Tricky customer

Samuel is going into hospital on Monday as an inpatient to start the ketogenic diet. I like our hospital, well as much as anyone likes a hospital. I’m use to it. We got there a lot for appointments or to pick up something – like tubes or new feed. To me it’s just a building where they treat poorly people. The doctors and nurses I’ve met there are really nice. The nurses always seem to fall in love with Samuel quite quickly and are really kind and gentle with him. Also, we are very lucky that Samuel’s pediatrician is wonderful (I’m a bit of a fan of his).

But I must admit I am nervous about going in next week. Samuel isn’t having any invasive procedures, he’s not going under the knife or being given general anesthetic. But I still am nervous.

I’m nervous because of his seizures. As the pediatrician put it, Samuel has off the scale epilepsy. Doctors and nurses are trained, are programmed, to treat seizure activity when it occurs. But you don’t do that with Samuel. He has seizures every day, so you would be sedating him every day. As I’ve said before, some seizures you just let happen, you cuddle Samuel and hold on for the bumpy ride until he’s settled again. Sometimes he twitches a lot. That is seizure activity. It unnerves doctors.

Last year we had to take Samuel into hospital because of his seizures (Better late than never). The doctor was a really nice guy. But I almost had to wrestle the emergency seizure medicine off him. We were having a rest in the parents room when the nurse called us to say that they might have to medicate Sam. As we approached the cot the doctor was prepping Samuel’s canula to give him some intravenous medicine. Samuel was twitching. Just twitching. The doctor said that he had seen what Samuel had done the night before (the previous evening was a very rough ride for us all) and said he anticipated that Samuel was about to do the same. I said no. That’s not how we treat his epilepsy. We have to wait and let it become something before we medicate, we don’t medicate just in case (that would mean he’d be medicated every day). I asked the doctor for five minutes more, just give him five minutes. And he did. I got Sam out of his cot and we had a cuddle. The twitches, the ‘seizure activity’ stopped. He settled. Oh yeah, he then went off to sleep.

When we see new doctors, doctors that haven’t met Samuel before, there are always the same questions. Now I know doctors have to ask these questions, it would probably be wrong if they didn’t. But I just find it difficult when the doctors first meet Samuel and are still looking at him through ‘textbook epilepsy’ eyes (I do of course appreciate that there isn’t textbook epilepsy):

• How many seizures does he have in a day?
• You realise that this is seizure activity? (Pointing at the twitchy, jerky movements that I haven’t appeared to acknowledge. But I always know every movement my boy does, I just don’t make a song and dance about it every time)
• What do his other seizures look like?
• How long do they normally go on for?
• Is this normal for Samuel? And this is the question I do like because I respond by very enthusiastically saying ‘YES! This is very normal for Samuel.’

And that’s it, what Samuel does is normal for Samuel. It isn’t normal outside of our bubble, but in his bubble it is what he does. He has an abnormal brain, that is why every EEG he has had has always come back the same. As we always say it ‘abnormal, but normal for Samuel’.

The other thing that although doesn’t annoy me, I do find strange is the enthusiastic wafting around of oxygen. Samuel doesn’t have oxygen at home. We have never had oxygen at home. When we came home from NICU we came home with a barrel full of medicines but no oxygen. It was always felt by the doctors in NICU that oxygen didn’t really help. He’d either come out of the seizure by himself or once we’ve given him emergency medicine. This really surprises people but his body seems to cope. with one type of his seizures, when he first starts, his lips very briefly go blue, but then they return to normal. I do thank our lucky stars every day (yes readers, we are extremely lucky) that Samuel doesn’t need help breathing and know that in the future it might all change. But for now it’s a nice feeling I can tell you, knowing your child can breathe independently and not require help.

So when the nurses say ‘shall we give him some oxygen?’ I always respond with ‘well you are very welcome to but we don’t have it at home’ And they do give him a big old waft of oxygen.

Samuel’s pediatrician, have I mentioned I’m a fan? will be around in the background and he is very in tune with our boy, so I do keep reminding myself of that which makes me feel more relaxed. I know he will do everything he can to ensure that the doctors on shift understand as much as anyone can about the quirks of Samuel and what to do and when. And hopefully the doctors and nurses will quickly learn the mantra of: ‘KEEP CALM AND ASK MUM’

I’m not sure the point of this post. But I think it just confirms that for nurses and doctors, Samuel is most definitely a tricky customer. I probably should get him a t-shirt made with that on!

Believer in hope

We finally have a date for Samuel to go into hospital to start the ketogenic diet. Assuming that he doesn’t suddenly come down with a bug and that there is a bed available, we are booked to go in on 23 April.

If you have not heard of the ketogenic diet, well it is a high-fat, adequate-protein, low-carbohydrate diet that in medicine is used primarily to treat difficult-to-control epilepsy in children. The diet mimics aspects of starvation by forcing the body to burn fats rather than carbohydrates. Normally, the carbohydrates contained in food are converted into glucose, which is then transported around the body and is particularly important in fuelling brain function. However, if there is very little carbohydrate in the diet, the liver converts fat into fatty acids and ketone bodies. The ketone bodies pass into the brain and replace glucose as an energy source. An elevated level of ketone bodies in the blood, a state known as ketosis, leads to a reduction in the frequency of epileptic seizures.

