Showing posts with label THC. Show all posts
Showing posts with label THC. Show all posts

Tuesday, January 16, 2018

That pot of gold

C. gets hydrotherapy
I was thrilled with C.'s hydro session this week where she surpassed last week's performance. Here she is floating unaided (over on the right).

Her walking has also been advancing. Still nothing like what it was pre-liver saga but better than it has been since her liver recovered.

She's actually sturdily on her feet cooperating slightly while I move her legs. We do this for 45 minutes every night. It's so strenuous that Ive apparently injured my left hand in some way. For the last week, I've been waking up after about five hours of sleep with numbness and pain in my left fingers.

I unearthed a hand brace which I bought many years ago. (That's no mean feat in my chaotic household.) The exercises I was doing back then with C. triggered similar symptoms in the same hand.

Me walking C. today
I've now been wearing it during the walking and while I sleep for a couple of days with amazing results.

UPDATE: I wrote all that a few days ago but things aren't looking so rosy now. We get periods of intense and repeated seizures for which I give either Advil or 20 drops of Cannabis THC, or both. We're also treated periodically to those tiny eye seizures that lock her trembling eyeballs into the left side. The latter aren't as visually alarming as the whoppers but they're still very disconcerting. Needless to say, she doesn't function at her peak while in their grip which can be for over an hour.

We're at the same 25 drops of Cannabis CBD, three times a day, 3 drops of Cannabis THC three times a day, 1,500 mg. of Keppra twice a day and 100 mg of Vimpat twice a day. Still haven't learned if and how we can buy that CBDA. So, for now, I am at a loss as to what changes to make.

That pot of gold - seizure control - seems more elusive than ever.

Tuesday, January 2, 2018

New year, new campaign, new drug regimen

C. in the hydro pool a week ago
Last week, C. had her first hydro session since being hospitalized. We were all blown away to see her float with her usual finesse as if she hadn't just been through a 3 week hospitalization for status epilepticus.
 
And the previous day, I gave her THC for a sudden seizure surge. That's happened a few times lately. Occasionally she has a fever so I only give her Advil to control them. But with her status experience still so fresh, each increase in seizures is unsettling. 
 
I've been busy writing about my pet peeve: institutionalization of people with disabilities. As I've shouted from the rooftops, that practice is rampant and accepted in these here parts.
 
During C.'s hospitalization, one of the doctors on the team suggested to the Hubby: "Why don't you put her in some sort of medical facility?" That was after the team had reined in her seizures with a cocktail of powerful drugs that left her near-comatose. We were wondering how we'd care for her at home in that state. The "send her away" suggestion was that doctor's response. (Here's what happened afterwards.)
 
I was encouraged to learn about a new local grass-roots movement against institutionalization. Its specific goal is to win government-funded personal aides for people with disabilities along with the right to live wherever they choose to within the community. Exactly what I've been hankering for! Our national center for human rights for people with disabilities is promoting the campaign.
 
A creative approach to achieving that is to dissuade those benevolent people who volunteer at and donate to such institutions from doing so. Lumos - founded by J.K. Rowling - is at the forefront:of that push.

Here is what Georgette Mulheir, Chief Executive of Lumos had to say about that: 
"More than 80 percent of children in the world’s orphanages have at least one living parent and most have relatives. They should be at home with their families, not in institutions. What orphanage children and their parents really need is to be reunited, with all the supports and services that will enable those families - no matter how poor - to give their children what they need to thrive and reach their full potential.

J.K. Rowling, the founder of Lumos, who has spoken out against orphan voluntoursim frequently on Twitter, could not have put it better: “ Voluntourism is one of drivers of family break up in very poor countries. It incentivizes ‘orphanages’ that are run as businesses. Globally poverty is the no. 1 reason that children are institutionalized. Well-intentioned Westerners supporting orphanages perpetuate this highly damaging system and encourage the creation of more institutions as money magnets.”

Yet evidence suggests the number of children going into orphanages in some parts of the world is increasing."
Wishing everyone a happy, healthy, seizure-free and de-insitutionalized 2018!

P.S. Last night I began giving C. a daily dose of THC. For the next couple of days, it'll be just one drop 3x/day but I'm planning to raise it gradually. I'm winging this; no doctor has recommended it but Elizabeth Aquino - my cannabis guru - gives it to her Sophie with CBD.

Thursday, November 16, 2017

Rising stress

IV Drip
Nothing uplifting to report about C.

When the hospital doctors tried stopping the IV Dormicum (aka Midazolam), she returned to Status Epilepticus with a vengeance within a couple of hours (one minute between seizures).

So she was rehooked-up immediately to the stuff.

Then today the doctor lowered the dose from 3% to 1% and before our very eyes she began seizing again. So he promptly re-raised it and the seizures disappeared. Not much of a solution.

I inquired about the longer term plan.

He told me their plan was to get her off Dormicum and replace it with an oral benzodiazepine, Frisium (aka Clobazam); raise her Keppra (aka Levetiracetam) dose; stop the Phenytoin; and continue with Vimpat (aka Lacosamide) aiming to raise it from 100 mg twice a day to 200 mg twice a day.

Can't imagine there will be much of C. left on that potent a cocktail.

At the same time he said the team is encouraging continuation of Cannabis CBD and THC.

That's all very nice (I'm referring to the cannabis green light) but there's no point in giving THC if she has already been zapped with the other stuff. How will we know whether it's worked?

