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When My Daughter Asked, “Do You Hope This Baby is ‘Normal’?”

I have yet to share our exciting news on the blog, and if you’ve followed us on Facebook, you already know…Braxton is going to be a big brother!! We’re expecting a baby girl in January! ❤

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Several years ago, the thought of having another baby after all we’d been through with Braxton was simply out of the question. I was scared and nervous to even entertain the thought. As friends of ours who also have children with special needs began expecting a child, I started to think more about the possibility. I asked them questions about how they felt, if they were doing more in-depth genetic testing from the very beginning this time, and ultimately admired from afar. At that point in time, I had decided that *if* we did get pregnant again, that I wasn’t going to be blindsided this time. I was going to ask for more testing up front so we would know what to expect this time.  Going through an uneventful pregnancy and being told something is wrong with your baby moments after birth and then waiting nearly 2 years for answers is an experience I never wanted to go through again.

But, this summer, it happened. I found out I was pregnant. We had been talking about having another baby for quite some time and finally our prayer was answered.  At my first appointment, I was 8 weeks along, and the doctor explained she wanted to go through everything as if it were my first pregnancy to be sure she didn’t forget something or assume I knew something I didn’t.  She began explaining our options for the standard “First Trimester Screen.” She told us about the standard testing they have been doing for years and explained the test and it’s efficacy in determining if a child will be born with Down Syndrome. She went on to explain that there is a new test that can predict with approximately 96% accuracy and will also tell you the baby’s gender by 12 weeks. And there is another test that can check for a variety of other conditions as well. I looked over to my husband, and knew we were on the same page.

When we spoke after the appointment, my husband asked if I wanted to do the in-depth testing, and surprisingly, I said no. He then told me he felt the same way. We decided that knowing wouldn’t change anything. We’ve already been on the journey, we’ve already got the resources and the support. If, by chance, we found ourselves on the journey again, we wouldn’t be blindsided this time. This time, we were ready. And finding out wouldn’t change whether or not we would keep the baby or make us love her any less. I realized that we were in a very different place than we were several years ago, when we thought we’d ask for every test under the sun. I knew that with my husband the systems we had in place, there was nothing we couldn’t face.

However, it wasn’t until several weeks later that I realized that not everyone was on the same page. Disability affects the whole family. I know this. Disability is a part of many conversations in our household and my daughter is very attuned to the issues we face with Braxton and more recently, with her as well. She was diagnosed with ADHD in December of 2014, and while some people may not see that as a “special need” or a “disability,” there have been some aspects of the condition that have been truly debilitating for her and we have been working hard to get her the support she needs medically and in school. She is very aware of the difficulties she’s faced and often feels like an outsider, despite our best efforts to build her up and make sure she is included.

Some time after I told her she was going to be a big sister again, she came up to me while I was cooking and said, “Mom, do you think the baby is going to be born like Braxton or like me?”  At first I thought she was asking if the baby was a boy or a girl, or maybe if the baby would have her tanned skin or Braxton’s light skin. “What do you mean?” I asked. “Do you think the baby will have a disability like Braxton? Or do you think she will have ADHD like me?”  I was completely caught off guard and said something like “Oh, don’t you worry about that. Baby is going to be just fine.” She seemed content with that answer and scampered off to watch TV.

She’s asked me some variation of this question at least 4 more times and every time, I am without the right words to say. Last night, again “Mom, Do you hope this baby is normal when she’s born?” Again, I am less than eloquent. “Baby girl, we are all born with our own special gifts, talents, and difficulties. We don’t know what to expect when the baby is born, but I promise she’s going to be okay.”

I have struggled with the disability conversation with my daughter from the beginning. How do I tell her about her brother? How do I make sure she doesn’t feel left out? What do I do when she thinks all the attention is on him and not her? We have had some struggles but for the most part I seemed to have found the right words and she has been such a huge advocate for herself and for her brother. But, now, I am at a loss again. Do I reassure her that the baby will be fine? Or will that make her feel inferior because the baby is “normal” and she’s got a diagnosis?  I have tried to tell her that there is no such thing as “normal,” that we are all born with our own special quirks and that’s what makes us all so unique.

