His eyes

It’s been a long day at hospital.

My back is aching and I am so tired. I go to bed but cannot sleep. When I turn out the light and lie down all I can see is his eyes. Red-rimmed and full of tears they look into mine and beg me to make it stop.

It was just a routine trip really. Our usual monthly trip to Manchester Children’s hospital for the clinical trial that Pudding is on. T came with us too as he really wanted to see where his brother has been coming for 3 years now. But as those who follow us on Facebook will know, we’ve been having a few problems with Pudding’s IV port – the one which we use for his weekly treatments. Towards the end of the day, we went down to Radiology to try and get a lineogram.

Pudding was already tired and we ended up having to wait far longer than we expected. I knew it wouldn’t be easy. He was hitting out in the waiting room. Shouting and hard to distract. He fought us as we got him on the X-ray table. We needed him to be still so we could get a clear picture but of course he can’t know this. He doesn’t understand.

So often his behaviour is physical  – being non-verbal he can’t tell us what he wants. He can take my hand and lead me to the kitchen cupboard to ask me for food. He can hand me his tablet to ask it to be turned on. He can throw things until I notice that his programme on TV has finished and needs to be turned over.

But as I stood at his head and pinned his arms down, he looked at me with those heartbreaking eyes. And I knew exactly what he wanted. It didn’t matter that he can’t talk. It didn’t matter that he has a severe learning difficulty. Clear as anything, he was saying ‘I don’t want to be here’. Speaking to my soul and begging me to help. And I held him down.

The lineogram couldn’t show anything anyway. In the time since it had been accessed the needle had come out of place. So we have to try again in two days time. He is now fast asleep, lying peaceful and unconcerned by anything. And I’m left here wondering what it will be like next time. Will he be in a better mood and will it all go swimmingly. Will he see the room and start fighting again? Will I need to look into those eyes again and tell him it will all be alright? Will I do my best to calm him when I’m close to tears myself?

At times like this all I want to do is whisk him away. Get him miles away from needles and x-rays and monitors and all the shitty implications of a medical life. Say goodbye to the hospitals. Live life in the moment and not think of the future. He should be in a field somewhere – kicking a ball, stroking a bunny, throwing stones in a river.

How can I ever know what is best for him? He’ll never be able to tell me whether I got it right. When the moment is past he doesn’t hold it against me.

But those eyes stay with me…

eyes

The necessary

We’re back in Manchester again. Clinical trial dosing day. Sometimes it seems to come round really quickly. And today I really didn’t want to come.

Pudding watching TV in the hospital playroom

There’s a bug doing the rounds at the moment. Pudding had it last week and very kindly passed it onto me. It wiped me out completely on Friday (Hubby said that he knew I was ill as I wasn’t even going on Facebook) and I expected to feel better the next day. But I didn’t. Or the next day. Or Monday. No awful symptoms, just feeling bloated and spacey and draggingly tired.

The thought of setting off on the train and spending a long day in hospital today was about as welcome as…well I’m sure you can think of something. I checked with the ward hoping that they would say not to come, but they didn’t.

A couple of people asked whether I’d be better just staying at home and missing the dose, and oh I was so tempted. But I couldn’t ignore that little voice in my head. The one that reminds me how important this treatment is. The one that whispers how lucky we are. The one that warns we may not have too many other doses left to us if it doesn’t get approved or funded.

So I’m here. And coping.

We do what we have to, don’t we? All parents do. We get out of bed. We make sure they’re clean and fed. We nag them about homework. We stand by the side of a pitch in the rain. We travel across the country. And we hold them down for needles. Our own needs sometimes just have to take second place.

We do what is necessary.

A letter to our doctor

We usually meet in a clinic situation of course. Whilst I and the nurses don’t treat you with the proper respect and joke about all the time you spend away from the hospital playing golf (which you don’t) there is always a professional boundary. A line which I don’t feel I can step over.