And we are currently allotted such a small quantity by the government's medical cannabis agency. We'd need a lot more to administer it freely.

A quick bedside sketch
I'm giving CBD whenever she's sufficiently awake to enable me. But that's rarely.

Well, if any of you would not find the above stressful, please let me know. Because the senior neurologist who dealt with yesterday's setback told the hubby: "Your wife seems very stressed. She reminds me of my mother. I see I can't share all information with her."

Who knew senior neurologists go in for crude mansplaining?

PS: C.'s own neurologist came by today after being away all week. She offered the option of an induced coma which would entail intubation accompanied by the risk of C. never being able to breath independently again. I said thanks but no thanks.

She then warned that even C's current treatment protocol could at some point necessitate intubation. Would we agree to that? Something to ponder.

But, of course, not get stressed over. Perish the thought.

Saturday, November 11, 2017

Stuck in status - Part 3

C. and friend in her hospital bed
Written Saturday, November 11

We're still in the hospital, third day running, but no longer in the Emergency Room. Now we're in the ward.

The major seizures are nearly under control and feeding C. meals is much easier. She even seems to have a better appetite than usual.

The severe seizures do still erupt from time to time. We've also noticed some small, new sorts involving only the face or only her right arm and hand.

A neurologist came by today and promised he'd order another EEG to ascertain whether those new movements are actually seizures.

The doctors are piling on the drugs like there's no tomorrow. When I expressed concern about that, the neurologist promised that two of them will be removed as soon as she's stabilized but I'll believe that when I see it.

So C.'s drug tally now stands at: Keppra (also known as Levetiracetam and given IV while in hospital); IV Phenytoin (aka Dilantin) (to replace the IV Valium (Diazepam) which was ineffective); oral Vimpat (aka Lacosamide); Cannabis CBD (Cannabidiol); Advil (aka Ibuprofen) for her central fevers which are proliferating; and Cannabis THC (aka Tetrahydrocannabinol) for strings of seizures without fever.

As you see, the positive news is in short supply.

Stuck in status - Part 1

Written Wednesday night, November 8 (but posted on November 11)

I have just spent three hours getting a meal into C. She takes forever to swallow the smallest mouthful. Throughout, she was having small seizures that affected her face. (That grimace in the photo is relatively new to us.) Now have put her to bed but she has begun to have really hard seizures affecting her entire body, and every five minutes or so. I am at a loss.

She had a fever a few hours ago so I gave her Advil followed by Cannabis THC and the hard seizures subsided. But now they've resumed and without any fever.

I am loathe to give her another round of THC only four hours after the last. Haven't touched the rectal Diazepam - wary of it.

Tomorrow we have an appointment with C.'s neurologist but still must get through this night. I often wonder what I did to deserve this.

Monday, November 6, 2017

Status Epilepticus strikes C.

From an online guide to administering Diazepam rectally
We are enduring rough seizure-laden days. C. has even gotten tangled in status epilepticus a couple of times. It's reached the point where a few hours' stretch without seizures is pure heaven.

This bad run began out of the blue on Friday. As usual, there is no change in her routine or in her diet we can blame.

The Cannabis THC did work this morning, zapping a particularly intense status session. But after my daughter-the-dentist reminded me of it, I asked C.'s pediatrician for a Stesolid script.

So we are now stocked with two boxes of 10 mg Diazapam rectal tubes (the equivalent of Stesolid). We haven't used the stuff in at least a decade but it seems a better option than the ER. We are braced for a fresh round of this curse.

PS: The dreaded status struck again tonight. THC took a little longer to work but eventually reined in the seizures. To inject some variety, C. has also vomited twice in the last 24 hours, raising the suspicion that there's something non-neurological underlying this mess. If there's no improvement tomorrow, we will try to do blood tests.

Monday, October 9, 2017

Uplifted by Downs

Isaac Levya, actor
It's been a while since the last post but not much has happened. Still the daily 3-5 intense seizures which wear me down.

So we finally wrote to the neurologist for guidance, enquiring specifically about starting a daily dose of THC to try and tackle them. (We now thankfully have a precious new bottle of the stuff.)

She recommended that we raise the dose of Keppra by 250 mg/day. But our THC idea didn’t appeal to her. She noted that a colleague who is more knowledgeable about cannabis assured her there is no evidence that THC affects seizures in any way, notwithstanding our anecdotal evidence to the contrary.

Nevertheless, she OKed one drop of it/day maximum.

For now, we’re trying the additional Keppra, so far without success. We’ll give it 2-3 weeks and then return to the previous dose of 2,500 mg./day. Afterwards we’ll try that daily drop of THC. Not that I have any hope a micro-dose like that will help. To zap C.’s long strings of seizures, we give 17 drops.

I’ve been encountering many Downs children lately when I pick up one of my grand-daughters from kindergarten. She attends a semi inclusive kindergarten. That translates into a small group of Downs students joining her “typical” class for a couple of hours each morning. The group then returns to its segregated class for the rest of the day.

I know, I know, that’s just token inclusion and the school could do more. But it’s better than none at all.

I mention this because I’ve noted how longingly I watch the Downs kids. I envisage the rosy life we’d have if only C. had been blessed with Downs instead of the disabilities she’s lumbered with.

That’s quite a switch from the days of my pregnancies when my deepest dread was giving birth to a Downs baby. It seemed the direst scenario possible.

Live and learn.

