This Is Where the Healing Begins...

That's the song by Tenth Ave North that was playing on the radio at 5:15 am as Mason and I headed to the hospital for his repeat MRI, (mainly to determine the status of his tethered spinal cord so the neurosurgeons could schedule his surgery sometime in August). It felt like God was whispering those words straight to my heart, and I prayed that it could be true for our guy ... I can just imagine the sparks flying as His grace comes crashing in :)

Mason was cheerful all the way to the OR by 7:30 am, giggling his cute little way down the hall with the nurses. The rest of the day was long and hard...the best part of it all is that they were able to sedate him with gas before they tried to get an IV going, and intubation. They put in a catheter too to do a test when he woke up to see how his nerve function/spinal cord was performing. When he came back (3 hours later) to recovery, at first glance he was doing well...

But then it became clear that he was getting another roaring case of stridor from the intubation, so he was wheezing and honking like an awful case of croup. He really started crying in distress after about 15 minutes in recovery. (We told them in advance - several days actually - that he was a tough intubation and they promised to use a special device to make it less traumatic but clearly it was still pretty rough for his lungs.) They tried 2 albuterol treatments with no help and he was so miserable with sore throat and lungs that he was mostly inconsolable the rest of the day. Finally a dose of Decadron (sp?) steroids and Tylenol brought him to a more comfortable level and he was able to get a little sleep before his test.

The IV on his arm was really bugging him too...the one that took no less than 15 (should I spell that..FIFTEEN holes all over his body to get in him???) His ankles and arms look like he got into hornets :( I had also asked the anesthesiologist to use the ultrasound guide to find a spot faster like last time...clearly he ignored that bit and chose instead to use Mason as a pincushion. Sigh. So note to self....(a note that has already been added to his Plan of Care at the hospital since it apparently carries more weight than mom's pleading) ...ALWAYS use ultrasound guidance for Mason getting IVs and labs...and ALWAYS use preventive Decadron/and or Tylenol when he's still in the OR to try to head off the stridor (takes a good five days to resolve once it hits). Anyway, the stridor so bad they wouldn't let us leave and kept having the doc come in to re-check him before he was allowed to be discharged for his test. That took another very distressing hour and we had to go back to the surgery area to be checked again. We were double rooming with a poor little guy getting his tonsils out and he was in bad shape too...couldn't stop throwing up :( Finally around 4 pm we got the all-clear and finally were able to get a proper meal in him around 5:30 that night.  The next day Mason started feeling even worse, but his stridor was a little improved...seemed like another UTI with soaked diapers/bed, not sleeping, fever, diarrhea, etc. The catheter probably helped it along :( The test at the ped's office came back positive but they weren't convinced it was "real" vs. contamination so we are waiting for the full culture results before having to add another antibiotic to the regime. That is a current prayer request...antibiotics just make the UTI trouble worse in the future, and his eating/tummy issues worse while he's on them. We're hoping he gets better without all that!

In the meantime we didn't have to wait long for the MRI results...which were a HUGE and WONDERFUL suprise!!

The next day we found out his tethered spinal cord is... NOT TETHERED ANYMORE!! Meaning, where the cord was originally adhered to his spinal column as a newborn and they were worried it was stretching/pulling as he grew and would need to be freed surgically to avoid nerve damage - it wasn't just not tethered, they said it now appears NORMAL!!! :D (previously it was also too long and had an abnormal fatty area at the bottom. SO NO SURGERY!! And no laying on his tummy 96 hrs sedated with a ventilator!!! No repeat cath test after the surgery because there will be NO surgery!! WHOOO HOOO!! Hmm... I wonder Who could've had a hand in all that? There's that music again... "This is where the healing starts..."  !!

It gets better :) As for his brain, he does NOT have a Chiari Malformation. :) So no decompression surgery either!! DOUBLE YAY! He does still have Dandy-Walker Variant. No action to take there. He does have new lateral ventricle swelling in his brain but the neuro assured us, it's NOT fluid :D So no shunt surgery needed!! TRIPLE YAY!!! And his brain growth is slowed which we kind of expected. And the missing/undeveloped area of his brain is the part controlling, in part, his trunk and that's the reason for his profound hypotonia especially upper body. She thinks with good PT he'll be able to overcome it, in his own time :D QUADRUPLE YAY!!

