One Year Follow-Up

Little Bear was diagnosed with PDD-NOS in July of 2016. It was a devastating day for our family and I was overcome by a range of feelings ranging from fear to desperation to anger, culminating in an anxiety attack that I thought would overwhelm my entire being.  There is no way to easily describe how it feels to have your child’s future slip through your fingers like grains of sand, becoming indistinguishable from its previous self as it blends into the endless beach that makes up the Autism spectrum.

This past year has been filled with a number of ups and downs, many of which I’ve written about in this blog. We’ve gone from an almost-completely non-verbal 18 month old who was just starting to walk to a speaking child with a large vocabulary, but difficulties in sentence formation and word combinations. He can run, squat, and is trying to jump, even though he’s not quite there yet. A year ago he didn’t make any eye contact unless you were playing a game and he didn’t respond to his name. Now he makes eye contact most of the time, has developed joint attention, and he answers to his name most of the time. He’s a nice child and we’re very proud of his progress.

There have been ups and downs with providers. Finding a good support system of therapists is not an easy task. We found an excellent OT right away, but everyone else has been rough. We’re starting to settle in. We’ll see what happens in August when school starts and everything gets shaken up, but for now the therapy is settled and to our satisfaction.

Then there’s what should be the key component: the neurologist. At our second appointment in October, he went over the results of Little Bear’s MRI/EEG. He said Little Bear had a bright spot in the area where all of his symptoms were located. That, combined with his unremarkable genetic testing results, made him tell us that there was a very good chance that he actually had delayed myelination rather than ASD. He said, “Look. I’m going to give you the ASD diagnosis because you need it to get services. But honestly, I don’t think your son is autistic. We’ll know more in a year after you repeat the MRI.”

Days passed. Weeks passed. Months passed. Goals were made, goals were reached. Milestones were hit. Progress was achieved. We were very proud of our son and felt confident going into his MRI earlier this month.

I held his little hand while they burritoed him up for the IV. I stroked his hair as he fought the sedation. I rocked him and held him when he came out and tried to get him to eat or drink something so we could go home. When he was finally cleared for home, we had a weeklong waiting game in which we would wait patiently for his appointment so we would receive hopefully-good news from his neurologist.

The day of the appointment came. We went in, nervous for the results that would potentially be as life-changing for us as the diagnosis he received a year prior. We felt confident, though. We knew our Little Bear was slowly opening up to us more and more. We were sure that good news would come from this meeting.

We entered the room and the neurologist asked us when we were going to do the MRI. We looked at each other, confused.

“We did the MRI last week.”

“Where did you do it? It’s not in the system.”

“We did it at Hospital Where Big Bear Was Born.”

“Why didn’t you do it here at Big Children’s Hospital?”

“Because they called us less than a week before and told us that they no longer accepted our insurance. Then they called us 2 days after and asked why we didn’t come to our appointment and said they did, in fact, accept our insurance now.”

Dr. Neurologist looked up the MRI results on his computer and spent at most 1 minute reading them.

“Well, his MRI came back as normal. It says everything is unremarkable. The EEG shows improvement. It’s a much faster reaction time.”

Papi Bear and I start getting excited. Smiles abound. Holding each other’s hands a little tighter. This was incredible news!

Dr. Neurologist kept talking and saying, “Yeah, so nothing really interesting.” We were stunned. What? Nothing interesting? You literally just told us that our son most likely had delayed myelination. This is incredible news! We asked about this.

“Oh no, you just didn’t understand what I said last time. I never said your son might have delayed myelination. Your son is autistic. You need to accept that. It’s obvious.”

“Dr. Neurologist, you told us it might be delayed myelination at two appointments. You gave us in-depth descriptions of why. You told us, ‘I’m giving him an ASD diagnosis, but he might not have the same one in a year or two.’ This was the reason you ordered the MRI again.”

“Again, you misunderstood what I said. I never said that he wasn’t autistic or that it was delayed myelination. That’s something completely unrelated. Also, even though this came back as unremarkable, it was done at a different hospital and it was read by a different tech. There is room for error. You need to accept the results. There are studies being done related to genes, but when you have a gene that is multiplied or is irregular, there are currently no therapies to change it.”

