And Now For Something New…

We seem to have discovered another “possible” symptom or characteristic for Josephine and “her” disorder (I use quotes because each kid with Tet 8p is their own patient, until we can get a sense of what is what for all the kids).

The OT and PT are thinking Josephine has a sensory defensiveness issue (http://en.wikipedia.org/wiki/Sensory_defensiveness), as well as a hyposensitivity to movement.  These are both considered to be Sensory Processing Disorders.

Is this a result of Tetrasomy 8p?  Could be or it could be it’s just Josephine.  What we do know is while some typical kids have can have these issues, kids with special needs tend to have this more often.

Why is this presenting now?  My thought is Josephine is getting older and becoming more familiar with touch, sound, taste and smell.  She is “waking up” to the world a bit more.

Josephine has been having “gag reflex” moments in the past, but I always thought it was due to saliva or eating something that got caught in the throat.  Now I look back and realize she may have been having sensory issues for some time now.

How did we figure this out?

We were at Stepping Stones for group therapy and the OT, Alexis, suggested putting Josephine in a tub with uncooked pasta (penne, rotini, elbows…yum!).  I did so without any explanation to her and she freaked.  We took Josephine out and while the Alexis was holding her, Josephine started to gag.  Immediately, Alexis identified that the pasta was the reason for the gag reflex.  Not a clue until now!

So, to make sure I felt comfortable with this new information, I mentioned it to Kim, our Early Intervention OT.  Kim agreed.  In past therapy sessions, Josephine has been unhappy with messy play such as with pudding and finger paints.  She can’t stand holding a crayon and won’t touch a marker.

In fact, after discovering this potential issue, I observed more of the same reaction during lunch one day last week.  I gave Josephine pieces of mixed fruit, which is a little slimy from the juice.  She didn’t want it, so I added some Cheerios as an “incentive”.  Instead of eating both, Josephine looked at the tray and started to gag again.  Then she tried to separate the two foods and got very frustrated at the sight of the food.  I took the food away and she was fine.

I mentioned these occurrences to Lana, our Early Intervention PT, and she was surprised to hear this.  She wanted to test it herself.  So, she put some bath foam on a table and showed it to Josephine.  No reaction.  She put one finger in the foam.  Little reaction.  Two fingers.  More of a reaction.  The whole hand = GAG REFLEX.  Lana was convinced.

What happens now?  Will Josephine have this for the rest of her life?  Who knows.

Kim gave us a brush and explained that we now need to do a brushing protocol.  Brush Josephine’s hands, feet, legs, arms and back every 2 hours and follow it up with joint compressions.  This will help desensitize her body a bit.  Follow this link for more information on brushing:  http://www.developmentaldelay.net/page.cfm/135.

Maybe she will always be sensitive to these things.  But we now know if there is a random meltdown, we can better understand the source and how to correct it to make Josephine more comfortable immediately and in the future.

Sleep? Who Needs Sleep?

It seems that Josephine likes to keep Mommy and Daddy awake throughout the night…keeping us on our toes, I suppose.

But seriously, the trials and tribulations of getting this girl to sleep – outrageous.  If we would let her, Josephine would cry for 2 hours straight while in her crib, rather than fall asleep, like most children her age.  Then again, what is “Normal for Josephine”…

We are having some issues with middle of the night feedings over the past two weeks.  Mitch Bentler (Nutritionist Extraordinaire) said she was doing great, as long as she didn’t wake up to eat in the middle of night.  OKAY…so now what?  I am calling Mitch on Monday to find out the next step.  Do we need to increase formula intake before bed?  Increase caloric intake whenever we can?

I have read that other Tetrasomy 8p kids have difficulty sleeping, even to the point that one of them must be sedated for 5 hours at night in order to get a decent rest.

So, is this another symptom or just a kid fighting sleep?

On to the next bit of research…

Josephine’s Symptoms

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OK.  We are done with all the tests to determine how Josephine has been affected by Tetrasomy 8p.

As of December 30, 2009, here’s where we stand so far..

  1. Hypoplastic left first rib
  2. Assymetry of left side of rib cage – ribs flair out
  3. Agenesis of the Corpus Callosum
  4. Hypotonia
  5. Speech delay – at 16 months old, her developmental age is 6 months
  6. Cognitive delay – developmental age is 7-8 months
  7. Gross motor skill delay – developmental age is 6 months
  8. Fine motor skill delay – developmental age is 6 months
  9. Pelvic kidney on left
  10. Failure to thrive – recent weight gain was 3 oz. in 4 weeks (1/2010)
  11. Prone to future seizure activity
  12. Epicanthic folds on eyes
  13. Flat bridge of the nose
  14. Slight cupping of the ears
  15. Trigger finger on right index finger
  16. Exotropia of the eyes (mild case)
  17. Retnal development is good and not affected
  18. Excellent heart, lungs and liver
  19. PERFECT IN EVERY WAY!