The only thing we're still unclear on is if he has "Molar Tooth Sign" (a symptom of one group of syndromes, COACH/Joubert-related syndromes) - we sent a question to the radiologist about it through the anesthesiologist since genetics had wanted us to ask them to rule that out, but I guess he didn't pass that on.


In other good news, Mason is getting glasses! He won't get a huge benefit from them visually but it should help some nearsightedness/astigmatism and anything is better than nothing when it comes to sight :) It should also help protect his good eye since it's the only one he has really any vision in. And he gets some transition lenses with them too since he is so photosensitive outside... I can hardly stand how cute he is in them!

It will take about a week for them to be ready to pick up...then there will be more pics of course :D Anyway all we can say is PRAISE GOD...HE IS GOOD, ALL THE TIME :D

LOTS to Update

Whew...after a WONDERFUL vacation to Orlando for a week (just Biscuit and I - Daddy and Grandma stayed home with Bear) that included lots of family time and celebrating my Grandpa's 80th birthday, a trip to Clearwater Beach, Rock Springs, Downtown Disney, an uber-fun splash park, and lots of other adventures, we hit the ground running back at home with a string of drs and lots of news. It's shaping up to be one busy fall! Here's what we know right now:

The good news...

1. Mason had his first swallow study and passed! No consistencies of food (fluid or thickened fluid or purees) caused him to aspirate food into his lungs. This is AWESOME news - especially considering he was screaming his head off. However, he did reflux some of the milk into his nose and was diagnosed with "severe dysphagia (difficulty swallowing) secondary to severe oral aversions." We have the green light to let him try solids in small amounts, twice a day, at least from their department ... the OT said to avoid the fluids for now since he had them in his nose and that's no fun and will make him even more aversive to drinking until he can learn to not reflux...we're trying to make it as pleasant as possible so we can save the liquids for later.

2. Mason had allergy skin prick testing (this itself wasn't any fun for him - he again screamed the whole time because not only did he itch but he had to lay on his tummy for 15 solid minutes and was not a fan to say the least) ... but the good news is, he wasn't IgE allergic to ANY of the five biggest food allergens or dust or mold - not even peanuts, so this was wonderful considering Micah's history. The question mark is how eating by mouth will affect his GI tract (right now he doesn't tolerate volumes so he can handle tastes but once he starts getting regular amounts by gravity not pump it may have to be slow going on that.... they are optimistic that he will tolerate puree volume better than fluids.)

3. Mason had x rays taken of his adenoids which showed that they were not too big and didn't need to be removed - they weren't contributing to his constant night-time nasal congestion! :)


The not - so - good news...

1. Mason had to have immunology testing. We've had this coming a long time and it needed to be done, but I dreaded it and for good reason. The amount of blood needed for this workup was astounding. The limit for blood from a baby his size was 20 mL , the max in a month like 45 or 50. They needed 35 mLs. The sheet of lab stickers had to be lifted over my head and fell to the floor to view them all, it was like SIX FEET LONG, not kidding!! So they were planning to split it into two blood draws. This in itself is a disaster with Mason because every blood draw is such an ordeal - not only are his veins microscopic and wobbly, they are now buried under several layers of baby chub. So the tech basically took one look at him, remembered how hard of a stick he is, and called the transport nurses. They spent about thirty minutes with a tourniquet, systematically going around all his veins. Just the forceful rubbing and tightly-pinched band bruised him right up and got him majorly stressed out. Of course they couldn't find anything either - they made ONE attempt (a long, painful attempt that brought me to tears) in his foot using an IV catheter since they were afraid the vein wouldn't hold out for that much blood - and even with the catheter, it blew out before they had 2 mLs. At this point they said they would call the "resource team" to bring someone with an ultrasound machine to try to find it. I told them they could try once with the ultrasound and if they didn't get it that was it. The lady running the machine said "We're gonna get it, Lord willing!" The lady helping said, "We really should get a nun or a sister to pray for us." The first answered, "Oh no...we don't need anyone to do it for us. We've got it covered..." I was thankful for the direct route too and was praying right there with them, and He answered bigtime, because not only did they find a big juicy vein on the first try - they were able to get ALL 35 mLs and even enough for some thyroid labs for endocrinology that were also due. So no return trips for labs anytime soon, praise God!! Mason still had a lot of trauma from the ultrasound stick because they strapped him down and used an arm board to get him super still so he was very freaked out and majorly stressed out and sweating ... then we had to go out to the 95 degree oven of a car...I think he actually had a small seizure in the car from the stress plus the heat, but by the time I got pulled over with the oxygen he was back to himself. All in all it was a very bad memory that we hope to all put behind us but VERY glad it is over but especially that so many things about it worked out for good - especially being able to get all of it in one day (the doc had called to tell them that all 35 mLs would be safe at once...cutting it close, but safe.)