I stopped him right there. “What are you talking about?”

“I’m talking about how autism is genetic and you can’t do anything about it.”

“Our son’s genetic screening came back normal. There were no markers for autism.”

My god if this man didn’t decide to do a 5 second diagnostic exam of my bored 2 year old RIGHT THEN AND THERE. Yep. He sure as hell did. He pulled out the diagnostic criteria for ASD and started asking “told you so” tone questions.

“Well, I can see right now he has repetitive motions. He’s walking in circles.”

“Actually, he’s singing his favorite song and it’s a circle song. He’s bored. He only walks in circles when he’s singing to himself.”

“But he doesn’t have joint attention. He should have had that a long time ago and he still doesn’t.”

“What are you talking about? We go to the park and point at planes together all the time when they fly overhead. His joint attention may not be perfect, but it’s there.”

“Does your child like Mickey Mouse?”

“I guess so. As much as the next kid, I guess.”

“Look over there! It’s Mickey!”

My son was facing the door because he wanted to leave, but he looked over to see what Dr. Neurologist was pointing at. Dr. Neurologist claimed he didn’t see it and tried again. This time Little Bear glanced for a second, but he already knew what was there, so why linger?

He wrote on his paper “NO” next to “joint attention.”

He went through the list… Questioned us. “Observed.” At the end, he paused… I knew why. Because I’ve done the MCHAT a thousand times. I do it every single month. And for the past 3 months or so it has always resulted the same: “At risk.” A year ago he was “high risk.” Now he’s “at risk.” He has improved greatly. He’s no longer a clear cut case. Dr. Neurologist seemed upset at our son’s five second diagnosis. He told us to come back in nine months.

Papi Bear and I left furious. We were both expecting our child to leave with good news and we felt that this doctor had not even opened his case file before we walked in. The tipping point for me was the spiel on genetics when our son’s genetic testing was clear. This told me that this doctor knew nothing about our son. He cared nothing about our son. He didn’t want to do anything about our son. He just threw him in a heap with a bunch of other kids and couldn’t be bothered to look up his records and see what he had said previously.

I called the office the following day to make an appointment with the other neurologist in the practice. No can do. They don’t do “second opinions” within  the same practice. There is one other practice in my county and we’ve been trying to get an appointment for a year now without success. I was in tears because nobody would help our child. I complained to Big Children’s Hospital’s complaint line and they said that this is a separate office that doesn’t represent them. I told them, “Like hell they don’t represent you. They have your name on their office and they are in your building. They most certainly represent you. They’re your neurologists on your website and I just want to see a different doctor because this one didn’t even read my child’s case file.”

Nope. Nothing. Can’t do a damn thing for us. They said they would talk to the office manager and get back to us. It’s been over a week and nobody’s called me. I’m not surprised in the least.

So that’s where we are now. We’re nowhere. We have a horrible neurologist who doesn’t look at our son’s data with an objective eye. We can’t get an appointment with another neurologist because there are literally none outside of these two practices. We paid for these expensive tests to be done and nobody bothered to properly compare them to the first ones.

I’m just done.

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When autism is enviable

Two years ago, shortly after Little Bear was born, I became active in an online group for evidence-based birth information. I started chatting with a girl that was living in the country my best friend was born in and who had given birth to her first son in another country in the same region. Since she was living in Latin America and I was married to a man from Latin America, we had common interests and became occasional chat buddies.

When she became pregnant with her second child, our conversations moved towards sewing. She and I had both recently begun classes and we both used cloth diapers with our children. She was tight on money, so I sent her a box of cloth wipes that I no longer had a need for. She showed me her progress on diapers she was making for her second little boy, proud of the improvement she was making on each one.