A propos of Downs Syndrome, I just learned of a film starring a Downs actor, "Any Day Now". As usual, I’m playing catch up – the film was released back in 2012. It hasn’t aired yet on TV in these parts so I’ve only seen clips from it on YouYube. It strikes me as a gem and the many awards it’s won attest to that.

Playing alongside its stars, Alan Cumming and Garret Dillahunt, is a young actor with Downs, Isaac Levya. The film is about a gay couple in the 'seventies trying to adopt a child with Downs Syndrome and the legal battles they face along the way. In an interview [here], Dillahunt describes Levya’s professionalism and how, during filming, Levya would occasionally tell his co-actors: “Give me some quiet; I’m trying to get in character”.

He attends acting school, auditioned for the part and endearingly discusses his acting experiences here.

I live in a place where mothers are still known to abandon Downs newborns in the hospital and where some who do bring them home later institutionalize them. Success stories like Isaac Levya's are particularly uplifting in this environment.

Friday, September 8, 2017

A small cannabis victory and a mysterious laugh

Since Wednesday, I've been revelling in giving C. her full dose of CBD. That's when our cannabis provider notified us that the government's health authority granted us a new license with the increase we'd requested (more like begged for) in our monthly allotment of cannabis.

This license entitles us to take that extra bottle either as CBD or as THC. So we've got one bottle awaiting us for August which we'll take as THC. I intend to begin experimenting with a very low daily dose of THC.

Then, starting with our September batch, we'll opt for an extra bottle of CBD bringing our total to 11 per month.

It's unclear why the government officials acquiesced after initially refusing. But C.'s neurologist earnestly went to bat for us with a written complaint and a nudge to her colleague with some position in the government's cannabis section. Presumably her efforts played a role.

All this has renewed my pride in this country's trailblazing in the field of medicinal cannabis. Close to 30,000 citizens are license holders and we are slated to become a major medical cannabis exporter.

But back to C. She has been seizing several times a day without running a fever. That's why I intend to introduce daily THC, though the Hubby wants me to run it past C.'s neurologist first.

C. enjoyed two hydro sessions this week, one with me as therapist, the second in the heated therapy pool with a professional hydro-therapist.

Upon her return from that session she began to vocalize - a lot - until late that night. It resembled laughter. But the Hubby and I were creeped out by it. I was convinced she was just getting creative with her seizures. Her caregiver, E., insisted it was a positive step.

Here's a brief video of the sound so you can judge for yourselves.


Whatever it was, we've only heard it once more, two days later.

And as the summer draws to an end, here's a suggestion for those still enjoying hot weather: a disability-friendly beach equipped with special chairs that maneuver easily on sand and water. You just fly to Italy and ecco là: real "access to the sea".

A snap from the beach as captured in the NYT article:


Here's a description of the beach.

Friday, June 30, 2017

Summertime and the livin' is none too easy

C. is lying beside me and I'm afraid to move or touch her lest I trigger another seizure.

She has been having lot of them today. Not enough to qualify as status epilepticus, but nonetheless, not a pretty picture.

Yesterday, they were frequent but mild. Today, they're the full blown sort; the ones that engage every cell in her body, contort her face, cause moans and cries and devastate me.

I write this with the expectation and dread of the next one.

Unfortunately, she has no fever - and I mean not a trace of it. The thermometer read 37.3 degrees Celsius rectally (say 99.1 in Fahrenheit terms) which can't be considered fever by any stretch of the imagination. So I haven't given her any Advil. When she gets her neurological fevers, Advil banishes the seizures.

Then there's the THC oil which usually zaps strings of seizures. When I gave it to her this morning, it had no effect. Since that was ten hours ago, I could try another dose now. But I'm reluctant to because we're down to our last few drops of it.

Our neurologist's request from the medical cannabis authority for a new license which adds a bottle of THC to the ten bottles of CBD we receive has gone unanswered.

Our own numerous calls, emails and faxes to the frigging government office have also been in vain. The only response we have gotten was a couple of weeks ago when we received a new, temporary license. It permits the same number of bottles of CBD we've been receiving and makes no mention of THC! 
________

I wrote that last night. Today she's only marginally better; slightly fewer seizures, but still looking like a rag doll most of the time.

We've emailed her neurologist for her advice and just to "kvetch" a bit. I asked her whether she thought we could raise the Keppra dose although that really isn't a route I relish taking. (C. is now at 1,000 mg of it twice/day.)

Here's a photo of C. (below) taken on Tuesday before this downturn - at her weekly hydrotherapy session.


And here (below) she is last week with her little nephew. The interest they show in her as babies fades fast when they realize she can't interact. By around the age of one, they ignore her.

Thursday, May 18, 2017

Yay - we're back to hydrotherapy!


C. had her first, post-school-hydrotherapy session yesterday.

She seemed relaxed and at times floated nearly independently - that is, after I donned my "meddling mom" hat and urged the therapist to reduce her support.

But those seizures persisted during the session. A couple of whoppers and many of the minis.

And while I did meddle, I was mindless of the proper gear for C. For instance, I entirely forgot about bringing along Huggies Little Swimmers. So C. had to contend with a weighty water-logged diaper.

The photo shows her contending.

Meanwhile we're giving THC when the going gets tough, and it has been effective the last couple of times. (Despite the bottle's expiry date of 03/17 - it's all we've got while awaiting our new, amended medical cannabis license that will enable us to purchase a fresh bottle.)

