Dexadrine

Dexadrine (Dextroamphetamine) is a powerful psychostimulant which produces increased wakefulness, energy and self-confidence in association with decreased fatigue and appetite. It works primarily by inducing the release of the neurotransmitters dopamine and norepinephrine from their storage areas in nerve terminals.  (wikipedia)  It is used with great success in treating ADHD, narcolepsy and chronic fatigue.


Well whatever it does and whatever it  is, it is certainly working.  As long as Leah takes the pill in the morning and then again after her nap at school she is able to stay at school.  If, like this morning, her dose is forgotten, the school is calling by about 10am.


As for noticeable side effects for Leah...have you ever seen the movie Hoodwinked?  She is a little bit like the character Twitchy on caffeine.  Chatters a mile a minute about the minutiae of her day, is restless and amazingly enough quite distract-able. This gradually wears off by about suppertime and then shortly after that she is ready for bed.

Her morning dose keeps her going until about 11, then she is able to take a nap at school, eat lunch and get her next dose.  It hasn't affected her appetite too much at lunch as she gets to eat prior to taking another one.

On the weekends and other school holidays, she does not get the meds.  This does result in episodes and extra sleepiness on those days but we believe her body needs a break from the medication and we want her to be eating as much as she can on those days.  Currently I do not plan on keeping her on it over the summer break.  

In less than a month we finally get the appointment with the Endocrinologist. Our success with the Dexedrine might be the key we are looking for in getting a diagnosis.  Hopefully it will help him at least narrow down the possibilities.

Appointments! Medications!! Report Cards!!! Oh My!

As I mentioned in the last post, Leah was prescribed Dexadrine as a method of *hopefully* keeping her more awake and alert during school hours.  On day 3 of the meds, the school called to say she was exhibiting some new symptoms and they weren't sure what to make of it.  She complained of her right eye (what is with that RIGHT eye?!?!?!?) being very blurry and the right side of her face feeling funny - which after much questioning really meant numb.

I attempted to get an appointment with our paediatrician, but not only was he not in the office that day, but none of his partners were either!  I tried to call the neurologist but he is on vacation and apparently so was his nurse although her voice mail didn't say that, so I left a message asking for advice.  Against my better judgement I took her to our local hospital.  Now, don't get me wrong, I used to work for this hospital, I know that it has many good attributes, but I also know that the waits are long, the nurses (not all of them) can be rude and lazy, that some of the doctors need refresher manners courses and sometimes they just aren't all that effectual.  But as with anything else, some days are good and some days are bad.

Well that day certainly wasn't my day.  We had an hour's wait just to be triaged.  I explained to the nurse that she has a neurological history, that she is currently being followed by her pediatrician and 3 specialists,that this was a new medicine with new symptoms.  I told her I was concerned about it possibly being a TIA She took Leah's temperature, checked her O2 and heart rate, asked me to guess at her weight, gave her a priority level of 3 on a scale of 1-5 and sent us back to the waiting room. Then we waited another 6 hours to see the doctor only to be told that since she seemed to be doing better that maybe it was "only" a complex migraine, but taking into consideration her neurological background he really couldn't be certain and we should follow up with her doctor!  Oh and maybe stop the meds until we spoke with the specialist. Well, by that time I had had no sleep from working the night before, it was now 7pm.  I was so tired I was nauseous and between the lack of food, stress, frustration and worry, I was cranky and very very close to becoming weepy.

 But I held it together and very politely told him what I thought of his hospital, his triage nurse, his emergency department and our treatment.  I explained to him that the symptoms he was seeing at the 7 hour mark were quite different than they had been when we first arrived. I told him it was unconscionable that a child with a history of neurological issues, presenting with neurological problems should be left for 6 hours and not even been checked on by a nurse!  Not once did someone come and see if she was okay, or if there were any changes!  That it was inexplicable that the triage nurse did not do any other sort of check on Leah.  Didn't check her eyes, blood pressure, balance, or even a set of very basic neuro checks.  He was very understanding, apologetic, attempted to explain away the long wait and the triage nurse's inexperience with children etc.  But in the end, none of it mattered.  Her symptoms persisted until the next day and then disappeared.....as usual.