2. Mason has immunology results...at least from some of his labs. And although we have to wait a few more weeks for more definite explanations, what they know is that Mason DOES have a serious immune deficiency :( In laymen's terms, no it isn't AIDS or Bubble Boy syndrome, but the same basic problem - his body will be subject to recurrent infections due to the inability to effectively fight off infections and we will have to be very careful what he is exposed to :( That is why he has already had so many infections, so many times - ear, eye, UTI, gtube, sinus/cold, etc. We don't know how severe his is yet, or if it's expected to get better before he's ten or be lifelong - only that he must have SOME immune protection since his levels are all low, not absent, which means he at least is making SOME antibodies (praise God!) This I would hope rules out the most severe primary immunodeficiencies but they are pretty concerned about his lack of protection right now and want him on antibiotics all the time as a first step.  They will give us further recommendations once we get all the labs in, as to what PIDD ("primary immune deficiency disorder") he has (over 120 different ones?), prognosis, treatment, etc. Right now we know he is low almost across the board of immune globulins - IgG, IgA, and IgM and he has been put on Cefdinir. This itself presents problem because when he is on antibiotics he tends to get real congested to the point of it sounding like he's drowning at night, and bad bad cramps - we never know if he's allergic to the drugs, or just snotty because of an infection (he runs a fever almost all the time). I checked into getting donor breast milk for maternal antibodies to give him some extra protection (since he didn't grow an ounce in three weeks on mine, even fortified with formula, presumably due to the presence of too much thyroid hormone) but the doctor said it wouldn't help nearly enough to get him into the range of antibody protection he needs. :( And the small adenoids, as it turns out, may not be so good as I thought when he was saying how they were "quite small" and not obstructing breathing - small adenoids are a sign of the more long term immune problems. So we ask for your prayers that it is temporary and gets better on its own. This condition is also able to affect his GI system / food tolerances as immune deficiencies often cause inflammatory bowel disease , celiac sprue and other autoimmune issues . Please be in prayer for my cousin Jake who was just diagnosed with Ulcerative Colitis and his immune system might be part of the problem too :( And for Micah, who is chronically sick with every virus under the sun and ear infections one after the other again now that his tubes are out (just went to the doc for him for sinus infection today, after being up almost all night long with the loudest screaming boy in the city, guaranteed. Sorry to the neighbors! - they won't allow new tubes again until he's had 5-6 new infections this year!?? he's already had ruptured ear drum, doesn't that count for something?) Since these immune problems are genetic and Micah's allergist has tried to do this same immune workup on him several times already, but we haven't been able to get all that blood, we are very concerned that whatever is happening with Mason's immune is affecting Micah's too in a similar, but lesser way - he has constant mouth ulcers and terrible GI pain and related problems himself too and no real answers there either.

Ever stronger boy, ready to keep fighting no matter what his immune system says ....

3. Mason had his Mylomengicele Clinic to see Neurosurgery and Orthopedic. For the neuro part, he is due to have surgery for his tethered cord within the month. In order to do that he has to have a repeat MRI of his brain/spine to be sure his cord is still tethered. He also has to have a bladder function study before and after to see how the lower spine is functioning now, which they will attempt to get while he is sedated for the MRI. The orthos are concerned about Mason's lack of muscle development in his upper body (he can't breathe if we put him upright as if to stand - he has so much weakness in his shoulders he just hunches forward - they said he actually has more than low tone there - he doesn't even have muscles developing there at all :( And his arms and hands are very weak so they are looking for a specific malformation, a Chiari malformation, on his MRI , to see if the weakness may be caused by spinal compression (this is apparently pretty common in those with hereditary connective tissue problems like joint hypermobility, which we have, and we were actually told Mason had the Chiari in the NICU until someone said it was wrong interpretation, instead it was Dandy Walker, etc - if he indeed has the Chiari, that may (depending on type) be surgically treatable and could give him back some of his lost function in these areas. We pray whatever they find, is treatable easily and really frees him up to do all the baby things he is so eager to do but just physically doesn't have the strength for. They also want to get him a stander when he has his cord released to help get him weight bearing since we can't do it holding him up due to the breathing issue/too much pressure on his chest. The tethered cord surgery is supposed to be fairly easy but requires an ICU recovery the first night, on his tummy (ugg, looong night) and 2-3 total stay. All his surgeries are more risky for infection too due to the immune issue, so that is a HUGE prayer request, as when he recovers from the cord surgery, presumably in August, he is due to have another surgery in September. Speaking of hypermobility, these are all issues with Micah too and we have to address it at his 4 year checkup as he is so weak and loose in the upper body that he can't hang by his arms, like for the monkey bars, without them easily coming out of joint, and his ankles are real floppy so he twists them a lot. etc...