Tuesday, May 16, 2017

Piling on the therapies and the Keppra

It's been a rough three days for C. with seizures up the wazoo, some accompanied by fever, others without. Up to eight major ones a day and many small ones involving only her eyes and mouth (too many to count).

THC didn't work its magic. Nor did Advil when there was a bit of fever so I finally raised the Keppra from 750mg twice a day to 200mg twice a day. The neurologist had advised doing that a few months ago but I put it off, hoping that raising her CBD dose would suffice.

The physiotherapist from our HMO came twice last week and is due for another visit today. He does the same sort of limb-stretching that the other one, hired privately, did only minus the white coat and the almond oil massage, and he does it for 15 minutes instead of one hour. Well, these sessions are totally free so some corner-cutting is to be expected.

C.'s spasticity has become rather serious so we'll also persevere with these stretches on our own throughout the day. So far, no results, though.

At this point, we're postponing starting a new drug recommended by the gastroenterologist to reduce spasticity. You know that cardinal rule: never introduce multiple new med variables simultaneously.

And, after a nine month hiatus, C. is having her first hydrotherapy session today.

I'm hoping she'll function as well, or nearly as well as she used to: floating on her back, kicking her legs slightly, scrupulously keeping her face out of the water. But I have a hunch that won't be the case. Stay tuned for her hydro "report card".

The snapshot above, slightly obscured to protect his privacy, is of our HMO physiotherapist at work with C.

Thursday, January 5, 2017

Our mammoth meds mess

We are deeply submerged in a morass of horrific seizures, new meds that aren't working and may be harming, deterioration in functioning and doctors whom we like and trust but who have no firm convictions, only wild guesses.

The silver lining is that at least they are humble enough to admit that to us.

My daughter C. has been suffering bouts of severe seizures on a daily basis now which we can only halt with some 13 drops of Cannabis THC. That in turn zombies her out, so there's no food or fluid for a while afterwards.

Keppra is the only anti-epileptic she is currently getting. It replaces the Valproic Acid she had been on for about two years. We had to wean her off the VA because doctors suspected it either caused or exacerbated the liver damage we discovered some six months ago. (The jury is still out on that point.)

The liver damage was uncovered when we tested C.'s blood albumin levels and found them to be much lower than normal. We had tested for albumin because the half dozen pressure sores scattered over her body hadn't been healing for several months.

C.'s damaged liver triggered Ascites in her abdomen and extremities, So after drainage in the hospital - and removal of 4 litres of abdominal fluid - she was placed on daily doses of two diuretics.

After a month of that regimen, C. had grown frighteningly gaunt. Her bones and veins protruded, her cheeks were sunken and she looked about ten years older. A parade of dietitians was consulted but none could figure out where all that wholesome and calorie rich food I was feeding C. was vanishing.

Blood tests finally showed high levels of saline, indicating extreme dehydration which was fingered and blamed for her gauntness. Here's how the dietitian explained it to me: Every cell in the body contains fluid. When there's dehydration, they all shrivel up just like a dried out plant.

So we had been shrinking C. with our very own hands. The liver expert ordered the diuretics halted immediately.

We had reluctantly started Vimpat for C.'s seizures since the Cannabis CBD alone wasn't doing the trick. But one day into that, she went into status epilepticus which even THC couldn't tackle. So it was off to the ER again.

There the neurologist ordered Keppra for the seizures (replacing the Vimpat) and the liver diseases guy chose Prednisone for the liver.

That brings us full-circle back to our current morass which we reported to both the gastro/liver doctor and the neurologist.

Their responses were the following changes:
  • Wean C. off the Prednisone and replace it with a different steroid
  • Increase the Keppra dose from 500mg 2x/day to 750 mg 2x/day and then, perhaps, to 1,000mg.
To view the video
For some reason we can't fathom, the gastro doctor has shelved the liver biopsy idea, leaving us in the dark about the source of C.'s liver issues. (In his email conveying this decision, the doctor factored in my recent Takotsubo event. Huh??)

Since the gastro doctor prescribed L-Carnitine, I've been reading a lot about it and see it's quite trendy. Have any of you seen impressive results from it in your children?

I stumbled across a sobering clip [on this page] after writing the above update and am reconsidering: We may actually be living on easy street.

Sunday, December 25, 2016

Bummer: Back to anti-epileptics


It was with a sense of disappointment and defeat that I deposited a 50 mg Vimpat pill down C.'s gullet today. I did it quickly, in the midst of a slew of rough seizures.

A small blessing was that the hubby and I were unequivocally on the same page. C. has had several days of such events and we felt we could no longer rely on the THC oil to rescue her. We've been giving it too often and it zombies her out.

She has lost so much of her always-minimal functioning in recent weeks. I had hoped that a C. off all anti-epileptics would be a more alert and higher functioning.child. Yet the only "positive" result we've seen is her return to crying at appropriate times. Last night, for example, she cried when I removed the bandage from the most horrific of her pressure sores. Not exactly cause for confetti. Particularly in light of her loss of the ability to do her assisted walking and to feed herself.

Now I'm hoping that, with Vimpat, she'll regain those skills and return us to the "good ol' days" - if you can call them that.

Of course I've had to weather all this while reigning in my nerves to avoid a return visit of my new Japanese friend.

Update: The hubby just paid a visit to C.'s gastro/liver expert on his own. I didn't didn't feel up to joining him and C. was in a bad postictal state. They hooked up with me by phone mid-visit so I learned the following.

