Tag Archives: INAD

Team Rare Disease

In many ways, I feel as though I have a good idea of what it entails to raise a future Olympian. The practices, the travel, the debt, the ups and downs, the feeling that you only get one shot at success, and the witnessing of a powerfully determined spirit.

Except my child isn’t competing to be the best in her sport; she wants to learn to walk with a gait trainer, and then have the strength and balance to take steps independently, and maybe, just maybe, twirl like a ballerina in her tutu.

I’ll never forget the first time a medical professional told me something may be wrong with my then two-year old. He said, “not all kids are athletes or Olympians, but they learn to compensate in other areas.” No doubt, this was an odd way of starting the conversation that my child needed to see a neurologist because she wasn’t walking independently, and nearly three years later,  I’m still shaking my head over his bedside manner.

What began as that awkward referral to a neurologist, turned into an eye-opening, emotionally draining  journey into the world of rare disease. A world where the tear-filled eyes of neurologists tell you they are 95% certain that your daughter is slowly dying of something they are unable to 100% diagnose; a world where science offers hope but at a high cost and without any guarantees for results.

In this world, parents quickly learn to fend for themselves because the same answer from the medical community is on repeat: We do not know at this time. I’ll never forget when the impact of this uncertainty hit me over the head. As I made a defeated walk across the campus of the Cleveland Clinic with my daughter in my arms, I realized we were on our own. I remember thinking that unless we know what type of disease was affecting our daughter, then we won’t know how to treat her, ranging from the decision to treat symptoms with tylenol versus ibuprofen, all the way up to different types of anesthesia. When you do not know the what, the how becomes a parent’s worst nightmare.

In the absence professional assistance and experience, the burden rests on the caregiver to make day-to-day decisions. If you have never been in this position, please take a moment to count your blessings.

We are all conditioned to believe that doctors know all the answers, when in reality they do not. What they do offer is a background of extensive medical training, and perhaps, most importantly, the experience of seeing countless patients with a similar presentation of symptoms, etc. so they can diagnosis and treat what ails you.

When your child has a rare disease, however, most doctors have never seen a patient like your child. It isn’t the doctor’s fault; they may be the best doctor in their field and still not know the answer because you don’t know what you don’t know. An excellent doctor will not be afraid to admit this.

We consider ourselves amongst the lucky because Whole Exome Sequencing gave us answers, confirming the genetic mutations causing our daughter’s disease. Knowledge about her type of disease opened the door for vitamin supplements, a clinical drug trial, therapy options, and basic answers to questions regarding tylenol vs. ibuprofen, best antibiotics and anesthesia, and now we are armed with an emergency protocol letter with all of this information. To say this piece of paper is a life-line is an understatement.

When you have a child like Katherine, the word “team” is used often to refer to the people we’ve hand-selected to give her the best chance possible at life. From medical professionals, to physical, occupational, and speech therapists, to the school where she spends her days, to clinical trials, these people make up our team.

As her caregiver, my job is to manage the team – to interview prospective members, to facilitate the communication of short-term and long-term goals, and to coordinate best practices and outcomes to other members. The stakes are HIGH and only the best will get the opportunity to be a part of her team. This is our one shot to get it right, so I really don’t have much use for inexperienced, uncooperative, or narrow minded team members.

Sometimes it is difficult for a trained professional to suspend their beliefs, which is pretty much required when dealing with a rare disease patient. After all, there is not a scientific, medical, or mental database from which to compare best treatments. Realistically, though, they are trained and paid to test, analyze, and give an opinion. That’s what we are asking them to do, after all. More often than not, there is strong scientific evidence and documentation to support that opinion. When that doesn’t happen, when they really just don’t know, that’s when their character and belief system matters most to us.

We decided to interview doctors to select one with the best experience and credentials, yet willing to admit he or she didn’t know everything. We learned very early that you don’t have to “hire” just any professional, that shopping around for a good fit is important. At the time we had been told by one doctor that our daughter was dying and basically sent home without plans for future testing. Thankfully, I didn’t feel this diagnosis was correct. Of course, I debated the power of denial verses motherly instinct for a year and a half, but in the end, instincts beat professional ‘opinion’.  And why shouldn’t you question an opinion based on the comparison to one – just one – other patient? Clinicians are taking a shot in the dark when they say they think your child has a particular disease they’ve never seen before. Truly.

Ultimately, I feel sad for the people who make statements like, “your child will never be an Olympian,” or “this family needs this genetic test to get closure on my diagnosis because the child is dying,” or “her parents think she’s going to be running up these hallways next year, but that’s not going to happen.” These professionals fail to acknowledge what they do not know. They make broad assumptions based on their experiences and fail to take into account the power of love, determination, and above all, the human spirit. I say this not to judge their character or intentions, which I believe are good, but with the hope that they see how this mind-set doesn’t offer any positive progress.

We are not unrealistic about the challenges our daughter faces, but nobody can say with certainty that she won’t walk independently or be an Olympic athlete. What I do know is she has more determination in her pinky finger than most have in their whole being.

Believing something is possible when everything tells you it isn’t takes a leap of faith, but in the end, regardless of the outcome, people don’t feel disappointed at the people who believed that anything was possible.

The Christmas I Thought Was My Child’s Last

December 2014 was one of the hardest months. Katherine had been given her second 90-95% diagnosis of Infantile Neuroaxonal Dystrophy (INAD) from another top neurologist. She showed signs of regression that are typical for INAD patients – loss of skills (she no longer was able to climb and asked for help getting up on the bed), seizure-like activity, and she started saying she couldn’t see very well in low light. We found ourselves in the hospital for four long days of testing as others were putting up their Christmas trees and baking cookies.

