EEG, Early Intervention, and Prednisone

Vivian’s first EEG was done on Tuesday.

Ben is unfortunately sick with a cold/cough thing, so we thought it best he didn’t go to the hospital to make anyone sick. This meant it was just me and Vivian headed to the hospital. She cried the entire way there :( It was really rough.  She cried the entire 15 minutes I had to wait to get a parking spot. When I finally got her capusle clicked into our snap’n’go stroller system, she passed out from crying so much. Then of course, once we got into the appointment, she screamed the entire time they fitted the special cap on her.

The poor technicians were just beside themselves (and me too at that point), and started asking me if I’d tried this and that. I had to tell them that no, she wouldn’t take a bottle like this and that no, she wouldn’t be interested in her pacifier when she was screaming her head off. It took about ten minutes for me to calm her down again and then she passed right out on my shoulder, which isn’t something she normally does at all. It was definitely sleep from too much crying, not from being soothed or calmed. I hate it and it makes me feel like a bad mom when it happens :(

We won’t know the results for a few more days, when we are due back at the hospital at some point to see the neurologist again, and to get Vivian’s blood pressure checked.

We finally were contacted by our early intervention provider, The Champion Centre.

We should have been referred on to Early Intervention the week Vivian was discharged from hospital (first week of July), but due to whatever crappy reason, be it shit timing or lack of good procedures, we only got referred last week and there is a 3-week wait at all of the four providers in Christchurch. 8 weeks of no support there for us and Vivian, after all we heard about was that our early intervention provider would help with this or that.  I am angry about this. I am angry about a lot of things that have happened in hospital and things that should have happened in hospital but didn’t. It seems like a lot of times we have fallen through cracks in the health care system with Vivian and she’s not even 3 months old!

We had our initial meeting with someone from Champion Centre yesterday and will be going to a meet & greet on Monday to meet the team of specialists that will be working with Vivian in the months and years to come. These include a physiotherapist, a speech and language therapist and an early intervention teacher. It’s a lot to take in, and I’m not sure we made the right decision. We could have chosen to have a home-based provider, and I’m starting to think that might be the better way to go because Vivian is so easily thrown off of her feeding and sleeping if we have to take her anywhere. They will most likely do the first few sessions with Vivian at home due to the prednisone’s immunosuppression side effects, but after that we will need to take her in once a week.

Ben and I are running really low on energy this week and with Ben sick it’s been really hard on both of us. He’s been absolutely amazing even though he feels like death warmed over and taking extra precautions around Vivian to make sure she doesn’t catch whatever he has. Fingers crossed she doesn’t get sick! We have appointments every day next week, so I can’t afford to get sick either.

We started Vivian on the prednisone Monday evening.

It tastes sweet at first but then has a horribly bitter aftertaste. I think she’s starting to show some oral aversion now…she used to be a hardcore pacifier fan while falling asleep and now she won’t take it after having prednisone, unless she is very, very sleepy. She spits it out and grimaces, or grimaces if you even put it near her mouth.

Her poor tummy has been very sore yesterday and today- she has started spitting up (spilling as New Zealanders say) a bit and she’s never done that before. She is also crying a lot more than usual, and she is already a baby who cries *a lot*.

You can just tell it hurts. She brings her little legs up to her stomach and screams. And it’s messing with her bowel movements as well, giving her horrible gas and painful bowel movements. Not fun at all. And this is only the end of day 2. I don’t know if we can take 6-8 weeks of this and still have a child that is willing to eat on her own. :( Her intake volume has been down the last two days due to her not feeling well. I am doubtful she will gain weight this week at the rate she’s going and the amount of crying wasting her calories.

I wish we didn’t have to syringe any medicine into her mouth at all; this makes medicine number four, and we have to give it to her four times a day, with food, which isn’t going to create an awesome association with her food.  I thought we might be able to disguise the prednisone in some breast milk, but it’s got too strong of a taste, and some parents of IS kids have said their child refused to take a bottle after starting on prednisone, so my idea of putting it in a bottle is not going to happen.