The doctor said he's still organizing C.'s liver biopsy which will involve a general anesthetic and an overnight hospital stay. When I asked about her functional deterioration, he said that could be caused by a toxic excess of ammonia in the brain due to the liver malfunctioning. This can occur even when blood levels of ammonia are normal (which C.'s have been).

After steroid treatment, which he's considering if the biopsy confirms that she has an autoimmune illness, C. might retrieve those skills.

Dare I hope?

Monday, May 16, 2016

Two nice nurses and a heart-wrenching story

C. after a seizure caused her
to bit her lip

Now back to Tuesday's nurses. One was the VNS company's rep. She observed and photographed C.'s VNS. Then she listened to our history of C.'s epilepsy and gave us an hour's spiel about the VNS.

She "repped" so well that she swung me from lukewarm to ga-ga about the idea. She told us that the VNS' benefits aren't limited to seizure reduction, which is pretty impressive in itself - 62% of implantees improve either in number of seizures, length/intensity of them or in recovery time after each one.

But we learned that the VNS can also provide benefits unrelated to seizures, in cognition and memory. The nurse/rep emphasized that C. is not likely to ever enjoy any dramatic improvement in those areas, just tiny changes.

Well, as I've mentioned before,  tiny smidgeons of progress are very alluring to us. Of course, dramatic would be a lot more welcome but we're realistic. So the chance of tiny smidgeons won us over.

We already have an appointment to have C. assessed by the surgeon (early June).

Nurse #2, our health fund savior, arrived while the VNS nurse/rep was still around. He assessed and re-bandaged C.'s pressure sore and gave it what sounded like a D+ for healing progress. Ah, well, can't win them all.

Most intriguing about his visit, though, was what he told me about his wife who, after months of bureaucratic hurdles, finally scored a medicinal cannabis license a few weeks ago. Last visit, he told me it was controlling the pain nicely. But this time he said she has stopped using the stuff because it was triggering her nightmares.

Champion nurse/rep chimed in with an anecdote about an epileptic child who became irreversibly psychotic on cannabis and whose neurologist is beside herself with concern now. Hmmm. Of course this reached us 3rd or 4th hand so we took it with a bucketful of salt.

Over here, we are still enduring "bad days", with C.'s old "central fevers" in the picture too. THC continues to help but this period has been very debilitating for her and me. Yesterday, after one seizure we found her like this (see photo at the top).

The source turned out to be a small cut on her lower lip which stopped bleeding immediately after I wiped her clean. Her lip is a bit swollen today but doesn't qualify as a major concern.

In light of the current seizure situation, the VNS is looking increasingly attractive. I just hope the surgeon doesn't reject her as "too complicated a case" because of her current VNS which was implanted in December 1999. It's a possibility the nurse warned us of.

Now for the heart-wrencher alluded to in the title - an Israeli opinion article I found on line, unrelated to our nurses. (though it does feature a nurse).  It will undoubtedly resonate with many of you. Caution: keep the tissue box close by.

A child isn’t a lollipop
Alon Idan | Haaretz (Israel - Hebrew), May 5, 2016

He looks at me for a moment as if he wants to say something but immediately lowers his eyes. I notice that on his left knee lies the head of an adolescent girl. I walk back to the bench I had been sitting on.

“Listen...” he is nearly stuttering now, a few seconds later, “Can you perhaps help me?” I tell him yes but don’t understand what help he needs. “I need you to help me hold her,” he answers looking in the direction of the head that is resting on his left knee.

Patients in waiting room (in Birmingham AL as it happens)
We are outside the ultrasound rooms in a hospital with people lying on beds scattered along  the length of corridor, most of them old, wrinkled,  eyes stricken, but the head  lying on his knee is the head of a young pretty girl. I ask: “Help holding her?”

He nearly apologizes: “She is mentally retarded, she doesn’t speak at all and the last time they wouldn’t x-ray her because she got wild, and everything she eats she immediately vomits up, for a long time now, and I must have her x-rayed, must.”

He’s her father and is over the age of 50, and he’s an Ethiopian immigrant from many years ago and now sits alone on a hospital bench, and his daughter is lying on his left knee, and when he speaks about her in a mix of apology and pleading she suddenly raises her head, opens her beautiful eyes and looks at him, and afterwards at me, and says nothing.

He has an orange hat, and under it is a man who works every day in a hotel, the night shift, always the night shift, “so that I’ll be able to be with her in the mornings and afternoons until my wife returns from work.” And he returns from his shift at 2 at night and falls asleep on the sofa beside her. “I fall asleep like this”, he demonstrates. “Sitting, I fall asleep sitting. There’s not much room in the living room, and I must be beside her at night, in case she wakes up suddenly and does something.”

An orange hat and a hand that is now resting on it, while I sit beside him and don’t know what to tell him. “It’s hard”, he suddenly says, his voice cracking, “This life is hard, very hard.” I nod, helpless. “It’s not a life.... nobody comes to us, and I don’t go to anybody, and everything revolves around the child.”

I ask him whether the state helps, and he answers that “there’s no state that helps like this one, but I’m not prepared to give her away, not prepared.” And then he says a sentence that he will repeat over and over again: “A child isn’t a lollipop, you don’t give away a child like that. She’s my child. Who will care for her the way I do? I will care for her as long as I am able to, until I die. A child isn’t a lollipop.”