IMG_6861 The only things standing between what appeared to be the inevitable and hope were a miracle and a whole exome sequencing test. We wouldn’t get results back until February.

A few months earlier I ran into a dear friend’s mother whom had recently lost her husband to lung cancer. Full of grace and eloquence, she passed along some wisdom as our tear-filled conversation concluded:

As my own mother battled cancer, she taught us that how we leave this life is as important as how we live it, and that we should try our best not to grieve the dying until they are gone. This is very hard to do, though, I know.

Christmas is especially tough for the caregivers of those with a terminal illness.  Amidst the magic of a season rich in faith, family, and tradition, your own pain is amplified against the backdrop of a world that is enveloped in a warm, merry bubble of happiness and joy. For me, this time of year hurt a little deeper, especially with Katherine’s recent regression.

As I walked down the aisles of the grocery, slowly and methodically gathering ingredients for Christmas dinner, overhead Bing Crosby was singing “I’ll Be Home for Christmas,” told from the point of view of an overseas soldier during WWII, writing a letter to his family:

I’ll be home for Christmas
You can plan on me
Please have snow and mistletoe
And presents on the tree.

Christmas Eve will find me
Where the love light gleams
I’ll be home for Christmas
If only in my dreams.

I looked around at the smiling faces as these words blared in my head and realized I was shopping for what I believed was my child’s last Christmas dinner; there would be no more snow and mistletoe, or presents under the tree. The ghost of Christmas future was whispering my worst nightmare in my ear: I would be a childless mother for the rest of my life.

Right then and there, in the middle of a grocery store aisle filled with singing reindeer and Christmas tree shaped candy, I came face-to-face with my child’s fate and my future. I openly grieved for the life she’d never have, for the Christmases we’d never get to share, and the short motherhood I’d experience. The cart supported my weight as I maneuvered my way to a place where I could be as alone as one can be in the middle of the holiday section at a grocery store a few days before Christmas.

Somehow I managed to walk myself up the the check-out and pay for the items. As I drove home, I reminded myself of what my friend told me a few months earlier:

As my own mother battled cancer, she taught us that how we leave this life is as important as how we live it, and that we should not try our best not grieve the dying until they are gone. This is very hard to do, though, I know.

Yes, I know. So tough. It was nearly impossible.

I managed to cook one of my best meals ever that year, and Katherine looked so lovely sitting at the table, basking in the glow of candlelight, love, and Christmas magic. Across the table I was savoring and imprinting this memory – praying the warmth and love I felt in the moment would get me through the coldest days ahead.

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#Hope4KB

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I like a challenge, especially when the challenge is for a good cause. What is #Hope4KB?

  1. #Hope4KB is a T-shirt campaign designed to raise awareness for rare diseases around the world through social media (KB is our daughter, Katherine Belle, a three-year-old from Lexington, KY, who is battling an unknown, progressive rare disease);
  2. You purchase your #HopeforKB shirt from Print My Threads here;
  3. Orders will be collected through March 1st. Wear on Rare Disease Day on February 28, 2015 (only orders placed by February 18th will arrive for Rare Disease Day, but we want you to wear this shirt all the time!) ;
  4. Take a picture of yourself and/or family and friends wearing your #Hope4KB shirt and share it on your social media accounts, i.e. Facebook, Instagram, Twitter, etc. with #Hope4KB; and
  5. The goal is to BREAK. THE. INTERNET.

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Ellen did it.  Kim Kardashian did it. It happened with the ALS #IceBucketChallenge – Let’s do it with #Hope4KB! Not to mention these are the softest, most comfortable American Apparel tri-blend short sleeve track shirts.  Trust me, you’ll be wearing this shirt LONG after February 28, 2015. (Psst…you can still help even if you don’t have any social media accounts – this campaign is for everybody!  Simply take a picture and send it to me at gcmccoy1@aol.com and I’ll make sure it’s shared!) *Proceeds will benefit Katherine Belle and Katie Webb Kneisley. (Click here to read her story.)

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A Magical Vacation

Laughter is timeless, imagination has no age, and dreams are forever.  
Walt Disney

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IMG_7348After working hard on a brief from December through early January, the time came for a much-needed break. Fortunately, this aligned with availability at our friends’ condo in Sarasota and while Glenda’s mom was in Wildwood, Florida.

Sandwiched between these two locations is Disney World. We are “wish-eligible” at Make-a-Wish and similar wish-granting organizations and have wondered whether Disney would be a good place to use our one wish for Katherine. With her sensory processing issues, we did not know if she would enjoy the experience. So, we decided to splurge for two park days to see in between Sarasota and Wildwood. I’m glad we did. Katherine really enjoyed the trip.

