The importance of genetic testing and Rett Syndrome…

I’ve recently been approached by two families who have concerns about their daughter’s development.  And both have asked me to share our journey to an accurate diagnosis.  If you remember, Lily was given two mis-diagnoses along this journey.  So I’ve decided to dedicate a post for families who are on a similar journey.  if you’re new to this site (you found me through middle of the night googling), please feel free to leave a message below and I’ll get back to you if you have any follow up questions.

Q: I am wondering if you could share with me a little more about your journey to an accurate diagnosis, as well as any providers or evaluations that you felt were significantly helpful?

To me, what was the MOST definite and defining moment for Lily was getting the genetic test results with the Rett diagnosis.  Here are the ‘steps’ it took to get there:

Autism diagnosis August 2012

Lily was talking and social and hitting all her milestones and then BAM.  At around 15-16 months, there was a major regression. The language went away, she became super aloof and disinterested and physically started demonstrating some delays as well.  She was initially diagnosed with autism at 18 months (both through Early Intervention and a private developmental pediatrician).

ESES Diagnosis November 2013

Once we started EI services (she was getting 20 hours of ABA, plus Speech, OT and PT), it became apparent that the autism label didn’t fit.  The words started to come back (and then go away – which is still happening).   She came out of her shell and was social and interested in the world around her again.  We then had a bunch of EEG’s done to try and figure out the underlying cause of her regressions and found out she had a rare form of epilepsy called ESES.  And we thought ‘aha! this is what is causing her regressions’.

Rett Syndrome Diagnosis January 2014

But while she was being treated for the ESES (using high doses of steroids that I had to inject into her leg every day which totally sucked for us both), we got the genetic results back (which we did to see if there was an underlying reason for the ESES).  Rett Syndrome was confirmed.  All her doctors (and she has many) were surprised with the results as she didn’t fit the ‘Rett girl’ profile.  She walked, she had some hand function and she wasn’t having seizures (though she does technically have epilepsy and has epileptic episodes which I’ve been told are NOT seizures).

Q: Who did you work with to get the Rett diagnosis?

The geneticist we worked with was Dr. Marion at Montefiore in the Bronx.  And what was especially great about being at Montefiore was that there is a Rett Clinic there (the only one in the tri-state area, led by Dr. Sasha Djukic) so we were already in the Montefiore system.  It also helped in terms of scheduling doctors appointments as the Rett clinic is open on Fridays and we now just go there once a year and see anywhere from 2 to 5 specialists in a day instead of going back and forth to the hospital to see all the different doctors.
Q: Where are you today?
A Rett diagnosis sucks.  But you learn to live with it.  And knowledge is most definitely power.  I know what I’m dealing with and I can better prepare myself and my child for the road ahead.  And by the way, it’s mostly a happy road we walk.
Q: Is she on a special diet?
Lily has been following the GAPS diet for the past two+ years (though she has pizza on Fridays at school) and is on the growth charts which I believe is because of the healthy foods and supplements she takes (many girls with Rett start to fall off the growth charts by the age of two).  She sees a nutritionist regularly.
Q: What types of therapies does she receive?
She goes to a private special needs preschool where she receives numerous therapies, and has an augmentive communication/speech generating device that she navigates with her eyes (think Stephen Hawkins).  It is called a Tobii.  Actually she has two Tobii’s – one at home (which we own and were able to procure through the EI program) and one at school (which took a year of advocating through the DOE CPSE program).
Here are the services she receives through the DOE, on a weekly basis:
At school:
  • 1:1 para professional for health and safety reasons (this is imperative: our girls cannot self defend)
  • 5×30 Speech Therapy
  • 4×30 Occupational Therapy
  • 4×30 Physical Therapy
At home (she has a ‘dual recommendation’, sometimes called an RSA, and is supposedly impossible to get through the DOE):
  • 6×60 SEIT (Special Education Itinerant Teacher)
  • 3×45 Speech
  • 3×45 OT
  • 1×45 PT
  • 4×60 Assistive technology services (so that the home speech therapist can program both Tobii’s and upload course curriculum to them so Lily can follow along in class and participate).
On the weekends she goes horseback riding through the GallopNYC program and is loving it.
Yes.  It is a lot of therapies.  And yes.  It was not an easy decision to put her in to all of these therapies.  But the proof is in the pudding:  My kid is thriving.
We live a mostly happy, and always busy life.  Yes.  It is possible.
Happy Girls, Halloween 2015

Happy Girls, Halloween 2015

Knowledge is power

I remember struggling through the book ‘Orientalism’ by Edward Said when I was in grad school. I think it was one of the very few books I didn’t finish as it was too dense and, truthfully, boring. But what I did get from this tedious, yet paradigm-shifting and acclaimed read is the underlying thesis of his book – knowledge is power.

