic variant, related to the port-wine stain, seizures and global developmental delays found in this client.”

So basically, G fits into both the category of 40% no definite answer found and the 1% of the extremely rare variant that causes MIC-CAP. As of 2019, we know that it is so rare that he has an extremely mild form of MIC-CAP, but in two years, he could have the diagnosis. In conclusion, the report also offers another open-ended question after stating:

“While no other potentially disease-associated variants were identified by exome sequencing of the STAMPB gene, it is possible that this individual harbors a second variant that is undetectable by this test.”

So, he could have this rare disease, but a less crippling form? As of 2019, it’s a maybe, but come 2021, it could likely be a definite.

One last test that could show the second variant needed for the positive diagnosis, is a skin biopsy of G’s port-wine stain. Yes this is invasive and he would have a small scar, but what would be the benefit of that definite answer? Is it worth it, or should we just be content with knowing this is likely what has caused all of these issues? What good will a biopsy do if there’s not cure or treatment available for MIC-CAP? Again, we are leaving with more questions rather than answers.

After digesting all of the information accrued over the two appointments, I found it relieving to hear the fire alarm go off. A fire drill of all days, with our child that is extremely sensitive to light, sound and crowds, being carried outside on the streets of Baltimore for a fire drill. We found a nice bench and popped a squat until the alarms stopped and we were cleared to go inside and be discharged for the day.

A beautiful spring day with Daddy

After discussing all of this information with my mother (who always has the magic touch when needing to calm someone down to think about things), she gave me some great advice: “take a few days and process this information. These answers specifically will not make a difference to the past and the future at this time.” So, why worry about the future and the past? We can’t change our genes and our family inherits, so we will live for today. We will continue to support our son and help him the best that we can and pray that we find the peace of mind with this information.

A B(e)acon of Hope

If you’ve been reading previous posts, you’ll know that G’s appetite has come and gone several times over the past year. He’s extremely picky when it comes to textures and hates spicy foods (to which Derek is convinced he’s not his child). It seems that if Greyson eats something he doesn’t like, he will never try that food again, come hell or high water. That is, until he tried bacon.

This kid loves his bacon! Every Sunday while Derek and I are at church, G is feverishly finishing off half a pound of salty, crispy, fried pig. His obsession has become so intense, we now order him pizza with bacon on top. I have even debated buying bacon bits and sprinkling them on everything, just to get this child to eat vegetables or red meat. I am minorly concerned about giving him too much sodium, but I’m just happy he’s actually eating!

This isn’t the beacon of hope that I’ve alluded to in the title of this post. Today was another day, another doctor appointment with little man.

We met with Greyson’s local neurologist in Ephrata for a 3 month follow up. A few weeks ago, I called the neurologist with concern that Greyson’s cyproheptadine was losing its effectiveness for Greyson’s migraines. At that time (about 5 weeks ago), we doubled his dosage from 5 ml to 10 ml. This made G extremely tired and very very hungry. Not sure if it’s the cyproheptadine that surfaced his love for bacon, but he’s put on 5.2 lbs in a little over a month. I think that the bacon is to blame…

The neurologist said everything looks great with G! No seizure activity recently, no motor tics and his headaches appear to be under control. We have blood work to do before our next visit, but he’s in the clear for 6 whole months unless concerns arise! I am so happy that this is one less appointment we will be regularly attending. We will have a follow-up with the genetics team and neurology clinic in Baltimore on the 27th, and hopefully we will know more about what genetically is going on. Hopefully. I’m not sure if I’m ready to face the fact that we really could never know what has caused Greyson’s brain issues. Though I do feel like knowing could also be just as bad as not knowing.

Each month, the admin team at CADD meets for an engagement gathering to discuss ways we can better ourselves as individuals and as a team. This month’s gathering was about finding the positives in all situations, and how negativity and poor attitudes ultimately cause failure and is detrimental to the workplace and home settings. While watching the Ted Talks video, the speaker, Shawn Achor mixes humor with beneficial points about happiness and attentiveness to attitude.

This engagement gathering was particularly interesting for me because I have often struggled with finding the happiness in all situations, especially when you’re an exhausted mother of an autistic child. I wanted to take a tip from the video and find ways to promote my own personal happiness. I have decided that it would be difficult to write or journal about a daily moment of happiness, so I will commit to a weekly moment of happiness. My weekly moment of happiness will revolve around our journey with G and finding happiness in any situation, good or bad.