For now, she is appeased. She is excited to meet her sister. She kisses my belly every night and talks to her sister often. Hopefully I can find the right words to put my sweet girl at ease the next time she asks. Hopefully I can help her find her way to a place of acceptance and help her move past whatever mountain seems to be standing in her way.

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One Year After the Diagnosis

It’s hard to believe that it has been exactly one year since we finally learned Braxton’s diagnosis.

I went back and read my entries leading up to the day we received our results and even a few weeks after, and I recognize that there has been so much personal growth.  I am in a very different place now and continue to grow with every passing day.

Before we received our diagnosis, life was full of questions, uncertainty, fear, confusion, frustration, and a host of many other unpleasant feelings.  It was so difficult to have to go to the doctor and tell them that I had no idea what was going on with my son.  Braxton’s care was entirely symptomatic.  As new things came up, we treated that specific issue, but had no idea how it fit in to “the big picture.”  It was as if we were grasping at straws just hoping that something would work.

Outwardly, we presented our best face and tried to remain positive, but the battle within was constant.  There were so many sleepless nights and nights full of tears simply because I felt as though I’d failed as a parent and felt that the medical community had failed us.  I was always grateful for our team of doctors, but always, always felt like more could have been done, like more should have been done.  But, alas, “coulda, shoulda, woulda” changes nothing.

Life after the diagnosis has been a dramatic difference.  Sitting in the doctor’s office one year ago, I remember my uneasy breathing and grasping the chair beneath me until my knuckles were white, until the doctor walked in.  When she finally delivered the news, I remember exhaling, a weight being lifted, and even smiling because I had already known what the doctor just told me.  I will always be grateful to the few people who reached out to us through our blog to suggest Rubinstein-Taybi Syndrome.  Doing my research then, helped me accept the diagnosis in the office that day.  It was familiar, it was not life-threatening, I was at peace.  I was relieved.

BraxtonThe first few weeks of researching and trying to explain things to our family was very difficult.  Our family members learned and dealt with it in their own way.  Some are still coping.  Some still believe that Braxton will magically be “cured” of RTS, although there is nothing to cure.  You can’t change genetics.  Braxton is who Braxton is going to be for the rest of his life.  He is loving. He is full of joy. He is full of spirit. He is full of drive and determination. He is a fighter. He is just like any other 2-yr old daredevil little boy. He may not move as fast, but he is well on his way.  Our family has been supportive every step of the way.  We have all grown and we have all come together.

Every day is a little bit easier.  Life is still full of therapy, but the doctor’s visits are less than before the diagnosis.  Most of the doctors are now seeing Braxton on an annual basis, with the exception of his Cardiologist who still monitors his heart closely.  Now that we have a diagnosis, our care is more focused.  I know some of the issues we will face and how other families have dealt with them, which has helped tremendously.  I can make informed suggestions to our doctors based on real experiences.

Our therapy goals are now geared toward the things we know will present difficulty.  We know Braxton will walk, so we are really pushing that goal and even his daycare is doing everything they can to get Braxton there.  We purchased a medical stroller instead of a wheelchair because we know Braxton will walk soon.   We know that Speech will be our greatest difficulty so we are trying many different methods of communication.  Braxton is still not picking up any sign language, but he has taken to the iPad and successfully demonstrated purposeful choice-making.  We’re now moving forward with a grant to purchase an iPad and augmentative communication program.  We’re still using sign language and picture cards, but we know this is what he is going to need long term, so we are able to provide medical documentation for a grant.  Before the diagnosis it may not have been so easy.

There is a whole other world of possibilities that has opened up for us now that we have some insight in to exactly what is going on with Braxton.  I can make decisions with more confidence and have more options available.  I felt stuck before the diagnosis and just accepted most of what the doctors recommended, because I didn’t want to look back in hindsight and wish I would have done more.