Vivian is exclusively bottle fed because she refuses to latch for breastfeeding. My c-section, her month-long stay in NICU, the pacifier being introduced (without our permission) by hospital staff, and all these medications being syringed into her mouth have caused some nipple confusion. And my letdown isn’t fast enough or long enough for her, so she prefers the bottle. If she starts having a bottle aversion, we’re really screwed.

All of the above being said, we still managed to get a few smiles from her today and she had a long conversation with Ben after he discovered she likes it when he makes monkey noises at her. :) I hope we can still get at least one smile each day while she’s on the prednisone. It looks like it’s going to be a hard couple of months ahead for us. I don’t know how other parents get through it. One day at a time, I guess!

Starting Steroids Tomorrow

Vivian has had more seizures this evening :(

Finally got her to sleep about an hour ago; hoping she stays asleep and rests up so she can have a good feed, as they really make it hard to get her settled and to sleep which affects her eating because she gets over tired.

Looks like we will be filling the prescription for the prednisone tomorrow morning and starting down that road. I am really worried about what this will do to her. I know that if it stops her seizures it will be worth it, but I’ve read so many stories about side effects and just the rough time overall that they cause.

I am trying so hard to stay positive, but I am so sad tonight.   I managed to find a place offering free counselling and began going last week. It has helped some. On days like today it feels like we are back at day one though. Like we’ve been put back in the middle of a bad dream that we can’t wake up from. We’re reminded that Vivian won’t have a normal, healthy life. It’s easy to forget when we’re taking care of Vivian on a good day. But on nights like tonight, when I remember, it’s so hard.

Please keep your fingers crossed for her that she makes it through this without getting really sick.

 

Next Steps

Vivian’s doctor appointment on Tuesday went better than we expected.

She has had no further seizures since Monday afternoon; the neurologist wanted us to get more of her seizures on camera and of course as soon as he said that they (thankfully) stopped.

After asking tons more questions about Vivian’s spasms, the neurologist suggested we stick with Vivian’s current medication for a bit longer, because she isn’t having daily seizures like some babies with infantile spasms do. He said there is a small chance they could go away while on the current medication, so we are keeping our fingers crossed that it happens.

He also confirmed that Vivian will be having an EEG done this Tuesday, to find out what we can see. I am very happy that they are finally moving in the right direction on getting all the information we can about what’s going on with Vivian’s brain.

We also talked about next steps if Vivian continued to have more spasms; the doctors gave us a prescription for prednisone to get filled immediately if she does have more, so we don’t have to wait around for someone from the hospital to get one for us. The recommended dose is enough for an adult with acute arthritis…a lot for a little baby. The side effects are daunting – irritability, rapid weight gain, facial swelling, high blood pressure, immunosuppression. The list goes on.  I really hope we don’t have to get that prescription filled.

If we have to use it, she will most likely be on the steroids for 6 weeks. If they don’t work, we move on to the vigabatrin. It looks like we will not have to look elsewhere to get the treatment we need for her now that we’ve put a plan in place with her doctors on what happens next and we’re getting her EEG done, which is a huge relief!

The rest of the appointment went fairly well; Vivian’s pediatrician was impressed with the video clip I included in the last post. I don’t think she expected Vivian to be so active and happy. Vivian was actually very settled during the appointment. So much so that when the neurologist tried to get her to fuss at him, she wouldn’t. She just cooed at him instead. He had a super calming effect on her- we told him we needed to have his number so he could come soothe her when she was inconsolable for us.

We also discussed her treatment for reflux and are sticking with the current medications at the moment (gaviscon, prilosec) and assessing again in two weeks, with the speech and language therapist.

Vivian even managed to gain weight between Friday and Tuesday, when we were so sure she would have lost weight from having the rough weekend due to having seizures and low feeding volumes. Some days she has excellent feeds and others she doesn’t. There is no rhyme or reason that we can discern, and when we don’t know why she is having a crap day of feeding it really takes its toll on Ben and me, especially because of the weekly weigh-ins by the Neonatal Outreach nurse. We have spent so much time stressing about how much she is eating and feeling  pressured to get as much milk into her as we can. It’s enough to make you cry on the bad days when she’s screaming and won’t eat and we can’t figure out why.