Glenda and I have decided to give you our top 10 moments on our Sarasota-Disney-Wildwood trip. We are not looking at one another’s list, so these may overlap. They may not. Here are mine, in chronological order:

  1. Walking from Sarasota to St. Armand’s key on our first day, in the beautiful 70-degree weather (leaving behind frost at home), eating lunch and gelato outside, and then walking back;IMG_4654IMG_4134IMG_4138IMG_5331IMG_5342IMG_5279IMG_5270
  2. Building Katherine a “bouncy castle” out of blow-up mattresses at the condo in Sarasota, and her laughter playing inside of it;IMG_5606
  3. Putting on a “puppet show” with Katherine’s stuffed animals from outside the “bouncy castle”;IMG_4246
  4. After learning of Katherine’s diagnosis, the concierge at the Disney resort booking reservation times for us at the rides we wanted to do, and then bringing her a stuffed Minnie Mouse doll. Well-played Disney, well-played;IMG_4403
  5. After running out to get something from the gift shop, returning to the room our first night at Disney to hear Katherine exclaim “Look Daddy, I can walk!” Followed by her letting go of the sides of her pack-and-play and taking a very good step by herself. She then showed mommy another step. While she cannot walk on her own, these steps are the best I’ve ever seen her take and her excitement at “being able to walk” was priceless. Magic Kingdom, indeed;
  6. Taking her on Dumbo as her first ride, then tentatively waiting to hear whether she liked it. Her exclamation, “play another game,” meant “yes”;IMG_6351IMG_6335
  7. Watching her slowly come to love the characters. She met Cinderella, Rapunzel, Belle, Ariel, Donald Duck, Goofy, Mickey, Daisy, Minnie (from a distance), Chip and Dale and some monkey-thing from the Lion King. Goofy and the monkey-thing frightened her – though she has a Goofy obsession. After being tentative, she grew to like them. She still held Glenda’s hand while meeting the animal characters, a separate favorite thing for me;IMG_6569IMG_6524
  8. Dancing with her in her princess dress while waiting for a table at a restaurant, while she made her dress puff out while jumping and twirling (with my assistance) only to realize that the entire restaurant was set up to look out the large windows over the lake behind us. We were the floor show;IMG_7392
  9. Looking at all the sleeping children and zombie-fied adults waiting for the bus back to the hotel after the fireworks, with the only spark of life in the entire line being our little KB, after 12 hours in two parks and no nap, still jumping up and down, screaming “Jump! Jump! Fireworks! Jump!” Boy were my arms tired; IMG_4557
  10. Listening to Katherine sing along with her Mickey’s Clubhouse DVDs on the ride home.
    (Ok, I have to give a couple more, sorry Glenda):
  1. Watching Katherine crawl-chase Glenda’s mom’s dog, Joey, to pet, kiss and play with him. Only last year, she was still physically shaking in fear at the sight of a dog;
  2. During a silly spat with Glenda on our last night in Wildwood, having Katherine say, in her best Glenda voice, “Calm down, Dave. Just calm down” – I honestly wasn’t “not calm” just a little animated – after laughing and sitting down and re-assuring her that I was ok and it was silly, and reminding her to always call me daddy (she only calls me “Dave” when she is imitating mommy), having her hug and kiss me and ask “does that make you not mad, daddy?” After answering “yes,” having her sit thinking for a minute, grin and then ram her toy rabbit, Bibi, in my face, then ask “Does that make you mad again?”;
  3. Watching KB bounce around singing “hot dog, hot dog, hot diggety dog”;
  4. After leaving our meeting with mermaid Ariel, hearing her remark that she was wearing the mermaid’s dress; andIMG_7297
  5. Being covered in glitter from carrying my little princess all over the park. Who knew I look fantastic in green glitter?

    Glenda’s top 10 moments, in no particular order:

  1. Our friends’ condo in Sarasota is a pink Spanish style built in the 1920s.  When we arrived, Katherine excitedly pointed to the condo, exclaiming, “We’re staying in a pink hotel!”  She talked about the ‘pink hotel’ the entire time;IMG_4149IMG_5594IMG_4109
  2. Katherine watching Mickey Mouse Clubhouse DVDs on the trip and knowing all the songs by the time we got home.  This was really a first for her in terms of trying to sing along. Hearing her sing, “hot dog, hot dog, hot diggity dog” is priceless;
  3. Riding “It’s a Small World” at Disney. It took me back to my own first Disney experience as a child.  I loved watching her eyes light up with delight.  When it ended she exclaimed,  “ride again!”  We did.  She loved it;IMG_6431IMG_6451IMG_6459
  4. Shortly after arriving at our Disney hotel, Dave asked the concierge about getting a handicap pass for our stroller.  Not only did he proceed to book everything we wanted to do in advance and give us guidance on everything we needed, but he showed up at our door 30 minutes later with a Minnie Mouse doll for KB.  As he handed it to me he said, “we hope your daughter has a magical stay at Disney”; IMG_4267
  5. I knew that I wanted her visit with Ariel to be extra-special.  We decided to take her to a shop to pick out a new dress and have glitter sprinkled in her hair.  Ariel was so excited to see that KB was dressed like her and made the visit memorable for all of us.  As I was taking photographs I saw the look of pure joy on KB’s face .  That moment brought tears to my eyes and a smile to my face.  Yes, this was where we needed to be at this moment.  As we pushed her away in her stroller, she looked at her dress and said, “This dress is really cute. I am a mermaid”;  IMG_7253IMG_7202IMG_7246
  6. Bibi was with us everywhere we went and got to enjoy all the sights and sounds, even getting a little glitter on her head;IMG_6801
  7. Seeing Dave covered in glitter from head to toe from carrying and dancing with his princess;IMG_6779
  8. Seeing Dave and KB dancing together in her beautiful princess gowns;IMG_4563IMG_6488
  9. We took her to a character breakfast even though we knew she might be afraid of life-size characters.  She was scared but we told them she just wanted to wave so they didn’t get too close.  By the time Daisy Duck came by she was less afraid and would reach out to hold my hand for reassurance.  It was very sweet how she held my hand and also very brave for someone who was completely over-stimulated; andIMG_4575
  10. Seeing Disney through the eyes of my daughter. Sometimes it’s best to jump in the car and drive to Florida, in the direction of Disney, with no particular plans but to feel sunshine on your face, eat ice cream, and laugh. As Disney himself said, “Adults are only kids grown up, anyway.”  After a very tough year of being more grown-up than I’ve ever imagined, it was fun to feel like a child again, if only for a few days.IMG_6478IMG_6372IMG_6378IMG_7273IMG_7179IMG_5836IMG_5436IMG_4434IMG_4576IMG_6130IMG_6156IMG_4164