At the MPS conference though I took the chance to give you a hug and tell you how much I thought of you. You laughed it off with a comment about being emotionally unavailable. You may also have thought I was a little bit tipsy. (I suppose I was, but I’d only had one glass – just enough to loosen my tongue.)

I’ve written about the wonderful nurses before and how they kept me going. But at a time when some pediatric doctors’ expertise and integrity has been called into question by sections of the media, I think it’s important you know what you yourself mean to our family, and I’m sure many others.

Just over two years ago, on Wednesday the 1st July 2015, we were told that our youngest son has MPS II, a progressive, life-limiting condition. These are the words that no parent wants to hear. Ever. We had been called in to see our local pediatrician who confirmed the diagnosis we had been expecting. And he told us that an appointment had been arranged for us to see the experts in Manchester the following Monday.

You’re probably used to shell-shocked parents arriving in your office, but to us of course it was all new. And yet… Having heard the worst already (at least I thought we had) it was reassuring to be there amongst people who knew all about this terrible diagnosis.

Infusion pump in sharp focus with Pudding on hospital bed behind.I’d already read everything the internet had to offer on Hunter Syndrome, or so it seemed. But you were so patient explaining it all again to Hubby and taking us through the next steps, telling us about the enzyme replacement treatment Pudding could start the next week. I’ve no idea how long we were in that office – over an hour I think – but I never felt that you were rushing us.

Over the next few weeks you often popped in when Pudding was having his ERT to see how we were doing and answer my questions. I had a lot, and you never shied from giving me the difficult answers. It was often hard to hear, but I needed and appreciated your honesty.

You joke about the nurses calling you emotionally unavailable but I think we all know that is far from the truth. When you had to tell me that Pudding’s DNA results showed a complete gene deletion (meaning inevitable progression of Hunter Syndrome) I could see how deeply you cared about us all.  Later when we talked about the fight that MPS IV patients had (and will face again) for a treatment to be made available, your anger at the situation was clear.

I have entrusted my son’s life to many people already – anesthetists, surgeons, pharmacists, even down to those who safely access either of his ports – but you are the expert at the heart of all these services. A kind, caring, down-to-earth, approachable expert that I am very grateful to rely on.

All our love,

From your biggest fans

Optimism

Two weeks ago we had a meeting in Manchester with the team that co-ordinate Pudding’s care. It was strangely relaxing in a way to drive over there outside of rush hour traffic, in beautiful sunshine, and knowing that we weren’t facing any needles or treatment that day.

We gathered in a room – me, him, the consultant, the doctor running the clinical trial and his specialist nurse – to talk through how things have been going over the last year. There are a few small concerns that we’ll look into; Pudding has been getting very tired again lately, sitting down to rest more often and having more naps. But overall, his weekly enzyme treatments seem to be doing the job of keeping his body working a little better.

We’ve had a blip with the clinical trial of course, meaning that he missed three doses of the enzyme into his brain. The operation to replace that portacath went very well though, and we are now back to the monthly routine of trips to the trial ward.

Pudding in a stripey black and white top looking directly at camera, unsmiling.Pudding is very slowly continuing to add to his vocabulary and make progress in small ways. I was able to tell them how recently he got a snack out the pantry which I’d accidentally left open and then put it back when I told him!!!! (This is huge, people!) Throughout most of the meeting, Pudding was sitting beautifully in his buggy and playing games on his tablet. The consultant commented on his concentration levels and said that in the normal course of Hunter Syndrome he would expect increased levels of hyperactivity by now. Overall therefore, he was ‘cautiously optimistic’ that the trial meds are working for him.

That’s good, right? So why do I not feel more…optimistic?

So many feelings continue to battle inside me. After the meeting I sat in the coffee shop downstairs and shared biscuits with my gorgeous boy. I watched children and their families passing by and saw PEG tubes and drip stands and monitors. And I was hit yet again by the thought that this is our reality now. The world where all these medical things have become things that I recognise and barely take a second glance at. The world that many people are blissfully unaware of.