The only bad thing that came out of the appointment is the discovery that Vivian’s head circumference hasn’t grown at all since she was born. The pediatrician said we would need to keep an eye on it. Of course Googling this led to me reading up on microcephaly, which can lead to even more developmental delays and can also cause seizures. Add that to the list of secondary diagnoses stemming from Vivian’s rough start. Trying not to worry about that too, now. Failing! I guess that’s part of parenthood?

Bonus: Vivian didn’t really cry on the trip to and from the appointment. Definitely a first! Here she is in her car seat, watching the world go by:

Watching it all go by

 

I think her eyes are turning brown. I told her to stop that. They are meant to stay blue, damn it.

Hope your weeks are going well. Leave us a comment and tell us what’s going on in your world.

Staying hopeful

Vivian started having more seizures last night, so the doctors finally scheduled an EEG for her – possibly within a week or so – and it looks like we will be changing Vivian’s medication after our doctor’s appointment tomorrow. The increased dose of her current medication is obviously not working :( As unhappy and terrified I am at her having more seizures, I’m glad our doctors are finally on board.

The seizures only happen when she is on her back, which is very strange. This led to a very exhausted family last night after 5 hours of nonstop crying due to seizures every time we would get Vivian settled. Ben and I were just beside ourselves as it looks like she is just so afraid during them and then afterwards is so inconsolable. She ended up so exhausted that she passed out on my chest (very rare) last night and today we finally figured out that if we prop her on her side they don’t seem to happen, so for now this is our solution:

Side sleeping

We were going to take her into the hospital again, but the registrar called and said there really was no point, as there is nothing they can do for her in the short-term. This was very discouraging and frustrating to hear, but later on we actually spoke to the neurologist via phone and got a lot more solid information from him about where to go from here, including a more thorough explanation of why an urgent EEG isn’t going to change our options at this point now that the Keppra (levetiraceatam) isn’t working.

The neurologist clarified what the pediatrician was trying to say on Monday: because they are sure these are infantile spasms, the main thing to do right away is to treat the seizures, not what we would see on an EEG. If they weren’t positive these were infantile spasms, they would be getting an urgent EEG done. Because any of the new medications we could try will take at least 10 days to work, the EEG we (now) have scheduled will still show the abnormal patterns of the infantile spasms and the abnormal patterns caused by Vivian’s brain injury.

So, the follow-up appointment tomorrow is still when we will figure out what the next steps will be.

I still don’t think they are giving Vivian much credit in the developmental milestone department, but at least he didn’t say they aren’t expecting much because she already has brain damage. Still not a perfect run through what I would have liked initially (I would have liked her to have already had an EEG done, or for them to have already scheduled one when we first saw these seizures), and definitely not the same thing as “we’re only treating these seizures because they are making her uncomfortable, not because they will affect her outcome.”

The neurologist also said we’ve caught them very early, and that he wouldn’t worry overly much about them causing much developmental regression now. He said if the seizures were left untreated for 3-6 months he would worry more about developmental regression, because they have a cumulative effect.

The two main treatment options we have to consider now are either steroids (prednisone) or a drug called Sabril (generic name vigabatrin). Each of them have some pretty hefty side effects, but due to Vivian already having possible renal impairment and possible vision problems, I think the doctors will suggest we try the steroids first. Still pretty afraid at this point, but a bit more hopeful that our doctors will actually be working cooperatively with us to try to get these seizures gone. I am hopeful that we will not need to change hospitals or look at going to Starship in Auckland.

I know that infants with symptomatic cases like Vivian have a harder time achieving seizure free status, but I will continue to have hope that Vivian is one of the success stories so she can have many more happy, seizure free days.

 

I recorded this yesterday before she started having more seizures. She is 10 weeks old today. Time has gone so fast. Tonight the seizures have stopped, and she’s been able to be settled to sleep pretty easily. Keep your fingers and toes crossed for us, please!

Also, a huge, gigantic thank you to everyone who has been praying for us, and to everyone who has contributed to Vivian’s Givealittle fund. The generosity we’ve been shown is so amazing. It’s good to know we will have some funds available to go to Auckland if we need to, and if we don’t, for whatever Vivian may need to help along her journey. Ben and I can’t thank you enough.

How do they know?

I talked to Vivian’s pediatrician on Monday, twice. Both times via phone. Both times were incredibly awkward.