We have a new support group that has been fantastic.  In the first few weeks after the diagnosis, I asked A LOT of questions on the Facebook group and Listserv. Thankfully, so many shared their experiences and put my worries at ease.  A year later, I can now welcome new parents and share our own experiences. I’ve had parents reach out and tell me that my blog helped them come to terms with the diagnosis and to a place of acceptance. We have come full-circle.  There is a sense of family among our diagnosis and at any given time I can reach out for support and answers.  That is, perhaps, one of the most important differences in life before and after the diagnosis.  Before, I could reach out to families who had similar experiences but due to their specific diagnosis, it was handled differently than Braxton would have been.  I was thankful for the support and guidance, but it never really quite fit exactly.  After diagnosis, I see/hear stories and think “Oh my, that is EXACTLY how it happened with Braxton.  Here is what worked for us…” We finally have a “medical home,” a group of people who truly understand, people who have “been there, done that” who can offer advice and words of wisdom. It has truly made such a difference.

Braxton has grown tremendously and is making wonderful progress.  His receptive language is getting better every day and he is finally showing real signs of understanding.  His gross motor skills are taking off as well.  He is cruising like a champ, “knee-walking” all over the place and taking independent steps during therapy.  His is eating almost completely on his own now.  He will eat about 30 ounces a day by mouth and he gets one bottle via g-tube just to supplement calories.  He is even starting to drink now! With most of my worries gone, I can focus on all of the amazing things Braxton is doing and just be in the moment.  And the moments are incredible. Positivity is no longer something we pretend, it just comes naturally.  We are still going to have hard days ahead, but I am better equipped to face them and I know I don’t have to face them alone.

 

 

This anniversary comes just before “Undiagnosed Children’s Day” and I am reminded that there are still so many searching for what we have found.  The average journey to rare diagnosis takes about 7 years.  Yes, SEVEN years.  Our diagnostic journey was significantly shorter than the average but still took quite a toll on us. I can only imagine the families who are in agony and still searching.  To those families, I say please don’t ever give up hope.  Soon the answers you seek will find you.

To everyone else, I say please keep these families in your thoughts and prayers.  Continue to support the organizations who serve the Undiagnosed and Rare community because it is those organizations that helped lift us through the hard times.  I don’t know where we would be were it not for U.R. Our Hope and our Physical Therapist who helped guide our journey.  I’m grateful to them for fighting the fight.  And I’m so proud of the documentary team who is filming “Undiagnosed: Medical Refugees.” I hope this film comes to fruition and the world learns what we have had to face and why answers are so important.  More can be done and more needs to be done for these families.

 

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Jumping for Joy!

I’m happy to announce some EXTREMELY exciting news!!!!

This morning I got a call from our geneticist’s office regarding our insurance authorization for the Exome Sequencing….

Insurance APPROVED our request!! Our insurance is going to cover the cost of Exome Sequencing and our out-of-pocket expense is ZERO!!

Fortunately, (but unfortunately ? ) our deductible has been met and our out-of-pocket maximum has also been reached so we won’t have anything extra to pay to have this much needed test.   What an amazing blessing and early Christmas present for us! I am beyond words excited. If I could do backflips, I would have been doing them all day!

LoveI was sitting at my desk at work frustrated with our GI doctor for not calling me back and at my wits end trying to figure out what else I can do for Brax’s vomiting when I got the call…Immediately I felt the tears well up and start to fall down my face.  Tears of JOY! Thank you, thank you, thank you ALL so much for your prayers and well wishes! God has been so good to us and continues to bless us along this journey.  We go next week to have blood drawn and sent off and then it will take about 5-6 months to get the results. Hopefully, this finally gives us a diagnosis and the answers that we need.  Just another step on the journey, but it’s such an important one and I’m sooo thankful we have the opportunity…