The door opens and shuts but nobody looks at him. He begins to fear that I might need to leave. “I’m holding you up”, he says to me “I’m holding you up.” I say that it’s OK, he shouldn’t get stressed and he relaxes a bit. “You understand,” he continues, his hand rests again on his orange hat trying to crush it into his skull, “I don’t leave the house, only to work, it’s hard like this, it isn’t a life.” And a moment before I say to him that I understand – can you really understand? – he breaks: “There are no friends, nobody, alone all the time.”

A grown man, a child lying on his knee, now sits on a hospital bench and cries.

Presently they call him. It’s time for the examination. We walk towards the door: the father, his daughter and a total stranger. “Who are you?" the nurse asks me. And the father immediately cries: “He’s with us.” “Why does he have to be with you,” she asks and the father says: “Because she moves a bit and he’ll help us hold her.” “Hold her?” She’s suspicious and immediately determines: If it’s “a case like that” then the ultrasound can’t be done.

The father is stressed. He says everything will be alright, that his daughter must be checked,  just as a large-bodied janitor approaches us: “Come, come a minute,”  the father asks and the janitor doesn’t understand. “I need you to help us too,” he says, and the nurse looks on in disbelief. Suddenly, without asking, the father raises his daughter – long, thin and frightened like a baby – and simply lays her down on the examination bed. Before the nurse has a chance to object, he says: “You’ll hold her legs, and you’ll hold this hand and I’ll hold her like this.” The nurse is about to say something, apparently to object, but she never finishes the sentence she begins to formulate.

Lying on the bed in a darkened room, three men gripping her body, a strange device, perhaps painful, threatens to touch her – the child trembles from fear and begins to go wild. “Don’t be afraid, my darling” the father cries and caresses her face, “don’t be afraid, everything will be OK.” Now the janitor, his face large, a yarmulke on his head, his eyes moist, says to her: “Don’t be afraid, don’t be afraid.” I too join the plea, as her right hand struggles forcefully to escape my grip.

But the girl is still going wild and the nurse is still hesitant, and now the father strokes his daughter’s face again, repeating the words: “Don’t be afraid, darling, don’t be afraid.”

He stands directly above her, his head above hers, so frightened that the nurse won’t perform the examination. “Don’t be afraid, darling,” he continues; now it is truly a prayer. “Don’t be afraid darling”. But she continues to move, to go wild, to resist, when suddenly I notice tears trickling onto her face. The father is sobbing on his little girl. Sobbing onto her and begging: “Don’t move, please, don’t move, let her check you, you must be checked, please.”

And the nurse, who can no longer avoid the sadness and the power and the beauty of life that coalesce in the tear drops flowing from the pure heart of the father to the frightened face of his daughter, immediately smears the gel on the girl’s stomach and places the scanner on her.

(Translation: Frimet Roth)

Friday, May 13, 2016

Seizures CEASED like the rain

After 10 seizures
and 5 drops of THC
I intended to launch this post with the 2 nurses' visits on Tuesday.

But then came yesterday morning: About 10 seizures in 10 minutes leaving C. limp, coated with saliva and twitching. At that point I grabbed the THC and gave her 5 drops. That was one drop more than the highest dose she'd had about 3 weeks ago when we brought her to the neurologist for a routine checkup.

This time it had an almost immediate affect on her. It reminded me of a line from one of my favorite children's book which I often read my grandchildren, Sylvester and the Magic Pebble: "It didn't stop gradually as rains usually do. It CEASED."

Likewise, C.'s seizures weren't subsiding; they were actually growing more intense. But after the THC, they CEASED.

Some six hours later, she had about three more seizures and after 2 drops of THC, they CEASED again.

This morning, I was greeted by another barrage and after five drops of THC and two more seizures, it ended. 

The Hubby is a bit skeptical but, despite the absence of definitive proof, I'm convinced the THC earns the credit.

Next post, I'll summarize the two nurses' visits.

Wednesday, April 20, 2016

Doc disses the new drug (THC)

This week brought three "perfect bad days" so we finally cracked open our bottle of THC.

On the first, I gave one drop, waited a few hours, observed no adverse effects, saw another couple of seizures and gave a second drop. Still no adverse effects and seizures stopped.

The following day, C. had a string of severe seizures (or so they were described over the phone by the school nurse). But we were too far away to race over there (at the eye surgeon to plan cataract surgery). So I just advised giving Advil even though it wasn't obvious she was feverish. Eventually, after missing her hydrotherapy because of them, the seizures abated. (so I was told).

When she seized twice at home that evening, and with the bad morning in mind, I gave her one drop of THC. A few hours later, after another seizure, I gave a second drop.

This seemed to render her tired and floppy. She did manage to do her MEDEK-walking for 40 minutes. But she was incredibly and unusually loose-limbed which I attribute to the THC. Not at all terrible as side effects go.

The following day, after an awful string of seizures (approximately eight), I gave three THC drops at once and after just one more drop, they abated.

C, waiting to see the
neurologist. She was
having a very bad day
Yesterday, again a horrific seizure tsunami (around ten), I gave her four drops and again, after one last seizure - calm! Yes, limp, perhaps lethargic, but seizure-free until the evening when she just had one.

Right after the awful morning, which also resulted in a bitten and bloody tongue - as her clothing attests (see photo) - we saw the neurologist.

I handed her the boxes of CBD and THC oil for her perusal and - wham! She blew a gasket. In her gentle and restrained manner, she rebuked me for ordering and administering the THC oil without first consulting her. I explained that I had expected to do that but when the cannabis nurse said the pediatrician would suffice, I opted for that. With our scheduled visit only a week away, I figured I'd notify her, the neurologist, then.