The first time in the morning in front of our Neonatal Outreach nurse and Ben, as it was the nurse’s mobile phone we were talking on.

I asked the doctor why we were not getting an EEG done for Vivian, why were the doctors just happy to up her current medication without doing an EEG as well? Her reply was that they were 100% happy to say that Vivian was presenting with infantile spasms and that because of Vivian’s brain injury, she will already have an abnormal EEG. That they did not want to ‘chop and change’ her medication right now, although we may end up having to do that further down the line if this medicine doesn’t work. She told me that the cases I’ve read will not apply to Vivian, because she is a symptomatic case of IS, and they already know that this is stemming from her brain injury. That we need to put her into a different category.

I was just shocked by this. She said she would call me back in the afternoon to discuss upping Vivian’s current medicine to the maximum dose.

I got off the phone, not knowing what to say or what to ask. It only created more questions for me. I went to the Infantile Spasms community and asked if there were other cases of symptomatic IS that have been treated in this manner parents replied that their doctors had done numerous EEGs on their children, even though they knew what was causing the IS, because to treat IS you have to treat the seizures and the EEG activity.

Another parent pointed out that many doctors will treat the child and not the EEG- only treating for clinical seizures.

The doctor called back, and I asked again, why are we not doing an EEG? She said because it will not change Vivian’s outcome. I asked, could we be missing seizures that would be seen on an EEG though? She said yes, we could be, but that they were only treating the clinical seizures because they were making Vivian uncomfortable. Not because they would change Vivian’s outcome.

So, in other words, because my child already has brain damage, the doctors seem are unwilling to go the full mile to treat the IS fully, because they do not believe it will help her development or brain activity. The doctor said she was sorry that I had to come to terms with this. That the neurologist would “try” to be there for our appointment on 19 August.

How do they know what Vivian might be capable of? Nobody thought she would even be able to breastfeed, and she did that. They thought she wouldn’t make eye contact, and she does that. She smiles, she bats at her toys like any other baby her age would. Her head and neck control have always been very strong, and she can push up on her arms while on her tummy, just like any other baby can right now. If you talk to her she will coo at you quite happily while looking at you in the eye. I know some babies with IS cannot do any of these things. I am afraid of losing these milestones.

PlayingWithCaptainCalamari

How do they know that treating her more aggressively would not be worth it? How do they know that we are not risking regression of her development by not treating it fully? Again, how do they know what Vivian could actually do if she was given the chance to live fully seizure free?

I believe Ben and I will be asking someone to accompany us to the appointment, to make sure we get all the questions asked and answered, because I can’t seem to get my words out correctly when talking to the doctors about this.

I am praying that the current medications are enough to treat her seizures but how will we know without having all of the information? How do they know?

Infantile Spasms

I haven’t even had a chance to write about how Vivian made her debut; it was a very bumpy ride into this world for her, and a very traumatic experience for all three of us. After an emergency c-section, we spent the first month of her life in hospital in NICU with her. What is happening now relates to what happened then- long story short, Vivian suffered perinatal asphyxia at birth from severe meconium aspiration. She was placed on a cooling system for the first three days of her life to protect her brain, intubated, and hooked up to BRAINZ monitors.

We didn’t get to hold her for days. We had our first skin to skin on day 7. First breastfeeding at day 9. Not your average birth experience by any means. It’s been a very hard road since then with her, as she is a very irritable baby and the normal things that usually soothe babies do not always work for her. Skin to skin infuriates her most of the time. Baths could go either way. Showers are great, but once you take her out, it’s like you never calmed her down in the first place.

Ben and I are having an especially rough week after having to take her in to the hospital.

Vivian started having some seizures the week before last, just a few, and we didn’t know that’s what they were at the time. We put it down to stomach pain from one of her 6-week vaccinations. Unfortunately, this is not her first time having seizures, as she had some during her first week of life when she was in NICU. We had never seen them and had only read about what they looked like in her notes – lip smacking and eye flicking – this is not what we were seeing.

She had some more on Wednesday evening this week, and then again on Thursday morning. We were quick enough to catch some on video and took her in to the hospital to be seen in the Children’s Acute Assessment Unit, but of course we forgot our camera.