On Monday we went for her follow up visit to the Sleep Specialist - he didn't feel the medication caused the symptoms and that it might just be a progression of whatever it is Leah has.  He had neglected to look into the functional MRI, and restarted her on the meds.  We go back to see him on the 27th.

Just because this picture makes me smile!  It is from her sleep study from a couple of months ago- she woke up with the cords wrapped around her neck 2x and the wildest hair I have ever seen on her!  Obviously she is a restless sleeper!

Report Card
For many students, getting a report card like Leah's would be great.  She had a B- average, a few Cs, an A or two but mostly in the B range.  For Leah who previously has had an A to A- average, I was not happy.  The teacher commented right in the notes, that Leah is constantly struggling to catch up due to her frequent absences - 29.5 days.  But that only captures the time missed when I have called in to say she won't be in school.  That number is deceptively low - it doesn't show all the days that I get a phone call shortly after lunch saying she needs to come home.  In reality she is at  50+ days missed.  If an average school year has 190 days in it and we are only in February (60% of the year), that means there have been approximately 114 school days so far.  So in reality she has missed about half of her year already!  This year's marks may not look so bad, but what about next year? And the year after that?  What about the skills she needs to learn and master this year for the foundation of all the other years?

At the parent teacher meeting we discussed keeping Leah current.  She states that any work completed at home can not be graded.  She does not use a lot of work sheets in her teaching repertoire - instead she uses a lot of hands-on, experiential learning - which is awesome....if you are in class.  When Leah is at school, the teacher makes an effort to spend time with her trying to get her caught up, or explaining a new concept.  But she says Leah's ability, focus and endurance differ greatly depending on the day and how she feels, making it difficult.  And of course, she has the rest of the class to teach.

I spoke with the Resource Teacher and the Principal and asked if it was possible for Leah to lay down somewhere to take a quick nap - maybe that would help her stay in school more days.  Logically, their outright refusal, cover their a$$'isms, counter arguments make sense.  No place for her to lay down, no available staff to watch her, can't assume responsibility for determining severity of her symptoms... yadda yadda yadda.  They were quick to suggest I pick her up, take her home for a quick nap and then drive her back to school.  In a perfect world that would be great, but my world doesn't work that way as of course I am supposed to be sleeping all day!

Unfortunately for them, I don't feel like being logical anymore. I am tired of being understanding, logical, patient etc.  I want answers for her, I want help for her, I want some type of educational intervention.  Out of everything this I feel I can make happen.

A family friend is an Educational Assistant and I picked her brain a bit. Because her marks have not fallen "enough", she wouldn't be tagged for an IEP - which is ridiculous!  Why wait until she is SO far behind before helping her, wouldn't their time and effort be better served keeping her current?   Even though Leah does not have a "label" yet, the combination of her health, attendance and the school's insistence that she never be alone (must always have another student with her), our friend believes she fits into the parameters to have some EA time dedicated to her.  Unfortunately she doesn't work for our school board, but her sister does!  She is putting us in contact with each other so I can be fully prepared when I approach the school and/or board demanding requesting  these interventions.  Yippee!  Insider information!

We also spoke with the Neurology clinic and requested they move up her follow up appointment.  Now that Narcolepsy has been ruled out, I see no reason to wait the 3-4 months for the genetic testing to come back.  It is time we moved on to investigating whatever is next on their list.  I have to wait until Dr. Callen comes back from vacation before I get an answer.

Yet again, it is another LONG winded update without any real news, just more issues and questions...so disheartening.

As always, if you made it this far THANKS!  Please continue to pray, pass this on/discuss with your friends and families.  Someone out there knows the answers Leah needs, we just have to get the information to them!

