Love it when you get the personal phone call from the (not so) retired Dr. Neuro! Did I mention he's pretty up there in age? He's retired except the Spina Bifida kids and he has a tendency to pass out his home number to patients!
Anyway... late last night we finally heard back about Dylan's EEG and the result? No hypsarrythimia. He said there's an undercurrent of abnormal activity, an abnormal electrical pattern, but not the typical hypsarrythimia associated with IS. This abnormal activity is expected due to her abnormality.
I was talking to another blogging mom about her child with Holoprosencephaly and IS and she said that her son never showed the hyps pattern and they are on round three of dealing with it. (The first two times ACTH did the trick but this third time is proving far more tricky...) So I inquired about this and how common it is and he said it's all semantics really, it's just not 'technically' IS without hyps but there's no other name (possibly Myoclonic clusters?). Funny though, doing reading this morning, over 40% have no cause, no hyps... so it's a bit of a confused mess, just like the doctor said!
So, how to treat? He mentioned other drugs that we had spoken about previously, Depocate, Vagabitron (Sabril), Topomax and then ACTH. Normally without the Hyps it wouldn't call for ACTH but we talked about how she responded last time and because there she had no huge high risk problems (high blood pressure, severe infection, swelling, not sleeping) just general crankiness that it might be worth a try again.
He asked how insurance responded last time (given the cost) and I explained how we were super lucky and never had to go through insurance. He said the company is performing robbery so insurance usually drags their feet but they typically end up paying for it. Boy wouldn't that be nice to get done before the end of the year... Hello already met deductible!
Paula is out of the office this week, actually until Monday, since she runs the ACTH program we could try and contact her or we could wait. I opted to wait. The spasms have gotten a little worse and I almost want to see what might happen by Monday. Not way worse... just a teensy bit worse and still no damage so we aren't that worried. The only issue is that she's been very cranky since they started, mostly in the afternoon and evening, but that will only get worse with ACTH so, eh...
What this means... Dylan will be again at a huge risk of infection. (I had forgotten about this part.) She will not be able to go to school. I inquired, and he said that this time of the year he would definitely recommend pulling her out. It's also up to us whether or not we should also pull Duncan out of school. This makes me sad! He loves school! It's really up to us, Dr. Neuro said if Duncan ends up getting sick we would need to "quarantine" him away from Dylan and if he's not quarantinable... then we should avoid having him get sick altogether if possible.
I spoke more with the doctor about this and he was telling me that they used to keep kids in the hospital for the duration of the treatment so they wouldn't get exposed to illness and how this was absolutely the wrong approach! He said, the risk of infection is terrible and the drug resistant strains floating around the hospital just make a bad combination! He mentioned a patient from Japan who was int he hospital two-months for treatment. Can you imagine?
Last time we rarely left the house, definitely no church, we had very few scrubbed up visitors and no Sunday evenings with the family to play with all the cousins. No family? Over Christmas?! Poor little gal, we might just have to send family representation or have some clean =) visitor come sit Dylan while the rest of us go to family activities. But not many. Ugh! We can do this though, it's only for a short amount of time!
He also mentioned another EEG which he admitted would be a pain but it would be nice to have a few more during and after treatment. As I mentioned, he kind of regrets not having a baseline from when they stopped the last time.
I have already asked Aunt Trina to make her daily visits again (oh yea... you bet I did...) and she said she would definitely do it. I thought I would be tough and do it this time but then I got to the part about pulling the plunger out to make sure there was no blood before pushing it in (to make sure it's in the muscle) and I got a little queasy. Blech! This should be done by someone who can do it all as quickly as possible!
The treatment will likely run as it did last time, a couple weeks at full dose with a possible extension of three or four days a couple of times and then the weaning process which is 1/2 dose every day for a week or two and then half dose every other day. We will get all of the details from Paula early next week.
On Monday we went to Dr. Sight and talked to him a little about Dylan's crazy eye. I wasn't terribly concerned about it after our last appointment, he just wasn't seeing it and it didn't require treatment yet. BUT, the school pointed it out again and there is concern for loss of sight in the eye that goes wickity wack. So I made the appointment and went in to ask about it again (we were due anyway).
He still didn't see it. It was certainly NOT lazy and no patching would be required. So we chatted a little more. He took pictures of her to make sure her pupils lined up (interesting no?) and she was doing really well. No loss of sight in her eyes. So what's the deal yo? Well... fascinating enough, he thinks her left eye is the problem, not the right one that turns in. He said it's possible she has Sixth Nerve Palsy.
Sixth nerve palsy is where the outer muscle of the eye is weak, so Dylan's right eye is actually looking at what she is trying to look at but that muscle in her left eye can't pull her left eye to the left to also look at whatever it is. Giving the appearance of a crossed eye, and probably also double vision! She tends to move her eyes when looking to the right but move her head to look to the left because she's really trying to use her eyes together! (Good on her!)
They can operate to correct this, no thank you very much. I know of another little guy who they keep trying to correct the muscles and they throw off the balance of him looking in another direction! Fixing it is probably more important for a "normal" child. The doctor said if she ever drives a car we would need to correct it... Matthew said if she drives a car she can have anything she wants!
Really though, he said that she sees so well together when looking at most things that it's not that big of a problem. Her eye sight isn't being compromised and now that we kind of have a baseline we need to go back in three months to check again.
He also said this is probably while she spins in circles when on her knees, either to turn the direction that she can't see without turning her head (left) or turning the direction where seeing is more comfortable (right).
He also said that we are lucky that she sees well enough to even see that this is a problem. Her CVI has definitely gotten better and he said she really has "CVI plus" because of those small optic nerves. He said most of these kids with the same problems don't see well at all!
That's all that's fit to print on this day. Love to all!