A Year in Review (2014)

Yesterday is history. Tomorrow is a mystery. Today is a gift.  That is why it is called the present. – Alice Morse Earle

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It’s true that your life can change (for better or worse) in the blink of an eye, only to realize you spent your prior days focused on a future that may never exist.

Learning to live in the present is not easy.  Our lives are filled with clocks,  calendars, and deadlines.  It is nearly impossible not to think about the future.  And not just tomorrow or the next day, but that distant future that lures us in with false promises of happiness.  For most, “someday” is that glorious day when all our dreams come true and the troubles of today fade away.

It is such an enticing place that I have no doubt that most people cannot help but smile when they say the word “someday.”  Up until a little over a year ago, I was always dreaming about “someday.”  I remember thinking someday I will have more free time, find a more fulfilling job, have my house exactly the way I imagine…

On Friday, August 30, 2013, at around 7:30 p.m. my glorious someday ceased to exist as I received the devastating news that my daughter is  dying of an incurable metabolic disease.  In an instant, someday became so scary and painful that my mind tried to obliterate the concept entirely.  I hated that day and never wanted to see it.  I wasted so many years fantasizing about a day that I now dread with every fiber of my being.

My best analogy I can think of that most accurately describes in words the challenges of the past year requires an imaginary exercise:

You’re asleep and having your normal dreams when all of a sudden you are thrown into the middle of a big, cold ocean.  It’s really stormy, huge waves keep crashing over you, and you’re all alone.  You’re not the best swimmer, but somehow you don’t drown even though you are very fatigued and scared.  You are in survival mode.  You don’t remember how you got there, nor do you think about how long you’re going to be there.  You are there and you will die if you stop swimming.  Sometimes you tell yourself that you are asleep and it’s all just a nightmare, yet it’s not.  It’s beyond your understanding, but it is really happening.

You pray and ask God why this is happening?  Is this part of His plan?  In time you will understand His plan a little better and learn to trust it more than question it. And by doing so, you will find some peace.

Although nobody can pull you out of the water, many boats pass by and give you support (prayers, a life vest, encouragement, a boat, an ore, a compass, food, a fishing pole, water, etc.).  The boats that help far outweigh the ones that don’t.   Slowly but surely you become more familiar with your surroundings.  You are still vulnerable to the elements and storms, but you are paddling your boat the best you can one day at a time.  Over time you meet others in that vast ocean; people just like you.  You are not alone.

Navigating rare disease is much like learning to survive alone in the middle of a big, stormy ocean.  You really are left on your own to learn how to survive.  The sad reality is there are many barriers in our healthcare system.  Sure, there are benefits, but there is nothing worse than when the system fails your three year old. Sometimes in life you have to be your own life preserver.  And if you do it the right way, you may have to the opportunity to help others along the way.

I have learned a great deal about myself this past year.  It is amazing how little you fear when you are face-to-face with your worst fear.  After reviewing our work for 2014, I feel good about our accomplishments.  This list confirms we are not only surviving, which is a major accomplishment alone, BUT we are fighting.  And, based on the comments and letters I’ve received from so many this year, we are also helping others.   I have no doubt that God is with us on this journey and fully trust that His plan is far better than my once imagined “someday,” for better or worse.

A Year in Review (2014)

Advocacy

  • First article about our family was published in The New York Times, When the Diagnosis Is Rare, Parents May Know More Than Professionals;
  • Hope for KB sign campaign has received hundreds of photographs from around the world and from several notable celebrities, including Courtney Cox, Josh Hopkins, & Colin Hanks;
  • Made a short video about rare disease to share with Congress and on social media;
  • Encouraged individuals to write to Congressional members and ask them to join the Rare Disease Caucus. To date, Rep. Brett Guthrie, Rep. Andy Barr, and Rep. John Yarmuth have joined;
  • The Kentucky House of Representatives issued a Citation for Rare Disease Day (2013) and we took Katherine to the House floor to give a face to rare disease as the Citation was read by Representative Sannie Overly;
  • Hope for Katherine Belle has established a good following through social media networks, including Facebook, Instagram, and Twitter;
  • First blog post published on January 27, 2014.  To date we have published 31 posts detailing our journey.  Total reach is 45,049 views in almost every country around the globe;
  • Invited by the Rare Disease United Foundation to be included in Beyond the Diagnosis Art Exhibit at Brown University’s Alpert Medical School. The exhibit will travel to medical schools and hospitals across the country as a way of raising awareness about the many unmet needs of the rare disease community;
  • I have been invited (and accepted) to serve on the Board of Advisors for NGLY-1 Foundation and RUN (Rare and Undiagnosed Network); and
  • Dave offered legal assistance for several families (pro-bono) in their insurance appeals for genetic coverage.