It's official!

Yes, it is official, Leah does NOT have Narcolepsy. 

Not that any of us are surprised by the news, we (family) never believed she did anyway.  But it is nice to have it verified by the professionals.

We went for the follow up appointment on Wednesday with the Sleep Specialist - very nice man.  Unfortunately we left him scratching his head because he can't figure out what this thing is either!

We go back to see him in three weeks for another follow up.  He has offered us the option of starting Leah on Dexedrine - a half tablet in the morning and if no results add another half at lunch.  The thought process is that it <might> help with her episodes of overwhelming tiredness, as Dexedrine is a stimulant and has proven very beneficial in patients with Narcolepsy.  He is hoping if we could eliminate the symptom of overwhelming tiredness, maybe she would be able to stay at school and not come home so often. We haven't decided yet if we will start her on the meds.  I need to do some more reading and weigh the pros and cons.  I have the prescription if I decide to go ahead with it.  He said if it was going to help we would notice a improvement quickly.  I just need to see if the benefits would outweigh the side effects.

He was also going to do some research into a Functional MRI.  In a nutshell, a regular MRI is to see the structural aspects of the brain, a Functional MRI allows you to see how the blood and enzymes affect the brain.  He needs to do some research because he had a niggling thought in the back of his brain, that there have been some advances/research on the role of a functional MRI and Narcolepsy/Sleep disorders.

As for Leah herself, she has developed a prolonged case of the "blurries"- since an episode on Jan 16th, she has maintained a constant state of her head feeling blurry on the inside.  Back in the spring when this all started, this had happened, and she stayed blurry for a over a month.  Since then, the blurriness had occurred only during an episode and then faded shortly afterwards.

In addition, this past weekend, Leah began having trouble with her right eye.  During an episode, Leah always says her right eye is bothering her, she rubs at it, tries to keep it closed, wipes at it etc.  She can't explain what the issue is, only that it bothers her or feels weird.  On Saturday, I noticed she continually placed her hand over her eye while reading me a story - she couldn't focus on the words unless she closed/blocked her right eye.  This carried over to watching TV as well.  It continued until Sunday when it resolved itself.  We had her checked out by the eye doctor again who says her eye/vision is just fine.

We have reported both issues to the neurologist, but no advice/info for why it is happening has come back to us.

So, while it still isn't an answer, we can check Narcolepsy off the list. 

On a side note...it feels like we have been fighting for answers for SO long, but in reality it has only been 8-9 months.  In that time we have been to see a Paediatric Specialist, a Blood Specialist, a Muscle Specialist, a Neurologist, had a CT Scan, 2 EEGs, a EGG, worn a holter monitor, had a sleep study and a sleep latency study, had a MRI and genetic testing.  Considering wait times in Ontario, she has had incredible access to medical resources!  

I have to remind myself to continue looking on the bright side of things....it could be much worse! 

I received that reminder on Wednesday shortly after our appointment.  We had stopped by Ikea for a quick shopping trip.  Waiting for the elevator, I was grumbling in my mind about the lack of a diagnosis, feeling sorry for myself about all the trips to Hamilton, all the worry and stress, feeling sorry for Leah for all the missed school and activities; the elevator doors opened and I saw a mother pushing her daughter in a wheelchair.  Even though she had a hat on, you could tell the girl was bald, her colouring wasn't good, she had big dark circles under her eyes, she was bundled up to keep warm in the store and had a blanket lying across her lap.  Cancer/leukemia immediately came to mind.  My eyes connected with the mother and we shared a brief smile.  I can not begin to imagine what struggles and heartache she feels;  it certainly put mine into perspective.  Yes it sucks that we are on this quest (it is now a quest in my mind, not a battle, or a struggle or anything else negative), it sucks that it has already impacted us as much as it has, but when I think about how bad it could be, I remember to count my blessings and not borrow trouble.

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".