When we described the seizures to the doctor, she put it down to reflux, and when my reaction wasn’t really overjoyed at her wait and see approach, she told us to email her the video when we got home. She called us to confirm that it looked like Vivian was having infantile spasms, a pretty rare form of epilepsy that presents in infants. This is what I was very afraid of. Unfortunately it can be easily missed and we are lucky that we videoed what we were seeing.

They have advised us to up her anti-seizure medication, levetiracetam, on advice from the pediatric neurologist at the hospital and in conjunction with her neonatal doctor that we are seeing again the week after next. They didn’t even want to do an EEG, which is normally done if an infant presents with them, and this concerns me a great deal.

From what I have read, infantile spasms should be treated very aggressively as soon as they are picked up because they can lead to developmental regression if seizures are not controlled and EEG activity is not normalized. I’ve also read that levetiracetam is not a front-line medication for treatment of infantile spasms. The doctor tried to tell me it was, but I’ve joined the only two communities for parents of children with IS, and the parents there have overwhelmingly said I should seek a second opinion, as this is not the drug that should be used as the first line of action for these seizures.

The two main drugs used to treat IS both have chances of some side effects, but I think the risk of those happening may outweigh the risk of her developing even further brain damage and developmental regression if we don’t get the IS under control.

Really struggling with what to do here. I’ve emailed the doctor as I don’t have her number and I’m waiting to hear back as to why they are happy to make us wait to do an EEG (or not do one at all right now), and why they feel levetiracetam is the better option when the other two drugs are shown to be far more successful at treating IS. Two parents in NZ told me to take her to Starship hospital, but obviously that’s in Auckland and we’re in Christchurch, and we are so broke right now. So very broke.

Really hoping for a miracle that this can be treated successfully in Vivian. So many stories I’ve read have had unsuccessful outcomes if the child’s case is symptomatic, like Vivian’s, where the doctors know why they are happening (her brain injury at birth). The odds would be so much better for her if they had no idea why they were happening. The longer the child has seizures, the worse their developmental regression is. If you can quickly and successfully get them under control, kids have amazing outcomes.

I feel so helpless. I want to make this all better for her, and I can’t.

Smiles

New life, in more ways than one

Forgive me bloggers, for I have disappeared. It has been over a year since my last post.

And so much in my life has changed. The past year has been an absolute whirlwind of change, and I welcomed it with open arms.

My job in Wellington ended in May last year. Thanks to a wonderful woman I used to work for, I was blessed to begin two part-time jobs in Christchurch, to make up one full-time job. For the first three months after my job ended, I lived in Christchurch and Ben stayed in Wellington with our lovely kitties until our lease there ended.

Ben and the kitties joined me in July, when we were lucky to find a reasonably priced rental in Christchurch among horrible rising rent prices. So many houses were damaged or demolished due to the earthquakes, which has resulted in a shortage of affordable housing here. It’s not a spacious house, by any means; it’s about half the size of our home on the Kapiti Coast, and only $30 cheaper per week, but it’s a good little house.

Ben found a new job as well and life for us resumed the familiarity that we once knew; we were home again.

While we were up north, I was on my way to being diagnosed with polycystic ovarian syndrome. I had started that journey before we left Christchurch in 2012, but it took forever to find a doctor’s office that was accepting new patients on the Kapiti Coast/in Wellington. I picked it up again when I returned to Christchurch. My very first blood tests pointed to the possibility of me actually being pregnant, which hadn’t happened on its own even though we hadn’t been preventing pregnancy for over two years. Ben and I really thought it wasn’t possible for us to conceive naturally at that point, but alas, we finally did it!

We built dreams and hopes for the new life I was busy growing. We planned and prepared. We were so ready. We had been waiting for this for so long.

In June 2014, our family grew by two tiny feet when our daughter was born. Her birth story and journey thus far will come in another post, one that I desperately need to write for myself.

For now, I am amazed at how quickly days blur into nights and back to days again. And at how well I am surviving on naps (reminding me of my days as a breakfast chef). And how astonishing it is that I can love someone so fiercely that I’ve only known for two months. And how lucky I am to have such a devoted husband, who is becoming the most wonderful father to Vivian.

Vivian

What’s new in your world?

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