Medical

  • Exhausted all testing at the Cleveland Clinic and received a 90% diagnosis of Infantile Neuroaxonal Dystrophy (INAD); received a third opinion from an INAD expert in Oregon of unlikely for INAD;
  • Appealed insurance denial for INAD test (won);
  • Researched every article available for INAD and similar diseases and performed genetic research on both sides of our families;
  • Participated in our first clinical study (NC Genes) at UNC – Chapel Hill.  We are awaiting whole exome results from this study (July 2015);
  • Second whole exome test through GeneDx.  Awaiting results (April – at the earliest – 2015); and
  • Raised $15,680 on KB’s GoFundMe page for whole exome, medical expenses, and travel; and
  • Established emergency care at the University of Kentucky following seizure activity in December. KB is now on seizure medication.

I have crossed paths with so many inspirational people and organizations this year – people whom I never would have met in my previous life.  So many friends, family, and strangers have helped in every single step of 2014.  Nothing was accomplished single handedly.  Nothing.  We have been blessed with phenomenal doctors, lawyers, nurses, techs, geneticists, politicians, clergy, therapists, this list goes on and on.  All the helpers of the world have shown up to help us during our crisis.

As for now I can tell you that Katherine is a very happy child who brings us far more joy than we imagined possible.  She is bright, funny, strong willed, fiercely independent, and delicate and dainty but tough as nails.  I miss her when she’s sleeping, laugh with her when she’s awake, and love watching her personality develop.  She’s my best girl always and forever.

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Learning to live in the present is a hard earned gift – one that has changed my life for the better.  My once “someday” has become my every “today,” and each day is an incredible gift. I look forward to sharing our days and a few goals with you in 2015.  Happy New Year!

Merry Christmas

 

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Thanks to Lisa Auge for the photo edit

Katherine gave us a big scare last Saturday when she had what we (and two neurologists) think was a seizure. After a four day stay at the University of Kentucky Children’s Hospital and a two-day EEG video, she is now on seizure medication.

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We are so happy to be home to celebrate Christmas. We made our annual Christmas cookies and ate them under the tree.

IMG_2386_2 IMG_2997We are doing our best to make this Christmas as magical as possible for Katherine.

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We do not have a P.O. Box established to receive cards or gifts.

We have asked that you please refrain from sending presents. We are trying to sell our home and I can assure you that KB has more than enough. If you want to help our family, we ask that you please make a donation to www.gofundme.com/hopeforkatherinebelle to help pay for medical expenses, testing, etc.

I have a bag of duplicate toys she’s received – yes, a bag a them! – ready to take to a toy drive.

If this isn’t something you want to do, then please donate a toy to a local charity, or donate to Rare Disease United Foundation, or Global Genes Project. Or share our story and help us raise awareness.

Also, please consider sending a card to sweet Addie.  She has an unknown rare disease and loves Christmas cards.

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Finally, if we could we would send each of you a Christmas card. Instead, please accept this card as a token of our love and appreciation for each of you. Thank you for following our story, for helping us raise awareness for rare disease, and for listening to and sharing our fears, our triumphs, our sorrows.

We are so grateful for the many generous donations you have made to help us fund this diagnostic odyssey. Mostly, we appreciate your prayers, kind hearts, and for loving a child you’ve never met, but want to help and pray for on a daily basis. You give us more comfort and hope than you may realize.

We truly believe that no matter what may come, we can all rejoice in knowing the world is a better place because of children like Katherine Belle.

From the bottom of our hearts, we wish each of you a very Merry Christmas!

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How am I doing? (Glenda)

KB is so sweet and innocent.  She has the voice and face of an angel and the kindest disposition.  Truly.

I miscarried my first pregnancy and was a nervous wreck throughout Katherine’s.  I knew I was going to feel so much joy and relief as soon as she was out of my belly and finally in my arms. What I wasn’t prepared for was the unbearable pain motherhood brought. A flood of emotions washed over me right after her birth and I remember crying so much, even asking myself “what have I done?”

It was the first time I understood – truly understood – that if anything ever happened to her that a part of me would die, that it would result in my complete undoing, and I would never be the same again.

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She is reaching the stage where she wants to do everything by herself. She even pushes my hand away when I offer her much needed help with eating, holding her so she won’t fall, etc. Today she told me she doesn’t need my help anymore, but the harsh reality is she needs it increasingly more because whatever is affecting her cerebellum is getting worse with each day.

I hear myself saying “be careful” too often.  I am having a hard time figuring out how to give her the independence she desperately desires without letting her hurt herself.

She has lost her ability to climb.  Not all that long ago she was climbing up and down on the bed and couch; now she asks for help just to get up.  She isn’t interested in using her walker anymore.  And just the other day I found her resting in the hallway as she crawled between our bedroom and her playroom.  

She chokes more when drinking and eating – another sign of progression – which will likely require a feeding tube in the future.

She falls more frequently when sitting and crawling.

As you can imagine, this is excruciating to watch, much like a child watching their parents slowly deteriorate before their eyes. But this isn’t my mom or dad. She’s my baby. And there’s nothing I can do about it at the moment except what we’re already doing. It is such a helpless, sad feeling. Of course it isn’t fair, but “fair” doesn’t have anything to do with it.

Katherine looks healthy in my photographs. Honestly, she is “healthy” and happy in the day to day sense, which is a blessing. However, my photographs don’t show the falls, the tremors, the tears of frustration, or the pain we feel as we helplessly watch her progression slowly unfold before our eyes with nothing to offer in terms of treatment, except for love and reassurance. Some days I try to convince myself this will be enough; other days I know it can’t stop what is happening. Mostly, I pray for time, understanding, a cure. Or to wake up from a nightmare and none of this be real.