4. The MRI/urodynamics study and 2 surgeries will all require IV sedation/anesthesia, so please pray we can have it handled very smoothly for him - that the teams will be willing to make special arrangements to minimize his stress, like Versed before the MRI stick, and possibly gas in the OR before the IV is placed, and the use of an ultrasound both times to minimize the sticks (they did the gas before the IV during ear tubes and he never felt a thing, it was wonderful!!)

5. Mason outgrew his Mickey button so he's getting a bigger one tomorrow, Lord willing, after a search around the region to find someone who had the right size.

So . A lot to swallow (literally and not so much) in the coming weeks; not a fun time for our little bear, or biscuit for that matter, or any of us. But we are praying and hoping it is all for good and SO worth it! :D

Praise be to the Lord, to God our Savior,
   who daily bears our burdens.
 Our God is a God who saves; 

Summon your power, God...
   show us your strength, our God, as you have done before.  (Ps. 68:19, 20, 28)

Is It Genetic?

Mason had his 9-months genetics consult recently. He is still a puzzle to the team but he has features of the following genetic conditions so they are interested in watching him for other signs of any of these as he grows to determine if he will need testing.

*Rubenstein-Taybi Syndrome (if Mason has this syndrome, it's probably not caused by mutations in the usual RSTS genes, but instead, is a new variant of the syndrome caused by the deletion he and I share--one of the  genes we are missing interrupts signaling pathways for both RSTS genes. They do not know at this point if the deletion is the main problem, but because of his brain malformation, colobomas, broad thumbs/toes, thick, dark, curly head of hair, feeding issues and narrow nasal passage etc they think this possibility is "intriguing." (Ironically ,before we ever got the results of his karyotype and microarray at a few weeks old in the NICU, we asked the docs if he could have this syndrome; they assured us "definitely not." Now it seems high on the list of possibilities. We have found so many friends online whose little ones have the classic versions of this syndrome and have been very encouraged with the progress we are seeing in them, and have found much so much in common with Mason. In this case, if this is the problem, then it is definitely genetic and we have up to 50% chance of passing it on to another child (for that matter, Micah could have the deletion too, but he and I may have a mosaic version of it --not in as many cells as it is in for Mason (the only way to test for that would be an invasive procedure and they won't do it without another reason for a surgery).

*Mosaic Trisomy 13 (Mason will probably get a test for this when he is about a year old when he is sedated for other procedures to be sure this is not a hidden genetic issue in the family. Trisomy 13 and Rubenstein-Taybi can mimic each other clinically and our family has some physical signs of genetic issues like mosaicism or possibly a translocation even in otherwise healthy individuals - for instance, me, Micah, Mason, Dad, etc. all have persistent epicanthal folds around our eyes (you can see if you have them by gently pulling downward on top of

 your nose on either side) - but according to National Institutes of Health, "A child who is not Asian and is born with epicanthal folds may be examined for additional signs of Down syndrome or other genetic disorders."  If you or your kids have these somewhat obviously and you are not of Asian descent, it wouldn't be a bad idea to get genetic testing in my opinion, even if you are "basically healthy." (It can be an innocent trait or not, like so many other genetic issues--if you have it in combo with other genetic type health problems it's more likely to be significant in some way - I was also born with eye trouble/strabismus and my head is very small, etc - still not sure if it matters or not).