In August of last year, our lives and our friendship took a dramatic turn as I dealt with the diagnosis of Little Bear’s autism and she dealt with her son being born with severe illness that was not immediately defined. At first they thought Down’s Syndrome, then they thought it was a heart defect. The newborn was airlifted to a larger hospital and mom was left with no answers and a thousand questions. I was similarly flailing for answers with Little Bear’s diagnosis. She was one of my anchors and I’d like to think I was one of hers. It was like we were both swimming in a sea of uncertainty and we were grabbing towards each other’s hands, hoping neither of us drowned.

Then, in November, we both received answers. Little Bear might not be autistic. He might actually have delayed myelination and outgrow many of his symptoms. We would repeat tests in a year to see. It was like a lifesaver of hope had been thrown to us and we saw so much improvement from his therapies, that we suddenly felt like we were coasting by.

Screen Shot 2017-03-16 at 11.52.03 PMMy friend also received the answers she waiting for, but it was no life preserver. No, she was thrown a pair of cement shoes: ARPKD. Her son had a genetic defect that had no cure. He would not live to adulthood. Possibly not even past early childhood, given the symptoms that were already evident at birth. Her world crumbled around her. Her boys’ father was no longer in the picture. Her baby was going to die. She felt that she was leaving her older son with nothing more than an absent father and a dead brother. My heart broke in two for her.

She took her older son to be tested last week. I waited anxiously for the results. I was certain he was fine. He was already four and asymptomatic. There was a 75% chance that he was carrying healthy kidneys and healthy genes. She texted me on Friday night with the results. Her older son was also affected. Both of her children would die before they were 21.

My heart broke into a thousand pieces for this friend. I’ve never even heard her voice, but I sat in my car and cried buckets for a woman I’ve only chatted with. I cried for a mother who would lose her entire world in one decade. I cried because I want to continue to hold her hand through this, but I feel that she may end up resenting me and my “problems” with Little Bear. My Little Bear who will one day be a Big Bear and have a completely normal life expectancy. We were two mothers navigating the waves of emotion that accompany the unknown medical diagnoses of our children and one of us was left with a non-neurotypical child and the other was left with two terminally ill children.

The guilt. I feel so much guilt. I have no reason to feel this guilt, but yet I feel it because I don’t think it’s fair at all for a mother like her to have to suffer through this. I feel it because I’m still upset about Little Bear, but Little Bear is growing bigger and stronger while her boys will eventually grow weaker and lose their kidneys. It’s not a fair friendship. I won the freaking lottery of problems compared to her. The goddamn lottery.

I put her in touch with another internet friend who has a son with a mitochondrial disorder. Her son’s life expectancy is similar to the poor mother who will lose her two boys. She has also already lost a child due to a surrogate who didn’t have a c-section early enough when there was a labor complication. She has become the new hand to hold for my online friend. She knows the drill. She also guides me on how to talk to this friend so that she doesn’t feel like I’m babying her or ignoring her.

Autism is a difficult disorder to deal with. Trying to peak into my son’s world and mind can drive me to tears at times. However, there are more and more moments when I feel like he’s left the window open – maybe even the side door – and I can see inside and really know him for a few moments before it closes again. I feel like there’s hope that one day he might invite me in for a conversation and we will know each other. This will continue until I depart this earth before him, as it should always be.

My friend has two children who are neurotypical in every sense of the word. They are happy, active, “normal” children with not a worry in the world. Happy, active, neurotypical children who will have to come to terms with their own mortality before they even begin to live.

I feel so guilty that I lucked out and got an autistic son.

Normal

“Let me call my husband. He couldn’t be here, but he wanted to be on speakerphone to hear the results.”

“Don’t worry about it. Everything came back normal. Your son’s genetic results were all normal. No additions, no deletions, nothing out of range. He has the results we would expect for any neurotypical two year old boy.”

Normal.

This is the first time a doctor has referred to my son as normal since we began this journey in July. Suddenly the idea of having a third child isn’t off the table and the idea of testing our older son for autism is. We have a normal 2 year old who just needs intensive therapy to reach his milestones. Of course, we don’t know why he hasn’t reached them yet or whether or not his future will include this level of therapy, but he is improving little by little and each day brings us closer to having a “normal” little boy.