And then I remind myself that I have to take this one day at a time. Otherwise I will be consumed by my grief and miss the precious moments we have with her.

How am I doing?  I have no idea, honestly.  I am just doing; just breathing; just trying not to think about the future.  There are times when I cannot stop crying.  Moments when her beauty and innocence take my breath away and I don’t understand how I am ever going to find the strength to watch her feel pain or go blind or the others things that could happen. Things I don’t even want to think about.

One day at a time; one moment at a time; one breath at a time.

How am I doing?

I received a call from my mom the other night asking if I was “ok.” She had read my post about Robin Williams’ suicide and noticed that I seemed to have low energy when I took Katherine to meet my parents for breakfast a few days earlier. She was concerned about my well being, much like I get concerned about Katherine’s.

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Am I ok?

The blunt answer is “no, I am not ok. I do not know that I will ever be ok again.” None of you want to read that. I am sorry to write it. Yet, that’s the truth.

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My daughter, the light of my life, is regressing. In the absence of a miracle, she is expected to live only a handful of years, will become increasingly off-balance and immobile, and will experience frustration at losing her ability to do things she wants to do and did just months before (to be candid, she already is expressing such frustrations), and that is just the precursor to possible dementia, seizures, blindness, and an inability to swallow. Her speech will become harder (is already becoming harder?) to understand until she cannot speak at all.

I have a recurring nightmare (what I am saying, these thoughts come to me in panic attacks in the day more often than at night) in which I go to work while Katherine is still asleep, so I do not get to say goodbye. By the time I get home, Katherine has lost her ability to talk. I will never again hear her say “I love you soooo much” or even “daddy.” I missed my last chance to hear these words while I was sitting at the desk at which I am now typing. At this very moment and as I am writing these very words, these thoughts are so real to me that my chest is tightening in panic and tears are welling in my eyes.

No, I am very much not ok.

The truth known by rare disease families is that despite being “un-ok,” you manage. In some ways you even thrive. You have moments, even days and weeks, of pure joy and happiness; when your only tears are those of laughter and joy.

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Laughter and joy are Katherine’s currency. She spends them freely. I am more alive than I have ever been. I feel more deeply than I’ve ever felt. I am better at living in the moment than before. I see genuine goodness in people around me, in friends, family and complete strangers. People who reach out to lift our spirits and to help us practically and emotionally. I see my daughter in all children and love them for it.

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We do not deserve the pain of rare disease, but we did not deserve the immense blessing that is Katherine, either.

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My dearest baby girl, I would go through the pain of this journey a million times in return for the joy I have experienced. As I wrote in that prayer book in Cincinnati on the day of your first MRI, “you are everything.”

Robin Williams and Rare Disease

I read today that Robin Williams’ autopsy confirmed that he had Lewy Body Dementia. For those that do not know, this rare disease causes protein “bodies” to appear in nerves. These bodies impair nerve signals, often leading to hallucinations, dementia, and poor motor control.

This struck me particularly hard since Lewy Body Disease is similar in certain respects to Infantile Neuroaxonal Dystrophy (“INAD”), the condition two of Katherine’s doctors believe she likely suffers from. While the manifestations and causes are different, both involve problems and “bodies” in the nerves. With INAD, “spheroids” appear in neuronal axons throughout the body, but particularly in the Cerebellum (because the Cerebellum contains more neurons than the entire rest of the brain and body combined). In both cases, nerve functioning is impaired. With INAD, it also can lead to dementia and always results in poor motor control.

Neither condition has a cure. Both can be difficult to diagnose. Both are debilitating. Both are progressive.

It also hit home because Glenda’s grandfather “likely” had Lewy Body Disease. I say “likely” because he was never definitively diagnosed with it. As we now know all too well, it often is difficult to diagnose rare diseases. Indeed, Robin Williams was only diagnosed with Lewy Body Dementia after a brain biopsy performed during his autopsy discovered the tell-tale Lewy bodies. Glenda’s grandfather died in 2013, just months before the MRI that led the physicians to telling us that Katherine “likely” has INAD. I looked for a relationship between these conditions in my first frantic internet searches, and wonder about possible connections still. It is no wonder, then, that Robin Williams’ suicide resonates with me.

His painful decision to end his life strikes a different, but familiar, chord. Whether dementia caused by the Lewy bodies was a contributing factor in Williams’ decision to commit suicide, loss of muscle coordination was the final straw in a man suffering from life-long depression, or Lewy Body Disease played no factor at all in his decision to commit suicide may never be known. What we do know is that little hope is given for sufferers of Lewy Body Disease – or INAD or any of the other (approximately) 4,000 known or countless as-yet-unknown rare diseases. Few resources are devoted to studying rare diseases and few treatments are available. In many cases, few options are available to even diagnose them — and insurance steadfastly refuses to cover most genetic testing by labeling these non-invasive diagnostic tools as too “experimental;” this translates to “too expensive.” Support groups are hard to come by because patients are few and too wide-spread to find or meet with others like them. There is little community for those of us in dire need of a community’s support.

In the wake of the Robin Williams revelation, we should all take a moment’s pause to consider that a man as objectively successful as Robin Williams saw his life with rare disease as so bleak that his chosen alternative was to end it. While I do not support Robin Williams’ decision, I do understand it. I suspect many others in the rare disease community understand it too.