This week’s moment of happiness was Greyson’s first dance party. Now I cant take credit for this video since I was at work, but I’ve watched it at least a hundred times, and it never gets old. I’ve only seen Greyson dance maybe once for a few seconds… definitely not long enough to catch a video of it. I was extremely grateful that his BT was able to catch it and send the videos to me. See below and tell me that this tops all moments from this week. Maybe even your week. It was a close call between this and him giving me a kiss when I asked for one.

Now, don’t be jealous that you don’t have these moves yet, but hopefully Greyson will be ready to start teaching dance classes once he his age 5.

I encourage all my friends, family and readers to find a moment of happiness from this week and share it with someone else. You’d be surprised at how great you’ll feel after reliving the happy moment in your mind, and being able to put a smile on someone else’s face.

The Tooth Fairy

For the past 2 months or so, Greyson’s insurance company has been bugging me to take him for his first dental appointment. Coincidentally, I’ve been avoiding taking him for the past 2 years or so. With the amount of specialists we see on a regular basis, I really neglected his “typical” appointments. I finally bit the bullet and scheduled an appointment with a local pediatric dentist. I had a tough time finding a pediatric dentist that accepted G’s insurance, but I finally found one that did, and they were accepting new patients. Score. Unfortunately, I did not read reviews online of this particular practice before our first appointment today.

Now, I am not one to “bash” an establishment, particularly because all practices are different and people have different opinions. So, for the sake of respecting those that enjoy this particular practice, I won’t disclose the name of the group.

Now, if you’ve been reading my blog over the past several months, you know that G is not the type of child that can sit and wait. Our appointment began at 3:30 pm today, so I met Derek there with the kids. I purposely completed the new patient paperwork from the practice’s website and faxed them over in advance, so we could arrive right at the appointment time, rather than 30 mins early, as requested. I did this because I knew that there was no way this kid was going to stay quiet and sitting in one place for 30 minutes. The receptionist confirmed that she had the documents when I received the reminder phone call, and stated that arriving at 3:30 pm was fine. I never really thought that I had to anticipate arrival times and waiting rooms until G came along (and became mobile).

We arrived around 3:20 pm and checked in. Fully expecting to have a quick in and out visit, we didn’t bring a diaper bag (stupid on our part). Now, it was a pediatric office, so luckily he was occupied with toys and books that were available. 3:30 pm came and went and Derek and G were still waiting to be taken back (I took Roslynn home because Duke had to go out and she was getting restless). 3:45, 3:50, 4:00 passed and still, waiting (and running) around the waiting room. Derek was exhausted from running after G, and G was tired of waiting…. and rightfully so.

Waiting to be taken back

Finally at 4:25 pm, they were taken back. After sending several angry texts to Derek about the wait, he informed me that he was taking Greyson back, just as he was going to walk out the door from the ridiculously long wait. I thought to myself, “Geez, if our office made an autistic child wait for over an hour and a half (this includes the time waiting in the exam room for a hygienist), we would have zero clients.” Thankfully Greyson was fairly well behaved and Derek didn’t have too much of a panic attack from chasing him all over. Once the hygienist and dentist came into the exam room, they did a check very quickly in his mouth and BRUSHED HIS TEETH. No, they did not clean his teeth. No they did not polish his teeth. No they did not do x-rays or take any photos of his teeth.

THEY BRUSHED HIS TEETH

Avoiding the chair

Now, again, I do not want to bad mouth another practice, but oh my word. I could have brushed G’s teeth at home for free and without the 2 hour wait! When Derek checked G in, he was told to make a follow-up appointment immediately, before he was even seen. Derek made the appointment for early September, but after the impression we had today (and reading online reviews), we unfortunately will be starting our search again for a pediatric dentist. In an easy world, we would just take him to our family dentist office, but because of his behaviors and lack of patience, we need an office that will sedate him for cleanings. So if you have any suggestions for us, we are all ears for local children’s dentistry offices!

I hope the next few weeks will be anticlimactic. Our next big appointment is on March 27th, when we go back to Baltimore for our final (hopefully) appointment with Dr. Comi and the genetic specialist. As for now, we will take our little man to our own office in the upstairs bathroom, and brush his teeth ourselves….with no wait.