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The First Year

After Braxton was born he had a tough time breastfeeding.  At first I thought I was doing something wrong, later we’d learn that he had a poor suck-swallow-breathe reflex which prevented him from being able to breast or bottle feed.  The nurses took him from us and tried to bottle feed him multiple times, but he just refused and would gasp and cough each time they tried to feed him. As a result, Braxton had persistent low blood sugar (hypoglycemia) and he was kept in the nursery.  They brought him to me a couple times to try and feed, but in total I probably saw my son for about 15 minutes that first day.  After a few failed attempts at breast/bottle feeding the doctor came in and forever changed our lives.

The doctor told us that Braxton was having trouble feeding and therefore was hypoglycemic and they were concerned of aspiration (fluid going in to his lungs) because of all the coughing and gasping when he tried to feed.  She also told us they had realized he had a significant heart murmur.  In addition, he had several traits that on their own are no reason for alarm, but since they were all present at the same time, that it was a pretty good indicator of some kind of genetic syndrome.  The concerning traits included: Small head, small deep set eyes, flat nasal bridge, thin philtrum, small jaw, low set ears, short neck, bilateral syndactyly [webbing of pinky and ring finger on both hands], single palmar crease, crossed toes, high muscle tone and the murmur.  Because of all of this they felt it would be best for Braxton to be transferred to the Neonatal Intensive Care Unit (NICU) at another hospital. I didn’t find out until later, that this particular doctor was concerned that Braxton WOULD NOT LIVE more than a couple weeks at most and therefore the transfer was necessary.  At 9:00 pm my son was taken from me and transported to another hospital while I had to stay while recovering from my C-Section.

The next few days were kind of a blur.  Joseph (dad), followed the ambulance to St. David’s Main Hospital to get Braxton admitted.  He would undergo several tests throughout the night and the next morning.  Determined to get out and see my son I was walking around the next morning and released that evening, a couple days earlier than my dr would have liked.  Once I arrived at the NICU, we learned that Braxton was placed on IV fluids since he was not eating on his own, a nasal feeding tube ws inserted for feedings, he underwent an EKG to look at his heart, an EEG because they thought he had a seizure during transport, and a head ultrasound.  The EKG revealed that he did NOT have a heart murmur, but he did have a bicuspid aortic valve and a dilated aortic root. The EKG was read as normal with no seizure activity. The head ultrasound revealed a mild bleeding in the brain, but the doctors were not concerned and said this would resolve on its own.

We learned that they would want to draw blood and send off for genetic testing.  All chromosomes would be tested, but the doctors but a rush to test for Trisomy 13, 18 and 21.  Trisomy 13 is Patau Syndrome – 80% of children with this syndrome die within the first year.  Trisomy 18 is Edwards Syndrome – Half of infants with this syndrome do not live beyond the first week of life. Trisomy 21 is Down syndrome, which thankfully is something I could have dealt with.  But, as you can see the outlook on Brax’s life was grim.  Results for all three came back and ruled out Trisomy 13, 18 and 21.  Later, the rest of the genetic results came and and they told us everything was “normal” with no additions/deletions to chromosomes, and no abnormalities with his X and Y chromosome.  Relief right?! No.  The doctors are still convinced he has a syndrome and tell us we will need to see a geneticist for further lab workup.

A retina specialist came in doing routine checkups on all the NICU babies and examined Braxton.  His exam revealed that Braxton had a bilateral coloboma.  A coloboma is a hole in one of the structures of they eye, such as the iris or retina, where it just didn’t close up correctly.  The specialist said it didn’t seem like Brax would need surgery, nor would he be blind.  He said at most there would be a blank spot in the field of vision, but the brain would compensate and fill in the gap so Brax should be able to see normally.  Unfortunately, we would not be able to really know the full extent of Braxton’s vision until he himself could tell us what he could and couldn’t see. Great, more uncertainty.