Hospital: Day 3

Our morning was wonderful today because we got to see Little Sheldon!  He came to visit his sister and boy was she happy to see him!  I realized at that moment just how much I missed not seeing him.  What a strong boy he is.  I know he has been concerned about Josephine and was happy to see her too.

And thanks to our wonderful friend, Trish for all her help.  She hosted a playdate and gave us all some much needed time to unwind.

Dr. Morse, who is Dr. Bojko’s partner, said there are regular spikes in her brain activity and they needed to monitor Josephine for one more day, at least.

Not really sure what that means and we are looking forward to hearing more about what happens next.

Are we going to need to stay longer?  What else has to be done?  Will she have to be on medication?  If so, why and for how long?  What if she is not on medication?  What happens?

So much do deal with for such a little girl…

First full day at the hospital

What a day today!  Josephine had a few tests done to check her organs and bone structure.

Great news – her heart is fabulous and beautiful!  So the Tetrasomy 8p has not affected that at all!  Such a relief.  The pelvic and abdominal ultrasound were also positive and showed nothing unusual, other than her left kidney is located in her pelvic region instead of in her back.  But it is functioning properly and is a normal size for her age.

We are still waiting on the skeletal scan results, but the doctors tell us that no news is good news, which is also a relief.

Since we had to cancel Josephine’s 1st birthday party, we decided to bring the cake to the hospital for the doctors and nurses to enjoy.  And boy did they enjoy, as did we!  Even the birthday girl had a few bites.

With all of the excitement, Josephine was pretty worn out and took a relaxing nap, giving me a time to relax as well.

Although we were in the hospital, I know our Birthday Princess had a great day and fun celebrating!  Life is a gift and we are thrilled to have Josephine in our lives!  We love you!

Josephine’s 1st ER visit

Well, Friday started out as any old day and then dinner came along.  We all sat down for a relaxing meal and noticed Josephine started moving her head left to right in a repetitive motion.  My mom noticed Josephine had been looking at the dining room light just before the movements.  We waited and observed for about 15 minutes and saw the same thing occur again.  And again.  After brief discussion, we decided to call the neurologist, Dr. Bojko, to alert her of the situation.

The on-call doc told us to take Josephine to the ER, which we did without too much panic.  We didn’t want Little Sheldon to worry.

The ER staff was amazing!  They whisked us in quickly and we were seen by the attending pediatrician within 20 minutes.  After consultation with Dr. Bojko, Josephine was admitted for another EEG test.  The difference is this time the doctors will monitor her with a video camera so the movements can be captured on camera as well on electronically on the EEG machine.  Updates to follow…

Josephine and the Ambulatory EEG

On the medical side of Tetrasomy 8p (Genetic Disorder)

josephine EEG 3josephine EEG 2josephine EEG

Josephine took a trip to the neurologist on July 26.  The neurologist wanted to monitor her brain activity for a 48 hour period.  The process of attaching the 26 electrodes was less than wonderful, both for Josephine and Mom and Dad.

But after the procedure, Josephine became our little cosmonaut (see pictures above)!

No results yet from that test.  Next up is the brain MRI, which is scheduled for August 6.  This is another big test to give us some big answers – does Josephine have a corpus callosum (arched bridge of nervous tissue that connects the two cerebral hemispheres, allowing communication between the right and left sides of the brain) and does she have hydrocephalus  (water on the brain)?

Josephine has been experiencing, what I think to be petit mal seizures – vacant stares for a few seconds and head twitching in repetition of 2-4 movements.

This MRI will give us a better idea of her prognosis.  Every test leads to a new piece of the puzzle.  We may not always get the answers we want to hear, but it’s better to deal with what’s coming head on.  Denial is not our friend at this point.

We are not alone.

I found a wonderful web site, http://www.chromodisorder.org/CDO, Chromosome Disorder Outreach.  Through this site, I found a wonderful family in Iowa that has a 3-year old with the almost identical diagnosis as Josephine, so they have been our lighthouse in the storm!  Their daughter is the 13th documented case at this point.  Her mom and I have been emailing and we are so blessed to have found another family!  Their daughter is doing very well and certainly much better than the doctors told them she would do.

So, as our geneticist and counselor have said, Josephine is her own research project, just as this 3-year old girl is her own.  When we find more cases, more doors will open to the mystery of Tetrasomy 8p Mosaicism.