I agree. Knowledge IS power. But sometimes knowledge sucks.

For example, Rett Syndrome.

Here is some knowledge about Rett Syndrome:

Rett syndrome is a neurodevelopmenal disorder that affects girls almost exclusively. It is characterized by normal early growth and development followed by a slowing of development, loss of purposeful use of the hands, distinctive hand movements, slowed brain and head growth, problems with walking, seizures, and intellectual disability.

Devastating.

AND…. And yet, there is still hope. Plenty of hope.

Lily’s therapists are amazing and are teaching the both of us how to maximize her potential (which, from an intellectual capacity is limitless) and mitigate her regressions (which is, unfortunately, ongoing – swallowing and hand function continue to be an issue).

From a physical perspective, Lily is growing normally. No slowed head or height growth (her current height puts her 6 months ahead of her actual age). I equate her ‘typical’ physical growth to knowledge. The knowledge to research like hell and talk to cutting-edge nutritionists to learn how to support this kids body which is constantly working against her. Lily takes supplements and vitamins galore – I look like a mixologist when putting together her morning and evening bottles. She eats clean and healthy foods. I stay on top of her constipation (which is a constant battle) to keep her comfortable. She gets PT and OT to ensure that she gets physically stronger every day.

So not all knowledge sucks.

But for Rett Syndrome in general? So much of it is unknown. How it manifests in each girl is different. And how it unfolds over the course of a girl/woman’s lifetime is a complete shot in the dark. There is NO body of knowledge to point to how this will fully impact MY child.

A fellow Rett momma blogger aptly put it this way:

Rett Syndrome is a relentless bully. …It is the type of bully who, just when you think you have fought hard enough to keep it at bay for awhile, sneaks around a corner and kicks you in the face.

I constantly need to be on my toes. On watch. On guard. Researching and reading and watching my kid like a hawk and meeting other parents who are years in to this experience (regardless of the pain their knowledge causes me). It’s a nonstop process.

Lately Lily has been having some pretty major zoning out episodes. They’re not seizures (as per the Rett specialist). They’re just Rett zone-outs, for lack of a better term. And it’s scary to watch. And there’s nothing I can do but hold her hand and talk to her soothingly until she snaps out of it.

Regardless of all the scariness, there is this hope.

I believe that my kid is going to rewrite the Rett books; that she is going to help pave the way for a new way to look at Rett Syndrome. That she will be cured of this horrific disorder and will be able to live a fully independent and symptom-free life.

And in the meantime, I’m just going to keep loving my kid. And reveling in her strength and beauty and joy.

This holiday season, please take a moment to put your life, and the lives of your children, in perspective. Give thanks for ALL the gifts you’ve been given – especially those gifts that you take for granted on a daily basis.

We ALL have so much to be thankful for.

Love,

C and L

All dressed up for her preschool's holiday soiree!

All dressed up for her preschool’s holiday soiree!

Pizza!

PIZZA!!!

As many of you know, my child is highly motivated by food.

Well, when she started preschool, I was faced with a dilemma.  The school has pizza Fridays and Lily’s diet is so restrictive (she’s on the GAPS diet for those unaware), that pizza is a BIG no-no for her.  Her dad and I both hemmed and hawed it for a while but agreed that it would be a great experience for her to fully participate in this sacred meal.  She is VERY curious about what other people are eating (oftentimes, after she finishes her dinner, she starts to pick on mine) and she has so many restrictions in her day to day life that giving her this one – easy – thing would help her feel more of a part of something, rather than being on the sidelines – like she is with so much else.

So pizza Fridays have begun.  Here is an excerpt regarding the first pizza Friday from the communication book her teachers and I pass back and forth each day:

Lily LOVED pizza Friday. She ate  consistently for a half hour. Lily loved it so much she was saying ‘give me’ and ‘more’…  I was so proud of how much she was talking.

Miss Susan (her teacher)

Lily said more words in one day than she has in an entire month!

So, yesterday was Friday and she didn’t have school so I decided to take her out for dinner and we had pizza!  Again, she loved it.  Again, she said more words at that meal than I had heard throughout the week.

I wish every day were pizza Friday!

MORE!