As days passed, Braxton started doing well.  He was able to regulate his own body temperature, so he was taken off the infant warmer.  He had a bout with Jaundice, but that resolved will with normal phototherapy.  I was pumping breastmilk for him and he was getting that through the N-G tube.  He finally overcame the low blood sugars and the IV was taken out.  Once he was off the IV fluids, he was gaining weight well, regulating his own body temperature, and maintained a normal blood sugar level, we were told we were waiting on feeding to be able to release him home.

A speech team was brought in to work with Braxton on feeding, but after multiple trials it was deemed that he could not and would not be able to feed on his own for quite some time.  A Swallow Study revealed evidence of aspiration and therefore feeding him by mouth was actually dangerous to his health as it could lead to pneumonia if too much fluid got into his lungs, which of course would be another cause of death for him.  Ultimately, it was decided that Braxton would need a G-Tube for feedings and would probably need it for quite some time, years possibly.  Since feeding was the only thing still keeping him in the hospital, the doctors decided it would be best to go ahead and insert the G-Tube so Braxton could go home and continue Speech Therapy there.

Braxton made it through the surgery to have the G-Tube inserted just fine. He did not have a nissen fundoplication.  He stayed an extra week so the staff could keep an eye on it and make sure the area healed well.  At the end of the week we were finally released.  Braxton’s total NICU stay was just over 3 weeks.  We were sent home with instructions to care for the G-Tube, but also with a number of follow-up Doctor appointments and therapy services.  Definitely only the beginning.

Summary of the Year

I could go into great detail about each and every doctor’s visit, but I’ll just summarize what we’ve learned so far.

We were released with Home Health Services to come in and check on Braxton at home to make sure he was gaining weight appropriately since he was on a feeding tube, so feeding amount had to be manually adjusted and he could not gain weight if we weren’t feeding him enough.  They also continued to monitor the G-Tube site to make sure to teach us how to keep the area clean and proper use.  Home Health was only with us a few weeks, before they decided he was in good hands and they didn’t need to keep coming.

We were also released with a  prescription to start Physical and Speech Therapy.  We started both of those within a month of Braxton being home.  We are currently at twice a week visits from both and Braxton is doing amazing! With Speech therapy, we continued trials of bottle feeding at home.  Once our therapist noted that his suck reflex was much stronger and there was significantly a lesser amount of coughing and gagging with feedings she had us go and get another Swallow Study to again check for the risk of aspiration before we moved forward with bottle feedings.  On September 1, 2011 the MBSS revealed NO aspiration across all consistencies. Yay! We were able to start direct breastfeeding and bottle feeding.  Unfortunately, Brax did not do well with breastfeeding.  The flow was just too much for him to handle, so I had to just continue pumping and offering the bottle.  Over time, Braxton has gotten up to being able to take 3-4 ounces by mouth before he gets tired and can’t eat anymore.  We offer him the bottle first and whatever he doesn’t eat we then put through his g-tube.  He’s currently doing really well and if we can work up to him taking full feeds by mouth hopefully the G-Tube will come out!  🙂

With Physical Therapy, Braxton just continues to improve.  He is now significantly less hypertonic than he was at birth.  He still has some areas of high muscle tone, but doing well with that.  He finally sat on his own with no support at 12 months.  He’s up on all fours rocking and trying so hard to crawl. So far, he’s only scooting backwards (which of course, is developmentally on track), but he’s determined to get it right soon!  He can bear weight on his feet so not any real concern about him being unable to walk right now.  Very mild scoliosis, but there is nothing we can do about it right now.

We also just started Occupational Therapy to help with some of the fine motor skills like grasping, feeding, and dressing on his own.  We’ve only had a few visits with her so not a whole lot to report here…yet!