For those of you who may wonder why Glenda and I have this blog, it is more than an attempt to build awareness for rare diseases (though it is certainly that too). It also is our life raft in deep water. We are trying to keep afloat as we search for others. We rely on your contact and support to keep us paddling toward a shore we cannot see and often lose faith is even there, but continue to hope to find before it’s too late.

For those of you who found Robin Williams’ death to be tragic, please consider that you are surrounded by people – a full 10% of the population suffering from rare disease plus their affected loved ones – who may sympathize all too closely with his decision.

Then do something to help.

Connected To The Past

Timing is everything in life.  Just as those who came before us, we all have a ticking clock over our head.

Lately, I’ve frequented antique shops scouting out props to use for food photography projects and collaborations.  More than ever I feel a greater connection to the past.  I find it impossible not to think about the lives, conversations, relationships, tragedies, etc. of the previous owners as I touch, repurpose, and use their personal household items.

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My most recent excursion brought tears to my eyes when I stumbled across a beautiful wooden cradle sitting silently in the corner. That cradle belonged to somebody else’s Katherine, and the bond between a parent and child is timeless.  What was that baby’s story?  Did she have a long, healthy life, or did she die young from Scarlett fever, influenza, an appendicitis, or a rare disease?

Although many medical advancements have occurred since that cradle was made, it’s hard not to feel stuck in the past when doctors say they believe your child is slowly dying of a disease they cannot diagnosis or treat.  Intellectually, I grasp and appreciate the fast-paced nature of genomic medicine; emotionally, however, I fear my own daughter’s timing may not be on the right side of science.  Then again, children still die from influenza.

None of us can escape death or its timing.

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Silhouette of Katherine Belle by Clay Rice.

As I closed my eyes and filled my mind with the sound of giggles and the tender moments shared between a mother and her child, I was reminded that hope is the only thing stronger than fear.  Yes, I am afraid, but my hope and faith are much stronger than my fears.

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Around We Go

On June 19, 2014, we were told a second time by a doctor that, in his opinion, he thinks there’s a 90% chance Katherine has Infantile Neuroaxonal Dystrophy (INAD). Once again, this opinion is based solely on her brain MRI.  However, (at this point) she shows no clinical signs (i.e. involuntary eye and muscle movement, muscle rigidity, etc.) of INAD.  We are still awaiting some results from her spinal tap. All other tests, including those that typically show abnormalities in INAD patients, have been normal except for her brain MRI.

Feeling confused by the certainty of the diagnosis based on the MRI alone, we decided to seek a third opinion, this time from an INAD expert in Oregon.  We sent her all of Katherine’s test results, MRI reports and images, medical history, etc. After a thorough review, she informed us that she thinks it is unlikely that Katherine has INAD.

Again, an expert in the family of diseases that include INAD says she thinks it is unlikely that Katherine has INAD.  Unlikely.  Unlikely is a far cry from a 90% likelihood.

Without getting too technical, Dr. Hayflick says the progression shown on Katherine’s last MRI is not the same as she’s seen in other INAD patients, and one abnormality is not one she has ever seen in an INAD patient. In addition (as we knew), the genetic test results for INAD were normal.  She also believes she should be experiencing clinical aspects of this disorder other than those directly associated with the cerebellar atrophy, which she is not.

So, where do this leave us?  Is this a cause for celebration? Well, we do not know what this means since she did not give us any alternatives.  Instead, she agreed that the next step should be the Whole Exome Sequencing for possible answers.  We are in the process of getting the test cleared through our insurance company (fingers crossed).  This test costs around $13,000.  Insurance may or may not cover some or all of the costs.  Test results take four months.

It is likely that this test is the end of the road for us as far as conventional medicine is concerned.  Few of the things Exome Sequencing might reveal have FDA-approved treatments – but “few” is better than “none.” Four months from now we may be left with this answer: we just don’t know right now.  Or, this test could uncover something other tests have missed – perhaps a disorder that is treatable. Perhaps it will reveal an atypical INAD, leaving us where we were last August and again last month.

For now, we must be patient, enjoy our precious moments with Katherine, and have faith in the things we do not understand. This journey continues to confirm my belief that Katherine truly is rare –  a living, breathing miracle who is spreading her joy around the world – and none of her doctors have ever seen another person with her condition.  We all seek answers under these circumstances, but for now they can only estimate with percentages as to what is happening in her body because they are not certain.   And, as uncomfortable as it may feel at times, uncertainty isn’t necessarily a bad thing.

After all, hope shines brightest in the darkest moments, right?

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Back Where We Started

On June 19th and 20th, 2014, Katherine had several different appointments and procedures at the Cleveland Clinic. These included a follow-up MRI, a spinal tap to draw spinal fluid for testing, an appointment with a genetic ophthalmologist to look for signs of metabolic disease that commonly appear in the eyes, an appointment with our neurologist, Dr. Parikh, and with a geneticist. As will be discussed below, an EEG was added at the last minute.

The MRI and spinal tap occurred on the morning of the 19th. The ophthalmologist was that afternoon. Our appointment with Dr. Parikh was set for the 20th, but we received a call a little while after the MRI that they needed to schedule it for later that afternoon. At that moment, we feared the MRI showed that something was wrong.