Prominent epicanthal folds are common in Rubenstein-Taybi, Trisomy 13 and various genetic conditions including Ehlers-Danlos Syndrome (a similar hypermobility issue to EDS also runs in our family - there are some wacky things my mom, Micah and I can do with our joints/skin/connective tissue, etc....

hypermobile hands/fingers/thumb

hypermobile wrist/thumb

"Gorlin's Sign"

missing frenum is specific sign of EDS - Mason's is either missing or malformed, dr isn't sure

Regardless, I strongly feel that something is going on that is both subtle and hereditary in our family, especially if the deletion is not the main issue, and if so, it is not necessarily "a remote chance of recurrance" as we were first told by the docs, and in fact could be highly likely to recur (with mosaicism the mom/carrier could be practically asymptomatic but the baby could be affected fully or to varying degrees). I'd be relieved to know if it was just a one time thing but it's hard to believe for me at this point in time.

*Joubert/COACH syndrome (Mason has colobomas, developmental delay, incoordination and facial features somewhat similar to this syndrome as well; if neither of the first two options are evident this one is another possibility (when he has an MRI later this year they will try to rule it out with more specific pictures of his brain). If this is the problem it is likely a combo of mutated genes given by BOTH Brian and I and means the deletion is probably not the issue (though it still could be if the deletion also causes this syndrome and researchers haven't discovered that gene connection yet).

I also asked the team about a study I read about where National Institutes of Health docs would check his entire genome for mutations instead of having to just guess where the problem is out of so many possibilities. They are providing Mason's info to the NIH to see if he would qualify for the study. The advantage of this would be one testing session that would let us know all the possible mutations instead of him having to have repeated testing as he grows to investigate various possibilities. The disadvantage is we may find out "TMI" (more than we ever wanted to know about what could happen with other problems he may or may not have), and we would have to most likely go to the NIH in New England for the testing.

Why does it matter? Some of these syndromes bring with them certain severe but subtle conditions that no one would even know to test for unless they know you have that syndrome. That means, without knowing the underlying condition, things that are severe could pop up without warning, too late to do anything about it, whereas if we know what to watch out for, we can be pre-emptive about screenings. That is the main reason we'd like to know what we're dealing with - to get him the best health care possible without having to wait for things to surprise us - to the extent possible (we know there will ALWAYS be surprises with Mason, and in life in general).

Is it genetic? We may never know this side of Heaven. What we do know...Mason is a joy and a treasure and he has the happiest disposition and attitude of anyone I know :D See for yourself...

"Our mouths were filled with laughter, our tongues with songs of joy. Then it was said among the nations, “The LORD has done great things for them.” Ps. 126:2

Wordless Wednesday

Do-It-Yourself Shopping Cart Seat for Hypotonia! :D

I have been looking high and low for a solution to the grocery cart/restaurant problem for Mason. That problem being, he doesn't have enough head and trunk control yet to ride in the front unsupported (or sit in a high chair at the restaurant), but is quickly outgrowing his infant car seat (which doesn't fit too well in the cart anyway). All the cart covers you can buy are nice but they don't have much support, just a lap belt or maybe simple shoulder straps but nothing substantial enough to handle Mason's low tone right now.  So here's how we worked around the problem...so far, so good!!

I found a soft, stretchy fleece zip-up shirt in a few sizes bigger than Mason wears ($3.50 at Once Upon a Child!!), and cut off the sleeves (so it's not too hot to wear) and use it as a harness to "zip him in" safely against the back of the cart with a cushion or blanket behind him; most of the carts have metal bars/slats as the back of the seat so the shirt can be wrapped around these easily before I put him in it and zip him up. It really holds him well and makes him comfortable! He sure enjoys this view and loves checking things out as he rides around the store! I'm hoping other moms in a similar situation are able to adapt this idea and use it with your little ones too, to simplify things a bit, especially if you have to do your shopping with more than one kiddo :)

For restaurants, if the chairs are slatted like this one, it works as a booster/safety seat too. :) His PT approved and says it's helping strengthen his chest/trunk muscles to sit like this (we do it for playtime throughout the day) and sure enough he is starting to lift his head and chest much more in tummy time now!! :D

UPDATE: it actually works even better turned backwards, zipped up the back...so the top of the zipper doesn't rub his chin.

Carry each other’s burdens, and in this way you will fulfill the law of Christ..." Gal.6:2