Even if Pudding continues to do well on the IT medication it’s just the beginning. The treatment would need to get approval, we would have to fight for it to be funded. Gene therapy may become available and halt the progress of the disease even more effectively. And we continue to hope for all that. But I also have to bear in mind that Pudding will always have MPS – when looking for a new house I still need to think of future-proofing it. Would there be space for a downstairs bedroom or lift? What would wheelchair access be like?

Perhaps when it comes down to it there’s also an element of defence mechanism in my lack of optimism. If I continue to remember the worst outcome, then my world cannot crash too far.

I would so love to have a crystal ball. To look into it and take away the uncertainty. But of course we don’t. So in the meantime we continue learning to live with MPS. And we continue to love our little boy who is beating the odds and teaching us to walk through this world on a slightly different path. Despite how miserable my blog posts can sometimes be (sorry!) this path has many beautiful moments on it – smiles and laughter, wet kisses pressed onto my cheek and satisfying armfuls of chubby cuddles.

I may not be hugely optimistic about the future, but that doesn’t mean I can’t enjoy the present a lot of the time.

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Surgery

Surgery this evening.

After finding out in March that the port that delivers Pudding’s trial medication to his brain is no longer working properly, he is having it replaced today.

This morning I chased him and let him climb on my back  and tickled him until we were both in helpless giggles, as I knew we wouldn’t be able to do that for a while.  I watched him eat a very early lunch knowing that in a few hours he would be looking at me with those accusing eyes and repeatedly asking for ‘bibit’ (biscuit). He kept running away with the bag I was trying to pack and for once I didn’t get cross or frustrated because I knew that he’s going to feel reluctant to move at all for the next week or so.

Pudding was very excited when we got back to the trial ward in  Manchester. We’ve not been for three months now so he was obviously keen to make up for lost time, running up and down the corridor and shouting ‘Found you!’ at all the nurses. Very cute, but it was difficult to share his enthusiasm knowing that in a few hours I had to sign a consent form for surgery listing ‘permanent nerve damage’ as a potential side effect.

The anesthetists here are fantastic, and experienced with the short neck and difficult airways that Hunter Syndrome produces. I trust them with my son’s life but I wish I didn’t have to.

At 6pm we walked down to surgery with him complaining all the way. It was nearly his bedtime. He was tired and hungry and had had enough. I watched his eyes roll back into his head as the anesthetic took effect. Now we wait for three hours until we can see him in recovery and listen to those pitiful cries as he tries to tell us that he feels rotten and he hurts and he doesn’t know why. And I’ll feel helpless because I can’t explain to him why he needs to go through this.

We’ll stand ready with the sick bowl and obsessively watch the SATS monitor over the next few hours. The TV will stay on for a week and we’ll check his dressings for any leakage of spinal fluid.

It’s his sixth general anaesthetic since diagnosis almost 2 years ago, and we’ve got used to the routine but it never gets any easier.

Clinical trial – a year on

Monday and Tuesday we were in Manchester again. It is the end of Pudding’s first year on the clinical trial that aims to halt the progression of Hunter Syndrome in his brain. So he needed to go for an MRI scan and lumbar puncture under general anesthetic.

It’s IMG_20170109_180120been an emotional journey of course. First there was the decision to enter the trial when the potential good had to be weighed against the negative implications. There was the major surgery itself meaning the placement of a portacath into his spinal cord. The first few months when he reacted with sickness, and then the gradual easing of tension as the reactions were brought under control. The waiting game as we wondered whether it would help him at all. And the slowly dawning hope that as he approaches his fifth birthday there is no sign yet of him losing skills. Indeed he seems to be gaining them.

It is little things. Things that other parents would hardly notice. Like me asking him to turn on a light that was beside him and him doing it. Like me saying ‘good building!’ as he played with his blocks and him responding ‘da dyu!’ (his version of thank you).

So although the results of this end of year MRI scan won’t be available to us, I’m pretty sure it will be positive. Enough boys with Hunter Syndrome have now been recruited onto this study and while we wait for them all to complete the trial year, Pudding will join others on the extension study. They continue to receive the monthly doses but with less regular blood tests, ECGs and so on – something both Pudding and I will be very happy about.