When you get news like we’ve gotten in the past week, it’s hard to decide how or what to feel. First comes the overwhelming feeling of relief that the “diagnosis” of ASD is temporary. When a doctor tells you that your child is most likely just experiencing autistic-like behaviors, it somehow sounds temporary and completely curable. I mean ASD is not curable, but autism-like behaviors can be overcome, right? We’ll just do lots of therapy and he’ll continue to improve and he’ll be fine.

But then there’s the lingering fear that autism-like behaviors are just that – behaviors that mimic autism. The fact that they mimic a disorder says nothing of how long they will last or their permanence. For all we know, his prognosis remains unchanged with the added risk of seizures.

We’re very happy that our child’s diagnosis is temporary, but we also feel that we need to push hard for him to continue in his therapies and reach his full potential. To us, he’s still the same child he was before he had his first diagnosis, the same child he was when he received it, and he’s the same person he’ll be throughout his life.

He is our son and we will love him and fight for him, no matter what his medical situation is.

Penciling in Life

Last week Little Bear was approved for therapy through our private insurance to add on to his Early Intervention therapy. At the moment, he has 9.5 hours a week. We’re still screen-shot-2016-09-18-at-11-25-44-pmwaiting on an eval for private speech therapy, possible OT through Early Intervention, and a possible doubling of PT through Early Intervention. All in all, he may end up with 15-18 hours a week by the time we finish scheduling everything.

Little Bear is doing extraordinarily well in his new school and every day we see him more and more eager to go to class. He cried for 15 minutes after we left him on the first day, but Papi Bear said he just goes over to his seat and sits down with his breakfast when he leaves him now. His new PT told me she observed him for 15 minutes before she started her therapy with him on his first day on Thursday. She said he is very attached to the main teacher in the classroom and he likes to hold her pants and sit in her lap during circle time. The same teacher has told me he’s the sweetest little boy ever (except for the pinching) and that she adores him, so I’m glad he’s found a teacher at school that he can find comfort in while he’s away from Mama and Papi. We’re also thrilled to walk in at the end of the day and find him running around on the playground, rather than in a classroom or watching TV.

Today was a special day. A milestone day. Today was the day Little Bear picked up a remote, held it to his ear, and said, “Hewwo? Hewwo?” And then gave it to Mama to listen. Today was the day Little Bear truly played pretend and his Mama Bear’s fears lowered down one more notch. He can play pretend. My Little Bear can play pretend!!

The fears are still there. We still worry about the future. We still worry about the present and about the things we may have done to cause his disorder. We don’t, however, feel the terror that we felt back in July. Our terror has been replaced with hope: the hope that Little Bear will have the capacity to live a productive life in society and function as someone who is simply “different.” We’re okay with him being “different.” We’re both “different” ourselves. We just don’t want him to ever feel like he’s a burden to us or his brother. That is what we want for our baby boy.

And every day that goes by fills us with more relief that that will not be his case. We’ve passed the 3 week mark since Little Bear’s urine sample was given. The geneticist said that if he had something concerning like Fragile X, we would be called in earlier than our November 1 follow-up and the tests generally take 2 weeks to get back. I don’t want to say we’re in the clear for serious genetic conditions, but the stress has definitely gone down now that we’re heading towards a month since the second test was turned in.

For now, we’re just trying to pencil in life between therapy. Deep breaths and away we go towards the prize: our son reaching his full potential and finding coping mechanisms that work for him.

Testing 1…2…3

Today was our first appointment with the geneticist. She started throwing out all these Screen Shot 2016-08-02 at 11.26.56 AMsymptoms and possibilities, and we just answered questions about our family history as best we could.

History of seizures? No. In the family? No. What did your father die of? Heart disease. And your father in law? Pneumonia. Do you know of any person in your family with a learning disability? No, not that I’m aware of.

Lots of questions. No answers.

A form to take to the lab later today. Results will be back in three months.

Will we find out anything before then?

If something comes up on the exam, you’ll be called in earlier.

I hope the phone rings the day before to confirm the appointment. This is a doctor I wouldn’t mind getting no answers from.