After our initial visit with an ophthalmologist, Vision Therapy was also recommended.  She helps us with ways to get Braxton to respond to visual stimulus and ideas on how to get him to focus better.  Since we don’t really know the extent of the coloboma, she helps us make sure we are optimizing his field of vision early.  The ophthalmologist reports that the coloboma does not affect his optic nerve, so there should be no significant vision problems in his future, but it’s really difficult to tell at this point.  He also suffers from a clogged tear duct.  Probing and Irrigation surgery was tried on April 6, 2012, but the ophthalmologist found at that even his tear ducts are abnormal.  The upper ducts are either missing or were too small to find, and his lower ducts are very small.  Even the smallest prob was difficult to fit.  We have to wait until he gets older to see if the clogged duct resolves on its own or if inserting tubes/further surgery might be necessary.

Our Cardiologist continues to confirm the bicuspid aortic valve and dilated aortic root.  He’s following Braxton closely, but right now we aren’t concerned with surgery or anything like that.  He says that considering the heart defect, Brax’s heart is working “normally” so no need for concern right now.  The dilated aortic root is still enlarged, but it is growing with Brax proportionately so there is no alarm there either.  We see him every 6 months.

Braxton has also suffered from persistent ear infections.  His Ear, Nose and Throat (ENT) placed PEG tubes in his ears April 6, 2012.  He hasn’t had any since…thank goodness! Ear pain is the WORST for kids.  At Brax’s first visit an in-office hearing test showed concern of hearing loss since Braxton did not respond to any of the sounds.  He had an ABR after the PEG tubes were placed, but there was so much fluid draining the results were somewhat skewed. Initially they showed a significant hearing loss.  The ABR was repeated about a month later and while the results were much better, they still showed mixed hearing loss and so he was labeled as having mild to moderate bilateral mixed hearing loss.  We are still waiting to get hearing aids to hopefully bring him up to normal hearing and therefore finally getting some meaningful speech out of him. Can’t wait!

We just saw an Endocrinologist to check out growth hormones and make sure there are no abnormalities there.  We are waiting to do blood work to see if everything is in order or if there is something further that needs to be done.

Our Gastroenterologist (GI) is following closely to monitor the amount of fluid Braxton needs. At first, Braxton was gaining way too quickly so he helped us adjust feeds to keep Brax on a better growth curve.  He’s currently gaining along the 75th percentile.  We’re still only giving him pureed foods, but since he isn’t getting enough nutrients from that GI has him on Pediasure for all his nutritional needs.  Braxton does not have any signs of reflux or anything.

There is also a Hand Surgeon monitoring the Bilateral Syndactyly.  Thankfully, the webbing of his fingers seems to be easy to correct with surgery.  We are actually having that surgery August 24, 2012, we’ll keep you updated with that!

The Geneticist is still at a loss as to what Braxton’s specific syndrome could be.  We had a microarray genetic test done and that also came back normal showing no additions/deletions to chromosomes.  We will have further testing done later, but for now it’s mostly just wait and see what develops.

Finally, the neurologist is also following us pretty close to monitor developmental delay.  Braxton had a brain MRI in September 2011 which showed that he has a dysplastic corpus callosum.  The corpus callosum is the center part of the brain which sends communication to both hemispheres of the brain.  Dysplasia means that it is thinner than normal.  This could lead to learning delays later, and is also probably why he has the coloboma since it is a midline disorder.  The neurologist says that Braxton seems to be maybe 3-4 months behind developmentally at this point.  The good news is that everyone who needs to be involved therapy wise is already involved and obviously helping him quite a bit.

He also continues to follow-up with his normal pediatrician for routine care and immunizations.

Whew! I think I got everything and everyone.  Sure is a lot that Braxton has been through and continues to go through.  The one thing that makes everything tolerable, is that Braxton is such a happy baby! He is always smiling and laughing.  He very rarely fusses or cries too much.  With everything he’s been through it sure is a surprise that he’s not always a grump.  He is continuing to grow and flourish.  Needless to say, that initial grim prognosis of Braxton not living more than a few weeks has been thrown out the window.  He just had his first birthday and is making significant strides in trying to become mobile.

 

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