"You could have emailed me first," she noted        .

I didn't want to quibble but the truth is she often takes ages to respond to emails and I wanted that THC asap. Nonetheless, I apologized and promised to halt it after she emphasized that there's no evidence of its efficacy in treating epilepsy. (What choice did I have? We've been through many awful neurologists and don't want to risk losing this one).

She is particularly opposed to using THC with children but when she remembered that C. turns 21 next week, conceded that it isn't a concern here.*

C's VNS implant
The neurologist quickly recovered from her THC meltdown and was her kind and supportive self for the remainder. At my suggestion, she agreed to apply to the Ministry of Health for a new license citing a higher dose. We are still far from the maximum, she said. She also convinced us to submit C. to a second VNS implantation in the near future. More about that next time.

In the meantime, here's a glimpse of the old one.

---
* Once out of the office, the Hubby and I agreed we'd continue giving THC in future tsunami circumstances. It's clear to us it works.

Friday, April 8, 2016

Cannabis Chapter 2: We're starting with THC oil

Video still from the CNN clip: An Israeli father gives his
son THC oil [Video Source]
After reading about it, thinking about it, talking about it and blogging about it, I watched a CNN video clip about it: that is, THC oil used in conjunction with CBD oil.

The clip [online here] finally spurred me to call our Cannabis supplier's nurse to inquire about the bureaucracy involved in getting THC. Mind-blowing answer: no requirements.

As Murphy's Law would dictate, to get the CBD oil, which is low in THC and can't produce a high, you need a neurologist who has treated your child for an extended period already and who is willing to submit the demanding Ministry of Health paperwork. Then you must wait a month to, hopefully, receive the license which states precisely the amount your child is permitted to receive per month. That license must be produced every time you purchase the CBD oil. If you raise the dosage to a point where the stated amount won't suffice, the neurologist must re-submit all those documents to apply for a brand new license.

But for the THC oil which does induce highs and possible other effects, you need only text a doctor's recommendation to the Cannabis nurse. Any MD at all will suffice. Even your garden variety family doctor, even one who has never met your child. Anybody who'll oblige you! (Provided, of course, that you already have a license for CBD oil.)

And thus, within 48 hours of watching that CNN segment, we had ourselves a bottle of THC along with these precise phone  instructions from the nurse:
  • Start with one drop.
  • Watch for reactions. 
  • Raise the dosage as required. 
I kid you not.

I haven't given C. any yet, but am very eager to. The family profiled on the CNN clip, whose child appeared to be as severely epileptic and CP-disabled as C. is, said they use it only on "bad days". So I'm eagerly awaiting a "bad day" that isn't caused by C.'s periodic neurological fevers which we zap with a couple of Advils. I'll keep you posted.

And how about this? Our Ministry of Education will be granting its most prestigious annual award in 2016 to a man who founded one of our largest closed institutions for children and young adults with severe disabilities.  I feel as though we are locked in a time machine hurtling back to the Middle Ages.

Thursday, January 22, 2015

EEG enigma and dosing in the dark

Last week was our quarterly visit to the neurologist, but my cataract and dental issues left no time to blog. I'm glad to have a few minutes to share what she told us.

The visit began with C.'s first EEG in several years. She was so calm that an anesthetic was unnecessary. She even stopped grinding her teeth after I stroked her cheeks. The technician asked me to intervene because the grinding made the EEG go haywire. After that it was smooth sailing. C. even fell asleep.

To my layman's eyes, the lines on the screen looked a lot less zig-zaggy than in the past. But that may just be wishful thinking at work. The neurologist herself explained that the zig-zags definitely indicate epileptic activity but without seeing her previous EEGs - something she had no time to dig up - she couldn't comment on improvement. Hopefully she will eventually compare them (and confirm my rosy assessment).

She then gave the green light to raise the cannabis dosage by another 50% of her current dose. So we can go up from her current 46 drops/day to 65 drops/day and then stop raising it. That final dosage will only be a moderate one. The doctor doesn't recommend reaching the maximum. She says the dearth of reliable studies leaves cannabis dosing in uncharted territory. A higher dose might even be detrimental.

So here are a few numbers to crunch:
- C.'s oil contain 15% CBD and 0.75% THC which equals a 20:1 ratio. 
- Her 45 drops/day equal 7 mg per kg. 
- We aim to raise her to 65 drops/day or 10 mg per kg 

I'll keep you posted as to her progress. 

At this point, in addition to a reduction in the number of seizures on most days, I have noticed an improvement in her walking. (It's the MEDEK assisted sort.) She seems to stand straighter and takes bigger steps with her right leg. The left does not step independently. 

But I still crave a touch of cognitive progress. No headline-grabbers; I'm too realistic for that. Just a few new, minor, non-verbal reactions from C. would do me fine. 

And while on that topic, we still haven't heard from the neurologist who promised to canvass his colleagues about minocycline as a treatment for cognitive impairment. We emailed him a reminder today. I didn't ask the neurologist we saw last week about the drug because she's an epileptologist, so I figured this subject is not her field. 

Other brief updates:

Our grand-daughter's aplasia cutis was officially declared history by the neurosurgeon this week. No more bandaging and no follow up visits. We are one very thankful family this week.

