Mayo Moments

Showing posts with label Multiple Sleep Latency test. Show all posts
Showing posts with label Multiple Sleep Latency test. Show all posts

Wednesday, 11 January 2012

Happy New Year!

Happy New Year readers!  Our family had a wonderful Christmas holidays and we hope you did too!

Paul and I both had the Christmas week off work and we were able to spend a whole lot of family time together - something that our work schedules don't usually allow. 

Leah only had two episodes over the holidays, they were both during times she was in a warm, busy, loud environment.  We thought we had the pattern figured out based on the last 4 episodes....then she had one today.  And of course, today was different and threw my theories out the window.

Our middle daughter Hannah gave the family a night at the movies as a Christmas present, and we were finally able to go en masse to see Alvin and the Chipmunks - Chipwrecked.  Leah was loving the movie, she was happily gobbling popcorn, sipping some sprite and giggling away.  I was feeling confident that we would have an uneventful time - the theatre was not overly crowded, the temperature was a little on the low side, the sound as always was loud but not painfully so.  Then slowly, slowly, she started leaning into me, then laying against me, then on my lap, then draped across me in her boneless way.  Feeling smug and secure in my understanding of her pattern (at this point she is ALWAYS extremely cold) , I grabbed a coat to bundle around her -  and she responded by complaining she was too hot and took off her sweater!  Well darn it!  What the heck is going on now?  She told me she was dizzy but not blurry, her right eye was "bugging" her and she was tired.  When the movie was over, we carried her out to the van and she was in bed as soon as we got home.  When I was tucking her in she told me her head was starting to get blurry and she just really wanted to sleep, she was very groggy, her voice was wispy and she was having a hard time maintaining her side of the conversation.  My poor baby.


On the positive news side of things, we have a date for her sleep study and the requisition for her genetic testing and Lyme disease bloodwork.  Leah and I are to present ourselves at 9pm on Monday January 16th, at the sleep clinic at St. Joesph's Hospital..  She will hooked up to all manner of monitoring devices and then asked to sleep normally - seems a little contradictory to me, but I guess they still get results.  Then in the morning she remains hooked up, but can be mobile.  We will remain in a dimly lit environment, with little to no stimulation.  Leah will be asked to take a nap every 2 hours - they will only let her stay asleep for a maximum of 20mins each time.  They will do this 4 or 5 times through out the day.  We should be on our way home by 5pm on the 17th.  These results along with the genetic bloodwork (which takes 3 months to get results) will either prove or disprove the working theory of Narcolepsy.

We now also have another symptom to add to our list - Periodental Abscesses.  Leah had another one over the holidays and true to form it occurred over the New Year's long weekend when access to her dentist and/paediatrican was impossible.  We got her on antibiotics as soon as we could and got her to her dentist first thing on Tuesday morning but it was too late, they had to remove the tooth where the abscess was located.  They do this for a number of reasons
  • in order to clean out the abscess 
  • to ensure it does not spread to other sockets
  • to ensure it does not damage the adult tooth underneath
  • to ensure it does not spead into the blood stream or the jaw bone
While it really really sucks that she had to have another tooth pulled, I understand the reasons behind it.  We had them fit her for a Space Maintainer since it was one of her back teeth and very likely will take a long time for the adult tooth to grow in.  Keeping in mind that her two front teeth were pulled for the same reasons about a year ago and still have not grown in!

If you add the abscesses to her symptom list, a new syndrome pops up - Ehlers-Danlos Syndrome.  This actually may make sense if enough reading is done and the family history on my side is taken into account.  And of course if you take a good look at this picture!  :) At the very least it gives us another direction to search in.

She does this without even thinking, with no effort, no pain...just sitting around colouring, or as she says "just getting into a comfortable position Mom". 

Friday, 16 December 2011

Neurological Differential Diagnosis

I feel like I am living an episode of House.

You know the part where House and his entourage sit around the office throwing out possible syndromes/diseases/disorders?  That is called a "Differential". And you know the part where he chooses one syndrome/disease/disorder that the others don't agree with?  Well that is kind of what happened at McMaster.

We got to McMaster only to find out they had mailed us a postponement letter pushing Leah's appointment back to the 19th.  Obviously we didn't get that letter so they agreed to see us anyway.  They went off in search of a Resident  who didn't have a caseload that day and found us Dr. Fudge.

Dr. Fudge and his student did a very thorough history and physical exam.  When I say thorough I really mean thorough - it lasted for almost 2 hours!  They asked tons of questions, and did a neuro assessment on Leah.  Then they left to go discuss it with Dr. Callen and his team. 

We could literally hear them doing the differential, and we saw them looking at her MRI.  Then they all toddled back into our room and began the explanation of their thought process and gave us a "working diagnosis".

According to Dr. Callen he would be "flabbergasted" if the tests he has ordered for Leah come back as negative for Narcolepsy with Cataplexy

So our working diagnosis is Narcolepsy.  Strangely enough, it was mentioned in a couple of comments from a reader at the very beginning and was discarded as I didn't feel Leah met the criteria.  I still don't think it really fits as so many of her problems are not included in the symptom lists.  No matter, regardless of how sceptical I (and others) may be, we are just so darn glad that we are moving forward.


They have sent of the paperwork for the government grant necessary to do the genetic testing in Boston.  This testing will tell us if she has the genetic form of narcolepsy.  They are scheduling a polysomnogram (PSG) and the multiple sleep latency test (MSLT). 

Basically those tests will tell us if she slips into REM sleep much more quickly than the norm.

They encouraged (can you believe it!?!?!) us to research Narcolepsy and become very familiar with it.  One of the first things we saw was the Epworth Sleepiness Scale   My mother and I score very high on it, so I guess a genetic link is possible (note to self: call the doctor for a sleep study for me!)


As well, he has agreed to do the test for Lyme disease!  He actually considered the probability of a positive finding.  You could see him thinking - he thinks like I do...rolls his eyes upwards as if he is looking at a mental chalkboard.  :)  He doesn't think it is going to show a positive result but he said it was a simple addition to the bloodwork he was already ordering.

So keeping with the "House" theme, I fully expect the tests to come back negative for Narcolepsy, and then they will pick something else to investigate.  And I am okay with that as long as they continue to investigate. And I know that at some random moment, Dr. Callen's eyes will gloss over and random thoughts and ideas will suddenly converge to give him the magical diagnosis that will set Leah's life back on the right track!