Uncle Midaz

Midazolam has been in our lives since the early days. It has become a very important part of our armoury in the battle against Samuel’s seizures. It is his emergency drug.

The protocol of when to give Midazolam to Samuel is if he’s had a seizure lasting more than 10 minutes or if he’s had a cluster of four or five short ones in half an hour. It is only given for full on focal seizures and not his general twitching.

In the very early days, Samuel had Midazolam a lot. On average he’d have about five doses A DAY! There wasn’t really a clear protocol at that time so he was given it almost as soon as he’d seizure. Problem was, Samuel would seizure a lot and medical staff are trained to zap seizure activity immediately! But the neurologist stepped in and changed the rules. She made us and his hospital team wait. It was hard. I’d be there holding my boy who’d been having a seizure for 8 long minutes and I wasn’t giving him anything. But it worked. It showed us all that more often that not, Samuel will self resolve after about 10 minutes and then be fine.

When the going is good and things are quite balanced, Samuel on average has Midazolam about once every two weeks. Although when the Ketogenic Diet was at it’s best he went without it for about 60 days!

Midazolam is the only thing Samuel has orally. It is squirted into his cheek and absorbed that way. After Samuel has been given it, he can take a bit of time to wind down. Sometimes he will even have another seizure after he’s had it. But then he eventually calms down and relaxes and usually goes off to sleep for about three hours.

Giving Midazolam is at last much easier after the introduction of pre-filled syringes. Before, Midazolam came in a little brown bottle and you would have to push the syringe through the stopper to draw up the Midazolam. This wasn’t always as simple as it sounds. There was always a big label over the bottle making it awkward to see what you were doing, if you’d already used the bottle a couple of times and the liquid was getting low, you’d have to angle the bottle a certain way to ensure you got enough in your syringe. Then you have the problem of air bubbles. When drawing up a medicine, you have to get rid of air bubbles as where air bubbles are, medicine isn’t. Don’t forget this is an emergency medicine. You are trying to do all this as quickly as possible too!

So at last we have pre-filled syringes. All you do is remove the seal of the tube, take out the syringe, break off the tab and it’s all ready to give.

We have a bit of a love & hate relationship with Midazolam. We love the effect it has. How it works. How it stops what is happening. But we hate it too. We hate having to give it. We hate what it symbolises…that Samuel’s had a bad patch.

But the relief you feel when you’ve been watching Samuel seizure for over 10 minutes and then suddenly he stops, relaxes and yawns and goes off to sleep. All is calm. Samuel is safe and content once more. That is why Uncle Midaz is a very important part of Team Sam.

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.

Medicine cabinet

You may not be surprised to know that we have a rather bulging medicine cabinet (well actually it’s a red box rather than a cabinet) with all the medicines needed to manage Samuel’s epilepsy, reflux and general bits and bobs:

Topiramate, Clobazam, Vigabatrin: Epilepsy medicines given twice a day

Buccal Midazolam: Emergency medicine given for seizures lasting longer than 10 minutes or for cluster of four or five in 30 minutes

Chloral Hydrate: Samuel has this at bedtime to help him sleep

Gaviscon & Lansorprozole: Medicines given every day for Sam’s reflux

Calpol: pain relief medicine (used a lot during teething)

All medicines are given via syringe through Sam’s gastrostomy button on his tummy

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.

On days like these…

Today has been a bit of a frustrating day. It started with me complaining to the manager of our doctors surgery for their continued incompetence with dealing with the boy’s prescriptions. If it wasn’t for the adjacent chemist who have simply been amazing we’d have found ourselves in trouble a number of times.

Because of the strict use-by dates on his medicines we can’t order them too early or we will end up wasting a lot of the medicine to then go on the new bottle. But I always give us and the surgery plenty of time to process the request. But more often than not they make a mistake. They either lose the prescription request (“sorry it’s been left in the drawer” or “sorry it had fallen through the tray and we hadn’t noticed” or just “we don’t know what’s happened to it”), or they change what I’ve requested and put through a request for a medicine that Sam no longer has – thankfully the chemist queried it as he hadn’t had the medicine in quite a while. A number of times we’ve been told that the form was in the pile about to be taken over to the chemist but then I speak to them next day and it hasn’t even been signed off by the doctor! Aaaarrghh!

Anyway, I called the manager, found myself angry one minute then quite emotional, particularly as I said that these weren’t just vitamins, these medicines stop him having a seizure that could kill him.

Then I had a really annoying appointment at the hospital. It wasn’t to do with Sam’s head or seizures in fact it was to do with the other end. When he had his gastrostomy operation they dropped one of his testes but decided not to do the other. They are now talking about doing the other one. I’m not keen. He wees just fine and I really aren’t keen on him having an operation at the moment (especially as we’ve just got over a series of bugs) and will it really make a difference?

The surgeon we met today hadn’t met us before. Had probably only seen Sam’s notes briefly before our appointment. He didn’t understand Sam’s condition. I had to explain. I had to explain Sam’s life expectancy and whether he is expected to reach his teenage years. Bearing in mind 50% of children with Sam’s condition don’t reach one year old, the answer is unlikely. I had to go over this stuff with him more than once. I asked him to go back and discuss this with Samuel’s Neurologist and then come back to me as they are the medical experts. This chaps colleague (who did the previous surgery on Samuel but had been called away today) actually shares an office with Samuel’s Neurologist so the phrase ‘get a room and discuss’ seems a bit daft. Anyway, I was pretty hacked off.

(By the way the surgeon told me right at the end of the appointment that there is a slight risk that if the other testical isn’t dropped into place then it could become cancerous. I’ll just add that to the list of stuff to worry about then.)

But then afterwards I had a coffee with my friend T or Auntie T as I should call her as she is Sam’s other Godmother. On days like these you need a friend like her. I’ve been banging on recently about needing people in ‘our world’ to talk to but I already have a great friend in T. Yes her son J is fine, developing so quickly he’s going to be running about before long and I may be the only person she knows with a disabled/special needs child, but you know, I think she gets it. When we had Sam’s diagnosis and prognosis I rang her to tell her. We both cried on the phone. She demanded that she had to come over and see us and have a cuddle with Sam. She’s always been there and I don’t think I’ve ever really appreciated that. Although she has her little man now and he is quite a handful, it is so obvious how much she loves Sam and relishes being his Godmother.

So although I’ve felt really quite pissed off today I have learned something. Sometimes what you are looking for can be just under your nose. Auntie C and Auntie T, friends for life. x