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Unfortunately, we were correct. The MRI showed that the damage to her cerebellum had spread since her original MRI in August of 2013 and now impacted her “entire balance center.” Dr. Parikh then uttered the dreaded acronym: INAD (short for Infantile Neuroaxonal Dystrophy). For additional information, go to:

http://www.ninds.nih.gov/disorders/neuroaxonal_dystrophy/neuroaxonal_dystrophy.htm

The appointment with Dr. Parikh immediately turned to chaos. Glenda started crying very hard, Katherine got upset and kept asking “mommy, you ok?” and I felt like I was falling into a hole. Dr. Parikh wanted to discuss our reaction and the MRI some more, including showing us the images, but it just wasn’t really possible to focus. I remember he kept putting his hand on Glenda’s shoulder to give comfort and reassure her, but she was inconsolable.  I did manage to explain to him that we had hoped that her MRI had not changed and that we hoped it was not INAD based on the prior negative tests. I also said that we felt like this was a death sentence.

Dr. Parikh said that the other tests were not definitive. The genetic test that was normal is normal in 20% of the cases where other tests shows that the patient has INAD, the nerve testing (EMG) is sometimes normal in the early stages of the disease, as is the skin biopsy, and the eye test (done earlier that day and showed no abnormalities and that she has better eye-sight right now than either mommy or daddy) was often normal throughout the course of the disorder. While the MRI was also not definitive, he knew of no other medical condition that shows her particular MRI findings. He asked if we wanted to look at the images, but we did not have the strength. We may regret this, but we just couldn’t right then.

He went on to say that he is 90% certain that she has INAD. I guess that means there is still a 10% chance that she has something else. He wants to follow up with the genetic testing to see if that “something else” comes up.  Dr. Parikh also tried to reassure us that even if it is INAD, there is still hope. He said these cases are so very rare, that we cannot assume that our daughter will follow the same course as those that went before her; they are constantly learning that these rare disorders have different types, different outcomes and different time frames. I replied, “but her MRI is showing that her condition is advancing.” He answered “yes.” I do not remember anything that followed during that appointment except for Katherine’s repeated question “mommy, you ok?” Glenda later told me that Dr. Parikh said, “I was hoping the MRI result was going to be different, but it is not.”

Based on the MRI, an EEG was added to Katherine’s appointments. Abnormalities in the EEG are an early sign of INAD. We got up early the next morning to put Katherine through this test. A few days later we received a call from the Dr. Parikh’s office. The EEG showed “no signs of concern.” Yet another typical finding for INAD is missing. Only her MRI appears in any way like this dreaded disorder.

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Yet, it is the MRI that really matters. Regardless of the label or acronym put on the disorder, the bottom line is that it is damaging Katherine’s brain. Her higher functioning remains normal for now, but her ability to control her movements is becoming increasingly impaired.

For example, her intelligence seems unaffected. Her vocabulary is growing. Her sentences are becoming more complex. She understands ideas that we thought beyond her age, including a pun the other day on Bubble Guppies, which she proved was no fluke by immediately telling a related joke (though not a pun) of her own. Her memory is better than ours. In fact, we use her as our shopping list, telling her what we need to get at the grocery, sometimes a day in advance, and she invariably remembers to tell us to get it when we go to the store. Yet, she struggles with movement. She cannot walk. Standing without aid is rare now. Standing with aid is unsteady. She falls often when sitting or crawling. Her right foot is becoming tighter when manipulated and drags when she walks with aid. She is clumsy when using her hands to reach for something or feed herself.  She is unable to hold a large popsicle.

While her language content and structure is getting better, her ability to communicate the words is becoming more of a struggle; she is slipping back into that stage that all parents know well when mommy and daddy can understand most of what she says, but other people have trouble understanding her. In short, she is a happy, smart and funny little girl, slowly (for now) losing her ability to control her movements. This is slow enough that we have been able to convince ourselves that we see no regression, only the result of someone trying to do more and to do it quickly, but with a problem in her cerebellum. We now know that this is not true. In the end, what we learned is that her condition is spreading damage through her cerebellum, leading to increased balance and motor problems; she is regressing.

We can continue to hope. We are re-involving a physician from Oregon who ceased to be part of the picture after PLA2G6 testing appeared to indicate that INAD was unlikely, but who is an expert in this family of disorders. She may offer additional opinions or ideas of how to proceed. Dr. Parikh mentioned something about consulting with INAD experts in other countries, but what he said is lost in the haze of that appointment. We are going to perform whole exome sequencing at the Cleveland Clinic to see if “something else” pops up – assuming that insurance agrees to pay for it to be done, which is far from given. We will discuss this testing in a future post. Whether it shows a known mutation that leads to a different diagnosis, a mutation that becomes part of the body of knowledge about the causes of INAD in those 20% of cases where there is no PLA2G6 mutation, or a new mutation and a new rare disease, the answer matters to us. It gives us our only chance, however slim, to find something treatable. It also may add to advancements in the science behind these rare diseases that one day may save someone else’s child, even if not our own beloved Katherine. Soon, we may be left with nothing that current science can offer and no more battles we can fight.

Following the devastating appointment with Dr. Parikh, we made a tear-filled, defeated walk across the Cleveland Clinic campus. We decided that a trip to the beach with Katherine would be good for all of us, which it was.

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On our drive to South Carolina, we discussed our options, which are very few, and realized we were right back where we started last September.

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And then THIS happened.  Celebrities, friends, family, strangers, and even a few mermaids started sharing their “Hope for KB” images, reminding us more than ever there is always hope and we are never alone on this journey.

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Courtney Cox

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Thanks to all for sending us your photos and messages during our darkest hours, and for your constant prayers, love and support.  To view more photos of Hope for KB, please click below or follow us on Facebook: https://www.facebook.com/media/set/?set=a.308673892635515.1073741834.250763271759911&type=3