I have butterflies in my stomach. I so want this diet to work. To have a positive effect on Samuel. Even at the very least if it means that he just comes off one medicine, that would be fantastic. But I know for some children it has done so much more and made a huge difference to them. I know of a little girl that belongs to Samuel’s hospice and by a year after she started the diet she had come off all her medicines. The diet has made a huge difference to her in other ways too.

The idea of it having such an impact on Samuel, well I can’t put into words what that would mean to all of us. Could it mean that we come of one/some/all of his medicines? Would it allow him to develop – could he finally reach a milestone? Will he be almost/totally seizure free?

Samuel’s doctor has told us that they give the diet three months to see whether it is working. Some children show an improvement very quickly, while some show a slower response. If after three months sufficient ketones are being maintained but there have been no beneficial changes then the diet is stopped. For Samuel it would mean that the doctors return to the drug book and review the cocktail he is on and possibly take him off one and add a new medicine to our drug box.

I hope with every part of me, I pray, oh goodness do I pray and have everything crossed that this does work for our boy. If this works reader, oh my god, if this works it could change everything.

Please hope and pray with us. Team Sam..x

For more information about the ketogenic diet visit www.matthewsfriends.org

A sign?

Sam's war wounds after blood test

Yesterday, I took Samuel into hospital for a blood test which was to be followed by a clinic appointment with Sam’s pediatrician, Dr H. Samuel had to fast for the blood test as it was in relation to starting the ketogenic diet, so we turned off his feeding pump at midnight instead of letting it continue until 8am.

As there was time in between appointments I thought I’d take his pump bag & feed with us so I could give him a quick feed before seeing Dr H. But no, it didn’t work out as planned. I think they were either running late or forgot about us, but we got called in late for the blood test, which took a while to do as his veins aren’t very cooperative, oh yes and they had to pause while he had a seizure.

Anyway, we finally got into see Dr H. I normally arrive to appointments early and am always calm and quite relaxed. But on this occasion I was late and very flustered. And then it hit me. Sam had essentially been fasting for 13 hours and the poor boy was really unsettled and very twitchy (I should add that although I might refer to Sam having ‘twitches’ sometimes, it is in fact all seizure activity).

You may  not think it is surprising that he was unsettled as the poor boy was probably hungry. But you see, the ketogenic diet is a high fact diet, used to mimic starvation. I understand from Dr H that back in good old days, that was how doctors treated epileptic patients, by essentially starving them. And Samuel, well there was no visible change to him whatsoever. In fact, it appeared that we were having quite a bad day. I was thinking about it but chose not to  say anything out loud about it to Dr H. But I didn’t need to. While looking at Samuel as we were chatting, Dr H said what I really didn’t want him to say. That he was concerned that this was a sign that the ketogenic diet might not work for Samuel.

Right from the start when we started talking ketogenic, although extremely keen to start it (anything is worth a try), I have continued to remind myself that it certainly isn’t a cure and not guaranteed to work on everyone. I didn’t really need to remind myself what a tricky customer our boy is. In fact I’ve almost told myself it wont work, just so I’m prepared because I’ve seen the ‘conventional’ epilepsy drugs that have been tried on Samuel not even touch the sides,  as the doctors have put it, his epilepsy ‘is off the scale’.  And I guess because I’m use to preparing for the worst.

Samuel is on three strong medicines, which he has twice a day (this doesn’t include his bedtime medicine to help him sleep or his emergency epileptic medicine). If this diet works, we could take him off one or more of these medicines. If it works it could mean he has far less seizures. Less seizures mean less distress for him, less pain and discomfort. It would give his brain a rest. May give his brain a chance to develop – could he even reach a milestone? Oh my goodness, if it works, I can’t begin to tell you what that could mean for Sam and us. But I can’t let myself get too excited. It may make no difference at all.

But I must remain hopeful. I mean Samuel has already surprised the doctors and proved them wrong. He’s still here isn’t he? He’s still fighting. And I can’t help but think of one day last November (it was a Thursday) when he had bad diarrhoea and on one day when he must have been pretty empty because of his upset stomach, he was so still it was like he was a different child. He was wide awake, but there was no twitching and ‘abnormal movements’.  Auntie C visited that day and couldn’t believe that it was the same boy. So I think we can still have a little hope.

Time will tell. We are hoping to start the diet in April and it becomes apparant if it’s working within the first three months.

I just pray that it does make a difference to Samuel. Even the smallest difference could change everything. So, dear reader, I ask one small thing of you. Say a little prayer for Samuel. Pray that somehow this diet will work for our boy. Because we really need it to. Samuel needs it to.