My article about institutionalization of people with disabilities - sadly, it still thrives here - was published last week. After its umpteen revisions, the piece didn't feel like 'my baby' anymore so I wasn't quite thrilled. But at least the message it conveyed is circulating. Today's tally is 75 tweets and 135 recommends

Tuesday, January 6, 2015

A day-long saga

That's me walking C. for the PT
Last Wednesday was a long, exhausting day revolving entirely around C. So here is a long, exhausting post about it.

The first half of the day was spent at a rehabilitative center for C.’s annual multi-disciplinary assessment by a  physiotherapist, an occupational therapist, a social worker, a neurologist and an orthopedist.

In previous years, our health fund footed the bill but warned us after last year’s visit that they would no longer do so. Nonetheless, we tried our luck this year again. Since C. is now an adult, the decision was no longer in the hands of that same health fund pediatric neurologist who has been the bane of parents’ lives throughout this city for decades. Many children have been denied therapies or specialists’ exams by this health fund thanks to this s.o.b. So many in fact that TV and newspaper exposes about him  have abounded  - but to no avail. 

In any case, our approval for funding this year arrived without a hitch.

Now we don’t usually hear much that’s earth-shattering  from the team at this center but the visit always proves worthwhile in some way.

The neurologist, reminded us that we had told him C. seizes 3-4 times a day. Since we used to count only the ones she had awake and out of bed, that tally reinforces our conviction that C. has improved on cannabis. We’re now giving her 14 drops, 3 times/day of the 20:1 ratio, a.k.a. 15% of CBD and 0.75% of THC. (Why these percentages translate into a 20:1 ratio is something I’ve got to ask the nurse next time we speak.)

I mentioned to the neurologist the research into minocycline as a treatment for cognitive impairment. He was totally unaware of it and promised to inquire about it among his colleagues. I’m eager to hear what information he culls so we can start C. on the drug asap.

The physical therapist was impressed with C.’s MEDEK walking which we demonstrated for her and in particular with her straight torso. (Photo on the right.) But she noticed that C. barely lifts her right foot when stepping. Instead, she drags her toes on the floor. She thought a brace might help (she currently only wears one on the left foot) But in order to determine whether it would actually be beneficial, she recommended first trying the cheaper "Dictus" (video here)

I’m reluctant to try either of these. From my experience, C.’s walking doesn’t take well to even the slightest adjustments. So I fear introducing either device would do more harm than good. But I plan to try the Dictus just to be sure. 

The occupational therapist referred us to an article about restraining the strong limb in order to strengthen a weak one. I have limited the work I do with C. to her right and stronger hand/arm, ignoring her weaker left one entirely. This therapist urged me to focus more on her left since it might improve her brain/cognitive function. The words “cognitive improvement” are like light to a moth for me. So I intend to give C.'s left hand some attention from now on while holding down her right.

The orthopedist scrutinized C.’s overlapping toe for an inordinate amount of time and actually concluded that she’s a candidate for surgery to repair it! Since she walks a maximum of one hour per day and only with constant support, this seemed like overkill and we told him that. So he drew another solution out of his bag of tricks: bringing C. to an orthotics expert who will make a custom “toe separator”.

I might add that the standard silicone insert (photo on the right) I’d tried on this doctor’s advice last year produced sores. I can assure that expedition is nowhere near the top of our “to-do” list.

I had to remind the orthopedist to assess C.’s scoliosis which he promptly did by glancing at her position in the wheelchair. “No need for any intervention” was his verdict.

Needless to say, I wouldn’t write home about this orthopedist  

The social worker, poor woman, was subjected to one of my rants about C.’s school and about the limited options available for children with profound disabilities after “graduating” at 21. She listened patiently, commiserated and if. she found me tiresome – like my immediate family tends to - then she did a great job of hiding it.

Following my tirade she advised having our pediatrician send a referral note to the home-care advisory unit of our health fund. They’ll assess our home for accessibility and might offer to fund some minor improvements.

After this we headed to another city, with C., to pick up her two bonus bottles of cannabis. Our always-supportive neurologist arranged for a new license from the Ministry of Health. This one permits us 30 grams per month which translates into 6 bottles instead of the previous 4.

As we approached that city, the hubby realized that we had left our license at home. The distributor insists on the presentation of that piece of paper before each hand-over even though they’ve got everything on line. We knew they’d give us a hard time but figured they’d ultimately hand the bottles over.

Well, we figured wrong.

The guy who runs it did give me a hard time – cannabis wafting  from his every pore. But, never losing his cool, he would not budge. My kvetches and pleas fell on deaf ears (he was very cannabis-cool). The only way he’d part with those bottles was if I presented an official police declaration that I’d “lost” the license. He kindly wrote down the address of the nearest precinct.

The chance of my getting such a document seemed slim to nil and would undoubtedly be a lengthy process. But the alternative was driving back the following day, along with C. (mandatory, since hers is the sole name appearing on the license) and with the license. All told, about four hours total on the road. By this time the hubby and I were deep into the blame game. We had by then picked up our dental-student daughter from her campus and it was “less than pleasant” in the car.

To make this already very long story shorter: the policeman at the front desk whisked out the desired document before I’d even finished my sob story and filled it in according to my dictation. I was out of there with the signed and stamped piece of paper in three minutes. 

But this joke of an “official” declaration satisfied  the distributors. Within seconds the liquid gold was in my hands.

Like I’ve said: when it comes to cannabis here, we’re practically neck and neck with Colorado.