At the end of this calendar year, Shire (the pharmaceutical company who developed this drug) will be putting the numbers together and starting the process of getting it approved as a treatment.

I should be feeling positive.

Yet my newsfeed has been filled this week with stories of an NHS in crisis. Not enough beds, not enough doctors, not enough money to treat an increasing number of patients. With these sort of pressures who is going to sign off an eye-wateringly expensive new treatment?

Right now I should be filled with campaigning zeal. I should be writing to my MP and demanding to know what can be done to save the organisation that could save my child’s life. But I know what the response will be. The NHS is ‘very important to us’. ‘We are doing all that is necessary’. Health funding is at ‘record levels’.

It shouldn’t stop me, I know. I shouldn’t let the sense of powerlessness take over. But I just…right now, I just…can’t…

Home

Has it really been that long since my last post? In a way it feels longer…

The evening of my last post, Pudding went down with a sickness bug. Little sleep, much washing of towels, endless hours of TV and four days without hearing the word ‘Ungry!’ from him, and at last I thought he was feeling better.

Then it was time to head to Manchester for the next trial dose.

Even though it is now exactly a year since the diagnosis of MPS II (Hunter Syndrome) was confirmed, there are still days when I find it hard to take in. Sometimes it just seems so unlikely that our son can have such a condition. We’re just a normal family with two gorgeous boys, aren’t we?

Then there are the times like these last few days when I have no choice but to admit the existence of MPS. We had three overnight stays this visit – two of them in hospital.

The ward is lovely, and the people fantastic. I’m grateful, I really am. But…

… my son, who is still feeling a little under the weather, sees the nurse in an apron approach him with a tray and starts screaming. He is held tight by his father and they start looking for a vein. Like many with MPS, his skin is thick and the elbow joints don’t straighten fully so cannulas are never easy. The distraction of TV doesn’t work this time, and he struggles violently to fight them off. He looks at me with desperate red eyes and yells ‘Mummy! Mummy! Mummy!’ but I can do nothing except press my face against his, and try to calm him. It’s hard to even whisper as my voice is breaking with tears. I don’t want to cry in front of everybody. I want to be strong for him. I have no concept of time and no idea how long he has been crying. They ask if they should take a break, but it has to be done so I say no, even though I want to shout at them to leave him alone. Eventually it’s in and bleeds well. But by now, he’s beside himself and the pre-meds he is given are vomited straight up again. My poor boy is exhausted. Even when he does fall asleep his breath continues to catch in little hiccuping sobs for ten minutes. And I know we can’t let him rest for long, as he still needs to take the medicine again and there is another needle to go…mum pic

He spent the rest of the afternoon slumped on the bed looking pale and limp.

Of course, when things have been bad they usually get better again. The next day we had an audiology appointment that shows his hearing is still doing ok with the grommets in, and he is almost at the developmental stage where he can do the proper test. (Waiting to hear the beep BEFORE he jumps the little men into the boat is still a bit beyond him). We also escaped to the nearby museum that afternoon for a hot chocolate and cream scone (his appetite was coming back) and although I got more soaked than a drowned rat on the way back, hospitals are a great place for drying things out (including my eczema-prone hands, but I’m trying to be positive here)!

And best of all, when Pudding decided to get out of bed at 1.30am and run around the ward corridors waving a light sabre, I was able to go back to bed after two hours and leave the night nurse in charge of him. Apparently he only tried to escape from the ward a few times, didn’t destroy anything and was asleep by 4.30….

And then – home again, and the blessings of our own beds and familiar things around us. The school run and cuddles with Twiglet. Letting off steam in the playground. Ben and Jerrys icecream.

MPS governs our lives now in so many little ways. It isn’t just a bad dream that I can wipe away with the sleep from my eyes. It’s our reality. When I started this blog I gave it the subtitle ‘Learning to live with MPS II’ and that’s just what we’ll continue to do. Most of the time, we’re doing it pretty well.