More information about ketogenic diet:  A useful website to visit to find out more information about the ketogenic diet is matthewsfriends.org and their document about the different types of ketogenic diet is particularly useful.

Getting it right

Samuel and I spent the day today with our friends at Julia’s House. I’ve come home feeling knackered, which is probably because I did a lot of nattering (I am a chatterbox to be honest) and having to think even more about Samuel’s epilepsy and trying to explain to the carers and nurses about how we medicate Sam’s seizures.

I’ve talked before in my post Early days about the difficulties in explaining just when is the appropriate time to medicate Samuel with Midazolam (his emergency medicine) and when you just give him a good cuddle and ride it out. It isn’t a perfect science and I’m sure I get it wrong sometimes but it can be so difficult, especially as he really does live up to being a tricky customer!

Samuel started off today really snoozy but then as the day went on he became more unsettled. I was hoping that it might be his teeth giving him agro so I gave him some paracetamol as his cheeks were really pink but that didn’t make much of a difference. He progressed to an afternoon of on and off clustering. If I hadn’t have been there he would have had Midazolam, we all knew that.

But the problem is the grey area within his protocol.  There are some seizures you count, you look at your watch and mentally log, others you just give him a good old cuddle. But should we be ignoring those seizures? Are we pushing the boundaries too much? I think everyone understands that by nature Samuel is a twitchy boy and those twitches (which are in actual fact seizure activity) are inevitable due to the set-up of his brain, but it’s the other things he does, the seizures. How can I expect people to ignore some but count others? We just don’t want him medicated every day which realistically could happen. Samuel has seizures EVERY day.

I think the nurses, well one in particular, could see the difficulty I have and advised me to talk to Sam’s doctors about it to clarify his protocol. The ridiculous thing is I do agree with the written protocol, in fact I co-wrote it with the doctor over the phone BUT it’s about how it works in practice. She said that she felt that it is such a huge responsibility on my shoulders to make sure that they get it right when I leave him in their care.

You see I love Julia’s House, I really do. The whole place, the people, I just love it there. I cannot explain how amazing the nurses and carers are, how kind, lovely and understanding they are. They make me feel normal. Nothing I tell them phases them. I doubt there is much I can tell them that would surprise them or they hadn’t heard before. They must be the best childminders in the world!!! And I can’t begin to tell you just how lovely they are with Samuel. Right from day one, the way they talk to him, stroke him, cuddle him. As his mother who loves him with every grain of my being, watching these people hold him so gently, look after him with so much care. It just makes my heart swell.

If it wasn’t for this situation with his epilepsy and emergency medication I would have left him there on his own after the first day. I trust them, I really do.

We did end up giving him Midazolam in the end. He did need it to break the cycle he’d got himself into. But although it’s always disappointing when he has to have it, I really did feel we achieved something today. They saw what he does. They witnessed what his epilepsy can be like and they saw how much I want him to be awake and alert as much as possible. They saw the difficult situation I’m in, the hard decisions I often have to make about medicating him and I really felt that they were there behind me, supporting me.

Why is no-one cuddling me?

The nurse was keen to make me see that it isn’t a test of me. It’s not about right or wrong or whether we are looking after Samuel correctly. It’s about us all being in the same team and understanding how we can care for Samuel together.

We will get it sorted. We must. I’ve already put forward some dates to have community sits which is where carers come over to the house to look after Samuel. I will be home, just for the time being, but do have every confidence in them, Samuel and me, that we will get there.

There is a sign up in Julia’s House that says ‘Julia’s House is a happy place’ but it is more than that. Julia’s House is a happy, loving, caring, supportive, cuddly, fun, positive, sunny, friendly place. The sun ALWAYS shines at Julia’s House.

Oh reflux!

I’ve been meaning to tell you that the doctors think that Samuel might (they don’t know for definite) have reflux.

When Samuel was in hospital in November the nurses noticed that he was arching his back (which he does sometimes when he’s a bit twitchy or sometimes when he’s having a seizure) and said that could be due to reflux.

Then a few weeks later when we had an appointment with the paeditrician and neurologist (who I adore and think are amazing) I mentioned the suggestion of reflux and both doctors said that Samuel probably has it as due to his epilepsy and disabilities he is a prime candidate for it (I can just see all you parents there nodding because you already know that). Samuel is over a year old and the doctors have never said that before. When we’ve been asked routinely by other professionals if he had reflux we’ve always said no as he’s never really dramatically vomited. When I put this to the doctors they said that he is probably swallowing the vomit back down (I have smelt his formula on his breath now and again). Right. Couldn’t we have been told this before? We are quite new to all this (and not just disabilities, we are first-time parents after all).

Anyway, he has medicine for it. We’ve now got to add infant Gaviscon to some of his feeds and give him Lansoprazole an hour before his first day feed. So the poor boy has even more stuff swishing about inside him.

I can’t tell you whether the medicine has helped him as it is impossible to tell, I mean we don’t exactly know whether he does actually have reflux. But at least he has it now if he does need it. He’s just had a wait a year for it.